251. Antimicrobial treatment challenges in the era of carbapenem resistance.
- Author
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Peri, Anna Maria, Doi, Yohei, Potoski, Brian A., Harris, Patrick N.A., Paterson, David L., and Righi, Elda
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CEFTAZIDIME , *THERAPEUTICS , *CARBAPENEMS , *ENTEROBACTERIACEAE diseases , *GRAM-negative bacteria , *ANTIBIOTICS , *AMINOGLYCOSIDES - Abstract
Infections due to carbapenem-resistant Gram-negative bacteria are burdened by high mortality and represent an urgent threat to address. Clinicians are currently at a dawn of a new era in which antibiotic resistance in Gram-negative bacilli is being dealt with by the availability of the first new antibiotics in this field for many years. Although new antibiotics have shown promising results in clinical trials, there is still uncertainty over whether their use will improve clinical outcomes in real world practice. Some observational studies have reported a survival benefit in carbapenem-resistant Enterobacteriaceae bloodstream infections using combination therapy, often including "old" antibiotics such as colistin, aminoglycosides, tigecycline, and carbapenems. These regimens, however, are linked to increased risk of antimicrobial resistance, and their efficacy has yet to be compared to new antimicrobial options. While awaiting more definitive evidence, antibiotic stewards need clear direction on how to optimize the use of old and novel antibiotic options. Furthermore, carbapenem-sparing regimens should be carefully considered as a potential tool to reduce selective antimicrobial pressure. • Carbapenem resistance represents one of the biggest challenges for clinicians managing severe Gram-negative infections. • Novel antimicrobials active on carbapenem-resistant Enterobacteriaceae, ceftazidime-avibactam and meropenem-vaborbactam, have been recently approved for clinical use. • Ceftazidime-avibactam and meropenem-vaborbactam showed improved clinical outcomes in the treatment of infections caused by KPC-producing Enterobacteriaceae compared with old antibiotics. • Optimization in the use of old antibiotics (carbapenems, aminoglycosides, fosfomycin, colistin) and careful use of novel compounds currently represent key elements to optimize antimicrobial stewardship programs. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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