ABSTRACT

Introduction

infections due to carbapenem-resistant Enterobacterales (CRE) constitute a worldwide threat and are associated with significant mortality, especially in fragile patients, and costs. Meropenem-vaborbactam (M/V) is a combination of a group 2 carbapenem with a novel cyclic boronic acid-based β-lactamase inhibitor which has shown good efficacy against KPC carbapenemase-producing Klebsiella pneumoniae, which are amongst the most prevalent types of CRE.

Areas covered

This article reviews the microbiological and pharmacological profile and current clinical experience and safety of M/V in the treatment of infections caused by CRE.

Expert opinion

M/V is a promising drug for the treatment of infections due to KPC-producing CRE (KPC-CRE). It exhibited an almost complete coverage of KPC-CRE isolates from large surveillance studies and a low propensity for resistance selection, retaining activity also against strains producing KPC mutants resistant to ceftazidime-avibactam. Both meropenem and vaborbactam have a favorable pharmacokinetic profile, with similar kinetic properties, a good intrapulmonary penetration, and are efficiently cleared during continuous venovenous hemofiltration (CVVH). According to available data, M/V monotherapy is associated with higher clinical cure rates and lower rates of adverse events, especially in terms of nephrotoxicity, if compared to ‘older’ combination therapies.

中文翻译：

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美罗培南/ vaborbactam：下一代β-内酰胺β-内酰胺酶抑制剂组合。

摘要

介绍

耐碳青霉烯的肠杆菌（CRE）引起的感染构成了全球性威胁，并与大量死亡率（尤其是在脆弱患者中）和成本相关。美罗培南-vaborbactam（M / V）是第2组碳青霉烯与新型的基于环硼酸的β-内酰胺酶抑制剂的组合，该抑制剂对产生KPC碳青霉烯酶的肺炎克雷伯菌显示出良好的疗效，而这是最常见的CRE类型。

覆盖区域

本文回顾了M / V在治疗CRE引起的感染方面的微生物学和药理学特征以及当前的临床经验和安全性。

专家意见

M / V是用于治疗因生产KPC的CRE（KPC-CRE）引起的感染的有前途的药物。它显示了来自大型监测研究的KPC-CRE分离物几乎完全覆盖，并且耐药选择的倾向性很低，还保留了针对产生对头孢他啶-avibactam耐药的KPC突变体的菌株的活性。美罗培南和瓦伯巴坦均具有良好的药代动力学特征，具有相似的动力学特性，良好的肺内渗透性，并且在连续静脉血液滤过（CVVH）期间可有效清除。根据现有数据，与“较旧”的联合疗法相比，M / V单一疗法与更高的临床治愈率和更低的不良事件发生率相关，尤其是在肾毒性方面。