Recarbrio (relebactam/imepenem/cilastatin) / Merck (MSD) - LARVOL DELTA

Empiric Imipenem/Cilastatin/Relebactam for Febrile Neutropenia After Allogeneic Hematopoietic Stem Cell Transplantation: Two Case Reports. (PubMed, J Blood Med) - "Two allo-HSCT recipients whose febrile neutropenia persisted on empiric carbapenem were promptly escalated to imipenem/cilastatin/relebactam, alone or combined with aztreonam and tigecycline-before culture confirmation. Immediate empiric imipenem/cilastatin/relebactam for CRE-high-risk allo-HSCT recipients with febrile neutropenia rapidly controlled infections and permitted successful hematopoietic recovery. Prospective studies are warranted."

Journal • Bone Marrow Transplantation • Febrile Neutropenia • Hematological Disorders • Infectious Disease • Neutropenia • Transplantation

Efficacy of imipenem/cilastatin/relebactam in infections caused by difficult-to-treat Gram-negative bacteria: a retrospective analysis of real-world data in Greece (ESCMID Global 2026) - No abstract available

Gram negative • Real-world • Real-world evidence • Retrospective data • Infectious Disease

New Lungs, Old Foes: The Challenges of Resistant Infections Pre - and Post-Transplant in a Patient with Cystic Fibrosis (ISHLT 2026) - "The patient was initiated on intravenous (IV) imipenem-cilastatin-relebactam and IV colistin based on clinical improvement with this regimen during a prior exacerbation...Sputum cultures grew methicillin-susceptible Staphylococcus aureus and P. aeruginosa susceptible to cefiderocol...He was started on empiric therapy for rapid growing NTM infection with tedizolid, azithromycin, ethambutol, imipenem, moxifloxacin, and inhaled amikacin...Following availability of susceptibilities, the patient was discharged on IV amikacin, oral azithromycin, and oral omadacycline. Donor investigation revealed a healthy 19-year-old man who drowned in a chlorinated pool.Summary This case highlights a successful lung transplant in a CF patient with ongoing pan-drug-resistant Pseudomonas infection, complicated by a donor-derived polymicrobial NTM infection. Although rare, such infections can be effectively managed with thoughtfully selected antimicrobial therapy."

Clinical • Post-transplantation • Bronchiectasis • Cystic Fibrosis • Genetic Disorders • Immunology • Infectious Disease • Nontuberculous Mycobacterial Disease • Pulmonary Disease • Respiratory Diseases • Transplantation

COST-EFFECTIVENESS ANALYSIS OF IMIPENEM/CILASTATIN/RELEBACTAM FOR CARBAPENEM-NON-SUSCEPTIBLE GRAM-NEGATIVE BACTERIAL INFECTIONS IN CHINA (ISPOR 2026) - "OBJECTIVES: To evaluate the cost-effectiveness of imipenem/cilastatin/relebactam (IMI/REL) compared with colistin plus imipenem/cilastatin (CMS+IMI) for the treatment of hospitalized adult patients with hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia, complicated intra-abdominal infections, or complicated urinary tract infections caused by carbapenem-non-susceptible Gram-negative bacteria in China. A cost-utility analysis was conducted from the perspective of the Chinese healthcare system, using a decision tree combined with a three-state Markov model (cured, uncured, death) to simulate lifetime outcomes. At a WTP threshold of per capita GDP, IMI/REL is a cost-effective option compared to CMS+IMI for adult patients in China with hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia, complicated intra-abdominal infections, or complicated urinary tract infections caused by carbapenem-non-susceptible Gram-negative..."

Cost effectiveness • Gram negative • HEOR • Infectious Disease • Nephrology • Pneumonia • Respiratory Diseases

Exploring the Effectiveness of Imipenem/Relebactam in Patients with Antimicrobial-Resistant Hospital-Acquired Infections: Findings from Systematic Literature Reviews. (PubMed, Antibiotics (Basel)) - "Imipenem/cilastatin + relebactam (I/R) is used against multidrug-resistant infections providing an alternative option which may support patients where traditional treatments are no longer effective... Two systematic literature reviews were conducted to include randomized controlled trials which aligned with the inclusion criteria reporting on the efficacy of I/R against placebo or other comparators such as piperacillin/tazobactam or colistin... These findings support the efficacy of I/R for key Gram-negative infections, particularly within vulnerable patient populations. Despite the favorable outcomes reported, there is a need for further real-world evidence generation to support the efficacy of I/R to aid in standardizing treatment guidelines and reducing the clinical and economic burden associated with multidrug-resistant bacterial infections."

