Antimicrobial susceptibility profiling of carbapenem resistant gram-negative bacilli with special reference to ceftazidime-avibactam and ceftriaxone-sulbactam with EDTA
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20252133Keywords:
Antimicrobial resistance, Carbapenem resistant Enterobacteriaceae, Ceftazidime-avibactam, Ceftriaxone-sulbactam EDTAAbstract
Background: Increased morbidity and mortality rates attributable to multidrug resistant organisms (MDROs) such as carbapenem resistant organisms (CROs) are being increasingly reported ultimately leading to limited therapeutic options. Several potential strategies are being explored to develop new antibiotics for Carbapenem-resistant organisms.
Methods: This was a retrospective study where Antimicrobial susceptibility testing for CZA and CSDE was done using the Kirby-Bauer disc diffusion method. Patient’s clinical conditions were assessed by the clinician and demographic details were recorded in the hospital EMR system. The outcome was decided based on the therapeutic effect of the antibiotics on the patients via primary and secondary endpoints.
Results: A total of 150 patients were included in the study, 41 (27.3%) were susceptible to CSDE and turned culture negative. The antibiotic susceptibility patterns of different antibiotics were compared against each other, especially with CZA and CSDE.
Conclusions: Colistin is still the drug with maximum susceptibility against the gram negative bacterial infections although CSDE and CZA are the novel antibiotics and show promising results and may be used on a case to case basis depending on the pharmacokinetics and pharmacodynamics which could be the limiting factor at times restricting use of Colistin.
Metrics
References
Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial resistance: a growing serious threat for global public health. Healthcare. 2023;11(13):1946. DOI: https://doi.org/10.3390/healthcare11131946
Sheu CC, Chang YT, Lin SY. Infections caused by carbapenem-resistant Enterobacteriaceae: an update on therapeutic options. Front Microbiol. 2019:10:80. DOI: https://doi.org/10.3389/fmicb.2019.00080
Nagvekar V, Shah A, Unadkat VP, Chavan A, Kohli R, Hodgar S, et al. Clinical outcome of patients on ceftazidime-avibactam and combination therapy in carbapenem-resistant Enterobacteriaceae. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med. 2021;25(7):780-4. DOI: https://doi.org/10.5005/jp-journals-10071-23863
Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Anandan S, Swaminathan S, Sundaram B. Colistin-sparing approaches with newer antimicrobials to treat carbapenem-resistant organisms: Current evidence and future prospects. Indian J Med Microbiol. 2019;37(1):72-90. DOI: https://doi.org/10.4103/ijmm.IJMM_19_215
Biswas S, Bhat V, Kelkar R. Carbapenem-resistant Enterobacteriaceae: a serious concern in cancer patients. Acc Microbiol. 2020;2(1):3. DOI: https://doi.org/10.1099/acmi.mim2019.po0008
Harris PN, Tambyah PA, Paterson DL. β-lactam and β-lactamase inhibitor combinations in the treatment of extended-spectrum β-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options? Lancet Infect Dis. 2015;15(4):475-85. DOI: https://doi.org/10.1016/S1473-3099(14)70950-8
JaypeeDigital. Colistin Resistance: a growing threat. Available at: https://www.jaypeedigital.com/book/9789352709106/chapter/ch31. Accessed on 15 April 2025.
Shirley M. Ceftazidime-avibactam: a review in the treatment of serious gram-negative bacterial infections. Drugs. 2018;78(6):675-92. DOI: https://doi.org/10.1007/s40265-018-0902-x
Gupta S, Kumar M, Shergill SPS, Tandel K. Evaluation of ceftriaxone-sulbactam-disodium edetate adjuvant combination against multi-drug resistant Gram-negative organisms. Afr J Lab Med. 2020;9(1):991. DOI: https://doi.org/10.4102/ajlm.v9i1.991
Singh S, Sahu C, Patel SS, Singh A, Yaduvanshi N. A comparative in vitro sensitivity study of "ceftriaxone-sulbactam-EDTA" and various antibiotics against gram-negative bacterial isolates from intensive care unit. Indian J Crit Care Med. 2020;24(12):1213-7.
Koh Jing Jie A, Hussein M, Rao GG, Li J, Velkov T. Drug repurposing approaches towards defeating multidrug-resistant gram-negative pathogens: novel polymyxin/non-antibiotic combinations. Pathogens. 2022;11(12):1420. DOI: https://doi.org/10.3390/pathogens11121420
Wattal C, Javeri Y, Goel N, Dhar D, Saxena S, Singh S, et al. Convergence of minds: for better patient outcome in intensive care unit infections. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med. 2017;21(3):154-9. DOI: https://doi.org/10.4103/ijccm.IJCCM_365_16
Zalas-Więcek P, Prażyńska M, Pojnar Ł. Ceftazidime/avibactam and other commonly used antibiotics activity against Enterobacterales and Pseudomonas aeruginosa isolated in Poland in 2015-2019. Infect Drug Resist. 2022;15:1289-304. DOI: https://doi.org/10.2147/IDR.S344165
Singh S, Sahu C, Patel SS. A comparative in vitro sensitivity study of "ceftriaxone-sulbactam-EDTA" and various antibiotics against gram-negative bacterial isolates from intensive care unit. Ind Soc Crit Care Med. 2020;24(12):1213-7. DOI: https://doi.org/10.5005/jp-journals-10071-23573
Wenzler E, Lee M, Wu TJ. Performance of ceftazidime/avibactam susceptibility testing methods against clinically relevant Gram-negative organisms. J Antimicro Chemoth. 2019;74(3):633-8. DOI: https://doi.org/10.1093/jac/dky483
Wang F, Zhou Q, Yang X, Bai Y, Cui J. Evaluation of ceftazidime/avibactam alone and in combination with amikacin, colistin and tigecycline against Klebsiella pneumoniae carbapenemase-producing K. pneumoniae by in vitro time-kill experiment. PloS One. 2021;16(10):0258426. DOI: https://doi.org/10.1371/journal.pone.0258426
van Duin D, Lok JJ, Earley M. Antibacterial resistance leadership group colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Infect Dis Soc Am. 2018;66(2):163-71. DOI: https://doi.org/10.1093/cid/cix783
Hakeam HA, Alsahli H, Albabtain L, Alassaf S, Al Duhailib Z, Althawadi S. Effectiveness of ceftazidime-avibactam versus colistin in treating carbapenem-resistant Enterobacteriaceae bacteremia. Int Soc Infect Dis. 2021;109:1-7. DOI: https://doi.org/10.1016/j.ijid.2021.05.079
Xu HG, Tian M, Pan SY. Clinical utility of procalcitonin and its association with pathogenic microorganisms. Crit Rev Clin Lab Sci. 2022;59(2):93-111. DOI: https://doi.org/10.1080/10408363.2021.1988047
Gudiol C, Albasanz-Puig A, Cuervo G, Carratalà J. Understanding and managing sepsis in patients with cancer in the era of antimicrobial resistance. Front Med (Lausanne). 2021;8:636547. DOI: https://doi.org/10.3389/fmed.2021.636547
Swaminathan S, Routray A, Mane A. Early and appropriate use of ceftazidime-avibactam in the management of multidrug-resistant gram-negative bacterial infections in the Indian scenario. Cureus. 2022;14(8):28283. DOI: https://doi.org/10.7759/cureus.28283
Rathish B, Wilson A, Warrier A, Prakash S, Babu R, Joy S. Clinical outcomes in carbapenem-resistant Enterobacteriaceae infections treated with ceftazidime-avibactam: a single-center observational study. Cureus. 2021;13(2):13081. DOI: https://doi.org/10.7759/cureus.13081