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Title: Emerging ceftazidime-avibactam resistance against carbapenem resistant Escherichia coli and Klebsiella pneumoniae in Lebanon
Authors: Sobh, Ghena M.
El Karaaoui, AbdulKarim M.
Chaar, Mira El 
Araj, George
Affiliations: Faculty of Health Sciences 
Keywords: Antimicrobial Resistance
Ceftazidime Avibactam
Carbapenem Resistance
CR E. Coli
CR K. Pneumoniae
Issue Date: 2021
Publisher: iMedPub Journals
Part of: The International Arabic Journal of Antimicrobial Agents
Volume: 10
Issue: 2:3
Introduction: Ceftazidime-avibactam (CZA) has been introduced as
a novel therapy to essentially combat the rising trends of carbapenem
resistant Enterobacteriaceae. In the absence of in vitro data
about the activity of this drug against carbapenem resistant (CR)
Escherichia coli and Klebsiella pneumoniae in Lebanon, this study
was warranted.
Method: A total of 150 isolates, identified using the MALDI-TOF,
encompassing 50 CR E. coli, 60 CR K. pneumoniae, and 10 isolates
each of extended-spectrum Beta-lactamases (ESBLs), and non-CR
multidrug-resistant (MDR) of each species were analyzed. The minimum
inhibitory concentration (MIC) for CZA was determined by
the E-test (Liofilchem, Roseto degliAbruzzi, Italy). In addition, the
disk diffusion (DD) test was used to determine the activity of CZA
and of the antimicrobials routinely used to test for such pathogens.
Results: The CZA activity against the 50 CR E. coli showed an
MIC50 ≥ 256 μg/mL, MIC90 ≥ 256 μg/mL, and an MIC range of
0.023 to ≥ 256 μg/mL, reflecting a susceptibility of 40%. As For
the 60 CR K. pneumoniae isolates, the MIC50 was ≥ 256 μg/mL,
MIC90 ≥ 256 μg/mL, and the MIC range was 0.094 to ≥ 256 μg/
mL, reflecting a susceptibility of 35%. However, uniform CZA susceptibility
(100%) was detected against ESBL and MDR isolates of
both species, being comparable or higher to the routinely used
Conclusion: Although CZA was recently introduced into Lebanon, it
was surprising to note this low activity of CZA against CR E. coli and
CR K. pneumoniae. To explain such findings, it is worth pursuing investigations
related to antimicrobial utilization in clinical practice and
antimicrobial stewardship. Moreover, genotypic determination is needed
to be revealed to help explain the observed phenotypic resistance.
DOI: 10.3823/858
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Department of Medical Laboratory Sciences

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