Journal • Review • Infectious Disease • Nephrology • Pneumonia • Renal Disease • Respiratory Diseases

Resistance development to new anti-gram negatives during treatment: geographical epidemiology and risk factors. (PubMed, Clin Microbiol Infect) - "Treatment-emergent resistance is a consequence of antibiotic exposure, but its impact is likely underestimated. Preventive strategies include optimization of pharmacokinetic/pharmacodynamic targets, therapeutic drug monitoring, timely and complete source control, and stewardship-driven rational use of novel agents."

Journal • Review • Infectious Disease

Emerging resistance to imipenem-relebactam among enterobacterales and non-fermenting gram-negative bacilli: a systematic review and meta-analysis. (PubMed, Infection) - "IMI/REL remains largely effective against Enterobacterales, including ESBL and MDR strains, but resistance is increasing in high-risk subgroups and non-fermenting bacteria. These findings underscore the need for local susceptibility testing, cautious empiric therapy, and robust antimicrobial stewardship to preserve the efficacy of IMI/REL."

Journal • Retrospective data • Review • Infectious Disease

Susceptibility to cefiderocol and other novel antibiotics against carbapenem-non-susceptible gram-negative bacilli. (PubMed, Jpn J Infect Dis) - "We conducted antimicrobial susceptibility testing on 89 clinical isolates of carbapenem-non-susceptible gram-negative bacilli (CNS-GNB) strains detected at our hospital, evaluating the efficacy of novel antibiotics including CFDC, ceftolozane/tazobactam, ceftazidime/avibactam, and imipenem/cilastatin/relebactam...Colistin were intermediate against all CPE and 92.5% of CRPA isolates. In S. maltophilia isolates, susceptibility to CFDC and trimethoprim-sulfamethoxazole were 100% and 89.3 %. Although non-susceptibility to CFDC appeared in 2 CRPA isolates, MIC90 of CFDC was within susceptible range against all three groups of clinical isolates. CFDC showed significant promise as a treatment option for infections caused by CNS-GNB."

Journal • Infectious Disease

Imipenem/cilastatin/relebactam dosing regimen justification using exposure-efficacy analyses in participants with hospital-acquired bacterial pneumonia or ventilator-associated bacterial pneumonia in the RESTORE-IMI 2 phase 3 study. (PubMed, Antimicrob Agents Chemother) - P3 | "There were no apparent trends in ACM rates by imipenem or relebactam exposure distributions overall or by individual key pathogens, suggesting an exposure-efficacy plateau. These results further support the recommended and currently approved IMI/REL 500/500/250 mg dosing regimen for patients with HABP/VABP."

Journal • P3 data • Infectious Disease • Pneumonia • Respiratory Diseases

New antimicrobial substances to combat increasing resistance (PubMed, Inn Med (Heidelb)) - "In addition to cefiderocol, the first siderophore cephalosporin, new combinations of β‑lactam antibiotics and β‑lactamase inhibitors (BLIs) such as ceftolozan/tazobactam, ceftazidime/avibactam, cefepime/enmetazobactam, imipenem/cilastatin/relebactam, and meropenem/vaborbactam, as well as the monobactam/BLI combination aztreonam/avibactam, have been approved and successfully implemented in clinical care. In addition, there is the synthetic tetracycline antibiotic eravacycline, which has a broad spectrum of activity against Gram-positive, Gram-negative (particularly clinically relevant Enterobacterales), anaerobic, and multidrug-resistant bacteria, and the new glycopeptide antibiotic dalbavancin, which is effective against Gram-positive bacteria...Some of these agents have already been tested with promising results in smaller phase 1/2 studies. In addition, monoclonal antibodies, antimicrobial peptides, small molecules, microbiome-modifying biotherapeutics,..."

Journal • Review • Infectious Disease

Cost-minimizing alternative dosage regimens of imipenem/cilastatin/relebactam for patients with renal impairment: a pharmacokinetic/pharmacodynamic simulation study. (PubMed, Eur J Clin Pharmacol) - "Alternative dosing regimens for IMI/REL in patients with renal impairment can optimize drug utilization, minimize waste, and provide significant cost savings. However, further clinical studies are necessary to validate the effectiveness and safety of these regimens."

Journal • PK/PD data • Renal Disease

The UK Antimicrobial Registry (UKAR): an overview of the first 20 months of recruitment. (PubMed, JAC Antimicrob Resist) - "UKAR is an ongoing prospective registry of adult inpatients prescribed 11 eligible study drugs (cefiderocol, ceftaroline, ceftazidime/avibactam, ceftobiprole, ceftolozane/tazobactam, dalbavancin, delafloxacin, eravacycline, imipenem/cilastatin/relebactam, meropenem/vaborbactam and oritavancin). The UKAR provides real-world data on the use of novel antimicrobials confirming they are sometimes used empirically as well as for directed therapy to treat both complex and common infections, and often for multiresistant pathogens. The study is a novel and important resource to support the judicious use of these drugs."

