A systematic review of data on the resistance of uropathogens to sulopenem.

INTRODUCTION: Sulopenem is a recently approved penem (in its oral formulation) by the Food and Drug Administration (FDA) for adult women with uncomplicated urinary tract infections that have limited or no other available therapeutic options. In this systematic review, we evaluated sulopenem resistance in Gram-negative and Gram-positive pathogens using the most recent published data. METHODS: Six resources, including Embase, Google Scholar, PubMed Central (PMC), PubMed, Scopus, and Web of Science, were used to identify relevant articles. The minimum inhibitory concentration (MIC) range, MIC50, MIC90, and resistance proportions were evaluated. RESULTS: After screening 477 articles, 11 studies were selected, comprising 9,768 isolates. Sulopenem demonstrated favorable activity against Enterobacterales and Proteus mirabilis, as well as good activity against methicillin-susceptible Staphylococcus aureus and Klebsiella species. Limited activity was observed against Enterococcus species, and no activity against methicillin-resistant S. aureus and Pseudomonas aeruginosa. Regarding Escherichia coli, the maximum MIC was < 0.25 mg/L in 5 of 9 (56%) studies with available data. For Klebsiella pneumoniae and Proteus mirabilis, the maximum MIC was < 0.5 mg/L in 5 of 8 (63%) studies with available data. DISCUSSION: Sulopenem showed activity against various pathogens, including both Gram-negative and Gram-positive bacteria. However, these observations were primarily based on MIC data for sulopenem against these pathogens. Further studies assessing the potential emergence of resistance to sulopenem using the recently published FDA susceptibility breakpoints would provide important epidemiological data of clinical relevance.