Ceftazidime-avibactam
Ceftazidime-avibactam (CZA) is a novel antibiotic with activity against serine-lactamase. Chen et al. investigated the sensitivity of carbapenem-resistant Klebsiella pneumoniae (CRKP) to CZA and the mechanisms of drug resistance in Fujian Provincial Hospital, Fuzhou, China.
Patient characteristics were obtained from medical records. Klebsiella pneumoniae and its antibiotic susceptibility were determined using the Vitek-2 Compact instrument. The antimicrobial resistance genes KPC, NDM, OXA-48, VIM, IMP, CIM, SPM, TMB, SMB, SIM, AIM, and DIM were detected using Real-Time PCR. Multilocus sequence typing was used for genetic RELATEDNESS analysis. In total, 121 CRKP strains were isolated from patients in the intensive care unit (51.2%), senior ward (12.4%), and neurosurgery department (10%). With an average age of 72.5 years, most patients were in care for respiratory (34.7%), brain (20.7%), digestive tract (13.2%), and cardiovascular (8.3%) diseases. Specimens were predominantly obtained from sputum (39.67%), urine (29.75%) and blood (6.61%).
Of 23 CZA-resistant CRKP strains (19.01%), ST11 being the most common at 56.52%, eleven NDM-1-positive (47.83%) and four NDM-5-positive (17.39%) strains were detected.
The study indicates that CZA resistance occurs in ~19.01% CRKP strains and that blaNDM-1 and blaNDM-5 might be critical for resistance 1).
3 patients diagnosed with MDR/XDR Gram-negative bacillus-associated CNS infections and effectively treated with CAZ/AVI. Moreover, we performed literature reviews. Before the onset of CNS infections, the 3 patients were subjected to neurosurgical operations, treated with mechanical ventilation, long-term intensive care unit therapy, and various antibiotics. By intravenously administering CAZ/AVI, combined with another antibiotic, the MDR/XDR K. pneumoniae and P. aeruginosa associated ventriculitis was effectively treated in the 3 patients.
CAZ/AVI is a viable treatment option for CNS infections caused by MDR/XDR Gram-negative bacteria 2).
A man with ventriculitis caused by P. aeruginosa and carbapenem-resistant K. pneumoniae was successfully treated with i.v. ceftazidime-avibactam and intrathecal amikacin 3)
Pektezel MY, Isikay I, Gocmen R, Inkaya AC. Carbapenem-resistant Klebsiella pneumoniae meningitis and abscess treated with ceftazidime-avibactam. Enferm Infecc Microbiol Clin (Engl Ed). 2021 Apr 12:S0213-005X(21)00083-5. English, Spanish. doi: 10.1016/j.eimc.2021.03.014. Epub ahead of print. PMID: 33858707.
Holyk A, Belden V, Lee JJ, Musick W, Keul R, Britz GW, Lin J. Ceftazidime/avibactam use for carbapenem-resistant Klebsiella pneumoniae meningitis: a case report. J Antimicrob Chemother. 2018 Jan 1;73(1):254-256. doi: 10.1093/jac/dkx358. PMID: 29040635.