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Traitement des infections à entérobactéries productrices de β-lactamases à spectre élargi (BLSE) et/ou productrices de carbapénèmases (CPE) : Quelle place pour le ceftazidimeavibactam dans l'arsenal thérapeutique belge ?

par Milas, Sandrine;Hites, Maya
Référence Revue médicale de Bruxelles, 41, 1, page (46-54)
Publication Publié, 2020-02-01

Article révisé par les pairs

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Résumé :

The number of infections due to extended spectrum β-lactamase producing Enterobacteriaceae (ESBL) or carbapenemase producing Enterobacteriaceae (CPE) are steadily increasing in Belgium. These infections are difficult to treat. Carbapenems are the most effective therapeutic class for the treatment of ESBL infections, especially for severe cases. The management of CPE infections most often requires a combined antibiotic treatment, determined by the type of carbapenemase involved and the clinical characteristics of the patient. The use of old molecules, including colistin, aminoglycosides or fosfomycin is often necessary, given the lack of newer antibiotics active on these CPE (except for tigecycline or meropenem prescribed in high doses and /or extended infusion for the latter). These treatments are often responsible for toxic effects, particularly renal. New antibiotics are urgently needed to treat these infections. Ceftazidimeavibactam, a third generation cephalosporin (ceftazidime) combined with a new non-β-lactam β-lactamase inhibitor (BLI), avibactam, has been licensed in Belgium since December 2018 and is active on ESBL and some CPE. It is necessary to define the place of this new antibiotic in the Belgian therapeutic arsenal to make good use of it and to avoid the emergence of resistance to this new therapeutic option for multidrug-resistant enterobacterial infections.