In vitro efficacy of imipenem-relebactam and cefepime-AAI101 against a global collection of ESBL-positive and carbapenemase-producing Enterobacteriaceae

Objectives: To evaluate the potential clinical in vitro efficacy of novel beta-lactam/beta-lactamase-inhibitor combinations - including imipenem-relebactam (IPM-REL) and cefepime-AAI101 (enmetazobactam) (FEPAAI) - against contemporary multidrug-resistant (MDR) Enterobacteriaceae. Methods: Agar-based MIC screening against MDR Enterobacteriaceae (n = 264) was used to evaluate the in vitro efficacy of IPM-REL and FEP-AAI, to compare the results with established combinations, and to investigate alternative beta-lactam partners for relebactam (REL) and enmetazobactam (AAI). The inhibition activities of REL, AAI and the comparators avibactam (AVI) and tazobactam, against isolated recombinant beta-lactamases covering representatives from all four Ambler classes of beta-lactamases, were tested using a fluorescence-based assay. Results: Using recombinant proteins, all four inhibitors were highly active against the tested class A serine beta-lactamases (SBLs). REL and AVI showed moderate activity against the Class C AmpC from Pseudomonas aeruginosa and the Class D OXA-10/-48 SBLs, but outperformed tazobactam and AAI. All tested inhibitors lacked activity against Class B metallo-beta-lactamases (MBLs). In the presence of REL and IPM, but not AAI, susceptibility increased against Klebsiella pnuemoniae carbapenemase (KPC)-positive and OXA-48-positive isolates. Both aztreonam-AVI and ceftolozane-tazobactam were more effective than IPM-REL. In all the tested combinations, AAI was a more effective inhibitor of class A beta-lactamases (ESBLs) than the established inhibitors. Conclusion: The results lead to the proposal of alternative combination therapies involving REL and AAI to potentiate the use of beta-lactams against clinical Gram-negative isolates expressing a variety of lactamases. They highlight the potential of novel combinations for combating strains not covered by existing therapies. (c) 2020PublishedbyElsevierB.V.