Emerging Carbapenem-Resistant Enterobacteriaceae Infection, Its Epidemiology and Novel Treatment Options: A Review

Figures & data

Table 1 Summary of the Global Prevalence of Carbapenem-Resistant Enterobacteriaceae

Study Area		Prevalence of CRE	Authors (Reference)
Europe and America	Belgium	3.46%,	[^Citation53]
	Turkey	2.8%,	[^Citation54]
	USA	5.7%, 0.08%,	[^Citation30,Citation55]
	Latin America	6.6%,	[^Citation56]
	Russia	11.6%,	[^Citation57]
	Australia	0.1%	[^Citation58]
	Poland	17.3%,	[^Citation59]
	Italy	7.5%,	[^Citation59]
	Greece	7.4%,	[^Citation59]
	Romania	5.0%	[^Citation59]
Asia	India	13.95%, 12.26% and 37.9%	[^Citation60^–^Citation62]
	Pakistan	69%,	[^Citation63]
	Kuwait	8%,	[^Citation64]
	China	18.1%	[^Citation65]
	Saudi Arabia	1.77%	[^Citation66]
	Malaysia	5.76%	[^Citation67]
	South India	8%	[^Citation68]
	Thailand	97%	[^Citation69]
Africa	Nigeria	15.2%	[^Citation62]
	Ethiopia	12.12%	[^Citation70]
	Uganda	28.6%	[^Citation12]
	Egypt	62.7%, 54.5%	[^Citation52,Citation71]
	Senegal	5.1%	[^Citation72]
	Morocco	2.8%	[^Citation73]
	Ethiopia	16.2%	[^Citation70]

Table 2 List of Antibiotics Used for CRE Infection Treatment and Under Pipeline Development for Future Treatment of CRE Infections

RX. of CRE	Action Mechanism	Mechanism of Action	S/E	Authors
Antibiotics from the past	Fosfomycin	Inhibitor of cell wall production	Appearance of resistance	[^Citation88]
	Aminoglycosides	Protein synthesis inhibitor	Appearance of resistance	[^Citation15]
	Colistin	Inhibit Cell membrane production	Other serious side effects include nephrotoxicity	[^Citation87]
	Tigecycline	Protein synthesis inhibitor	Low concentration in tissue	[^Citation89]
Double treatments	Ertapenem with meropenem/doripenem	Cell wall production inhibitor		[^Citation90]
	Ceftazidime or avibactam	Cell wall production inhibitor/ß-lactamase inhibitor	Appearance of resistance	[^Citation91]
	Meropenem or vaborbactam	Cell wall production inhibitor or ß-lactamase inhibitor	Inadequate clinical data	[^Citation91]
New treatments	Plazomicin	Protein production inhibitor	Unreactive against MBL-producers	[^Citation92]
	Eravacycline	Protein production inhibitor	Phase 3 RCT	[^Citation86]
	Imipenem or relebactam	Cell wall production inhibitor or ß-lactamase inhibitor	Phase 3 RCT	[^Citation93]
	Cefiderocol	Cell wall synthesis inhibitor	Phase 3 RCT	[^Citation94]
	Zidebactam	ß-Lactamase inhibitor	Phase 3 RCT	[^Citation87]
	Nacubactam	ß-Lactamase inhibitor	Phase 3 RCT	[^Citation95]

Abbreviations: ß-Lactamase, Beta lactamase; CRE, carbapenem-resistant Enterobacteriaceae; MBL, metallo-β-lactamase; RCT, randomized clinical trial; RX, treatment; S/E, side effects.

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