Aztreonam and avibactam combination therapy for metallo-β-lactamase-producing gram-negative bacteria: A Narrative Review

Abstract

Background: Carbapenem-resistant gram-negative bacteria represent a challenging healthcare threat, accounting for metallo-β-lactamases (MBL) production increase across the world. MBL-producing Enterobacterales and Pseudomonas aeruginosa represent the main target for ultimate antibiotics combinations due to the difficulty to include carbapenems within the antimicrobial treatment.

Objectives: To provide a comprehensive review of the current knowledge about the aztreonam/avibactam (ATM-AVI) combination, which has emerged as a promising option for treating MBL-producing bacteria.

Sources: Relevant in vitro and in vivo studies on ATM-AVI effectiveness.

Content: The review summarizes ATM-AVI characteristics and targets, examining how AVI restores ATM effectiveness against MBLs while protecting it from other β-lactamases. Key in vitro and in vivo studies on ATM-AVI efficacy are presented.

Implications: This review provides insights into the potential clinical management implications of ATM-AVI for treating carbapenem-resistant gram-negative infections, particularly those caused by MBL-producing organisms.

Keywords: Antimicrobial treatment; Aztreonam/avibactam; Enterobacterales; Metallo-β-lactamases; Pseudomonas.