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Ka Lip Chew, Michelle K L Tay, Bernadette Cheng, Raymond T P Lin, Sophie Octavia, Jeanette W P Teo
Newly approved Food and Drug Administration (FDA) β-lactam-β-lactamase inhibitor (βL-βLI) inhibitor combinations such as ceftazidime-avibactam and meropenem-vaborbactam are potent inhibitors of class A carbapenemase (typified by KPC [ Klebsiella pneumoniae carbapenemase]-like) (1, 2) but are ineffective against carbapenemase-producing Enterobacteriaceae (CPE) producing class B metallo-β-lactamases (MβLs) such as New Delhi metallo-β-lactamase (NDM) (1-4).….
May 14, 2018: Antimicrobial Agents and Chemotherapy
James A Karlowsky, Krystyna M Kazmierczak, Samuel K Bouchillon, Boudewijn L M de Jonge, Gregory G Stone, Daniel F Sahm
The in vitro activities of ceftazidime-avibactam and comparators were determined for 9,149 isolates of Enterobacteriaceae and 2,038 isolates of Pseudomonas aeruginosa collected by 42 medical centers in nine countries in the Asia-Pacific region from 2012 to 2015 as part of the International Network For Optimal Resistance Monitoring (INFORM) global surveillance program. Antimicrobial susceptibility testing was conducted by CLSI broth microdilution and isolate subset analysis performed based on resistant phenotypes and β-lactamase content...
May 14, 2018: Antimicrobial Agents and Chemotherapy
Abdullah Algwizani, Mohammad Alzunitan, Ahmad Alharbi, Abdulrahman Alsaedy, Sameera Aljohani, Bassam Alalwan, Jawaher Gramish, Adel Alothman
INTRODUCTION: Carbapenem-resistant organisms have become major healthcare-associated pathogens and are responsible for significant morbidity and mortality worldwide. CASES AND MANAGEMENTS: This case-series describes our experience with ceftazidime-avibactam in the treatment of six cases with carbapenem-resistant organisms in King Abdulaziz Medical City in Riyadh, Saudi Arabia. After trying various combinations of antibiotic therapies without improvement, cases were treated with ceftazidime-avibactam...
April 26, 2018: Journal of Infection and Public Health
Gregory G Stone, Paul Newell, Patricia A Bradford
Increasing prevalence of multidrug-resistant Gram-negative pathogens has generated a requirement for new treatment options. Avibactam, a novel non-β-lactam β-lactamase inhibitor, restores activity of ceftazidime against Ambler class A, C and some class D β-lactamase-producing strains of Enterobacteriaceae and Pseudomonas aeruginosa In vitro activity of ceftazidime-avibactam versus comparators was evaluated against 1,440 clinical isolates obtained in a phase 3 clinical trial in patients with complicated intra-abdominal infections (cIAI; NCT01499290)...
April 23, 2018: Antimicrobial Agents and Chemotherapy
Matt Shirley
Ceftazidime-avibactam (Zavicefta® ) is an intravenously administered combination of the third-generation cephalosporin ceftazidime and the novel, non-β-lactam β-lactamase inhibitor avibactam. In the EU, ceftazidime-avibactam is approved for the treatment of adults with complicated urinary tract infections (cUTIs) [including pyelonephritis], complicated intra-abdominal infections (cIAIs), hospital-acquired pneumonia (HAP) [including ventilator-associated pneumonia (VAP)], and other infections caused by aerobic Gram-negative organisms in patients with limited treatment options...
April 18, 2018: Drugs
Neta Sternbach, Yaara Leibovici Weissman, Tomer Avni, Dafna Yahav
Background: Ceftazidime/avibactam is approved for complicated intra-abdominal and urinary tract infections (UTIs) based on results from randomized controlled trials (RCTs). Data regarding its effectiveness in treating hospital-acquired infections or resistant pathogens have not been systematically compiled. Methods: A systematic review and meta-analysis including RCTs evaluating ceftazidime/avibactam versus comparator for the treatment of any infection. Primary outcome was 30 day all-cause mortality...
April 6, 2018: Journal of Antimicrobial Chemotherapy
Juri Katchanov, Lucia Asar, Eva-Maria Klupp, Anna Both, Camilla Rothe, Christina König, Holger Rohde, Stefan Kluge, Florian P Maurer
OBJECTIVES: To determine the spectrum of infections with multidrug-resistant Gram-negative bacteria (MDR-GNB) and the clinical impact of the newly available betalactam/betalactamase inhibitor combinations ceftolozane/tazobactam and ceftazidime/avibactam in a German academic tertiary care center. METHODS: Retrospective analysis. RESULTS: Between September 1, 2015 and August 31, 2016, 119 individual patients (0.22% of all hospital admissions) were colonized or infected with carbapenem-resistant MDR-GNB...
