Temocillin a good alternative to carbapenems in treatment of bacteraemia due to 3GCR-E

The use of temocillin demonstrates comparable efficacy and safety to carbapenems for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistant Enterobacterales (3GCR-E), primarily from urinary sources, reports a study.

“Temocillin is noninferior to carbapenems for the targeted therapy of bacteraemia due to 3GCR-E,” said lead author Dr Francesco Cogliati Dezza, Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena in Seville, Spain, who presented the study at ESCMID Global 2025.

“Nowadays, 3GCR-E is defined as ‘critical bacteria’ from the recently updated World Health Organization priority list,” he noted. The global spread of this bacteria “has impacted the overuse of antibiotics, leading to an important increase in carbapenems consumption.”

Such event gave rise to the need for alternative drugs, such as temocillin, which is a semi-synthetic β-lactam parenteral antibiotic.

“In this scenario, there is an increasing interest in old agents that should be re-evaluated from a new perspective of a carbapenem-sparing strategy,” Dezza said.

“[The] relatively narrow spectrum of temocillin has previously been seen as a disadvantage. This same property offers an advantage as a carbapenem-sparing option,” he added.

Dezza and his colleagues conducted ASTARTÉ, a multicentre, open-label, randomized, controlled, clinical trial, in 29 hospitals in Spain between 2020 and 2024. They randomly allocated 334 adult patients with bacteraemia due to 3GCR-E to receive either temocillin (2 g TID;) or carbapenem (meropenem 1 g TID or ertapenem 1 g QD).

Clinical success, the primary endpoint, was characterized by the following: (a) clinical cure at test-of-cure (7‒10 days after end of treatment); (b) no need to stop or change study drug due to adverse event (AE) or failure; (c) no recurrence of bacteraemia until day 28; and (d) alive at day 28.

Primary analysis was carried out in the modified intention-to-treat (mITT) population, consisting of participants who received at least a single dose of the study drug. The researchers recorded the AE incidence and calculated the absolute difference with one-sided 97.5 percent confidence interval (CI).

Clinical success

Of the 334 patients, 167 were assigned to the temocillin group and 167 to the control (carbapenem) group. Among those who were assigned to carbapenems, 102 received meropenem and 65 ertapenem. The mITT population included 165 patients in each group. Baseline characteristics did not significantly differ between the two treatment arms. [ESCMID 2025, abstract L0016]

Based on microbiological data, the most prevalent type of bacteria was Escherechia coli (69 percent). This was followed by Klebsiella pneumoniae (23 percent), Klebsiella spp (4 percent), Citrobacter freudii (<1 percent), Enterobacter spp (3 percent), Morganella morganii (<1 percent), Proteus mirabilis (1 percent), and others (<1 percent).

Overall, 118 patients (71.5 percent) in the temocillin group and 118 (71.5 percent) in the control group achieved clinical success (difference, 0 percent, 97.5 percent CI, ‒9.7 to ∞; p=0.5). Mortality within 28 days occurred in five (3.0 percent) and six (3.6 percent) patients, respectively (difference, ‒0.6 percent, 97.5 percent CI, ‒∞ to 4.5).

There were slightly more patients (n=35) treated with temocillin who experienced at least one severe AE than those (n=29) treated with carbapenems (21.2 percent vs 17.6 percent), but these AEs were deemed not related to the study drugs.

“These results support temocillin as a primary alternative to carbapenems in these infections, potentially allowing a reduction in carbapenems consumption,” Dezza said.