In Vitro Activities of Ceftazidime-Avibactam and Comparator Agents Against Carbapenem-resistant Enterobacterales (CRE) Collected in Africa/Middle East ATLAS Global Surveillance Program 2018-2022
Introduction: Avibactam (AVI) is a non-β-lactam β-lactamase inhibitor that when combined with the β-lactam ceftazidime (CAZ) has demonstrated activity against Class A, Class C and some Class D enzymes. This study evaluated the in vitro activity of ceftazidime-avibactam against carbapenem-resistant E...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224007069 |
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| Summary: | Introduction: Avibactam (AVI) is a non-β-lactam β-lactamase inhibitor that when combined with the β-lactam ceftazidime (CAZ) has demonstrated activity against Class A, Class C and some Class D enzymes. This study evaluated the in vitro activity of ceftazidime-avibactam against carbapenem-resistant Enterobacterales (CRE) isolates collected in Africa/Middle East as part of the global Antimicrobial Testing Leadership and Surveillance (ATLAS) program in 2018-2022. Methods: 9,828 non-duplicate Enterobacterales isolates were collected from 23 medical centers in 10 countries in the Africa/Middle East region in 2018-2022. A total of 695 isolates were CRE. Isolates were collected in (total n by country/% of total/n CRE): Cameroon (398/1.1/7), Côte d Ivoire (254/0.6/4), Israel (1819/4.2/26), Jordan (314/7.5/47), Kuwait (1435/17.5/109), Morocco (1292/17.5/109), Nigeria (1754/28.5/178), Qatar (365/5.8/36), Saudi Arabia (344/4.3/27), and South Africa (1853/24.4/152). Antimicrobial susceptibility to ceftazidime-avibactam and comparator agents(amikacin, ceftazidime, colistin, levofloxacin, and meropenem) was tested by broth microdilution using CLSI guidelines and interpreted with CLSI 2023 breakpoints. Isolates nonsusceptible to meropenem were screened for metallo-β-lactamase (MBL) genes by PCR and sequencing. Results: Ceftazidime-avibactam was active against more Enterobacterales isolates than all comparators tested (95.1% susceptible; MIC₉₀ = 1 mg/L). Meropenem and amikacin were also both active against this population, with 92.9% and 85.8% of the isolates inhibited, respectively. Against MBL-negative CRE (n=247), ceftazidime-avibactam was the most active among the drugs tested, with 90.3% susceptible (MIC₉₀ = 8). Ceftazidime-avibactam inhibited more of these isolates than amikacin (57.5% S; MIC₉₀ ≥64). Among the individual countries, ceftazidime-avibactam showed especially potent activity against MBL-negative CRE isolates from Israel, Qatar, Saudi Arabia, and South Africa with ≥ 95.7% of the isolates from these countries testing as susceptible. The isolate collection from Nigeria was the most challenging, with ceftazidime-avibactam inhibiting 7/14 (50%) MBL-negative CRE isolates. Conclusion: Ceftazidime-avibactam exhibited potent in vitro activity against MBL-negative CRE from the Africa/Middle East region. These data suggest ceftazidime-avibactam remains an effective therapeutic option for the treatment of Enterobacterales infections. |
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| ISSN: | 1201-9712 |