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Phenotypic synergy testing of ceftazidime-avibactam with aztreonam in a university hospital having high number of metallobetalactamase producing bacteria.
Infect Dis (Lond). 2020 Jul 06 [Online ahead of print]ID

Abstract

Background:

Ceftazidime-avibactam combination with aztreonam and role of rapid synergy reporting has not been widely evaluated. Also the synergy correlation with various betalactamases has not been widely studied.

Methods:

We studied phenotypic synergy testings and molecular detection of betalactamases in our university hospital where we have large number of mellatobetalactmase producing bacteria. We tested two phenotypic synergy methods for ceftazidime-avibactam with aztreonam (Disc-E strip method, E strip-Agar method) for rapid reporting to clinicians (153 isolates). The treatment (colistin, ceftazidime-avibactam, ceftazidime-avibactam with aztreonam) was guided as indicated in the synergy testings. The resistance genes in bacteria were identified by polymerase chain reaction (PCR) and correlated with synergy results.

Results:

The highest synergy was seen in Klebsiella pneumoniae by Disc-E strip and E strip-Agar method (86% and 84% respectively). About 70% of Pseudomonas aeruginosa and 29% of Escherichia coli showed synergy. Molecular methods revealed multiple resistance gene combinations and blaNDM (96%) was predominant gene in isolates showing synergy. Among isolates that were sensitive to ceftazidime-avibactam, the predominant genes were blaOXA-48 and blaIMP. Rapid laboratory reporting led to proper utilization of antibiotic combinations.

Conclusions:

Ceftazidime-avibactam and aztreonam rapid synergy testing will be highly beneficial in treatment of infections by metallobetalactamase producing resistant bacteria, especially K. pneumoniae and P. aeruginosa.

Authors+Show Affiliations

Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32628575

Citation

Sahu, Chinmoy, et al. "Phenotypic Synergy Testing of Ceftazidime-avibactam With Aztreonam in a University Hospital Having High Number of Metallobetalactamase Producing Bacteria." Infectious Diseases (London, England), 2020, pp. 1-7.
Sahu C, Pal S, Patel SS, et al. Phenotypic synergy testing of ceftazidime-avibactam with aztreonam in a university hospital having high number of metallobetalactamase producing bacteria. Infect Dis (Lond). 2020.
Sahu, C., Pal, S., Patel, S. S., Singh, S., Gurjar, M., & Ghoshal, U. (2020). Phenotypic synergy testing of ceftazidime-avibactam with aztreonam in a university hospital having high number of metallobetalactamase producing bacteria. Infectious Diseases (London, England), 1-7. https://doi.org/10.1080/23744235.2020.1788224
Sahu C, et al. Phenotypic Synergy Testing of Ceftazidime-avibactam With Aztreonam in a University Hospital Having High Number of Metallobetalactamase Producing Bacteria. Infect Dis (Lond). 2020 Jul 6;1-7. PubMed PMID: 32628575.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Phenotypic synergy testing of ceftazidime-avibactam with aztreonam in a university hospital having high number of metallobetalactamase producing bacteria. AU - Sahu,Chinmoy, AU - Pal,Sourav, AU - Patel,Sangram Singh, AU - Singh,Sanjay, AU - Gurjar,Mohan, AU - Ghoshal,Ujjala, Y1 - 2020/07/06/ PY - 2020/7/7/entrez PY - 2020/7/7/pubmed PY - 2020/7/7/medline KW - Synergy KW - aztreonam KW - ceftazidime–avibactam KW - clinical KW - phenotypic SP - 1 EP - 7 JF - Infectious diseases (London, England) JO - Infect Dis (Lond) N2 - Background: Ceftazidime-avibactam combination with aztreonam and role of rapid synergy reporting has not been widely evaluated. Also the synergy correlation with various betalactamases has not been widely studied.Methods: We studied phenotypic synergy testings and molecular detection of betalactamases in our university hospital where we have large number of mellatobetalactmase producing bacteria. We tested two phenotypic synergy methods for ceftazidime-avibactam with aztreonam (Disc-E strip method, E strip-Agar method) for rapid reporting to clinicians (153 isolates). The treatment (colistin, ceftazidime-avibactam, ceftazidime-avibactam with aztreonam) was guided as indicated in the synergy testings. The resistance genes in bacteria were identified by polymerase chain reaction (PCR) and correlated with synergy results.Results: The highest synergy was seen in Klebsiella pneumoniae by Disc-E strip and E strip-Agar method (86% and 84% respectively). About 70% of Pseudomonas aeruginosa and 29% of Escherichia coli showed synergy. Molecular methods revealed multiple resistance gene combinations and blaNDM (96%) was predominant gene in isolates showing synergy. Among isolates that were sensitive to ceftazidime-avibactam, the predominant genes were blaOXA-48 and blaIMP. Rapid laboratory reporting led to proper utilization of antibiotic combinations.Conclusions: Ceftazidime-avibactam and aztreonam rapid synergy testing will be highly beneficial in treatment of infections by metallobetalactamase producing resistant bacteria, especially K. pneumoniae and P. aeruginosa. SN - 2374-4243 UR - https://www.unboundmedicine.com/medline/citation/32628575/Phenotypic_synergy_testing_of_ceftazidime-avibactam_with_aztreonam_in_a_university_hospital_having_high_number_of_metallobetalactamase_producing_bacteria L2 - http://www.tandfonline.com/doi/abs/10.1080/23744235.2020.1788224 DB - PRIME DP - Unbound Medicine ER -
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