Assessment of the in vitro activity of ceftazidime-avibactam against a global collection of multidrug-resistant Klebsiella spp. from the INFORM surveillance program (2015-2017).

Icon for Elsevier Science Related Articles

Assessment of the in vitro activity of ceftazidime-avibactam against a global collection of multidrug-resistant Klebsiella spp. from the INFORM surveillance program (2015-2017).

Int J Antimicrob Agents. 2020 Jul 25;:106111

Authors: Rossolini GM, Stone GG

Abstract
Infections caused by Klebsiella spp. are difficult to treat when these pathogens exhibit multidrug resistance (resistance to ≥3 drug classes). This study determined rates of multidrug-resistant (MDR) Klebsiella spp. among clinical isolates collected globally (Africa/Middle East, Asia, Oceania, Europe and Latin America, but not the United States), as part of the INFORM surveillance program (2015-2017). The in vitro antimicrobial activities of ceftazidime-avibactam and comparators against these MDR isolates were determined using CLSI broth microdilution methodology. MICs were interpreted using EUCAST 2019 breakpoints. By species, 38.4% (4,555/11,864) of K. pneumoniae isolates were MDR, followed by 28.3% (452/1,598) of K. aerogenes. The majority of MDR K. pneumoniae isolates were extended-spectrum β-lactamase (ESBL)-positive and carbapenemase-negative (69.5%), compared with 1.3% of MDR K. aerogenes. Globally, >92% of MDR K. pneumoniae isolates were resistant to amoxicillin-clavulanic acid, aztreonam, cefepime, ceftazidime or ceftriaxone. Ceftazidime-avibactam, colistin and tigecycline MIC90 values were 1-2 mg/L against the global collection of MDR K. pneumoniae and MDR K. aerogenes. Approximately 5% (216/4,555) of all MDR K. pneumoniae isolates and 1% (5/452) of all MDR K. aerogenes isolates were resistant to ceftazidime-avibactam. Rates of resistance to ceftazidime-avibactam and colistin were low for MDR, ESBL-positive, carbapenemase-negative K. pneumoniae (0.1% and 3.0%, respectively). Resistance to ceftazidime-avibactam was highest among MDR, carbapenemase-positive, metallo-β-lactamase (MBL)-positive K. pneumoniae (98.0%), whereas colistin resistance was highest among MDR, carbapenemase-positive, MBL-negative isolates (30.2%). The results of this study suggest that ceftazidime-avibactam, colistin and tigecycline are potential treatment options for nosocomial infections caused by MDR Klebsiella.

PMID: 32721602 [PubMed - as supplied by publisher]