Ceftazidime-avibactam resistance determination in carbapenem-resistant Klebsiella pneumoniae infections before its use in practice

• Published in: Journal of infection in developing countries Vol. 18; no. 7; pp. 1020 - 1025
• Main Authors: Eren-Kutsoylu, Oya Özlem, Ceylan-Çimendağ, Hacer, Sari-Kaygisiz, Ayşe Nur, Tanriverdi, Elif Seren, Özbek, Özgen Alpay, Öktem, Ibrahim Mehmet Ali, Otlu, Barış, Avkan-Oğuz, Vildan
• Format: Journal Article
• Language: English
• Published: Italy 29.07.2024
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Azabicyclo Compounds - pharmacology; Azabicyclo Compounds - therapeutic use; beta-Lactamases - genetics; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - genetics; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Carbapenems - pharmacology; Ceftazidime - pharmacology; Ceftazidime - therapeutic use; Drug Combinations; Drug Resistance, Multiple, Bacterial - genetics; Female; Humans; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - isolation & purification; Male; Microbial Sensitivity Tests; Middle Aged; AP-PCR; carbapenem resistance; Ceftazidime-avibactam; NDM; Klebsiella pneumoniae
• ISSN: 1972-2680; 1972-2680
• DOI: 10.3855/jidc.18371

To ensure the appropriate usage of ceftazidime-avibactam (CAZ-AVI), recently introduced in our hospital, we aimed to determine susceptibility rates, enzyme analysis, and clonal relationship among strains, together with clinical data. Between June 1 and September 30, 2021, demographic and microbiological data of the patients were recorded. In the obtained samples, meropenem and colistin minimal inhibitory concentration (MIC) levels, carbapenem resistance genes, and the clonal relationship were studied by molecular methods. CAZ-AVI was not used in any of the patients. 140 carbapenem-resistant Klebsiella pneumoniae were isolated from 57 patients. Resistance to CAZ-AVI was found in 76 (54.3%) strains. Out of 57 patients, 31 (54.4%) isolates could be reached. Meropenem MIC level was ≥ 32 µg/mL in 26 (83.9%), and colistin MIC level was ≥ 4 µg/mL in 17 (54.8%) isolates. Enzyme analysis revealed NDM in 20 (64.5%), OXA-48 in 17 (54.8%), and KPC in seven (22.6%). NDM + OXA-48 was determined in 10 (32.2%) strains. NDM was determined in all CAZ-AVI resistant strains, OXA-48 in 16.1% (2/5) strains. Seven genotypes were detected. The largest cluster was genotype 3 clusters (11 isolates). Of 31 patients, 22 (71.0%) died. CAZ-AVI was susceptible in one of the patients who survived and four who died. Before using a new antibiotic, each center should determine the basal data and phenotypic/genotypic resistance ratios specific to that antibiotic. While a high NDM rate and low CAZ-AVI sensitivity limit the use of the drug in our center, it is clear that CAZ-AVI use in sensitive strains will decrease mortality.