Are New β-Lactam/β-Lactamase Inhibitor Combinations Promising Against Carbapenem-Resistant K. pneumoniae Isolates?

IF 3.3 3区医学 Q2 MICROBIOLOGY

Pathogens Pub Date : 2025-02-24 DOI:10.3390/pathogens14030220

Ayşe Nur Ceylan, Selda Kömeç, Kamuran Şanlı, Beyza Öncel, Mehmet Akif Durmuş, Abdurrahman Gülmez

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引用次数: 0

Abstract

Background/objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections present a significant clinical challenge due to limited therapeutic options and high transmission potential. This study aimed to identify the resistance genes associated with carbapenemase production in CRKP isolates and evaluate the in vitro activity of ceftazidime/avibactam (CZA) and meropenem/vaborbactam (MEV), among other β-lactam/β-lactamase inhibitor combinations.

Methods: Between October 2021 and June 2022, a total of 504 CRKP isolates were grown from patient samples in intensive care units. When duplicate patient samples were removed, the remaining 89 isolates were included in the study. Bacterial identification and antimicrobial susceptibility testing were per-formed using MALDI-TOF, Phoenix M50, and disk diffusion methods, following EUCAST guidelines. PCR analyses identified carbapenemase genes such as OXA-48, NDM, and KPC.

Results: The most prevalent carbapenemase gene was OXA-48 (79.8%), followed by NDM (21.4%) and KPC (17.9%). The susceptibility rate to CZA was 82.0%, significantly higher than MEV (10.1%). All isolates were resistant to piperacillin/tazobactam and ceftolozane/tazobactam. Among MEV-resistant isolates, most carried the OXA-48 gene, while NDM was common in CZA-resistant isolates.

Conclusions: CZA demonstrates high efficacy against OXA-48-producing CRKP, making it a viable treatment option in settings where OXA-48 predominates. The limited activity of MEV in this study underscores the need for molecular surveillance of resistance mechanisms to guide empirical therapy.

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新的β-内酰胺/β-内酰胺酶抑制剂联合治疗耐碳青霉烯肺炎克雷伯菌有希望吗？

背景/目的：耐碳青霉烯肺炎克雷伯菌（CRKP）感染由于治疗选择有限和高传播潜力，目前是一个重大的临床挑战。本研究旨在鉴定与CRKP分离株碳青霉烯酶产生相关的耐药基因，并评估头孢他啶/阿维巴坦（CZA）和美罗培南/瓦博巴坦（MEV）以及其他β-内酰胺/β-内酰胺酶抑制剂组合的体外活性。方法：在2021年10月至2022年6月期间，从重症监护病房的患者样本中共培养出504株CRKP分离株。当去除重复的患者样本时，剩余的89株分离株被纳入研究。按照EUCAST指南，采用MALDI-TOF、Phoenix M50和纸片扩散法进行细菌鉴定和药敏试验。PCR分析鉴定了碳青霉烯酶基因，如OXA-48、NDM和KPC。结果：最常见的碳青霉烯酶基因为OXA-48(79.8%)，其次为NDM（21.4%）和KPC（17.9%）。CZA易感率为82.0%，显著高于MEV（10.1%）。所有分离株均对哌拉西林/他唑巴坦和头孢唑烷/他唑巴坦耐药。在mev耐药菌株中，大多数携带OXA-48基因，而在cza耐药菌株中常见NDM基因。结论：CZA对产生OXA-48的CRKP具有很高的疗效，使其成为OXA-48占主导地位的环境下可行的治疗选择。在这项研究中，MEV的有限活性强调了对耐药机制进行分子监测以指导经验治疗的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pathogens Medicine-Immunology and Allergy

CiteScore

6.40

自引率

8.10%

发文量

1285

审稿时长

17.75 days

期刊介绍： Pathogens (ISSN 2076-0817) publishes reviews, regular research papers and short notes on all aspects of pathogens and pathogen-host interactions. There is no restriction on the length of the papers. Our aim is to encourage scientists to publish their experimental and theoretical research in as much detail as possible. Full experimental and/or methodical details must be provided for research articles.