Determination of Ceftazidime/Avibactam Susceptibilities of Carbapenem-Resistant Pseudomonas and Klebsiella Strains Isolated From Intensive Care Unit

Abstract

Objective: Increasing antibiotic resistance makes treatment of Gram-negative pathogens such as Pseudomonas aeruginosa and Klebsiella spp. difficult and increases mortality and morbidity. Therefore, new antibiotics that can be effective against resistant strains are being developed. The efficacy of ceftazidime/avibactam has been proven in Gram negative bacteria producing serine carbapenemase. In this study, we aimed to evaluate ceftazidime/avibactam, aminoglycoside, fluoroquinolone susceptibility in carbapenem-resistant Pseudomonas aeruginosa and Klebsiella spp. isolated from intensive care unit patients. Material and Methods: Between September 2022 and June 2023, 43 carbapenem resistant Klebsiella spp. and Pseudomonas spp. strains isolated from patients hospitalized in the intensive care unit were included in the study. Ceftazidime/avibactam susceptibilities were determined by disk diffusion test. The results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing criteria. The statistical package for the Social Sciences version 24.0 (IBM SPSS Inc, Chicago) was used for statistical analysis. Results: Ceftazidime/avibactam susceptibility was detected in all 33 carbapenem-resistant Klebsiella spp. and 10 Pseudomonas spp. strains. Aminoglycoside resistance in Klebsiella spp. and Pseudomonas spp. was 42.4% and 50%, respectively, and fluoroquinolone resistance was 6% and 40%, respectively. Conclusion: Ceftazidime/avibactam, which is recommended for the treatment of complicated urinary tract infections, complicated intra-abdominal infections, healthcare-associated pneumonia and ventilator-associated pneumonia, is recommended to be the primary treatment option for carbapenemase-producing strains (except metallobetalactamases) due to the susceptibility pattern found in our study.

Keywords

• Ceftazidime/avibactam
• carbapenemase
• antibiotic resistance

YOĞUN BAKIM ÜNİTESİNDEN İZOLE EDİLEN KARBAPENEM DİRENÇLİ PSEUDOMONAS VE KLEBSİELLA SUŞLARININ SEFTAZİDİM/AVİBAKTAM DUYARLILIKLARININ SAPTANMASI

Abstract

Amaç: Giderek artan antibiyotik direnci ile, Pseudomonas aeruginosa ve Klebsiella spp. gibi gram negatif patojenlerin tedavisi zorlaşmakta, mortalite ve morbidite artmaktadır. Bu nedenle dirençli suşlara etkili olabilecek yeni antibiyotikler geliştirilmektedir. Seftazidim/avibaktamın serin karbapenemaz üreten Gram negatif bakterilerde etkinliği kanıtlanmıştır. Bu çalışmada yoğun bakımdaki hastalardan izole edilen karbapenem dirençli Pseudomonas aeruginosa ve Klebsiella spp. suşlarında seftazidim/avibaktam, aminoglikozid (amikasin) ve florokinolon (siprofloksasin) duyarlılığının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Eylül 2022-Haziran 2023 tarihleri arasında yoğun bakım ünitesinde yatan hastalardan izole edilen Klebsiella spp. ve Pseudomonas spp. suşlarından karbapenem dirençli olan 43 izolat çalışmaya dahil edildi. Disk diffüzyon testi ile seftazidim/avibaktam duyarlılıklarına bakıldı. European Committee on Antimicrobial Susceptibility Testing kriterlerine göre yorumlandı. İstatistiksel analiz için the statistical package for the Social Sciences version 24.0 (IBM SPSS Inc, Chicago) kullanıldı. Bulgular: Karbapenem dirençli 33 Klebsiella spp. ve 10 Pseudomonas spp. suşunun tümünde seftazidim/avibaktam duyarlılığı saptandı. Klebsiella spp. ve Pseudomonas spp. suşlarında aminoglikozit (amikasin) direnci sırasıyla %42.4 ve %50, florokinolon (siprofloksasin) direnci ise sırasıyla %6 ve %40 olarak belirlendi. Sonuç: Komplike üriner sistem enfeksiyonu, komplike intraabdominal enfeksiyonlar, sağlık bakımı ilişkili pnömoni ve ventilatör ilişkili pnömonilerin tedavisinde kullanımı önerilen seftazidim/avibaktamın çalışmamızda saptanan duyarlılık paterni nedeniyle karbapenemaz üreten suşlarda (metallobetalaktamazlar hariç) birincil tedavi seçeneği olması önerilmektedir.

Keywords

• Seftazidim/avibaktam
• karbapenemaz
• antibiyotik direnci

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