Dinh Aurélien, Bleibtreu Alexandre, Duran Clara, Bouchand Frédérique, Bosch Alexie, Crozon-Clauzel Jullien, Roncato-Saberan Mariam, Matt Morgan, Boibieux André, Fanton Annlyse, Wille Heidi, Fiaux Elise, Pilmis Benoît, Lacoste Marie, Saint-Genis Quentin, Thumerelle Caroline, Pavese Patricia, Vuotto Fanny, Senneville Eric, Potron Anaïs, Corvec Stéphane, Boutoille David, Jeannot Katy, Dortet Laurent
Infectious Disease Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, 92380 Garches, France.
Infectious Disease Unit, La Pitié-Salpétrière University Hospital, AP-HP University of Paris, 75013 Paris, France.
Antibiotics (Basel). 2024 Dec 1;13(12):1152. doi: 10.3390/antibiotics13121152.
Meropenem-vaborbactam (MEM-VAB) is a novel carbapenem-beta-lactamase-inhibitor combination that demonstrates activity against carbapenem-resistant (CR) Gram-negative bacteria, and more specifically KPC-producers, since vaborbactam is an effective inhibitor of KPC enzymes in vitro. This study aimed to describe the initial uses and efficacy of MEM-VAB for compassionate treatment during the first 21 months following its early access in France.
A national multicenter retrospective study was conducted, including all patients who received at least one dose of MEM-VAB between 20 July 2020, and 5 April 2022. Clinical characteristics and outcomes were collected using a standardized questionnaire. The minimum inhibitory concentration (MIC) of antimicrobials, and complete genome sequencing of bacteria were performed when bacterial isolates were available.
Ultimately, 21 patients from 15 French hospitals were included in the study. The main indication for MEM-VAB treatment was respiratory tract infections ( = 9). The targeted bacteria included ( = 12), ( = 3), ( = 3), ( = 1), ( = 1), and ( = 1). Overall, no significant advantage of vaborbactam over meropenem alone was observed across all strains of in terms of in vitro susceptibility. However, MEM-VAB demonstrated a notable impact, compared to carbapenem alone, on the MIC for the two KPC-3-producing and .
MEM-VAB seems effective as a salvage treatment in compassionate use, but vaborbactam was shown to lack benefits compared to meropenem in treating -related infections. Therefore, it is crucial to compare meropenem to MEM-VAB MICs, particularly for , before prescribing MEM-VAB.
美罗培南-巴波巴坦(MEM-VAB)是一种新型碳青霉烯类-β-内酰胺酶抑制剂组合,对耐碳青霉烯类(CR)革兰氏阴性菌具有活性,更具体地说,对产KPC酶的细菌有活性,因为巴波巴坦在体外是KPC酶的有效抑制剂。本研究旨在描述MEM-VAB在法国早期准入后的前21个月内用于同情用药的初始用途和疗效。
进行了一项全国多中心回顾性研究,纳入了2020年7月20日至2022年4月5日期间接受至少一剂MEM-VAB的所有患者。使用标准化问卷收集临床特征和结局。当有细菌分离株时,进行抗菌药物的最低抑菌浓度(MIC)测定和细菌全基因组测序。
最终,来自15家法国医院的21名患者纳入研究。MEM-VAB治疗的主要适应证是呼吸道感染(n = 9)。目标细菌包括肺炎克雷伯菌(n = 12)、鲍曼不动杆菌(n = 3)、铜绿假单胞菌(n = 3)、阴沟肠杆菌(n = 1)、嗜麦芽窄食单胞菌(n = 1)和产气肠杆菌(n = 1)。总体而言,就体外敏感性而言,在所有肺炎克雷伯菌菌株中,未观察到巴波巴坦比单独使用美罗培南有显著优势。然而,与单独使用碳青霉烯类药物相比,MEM-VAB对两种产KPC-3酶的肺炎克雷伯菌和鲍曼不动杆菌的MIC有显著影响。
MEM-VAB在同情用药中作为挽救治疗似乎有效,但在治疗肺炎克雷伯菌相关感染方面,与美罗培南相比,巴波巴坦未显示出益处。因此,在开具MEM-VAB之前,比较美罗培南与MEM-VAB的MIC至关重要,尤其是对于肺炎克雷伯菌。