Figure 4.

Activity of recently licensed (USA and EU/UK) agents against problem groups of Gram-negative bacteria. Green, widely active (>90%); orange, variably active (50%–90%); red, rarely (<50%) or never active. ^aTrial evidence of efficacy.^128bIn-use evidence of clinical activity against P. aeruginosa likely, based on phenotypes, to have these mechanisms.^129cTrial evidence of efficacy.^130dIn-use evidence of efficacy and of better outcomes than colistin combinations.^131,132eTrial evidence of better outcomes than colistin combinations.^133fTrial evidence of activity against imipenem-resistant P. aeruginosa, likely to have owed their phenotypes to combination of loss of porin OprD and expression of AmpC.^134gLicensing application withdrawn in EU. ^hMany isolates with NDM carbapenemases co-produce ArmA or RmtB 16S rRNA methyltransferases, conferring broad aminoglycoside resistance including plazomicin.¹³⁵ⁱGood in vitro activity against carbapenemase-producing Enterobacterales, but trial failures in cUTI.^136jTrial evidence of activity.^137kMICs raised for isolates with NDM carbapenemase compared with those for isolates with other carbapenemases; the proportion of these that count as resistant will depend on the breakpoints used.^138lIn vitro activity, but excess mortality in CREDIBLE-CR study compared with colistin combinations, associated with Acinetobacter baumannii, suggesting the need for caution.¹³⁹