Abstract
BackgroundThis study reports the global trends of antimicrobial susceptibility to ceftaroline and ceftazidime–avibactam using data from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program between 2012 and 2016.MethodsFor the 2012–2016 ATLAS program, 205 medical centers located in Africa-Middle East (n = 12), Asia–Pacific (n = 32), Europe (n = 94), Latin America (n = 26), North America (n = 31), and Oceania (n = 10) consecutively collected the clinical isolates. The minimum inhibitory concentrations (MICs) and in vitro susceptibilities to ceftaroline and ceftazidime–avibactam were assessed using the Clinical and Laboratory Standards Institute (CLSI) 2019and European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2019 guidelines.ResultsBetween 2012 and 2016, 176,345 isolates were collected from around the globe and included in the analysis. Regarding Gram-negative bacteria, ceftazidime–avibactam demonstrated high susceptibility (> 90%) against Enterobacteriaceae and Pseudomonas aeruginosa, with increased antimicrobial activity observed from the addition of avibactam (4 mg/L) to ceftazidime. Regarding Gram-positive bacteria, ceftaroline showed > 90% susceptibility against Staphylococcus aureus, Streptococcus pneumoniae, α-and β-hemolytic Streptococcus. The antimicrobial susceptibilities to ceftaroline and ceftazidime–avibactam were mostly stable from 2012 to 2016, but the susceptibilities to ceftazidime–avibactam to carbapenem-resistant (CR) Klebsiella pneumonia (88.4–81.6%) and to CR-P. aeruginosa (89.6–72.7%) decreased over time. In terms of regional difference, the susceptibilities of methicillin-resistant S. aureus to ceftaroline in Asia and of CR-K. pneumonia to ceftazidime–avibactam in Asia/Africa-Middle East were lower compared with other regions, while the susceptibility of CR-P. aeruginosa to ceftazidime–avibactam in North America was higher.ConclusionThe addition of avibactam improves the activity of ceftazidime against Enterobacteriaceae and P. aeruginosa. The global antimicrobial susceptibilities to ceftaroline and ceftazidime–avibactam were, in general, stable from 2012 to 2016, but a marked reduction in the susceptibilities of specific species and CR-P. aeruginosa to ceftazidime–avibactam was observed.
Highlights
The rapidly increasing and global spreading of the resistance of bacteria to antibiotics in recent years is a serious challenge for clinicians and a global health crisis [1]
The susceptibility of A. baumannii was not calculated because of the absence of a breakpoint, but the minimum inhibitory concentrations (MICs) of this antibiotic were higher for A. baumannii than for the other bacteria (MIC50/
Ceftazidime–avibactam showed susceptibility > 90% against Gram-negative bacteria, including Enterobacteriaceae, P. aeruginosa, and P. mirabilis, with overtly increased antimicrobial activity observed with the addition of avibactam to CRECO Ceftaroline Ceftazidime–avibactam Ceftazidime Cefepime Pip-taz Doripenem Imipenem Meropenem Levofloxacin Tigecycline Amikacin Colistin Aztreonam CRKPN Ceftaroline Ceftazidime–avibactam Ceftazidime Cefepime Pip-taz Doripenem Imipenem Meropenem Levofloxacin Tigecycline Amikacin Colistin Aztreonam CRECL Ceftaroline Ceftazidime–avibactam Ceftazidime Cefepime Pip-taz Doripenem Imipenem Meropenem Levofloxacin Tigecycline Amikacin Colistin Aztreonam CRPAE Ceftaroline Ceftazidime–avibactam Ceftazidime Cefepime Pip-taz
Summary
The rapidly increasing and global spreading of the resistance of bacteria to antibiotics in recent years is a serious challenge for clinicians and a global health crisis [1]. The increases in the occurrence of infections caused by third-generation cephalosporin- and carbapenem-resistant (CR)-Enterobacteriaceae, CR-Pseudomonas aeruginosa, and CRAcinetobacter baumannii are of particular concern since they are associated with tremendously increased mortality and morbidityrates [3, 4]. The World Health Organization has rated CR-Enterobacteriaceae, CR-P. aeruginosa, and CR-A. baumannii as top critical-priority resistant bacteria, outweighing methicillin-resistant Staphylococcus aureus [5]. It is mainly active against methicillin-resistant S. aureus and Gram-positive bacteria, and against Gram-negative bacteria [9]. Ceftazidime–avibactam has been approved for the management of complicated urinary tract infections, complicated intra-abdominal infections, hospital-acquired pneumonia, and infections from aerobic Gram-negative bacteria with limited treatment options [15]. This study reports the global trends of antimicrobial susceptibility to ceftaroline and ceftazidime–avibactam using data from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program between 2012 and 2016
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