Review of Therapeutic Options for Carbapenem-Resistant Enterobacterales

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Frontiers in Medicine Published April 18, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Recognize limited evidence for CRE therapies; select agents based on susceptibility and patient factors.

This review discusses therapeutic options for infections caused by carbapenem-resistant Enterobacterales (CRE). The authors summarize the evidence base for several agents, including polymyxins, tigecycline, cefiderocol, and ceftazidime-avibactam, noting that much of the data are derived from observational studies or small trials. No specific efficacy outcomes, sample sizes, or comparative results are provided in this summary.

The review identifies key challenges, including a lack of effective regimens for pan-drug-resistant (PDR) strains and insufficient large-scale clinical evidence for many novel agents. It also points to disparities in global access to newer therapeutics, which complicates treatment strategies in many regions.

Safety and tolerability data were not reported. The review’s primary limitation is the absence of synthesized quantitative results and the reliance on heterogeneous, low-certainty evidence. Given these constraints, the authors do not provide specific practice recommendations. Clinicians should interpret these findings cautiously, recognizing that definitive guidance will require more rigorous comparative effectiveness research.

Study Details

Study typeRct

EvidenceLevel 2

PublishedApr 2026

View Original Abstract ↓

Carbapenem-resistant Enterobacterales (CRE) have been identified by the World Health Organization as critical-priority pathogens, posing a severe global public health threat due to limited therapeutic options and high mortality rates. In response, this review provides a comprehensive assessment of current antimicrobial strategies against CRE, covering the efficacy and limitations of traditional antibiotics (e.g., polymyxins, tigecycline), novel agents (e.g., cefiderocol, ceftazidime-avibactam), and diverse combination therapies. Despite recent advances, major gaps persist, including the lack of effective regimens for pan-drug-resistant (PDR) strains, insufficient large-scale clinical evidence for many novel agents, and disparities in global access to newer therapeutics. Future priorities should including conducting high-quality randomized controlled trials (RCTs) to optimize treatment strategies, integrating rapid molecular dianostics into routine clinical practice to facilitate precision therapy, and continuing the development of novel agents and synergistic combination approaches. Simultaneously, establishing a global antimicrobial resistance surveillance network is indispensable for mitigating the ongoing spread of CRE.