Aztreonam plus ceftazidime-avibactam as treatment of NDM-1-producing Klebsiella pneumoniae bacteraemia in a neutropenic patient: Last resort therapy?

• Published in: Journal of global antimicrobial resistance. 2020-12, Vol.23, p.417-419
• Main Authors: Bocanegra-Ibarias, Paola, Camacho-Ortiz, Adrián, Garza-González, Elvira, Flores-Treviño, Samantha, Kim, Hyojin, Perez-Alba, Eduardo
• Format: Article
• Language: English
• Subjects: Aztreonam; Carbapenem-Resistant enterobacteria; Ceftazidime-Avibactam; Colistin; Klebsiella pneumonia; NDM
• ISSN: 2213-7165; 2213-7173
• DOI: 10.1016/j.jgar.2020.10.019

•CZA/ATM has been successfully used to treat NDM-producing Enterobacteriaceae.•Data about treatment with CZA/ATM in neutropenic patients are scarce.•Colistin may not efficaciously treat colistin-susceptible Klebsiella infections. We report the successful treatment of a bloodstream infection caused by Klebsiella pneumoniae harbouring NDM-1 using aztreonam-ceftazidime-avibactam in a neutropenic patient in whom colistin and meropenem therapy had previously failed. A clinical isolate was evaluated to determine the presence of NDM, TEM, SHV, CTX, and CMY, and the killing kinetics of aztreonam (ATM; 4 μg/mL), aztreonam-avibactam (ATM-AVI; 4/4 μg/mL), and colistin (2 and 4 μg/mL) were tested. ATM-AVI showed in vitro activity against the Klebsiella pneumoniae harbouring NDM-1, whereas colistin allowed re-growth. This report supports reconsideration of use of colistin for treatment of infections caused by K. pneumoniae harbouring NDM. CZA/ATM use should be kept in mind as a treatment option, perhaps earlier than colistin.