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The In vitro Activity of Carbapenems Alone and in Combination with β-lactamase Inhibitors against Difficult-to-treat Mycobacteria; Mycobacterium tuberculosis, Mycobacterium abscessus, and Mycobacterium avium Complex: A Systematic Review
Karolinska Univ Hosp, Sweden.
Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
Aarhus Univ Hosp, Sweden; Aarhus Univ GloHAU, Denmark; Statens Serum Inst, Denmark.
Karolinska Univ Hosp, Sweden.
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2023 (English)In: INTERNATIONAL JOURNAL OF MYCOBACTERIOLOGY, ISSN 2212-5531, Vol. 12, no 3, p. 211-225Article, review/survey (Refereed) Published
Abstract [en]

Difficult-to-treat mycobacterial infections are increasing globally. There is an urgent need of new treatment alternatives for multidrug-resistant Mycobacterium tuberculosis (MTB), as well as nontuberculous mycobacteria such as the Mycobacterium abscessus complex (MABC) and Mycobacterium avium complex (MAC). Recently, new carbapenems and combinations of carbapenems with beta-lactamase inhibitors have become available, but activity data in vitro against mycobacteria are so far scarce. Therefore, we performed a systematic review collating the minimum inhibitory concentrations (MICs) of carbapenems, with or without a beta-lactamase inhibitors for MTB, MABC, and MAC. The databases PubMed and Web of Science were searched for the relevant articles in English up until September 21, 2022. Screening of studies was performed by two independent reviewers. MIC data by recommended methods with at least five individual MICs were included. Data were reported as MIC range, MIC50, modal MIC, and/or histograms when individual MICs were available. The study protocol was registered at PROSPERO (CRD42021258537). After screening, a total of 75 studies with MIC data for carbapenems with or without beta-lactamase inhibitors were included in the review. For MTB, the oral carbapenem tebipenem combined with the beta-lactamase inhibitor clavulanic acid resulted in the most significant reduction of MICs. For MABC, the addition of avibactam to tebipenem resulted in a 64-fold reduction of modal MIC. Data were insufficient for the analysis of MAC. Carbapenems, and in particular the novel oral compound tebipenem, in combination with clavulanic acid for MTB and avibactam for MABC may be an untapped potential for difficult-to-treat mycobacterial infections.

Place, publisher, year, edition, pages
WOLTERS KLUWER MEDKNOW PUBLICATIONS , 2023. Vol. 12, no 3, p. 211-225
Keywords [en]
Carbapenems; minimum inhibitory concentrations; Mycobacterium abscessus complex; Mycobacterium avium complex; Mycobacterium tuberculosis; nontuberculous mycobacteria; systematic review; beta-lactamase inhibitors
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:liu:diva-199145ISI: 001087774300001PubMedID: 37721224OAI: oai:DiVA.org:liu-199145DiVA, id: diva2:1811857
Note

Funding Agencies|Stockholm County Council [SLS 20181256, SLS 20180615]; Swedish Medical Association [SLS 934021]; Swedish Research Council [2019-05 901]

Available from: 2023-11-14 Created: 2023-11-14 Last updated: 2023-11-14

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