Evaluating the susceptibility to ceftazidime-avibactam in clinical isolates of Klebsiella pneumoniae and Pseudomonas aeruginosa recovered from an apex medical hospital in north India
-
Nargis Bali
,
Tufail Ahmed
,
Biswajyoti Borkakoty
,
Roseleen Bali
,
Anjum Ara Mir
,
Zubair Teli
,
Qounser Nisar
,
Tantray Faisal
Abstract
Background and Objectives: We assessed the susceptibility of ceftazidime+avibactam (CZA/AVI) in Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from intensive care units of our hospital.
Materials and Methods: Clinical samples from Jan 2022 to Dec 2023 at SKIMS Soura, were processed for the recovery of K. pneumoniae and P. aeruginosa. Susceptibility testing was done by disc diffusion (DD) method and minimum inhibitory concentration (MIC) for CZA/AVI and meropenem was assessed using E-test strips. Categorical agreement (CA), very major errors (VME), major errors (ME) and minor errors (mE) between DD and MIC were measured. Statistical analyses were performed using SPSS version 22.0.
Results: A total of 111 K. pneumoniae and 81 P. aeruginosa were part of the study. Of these, 56.8% K. pneumoniae and 45.7% P. aeruginosa isolates were susceptible to CZA/AVI. MIC of CZA/AVI for K. pneumoniae ranged from 0.125 to ≥ 256 μg/ml and for P. aeruginosa it ranged from 0.032 to 128 μg/ml. CA was 97.29% between DD and E-Test for CZA/AVI in K. pneumoniae isolates, with a ME of 2.70%. For P. aeruginosa CA between DD and E-Test for CZA/AVI was 98.76% with a VME of 1.23%. MIC values of meropenem were higher than CZA/AVI even in sensitive isolates.
Conclusion: CZA/AVI shows good in-vitro activity against clinical isolates of K. pneumoniae and P. aeruginosa and can be part of empirical therapy for treating infections caused by these bacteria.
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8. Bae IG, Stone GG. In vitro activity of ceftazidime-avibactam and comparators against bacterial isolates collected in South Korea as part of the ATLAS global surveillance program (2016−2018). Diagn Microbiol Infect Dis 2022; 102: 115553.
9. Stone GG, Seifertb H, Nord CE. In vitro activity of ceftazidime-avibactam against Gram-negative isolates collected in 18 European countries, 2015–2017. Int J Antimicrob Agents 2020; 56: 106045.
10. Karlowsky JA, Bouchillona SK, Benaouda A, Soraa N, Zerouali K, Mohamed N, et al. Antimicrobial susceptibility testing of clinical isolates of Gram-negative bacilli collected in Morocco by the ATLAS Global Surveillance Program from 2018 to 2020. J Glob Antimicrob Resist 2022; 30: 23-30.
11. Sader HS, Carvalhaes CG, Kimbrough JH, Mendes RE, Castanheira M. Activity of aztreonam-avibactam against Enterobacterales resistant to recently approved beta-lactamase inhibitor combinations collected in Europe, Latin America, and the Asia-Pacific Region (2020–2022). Int J Antimicrob Agents 2024; 63: 107113.
12. ZhangY, Tao LN, Qu XY, Niu JQ, Ding YH, Zhang SX. Efficacy and safety of ceftazidime-avibactam in the treatment of complicated intra-abdominal infections (CIAIs) and complicated urinary tract infections (CUTIs): A meta-analysis of randomized controlled trials. Rev Assoc Med Bras (1992) 2018; 64: 253-263.
13. Hakeam HA, Alsahli H, Albabtain L, Alassaf S, Al Duhailib Z, Althawadi S. Effectiveness of ceftazidime–avibactam versus colistin in treating carbapenem-resistant Enterobacteriaceae bacteremia. Int J Infect Dis 2021; 109: 1-7.
14. Rodgers P, Kamat S, Adhav C. Ceftazidime-avibactam plus metronidazole vs. meropenem in complicated intra-abdominal infections: Indian subset from RECLAIM. J Infect Dev Ctries 2022; 16: 305-313.
15. Sathe P, Kamat S, Adhav C. Clinical outcomes of ceftazidime-avibactam versus meropenem in Indian patients with nosocomial pneumonia: subset analysis from the REPROVE study. Indian J Med Microbiol 2021; 39: 363-366.
16. Swaminathan S, Routray A, Mane A. Early and Appropriate use of Ceftazidime-Avibactam in the Management of Multidrug- Resistant Gram-Negative Bacterial infections in the Indian Scenario. Cureus 2022; 14(8): e28283.
17. Sreenivasan P, Sharma B, Kaur S, Rana S, Biswal M, Ray P, et al. In-vitro susceptibility testing methods for the combination of ceftazidime-avibactam with aztreonam in metallobeta-lactamase producing organisms: Role of combination drugs in antibiotic resistance era. J Antibiot (Tokyo) 2022; 75: 454-462.
18. Sharma B, Sreenivasan P, Angrup A, Kaur S, Rana S, Kundu J, et al. In-vitro Susceptibility testing methods for Ceftazidime-avibactam against Carbapenem-resistant Enterobacterales: Comparison with Reference broth Microdilution method. Curr Drug Saf 2023; 18: 563-570.
19. Wenzler E, Lee M, Wu TJ, Meyer KA, Shields RK, Nguyen MH, et al. Performance of ceftazidime/avibactam susceptibility testing methods against clinically relevant Gram-negative organisms. J Antimicrob Chemother 2019; 74: 633-638.
2. Karlowsky JA, Kazmierczak KM, Valente MLN, Luengas EL, Baudrit M, Quintana A, et al. In vitro activity of ceftazidime-avibactam against Enterobacterales and Pseudomonas aeruginosa isolates collected in Latin America as part of the ATLAS global surveillance program, 2017-2019. Braz J Infect Dis 2021; 25: 101647.
