Multi-Drug Resistant Gram-Negative Sepsis in Neonates: The Special Role of Ceftazidime/Avibactam and Ceftolozane/Tazobactam

.Neonatal sepsis is a major cause of morbidity and mortality in neonates. A particular concern is the increasing prevalence of antibiotic-resistant strains among Neonatal Intensive Care Units (NICUs). A significant challenge in the context of neonatal multi-drug resistant infections is the paucity of therapeutic options, as the majority of newer antibiotics targeting these infections are not authorized for use in neonates. Two novel beta-lactam/beta-lactamase inhibitors have recently been approved for use in neonates with multi-drug resistant infections: ceftazidime/avibactam and ceftolozane/tazobactam. These agents demonstrate efficacy against a range of multi-drug resistant gram-negative pathogens, including extended-spectrum beta-lactamases (ESBL)-producing and carbapenem-resistant Enterobacterales, as well as multidrug-resistant Pseudomonas aeruginosa. The objective of this narrative review is to provide a summary of the current knowledge concerning the utilization of ceftazidime/avibactam and ceftolozane/tazobactam in the NICU. According to the existing literature, both agents have been shown to be highly effective with a favorable safety profile in the neonatal population, suggesting that they are suitable options for the treatment of difficult-to-treat gram-negative infections.