Volume 13, Issue 3 (9-2025)                   JoMMID 2025, 13(3): 197-205 | Back to browse issues page

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Joshi C, Mudshingkar S, Petkar J, Deorukhkar S, Kakade K. In vitro Synergistic Activity of Ceftazidime-Avibactam and Aztreonam Against Carbapenem-resistant Enterobacterales. JoMMID 2025; 13 (3) :197-205
URL: http://jommid.pasteur.ac.ir/article-1-806-en.html
In vitro Synergistic Activity of Ceftazidime-Avibactam and Aztreonam Against Carbapenem-resistant Enterobacterales
Chetana Joshi , Swati Mudshingkar * , Jaishree Petkar , Sachin Deorukhkar , Kiran Kakade
Department of Microbiology, PCMC Postgraduate Institute and Yashwantrao Chavan Memorial Hospital, Pimpri, Pune, India
Abstract:   (138 Views)
Introduction: Infections caused by multidrug-resistant Enterobacterales pose a significant global health challenge, thus necessitating novel therapeutic strategies. The increasing prevalence of carbapenem-resistant Enterobacterales has led to reliance on colistin and polymyxins as last-resort antibiotics. However, emerging colistin resistance and associated polymyxin toxicity have significantly limited their use. Aztreonam is effective against metallo-β-lactamase (MBL)-producing pathogens but requires protection from co-produced enzymes such as extended-spectrum β-lactamases (ESBLs), AmpC cephalosporinases, and other carbapenemases. Avibactam, a non-β-lactam β-lactamase inhibitor, inhibits ESBLs, Klebsiella pneumoniae carbapenemase (KPC), certain oxacillinase (OXA)-48-like enzymes, and AmpC cephalosporinases but is ineffective against metallo-β-lactamases. This study evaluated the in vitro synergy of ceftazidime-avibactam with aztreonam as a potential colistin-sparing strategy for carbapenem-resistant Enterobacterales infections. Methods: In a prospective cross-sectional study from July 2022 to June 2023, 97 carbapenem-resistant Gram-negative clinical isolates (prevalence: 97/8876 =1.09%) were obtained from 8876 samples tested for aerobic bacterial culture and antimicrobial susceptibility at a tertiary care hospital in Pune, India. For 69 Enterobacterales isolates resistant to ertapenem, imipenem, and meropenem, synergy between ceftazidime-avibactam and aztreonam was tested using disk diffusion and modified E-test/disk diffusion method, interpreted as per the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Results: Enterobacterales comprised 69 (71.13%) of isolates, with 35 (50.73%) of these demonstrating synergy between ceftazidime-avibactam and aztreonam. Klebsiella pneumoniae (33/69; 47.83%) was the predominant species, followed by Escherichia coli (26/69; 37.68%) and Citrobacter species (10/69; 14.49%). Conclusion: In vitro synergy between ceftazidime-avibactam and aztreonam was observed in 50.73% of carbapenem-resistant Enterobacterales isolates, suggesting a possible colistin-sparing alternative for infections such as complicated urinary tract infections, intra-abdominal infections, and hospital-acquired pneumonia; however, further clinical studies are needed to validate its efficacy.
Keywords: Aztreonam, Ceftazidime-avibactam, Carbapenem-resistant Enterobacterales, Colistin, Metallo-β-lactamases, Synergy testing
Full-Text [PDF 964 kb]   (51 Downloads)    
Type of Study: Original article | Subject: Anti-microbial agents, resistance and treatment protocols
Received: 2025/12/1 | Accepted: 2025/09/10 | Published: 2025/12/2
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.