Risk factors and treatment advances for carbapenem-resistant Enterobacteriaceae infections in the urinary tract

TL;DR

This review discusses risk factors and new treatments for antibiotic-resistant Enterobacteriaceae infections in the urinary tract.

Contribution

The paper provides an updated overview of risk factors and treatment strategies for CRE-associated UTIs.

Findings

Advanced age, prior carbapenem use, and catheter use are major risk factors for CRE UTIs.

Ceftazidime-avibactam and cefiderocol show effectiveness in treating CRE UTIs.

Adjuvants like metal ion chelators may help restore antibiotic susceptibility.

Abstract

Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat in urinary tract infections (UTIs), which are among the most common infectious diseases. This review summarizes the risk factors and treatment advances for CRE-associated UTIs. Key risk factors include advanced age, history of carbapenem use, invasive urological procedures, indwelling catheters, immunosuppression (e.g., in transplant recipients), and prolonged hospitalization. The prognosis of CRE UTIs is generally better than infections at other sites but is influenced by factors like ICU admission and treatment failure. Treatment relies heavily on novel antibiotics, such as ceftazidime-avibactam and the siderophore cephalosporin cefiderocol, often used in combination regimens to enhance efficacy and prevent resistance. Recent clinical trials have demonstrated the effectiveness and safety of cefiderocol against CRE UTIs. Research on adjuvants like metal ion chelators (e.g., copper, bismuth) to restore antibiotic susceptibility is promising. Future efforts should focus on developing new antimicrobials, establishing rapid diagnostics for precise control, and conducting large-scale studies to optimize individual treatment strategies and infection control measures to improve patient outcomes and curb CRE spread.