Rapid ResaCeftazidime-Avibactam Enterobacterales NP Test: Rapid Detection of Ceftazidime-Avibactam Susceptibility in Enterobacterales.

Abstract

Ceftazidime-avibactam (CZA), a novel β-lactam/β-lactamase inhibitor combination, has good antibacterial activity against carbapenem-resistant Enterobacterales (CRE) producing class A and C and some class D carbapenemases, but in recent years, the emergence of CZA-resistant Enterobacterales bacteria is growing. Therefore, rapid, accurate, and timely detection of CZA is necessary for clinical anti-infection treatment. In this study, the rapid ResaCeftazidime-avibactam Enterobacterales NP test was developed; its principle is that metabolically active bacteria (CZA-resistant strains) can change resazurin-PrestoBlue, a viability colorant, from blue to purple or pink in the presence of CZA, whereas CZA-susceptible strains cannot. We used 178 Enterobacterales isolates to evaluate the performance of this test. This test allowed the susceptibility of Enterobacterales to CZA to be detected within 4.5 h with an overall performance of 96% category agreement (CA), 7% major errors (MEs), and 0% very major errors (VMEs). Performance for Escherichia coli included 100% CA and 0% MEs and VMEs. Performance for Klebsiella pneumoniae included 99% CA and 2% MEs and 0% VMEs. Performance for Enterobacter cloacae included 87% CA, 25% MEs, and 0% VMEs. Moreover, this test is both economical ($1.0106 per isolate) and convenient, as it only requires basic laboratory equipment. In a word, the rapid ResaCeftazidime-avibactam Enterobacterales NP test is rapid and feasible, which may provide certain backing for the rapid screening and timely treatment of CZA-resistant strains in the clinic.