Recent updates in treating carbapenem-resistant infections in patients with hematological malignancies

Expert Rev Anti Infect Ther. 2024 Dec;22(12):1055-1071. doi: 10.1080/14787210.2024.2408746. Epub 2024 Sep 29.

Abstract

Introduction: Patients with hematological malignancies (PHMs) are at increased risk for infections caused by carbapenem-resistant organisms (CROs) due to frequent exposure to broad-spectrum antibiotics and prolonged hospital stays. These infections result in high mortality and morbidity rates along with delays in chemotherapy, longer hospitalizations, and increased health care costs.

Areas covered: Treatment alternatives for CRO infections in PHMs.

Expert opinion: The best available treatment option for KPC and OXA-48 producers is ceftazidime/avibactam. Imipenem/cilastatin/relebactam and meropenem/vaborbactam remain as the alternative options. They can also be used as salvage therapy in KPC-positive Enterobacterales infections resistant to ceftazidime/avibactam, if in vitro susceptibility is shown. Treatment of metallo-β-lactamase producers is an unmet need. Ceftazidime/avibactam plus aztreonam or aztreonam/avibactam seems to be the most reliable option for metallo-β-lactamase producers. As a first-line option for carbapenem-resistant Pseudomonas aeruginosa infections, ceftolozane/tazobactam is preferable and ceftazidime/avibactam and imipenem/cilastatin/relebactam constitute alternative regimens. Although sulbactam/durlobactam is the most reliable option against carbapenem-resistant Acinetobacter baumannii infections, its utility as monotherapy and in PHMs is not yet known. Cefiderocol can be selected as a 'last-resort' option for CRO infections. New risk score models supported by artificial intelligence algorithms can be used to predict the exact risk of infections in previously colonized patients.

Keywords: Carbapenem-resistant organisms; aztreonam/avibactam; cefiderocol; ceftazidime/avibactam; hematologic malignancy; immunocompromised; sulbactam/durlobactam.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents* / administration & dosage
  • Anti-Bacterial Agents* / adverse effects
  • Anti-Bacterial Agents* / pharmacology
  • Carbapenem-Resistant Enterobacteriaceae / drug effects
  • Carbapenem-Resistant Enterobacteriaceae / isolation & purification
  • Carbapenems* / administration & dosage
  • Carbapenems* / pharmacology
  • Drug Combinations
  • Hematologic Neoplasms* / complications
  • Hematologic Neoplasms* / drug therapy
  • Hematologic Neoplasms* / microbiology
  • Humans

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Drug Combinations