The ideal patient profile for new beta-lactam/beta-lactamase inhibitors

Abstract

Purpose of review: The worldwide spread of extended-spectrum beta-lactamase (ESBL)-producing bacteria, the overuse of carbapenems, the emergence of carbapenemase-producing organisms and the growing importance of multidrug-resistant and/or extended drug-resistant strains have totally changed prescribers' habits, leading to very few treatment options in many cases. Beta-lactam/beta-lactamase inhibitor (BLBLI) combinations should be considered as an alternative to carbapenems for treating ESBL-producing bacteria and Pseudomonas aeruginosa infections. The purpose of this study was to provide insight concerning the patients who would constitute ideal candidates to receive these new BLBLI combinations.

Recent findings: Ceftolozane/tazobactam and ceftazidime/avibactam are the first drugs constituting the use of new beta-lactamase inhibitors. Ceftolozane/tazobactam is the drug of choice for treating MDR/XDR P. aeruginosa infections. Ceftazidime/avibactam is the best drug available for treating KPC and OXA-48 carbapenemase-producing Enterobacteriaceae. Ceftolozane/tazobactam and ceftazidime/avibactam are both carbapenem-sparing agents for treating ESBL-producing Enterobacteriaceae. The role of carbapenem/inhibitors remains to be clarified.

Summary: Each BLBLI combination has distinctive specificities and limitations that need to be investigated cautiously. Randomized trials will play a key role in defining the best strategies. Infection control measures and prompt diagnosis remain fundamental to prevent dissemination of MDR pathogens in healthcare settings and to optimize early antimicrobial treatment.