From the Research
Patients with a history of family Enterobacteriaceae infections should be treated with meropenem/vaborbactam or other novel β-lactam/β-lactamase inhibitor combinations (BL/BLIs) as they have shown comparable efficacy and safety to carbapenems in treating Enterobacteriaceae infections 1.
Key Considerations
- The Enterobacteriaceae family includes numerous clinically significant genera such as Escherichia, Salmonella, Shigella, Klebsiella, and Yersinia, which can cause various human infections.
- The emergence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has led to increased resistance to cephalosporins and fluoroquinolones, making treatment challenging 2.
- A network meta-analysis found that meropenem/vaborbactam, meropenem, imipenem/cilastatin, ceftriaxone, ceftazidime/avibactam, and ceftolozane/tazobactam had the highest ranking in terms of efficacy, with no significant difference between any two antibiotics (p > 0.05) 1.
- Risk factors for Enterobacteriaceae infections include male gender, invasive prosthesis, previous use of cephalosporins, and hospitalization in the last 6 months 3.
- Community-onset urinary tract infections (UTIs) caused by ESBL-producing Enterobacteriaceae are increasing, and many patients have no identifiable risk factor, highlighting the need for careful consideration of antibiotic therapy 4.
- A study found that the prevalence of Enterobacteriaceae in patients hospitalized with community-acquired pneumonia was 6%, with 19% of these being multidrug-resistant (MDR) 5.
Treatment Recommendations
- Meropenem/vaborbactam or other novel BL/BLIs should be considered as first-line treatment options for Enterobacteriaceae infections, especially in patients with a history of family Enterobacteriaceae infections or those at risk of developing resistant infections.
- Antibiotic therapy should be guided by susceptibility testing and local epidemiology, taking into account the risk of resistance and the potential for discordant empiric therapy.
- Patients with community-acquired pneumonia should be evaluated for risk factors associated with Enterobacteriaceae and MDR-Enterobacteriaceae, such as prior ESBL infection, being underweight, and hospitalization in the last 12 months.