Vol.73 No.S-1 April 2025
Treatment options for carbapenem-resistant Gram-negative bacterial infections - based on guideline recommendations -
1)Departments of Microbiology and Infectious Diseases, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, Japan
2)Department of Microbiology and Infectious Diseases, Toho University School of Medicine
Abstract
Infections caused by Gram-negative bacteria, including carbapenem-resistant (CR) strains, have become a significant global healthcare challenge. Recently, novel antibiotics, including β-lactam/β-lactamase inhibitor combinations and cefiderocol (CFDC), with activity against CR bacteria have become available, and it is hoped that appropriate use of these antibiotics will improve patient outcomes.
According to the treatment guidance from the Infectious Diseases Society of America (IDSA) and the principles of appropriate antimicrobial use, it is recommended that novel antibiotics be considered as a priority for the treatment of infections caused by CR bacteria. Avibactam/ceftazidime (AVI/CAZ) exhibits high activity against CR Enterobacterales (CRE), including KPC and OXA-48 producers, and is considered as the first-line choice in countries where the combination is available. While most CR Pseudomonas aeruginosa (CRPA) strains are susceptible to AVI/CAZ, CR Acinetobacter baumannii (CRAB) strains are resistant to this agent. For metallo-β-lactamase-producing organisms, including Stenotrophomonas maltophilia, administration of AVI/CAZ in combination with aztreonam is recommended. Tazobactam/ceftolozane exhibits high activity against CRPA, but is not active against CRE, CRAB, or S. maltophilia. Relebactam/imipenem/cilastatin is also one of the preferred treatment options for CRPA and KPC-producing CRE. CFDC exhibits high activity against various Gram-negative bacteria, ranging from CRE to CRPA, CRAB, and S. maltophilia, as reported by international surveillance studies.
Selection of therapy should take into account the strengths and caveats of each novel agent as well as specific infections and types of bacteria.
Key word
cefiderocol, carbapenems, Gram-negative bacteria, drug resistant bacteria
Received
November 21, 2024
Accepted
January 16, 2025
Jpn. J. Chemother. 73 (S-1): 24-33, 2025
