Practical Implications of New Antibiotic Agents for the Treatment of Carbapenem-Resistant Enterobacteriaceae

OBJECTIVE: To provide insight into the practical implications of the use of ceftazidime/avibactam and meropenem/vaborbactam for the management of carbapenem-resistant Enterobacteriaceae (CRE) and to identify strategies for overcoming barriers to the use of these agents in clinical practice. DATA SOURCES: A literature search of PubMed was conducted using the following search terms: ceftazidime/avibactam, meropenem/vaborbactam, carbapenem-resistant Enterobacteriaceae, antimicrobial stewardship, and clinical laboratory standards institute. Abstracts from infectious diseases conferences, article bibliographies, and relevant drug monographs were also reviewed. STUDY SELECTION/DATA EXTRACTION: Relevant English-language studies were considered. DATA SYNTHESIS: Studies demonstrating the clinical utility of ceftazidime/avibactam and meropenem/vaborbactam over older agents for CRE were summarized. Laboratory challenges, including lack of widespread technology and delays in usable information, and formulary considerations were discussed. Insight was provided into overcoming these challenges and minimizing barriers using infectious diseases pharmacists, antimicrobial stewardship teams, and infection control teams. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review informs clinicians of the potential difficulties of the use of ceftazidime/avibactam and meropenem/vaborbactam in clinical practice and provides tools to overcome these difficulties, thus allowing clinicians to stay at the forefront of CRE treatment. CONCLUSIONS: Clinicians treating patients with CRE infections need to be aware of challenges they may face when using ceftazidime/avibactam and meropenem/vaborbactam. Infectious disease (ID) pharmacists and antimicrobial stewardship teams play an important role in minimizing barriers and ensuring appropriate use of these antibiotics.