Aztreonam and avibactam combination therapy for metallo-(3-lactamase-producing gram-negative bacteria: A Narrative Review

Background: Carbapenem-resistant gram-negative bacteria represent a challenging healthcare threat, accounting for metallo-(3-lactamases (MBL) production increase across the world. MBL-producing Enterobacterales and Pseudomonas aeruginosa represent the main target for ultimate antibiotics combinations due to the difficulty to include carbapenems within the antimicrobial treatment. Objectives: To provide a comprehensive review of the current knowledge about the aztreonam/avibactam (ATM-AVI) combination, which has emerged as a promising option for treating MBL-producing bacteria. Sources: Relevant in vitro and in vivo studies on ATM-AVI effectiveness. Content: The review summarizes ATM-AVI characteristics and targets, examining how AVI restores ATM effectiveness against MBLs while protecting it from other (3-lactamases. Key in vitro and in vivo studies on ATM-AVI efficacy are presented. Implications: This review provides insights into the potential clinical management implications of ATM-AVI for treating carbapenem-resistant gram-negative infections, particularly those caused by MBLproducing organisms. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).