David L Paterson1,2, Andrew Henderson1,3, Patrick N A Harris1,4. 1. University of Queensland Centre for Clinical Research. 2. Infectious Diseases Unit, Royal Brisbane and Women's Hospital. 3. Infection Management Services, Princess Alexandra Hospital. 4. Central Microbiology Laboratory, Pathology Queensland, Brisbane, Australia.
Abstract
PURPOSE OF REVIEW: This article aims to give a state-of-the-art assessment of treatment options for bloodstream infection because of ceftriaxone-resistant Gram-negative bacilli, especially those caused by extended-spectrum beta-lactamase (ESBL) or AmpC-producing Enterobacteriaceae. In particular, this review assesses whether current data support 'carbapenem-sparing options' for treatment of these serious infections. RECENT FINDINGS: The MERINO trial refuted earlier observational studies some of which showed equivalence in outcomes between beta-lactam/beta-lactamase inhibitor combinations and carbapenems for treatment of bloodstream infection because of ceftriaxone-resistant Escherichia coli or Klebsiella spp. Although numerous factors influence mortality following bloodstream infection, the variability in piperacillin/tazobactam MICs observed in the MERINO trial make this a less secure option than meropenem. However, the search for carbapenem-sparing options continues with four randomized controlled trials (RCTs) in progress and a number of other options in clinical development. SUMMARY: Hard outcomes from RCTs are still needed before intravenous carbapenems can be displaced as the treatment of choice for ceftriaxone-resistant Gram-negative bacilli.
PURPOSE OF REVIEW: This article aims to give a state-of-the-art assessment of treatment options for bloodstream infection because of ceftriaxone-resistant Gram-negative bacilli, especially those caused by extended-spectrum beta-lactamase (ESBL) or AmpC-producing Enterobacteriaceae. In particular, this review assesses whether current data support 'carbapenem-sparing options' for treatment of these serious infections. RECENT FINDINGS: The MERINO trial refuted earlier observational studies some of which showed equivalence in outcomes between beta-lactam/beta-lactamase inhibitor combinations and carbapenems for treatment of bloodstream infection because of ceftriaxone-resistant Escherichia coli or Klebsiella spp. Although numerous factors influence mortality following bloodstream infection, the variability in piperacillin/tazobactam MICs observed in the MERINO trial make this a less secure option than meropenem. However, the search for carbapenem-sparing options continues with four randomized controlled trials (RCTs) in progress and a number of other options in clinical development. SUMMARY: Hard outcomes from RCTs are still needed before intravenous carbapenems can be displaced as the treatment of choice for ceftriaxone-resistant Gram-negative bacilli.
Authors: Burcu Isler; Yukiko Ezure; Jose Luis García-Fogeda Romero; Patrick Harris; Adam G Stewart; David L Paterson Journal: Antimicrob Agents Chemother Date: 2020-12-16 Impact factor: 5.191