A Simple Disk Stacking Plus Micro-Elution Method for Rapid Detection of the Synergistic Effect of Aztreonam and Ceftazidime/Avibactam Against Metallo-β-Lactamase Producing Enterobacterales

Overview

Journal Infect Drug Resist

Publisher Dove Medical Press

Date 2023 Mar 20

PMID 36937146

Authors

Zhou Liu

Xiubing Hang

Tao Yan

Wenwen Chu

Zhen Gong

Yanyan Liu

Yuanyuan Dai

Min Yang

Jiabin Li

Qiang Zhou

Affiliations

Soon will be listed here.

Abstract

Purpose: To establish and evaluate a simple disk stacking plus micro-elution (DSE) method that can be routinely performed to rapidly detect the synergistic effect between aztreonam (ATM) and ceftazidime/avibactam (CZA) against metallo-β-lactamase (MBL)-producing carbapenem-resistant Enterobacterales (CRE).

Methods: The DSE method was established, and a total of 32 MBL-producing CRE isolates collected from multiple centers were tested for ATM-CZA synergy. The results obtained after 8 h of incubation were compared with those obtained by a reference checkerboard assay (CBA) after 18~24 h. Reproducibility experiments were completed on three separate days.

Results: The reproducibility study showed that the results of the DSE method were precise. Compared with CBA, the DSE method exhibited excellent performance, with 92.8% sensitivity, 100.0% specificity 93.8% categorical agreement, 0.0% very major error, 0.0% major error, and 6.2% minor error over three days of testing.

Conclusion: The DSE method is a simple, rapid and practical method for ATM-CZA combination testing. Further evaluation should be completed to improve its clinical application.

Citing Articles

Case Report: Management of recurrent UTI with tigecycline in a kidney transplant recipient.

Shettar S, Sumana M, Shetty M, Maheshwarappa Y, Reddy R, Srinivasan A Front Transplant. 2025; 3:1496702.

PMID: 40040669 PMC: 11876407. DOI: 10.3389/frtra.2024.1496702.

Assessment of broth disk elution method for aztreonam in combination with ceftazidime/avibactam against isolates.

Song P, Xu J, Jiang L, Zhang Q, Liu C Microbiol Spectr. 2024; 12(10):e0095324.

PMID: 39225487 PMC: 11448081. DOI: 10.1128/spectrum.00953-24.

In vitro synergy of the combination of sulbactam-durlobactam and cefepime at clinically relevant concentrations against A. baumannii, P. aeruginosa and Enterobacterales.

Fouad A, Nicolau D, Gill C J Antimicrob Chemother. 2023; 78(12):2801-2809.

PMID: 37839896 PMC: 10689914. DOI: 10.1093/jac/dkad244.

Rapid Aztreonam/Avibactam NP test for detection of aztreonam/avibactam susceptibility/resistance in Enterobacterales.

Viguier C, Bouvier M, Sadek M, Kerbol A, Poirel L, Nordmann P J Clin Microbiol. 2023; 61(10):e0058823.

PMID: 37791761 PMC: 10595063. DOI: 10.1128/jcm.00588-23.

Evaluation of Aztreonam and Ceftazidime/Avibactam Synergism against by MALDI-TOF MS.

Wilhelm C, Inamine E, Martins A, Barth A Antibiotics (Basel). 2023; 12(6).

PMID: 37370382 PMC: 10295265. DOI: 10.3390/antibiotics12061063.

References

Karaiskos I, Galani I, Souli M, Giamarellou H . Novel β-lactam-β-lactamase inhibitor combinations: expectations for the treatment of carbapenem-resistant Gram-negative pathogens. Expert Opin Drug Metab Toxicol. 2019; 15(2):133-149. DOI: 10.1080/17425255.2019.1563071. View

Liu Z, Gu Y, Li X, Liu Y, Ye Y, Guan S . Identification and Characterization of NDM-1-producing Hypervirulent (Hypermucoviscous) in China. Ann Lab Med. 2018; 39(2):167-175. PMC: 6240523. DOI: 10.3343/alm.2019.39.2.167. View

