Ceftazidime/Avibactam and Meropenem/Vaborbactam for the Management of Enterobacterales Infections: A Narrative Review, Clinical Considerations, and Expert Opinion

Marino, Andrea; Campanella, Edoardo; Stracquadanio, Stefano; Calvo, Maddalena; Migliorisi, Giuseppe; Nicolosi, Alice; Cosentino, Federica; Marletta, Stefano; Spampinato, Serena; Prestifilippo, Pamela; Stefani, Stefania; Cacopardo, Bruno; Nunnari, Giuseppe

doi:10.3390/antibiotics12101521

Cited by 4 publications

(3 citation statements)

References 64 publications

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“…The carbapenem-resistant isolates also belong to P. aeruginosa (30.2%) and A. baumannii (77.7%) [ 16 , 17 , 18 ]. Moreover, literary data confirm methicillin-resistant S. aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) as potential ICU mortality causes despite their low prevalence [ 12 , 19 , 20 , 21 ].…”

Section: Epidemiological Detailsmentioning

confidence: 99%

Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

Calvo,

Stefani,

Migliorisi

2024

Antibiotics

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Intensive care units constitute a critical setting for the management of infections. The patients’ fragilities and spread of multidrug-resistant microorganisms lead to relevant difficulties in the patients’ care. Recent epidemiological surveys documented the Gram-negative bacteria supremacy among intensive care unit (ICU) infection aetiologies, accounting for numerous multidrug-resistant isolates. Regarding this specific setting, clinical microbiology support holds a crucial role in the definition of diagnostic algorithms. Eventually, the complete patient evaluation requires integrating local epidemiological knowledge into the best practice and the standardization of antimicrobial stewardship programs. Clinical laboratories usually receive respiratory tract and blood samples from ICU patients, which express a significant predisposition to severe infections. Therefore, conventional or rapid diagnostic workflows should be modified depending on patients’ urgency and preliminary colonization data. Additionally, it is essential to complete each microbiological report with rapid phenotypic minimum inhibitory concentration (MIC) values and information about resistance markers. Microbiologists also help in the eventual integration of ultimate genome analysis techniques into complicated diagnostic workflows. Herein, we want to emphasize the role of the microbiologist in the decisional process of critical patient management.

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Section: Epidemiological Detailsmentioning

confidence: 99%

Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

Calvo,

Stefani,

Migliorisi

2024

Antibiotics

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“…In the literature, some studies have highlighted the efficacy of CAZ-AVI in treating various infections due to MDR P. aeruginosa, from cUTIs to HAP [179][180][181]. However, clinical trials involving CAZ-AVI treatments are scarce.…”

Section: New Treatment Optionsmentioning

confidence: 99%

Resistance in Pseudomonas aeruginosa: A Narrative Review of Antibiogram Interpretation and Emerging Treatments

Giovagnorio,

De Vito,

Madeddu

et al. 2023

Antibiotics

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Pseudomonas aeruginosa is a ubiquitous Gram-negative bacterium renowned for its resilience and adaptability across diverse environments, including clinical settings, where it emerges as a formidable pathogen. Notorious for causing nosocomial infections, P. aeruginosa presents a significant challenge due to its intrinsic and acquired resistance mechanisms. This comprehensive review aims to delve into the intricate resistance mechanisms employed by P. aeruginosa and to discern how these mechanisms can be inferred by analyzing sensitivity patterns displayed in antibiograms, emphasizing the complexities encountered in clinical management. Traditional monotherapies are increasingly overshadowed by the emergence of multidrug-resistant strains, necessitating a paradigm shift towards innovative combination therapies and the exploration of novel antibiotics. The review accentuates the critical role of accurate antibiogram interpretation in guiding judicious antibiotic use, optimizing therapeutic outcomes, and mitigating the propagation of antibiotic resistance. Misinterpretations, it cautions, can inadvertently foster resistance, jeopardizing patient health and amplifying global antibiotic resistance challenges. This paper advocates for enhanced clinician proficiency in interpreting antibiograms, facilitating informed and strategic antibiotic deployment, thereby improving patient prognosis and contributing to global antibiotic stewardship efforts.

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“…To address these therapeutic challenges, new combinations of ß-lactam-ß-lactamase inhibitors (BL/BLI) have been developed. These advanced combinations involve cephalosporins or carbapenems paired with BLI 8 . Considering the variations in inhibition profiles among different BLI, optimizing the use of these agents would require precise detection of carbapenemases, and assessing the susceptibility of various carbapenemase producers to these drugs 9 .…”

Section: Introductionmentioning

confidence: 99%

Dissemination of NDM-1 and OXA-48 Co-producing Carbapenem-resistant Enterobacterales at Two Tertiary Hospitals in Egypt

ElFeky,

Awad,

Mowafy

et al. 2024

Egyptian Journal of Medical Microbiology

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Background. The global incidence of carbapenem-resistant Enterobacterales (CRE) is increasing, posing a major treatment challenge and serious infection control concern.Objective. We aimed to characterize carbapenemases both genotypically and phenotypically among CRE isolated from two tertiary hospitals in Egypt, and to detect the genetic relatedness among studied isolates. Methodology. A total of 107 nonduplicate CRE strains isolated from different clinical specimens of hospitalized patients were assessed for presence of carbapenemases genes using multiplex PCR. Onehundred isolates were also assessed for the presence of carbapenemases using MASTDISCS Combi Carba Plus kit. Molecular typing of the isolates was done by Enterobacterial Repetitive Intergenic Consensus region PCR (ERIC-PCR). Results. Klebsiella pneumoniae (K. pneumoniae) represented most of the studied isolates (n=85; 79.4%). The most prevalent carbapenemase gene among our isolates was blaNDM-1 (n=103; 96.2%) followed by blaOXA-48 (n=68; 63.5%). Among them, 64 isolates (59.8%) carried more than one gene as blaNDM-1 and blaOXA-48 genes. blaKPC, blaVIM and blaIMP were not detected in the isolates. The sensitivity of the Carba Plus kit for the detection of MBL was much better than respectively), however, the negative predictive value was poor for the detection of both (19.05% and 39.36%, respectively). The constructed dendrogram for each genus from each hospital revealed significant genetic diversity among the investigated isolates. Conclusions. The study highlights the wide dissemination of diverse clones of CRE isolates that co-harbor blaOXA-48 and blaNDM-1 genes among our hospitals as well as low accuracy of detection using phenotypic techniques like Carba plus kit.

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Ceftazidime/Avibactam and Meropenem/Vaborbactam for the Management of Enterobacterales Infections: A Narrative Review, Clinical Considerations, and Expert Opinion

Cited by 4 publications

References 64 publications

Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

Bacterial Infections in Intensive Care Units: Epidemiological and Microbiological Aspects

Resistance in Pseudomonas aeruginosa: A Narrative Review of Antibiogram Interpretation and Emerging Treatments

Dissemination of NDM-1 and OXA-48 Co-producing Carbapenem-resistant Enterobacterales at Two Tertiary Hospitals in Egypt

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