Spontaneous bacterial peritonitis due to carbapenemase-producing Enterobacteriaceae: Etiology and antibiotic treatment

Table 5 Advantages and disadvantages of the antimicrobials used to treat spontaneous bacterial peritonitis due to gram-negative bacteria producing carbapenem-resistant Enterobacteriaceae

Antimicrobial agent	Advantages	Disadvantages	Ref.
Aminoglycosides (i.e. Plazomicin)	Good activity against GNB producing ESβL, KPC, AmpC but not MβL enzymes	Heterogeneous susceptibility high dose (toxicity)	[49]
Polimixins (i.e. Colistin)	Low resistance emergence	Low efficacy for Klebsiella spp. producing KPC enzymes	[56]
Fosfomicyn	Moderate activity against MDR–CRE	Rapid emergence of antibiotic resistance	[59]
Glycylcycline (i.e. Tigecycline)	Good activity against MDR–CRE	High dose (toxicity)	[62]
Fluorocycline (i.e. Eravacycline)	Broad spectrum activity (even if MDR and XDR pathogens). Active against the most common tetracycline-resistance mechanisms. High oral bioavailability. Safety and tolerability	Not active on Pseudomonas spp. and Burkholderia spp.	[63- 65]
β-lactams/β-lactamase inhibitors (i.e. ceftazidime/avibactam)	Good activity against GNB producing ESβL, KPC, AmpC, OXA-48 and MβL. Safety and tolerability	Frequent emergence of antibiotic resistance	[67]
Carbapenem/β-lactamase inhibitors (i.e. meropenem/vaborbactam or Imipenem/cilastatin/relebactam)	Good activity against GNB producing ESβL, KPC and AmpC. Outcome improvement	Not active on GNB producing OXA-48 and MβL	[79]
Monobactam/β-lactamase inhibitor (i.e. aztreonam/avibactam)	Good activity against GNB producing ESβL, KPC, AmpC and OXA-48	Recently approved	[50- 52]
Siderophore cephalosporin (i.e. Cefidecol)	Broad spectrum of activity against GNB, including MDR Enterobacteriaceae, Pseudomonas aeruginosa and A. baumannii	Recently approved	[50]

GNB: Gram-negative bacteria; ESβL: Extended-spectrum β-lactamase; CRE: Carbapenem-resistant Enterobacteriaceae, KPC: Klebsiella pneumoniae; MβL: Molecular class B β-lactamases; MDR: Multidrug resistant; XDR: Extensively resistant.