The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020
Background Ceftazidime/avibactam, launched in the United Kingdom (UK) in March 2017, is an antibiotic against multidrug-resistant Gram-negative pathogens. It was selected for the government’s subscription model pilot, for incentivising new antibiotic development, which began in December 2020. Aim Ah...
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European Centre for Disease Prevention and Control
2025-04-01
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| Series: | Eurosurveillance |
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| Online Access: | https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.14.2400399 |
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| author | Berit Muller-Pebody |
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| description | Background Ceftazidime/avibactam, launched in the United Kingdom (UK) in March 2017, is an antibiotic against multidrug-resistant Gram-negative pathogens. It was selected for the government’s subscription model pilot, for incentivising new antibiotic development, which began in December 2020. Aim Ahead of the pilot, we assessed ceftazidime/avibactam testing, resistance (2016−2020) and usage (2017−2020) levels in England, as baselines for future surveillance. Methods From routine surveillance samples, we retrieved reported ceftazidime/avibactam resistance categorisation. From reference laboratory samples, we reviewed minimum inhibitory concentration (MICs) and molecular data. Among surveillance samples, per cent resistance was estimated. Referred samples’ MICs, by carbapenemase gene presence, were investigated. Ceftazidime/avibactam hospital use was measured in defined daily doses (DDDs). Results Overall, 6.3% (4,200/66,914; 95% confidence interval (95%CI): 6.1–6.4%) of surveillance-reported ceftazidime/avibactam-tested Gram-negative bacteria were resistant. Percentage resistance per bacterial species varied over time, somewhat stabilising as testing was established, with between April 2019 and March 2020, 1.3% Escherichia coli (288/22,736; 95%CI: 1.1−1.4%), 12.6% Pseudomonas aeruginosa (690/5,495; 95%CI: 11.7−13.5%) and 6.1% of Klebsiella pneumoniae (314/5,179; 95%CI: 5.4−6.7%) being resistant. For 8,437 referred Enterobacterales, MIC determination found 11.5% (968/8,437; 95%CI: 10.8–12.2%) resistant. Among resistant isolates, 89.3% (864/968; 95%CI: 87.1–91.1%) had metallo-β-lactamase (MBL) genes. Of 908 MBL-negative isolates, producing ≥ 1 non-metallo-carbapenemase(s), 2.1% (19/908; 95%CI: 1.3–3.2%) were resistant. Since March 2017, 69.5% (105/151) of English National Health Service Trusts used ceftazidime/avibactam. Monthly usage progressed from 21 to 744 DDDs in March 2020. Conclusion For appropriate treatment, carbapenemase gene detection and variant identification in ceftazidime/avibactam surveillance matters. Detecting emerging resistant pathogens and preventing spread within healthcare settings requires vigilance. |
| format | Article |
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| issn | 1560-7917 |
| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-a4e82a3506a343999f45f109bc8187962025-08-20T02:16:34ZengEuropean Centre for Disease Prevention and ControlEurosurveillance1560-79172025-04-01301410.2807/1560-7917.ES.2025.30.14.2400399http://instance.metastore.ingenta.com/content/eurosurveillance/30/14The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020Berit Muller-Pebody0https://orcid.org/0000-0002-8874-480XAMR & HCAI Division, UK Health Security Agency, London, United KingdomBackground Ceftazidime/avibactam, launched in the United Kingdom (UK) in March 2017, is an antibiotic against multidrug-resistant Gram-negative pathogens. It was selected for the government’s subscription model pilot, for incentivising new antibiotic development, which began in December 2020. Aim Ahead of the pilot, we assessed ceftazidime/avibactam testing, resistance (2016−2020) and usage (2017−2020) levels in England, as baselines for future surveillance. Methods From routine surveillance samples, we retrieved reported ceftazidime/avibactam resistance categorisation. From reference laboratory samples, we reviewed minimum inhibitory concentration (MICs) and molecular data. Among surveillance samples, per cent resistance was estimated. Referred samples’ MICs, by carbapenemase gene presence, were investigated. Ceftazidime/avibactam hospital use was measured in defined daily doses (DDDs). Results Overall, 6.3% (4,200/66,914; 95% confidence interval (95%CI): 6.1–6.4%) of surveillance-reported ceftazidime/avibactam-tested Gram-negative bacteria were resistant. Percentage resistance per bacterial species varied over time, somewhat stabilising as testing was established, with between April 2019 and March 2020, 1.3% Escherichia coli (288/22,736; 95%CI: 1.1−1.4%), 12.6% Pseudomonas aeruginosa (690/5,495; 95%CI: 11.7−13.5%) and 6.1% of Klebsiella pneumoniae (314/5,179; 95%CI: 5.4−6.7%) being resistant. For 8,437 referred Enterobacterales, MIC determination found 11.5% (968/8,437; 95%CI: 10.8–12.2%) resistant. Among resistant isolates, 89.3% (864/968; 95%CI: 87.1–91.1%) had metallo-β-lactamase (MBL) genes. Of 908 MBL-negative isolates, producing ≥ 1 non-metallo-carbapenemase(s), 2.1% (19/908; 95%CI: 1.3–3.2%) were resistant. Since March 2017, 69.5% (105/151) of English National Health Service Trusts used ceftazidime/avibactam. Monthly usage progressed from 21 to 744 DDDs in March 2020. Conclusion For appropriate treatment, carbapenemase gene detection and variant identification in ceftazidime/avibactam surveillance matters. Detecting emerging resistant pathogens and preventing spread within healthcare settings requires vigilance.https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.14.2400399ceftazidime/avibactamEnterobacteralesAMRcarbapenemaseAMUAMS |
| spellingShingle | Berit Muller-Pebody The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020 Eurosurveillance ceftazidime/avibactam Enterobacterales AMR carbapenemase AMU AMS |
| title | The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020 |
| title_full | The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020 |
| title_fullStr | The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020 |
| title_full_unstemmed | The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020 |
| title_short | The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020 |
| title_sort | importance of monitoring a new antibiotic ceftazidime avibactam usage and resistance experience from england 2016 to 2020 |
| topic | ceftazidime/avibactam Enterobacterales AMR carbapenemase AMU AMS |
| url | https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.14.2400399 |
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