Odds F . Synergy, antagonism, and what the chequerboard puts between them. J Antimicrob Chemother. 2003; 52(1):1. DOI: 10.1093/jac/dkg301. View

Khan A, Erickson S, Pettaway C, Arias C, Miller W, Bhatti M . Evaluation of Susceptibility Testing Methods for Aztreonam and Ceftazidime-Avibactam Combination Therapy on Extensively Drug-Resistant Gram-Negative Organisms. Antimicrob Agents Chemother. 2021; 65(11):e0084621. PMC: 8522751. DOI: 10.1128/AAC.00846-21. View

Simner P, Bergman Y, Trejo M, Roberts A, Marayan R, Tekle T . Two-Site Evaluation of the Colistin Broth Disk Elution Test To Determine Colistin Activity against Gram-Negative Bacilli. J Clin Microbiol. 2018; 57(2). PMC: 6355542. DOI: 10.1128/JCM.01163-18. View

Tan X, Kim H, Baugh K, Huang Y, Kadiyala N, Wences M . Therapeutic Options for Metallo-β-Lactamase-Producing Enterobacterales. Infect Drug Resist. 2021; 14:125-142. PMC: 7822077. DOI: 10.2147/IDR.S246174. View

Humphries R, Green D, Schuetz A, Bergman Y, Lewis S, Yee R . Multicenter Evaluation of Colistin Broth Disk Elution and Colistin Agar Test: a Report from the Clinical and Laboratory Standards Institute. J Clin Microbiol. 2019; 57(11). PMC: 6813006. DOI: 10.1128/JCM.01269-19. View

Sadek M, Juhas M, Poirel L, Nordmann P . Genetic Features Leading to Reduced Susceptibility to Aztreonam-Avibactam among Metallo-β-Lactamase-Producing Escherichia coli Isolates. Antimicrob Agents Chemother. 2020; 64(12). PMC: 7674043. DOI: 10.1128/AAC.01659-20. View

Jean S, Harnod D, Hsueh P . Global Threat of Carbapenem-Resistant Gram-Negative Bacteria. Front Cell Infect Microbiol. 2022; 12:823684. PMC: 8965008. DOI: 10.3389/fcimb.2022.823684. View

10.

Bhatnagar A, Ransom E, Machado M, Boyd S, Reese N, Anderson K . Assessing the in vitro impact of ceftazidime on aztreonam/avibactam susceptibility testing for highly resistant MBL-producing Enterobacterales. J Antimicrob Chemother. 2020; 76(4):979-983. PMC: 10838604. DOI: 10.1093/jac/dkaa531. View

11.

Hansen G . Continuous Evolution: Perspective on the Epidemiology of Carbapenemase Resistance Among Enterobacterales and Other Gram-Negative Bacteria. Infect Dis Ther. 2021; 10(1):75-92. PMC: 7954928. DOI: 10.1007/s40121-020-00395-2. View

12.

Yu W, Xiong L, Luo Q, Chen Y, Ji J, Ying C . Activity Comparison of Ceftazidime-Avibactam and Aztreonam-Avibactam Against Bloodstream Infections With Carbapenem-Resistant Organisms in China. Front Cell Infect Microbiol. 2021; 11:780365. PMC: 8656719. DOI: 10.3389/fcimb.2021.780365. View

13.

Falcone M, Daikos G, Tiseo G, Bassoulis D, Giordano C, Galfo V . Efficacy of Ceftazidime-avibactam Plus Aztreonam in Patients With Bloodstream Infections Caused by Metallo-β-lactamase-Producing Enterobacterales. Clin Infect Dis. 2020; 72(11):1871-1878. DOI: 10.1093/cid/ciaa586. View

14.

Marshall S, Hujer A, Rojas L, Papp-Wallace K, Humphries R, Spellberg B . Can Ceftazidime-Avibactam and Aztreonam Overcome β-Lactam Resistance Conferred by Metallo-β-Lactamases in Enterobacteriaceae?. Antimicrob Agents Chemother. 2017; 61(4). PMC: 5365724. DOI: 10.1128/AAC.02243-16. View