Editor's Note: The Infectious Disease Week (IDWeek) in the United States is a premier global academic conference in the field of infectious diseases. It gathers nearly 10,000 experts and scholars from around the world each year to discuss and share the latest research findings and clinical advances in infectious disease management. The conference covers a wide range of topics, including novel diagnostic techniques, innovative therapies, the application of artificial intelligence, and antimicrobial resistance. This article summarizes a key oral presentation from IDWeek on the stewardship of novel beta-lactam antibiotics.
How to Determine Which Novel Beta-Lactam Antibiotics Are Needed
Between 2014 and 2023, the U.S. Food and Drug Administration (FDA) approved 11 new antimicrobial agents, including cefolozane/tazobactam, ceftazidime/avibactam, delafloxacin, meropenem/vaborbactam, plazomicin, eravacycline, omadacycline, imipenem/relebactam, lefamulin, cefiderocol, and sulbactam/durlobactam. About half of these are novel beta-lactam/beta-lactamase inhibitor combinations (BL/BLI).
When considering these new treatment options, how should clinicians make decisions? For instance, with ceftazidime/avibactam already available, is there a need for meropenem/vaborbactam? If ceftazidime/avibactam can cover carbapenem-resistant Enterobacteriaceae (CRE) and multidrug-resistant (MDR) Pseudomonas aeruginosa, is the introduction of cefolozane/tazobactam necessary? Does imipenem/relebactam have a significant role in certain regions? When should sulbactam/durlobactam be considered? Given that cefiderocol has in vitro activity against extended-spectrum beta-lactamase (ESBL) strains, CRE, Pseudomonas aeruginosa, and Acinetobacter baumannii, does this mean we only need this one drug?
Clinicians need to consider various factors when making treatment decisions, including pathogen resistance, individual patient characteristics, the antimicrobial spectrum of the drug, its side effects, and treatment costs. Each drug has a specific antimicrobial spectrum and indications, so even if some drugs show broad-spectrum activity in vitro, they cannot completely replace other drugs.
Ceftazidime/Avibactam: Addressing the ESBL and CRE Challenge
ESBL-producing Enterobacteriaceae (ESBL-E) and CRE have become significant challenges in managing MDR infections. Ceftazidime/avibactam, a novel antimicrobial agent combining the third-generation cephalosporin ceftazidime with the non-beta-lactam beta-lactamase inhibitor avibactam, offers effective treatment options against these resistant pathogens.
The synergistic effect of ceftazidime and avibactam enhances the antibacterial activity against ESBL-E, providing new treatment hope for patients with complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI). These infections often pose serious life threats, and with the increasing resistance of pathogens, the treatment process has become more complex and challenging.
Ceftazidime/avibactam is not limited to these infection types. It also plays a crucial role in treating hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which are often associated with MDR pathogens. Ceftazidime/avibactam provides an effective treatment option for these respiratory infections.
Given the current severe issue of antimicrobial resistance, ceftazidime/avibactam has become an important addition to hospital formularies. Its efficacy against ESBL and CRE provides a new and effective strategy for combating resistant pathogens in healthcare settings. As its use becomes more widespread, its role in reducing the burden of MDR infections will become increasingly prominent.
Meropenem/Vaborbactam: Targeting KPC-Producing Enterobacteriaceae
Klebsiella pneumoniae carbapenemase (KPC)-producing strains have garnered widespread attention due to their resistance to carbapenem antibiotics. In response to this challenge, meropenem/vaborbactam, a drug specifically targeting these resistant strains, has become an important option for treating MDR infections.
Meropenem/vaborbactam, a combination of the carbapenem antibiotic meropenem and the beta-lactamase inhibitor vaborbactam, has demonstrated good clinical efficacy in treating cUTI, including pyelonephritis, and cIAI.
In the treatment of cUTI, meropenem/vaborbactam provides a new treatment option for patients for whom traditional therapies are limited. The drug effectively combats KPC-producing Enterobacteriaceae, which pose significant challenges to clinical anti-infective therapy.
Incorporating meropenem/vaborbactam into hospital formularies is a strategic move. It not only provides healthcare institutions with more treatment options but also plays a key role in antimicrobial stewardship. Given the risk of resistance development, the rational use of meropenem/vaborbactam is crucial to ensure its long-term efficacy and delay the development of resistance.
As antimicrobial resistance continues to pose significant challenges to global health, the careful stewardship of novel beta-lactam antibiotics is crucial. Clinicians must consider pathogen resistance patterns, patient-specific factors, and the unique properties of each drug to optimize treatment outcomes.
