Management of CRE Infection with a Focus on New Antimicrobial Agents

Background: Carbapenem-resistant Enterobacterales (CRE) infections represent a critical global health challenge, driven by diverse resistance mechanisms including carbapenemase production.This review synthesizes current knowledge on CRE management, encompassing epidemiology, diagnostics, resistance patterns, and novel antimicrobial therapies.Methods: A systematic literature search of PubMed/MEDLINE, Scopus, and Web of Science from 2020-2025 identified high-quality evidence, with a focus on clinical trials pivotal to new pharmacological treatments.Results: CRE epidemiology reveals a concerning rise in resistance, particularly in regions like India, with significant mortality implications.Diagnostic strategies have evolved, incorporating culture-based, phenotypic, genotypic, and emerging techniques for rapid and accurate CRE detection.Novel antimicrobial agents, including Cefiderocol and beta-lactam/beta-lactamase inhibitor combinations like Meropenem-Vaborbactam, ceftazidime-Avibactam, and aztreonam-Avibactam, offer promising treatment options.However, metallo--lactamase (MBL)-producing CRE strains remain a therapeutic challenge.Combination therapies, antimicrobial stewardship, and infection control are crucial for effective management.Emerging strategies like phage therapy, immunotherapy, and vaccine development hold potential for future interventions.Recent guidelines, including IDSA 2024, ESCMID 2022 & ICMR 2022 provide updated recommendations for CRE treatment, emphasizing the importance of tailored therapy based on resistance mechanisms.Conclusions: This review highlights the need for continued research, development, and global collaboration to combat the escalating threat of CRE infections.