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

Novel β-Lactam/β-Lactamase Inhibitors Versus Best Available Therapy on the Mortality-Related Carbapenem-Resistant Enterobacterales Infection: A Systematic Review and Meta-Analysis. (PubMed, Antibiotics (Basel)) - "Innovative BL/BLI combinations lower all-cause mortality compared to BAT. This effect is extremely reliant on the comparator regimen composition, the specific BL/BLI drug, and the underlying resistance mechanism. These data support a precision medicine approach guided by rapid molecular diagnostics. These findings underscore the urgent need for novel agents against MBL-producing strains, including the recently approved aztreonam-avibactam."

Journal • Retrospective data • Review • Infectious Disease • Pneumonia • Septic Shock

Imipenem/cilastatin/relebactam treatment of hospital-acquired/ventilator-associated bacterial pneumonia caused by imipenem-nonsusceptible pathogens: Subgroup analysis and molecular characterization of isolates from the RESTORE-IMI 2 clinical study. (PubMed, PLoS One) - P3 | "Day 28 all-cause mortality was similar among participants treated with IMI/REL, regardless of baseline pathogen susceptibility to imipenem. Emergence of nonsusceptibility to imipenem/REL on treatment was low."

Journal • Critical care • Infectious Disease • Pneumonia • Respiratory Diseases

Managing KPC infections in daily practice: when BLBLIs are interchangeable - and when they are not. (PubMed, Curr Opin Infect Dis) - "BLBLI with KPC activity interchangeability is clinically reasonable only in selected, microbiologically confirmed, low-risk scenarios. In complex infections, therapy should be guided according to resistance mechanism, infection site, pharmacokinetics/pharmacodynamics (PK/PD) parameters, and host factors."

Journal • Infectious Disease • Pneumonia • Respiratory Diseases

Targeting KPC-Producing Klebsiella pneumoniae Biofilms: Genomic Profiles, Clinical Outcomes and Novel Combinations. (PubMed, Microorganisms) - "Ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), and imipenem/relebactam (IMI/REL) were tested alone or combined with fosfomycin (FOS), cefepime (FEP), meropenem (MEM), or imipenem (IMI) using checkerboard assays. Conversely, FOS-based regimens were significantly less effective against biofilms. These findings provide a clinical rationale for selecting optimized dual regimens to eradicate biofilms, offering a critical therapeutic strategy to preserve vascular devices when catheter removal is unfeasible."

Clinical data • Journal • Infectious Disease • Pneumonia

Genetic Determinants of Nonsusceptibility to Novel β-Lactam/β-Lactamase Inhibitors in Non-Metallo-β-Lactamase-Producing Pseudomonas aeruginosa. (PubMed, J Glob Antimicrob Resist) - "Reduced susceptibility to BL/BLI agents among non-MBL-producing isolates appeared to be associated with chromosomal adaptations involving altered AmpC regulation, OprD dysfunction, and efflux-associated mechanisms. These findings highlight the importance of genomic surveillance beyond carbapenemase detection as the clinical use of these agents expands."

Journal

Relebactam enhances the activity of imipenem against Burkholderia cepacia complex isolates. (PubMed, J Glob Antimicrob Resist) - "Imipenem/relebactam effectively inhibited the growth of BCC isolates in vitro and reduced bacterial burden of BCC isolates in vivo. There are no interpretive susceptibility criteria for imipenem/relebactam against BCC; however, these results warrant further investigation in clinical studies."

Journal • Infectious Disease • Pulmonary Disease

Performance evaluation of antimicrobial susceptibility testing methods for ceftazidime-avibactam and imipenem-relebactam against Klebsiella pneumoniae and Pseudomonas aeruginosa. (PubMed, Eur J Clin Microbiol Infect Dis) - "CAZ-AVI and IMI-REL retain potent in vitro activity against contemporary CR-KP and CR-PA isolates. Gradient diffusion is a reliable alternative to BMD for ceftazidime-avibactam, whereas its accuracy is limited for imipenem-relebactam. K-B disk diffusion for IMI-REL is associated with unacceptably high error rates; reference method confirmation is recommended for isolates yielding non-susceptible results by this method."