2018: PloS One
Raúl Recio, Jennifer Villa, Esther Viedma, María Ángeles Orellana, Jaime Lora-Tamayo, Fernando Chaves
Predictors of mortality and the impact of multidrug resistance and virulence on patients with Pseudomonas aeruginosa (PA) bacteraemia were evaluated. Patients with PA bacteraemia in a 12-month period were retrospectively analysed. Carbapenemase production, molecular typing and identification of virulence factor ExoU were carried out. The activity of ceftolozane-tazobactam and ceftazidime-avibactam was also investigated. The primary endpoint was 30-day crude mortality. Of 64 patients with bacteraemia, 24 (37...
April 2, 2018: International Journal of Antimicrobial Agents
Mark G Wise, Mark A Estabrook, Daniel F Sahm, Gregory G Stone, Krystyna M Kazmierczak
A set of 908 clinically derived colistin-resistant Enterobacteriaeae isolates collected worldwide in 2014-2016 were screened for the presence of the plasmid-borne mcr-1, mcr-2, mcr-3, mcr-4 and mcr-5 genes. In total 3.2% (29/908) of the collection were positive for mcr, including 27 Escherichia coli, 1 Klebsiella pneumoniae and 1 Enterobacter cloacae. Twenty-four isolates possessed genes from the mcr-1 family, including the original mcr-1 (n = 22), as well as mcr-1.2 (n = 1) and mcr-1.5 (n = 1), which each differ from mcr-1 by encoding single amino acid variations...
2018: PloS One
L M Koeth, E Matuschek, G Kahlmeter, G Stone
Ceftazidime-avibactam disk studies were performed for disk mass selection and for establishing EUCAST quality control ranges and zone diameter breakpoints. The disk mass study included disk diffusion testing with ceftazidime-avibactam 10-4 and 10-6 μg disks and broth microdilution MIC testing for challenge set of 94 Enterobacteriaceae and 45 Pseudomonas aeruginosa. EUCAST SOP 9.0-based QC and MIC-disk correlations studies were followed for development of ceftazidime-avibactam 10-4 μg ranges for Escherichia coli ATCC 25922, P...
March 30, 2018: European Journal of Clinical Microbiology & Infectious Diseases
Pranita D Tamma, Yunfan Fan, Yehudit Bergman, Anna C Sick-Samuels, Alice J Hsu, Winston Timp, Patricia J Simner, Bonnie C Prokesch, David E Greenberg
We report our clinical experience treating a 2-month-old infant with congenital diaphragmatic hernia who experienced prolonged bacteremia with Burkholderia cepacia complex (Bcc) despite conventional antibiotic therapy and appropriate source control measures. The infection resolved after initiation of ceftazidime-avibactam. Whole-genome sequencing revealed that the isolate most closely resembled B. contaminans and identified the mechanism of resistance that likely contributed to clinical cure with this agent...
April 2018: Antimicrobial Agents and Chemotherapy
Hélène Bouxom, Damien Fournier, Kevin Bouiller, Didier Hocquet, Xavier Bertrand
We evaluated the activity of 18 non-carbapenem antibiotics on 100 ESBL-producing Escherichia coli (ESBL-Ec) and 50 ESBL-producing Klebsiella pneumoniae (ESBL-Kp) isolated from urinary tract infections and bacteremia in 2016. MICs were determined using reference methods and susceptibility profiles were defined according to the EUCAST 2017 recommendations. All the ESBL-Ec isolates were susceptible to ceftazidime-avibactam and a great majority of them were susceptible to fosfomycin (98%), piperacillin-tazobactam (97%), amikacin (97%) and nitrofurantoin (96%)...
March 23, 2018: International Journal of Antimicrobial Agents
Paolo Gaibani, Caterina Campoli, Russell E Lewis, Silvia Lidia Volpe, Erika Scaltriti, Maddalena Giannella, Stefano Pongolini, Andrea Berlingeri, Francesco Cristini, Michele Bartoletti, Sara Tedeschi, Simone Ambretti
Objectives: KPC-producing Klebsiella pneumoniae (KPC-Kp) represent a serious problem worldwide. Herein, we describe the evolution of ceftazidime/avibactam resistance by sequencing longitudinal clinical isolates from a patient with KPC-Kp bloodstream infection undergoing ceftazidime/avibactam treatment. Methods: WGS was performed on one ceftazidime/avibactam-susceptible KPC-Kp (BOT-CA-S) and two phenotypically different ceftazidime/avibactam-resistant KPC-Kp with low (BOT-CA-R) and high (BOT-EMO) carbapenem MICs...
