What to Know About Carbapenems Resistance

Medically Reviewed by Mahammad Juber, MD on October 19, 2022
Written by Sarah Vallie
5 min read

Antibiotic resistance has become a growing problem. When bacteria become antibiotic-resistant, treatment options become limited. Carbapenems are effective antibiotics that work on a wide range of bacteria, but some bacteria are starting to develop resistance.

Carbapenems are a group of antibiotics used for serious bacterial infections.

Bacteria are tiny, single-celled organisms. Bacteria were some of the first life forms to develop on earth and can be found all over the planet. Bacteria are used to create foods like cheese, pickles, and vinegar and are also used to clean oil spills and break down sewage.

Most types of bacteria are harmless to us, and some are even helpful. “Good” bacteria, those that help keep us healthy, are called probiotics, and they help our bodies do things like digest food, break down and absorb medications, and even fight off bad bacteria.

Bad bacteria are the bacteria that cause illness and infection. A relatively small percentage of the earth’s bacteria are bad bacteria, but some can cause severe illness and even death. Examples of bad bacterial infections include:

  • Chlamydia.Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis.
  • Lyme disease.Lyme disease is a tick-borne disease that has many different symptoms and is caused by the bacterium Borrelia burgdorferi.
  • Strep throat. Strep throat is an infection of the throat and tonsils caused by group A Streptococcus bacteria. 

To treat a bacterial infection, your doctor may prescribe antibiotics. Antibiotics are medications that prevent bacteria from continuing the processes they need to thrive and multiply. Different antibiotics do this in different ways, and your doctor will choose an antibiotic based on the type of bacteria you are infected with.

Carbapenems are broad-spectrum antibiotics, meaning they are effective against a wide range of bacteria. They’re a highly effective type of antibiotic, Carbapenems work by binding to and disrupting the enzymes involved in building the bacterial cell wall. This causes the structure of the cell wall to weaken and eventually burst.

Common types of Carbapenems drugs include:

  • Ertapenem. Ertapenem is used for infections such as pneumonia and urinary tract infections.
  • Imipenem. Imipenem is used for infections such as endocarditis, an infection of the heart lining and valves.
  • Meropenem. Meropenem is used for infections such as meningitis, which is an infection of the membranes around the brain and spinal cord.

Carbapenems antibiotics are often used to fight bacteria such as:

  • Anaerobic bacteria. Anaerobic bacteria are a type of bacteria that can survive without oxygen. Anaerobic bacteria can cause many different types of infections such as abscesses, wound infections, food poisoning, tetanus, pneumonia, and infections within the abdomen, bone, head, and neck.
  • Enterobacterales. Enterobacterales are a category of bacteria that includes E. coli. E. coli is primarily known for causing food poisoning but can also cause urinary tract infections and pneumonia.
  • Haemophilus influenzae.Haemophilus influenzae causes a wide range of infections, mainly in children, such as meningitis and conjunctivitis (pink eye). 
  • Staphylococci. Staphylococci are a group of bacteria that cause skin infections, toxic shock syndrome, and pneumonia, among others.
  • Streptococci. Streptococci are a group of bacteria that cause illnesses like sore throat, such as strep throat, and skin infections.

Because carbapenem antibiotics are so effective at what they do and can defeat so many types of bacteria, they are often thought of as a last-ditch effort. Doctors may use carbapenems as a last resort if other types of antibiotics fail. This is to avoid carbapenems resistance.

Bacteria, like viruses, can adapt to be more effective. They can mutate after coming into contact with an antibiotic, making them less likely to be defeated by that antibiotic the next time they meet. 

For example, some types of Enterobacterales have evolved to make enzymes called extended-spectrum beta-lactamases (ESBL). These ESBL enzymes can break down some types of antibiotics, destroying them and making them ineffective. As a result, these antibiotics no longer work against ESBL-producing Enterobacterales. That means that something as simple as a urinary tract infection could land you in the hospital.

Only a few types of antibiotics remain that can treat infections caused by Enterobacterales infections. Carbapenems are some of them. Unfortunately, Carbapenem-resistant Enterobacterales are becoming more common. In some cases, these Enterobacterales are resistant to all forms of antibiotics. One type of Enterobacterales that is resistant is Klebsiella pneumoniae.

Klebsiella pneumoniae primarily causes pneumonia.  Pneumonia is an infection within the air sacs of the lungs. It can cause symptoms like cough, chest pain, fever, fatigue, and nausea. But pneumonia caused by Klebsiella pneumoniae has been known to cause complications like:

  • Bacteremia. Bacteremia is a condition where bacteria enters the bloodstream. This can cause infection to spread throughout the body.
  • Empyema. Empyema is a condition in which pus collects between the lung or lungs and the surrounding membrane.
  • Lung abscesses. A lung abscess is a condition that involves pus-filled lesions on the lungs and the death of lung tissue.

To treat these complications, you must treat the pneumonia. To treat the pneumonia, you need to destroy the bacteria causing the pneumonia. Unfortunately, Klebsiella pneumoniae is highly resistant to antibiotics. As a result, it’s often fatal, especially for those with preexisting conditions. Pneumonia caused by Klebsiella pneumoniae kills over 50% of patients with this infection. 

There aren’t many treatment options once carbapenems have been ruled out. For some types of infection, there may be an alternative antibiotic, but not always. In many cases, once a bacterium has become resistant to carbapenems, it has already become resistant to all other forms of antibiotics.

The best way to move forward seems to be to look for new antibiotics, but this is not easy and could take a lot of time. In the meantime, bacteria could continue to get more antibiotic-resistant to the point that they are untreatable.

There currently is no way to “fix” a bacterium that has become antibiotic-resistant. Instead, the best thing we can do is to try to prevent antibiotic resistance in the first place. This includes steps such as:

  • Doctors should not prescribe, and patients should not use antibiotics to fight viruses.
  • Patients should follow their doctor’s instructions for their antibiotic prescription.
  • No one should share antibiotics.
  • Patients should always take the full course of antibiotics prescribed to them except in case of an allergic reaction. Taking the full course helps make sure the bacteria are all destroyed and cannot mutate.
  • Everyone should practice good hygiene and safe sex to avoid the spread of infection-causing bacteria.