Current progress in antibacterial agents for carbapenem-resistant enterobacterales

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.