Progress of researchs on drug resistance mechanisms and clinical antimicrobial treatment of carbapenem-resistant Enterobacteriaceae infections

The drug resistance of the carbapenem-resistant Enterobacteriaceae (CRE) strains was mainly induced by multiple approaches such as production of carbapenemases, increase of bacterial outer membrane permeability, activation of active efflux pump system, formation of biofilm and drug modifying mechanisms. Those mechanisms involve deletion, mutation, insertion and posttranscriptional modification of relevant encoding genes, which may affect the susceptibility of the CRE strains to antibiotics. At present, the conventional clinical therapies include the use of traditional antibiotics, either the one-drug use or combined use of drugs. The development of novel antibacterial therapy is under way. The epidemiological characteristics of CRE infections, drug resistance mechanisms, current and prospective treatment strategies for CRE infections (covering new application of the drugs in available, the novel drugs such as ceftazidime/avibactam, meropenem/vaborbactam and imipenem/relebactam) were deeply reviewed in this article, so as to provide reliable reference for clinical prevention, control and treatment of CRE infections.