Karbapenem dirençli Gram-negatif mikroorganizmalarda seftazidim-avibaktam duyarlılıklarının değerlendirilmesi

Year 2023, , 625 - 629, 31.12.2023

Özlem Koca , Gül Aydın Tığlı , Hatice Nevgün Özen , Yeşim Çekin , Derya Seyman

https://doi.org/10.47582/jompac.1372443

Abstract

Amaç: Yoğun bakım ünitelerinde yatan hastalarda karbapenem dirençli Gram negatif mikroorganizmalar giderek artmakta ve morbidite, mortalite ve maliyetin artmasına neden olmaktadır. Bu çalışmada, yoğun bakımdaki hastalardan alınan çeşitli örneklerden izole edilen karbapenem dirençli (CR) Gram-negatif bakterilerin neden olduğu enfeksiyonların tedavisinde hastanemizin yoğun bakım ünitesi (YBÜ) tarafından son yıllarda kullanılmaya başlanan seftazidim-avibaktam (caz-avi)'nin duyarlılığının araştırılması amaçlanmıştır.
Yöntemler: Çalışmada 1 Ocak 2021 ile 30 Ekim 2022 tarihleri arasında laboratuvarımıza gönderilen çeşitli klinik örneklerden izole edilen karbapenem dirençli Klebsiella pneumoniae (CRKP) ve karbapenem dirençli Pseudomonas aeruginosa (CRPA) suşları retrospektif olarak değerlendirilmiştir. Örneklerin kültür ve antibiyogram sonuçları Laboratuvar Bilgi Sistemi (LIS) üzerinden alınarak istatistiksel analizlerle değerlendirilmiştir. Seftazidim-avibaktam duyarlılığı disk difüzyon yöntemi kullanılarak araştırılmıştır.
Bulgular: Hastanemiz yoğun bakım ünitesinden çeşitli klinik örneklerden izole edilen 352 (%69,4) CRKP ve 155 (%30,6) CRPA suşunun seftazidim-avibaktam antibiyotik duyarlılık testi sonuçları analiz edilmiştir. CRKP suşlarının 313'ünün (%88,9) seftazidim-avibaktam'a duyarlı, 39'unun (%11,1) ise dirençli olduğu belirlenmiştir. CRPA suşlarının ise 131'inin (%84,5) duyarlı, 24'ünün (%15,5) dirençli olduğu belirlenmiştir.
Sonuç: Hastanemizden izole edilen karbapenem dirençli suşların caz-avi gibi yeni bir antimikrobiyal kombinasyona karşı bölgesel duyarlılığının belirlenmesi, direnç yayılımının daha iyi anlaşılmasına olanak sağlayacaktır.

Keywords

Antibakteriyel-ajanlar, Avibaktam Seftazidim İlaç Kombinasyonu, Antimikrobiyal İlaç Direnci, Gram-Negatif Bakteriler

Evaluation of ceftazidime-avibactam susceptibility in carbapenem resistant Klebsiella pneumoniae and Pseudomonas aeruginosa isolates

Abstract

Aims: Carbapenem-resistant Gram-negative microorganisms are gradually increasing in hospitalized patients in intensive care units and causes increased morbidity, mortality, and cost. This study aims to investigate the susceptibility of ceftazidime-avibactam (caz-avi), which has recently started to be used for the treatment of infections caused by carbapenem-resistant (CR) Gram-negative bacteria isolated from various samples received from the intensive care unit (ICU) of our hospital.
Methods: Carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) strains isolated from various clinical specimens that were sent to our laboratory between January 1st, 2021, and October 30th, 2022, were retrospectively evaluated in the study. The culture and antibiogram results of the samples were received over the laboratory information system (LIS) and evaluated using statistical analyses. Ceftazidime-avibactam susceptibility was studied using the disc diffusion method.
Results: Ceftazidime-avibactam antibiotic susceptibility test results of 352 (69.4%) CRKP and 155 (30.6%) CRPA strains isolated from various clinical samples from the ICU of our hospital were analyzed. Of the CRKP strains, 313 (88.9%) were found to be susceptible and 39 (11.1%) were found to be resistant to ceftazidime-avibactam. Of the CRPA strains, 131 (84.5%) were found to be susceptible and 24 (15.5%) were found to be resistant.
Conclusion: Determining the regional susceptibility of carbapenem-resistant strains isolated in our hospital to a new antimicrobial combination such as caz-avi will allow a better understanding of the spread of resistance.