Journal • Infectious Disease • Pneumonia

Phase 2/3, Open-label, Randomized, Active-controlled Clinical Trial Evaluating the Safety and Efficacy of Imipenem/Cilastatin/Relebactam in Pediatric Patients From Birth to Less Than 18 Years With Gram-negative Bacterial Infections. (PubMed, Pediatr Infect Dis J) - P2/3 | "IMI/REL was generally well tolerated in neonates and older pediatric patients with HABP/VABP, cIAI, or cUTI, with safety and efficacy profiles comparable to standard-of-care antibacterial therapy."

Clinical • Journal • P2/3 data • Infectious Disease • Nephrology • Pediatrics • Pneumonia • Respiratory Diseases

Global Survey on the Management of Multidrug-resistant Gram-negative Bacilli: Divergence of Practice Between High-Income Countries and the Rest of the World. (PubMed, Clin Infect Dis) - "Management practices for carbapenem-resistant gram-negative pneumonia and bacteremia vary widely, complicated by limited access to new antimicrobial agents in the LMICs. Evaluations of the potential impact of these new antimicrobial agents on the outcome of infections in LMICs are urgently needed."

Journal • Infectious Disease • Pneumonia • Respiratory Diseases

Successful Treatment with Imipenem/Cilastatin/ Relebactam of a Polymicrobial Bacteremia due to Meropenem/Vaborbactam-Resistant KPC-Kp and Enterococcus Faecalis. (PubMed, Mediterr J Hematol Infect Dis) - No abstract available

Journal

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

Risk factors for in vivo emergence of ceftazidime-avibactam resistance in KPC-producing Klebsiella pneumoniae and the associated resistance mechanisms: a case-control study. (PubMed, Microbiol Spectr) - "The emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (CZA-R KPC-Kp), primarily due to KPC variants, poses a growing challenge to clinical practice. Exposure to CZA independently predicted resistance in KPC-Kp, whereas carbapenem use was protective. These findings highlight the importance of antibiotic stewardship and warrant further comparative study of meropenem-vaborbactam or imipenem-cilastatin-relebactam versus CZA for KPC-producing K. pneumoniae infections."

Journal • Preclinical • Infectious Disease • Pneumonia

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

In vitro activity of ceftazidime-avibactam, imipenem-cilastatin-relebactam, meropenem-vaborbactam, cefiderocol, and plazomicin against non-fermenting Gram-negative isolates obtained from Bulgarian inpatients. (PubMed, Acta Microbiol Immunol Hung) - "In conclusion, the emergence of MBL-positive P. aeruginosa and the associated ineffectiveness of the novel BL-BLI combinations, as well as the relatively high proportion of CFDC-resistant A. baumannii isolates, are alarming. Therefore, continuous surveillance of AMR concerning newly approved antibiotics should be the mainstay of multifaceted global and national "One Health" strategies and infection control stewardship practices in hospital settings."

Journal • Preclinical • Infectious Disease

Efficacy and safety of imipenem-cilastatin-relebactam in resistant infections: a systematic review and meta-analysis of randomized controlled trials. (PubMed, Infection) - "IMI-REL demonstrates efficacy and safety comparable to standard-of-care treatments for resistant and complicated infections. It may serve as a valuable therapeutic option for patients with limited alternatives and can support antimicrobial stewardship when administered as a short-course empirical therapy followed by appropriate de-escalation."

Journal • Retrospective data • Infectious Disease

UK Antimicrobial Registry: Virtual Registry-an innovative surveillance approach for monitoring the real-world use and effectiveness of newly licensed antimicrobials in Scotland. (PubMed, JAC Antimicrob Resist) - "Adults (≥18 years) prescribed any of 11 RLAs (cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, eravacycline, ceftaroline, ceftobiprole, dalbavancin, delafloxacin, oritavancin) between June 2019 and June 2023 were included. UKAR:V shows that linked electronic data can support real-world RLA surveillance. With appropriate data linkage, this model offers a scalable, low-burden approach to monitoring utilization/outcomes providing a sustainable foundation for stewardship/policy and assessment of innovative reimbursement models."

Journal • Real-world evidence • Infectious Disease • Pneumonia • Septic Shock

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

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