Newer antibiotics reduce nephrotoxicity and improve eradication of carbapenem-resistant gram-negative bacilli versus generic antibiotics in HABP/VABP

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Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Published June 3, 2026 Medically reviewed June 3, 2026 Study authors: Nguyen Anh T K, Paterson David L, Mo Yin, Ezure Yukiko, Duy Pham Thanh, Thwaites C Louise PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider newer antibiotics for HABP/VABP to reduce nephrotoxicity and improve eradication of carbapenem-resistant gram-negative bacilli.

This systematic review and meta-analysis compared newer antibiotics against generic antibiotics for patients with hospital-acquired bacterial pneumonia or ventilator-associated bacterial pneumonia. The authors searched multiple databases including PubMed, Cochrane CENTRAL, Scopus, Ovid MEDLINE, ClinicalTrials.gov, and Google Scholar to identify relevant studies.

The analysis included 2881 patients. No significant differences were found in 28-day all-cause mortality (RR, 0.97; 95% CI, .72-1.30) or clinical response (1.04; 95% CI, .93-1.17). Microbiological response also showed no significant differences (1.05; 95% CI, .89-1.24).

However, newer antibiotics were associated with significantly lower occurrences of nephrotoxicity (RR, 0.30; 95% CI, .11-.79). Additionally, these regimens achieved significant improvement in microbiological eradication of carbapenem-resistant gram-negative bacilli (RR, 1.50; 95% CI, 1.18-1.90). The follow-up period was 28 days.

The authors note that while mortality and clinical response were comparable, the safety profile and specific efficacy against resistant organisms favor newer antibiotics in this context. Clinicians should weigh these findings when selecting empiric therapy for severe infections.

Study Details

Study typeMeta analysis

Sample sizen = 2,881

EvidenceLevel 1

PublishedJun 2026

PMID42227056

View Original Abstract ↓

BACKGROUND: Hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP), particularly cases caused by multidrug-resistant organisms, often require newer antibiotic treatment. The efficacy and safety of newer antibiotics compared with generic antibiotics in randomized controlled trials (RCTs) have not been evaluated before. METHODS: In this systematic review, we searched RCTs in the United States National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Ovid MEDLINE, ClinicalTrials.gov, and Google Scholar databases published between 2013 and 2025 (registration no. CRD42023476481). The primary efficacy end point was the 28-day all-cause mortality rate, and the secondary efficacy end points were clinical and microbiological response. The safety end point was nephrotoxicity. RESULTS: We identified 8 eligible RCTs involving 2881 patients with HABP/VABP (1450 treated with newer antibiotics and 1431 treated with generic antibiotics). The meta-analysis did not reveal any significant differences between newer and generic antibiotics in the 28-day all-cause mortality rate (risk ratio [RR], 0.97; 95% confidence interval [CI], .72-1.30; I2 = 30%), the clinical response (1.04 [.93-1.17]; I2 = 35%), or the microbiological response (1.05 [.89-1.24]; I2 = 52%). However, newer antibiotics showed significant lower occurrences of nephrotoxicity than regimens with a colistin component (RR, 0.30 [95% CI, .11-.79]; I2 = 0%). In the subgroup analysis, newer antibiotic regimens demonstrated significant improvement in microbiological eradication of carbapenem-resistant gram-negative bacilli (RR, 1.50 [95% CI, 1.18-1.90]; I2 = 0%). CONCLUSIONS: Newer antibiotics and generic drugs showed similar efficacy and safety in treating HABP/VABP. The superiority of newer antibiotics in the microbiological eradication of carbapenem-resistant gram-negative bacilli could suggest that future trials should be targeted to those patients to improve understanding of the therapeutic use of these antibiotics and the pathophysiology of these conditions.