2018 - Rapid detection of ceftazidime/avibactam resistance by MALDI-TOF MS

journal of antimicrobial chemotherapy 2018

Authors: Cecilia Godoy Carvalhaes, Ana Carolina Ramos, Lilian Caroline Gonçalves de Oliveira, Maria Aparecida Juliano, Ana Cristina Gales.


Over the last decades, MDR Gram-negative bacilli have emerged as an important aetiological agent of nosocomial-acquired infections worldwide. The combination of β-lactam and new β-lactamases inhibitors has become an option for treating those infections with fewer side effects than old compounds such as polymyxins. Avibactam is a diazabicyclooctane β-lactamase inhibitor that demonstrates excellent inhibitory properties against class A, class C and some class D β-lactamases (basically OXA-48). In contrast, it does not possess activity against most MBL-producing isolates.

Recently, ceftazidime/avibactam was approved for the treatment of patients with complicated intra-abdominal infections, complicated urinary tract infections and hospital-acquired pneumonia. To reduce the development of drug-resistant bacteria and preserve the susceptibility of ceftazidime/avibactam, it should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. However, susceptibility testing of new drugs in routine laboratories is restricted to disc and/or gradient diffusion methodologies until its inclusion on commercial panels of susceptibility automated systems. According to a recent evaluation, ceftazidime/avibactam susceptibility testing using Etest and disc diffusion methods presented very major and major errors, respectively, compared to broth microdilution, and those tests should be interpreted cautiously in clinical practice. MALDI-TOF MS has been applied for the detection of carbapenems hydrolysis. As susceptibility testing to ceftazidime/avibactam might be tricky, herein, we evaluated the performance of MALDI-TOF MS for rapid detection of ceftazidime/avibactam resistance by testing against 118 previous molecular characterized bacterial clinical isolates, including a range of different β-lactamase-producing Enterobacteriaceae and Pseudomonas aeruginosa (Table )., In addition, 21 non-carbapenemase-producing isolates were also studied. Species identification was confirmed by MALDI-TOF MS (Biotyper 3.3 version; Bruker Daltonics, Bremen, Germany).

DOI: https://doi.org/10.1093/jac/dky196


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