Antimicrobial resistance poses a significant public health challenge, particularly with the rise of gram‐negative hospital‐acquired infections resistant to carbapenems. Aztreonam–avibactam (ATM–AVI) is a promising new combination therapy designed to combat multidrug‐resistant (MDR) gram‐negative bacteria, including those producing metallo‐β‐lactamases (MBLs). Aztreonam, a monobactam antibiotic, is resistant to hydrolysis by MBLs but can be degraded by other β‐lactamases. Avibactam, a novel non‐β‐lactam β‐lactamase inhibitor, effectively neutralizes extended‐spectrum β‐lactamases (ESBLs) and AmpC β‐lactamases, restoring aztreonam's efficacy against resistant pathogens. This review covers the chemistry, mechanisms of action, spectrum of activity, pharmacokinetics, pharmacodynamics, and clinical efficacy of ATM–AVI. ATM–AVI combination has shown efficacy against a wide range of resistant Enterobacterales and other gram‐negative bacteria in both in vitro and clinical studies. Pharmacokinetic and pharmacodynamic analyses demonstrate that ATM–AVI maintains effective drug concentrations in the body, with dose adjustments recommended for patients with renal impairment. Clinical trials, including the REVISIT and ASSEMBLE studies, have demonstrated the safety and efficacy of ATM–AVI in treating complicated intra‐abdominal infections (cIAI), urinary tract infections (UTIs), and hospital‐acquired pneumonia (HAP) caused by MDR gram‐negative pathogens. The European Medicines Agency (EMA) has approved ATM–AVI for these indications, and further research is ongoing to optimize dosing regimens and expand its clinical use. This combination represents a critical advancement in the fight against antimicrobial resistance, offering a new therapeutic option for treating severe infections caused by MDR gram‐negative, including MBL‐producing, bacteria.

Introduction Stenotrophomonas maltophilia is notable for its rising incidence and multidrug resistance, which complicates treatment. As a result of insufficient clinical studies, the 2024 Infectious Diseases Society of America (IDSA) Guidance on Treating Antimicrobial Resistant Gram-negative Infection advises against using eravacycline (ERV) for S. maltophilia infections. We present real-world data on patients treated with ERV for these infections. Methods This multicenter, retrospective, observational study included adult patients who received ERV for treating S. maltophilia infections for ≥ 72 h between October 2018 and August 2022. The primary outcome was the clinical cure evaluated at the end of ERV therapy. Key secondary outcomes included a 30-day survival rate, absence of infection recurrence counting from the end of ERV therapy, and occurrence of possible ERV-related adverse effects (AE) noted in the patient’s records. Results Overall, 41 patients were included with a median (interquartile range [IQR]) age of 63 years (46.0–74.5). Most patients were male (63.4%) and white (51.2%). The primary source of infection was pulmonary (56.1%), and most patients received ERV for regimen consolidation (65.9%). Combination therapy was used in about 10% of the cases for S. maltophilia treatment. The median (IQR) duration of ERV treatment was 7 days (4.0–11.5). The clinical cure rate was 73.2%, and the 30-day survival rate was 68.3%. Four patients (9.8%) experienced possible AE from ERV. Conclusion S. maltophilia infections are challenging to treat because of limited options. An analysis of 41 patients indicates ERV may be an acceptable treatment option, but more clinical studies are needed to evaluate its efficacy and safety.

The treatment of osteoarticular infections in pediatric patients with sickle cell disease (SCD) is a challenging task for the practitioner. The aim of this study is to evaluate cefixime for the treatment of osteoarticular infections in pediatric SCD patients by retrospective design. This study was done in the pediatric hospital of King Saud Medical City, Riyadh, Saudi Arabia. The data was obtained from medical records of patients aged 1-16 years admitted between January 2019 to December 2020, diagnosed with SCD and received cefixime for the treatment of OI. A descriptive study for pediatric patients admitted between January 2019 to December 2020 diagnosed with sickle cell disease and diagnosed with osteoarticular infection. All patients were treated with cefixime. Medians and interquartile ranges (IQRs) were used for the descriptive analysis. A total of 260 patients were screened, and 51 cases [osteomyelitis (OM), n = 43, and septic arthritis (SA), n = 8] met the inclusion criteria. The median age of OM patients was 7 years, with males making up 67.4% of the cohort. The median length of IV antibiotics and hospital stays were 10 days and 11 days, respectively. The median total duration of antibiotic use was 37 and 25 days for OM and SA, respectively. The treatment success rate was 88% in OM cases and 100% in SA patients. Readmission was noted in 39.5% of the OM patients, while only 25% of the SA patients were recorded for reinfection. The study's findings revealed that Cefixime is a viable oral alternative for treating osteoarticular infection in pediatric SCD patients. Nonetheless, a prospective investigation is required to corroborate the findings of this study.

Purpose: To evaluate the real-world evidence of ceftazidime-avibactam (CAZ-AVI) compared to intravenous colistin for the treatment of multidrug-resistant (MDR) P. aeruginosa infections. Method: This is a multicenter, retrospective cohort study conducted in the period between 2017 and 2023 at five institutions for patients who received either CAZ-AVI or colistin-based regimens for treating MDR P. aeruginosa infections. Outcomes were compared using multivariate logistic regression analysis. Result: Among the screened patients, 203 patients were included: 89 in the CAZ-AVI group and 114 in the colistin group. A total of 57% presented with pneumonia, 21% with bacteremia, and 61% were in the intensive care unit. The rate of clinical cure was significantly higher among patients who received CAZ-AVI (67% vs. 50%; OR, 2.07; 95% CI, 1.16–3.68). The rate of in-hospital mortality was numerically lower among patients who received CAZ-AVI (40% vs. 49%; OR, 0.58; 95% CI, 0.33–1.03). The rate of AKI was significantly lower among patients who received CAZ-AVI (15% vs. 43%; OR, 0.23; 95% CI, 0.11–0.45). Conclusion: CAZ-AVI was more effective in treating MDR P. aeruginosa infections and showed a better safety profile compared to colistin. Thus, CAZ-AVI could be a better alternative for treating MDR P. aeruginosa infections.