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Bush K. Past, present, and future perspectives on aztreonam and avibactam. Expert Rev Anti Infect Ther 2025; 23:277-290. [PMID: 40011051 DOI: 10.1080/14787210.2025.2473047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 02/13/2025] [Accepted: 02/20/2025] [Indexed: 02/28/2025]
Abstract
INTRODUCTION Aztreonam is a monobactam antibiotic approved in 1986 to treat infections caused by aerobic Gram-negative bacteria, but, together with cephalosporins, lost clinical utility due to the emergence of extended-spectrum β-lactamases (ESBLs) and novel (serine) carbapenemases. Avibactam was the first in a novel non-β-lactam β-lactamase inhibitor class to effectively inhibit these enzymes. It has been approved in combination with ceftazidime to treat Gram-negative infections caused by bacteria that produce AmpC, ESBLs and serine carbapenemases, and with aztreonam to treat patients infected with metallo-β-lactamase-producing enteric bacteria. Combinations of avibactam with ceftazidime and/or aztreonam have been used successfully to treat enteric pathogens producing multiple classes of β-lactamases. AREAS COVERED Development of aztreonam, avibactam, and avibactam combinations are placed into a historical perspective, based on both preclinical and clinical data. A search of MEDLINE (Ovid) was used to identify relevant literature. EXPERT OPINION Avibactam combined with ceftazidime and aztreonam in either dual or triple combinations provides the opportunity to treat previously untreatable Gram-negative infections that produce multiple β-lactamases. Aztreonam combinations should be particularly attractive, due to stability to metallo-β-lactamase hydrolysis and its safety advantage in treating penicillin-allergic patients. Other inhibitor combinations in development may challenge these combinations.
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Affiliation(s)
- Karen Bush
- Biology Department, Indiana University, Bloomington, IN, USA
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Pipitò L, Bono E, Mazzola CV, Rubino R, Anastasia A, Distefano SA, Firenze A, Giammanco GM, Bonura C, Cascio A. Outcome of Bloodstream Infections Caused by Antibiotic-Resistant Bacteria: A 7-Year Retrospective Study at the University Hospital of Palermo, Italy. Antibiotics (Basel) 2025; 14:464. [PMID: 40426531 PMCID: PMC12108205 DOI: 10.3390/antibiotics14050464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2025] [Revised: 04/22/2025] [Accepted: 04/29/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Bloodstream infections (BSIs) are both a primary cause and a severe complication of hospitalization. This retrospective study aims to analyze the epidemiology of BSIs at the University Hospital of Palermo from 2018 to 2024. METHODS We conducted a single-center, retrospective, observational study at the University Hospital Paolo Giaccone in Palermo, analyzing microbiological data from blood cultures collected between 1 January 2018 and 31 December 2024. RESULTS A total of 6345 blood culture isolates from 2967 patients were analyzed. Bacteremia-related mortality per 1000 patients rose from 5.1% in 2018 to 10.5% in 2024. The most isolated pathogens were non-aureus staphylococci (39.7%), followed by Klebsiella pneumoniae (12.1%) and Staphylococcus aureus (7.47%). Acinetobacter baumannii and Pseudomonas aeruginosa were more prevalent in ICUs. The number of K. pneumoniae, A. baumannii, S. aureus, and P. aeruginosa isolates per 1000 admitted patients increased significantly over time. Oxacillin resistance in S. aureus peaked at 49.0% in 2020 before declining, while among non-aureus staphylococci, it remained consistently high (>80%). Carbapenem-resistant K. pneumoniae peaked at 80% in 2022 before decreasing in 2024. Resistance to ceftazidime-avibactam and meropenem-vaborbactam was observed in 11.3% and 11.8% of K. pneumoniae, respectively. Multivariable analysis identified A. baumannii and K. pneumoniae BSIs as independent predictors of in-hospital mortality. Additionally, female sex, pneumonia, and central nervous system infections were significant risk factors for mortality. CONCLUSIONS We observed an increasing trend in overall bacteremia-related mortality from 2018 to 2024. Microbiological data highlight the predominance of non-aureus staphylococci, K. pneumoniae, and S. aureus as leading pathogens of BSI, with A. baumannii emerging as a significant threat, particularly in ICUs. Rising antimicrobial resistance, especially among K. pneumoniae, underscores the urgent need for robust antimicrobial stewardship programs. K. pneumoniae and A. baumannii were associated with higher mortality.
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Affiliation(s)
- Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (R.R.); (A.A.)
| | - Eleonora Bono
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (R.R.); (A.A.)
| | - Chiara Vincenza Mazzola
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (R.R.); (A.A.)
| | - Raffaella Rubino
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (R.R.); (A.A.)
- Antimicrobial Stewardship Team, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
| | - Antonio Anastasia
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (R.R.); (A.A.)
- Antimicrobial Stewardship Team, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
| | | | - Alberto Firenze
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
| | - Giovanni M. Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
- Antimicrobial Stewardship Team, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
- Microbiology and Virology Unit, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Celestino Bonura
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
- Microbiology and Virology Unit, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (E.B.); (C.V.M.); (A.F.); (G.M.G.); (C.B.)
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the Fight Against AIDS, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy; (R.R.); (A.A.)
- Antimicrobial Stewardship Team, AOU Policlinico “P. Giaccone”, 90127 Palermo, Italy;
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Vidal-Cortés P, Campos-Fernández S, Cuenca-Fito E, del Río-Carbajo L, Fernández-Ugidos P, López-Ciudad VJ, Nieto-del Olmo J, Rodríguez-Vázquez A, Tizón-Varela AI. Difficult-to-Treat Pseudomonas aeruginosa Infections in Critically Ill Patients: A Comprehensive Review and Treatment Proposal. Antibiotics (Basel) 2025; 14:178. [PMID: 40001421 PMCID: PMC11851922 DOI: 10.3390/antibiotics14020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 02/04/2025] [Accepted: 02/08/2025] [Indexed: 02/27/2025] Open
Abstract
The management of infections caused by difficult-to-treat Pseudomonas aeruginosa in critically ill patients poses a significant challenge. Optimal antibiotic therapy is crucial for patient prognosis, yet the numerous resistance mechanisms of P. aeruginosa, which may even combine, complicate the selection of an appropriate antibiotic. In this review, we examine the epidemiology, resistance mechanisms, risk factors, and available and future therapeutic options, as well as strategies for treatment optimization. Finally, we propose a treatment algorithm to facilitate decision making based on the resistance patterns specific to each Intensive Care Unit.
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Affiliation(s)
- Pablo Vidal-Cortés
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Sandra Campos-Fernández
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Elena Cuenca-Fito
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Lorena del Río-Carbajo
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Paula Fernández-Ugidos
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Víctor J. López-Ciudad
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Jorge Nieto-del Olmo
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
| | - Ana Rodríguez-Vázquez
- Hospital Pharmacy, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain;
| | - Ana I. Tizón-Varela
- Intensive Care Unit, Complexo Hospitalario Universitario de Ourense, 32003 Ourense, Spain; (S.C.-F.); (E.C.-F.); (L.d.R.-C.); (P.F.-U.); (V.J.L.-C.); (J.N.-d.O.); (A.I.T.-V.)
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