Adverse Event Signals Associated with Beta-Lactamase Inhibitors: Disproportionality Analysis of USFDA Adverse Event Reporting System.

Background: Beta-lactamase inhibitors (BLIs) are widely used with beta-lactam antibiotics to combat resistant infections, yet their safety profiles, especially for newer agents, remain underexplored. This study aimed to identify potential adverse event (AE) signals associated with BLIs using the USFDA Adverse Event Reporting System (USFDA AERS).

Methods: The USFDA AERS was queried for AE reports involving FDA-approved BLIs from March 2004 to March 2024. After removing duplicates, only reports with BLIs listed as primary suspects were included. Disproportionality analysis was conducted using frequentist and Bayesian approaches, with statistical significance assessed by chi-square testing.

Results: A total of 12,456 unique reports were analyzed. Common AEs across BLIs included hematologic disorders, hypersensitivity reactions, emergent infections, organ dysfunction, and neurological complications. Signal detection revealed specific associations: septic shock and respiratory failure with avibactam; lymphadenopathy and congenital anomalies with clavulanic acid; antimicrobial resistance and epilepsy with relebactam; disseminated intravascular coagulation and cardiac arrest with sulbactam; and agranulocytosis and conduction abnormalities with tazobactam. For vaborbactam, no distinct AE signals were identified apart from off-label use. Mortality was significantly more frequent with avibactam and relebactam (p < 0.0001).

Conclusions: This analysis highlights a spectrum of AE signals with BLIs, including unexpected associations warranting further investigation. While some events may reflect comorbidities or concomitant therapies, these findings underscore the importance of continued pharmacovigilance and targeted clinical studies to clarify causality and ensure the safe use of BLIs in practice.