Title |
Can Ceftazidime-Avibactam and Aztreonam Overcome β-Lactam Resistance Conferred by Metallo-β-Lactamases in Enterobacteriaceae?
|
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Published in |
Antimicrobial Agents and Chemotherapy, March 2017
|
DOI | 10.1128/aac.02243-16 |
Pubmed ID | |
Authors |
Steven Marshall, Andrea M. Hujer, Laura J. Rojas, Krisztina M. Papp-Wallace, Romney M. Humphries, Brad Spellberg, Kristine M. Hujer, Emma K. Marshall, Susan D. Rudin, Federico Perez, Brigid M. Wilson, Ronald B. Wasserman, Linda Chikowski, David L. Paterson, Alejandro J. Vila, David van Duin, Barry N. Kreiswirth, Henry F. Chambers, Vance G. Fowler, Michael R. Jacobs, Mark E. Pulse, William J. Weiss, Robert A. Bonomo |
Abstract |
Based upon knowledge of the hydrolytic profile of major β-lactamases found in Gram negative bacteria, we tested the effectiveness of the combination of ceftazidime/avibactam (CAZ/AVI) with aztreonam (ATM) against carbapenem-resistant enteric bacteria possessing metallo-β-lactamases (MBLs). Disk-diffusion and agar based antimicrobial susceptibility testing were initially performed to determine the in vitro efficacy of a unique combination of CAZ/AVI and ATM against 21 representative Enterobacteriaceae isolates with a complex molecular background that included blaIMP, blaNDM, blaOXA-48, blaCTX-M, blaAmpC, and combinations thereof. Time-kill assays were conducted, and the in vivo efficacy of this combination was assessed in a murine neutropenic thigh infection model. By disk diffusion assay, all 21 isolates were resistant to CAZ/AVI alone, and 19/21 were resistant to ATM. The in vitro activity of CAZ/AVI in combination with ATM against diverse Enterobacteriaceae possessing MBLs was demonstrated in 17/21 isolates, where the zone of inhibition was ≥ 21 mm. All isolates demonstrated a reduction in CAZ/AVI agar dilution MICs with the addition of ATM. At 2 h, time-kill assays demonstrated a ≥ 4 log10 CFU decrease for all groups that had CAZ/AVI plus ATM (8 μg/ml) added, compared to the CAZ/AVI alone group. In the murine neutropenic thigh infection model, an almost 4 log10 reduction in CFUs was noted at 24 h for CAZ/AVI (32 mg/kg q8h) plus ATM (32 mg/kg q8h) vs. CAZ/AVI (32 mg/kg q8h) alone. The data presented herein, requires us to carefully consider this new therapeutic combination to treat infections caused by MBL-producing Enterobacteriaceae. |
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Country | Count | As % |
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United States | 15 | 48% |
Spain | 3 | 10% |
United Kingdom | 2 | 6% |
Australia | 2 | 6% |
Korea, Democratic People's Republic of | 1 | 3% |
Malaysia | 1 | 3% |
South Africa | 1 | 3% |
Unknown | 6 | 19% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 15 | 48% |
Scientists | 8 | 26% |
Practitioners (doctors, other healthcare professionals) | 6 | 19% |
Science communicators (journalists, bloggers, editors) | 2 | 6% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 194 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 27 | 14% |
Student > Bachelor | 22 | 11% |
Other | 20 | 10% |
Student > Master | 19 | 10% |
Student > Ph. D. Student | 13 | 7% |
Other | 36 | 19% |
Unknown | 57 | 29% |
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---|---|---|
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Immunology and Microbiology | 24 | 12% |
Biochemistry, Genetics and Molecular Biology | 14 | 7% |
Pharmacology, Toxicology and Pharmaceutical Science | 12 | 6% |
Agricultural and Biological Sciences | 8 | 4% |
Other | 18 | 9% |
Unknown | 73 | 38% |