About Superbugs

Enterobacterales is a group of bacteria that are highly resistant to antibiotics. These organisms are a normal part of human intestinal bacteria but can become resistant to carbapenem antibiotics. There are several species of bacteria within the Enterobacterales order, which include, but are not limited to, Escherichia, Klebsiella, Enterobacter, Salmonella, Shigella, Citrobacter and Yersinia. Many species of Enterobacterales are necessary for digestion and are usually harmless when contained in the gut.

However, some of these bacteria produce enzymes called carbapenemases, which prevent antibiotics from working on the bacteria. Bacteria that produce these enzymes are resistant to most types of antibiotics.

About Superbugs
Methicillin-resistant Staphylococcus aureus


Vancomycin-resistant Enterococcus

Antibiotic Resistance

Carbapenem-resistant Enterobacteriaceae

Treatment Options



Multidrug-resistant Enterobacterales infection

Drug-resistant Enterobacterales is a group of bacteria that are difficult to treat and that pose a serious threat to public health. These infections most often occur in people receiving health care, including those in hospitals and nursing homes.

  • In healthy populations, this usually means a urinary tract infection. Enterobacterales infections most often originate in the urinary tract.
  • Enterobacterales infections are common in surgical wards. As well as patients who require devices such as ventilators, catheters or intravenous catheters, and patients who take certain antibiotics for long periods of time are at greatest risk of infection.

Antibiotic Resistance

Enterobacterales is a large group of different types of bacteria that commonly cause infections in healthcare facilities and communities. In order to survive the effects of antibiotics, bacteria are constantly searching for new defense strategies to develop resistance mechanisms. Some Enterobacterales can produce enzymes called extended-spectrum beta-lactamases (ESBL). ESBL enzymes break down and destroy some commonly used antibiotics, including penicillin and cephalosporins, and make these drugs ineffective in treating infections. Carbapenem-resistant Enterobacterales (CRE) are a group of bacteria that are resistant to carbapenem antibiotics. Carbapenems are broad-spectrum antibiotics that are commonly used to treat serious, life-threatening infections. CRE are resistant to carbapenems or any other antibiotics due to the production of carbapenemases.

Resistance to Beta-Lactams

Penicillin and cephalosporins

Resistance to Carbapenems

May be resistant to some carbapenems but not others

Treatment Options

Prospective Treatment Options

Antibiotic therapy

For infections caused by ESBL-producing Enterobacterales, carbapenem antibiotics are the preferred treatment option. On the other hand, CRE is resistant to almost all β-lactams. Combination therapy is now the gold standard in the treatment of CRE infections. Scientists are also working to develop new antibacterial drugs to address these pressing challenges, such as new β-lactamase inhibitors.

Non-antibiotic therapy

  • Nanoparticles
  • Phage therapy
  • Vaccine strategy

Carbapenem resistance in Enterobacterales has developed substantially and poses a serious threat to global health. The diverse and adaptive mechanisms of resistance of these bacteria make the control and early identification of CRE infections difficult.

In short, we need to discover new classes of antibiotics. We can successfully control Enterobacterales infections if we continue to make every effort to maintain the effectiveness of antibiotics and develop novel antibiotics. At Ace Therapeutics, we discuss some new therapeutic approaches that deserve further study. We look forward to having you on board to develop the next generation of antimicrobial treatments for Enterobacterales.


  1. Pranita D, et al. Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa). Clinical Infectious Diseases, 2021,72(7):1109–1116.
  2. Tilahun M, et al. Emerging carbapenem-resistant Enterobacteriaceae infection, its epidemiology and novel treatment options: a review. Infection and drug resistance, 2021,4363-4374.
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