Journal • Critical care • Infectious Disease • Nephrology • Respiratory Diseases • Septic Shock

Sodium load of novel antibiotics: considerations for nephrologists and clinicians. (PubMed, Int Urol Nephrol) - "Parenteral antibiotics are an often-overlooked contributor to sodium intake. Clinicians should be aware of this hidden source in sodium-sensitive patients such as kidney disease patients. We propose a visual chart to support sodium-conscious antimicrobial selection as part of broader stewardship strategies."

Journal • Review • Chronic Kidney Disease • Nephrology • Renal Disease

Efficacy of Imipenem/Cilastatin/Relebactam in infections caused by Difficult-to-Treat Gram-Negative Bacteria: A Retrospective Analysis of Real-world data in Greece. (PubMed, Infez Med) - "The findings of this study reinforce the value of IMI/REL as an effective and well-tolerated treatment for severe GNB infections in a complex, real-world patient population. These outcomes compare favourably with published data for other new BL/BLI agents, supporting the targeted use of IMI/REL as a crucial component of modern antibiotic stewardship."

Journal • Real-world evidence • Retrospective data • Infectious Disease • Pneumonia

Recarbrio - opinion on variation to marketing authorisation (European Medicines Agency) - "The CHMP adopted an extension to the existing indication, as follows: Recarbrio is indicated in adult and paediatric patients from birth for: Treatment of hospital-acquired pneumonia (HAP), including ventilator associated pneumonia (VAP); Treatment of bacteraemia that occurs in association with, or is suspected to be associated with HAP or VAP; Treatment of infections due to aerobic Gram-negative organisms with limited treatment options."

CHMP • Infectious Disease • Pneumonia

Case Report of Treatment of Polymicrobial Bacteremia Caused by Carbapenem-Resistant Klebsiella pneumoniae, and Bacillus Species in an Immunocompetent Patient With Meropenem-Vaborbactam. (PubMed, J Pharm Pract) - "The Infectious Disease Society of America (IDSA) recommends meropenem-vaborbactam, ceftazidime-avibactam, or imipenem-cilastatin-relebactam as preferred options with cefiderocol as an alternative, all of which are also alternative options for CTX-M Enterobacterales...This case report illustrates the treatment course of CTX-M and KPC-producing Klebsiella pneumoniae, and Bacillus species bacteremia that included cefiderocol, followed by vancomycin and meropenem-vaborbactam, and then meropenem-vaborbactam monotherapy...In our report, an immunocompetent patient developed a polymicrobial bloodstream infection caused by an MDR Klebsiella pneumoniae, and Bacillus species, which was successfully treated with meropenem-vaborbactam. This unusual infection and treatment course also serves to promote awareness of another treatment option for invasive Bacillus species infection and furthermore encourages providers to request testing & sensitivities to consolidate therapy,..."

Journal • Infectious Disease • Pneumonia

Imipenem/Relebactam Plus Aztreonam: First Reported Use in MDR Klebsiella pneumoniae Sternal Infection Complicated by Bacteremia. (PubMed, Antibiotics (Basel)) - "Sternal swab and mediastinal liquid culture results highlighted CRKP harboring blaNDM and blaKPC genes, while the blood isolate showed blaCTX and blaKPC, indicating phenotypic resistance to ceftazidime-avibactam. All the strains exhibited phenotypic susceptibility to meropenem-vaborbactam (MEV), despite having a high minimum inhibitory concentration. Following clinical failure of MEV-based therapy, combination treatment with aztreonam (ATM) and imipenem/cilastatin/relebactam (IMI/REL), plus gentamicin, was initiated...The patient completed 49 days of ATM and IMI/REL without relapse over a 3-month follow-up period. This is, to the best of our knowledge, the first reported case of IMI/REL being used in combination with ATM."

Journal • Infectious Disease • Pneumonia

Significant Prevalence of Dual KPC/NDM Carbapenemase-Producing Klebsiella pneumoniae in an ICU Cohort in Thessaloniki (2023), Including an ST512 Isolate Co-Harboring blaNDM-1 and blaKPC-3. (PubMed, Antibiotics (Basel)) - "Bacterial identification and Antimicrobial susceptibility testing (AST) were performed by VITEK-2; Minimum inhibitory concentrations (MICs) for ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MER/VAB), and imipenem/relebactam (IMI/REL) were determined by E-tests...Tigecycline showed the highest retained activity; colistin remained active in a minority... Half of CRKP isolates in this ICU-predominant series co-produced KPC and NDM, severely limiting β-lactam/β-lactamase inhibitor options. These data support routine screening for carbapenemases, strict infection prevention, antimicrobial stewardship, and access to agents active against MBLs."

