In Vitro Activity Comparison of Ceftazidime-Avibactam and Aztreonam-Avibactam Against Bloodstream Infections With Carbapenem-Resistant Organisms in China

• Published in: Frontiers in cellular and infection microbiology 2021-11, Vol.11, p.780365-780365
• Main Authors: Yu, Wei, Xiong, Luying, Luo, Qixia, Chen, Yunbo, Ji, Jinru, Ying, Chaoqun, Liu, Zhiying, Xiao, Yonghong
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; avibactam; Azabicyclo Compounds; Aztreonam - pharmacology; beta-Lactamases - genetics; bloodstream infections; carbapenem-resistant Enterobacterales (CRE); carbapenemase; Carbapenems - pharmacology; Ceftazidime; Cellular and Infection Microbiology; Drug Combinations; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Sepsis
• ISSN: 2235-2988; 2235-2988
• DOI: 10.3389/fcimb.2021.780365

The aim of this work was to investigate the activity of ceftazidime-avibactam (CZA) and aztreonam-avibactam (AZA) against bloodstream infections caused by carbapenem-resistant organisms (CROs). Non-duplicate CROs, including 56 carbapenem-resistant (CR-Eco), 318 carbapenem-resistant (CR-Kpn), and 65 carbapenem-resistant (CR-Pae), were collected using the Blood Bacterial Resistant Investigation Collaborative System (BRICS) program in China. The minimum inhibitory concentrations (MICs) of 24 antibiotics were tested. Carbapenemase genes were amplified for CZA-resistant CROs by PCR. The MICs of CZA and AZA were further determined with avibactam at 8 and 16 mg/L, respectively. The resistance rate of polymyxin B against CROs was less than 5%. Only one CR-Kpn was resistant to tigecycline. The resistance rates of CZA against CR-Eco, CR-Kpn, and CR-Pae were 75.0%, 12.6%, and 18.5%, respectively. The MIC values of AZA against CR-Eco, CR-Kpn, and CR-Pae were 2/4, 1/4, and 64/4 mg/L, respectively. Among the CZA-resistant CROs, 42 (100%) CR-Eco, 24 (60%) CR-Kpn, and 1 (8.3%) CR-Pae isolates harbored metallo-β-lactamase genes. The increase of avibactam concentration enhanced the susceptibility of CZA and AZA against CROs, especially for CR-Eco and CR-Kpn. The activity of AZA was superior to that of CZA against CR-Eco and CR-Kpn, whereas CZA showed better effect against CR-Pae.