Keywords

Ceftazidime-avibactam, antimicrobial resistance, Gram negative bacteria

Ethical Statement

The study was performed with the permission of the Antalya Training and Research Hospital Ethics Committee (Date: 06.01.2022, Decision No: 1/8).

References

• Zasowski EJ, Rybak JM, Rybak MJ. The β-Lactams strike back: ceftazidime-avibactam. Pharmacotherapy. 2015;35(8):755-770.
• Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25(1):2-41.
• Zusman O, Altunin S, Koppel F, Dishon Benattar Y, Gedik H, Paul M. Polymyxin monotherapy or in combination against carbapenem-resistant bacteria: systematic review and meta-analysis. J Antimicrob Chemother. 2017;72(1):29-39.
• Yang X, Wang D, Zhou Q, et al. Antimicrobial susceptibility testing of Enterobacteriaceae: determination of disk content and Kirby-Bauer breakpoint for ceftazidime/avibactam. BMC Microbiol. 2019;19(1):240.
• Doi Y. Treatment options for carbapenem-resistant gram-negative bacterial infections. Clin Infect Dis. 2019;69(Supplement_7):S565-S575.
• Carmeli Y, Armstrong J, Laud PJ, et al. Ceftazidime-avibactam or best available therapy in patients with ceftazidime-resistant Enterobacteriaceae and Pseudomonas aeruginosa complicated urinary tract infections or complicated intra-abdominal infections (REPRISE): a randomised, pathogen-directed. Lancet Infect Dis. 2016;16(6):661-673.
• Bassetti M, Mularoni A, Giacobbe DR, Castaldo N, Vena A. New antibiotics for hospital-acquired pneumonia and ventilator-associated pneumonia. Semin Respir Crit Care Med. 2022;43(2):280-294.
• Choi MH, Kim D, Lee KH, Cho JH, Jeong SH. Changes in the prevalence of pathogens causing hospital acquired bacterial pneumonia and the impact of their antimicrobial resistance patterns on clinical outcomes: a propensity-score-matched study. Int J Antimicrob Agents. 2023;62(3):106886.
• Karlowsky JA, Biedenbach DJ, Kazmierczak KM, Stone GG, Sahm DF. Activity of ceftazidime-avibactam against extended-spectrum- and AmpC β-lactamase-producing Enterobacteriaceae collected in the INFORM global surveillance study from 2012 to 2014. Antimicrob Agents Chemother. 2016;60(5):2849-2857.
• Öztaş S, Er DK, Dündar D. Antimicrobial resistance of various antimicrobial agents in carbapenem-resistant and susceptible isolates of Klebsiella pneumoniae. KOU Sag Bil Derg. 2022;8(3):229-232.
• Arıcı N, Kansak N, Adaleti R, et al. Ventilatör ilişkili pnömoni etkeni karbapenem dirençli Klebsiella pneumoniae ve Pseudomonas aeruginosa izolatlarında seftazidim-avibaktamın in vitro etkinliği. ANKEM Derg. 2023;37(2):57-64.
• Spiliopoulou I, Kazmierczak K, Stone GG. In vitro activity of ceftazidime/avibactam against isolates of carbapenem-non-susceptible Enterobacteriaceae collected during the INFORM global surveillance programme (2015–17). J Antimicrob Chemother. 2020;75(2):384-391.
• Sader HS, Castanheira M, Jones RN, Flamm RK. Antimicrobial activity of ceftazidime–avibactam and comparator agents when tested against bacterial isolates causing infection in cancer patients (2013-2014). Diagn Microbiol Infect Dis. 2017;87(3):261-265.