March 16, 2018: Journal of Antimicrobial Chemotherapy
Helio S Sader, Paul R Rhomberg, Michael D Huband, Ian A Critchley, Gregory G Stone, Robert K Flamm, Ronald N Jones
We evaluated the correlation between MIC and disk diffusion inhibition zones when testing ceftazidime-avibactam using the 30/20-μg disk and the disk diffusion and MIC breakpoints established by the United States Food and Drug Administration (U.S. FDA) and the Clinical and Laboratory Standards Institute (CLSI). Organisms used included 2 groups of Enterobacteriaceae and 2 groups of Pseudomonas aeruginosa isolates; 1 group of each consisted of randomly selected isolates and the second group consisted of a challenge group from thousands of surveillance isolates with an increased proportion of organisms displaying ceftazidime-avibactam MIC values close to the breakpoints...
March 21, 2018: Journal of Clinical Microbiology
Norelle Sherry, Benjamin Howden
Multidrug-resistant (MDR) and extensively-drug-resistant (XDR) Gram-negative bacteria have emerged as a major threat to human health globally. This has resulted in the 're-discovery' of some older antimicrobials and development of new agents, however resistance has also rapidly emerged to these agents. Areas covered: Here we describe recent developments in resistance to three of the most important last-line antimicrobials for treatment of MDR and XDR Gram negatives: fosfomycin, colistin and ceftazidime-avibactam...
March 21, 2018: Expert Review of Anti-infective Therapy
Brittany A Rodriguez, Jennifer E Girotto, David P Nicolau
The rise in multidrug-resistant (MDR) infections has become a significant problem in both the developing countries and in the United States (U.S.). Specifically, MDR gram-negative infections are emerging, affecting not only adults but children as well. The specific gram-negative organisms that have been most concerning within the pediatric population include MDR P. aeruginosa, Enterobacteriaceae, and Acinetobacter spp. The increase in antimicrobial resistance rates are associated with various mechanisms, with, one of the most common being the production of beta-lactamases...
March 8, 2018: Current Pediatric Reviews
Ryan K Shields, M Hong Nguyen, Liang Chen, Ellen G Press, Barry N Kreiswirth, Cornelius J Clancy
Ceftazidime-avibactam was used to treat 77 patients with carbapenem-resistant Enterobacteriaceae (CRE) infections at our center. Thirty- and 90-day survival rates were 81% and 69%, respectively; these rates were higher than those predicted by SAPS II and SOFA scores at the onset of infection. Clinical success was achieved for 55% of patients but differed by the site of infection. Success rates were lowest for pneumonia (36%) and higher for bacteremia (75%) and urinary tract infections (88%). By multivariate analysis, pneumonia ( P = 0...
May 2018: Antimicrobial Agents and Chemotherapy
Norelle L Sherry, Sarah L Baines, Benjamin P Howden
Avibactam is a novel β-lactamase inhibitor active against classes A, C and some class D β-lactamases. In combination with ceftazidime, it may be useful for the treatment of infections due to carbapenemase-producing Gram negative (CPGN) bacteria from these classes; however, susceptibility data for some of the less-common carbapenemases are limited. To assess the in vitro activity of ceftazidime-avibactam (CZA), we tested a panel of fifty diverse CPGN collected from clinical isolates in Victoria, Australia, containing KPC, GES, SME, OXA-23 and OXA-48-like carbapenemases for CZA susceptibility using broth microdilution (BMD), E-tests and disc diffusion...
February 27, 2018: International Journal of Antimicrobial Agents
Jesús Rodríguez-Baño, Belén Gutiérrez-Gutiérrez, Isabel Machuca, Alvaro Pascual
Therapy of invasive infections due to multidrug-resistant Enterobacteriaceae (MDR-E) is challenging, and some of the few active drugs are not available in many countries. For extended-spectrum β-lactamase and AmpC producers, carbapenems are the drugs of choice, but alternatives are needed because the rate of carbapenem resistance is rising. Potential active drugs include classic and newer β-lactam-β-lactamase inhibitor combinations, cephamycins, temocillin, aminoglycosides, tigecycline, fosfomycin, and, rarely, fluoroquinolones or trimethoprim-sulfamethoxazole...
April 2018: Clinical Microbiology Reviews
Sherwin K B Sy, Luning Zhuang, Huiming Xia, Marie-Eve Beaudoin, Virna J Schuck, Wright W Nichols, Hartmut Derendorf
Objectives: To characterize quantitatively the effect of avibactam in potentiating ceftazidime against MDR Pseudomonas aeruginosa by developing a mathematical model to describe the bacterial response to constant concentration time-kill information and validating it using both constant and time-varying concentration-effect data from in vitro and in vivo infection systems. Methods: The time course of the bacterial population dynamics in the presence of static concentrations of ceftazidime and avibactam was modelled using a two-state pharmacokinetic/pharmacodynamic (PK/PD) model, consisting of active and resting states, to account for bactericidal activities, bacteria-mediated ceftazidime degradation and inhibition of degradation by avibactam...
February 3, 2018: Journal of Antimicrobial Chemotherapy
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