Introduction

Carbapenem-resistant Enterobacterales (CRE) represent a global public health problem. Precision medicine (PM) is a multicomponent medical approach that should be used to individualize the management of patients infected with CRE.

Areas covered

Here, we differentiate carbapenem-producing CRE (CP-CRE) from non-CP-CRE and the importance of this distinction in clinical practice. The current phenotypic CRE-case definition and its implications are also discussed. Additionally, we summarize data regarding phenotypic and molecular diagnostic tools and available antibiotics. In order to review the most relevant data, a comprehensive literature search of peer-reviewed articles in PubMed and abstracts presented at high-impact conferences was performed.

Expert opinion

PM in CRE infections entails a multi-step process that includes applying the current phenotypic definition, utilization of the right phenotypic or molecular testing methods, and thorough evaluation of risk factors, source of infection, and comorbidities. A powerful armamentarium is available to treat CRE infections, including recently approved agents. Randomized controlled trials targeting specific pathogens instead of site of infections may be appropriate to fill in the current gaps. In light of the diverse enzymology behind CP-CRE, PM should be employed to provide the best therapy based on the underlying resistance mechanism.

中文翻译：

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用于诊断和治疗对碳青霉烯耐药的肠杆菌的精密药物：从不同角度思考的时间。

介绍

耐碳青霉烯的肠杆菌（CRE）代表着全球性的公共卫生问题。精密医学（PM）是一种多成分医学方法，应用于个性化治疗CRE感染患者。

覆盖区域

在这里，我们将产生碳青霉烯的CRE（CP-CRE）与非CP-CRE区别开来，并区分这种区别在临床实践中的重要性。还讨论了当前的表型CRE病例定义及其含义。此外，我们总结了有关表型和分子诊断工具以及可用抗生素的数据。为了审查最相关的数据，对在PubMed中发表的同行评审文章和在高影响力会议上发表的摘要进行了全面的文献检索。

专家意见

CRE感染中的PM需要采取多步骤过程，包括应用当前的表型定义，正确的表型或分子检测方法的利用以及对危险因素，感染源和合并症的全面评估。强大的军备库可用于治疗CRE感染，包括最近批准的药物。针对特定病原体而不是感染部位的随机对照试验可能适合填补当前的空白。鉴于CP-CRE背后的多种酶学，应根据潜在的耐药机制采用PM提供最佳治疗。