Treatment of sepsis: What is the antibiotic choice in bacteremia due to carbapenem resistant Enterobacteriaceae?

Table 1 The most common sites of infection and mortality rates in sepsis

Site of infection	Mortality (%)
Blood stream infection	34.2
Respiratory	22
Genitourinary	8.2
Wound and soft tissue infection	10.55
Abdomen	10.25
CNS	17.4
Device related	9.5
Endocarditis	25.95
Others	7.05

Table was modified from the ref.[9]. CNS: Central nervous system.

Table 2 Resistance mechanisms of carbapenemase producing Enterobacteriaceae

Class	Genetic mutation	Clavulanic acid inhibition
Class A	Chromosomal encoded (NmcA, Sme, IMI-1, SFC-1)	Partially inhibited
	Plasmid encoded (IMI-2, GES, KPC)
Class B	Metallo-β-lactamase (IMP, VIM and NDM-1, SIM, GIM, SPM)	Resistant to clavulanic acid
Class D	Plasmid encoded oxa-48	Resistant to clavulanic aci

KPC: K. pneumoniae carbapenemases; OXA: Oxacillin-hydrolising; NDM: New Delhi metallo-beta-lactamase. Table was modified from the ref.[22].

Table 3 Bed side risk score for carbapenem resistant Enterobacteriaceae

Risk factor	Score (points)
History of chemotherapy in the last 3 mo	19
Invasive devices	10
Absence of peripheral vascular disease	10
Impairment of level of consciousness at the time of illness	9
Hospitalization for 3 or more days before development of BSI	7
Age < 65 years old	6

Table was modified from the ref.[28]. BSI: Blood stream infection.