• Kempf M, Arhin FF, Stone G, Utt E. Ceftazidime-avibactam activity against Gram-negative respiratory isolates collected between 2018 and 2019. J Glob Antimicrob Resist. 2022;31:239-247.
• Ramadan RA, Bedawy AM, Negm EM, et al. Carbapenem-resistant Klebsiella pneumoniae among patients with ventilator-associated pneumonia: evaluation of antibiotic combinations and susceptibility to new antibiotics. Infect Drug Resist. 2022;15:3537-3548.
• Torrens G, van der Schalk TE, Cortes-Lara S, et al. Susceptibility profiles and resistance genomics of Pseudomonas aeruginosa isolates from European ICUs participating in the ASPIRE-ICU trial. J Antimicrob Chemother. 2022;77(7):1862-1872.
• Livermore DM, Meunier D, Hopkins KL, et al. Activity of ceftazidime-avibactam against problem Enterobacteriaceae and Pseudomonas aeruginosa in the UK, 2015-16. J Antimicrob Chemother. 2018; 73(3):648-657.
• Castanheira M, Doyle TB, Hubler C, Sader HS, Mendes RE. Ceftazidime-avibactam activity against a challenge set of carbapenem-resistant Enterobacterales: Ompk36 L3 alterations and β-lactamases with ceftazidime hydrolytic activity lead to elevated MIC values. Int J Antimicrob Agents. 2020;56(1):106011.
• Isler B, Vatansever C, Özer B, et al. Comparison of ceftazidime-avibactam susceptibility testing methods against OXA-48-like carrying Klebsiella blood stream isolates. Diagn Microbiol Infect Dis. 2022;104(1):115745.
• Mirza HC, Hortaç E, Koçak AA, et al. In vitro activity of ceftolozane-tazobactam and ceftazidime-avibactam against clinical isolates of meropenem-non-susceptible Pseudomonas aeruginosa: a two-centre study. J Glob Antimicrob Resist. 2020;20:334-338. doi.org/10.1016/j.jgar.2019.09.016
• Hoşbul T, Aydoğan C, Kaya S, Bedir O, Özcan H, Gümral R. In vitro activity of ceftazidime-avibactam and colistin against carbapenem-resistant Pseudomonas aeruginosa clinical isolates. J Ist Fac Med. 2022;85(3):355-361.
• Shields RK, Nguyen MH, Chen L, et al. Ceftazidime-avibactam is superior to other treatment regimens against carbapenem-resistant Klebsiella pneumoniae bacteremia. Antimicrob Agents Chemother. 2017;61(8):10-1128. doi.org/10.1128/AAC.00883-17
• King M, Heil E, Kuriakose S, et al. Multicenter study of outcomes with ceftazidime-avibactam in patients with carbapenem-resistant Enterobacteriaceae infections. Antimicrob Agents Chemother. 2017;61(7)10-1128. doi.org/10.1128/AAC.00449-17
• Yang X, Wang D, Zhou Q, et al. Antimicrobial susceptibility testing of Enterobacteriaceae: determination of disk content and Kirby-Bauer breakpoint for ceftazidime/avibactam. BMC Microbiol. 2019;19(1):240.
• Çekin ZK, Dabos L, Malkoçoğlu G, et al. Carbapenemase -producing Pseudomonas aeruginosa isolates from Turkey: first report of P. aeruginosa high-risk clones with VIM-5- and IMP-7-type carbapenemases in a tertiary hospital. Diagn Microbiol Infect Dis. 2021;99(1):115174.
• T.C. Resmi Gazete. Sosyal güvenlik kurumu sağlık uygulama tebliğinde değişiklik yapılmasına dair tebliğ. 28.04.2021. Available from: https://www.resmigazete.gov.tr/eskiler/2021/04/20210428M1-1.htm