Meropenem-Vaborbactam for Treatment of Carbapenem-Resistant Enterobacterales: A Narrative Review of Clinical Practice Evidence

Among drug-resistant bacteria, carbapenem-resistant Enterobacterales (CRE) are a major clinical challenge with limited options for treatment. In the last several years, new treatment options have emerged for CRE, including meropenem–vaborbactam (MVB). MVB was studied clinically in the TANGO-I and TANGO-II trials, which evaluated the combination in complicated urinary tract infections and in different types of CRE infections, respectively. To date, clinical data on the efficacy of MVB in treatment of CRE remain limited, but are needed to understand the efficacy of a drug in routine practice. Eight retrospective studies have investigated the use of MVB for CRE. In these analyses, the overall clinical success rate varied from 60 to 75%, while mortality rates at 30 days ranged from about 15 to 30%. Most of these investigations involved patients with KPC-producing CRE strains, but also patients with Gram-negative infections, of which 80% were CRE. In addition, a number of small case series and case reports have emerged describing the use of MVB. In both retrospective studies and case series/reports, there appeared to be no major safety concerns. Collectively, these data have shown that MVB can be considered to have promising efficacy in severe Klebsiella pneumoniae carbapenemase (KPC)-producing-CRE infections and is safe and well tolerated.