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IDSA Guidelines

Background

CRE and P. aeruginosa

KPC and OXA-48

Ceftazidime/Avibactam Pfizer is recommended by the IDSA guidance as a preferred treatment option for MDR Gram-negative infections caused by CRE and DTR P. aeruginosa*1
  • Ceftazidime/Avibactam Pfizer has in vitro activity against pathogens producing AmpC, KPC and OXA-48 enzymes2
  • Ceftazidime/Avibactam Pfizer's range of in vitro activity against β-lactamases does not necessarily predict clinical success
  • Ceftazidime/Avibactam Pfizer has no in vitro activity against pathogens producing class B metallo-β-lactamases and is not able to inhibit many class D enzymes2
IDSA has published expert guidance on the treatment of MDR Gram-negative pathogens1

  • These 3 groups of MDR Gram-negative bacteria are considered to pose particular therapeutic challenges1
  • ​​​​​​​These 3 groups have been identified by the CDC as urgent or serious threats3
  • CRE and DTR P. aeruginosa have been identified by the WHO as critical priorities4​​​​​​​
*Defined as P. aeruginosa exhibiting non-susceptibility to all of the following: piperacillin-tazobactam, ceftazidime, cefepime, aztreonam,  meropenem, imipenem-cilastatin, ciprofloxacin and levofloxacin.2

 CDC: Centers for Disease Control and Prevention; CRE: carbapenem-resistant Enterobacterales; DTR: difficult-to-treat resistance; ESBL: extended-spectrum beta-lactamase; IDSA: Infectious Disease Society of America; MDR: multidrug resistant; KPC: Klebsiella pneumoniae carbapenemase; OXA: oxacillinase; WHO: World Health Organization.
References: 1. Tamma PD, et al. Infectious Diseases Society of America Antimicrobial Resistant Treatment Guidance: Gram-Negative Bacterial Infections. 2020. Infectious Diseases Society of America. Accessed August 2, 2021. https://www.idsociety.org/practice-guideline/amr-guidance. 2. Ceftazidime/Avibactam Pfizer, Summary of product characteristics, Saudi Arabia, February 2021. 3. Antibiotic resistance threats in the United States. 2019. CDC. Accessed August 2, 2021. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. 4. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. 2017. WHO. Accessed August 2, 2021. https://www.who.int/medicines/publications/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.pdf.
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CRECeftazidime/Avibactam Pfizer is recommended by the IDSA guidance as a preferred treatment option for MDR Gram-negative infections caused by CRE*1Ceftazidime/Avibactam Pfizer is recommended by the IDSA guidance as an alternative treatment option for uncomplicated cystitis caused by CRE.||Pseudomonas aeruginosaCeftazidime/Avibactam Pfizer​​​​​​​ is recommended by the IDSA guidance as a preferred treatment option for MDR Gram-negative infections caused by DTR P. aeruginosa¶1
*For infections outside the urinary tract, resistant to both ertapenem and meropenem, and carbapenemase testing results are either not available or negative.
†Defined as a UTI occurring in association with a structural or functional abnormality of the genitourinary tract, or any UTI in a male patient.
‡Meropenem-vaborbactam, imipenem-cilastatin-relebactam and cefiderocol are also preferred treatment options.
§Meropenem-vaborbactam and imipenem-cilastatin-relebactam are also preferred treatment options.
||Meropenem-vaborbactam, imipenem-cilastatin-relebactam and cefiderocol are also alternative treatment options.
¶Defined as P. aeruginosa exhibiting non-susceptibility to all of the following: piperacillin-tazobactam, ceftazidime, cefepime, aztreonam, meropenem, imipenem-cilastatin, ciprofloxacin and levofloxacin.
#Ceftolozane-tazobactam, imipenem-relebactam, cefiderocol and a single dose of an aminoglycoside are also preferred treatment options.
**Ceftolozane-tazobactam, imipenem-cilastatin-relebactam and cefiderocol are also preferred treatment options.
†† Ceftolozane-tazobactam and imipenem-cilastatin-relebactam are also preferred treatment options.
CRE: carbapenem-resistant Enterobacterales; DTR: difficult-to-treat resistance; IDSA: Infectious Disease Society of America; MDR: multidrug resistant; KPC: Klebsiella pneumoniae carbapenemase; OXA: oxacillinase; UTI: urinary tract infection.
Reference: 1. Tamma PD, et al. Infectious Diseases Society of America Antimicrobial Resistant Treatment Guidance: Gram-Negative Bacterial Infections. 2020. Infectious Diseases Society of America. Accessed August 2, 2021. https://www.idsociety.org/practice-guideline/amr-guidance.
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KPC and OXA-48​​​​​​​Ceftazidime/Avibactam Pfizer is recommended By the IDSA guidance as a preferred treatment option for KPC-producing*† and OXA-48-producing CRE infections1The IDSA guidance recommends Ceftazidime/Avibactam Pfizer as the only preferred treatment option for OXA-48-producing CRE infections.1
*KPC identified (or carbapenemase positive but identity of carbapenemase unknown).
†Meropenem-vaborbactam and imipenem-cilastatin-relebactam are also preferred treatment options.
CRE: carbapenem-resistant Enterobacterales; IDSA: Infectious Disease Society of America; KPC: Klebsiella pneumoniae carbapenemase; OXA: oxacillinase.
Reference: 1. Tamma PD, et al. Infectious Diseases Society of America Antimicrobial Resistant Treatment Guidance: Gram-Negative Bacterial Infections. 2020. Infectious Diseases Society of America. Accessed August 2, 2021. https://www.idsociety.org/practice-guideline/amr-guidance.
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