Aztreonam Acts as a Synergist for Ceftazidime/Avibactam Against Carbapenem-Resistant Enterobacteriaceae (CRE) of Various Carbapenemase Phenotypes in Southwestern China.

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES

Infection and Drug Resistance Pub Date : 2025-05-03 eCollection Date: 2025-01-01 DOI:10.2147/IDR.S523498

Xuelian Ruan, Zhiyu Gong, Moqiyi Zeng, Ziqing Zhong, Yongling Chen, Fangyi Wei, Chong Lei, Yuanyuan Zhu, Xue Qin, Meng Li

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引用次数: 0

Abstract

Background: Carbapenem-resistant Enterobacteriaceae (CRE) presents a significant challenge due to its role in severe and multidrug-resistant infections.

Purpose: This study aims to evaluate aztreonam (ATM) as a synergistic agent with ceftazidime/avibactam (CZA) for treating CRE strains with different carbapenemase phenotypes.

Methods: A total of 87 non-repeated clinical CRE strains were collected from various clinical specimens at The First Affiliated Hospital of Guangxi Medical University. Carbapenemase genotypes and phenotypes were identified using polymerase chain reaction (PCR) and NG-Test Carba 5 methods. The synergistic effect of CZA combined with ATM was assessed via the checkerboard MIC and disk stacking methods.

Results: The clinical analysis revealed that underlying pulmonary disease, pneumonia, urinary catheter, and central intravenous catheter were associated with poor prognosis in CRE infections (p<0.05). All 87 CRE strains showed high resistance to most antibiotics, especially cefazolin, ceftriaxone, piperacillin/tazobactam, ertapenem, and meropenem, with a rate of 100.00%. For strains with a single carbapenemase gene, NG-Test Carba 5 demonstrated 100.00% accuracy. Notably, The combination of CZA and ATM showed synergy in 95.40% (83/87) of the CRE strains overall, with specific rates of 100.00% (4/4) in strains lacking detectable carbapenemase genes, 94.29% (33/35) in those with _blaNDM, and 100.00% (3/3) in those with bla_NDM plus bla_KPC-2 or bla_KPC-2 plus _blaIMP-4.

Conclusion: In conclusion, ATM significantly enhances CZA's activity against CRE strains in Guangxi, achieving a high synergy rate across diverse isolates, regardless of the carbapenemase genes present.

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头孢他啶/阿维巴坦对西南地区多种碳青霉烯酶耐药肠杆菌科（CRE）的增效作用

背景：碳青霉烯耐药肠杆菌科（CRE）由于其在严重和多重耐药感染中的作用而面临重大挑战。目的：评价氨曲南（ATM）与头孢他啶/阿维巴坦（CZA）协同治疗不同碳青霉烯酶表型CRE菌株的效果。方法：从广西医科大学第一附属医院的各种临床标本中采集临床非重复CRE菌株87株。采用聚合酶链反应（PCR）和NG-Test Carba 5方法鉴定碳青霉烯酶基因型和表型。采用棋盘MIC法和磁盘堆叠法评价CZA联合ATM的协同效应。结果：临床分析显示，CRE感染（pblaNDM）的预后不良与肺部基础疾病、肺炎、导尿管、中心静脉导尿管相关，blaNDM合并blaKPC-2或blaKPC-2合并blaIMP-4的预后不良相关比例为100.00%（3/3）。结论：综上所述，ATM显著增强了CZA对广西CRE菌株的活性，无论存在何种碳青霉烯酶基因，其对不同菌株的协同率都很高。

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

Infection and Drug Resistance Medicine-Pharmacology (medical)

CiteScore

5.60

自引率

7.70%

发文量

826

审稿时长

16 weeks

期刊介绍： About Journal Editors Peer Reviewers Articles Article Publishing Charges Aims and Scope Call For Papers ISSN: 1178-6973 Editor-in-Chief: Professor Suresh Antony An international, peer-reviewed, open access journal that focuses on the optimal treatment of infection (bacterial, fungal and viral) and the development and institution of preventative strategies to minimize the development and spread of resistance.