Comparison of in Vitro Antimicrobial Efficacy of Ceftolozane-Tazobactam and Ceftazidime-Avibactam Combination Against Carbapenem-Resistant Enterobacteriaceae Species Isolated from Various Clinical Specimens

Abstract

Objective: The increase in resistant Gram-negative bacteria is a major concern and has led to difficulties in the treatment of infections. The aim of this study was to compare the in vitro efficacy of CLZ-TAZ and CAZ-AVB combinations against carbapenem-resistant Enterobacteriaceae strains. Methods: 80 carbapenem-resistant Enterobacteriaceae species isolated from various samples sent to our laboratory were included in the study. Identification and antimicrobial susceptibility of strains were performed using automated systems. The presence of carbapenemases in all isolates was tested using the CarbaNP test and the carbapenem inactivation method. The presence of carbapenemase genes was tested by multiplex PCR. Results: The presence of carbapenemases was detected in 60 % E. coli isolates and in 78.5% K. pneumoniae isolates via phenotypic tests. OXA-48 enzyme was found in 73.7% of isolates containing carbapenemase. The second most common enzyme was NDM.The assessment of the efficacy of the β-lactam/β-lactamase inhibitor combinations against CRE isolates revealed that the activity of CAZ-AVB (77%) was higher than CLZ-TAZ (48%). Conclusion: Our findings suggest that CAZ-AVB and CLZ-TAZ may be promising in the treatment of infections caused by CRE strains. Sensitivity rates were higher with ceftazidime-avibactam than with ceftolozane-tazobactam. The data obtained in this study will contribute to the clinical use of these agents in our country.

Keywords

• Carbapenem-resistant Enterobacteriaceae
• Ceftolozane/tazobactam
• ceftazidime/avibactam
• blaOXA-48
• bla NDM

Çeşitli Klinik Örneklerden İzole Edilen Karbapenem Dirençli Enterobacteriaceae İzolatlarına Karşı Seftolozan-Tazobaktam ve Seftazidim-Avibaktam Kombinasyonlarının In Vitro Antimikrobiyal Etkinliğinin Karşılaştırılması

Abstract

Amaç: Dirençli gram negatif bakterilerdeki artış önemli bir endişe kaynağıdır ve enfeksiyonların tedavisinde zorluklara yol açmıştır. Bu çalışmanın amacı, carbapenem-resistant Enterobacteriaceae suşlarına karşı CLZ-TAZ ve CAZ-AVB kombinasyonlarının in vitro etkinliğini karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya, laboratuvarımıza gönderilen çeşitli örneklerden izole edilen, karbapenemlere dirençli 80 Enterobacteriaceae türü dahil edildi. İzolatların tanımlanması ve antimikrobiyal duyarlılıkları otomatize sistemler kullanılarak gerçekleştirildi. Tüm izolatlarda karbapenemazların varlığı, CarbaNP testi ve karbapenem inaktivasyon yöntemi kullanılarak test edildi. Karbapenemaz genlerinin varlığı multipleks PCR ile test edildi. Bulgular: Fenotipik testler ile karbapenemazların varlığı %60 E. coli izolatında ve %78.5 K. pneumoniae izolatında tespit edildi. Karbapenemaz içeren izolatların %73.7'sinde OXA-48 enzimi bulundu. İkinci en yaygın enzim NDM idi. β-laktam/β-laktamaz inhibitör kombinasyonlarının CRE izolatlarına karşı etkinliğinin değerlendirilmesinde ise, CAZ-AVB'nin (%77) aktivitesinin CLZ-TAZ'dan (%48) daha yüksek olduğu tespit edildi. Sonuç: Bulgularımız, CRE suşlarının neden olduğu enfeksiyonların tedavisinde CAZ-AVB ve CLZ-TAZ'ın umut verici olabileceğini düşündürmektedir. Seftazidim-avibaktam ile duyarlılık oranları, seftolozan-tazobaktamınkinden daha yüksekti. Bu çalışmada elde edilen veriler ülkemizde de bu ajanların klinik kullanımına katkı sağlayacaktır.

Keywords

• Karbapenem dirençli Enterobacteriaceae
• Seftolozan/Tazobaktam
• Seftazidim/Avibaktam
• blaOXA-48
• bla NDM.
• bla NDM

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