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Management of Severe Infections: Multidrug-Resistant and Carbapenem-Resistant Gram-Negative Bacteria
Federico Perez1, Nadim G El Chakhtoura2, Robert A Bonomo3
1Geriatrics Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs, Cleveland, OH, USA; Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, OH, USA; CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (CARES), Case Western Reserve University, Cleveland, OH, USA.
Abstract:
This article provides an overview of the mechanisms behind carbapenem resistance and the antibiotic management for severe infections caused by key carbapenem-resistant gram-negative bacteria, specifically Enterobacterales, Acinetobacter baumannii, and Pseudomonas aeruginosa. For Enterobacterales, it highlights the relative advantages of meropenem-vaborbactam and imipenem-relebactam in treating Klebsiella pneumoniae carbapenemase (KPC)-producing strains with resistance to ceftazidime-avibactam, the preference for ceftazidime-avibactam in addressing oxacillin-hydrolyzing carpapenemase (OXA)-48-like -producing organisms, and the combination of ceftazidime-avibactam with aztreonam for metallo-β-lactamase (MBL)-producing Enterobacterales. Regarding A baumannii, sulbactam-durlobactam is identified as the preferred treatment, while ceftolozane-tazobactam, ceftazidime-avibactam, and imipenem-relebactam are viable options for P aeruginosa. Additionally, cefiderocol is presented as an alternative for MBL-producing carbapenem-resistant gram-negative bacteria.
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