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New Antibiotics Against Multidrug-Resistant Gram-Negative Bacteria in Lung Transplantation: Clinical Evidence,

Andrea Lombardi1,2, Davide Mangioni1, Giulia Viero1

  • 1Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Transplant International : Official Journal of the European Society for Organ Transplantation
|April 27, 2026
PubMed

Insights

New antibiotics combat multidrug-resistant Gram-negative bacteria (MDR-GNB) after lung transplantation (LuTx). These agents offer hope for difficult-to-treat infections, but further studies are needed for optimal use in lung transplant recipients.

Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Transplantation Medicine

Background:

  • Multidrug-resistant Gram-negative bacteria (MDR-GNB) and *Pseudomonas aeruginosa* infections pose significant risks post-lung transplantation (LuTx).
  • Limited effective treatment options exist for these challenging infections in lung transplant recipients (LUTR).

Purpose of the Study:

  • To review the pharmacology, clinical evidence, and safety of five novel antibiotic agents against MDR-GNB in LUTR.
  • To evaluate the efficacy of ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, and cefiderocol in LUTR.

Main Methods:

  • A literature review of the past 10 years was conducted.
  • Data on antibiotic spectrum, efficacy in LUTR, and adverse events were analyzed.

Main Results:

  • Ceftolozane/tazobactam and ceftazidime/avibactam showed high efficacy against difficult-to-treat *Pseudomonas* and KPC-producing Enterobacterales, respectively.
  • Meropenem/vaborbactam and imipenem/relebactam provide coverage for specific resistant strains.
  • Cefiderocol demonstrated the broadest *in vitro* activity, including against metallo-β-lactamase producers.
  • Pharmacokinetic variability necessitates optimized dosing strategies, such as prolonged or continuous infusions.

Conclusions:

  • These five antibiotics expand treatment options for MDR-GNB in LUTR.
  • Pathogen-directed, toxicity-sparing regimens can be developed.
  • Prospective, LuTx-focused studies are essential to optimize the use of these agents in this unique patient population.
Keywords:
MDRGNBSOTimmunocompromised hostlungtherapeutic drug monitoring

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