Carbapenems, our one-time silver bullet for multidrug resistant bacterial infections, are now threatened by widespread dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Successful expansion of Enterobacteriaceae clonal groups and frequent horizontal gene transfer of carbapenemase expressing plasmids are causing increasing carbapenem resistance. Recent advances in genetic and phenotypic detection facilitate global surveillance of CRE diversity and prevalence. In particular, whole genome sequencing enabled efficient tracking, annotation, and study of genetic elements colocalized with carbapenemase genes on chromosomes and on plasmids. Improved characterization helps detail the co-occurrence of other antibiotic resistance genes in CRE isolates and helps identify pan-drug resistance mechanisms. The novel β-lactamase inhibitor, avibactam, combined with ceftazidime or aztreonam, is a promising CRE treatment compared to current colistin or tigecycline regimens. To halt increasing CRE-associated morbidity and mortality, we must continue quality, cooperative monitoring and urgently investigate novel treatments.

碳青霉烯类化合物是我们一次性的耐多药细菌感染的灵丹妙药，如今，碳青霉烯类耐药性肠杆菌科（CRE）的广泛传播受到威胁。肠杆菌科克隆群的成功扩增和碳青霉烯酶表达质粒的频繁水平基因转移导致碳青霉烯耐药性增加。遗传和表型检测的最新进展促进了对CRE多样性和患病率的全球监测。特别是，全基因组测序可以高效跟踪，注释和研究与碳青霉烯酶基因在染色体和质粒上共定位的遗传元件。改进的表征有助于详细说明CRE分离株中其他抗生素抗性基因的共存现象，并有助于确定泛药耐药性机制。新型β-内酰胺酶抑制剂avibactam 与目前的大肠菌素或替加环素方案相比，与头孢他啶或氨曲南合用是一种有前途的CRE治疗方法。为了阻止与CRE相关的发病率和死亡率的增加，我们必须继续进行质量，合作监测并紧急研究新的治疗方法。