3. Bae IG, Stone GG. In vitro activity of ceftazidime-avibactam and comparators against bacterial isolates collected in South Korea as part of the ATLAS global surveillance program (2016-2018). Diagn Microbiol Infect Dis 2022; 102: 115553.
4. Isler B, Vatansever C, Ozer B, Cınar G, Aslan AT, Stewart A, et al. Comparison of ceftazidime-avibactam susceptibility testing methods against OXA-48-like carrying Klebsiella blood stream isolates. Diagn Microbiol Infect Dis 2022; 104: 115745.
5. Jean S-S, Lee Y-L, Hsu C-W, Hsueh P-R. In vitro susceptibilities of isolates of potentially naturally inducible chromosomal AmpC-producing metallo-β-lactamase-negative carbapenem-resistant Enterobacterales species to ceftazidime-avibactam: Data from the Antimicrobial Testing Leadership and Surveillance Programme, 2012-2019. Int J Antimicrob Agents 2022; 60: 106617.
6. WinnW, Allen S, Janda W, Koneman E, Procop G, Schreckenberger P, et al (2006). Koneman’s color Atlas and Textbook of Diagnostic Microbiology. 6th Edition, Lippincott Williams and Wilkins, New York.
7. CLSI (2022). Performance Standards for Antimicrobial Susceptibility Testing. 32nd ed. CLSI supplement M100. Clinical and Laboratory Standards Institute.
8. Bae IG, Stone GG. In vitro activity of ceftazidime-avibactam and comparators against bacterial isolates collected in South Korea as part of the ATLAS global surveillance program (2016−2018). Diagn Microbiol Infect Dis 2022; 102: 115553.
9. Stone GG, Seifertb H, Nord CE. In vitro activity of ceftazidime-avibactam against Gram-negative isolates collected in 18 European countries, 2015–2017. Int J Antimicrob Agents 2020; 56: 106045.
10. Karlowsky JA, Bouchillona SK, Benaouda A, Soraa N, Zerouali K, Mohamed N, et al. Antimicrobial susceptibility testing of clinical isolates of Gram-negative bacilli collected in Morocco by the ATLAS Global Surveillance Program from 2018 to 2020. J Glob Antimicrob Resist 2022; 30: 23-30.
11. Sader HS, Carvalhaes CG, Kimbrough JH, Mendes RE, Castanheira M. Activity of aztreonam-avibactam against Enterobacterales resistant to recently approved beta-lactamase inhibitor combinations collected in Europe, Latin America, and the Asia-Pacific Region (2020–2022). Int J Antimicrob Agents 2024; 63: 107113.
12. ZhangY, Tao LN, Qu XY, Niu JQ, Ding YH, Zhang SX. Efficacy and safety of ceftazidime-avibactam in the treatment of complicated intra-abdominal infections (CIAIs) and complicated urinary tract infections (CUTIs): A meta-analysis of randomized controlled trials. Rev Assoc Med Bras (1992) 2018; 64: 253-263.
13. Hakeam HA, Alsahli H, Albabtain L, Alassaf S, Al Duhailib Z, Althawadi S. Effectiveness of ceftazidime–avibactam versus colistin in treating carbapenem-resistant Enterobacteriaceae bacteremia. Int J Infect Dis 2021; 109: 1-7.
14. Rodgers P, Kamat S, Adhav C. Ceftazidime-avibactam plus metronidazole vs. meropenem in complicated intra-abdominal infections: Indian subset from RECLAIM. J Infect Dev Ctries 2022; 16: 305-313.
15. Sathe P, Kamat S, Adhav C. Clinical outcomes of ceftazidime-avibactam versus meropenem in Indian patients with nosocomial pneumonia: subset analysis from the REPROVE study. Indian J Med Microbiol 2021; 39: 363-366.
16. Swaminathan S, Routray A, Mane A. Early and Appropriate use of Ceftazidime-Avibactam in the Management of Multidrug- Resistant Gram-Negative Bacterial infections in the Indian Scenario. Cureus 2022; 14(8): e28283.
17. Sreenivasan P, Sharma B, Kaur S, Rana S, Biswal M, Ray P, et al. In-vitro susceptibility testing methods for the combination of ceftazidime-avibactam with aztreonam in metallobeta-lactamase producing organisms: Role of combination drugs in antibiotic resistance era. J Antibiot (Tokyo) 2022; 75: 454-462.
18. Sharma B, Sreenivasan P, Angrup A, Kaur S, Rana S, Kundu J, et al. In-vitro Susceptibility testing methods for Ceftazidime-avibactam against Carbapenem-resistant Enterobacterales: Comparison with Reference broth Microdilution method. Curr Drug Saf 2023; 18: 563-570.
19. Wenzler E, Lee M, Wu TJ, Meyer KA, Shields RK, Nguyen MH, et al. Performance of ceftazidime/avibactam susceptibility testing methods against clinically relevant Gram-negative organisms. J Antimicrob Chemother 2019; 74: 633-638.
| Files | ||
| Issue | Vol 17 No 2 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v17i2.18385 | |
| Keywords | ||
| Antimicrobial drug resistance; Carbapenem antibiotics; Disc diffusion method; Intensive care unit | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Bali N, Ahmed T, Borkakoty B, Bali R, Mir A, Teli Z, Nisar Q, Faisal T. Evaluating the susceptibility to ceftazidime-avibactam in clinical isolates of Klebsiella pneumoniae and Pseudomonas aeruginosa recovered from an apex medical hospital in north India. Iran J Microbiol. 2025;17(2):253-260.