Journal • Critical care • Infectious Disease • Pneumonia

Activity of cefiderocol against Pseudomonas aeruginosa from the USA and Europe (2020-2023) with difficult-to-treat resistance phenotype, including those nonsusceptible to recently developed β-lactam/β-lactamase inhibitor combinations: results from the SENTRY antimicrobial surveillance program. (PubMed, Microbiol Spectr) - "Cefiderocol and the β-lactam/β-lactamase inhibitor (BL-BLI) combinations ceftazidime-avibactam (CAZ-AVI), imipenem-relebactam (IMI-REL), and ceftolozane-tazobactam (TOL-TAZ) are recommended for the treatment of difficult-to-treat resistance (DTR) Pseudomonas aeruginosa by IDSA guidelines. Cefiderocol also sustained activity against a diverse array of isolates with various BL-BLI nonsusceptible phenotypes, and regardless of carbapenemase status. These findings support the use of cefiderocol as a first treatment option for infections caused by DTR P. aeruginosa."

Journal • Infectious Disease

Current and future options for the treatment of serious infections due to carbapenem-resistant Pseudomonas aeruginosa. (PubMed, Clin Microbiol Rev) - "Monotherapy with ceftazidime-avibactam, imipenem-cilastatin-relebactam, cefiderocol, or high doses of ceftolozane-tazobactam is generally considered an acceptable option for serious infections due to carbapenem-resistant P. aeruginosa. The role of testing combinations of antimicrobial agents for in vitro susceptibility is uncertain, as is the administration of nebulized colistin or amikacin in patients with ventilator-associated pneumonia...However, no phage options are yet widely approved for use. Other new options in clinical trials include beta-lactam antibiotics combined with new beta-lactamase inhibitors and antibody-based therapies."

Journal • Review • Infectious Disease • Pneumonia • Respiratory Diseases

Efficacy and safety of imipenem/cilastatin/relebactam (IMI/CS/REL): a meta-analysis of randomized controlled clinical trials. (PubMed, BMC Infect Dis) - "IMI/CS/REL demonstrates a non-inferior efficacy and safety profile compared to standard comparators in treating carbapenem-susceptible or carbapenem-resistant pathogens. Nevertheless, more robust clinical evidence-especially in resistant, polymicrobial, and pathogen-defined infections-is needed to fully establish its role in real-world practice."

Clinical • Journal • Retrospective data • Review • Infectious Disease

Molecular characterization of carbapenem-resistant Enterobacterales (CRE) and in vitro activity of novel beta lactams against CRE isolates from Malaysia. (PubMed, Microbiol Spectr) - "CRE is defined as Enterobacterales that is phenotypically non-susceptible to any carbapenems, including imipenem, meropenem, and ertapenem...The proportion of CRE isolates that exhibited susceptibility towards cefiderocol, ceftazidime-avibactam, and imipenem-cilastatin-relebactam was 86.4% (133/154), 41.6% (64/154), and 26.0% (40/154), respectively...Among novel β-lactam agents, cefiderocol and the combination of ceftazidime-avibactam and aztreonam have shown promising activity against blaNDM-producing CRE, supporting precision medicine approaches. Nevertheless, our study observed the emergence of cefiderocol resistance in isolates without prior drug exposure, highlighting a potential challenge in combating AMR."

Journal • Preclinical

Susceptibility and molecular characterization of isolates from a Phase 2/3, open-label, randomized, active-controlled clinical trial evaluating the safety and efficacy of imipenem/cilastatin/relebactam (IMI/REL) in pediatric participants with gram-negative (GN) bacterial infection (IDWeek 2025) - No abstract available

Clinical • Gram negative • P2/3 data • Infectious Disease

Efficacy and Safety of Imipenem/Cilastatin/Relebactam (IMI/REL) in Treating Hospital-Acquired and Ventilator-Associated Bacterial Pneumonia: A Systematic Literature Review of Randomized Control Trials (IDWeek 2025) - No abstract available

Clinical • Review • Infectious Disease

How do I manage Difficult-to-Treat Pseudomonas aeruginosa infections?: Key Questions for Today's Clinicians. (PubMed, Clin Microbiol Infect) - "Ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam and cefiderocol are newer options, but resistance and lack of relevant data from randomised clinical trials hampers knowledge of the best way to use them. Ceftolozane-tazobactam and ceftazidime-avibactam are initially preferred when susceptible because they enter the market first and there is more published evidence about them. Ceftolozane-tazobactam is preferred in P. aeruginosa pneumonia instead of ceftazidime-avibactam. Both can be equally used in other P. aeruginosa infection types. Imipenem-relebactam and cefiderocol may retain susceptibility when there is resistance to ceftolozane-tazobactam and ceftazidime-avibactam, and when metallo-beta-lactamases are not present. However, there are no head-to-head comparative studies to support a preference for one over the other. In the presence of metallo-beta-lactamases, cefiderocol is the preferred agent. Other options in this situation are..."

Journal • Review • Infectious Disease • Pneumonia • Respiratory Diseases