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Background <p>Multidrug-resistant Gram-negative bacteria (GNB), including carbapenem-resistant Enterobacterales and <i>Pseudomonas aeruginosa</i>, pose a growing global health threat with limited treatment options. Imipenem-relebactam (IMI/REL) is a promising therapy, but emerging resistance patterns remain poorly defined worldwide.</p> Objectives <p>This meta-analysis aimed to provide a comprehensive assessment of global IMI/REL resistance among Enterobacterales and non-fermenting GNB, highlighting species-specific, geographic, and temporal patterns.</p> Methods <p>Studies were searched in Scopus, PubMed, and EMBASE (until October 23 2024), and all statistical analyses were conducted using R (ver. 4.2.1).</p> Results <p>A total of 149,396 Enterobacterales and non-fermenting GNB were included. Overall, IMI/REL resistance was low at 8.8% (95% CI 7.3–10.5), with Enterobacterales showing the lowest resistance (2.9%) and <i>Pseudomonas</i> the highest (30.7%). Resistance was higher in carbapenemase-producing Enterobacterales and non-fermenting species, and varied by infection source and geography. Temporal analysis indicated a rising trend in resistance over recent years, while data were mostly derived from the Americas, limiting global generalizability.</p> Conclusion <p>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.</p>

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Emerging resistance to imipenem-relebactam among enterobacterales and non-fermenting gram-negative bacilli: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月9日

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  • Mengyu Ge,
  • Weidong Qiang,
  • Pengcheng Wang

摘要

Background

Multidrug-resistant Gram-negative bacteria (GNB), including carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa, pose a growing global health threat with limited treatment options. Imipenem-relebactam (IMI/REL) is a promising therapy, but emerging resistance patterns remain poorly defined worldwide.

Objectives

This meta-analysis aimed to provide a comprehensive assessment of global IMI/REL resistance among Enterobacterales and non-fermenting GNB, highlighting species-specific, geographic, and temporal patterns.

Methods

Studies were searched in Scopus, PubMed, and EMBASE (until October 23 2024), and all statistical analyses were conducted using R (ver. 4.2.1).

Results

A total of 149,396 Enterobacterales and non-fermenting GNB were included. Overall, IMI/REL resistance was low at 8.8% (95% CI 7.3–10.5), with Enterobacterales showing the lowest resistance (2.9%) and Pseudomonas the highest (30.7%). Resistance was higher in carbapenemase-producing Enterobacterales and non-fermenting species, and varied by infection source and geography. Temporal analysis indicated a rising trend in resistance over recent years, while data were mostly derived from the Americas, limiting global generalizability.

Conclusion

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.