susceptibility of carbapenem resistant Enterobacterales to meropenem-vaborbactam and ceftazidime-avibactam at a single academic medical centre. Journal Article

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Authors: Adams, J; Santarossa, M; Harrington, A; Bauer, M; Wozniak, A; Labuszewski, L; Albarillo, FS
Article Title: susceptibility of carbapenem resistant Enterobacterales to meropenem-vaborbactam and ceftazidime-avibactam at a single academic medical centre.
Abstract: BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) are considered an urgent threat. Ceftazidime-avibactam and meropenem-vaborbactam contain ß-lactamase inhibitors active against CRE isolates including those that produce carbapenemases (KPC). METHODS: Retrospective chart review of CRE isolates from 1 January 2016 to 1 November 2018. Collected data includes a descriptive overview of measured MIC values, resistance mechanism a polymerase chain reaction test (Xpert Carba-R, Cepheid, Sunnyvale CA), as well as clinical outcomes. RESULTS: Of 106 isolates reviewed, 86 isolates met the inclusion criteria from 85 individual subjects. The breakpoint:MIC ratio for ceftazidime-avibactam overall was 4, while for meropenem-vaborbactam this ratio was 32 (?0.0001). For KPC isolates, ceftazidime-avibactam MIC/MIC in 2016, 2017, and 2018 were 2/4?mg/L (?=?32), 2/4?mg/L (?=?17), and 2/8?mg/L (?=?30), respectively. The meropenem-vaborbactam MIC/MIC, for KPC isolates in 2016, 2017, and 2018 were 0.06/0.125?mg/L (?=?32), 0.06/0.1?mg/L (?=?17), and 0.06/0.5?mg/L (?=?30), respectively. Microbiologic cure was 75% (?=?16) in ceftazidime-avibactam subjects and 58.3% (?=?12) in subjects treated with alternative agents (?=?0.43). The 14- and 30-day mortality was numerically higher in subjects treated with alternate agents when compared ceftazidime-avibactam 2/9 (22.2%) vs 3/17 (17.6%) (?=?1.00) and 4/9 (44.4%) vs 4/17 (28.6%) (?=?0.38), respectively. For ceftazidime-avibactam, 30-day mortality in 2016, 2017, and 2018 was 0/5 (0%), 0/2 (0%), and 4/10 (40%). CONCLUSION: Selective pressure from the use of ceftazidime-avibactam at our institution may be decreasing its utility as a first-line agent for CRE infections. Meropenem-vaborbactam maintained low MIC values and may be a promising treatment option for CRE.
Journal Title: Infectious diseases (London, England)
Publisher: Unknown  
Date Published: 2023