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Vol. 46. Issue 11.
Pages 630-640 (November 2022)
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Vol. 46. Issue 11.
Pages 630-640 (November 2022)
Update in Intensive Care Medicine: Severe infections due to multi-resistant gram-negative bacilli
Antibiotics in development for multiresistant gram-negative bacilli
Antibióticos en desarrollo para bacilos gram negativos multirresistentes
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A. Rodrígueza,b,
Corresponding author
ahr1161@yahoo.es

Corresponding author.
, G. Morenoa, M. Bodia,b, I. Martín-Loechesc
a Servicio de Medicina Intensiva, Hospital Universitario Joan XXIII, Tarragona, Spain
b IISPV/CIBERES, Tarragona, Spain
c Trinity College Dublin, School of Medicine, Intensive Care Medicine St James’s Hospital, Dublín, Ireland
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Abstract

The rapid increase in antibiotic(ATB) resistance among Gram-negative bacilli(BGN), especially in strains of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii, with high resistance patterns (XDR), poses a huge threat to health systems worldwide.

In the last decade, different ATBs have been developed against XDR, some of which combine a lactam β along with a β-lactamase inhibitor, while others use non-β-lactam inhibitors. Most of them have adequate “in vitro” activity on several β-lactamases of class A, C and D of Ambler. However, combinations such as Ceftazidime/avibactam, Ceftolozane/Tazobactam and Meropenem/vaborbactam have no activity against metallo-β-lactamases(MβL). New combinations such as Aztreonan/AVI, Cefepime/Zidebactam, or new cephalosporins such as Cefiderocol, have efficacy against MβL enzymes. Although some of these combinations are already approved and in the commercialization phase, many of them have yet to define their place within the treatment of microorganisms with high resistance through clinical studies.

Keywords:
New antibiotics
Multiresistent gram negative bacilli
Beta-lactamases
Metallo-beta-lactamases
Resumen

El rápido incremento en las resistentes a los antibióticos (ATB) entre los bacilos Gram negativos (BGN), especialmente en cepas de Enterobacterias, P. aeruginosa, y A.baumannii, con elevadas elevados patrones de resistencia (XDR), plantea una enorme amenaza para los sistemas de salud en todo el mundo.

En la última década, diferentes ATB han sido desarrollados contra XDR, algunos de los cuales combinan un β-lactámico junto con un inhibidor de β-lactamasa, mientras que otros utilizan inhibidores no β-lactámicos. La mayoría de ellos presenta una adecuada actividad “in vitro” sobre varias β-lactamasas de clase A, C y D de Ambler. Sin embargo, combinaciones como Ceftazidime/avibactam, Ceftolozano/Tazobactam y Meropenem/vaborbactam no presentan actividad contra metalo-β-lactamasas (MβL). Nuevas combinaciones como Aztreonan/AVI, Cefepime/Zidebactam, o modernas cefalosporinas como Cefiderocol, presentan eficacia contra casi la totalidad de las MβL. Aunque algunas de estas combinaciones ya están aprobadas y en fase de comercialización, muchas de ellas aún deben definir su lugar dentro del tratamiento de microorganismos con resistencia elevada a través de estudios clínicos.

Palabras clave:
Nuevos antibióticos
Bacilos gram negativos multirresistentes
Beta-lactamasas
Metalo-beta-lactamasas

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