Clinical data from studies involving novel antibiotics to treat multidrug-resistant Gram-negative bacterial infections.

Abstract

Multidrug-resistant (MDR) Gram-negative bacteria (GNB) pose a critical threat to global healthcare, worsening outcomes and increasing mortality among infected patients. Carbapenemase- and extended-spectrum β-lactamase-producing Enterobacterales, as well as carbapenemase-producing Pseudomonas and Acinetobacter spp., are common MDR pathogens. New antibiotics and combinations have been developed to address this threat. Clinical trial findings support several combinations, notably ceftazidime-avibactam (CZA, a cephalosporin-β-lactamase inhibitor combination), which is effective in treating complicated urinary tract infections (cUTI), complicated intra-abdominal infections and hospital-acquired and ventilator-associated pneumonia caused by GNBs. Other clinically effective combinations include meropenem-vaborbactam (MVB), ceftolozane-tazobactam (C/T) and imipenem-relebactam (I-R). Cefiderocol is a recent siderophore β-lactam antibiotic that is useful against cUTIs caused by carbapenem-resistant Enterobacterales (CRE) and is stable against many β-lactamases. Carbapenem-resistant Enterobacterales are a genetically heterogeneous group that vary in different world regions and are a substantial cause of infections, among which Klebsiella pneumoniae are the most common. Susceptible CRE infections can be treated with fluoroquinolones, aminoglycosides or fosfomycin, but alternatives include CZA, MVB, I-R, cefiderocol, tigecycline and eravacycline. Multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa are increasingly common pathogens producing a range of different carbapenemases, and infections are challenging to treat, often requiring novel antibiotics or combinations. Currently, no single agent can treat all MDR-GNB infections, but new β-lactam-β-lactamase inhibitor combinations are often effective for different infection sites and, when used appropriately, have the potential to improve outcomes. This article reviews clinical studies investigating novel β-lactam approaches for treatment of MDR-GNB infections.

• Authors: Souha S Kanj, Matteo Bassetti, Pattarachai Kiratisin, Camilla Rodrigues, María Virginia Villegas, Yunsong Yu, David van Duin
• Journal: International journal of antimicrobial agents (Int J Antimicrob Agents) Vol. 60 Issue 3 Pg. 106633 (Sep 2022) ISSN: 1872-7913 [Electronic] Netherlands
• PMID: 35787918 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2022. Published by Elsevier Ltd.

Chemical References

• Anti-Bacterial Agents
• Carbapenems
• beta-Lactamase Inhibitors

Topics

• Anti-Bacterial Agents (pharmacology, therapeutic use)
• Carbapenems (pharmacology)
• Drug Resistance, Multiple, Bacterial
• Gram-Negative Bacterial Infections (drug therapy)
• Humans
• Microbial Sensitivity Tests
• beta-Lactamase Inhibitors (pharmacology, therapeutic use)