**Author details**

*Pathogenic Bacteria*

molecular or phenotypic assay" [29].

such a mounting health concern [29].

**9. Treatment options**

to address this concerned threat.

**10. Conclusion**

and Prevention" reveal that more than 21.3% of healthcare-related infections are due to *Enterobacteriaceae* [27]. Spread and the emergence of Carbapenemresistant *Enterobacteriaceae* is a mounting health concern around the globe [28]. Regulatory authority "Centre for Disease Control and Prevention" defines CRE as "Enterobacteriaceae that seems to be tested as resistant to any carbapenem agent including ertapenem or may demonstrate as carbapenemase production through

The emergence of carbapenem resistance among *Enterobacteriaceae* (CRE) possessing additional resistance genes to a variety of antimicrobial classes had led to the creation of organisms nearly resistant to all available therapeutics [30]. Carbapenem-resistant *Enterobacteriaceae* are a family of bacteria, responsible for causing significant mortality and morbidity, and hence are very difficult to treat. Among the *Enterobacteriaceae*, *E. coli* and *Klebsiella* species can easily become carbapenem resistant. CRE infections commonly occur in healthcare and hospital settings as well as in nursing homes, while the patients on-going long-term antibi-

Epidemiological data on carbapenemase-producing carbapenem-resistant *Enterobacteriaceae* (CP-CRE) varies country to country. An important carbapenemase-producing carbapenem resistance (KPC) was the first identified carbapenemase in the USA in 1996, and the prevalence is distributed unevenly among the US states [32]. Since epidemiology of CRE varies differently, so in this regard, KPC is endemic in Israel, while VIM, IPM, NDM, and OXA-48 carbapenemases are endemic in Greece, Japan, India, and Turkey, respectively, and are also disseminated successfully around the globe [33]. The continuous movement of subjects infected or colonized with CP-CRE in conjunction with the continuous exposure of these subjects to medical care is a significant contributor to the spread of CP-CRE [34]. Therefore, the decisive detection of CP-CRE may be the initial step to combat

Since CRE infections are very difficult to treat, some of the treatment options for addressing the threat of "Carbapenem-resistant Enterobacteriaceae" include tigecycline, polymyxins, aminoglycosides, fosfomycin, meropenem/vaborbactam, and ceftazidime/avibactam. Combinations of B-lactamase are also available and are safer and more effective for treating CRE infections. It has been reported that polymyxin monotherapy can also lead to the emergence of resistance; therefore, polymyxin in combination with carbapenems must be administered in an appropriate dose [35]. Similar is the case with fosfomycin. The use of fosfomycin intravenously is recommended for urinary tract infections [36]. Clinicians should be vigilant in exploring new treatment options as well as for detection of CRE infections. Many of the new treatment options are in process, but none of them represent a magic bullet

The rapid spread of carbapenem resistance as well as carbapenem-resistant *Enterobacteriaceae* into the community is a growing and emerging threat to public health. Despite of the large efforts being made to control this public menace, it is very essential to look for some definite solution which still seems to be far off. Until a potential alternative solution to overcome this problem is found,

otic treatment are also highly susceptible to these CRE infections [31].

**66**

Bilal Aslam1 \*, Maria Rasool1,3, Saima Muzammil1 , Abu Baker Siddique1 , Zeeshan Nawaz1 , Muhammad Shafique1 , Muhammad Asif Zahoor1 , Rana Binyamin2 , Muhammad Waseem1 , Mohsin Khurshid1,3, Muhammad Imran Arshad4 , Muhammad Aamir Aslam4 , Naveed Shahzad5 , Muhammad Hidayat Rasool1 and Zulqarnain Baloch6

1 Department of Microbiology, Government College University Faisalabad, Pakistan

2 University of Agriculture, Sub Campus, Burewala-Vehari, Faisalabad, Pakistan

3 College of Allied Health Professionals, Directorate of Medical Sciences, Government College University Faisalabad, Pakistan

4 Institute of Microbiology, University of Agriculture Faisalabad, Pakistan

5 School of Biological Sciences, The University of Punjab, Lahore, Pakistan

6 College of Veterinary Medicine, South China Agricultural University, Guangzhou, China

\*Address all correspondence to: drbilalaslam@gcuf.edu.pk

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
