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A review on bacterial resistance to carbapenems: epidemiology, detection and treatment options

Carbapenems represent an important class of antibiotics that are still reserved for infections caused by MDR microorganisms. However, the emergence of carbapenem resistance has dramatically increased worldwide and therefore poses a serious public health threat. Several mechanisms including reduced uptake, active efflux of carbapenems, as well as inactivation via carbapenemases are involved in the bacterial resistance to carbapenems.

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 Carbapenems: History, Structure, Mechanism of Action, resistance and Antimicrobial Activity

Carbapenems are a class of broad-spectrum antibiotics that are highly effective against a wide range of bacteria, including those that are resistant to other antibiotics. They are beta-lactam antibiotics, which means that they contain a beta-lactam ring in their molecular structure. This ring allows them to interfere with bacterial cell wall synthesis, ultimately leading to the death of the bacteria.

Articles of Interest

List of Carbapenems

Carbapenems are a class of beta-lactam antibiotic that are active against many aerobic and anaerobic gram-positive and gram-negative organisms. Thienamycin was the first carbapenem to be discovered in 1976. Carbapenems are notable for their ability to inhibit beta-lactamase enzymes (also called penicillinase) - a type of enzyme that greatly reduces the activity of antibiotics such as penicillins and cephamycins. Of all the beta-lactam antibiotics, carbapenems possess the broadest spectrum of activity and the greatest potency against bacteria. Because of this, they are often reserved for more severe infections or used as "last-line" agents.

A Brief Review of Carbapenems

Carbapenems are often considered to have the broadest spectrum of activity among all antibiotic classes. Closely related to penicillins, carbapenems are bactericidal beta-lactam antibiotics that bind to penicillin-binding proteins (PBPs). By binding and inactivating these proteins, carbapenems inhibit the synthesis of the bacterial cell wall, which leads to cell death.

Are all carbapenems the same?

Some practitioners believe that a carbapenem is a carbapenem is a carbapenem. Four carbapenems exist in the U.S. market but are they all the same? From a clinical standpoint and pharmacologic standpoint, each drug has its own niche, making choosing a particular carbapenem tricky in clinical practice.

Carbapenems: Past, Present, and Future

Carbapenems play a critically important role in our antibiotic armamentarium. Of the many hundreds of different β-lactams, carbapenems possess the broadest spectrum of activity and greatest potency against Gram-positive and Gram-negative bacteria. As a result, they are often used as “last-line agents” or “antibiotics of last resort” when patients with infections become gravely ill or are suspected of harboring resistant bacteria.

Carbapenems: the pinnacle of the β-lactam antibiotics or room for improvement?

A review of the currently available literature information shows that a carbapenem with a spectrum expansion beyond meropenem/imipenem remains elusive. This leads us to the conclusion that, given the current position of bacterial resistance to antibiotics, it is important that carbapenems are prescribed at optimal doses to appropriate patients to maximize efficacy and minimize the risk of development of resistance.

Mechanisms of Action of Carbapenem Resistance

Carbapenem antibiotics are the most effective antimicrobials for the treatment of infections caused by the most resistant bacteria. They belong to the category of β-lactams that include the penicillins, cephalosporins, monobactams and carbapenems. This class of antimicrobials has a broader spectrum of activity than most other beta-lactams antibiotics and are the most effective against Gram-positive and Gram-negative bacteria.

Oral Carbapenems: Promise, Peril, and Pushbacks

The approval of an effective oral carbapenem could change the way complicated UTIs caused by multidrug resistant organisms are managed. It could help reduce health care–related costs associated with the need for intravenous therapy by either preventing hospital admission or reducing hospital length of stay. However, the prospect of an oral carbapenem raises concern among health care professionals with regard to misuse further leading to antimicrobial resistance.