Resistance of Uropathogens to Tebipenem: An Analysis of the Evidence from In Vitro Antimicrobial Susceptibility Studies

Tebipenem is a new carbapenem antibiotic that binds to penicillin-binding proteins (PBPs). Given the need for effective antibiotics against multidrug-resistant (MDR) bacteria, this review evaluated the in vitro antimicrobial activity of tebipenem against Gram-negative and Gram-positive bacteria, focusing on uropathogens. Five resources (Google Scholar, Web of Science, Embase, Scopus, and PubMed) were used to identify relevant articles. Of the 1322 articles identified, 9 relevant studies were included, which evaluated 12,501 Gram-negative and 122 Gram-positive pathogens. All nine studies (100%) assessed the activity of tebipenem against <i>Escherichia coli</i>, with an MIC₉₀ value range of 0.015->4 mg/L. Seven studies (77.8%) included <i>Klebsiella pneumoniae</i>, with an MIC₉₀ value range of 0.015-0.5 mg/L. Six studies (66.7%) reported data on <i>Proteus mirabilis</i>, with an MIC₉₀ value range of ≤0.125-0.5 mg/L. Two studies (22.2%) evaluated the activity of tebipenem against <i>Enterococcus faecalis</i>, with MIC₉₀ of 1 mg/L among vancomycin-susceptible isolates and 32 mg/L in isolates with not-reported mechanisms of resistance. Two studies (22.2%) evaluated the activity of tebipenem against <i>Enterococcus faecium</i>, with MIC₉₀ of >4 mg/L among both vancomycin-susceptible and vancomycin-resistant isolates and MIC₉₀ of 128 mg/L among isolates with no resistance mechanism reported. Tebipenem demonstrated good activity against Enterobacterales, such as <i>E. coli</i> and <i>K. pneumoniae</i>. The antimicrobial agent exhibited higher MICs and a higher proportion of resistance among <i>P. mirabilis</i> isolates. Tebipenem could be effective for outpatient treatment of infections caused by MDR Gram-negative pathogens. However, given its potential to exert selective pressure for the development of antimicrobial resistance, it should be considered for patients with cUTIs when none of the first-line treatment options demonstrate in vitro antimicrobial activity.