Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa

Abstract Ceftazidime-avibactam is a β-lactam/β-lactamase inhibitor combination restricted for the treatment of multidrug-resistant infections of Pseudomonas aeruginosa non-susceptible to ceftazidime and resistant to carbapenems. Crucially, it has not been studied if its use could allow the design or...

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Main Authors: Sara Hernando-Amado, María A. Gomis-Font, José R. Valverde, Antonio Oliver, José Luis Martínez
Format: Article
Language:English
Published: Nature Portfolio 2025-04-01
Series:Nature Communications
Online Access:https://doi.org/10.1038/s41467-025-58597-6
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author Sara Hernando-Amado
María A. Gomis-Font
José R. Valverde
Antonio Oliver
José Luis Martínez
author_facet Sara Hernando-Amado
María A. Gomis-Font
José R. Valverde
Antonio Oliver
José Luis Martínez
author_sort Sara Hernando-Amado
collection DOAJ
description Abstract Ceftazidime-avibactam is a β-lactam/β-lactamase inhibitor combination restricted for the treatment of multidrug-resistant infections of Pseudomonas aeruginosa non-susceptible to ceftazidime and resistant to carbapenems. Crucially, it has not been studied if its use could allow the design or application of new or stablished evolution-based strategies that exploit the increased susceptibility that emerges when resistance is acquired (collateral sensitivity, CS). Works in the field have focused on the study of CS in model strains, but to be exploited it must robustly emerge in pre-existing resistant mutants that can coexist in a patient. This is the first analysis of CS robustness on this last-resort drug. We evolved 15 clinical isolates on ceftazidime-avibactam and in absence of inhibitor, and here we show that we found no robust -exploitable- pattern of CS. This, together with the selection of cross-resistance and the impossibility of using previously described CS-based strategies, supports that avibactam should be restricted for the treatment of particular genotypes.
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spelling doaj-art-150b1a8a352247d5bb653ae8c54b74f22025-08-20T02:16:06ZengNature PortfolioNature Communications2041-17232025-04-0116111210.1038/s41467-025-58597-6Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosaSara Hernando-Amado0María A. Gomis-Font1José R. Valverde2Antonio Oliver3José Luis Martínez4Centro Nacional de Biotecnología. CSICServicio de Microbiología, Instituto de Investigación Sanitaria Illes Balears, CIBERINFEC., Hospital Universitario Son EspasesCentro Nacional de Biotecnología. CSICServicio de Microbiología, Instituto de Investigación Sanitaria Illes Balears, CIBERINFEC., Hospital Universitario Son EspasesCentro Nacional de Biotecnología. CSICAbstract Ceftazidime-avibactam is a β-lactam/β-lactamase inhibitor combination restricted for the treatment of multidrug-resistant infections of Pseudomonas aeruginosa non-susceptible to ceftazidime and resistant to carbapenems. Crucially, it has not been studied if its use could allow the design or application of new or stablished evolution-based strategies that exploit the increased susceptibility that emerges when resistance is acquired (collateral sensitivity, CS). Works in the field have focused on the study of CS in model strains, but to be exploited it must robustly emerge in pre-existing resistant mutants that can coexist in a patient. This is the first analysis of CS robustness on this last-resort drug. We evolved 15 clinical isolates on ceftazidime-avibactam and in absence of inhibitor, and here we show that we found no robust -exploitable- pattern of CS. This, together with the selection of cross-resistance and the impossibility of using previously described CS-based strategies, supports that avibactam should be restricted for the treatment of particular genotypes.https://doi.org/10.1038/s41467-025-58597-6
spellingShingle Sara Hernando-Amado
María A. Gomis-Font
José R. Valverde
Antonio Oliver
José Luis Martínez
Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa
Nature Communications
title Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa
title_full Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa
title_fullStr Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa
title_full_unstemmed Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa
title_short Ceftazidime-avibactam use selects multidrug-resistance and prevents designing collateral sensitivity-based therapies against Pseudomonas aeruginosa
title_sort ceftazidime avibactam use selects multidrug resistance and prevents designing collateral sensitivity based therapies against pseudomonas aeruginosa
url https://doi.org/10.1038/s41467-025-58597-6
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