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

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

In Vitro Activity of Novel β-Lactam/β-Lactamase Inhibitors Against Carbapenem-Resistant Pseudomonas aeruginosa and Enterobacterales in Korea. (PubMed, Antibiotics (Basel)) - "This study evaluated the in vitro susceptibility of CRE and CRPA blood isolates from Korea to novel β-lactam/β-lactamase inhibitor combinations: ceftolozane/tazobactam (C/T), ceftazidime/avibactam (CZA), imipenem/cilastatin/relebactam (IMR), and meropenem/vaborbactam (MEV). CZA, IMR, and MEV showed promising activity against KPC-producing CRE. These findings can inform empirical therapy and stewardship efforts in Korea."

Journal • Preclinical • Hematological Disorders • Hematological Malignancies • Infectious Disease • Oncology

Nephrotoxicity of New Antibiotics: A Systematic Review. (PubMed, Toxics) - "The agents assessed included aztreonam/avibactam, cefepime/enmetazobactam, cefiderocol, ceftobiprole, contezolid, gepotidacin, imipenem/cilastatin/relebactam, lascufloxacin, lefamulin, levonadifloxacin, plazomicin, and sulbactam/durlobactam. There is a need for post-marketing studies to better characterize renal safety. Clinicians should remain vigilant and continue to monitor for and report renal-related adverse events."

Journal • Review

Activity of Imipenem and Imipenem/Relebactam Against Clinical Anaerobe Isolates (ASM Microbe 2025) - "Imipenem/relebactam maintains the activity of imipenem against Bacteroides spp., with 82.9-100% susceptible at the breakpoint of ≤4 μg/mL. The addition of relebactam to imipenem did not demonstrably increase activity against these isolates. IMI/REL could be an important option for situations where mixed infections including anaerobes are present."

Clinical • Infectious Disease

Tackling multidrug-resistant gram-negative infections in Children globally: current therapeutic options and perspectives. (PubMed, Expert Opin Pharmacother) - "New β-lactam antibiotics, alone or in combination with β-lactamase inhibitors - such as ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, and cefiderocol - have emerged as preferred options for treating carbapenem-resistant and difficult-to-treat Gram-negative infections. Therapy should be guided by pathogen identification and resistance mechanisms, as susceptibility profiles vary widely based on the resistance-mechanism. Older agents like colistin, fosfomycin, nitrofurantoin, and aminoglycosides remain important, particularly in resource-limited settings, despite concerns over toxicity and safety."

Journal • Review • Infectious Disease • Pediatrics

Breaking Through Resistance: A Comparative Review of New Beta-Lactamase Inhibitors (Avibactam, Vaborbactam, Relebactam) Against Multidrug-Resistant Superbugs. (PubMed, Antibiotics (Basel)) - "The introduction of new β-lactam-β-lactamase inhibitors (BLBLIs), such as ceftazidime/avibactam, meropenem/vaborbactam, and imipenem/cilastatin/relebactam, expands our therapeutic options against carbapenem-resistant Gram-negative bacteria, including those pathogens for which therapeutic options are limited...The recent introduction of aztreonam/avibactam marks a significant advancement in our therapeutic armamentarium against metallo-β-lactamase-producing pathogens...The present review aims to provide clinicians with a detailed understanding of each BLBLI treatment option to guide the optimal use of these new agents for the effective treatment of difficult infections caused by carbapenemase-producing Enterobacterales infections. This review is based on literature retrieved from PubMed, Scopus, Web of Science, and the Cochrane Library."

Journal • Review • Infectious Disease

Successful treatment of an intra-abdominal abscess caused by KPC-2-producing hypervirulent Klebsiella pneumoniae sequence type 11 with imipenem/cilastatin/relebactam in a Japanese patient. (PubMed, J Infect Chemother) - "Abscess drainage was performed, and he was initially treated with meropenem (2 g every 8 hours, prolonged infusion over 3 hours), gentamicin (5 mg/kg/day), and tigecycline (200 mg as a loading, followed by 100 mg every 12 hours). Imipenem/cilastatin/relebactam is potentially an option for treating infections caused by KPC-2-producing hypervirulent K, pneumoniae with porin mutations. Cross-border spread of pathogens that are both multidrug-resistant and hyperviirulent must be closely monitored."

Journal • Infectious Disease • Pneumonia

Activity of imipenem/relebactam against KPC-producing Klebsiella pneumoniae and the possible role of Ompk36 mutation in determining resistance: an Italian retrospective analysis. (PubMed, Ann Clin Microbiol Antimicrob) - "IMI/REL showed good in vitro activity against the KPC-Kp strains analysed. All the IMI/REL-resistant strains displayed a mutation in porin OmpK36 and produced carbapenemases, with KPC-2 and KPC-3 being equally distributed. MVB and CZA maintained good activity against IMI/REL resistant isolates."

Journal • Retrospective data • Infectious Disease • Pneumonia

Real-World Applications of Imipenem-Cilastatin-Relebactam: Insights From a Multicenter Observational Cohort Study. (PubMed, Open Forum Infect Dis) - "This study provides a comprehensive analysis of the real-world effectiveness and safety of IMI/REL. Comparative studies and investigations of specific subgroups will further enhance our understanding of IMI/REL in treating MDR infections."

Clinical • Journal • Observational data • Real-world evidence • Cardiovascular • Congestive Heart Failure • Critical care • Heart Failure • Infectious Disease • Respiratory Diseases

Single-centre real-life experience with imipenem/cilastatin/relebactam use at a tertiary care hospital in Italy, June 2022-November 2024 (ESCMID Global 2025) - No abstract available

Clinical

Efficacy and Safety of Imipenem/Cilastatin/Relebactam (IMI/REL) in Treating Complicated Intra-Abdominal Infections and Complicated Urinary Tract Infections: A Systematic Literature Review of Clinical Trials: RESOLVE (ESCMID Global 2025) - No abstract available

Clinical • Review • Infectious Disease • Nephrology

Phase 2/3, open-label, randomized, active-controlled clinical trial evaluating the safety and efficacy of imipenem/cilastatin/relebactam (IMI/REL) in paediatric patients with gram-negative bacterial infection (ESCMID Global 2025) - No abstract available

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

Whole genome sequencing characterization of the new KPC-245 variant-carrying Klebsiella pneumoniae strain isolated from a transplanted patient and resistant to ceftazidime/avibactam, meropenem/vaborbactam and imipenem/relebactam. (PubMed, J Glob Antimicrob Resist) - "In our study, by using WGS analysis on a clinical isolate, we identified a new blaKPC variant inside the Tn4401 transposon. Our results confirm the important role of the continuous surveillance of MDR K. pneumoniae in the clinical context."

Journal • Infectious Disease • Pneumonia • Transplantation

Antimicrobial activity of new anti-Pseudomonas beta-lactam-beta-lactamase inhibitors against Pseudomonas aeruginosa respiratory isolates recovered during the study for Monitoring Antimicrobial Resistance Trends (SMART) program in France (2016-2022). (PubMed, Infect Dis Now) - "C/T is a reliable treatment option in RTI caused by P. aeruginosa."

Journal • Infectious Disease • Respiratory Diseases