Carbapenem-resistant organisms

Background

• Mechanisms include decreased expression of porins, increased expression of efflux pumps, and carbapenemases

Management

Antibiotic	KPC	NDM	OXA-48	CRPsA	CRAcB	Stenotrophomonas
aztreonam-avibactam	+	+	+	±	–	+
cefiderocol	+	+	+	+	+	+
ceftazidime-avibactam	+	–	+	±	–	–
ceftolozane-tazobactam	–	–	–	±	–	±
eravacycline	+	+	+	–	+	+
fosfomycin	±	±	±	±	–	–
imipenem-relebactam	+	–	±	+	–	–
meropenem-vaborbactam	+	–	–	–	–	–
plazomicin	+	±	+	±	–	–
colistin	±	±	±	±	±	±
tigecycline	+	+	+	–	+	+

• For KPC, the most common Class A carbapenemase, consider:
  • Ceftazidime-avibactam
  • Meropenem-vaborbactam
  • Imipenem-relebactam
  • Cefiderocol
• For AmpCs, consider:
  • Ceftazidime-avibactam
  • Meropenem-vaborbactam
• For metallo-β-lactamases, consider:
  • Aztreonam-avibactam, or ceftazidime-avibactam plus aztreonam
  • Cefiderocol
• For all of the above, also consider:
  • Eravacycline
  • Tigecycline
  • Colistin, though increasing resistance
  • Plazomicin
• For carbapenem-resistant Pseudomonas aeruginosa, consider:
  • Cefiderocol
  • Imipenem-relebactam