Liu Congcong, Wu Yuchen, Huang Ling, Zhang Yanyan, Sun Qiaoling, Lu Jiayue, Zeng Yu, Dong Ning, Cai Chang, Shen Zhangqi, Chen Gongxiang, Zhang Rong
Department of Clinical Laboratory, School of Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou 310000, China.
Department of Clinical Laboratory Medicine, The Women's and Children's Hospital of Linping District, Hangzhou 310000, China.
Antibiotics (Basel). 2022 May 30;11(6):731. doi: 10.3390/antibiotics11060731.
Ceftazidime-avibactam (CAV) is a new treatment option against carbapenem-resistant (CRKP) infections. However, the rapid emergence of CAV resistance mediated by KPC variants has posed a severe threat to healthcare after its clinical application. The characteristics of CAV resistance in CRKP strains needs to be determined in China. A total of 477 CRKP isolates were collected from 46 hospitals in Zhejiang Province from 2018 to 2021. The results demonstrated that CAV had a potent activity against 94.5% of all CRKP (451/477, 95% CI: 93.0-96.1%) and 86.0% of CRKP strains carrying genes (410/477, 95% CI: 83.5-88.4%). A total of 26 CAV-resistant strains were found. Among these strains, sixteen harbored metallo-β lactamases, and two carried KPC-2 carbapenemase and mutated and . Eight CRKP strains encoded KPC-33 or KPC-93, belonging to ST11, among which seven strains were detected in patients hospitalized in 2021 after exposure to CAV and one strain was associated with intra-hospital spread. CAV is a potent agent in vitro against CRKP strains. The rapid development of CAV resistance mediated by various KPC variants after a short period of CAV treatment has increased and brought difficulties in treating infections caused by CRKP strains, especially those belonging to ST11. The surveillance of bacterial resistance against CAV is highly recommended due to the steep development of CAV resistance and rapid evolution of KPC enzymes.
头孢他啶-阿维巴坦（CAV）是一种针对耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的新治疗选择。然而，由KPC变体介导的CAV耐药性的迅速出现，在其临床应用后对医疗保健构成了严重威胁。在中国需要确定CRKP菌株中CAV耐药性的特征。2018年至2021年期间，从浙江省46家医院共收集了477株CRKP分离株。结果表明，CAV对所有CRKP的94.5%（451/477，95%CI：93.0-96.1%）以及携带基因的CRKP菌株的86.0%（410/477，95%CI：83.5-88.4%）具有强大活性。共发现26株对CAV耐药的菌株。在这些菌株中，16株含有金属β-内酰胺酶，2株携带KPC-2碳青霉烯酶且 和 发生了突变。8株CRKP菌株编码KPC-33或KPC-93，属于ST11，其中7株在2021年住院患者中检测到，这些患者曾接触过CAV，1株与医院内传播有关。CAV在体外是对抗CRKP菌株的有效药物。在短时间的CAV治疗后，由各种KPC变体介导的CAV耐药性迅速发展，增加了治疗由CRKP菌株引起的感染的难度，尤其是那些属于ST11的菌株。鉴于CAV耐药性的急剧发展和KPC酶的快速进化，强烈建议对CAV进行细菌耐药性监测。
