Dokuz Eylul University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
Dokuz Eylul University Faculty of Medicine, Department of Medical Microbiology, Izmir, Turkey.
J Infect Dev Ctries. 2024 Jul 29;18(7):1020-1025. doi: 10.3855/jidc.18371.
To ensure the appropriate usage of ceftazidime-avibactam (CAZ-AVI), recently introduced in our hospital, we aimed to determine susceptibility rates, enzyme analysis, and clonal relationship among strains, together with clinical data.
Between June 1 and September 30, 2021, demographic and microbiological data of the patients were recorded. In the obtained samples, meropenem and colistin minimal inhibitory concentration (MIC) levels, carbapenem resistance genes, and the clonal relationship were studied by molecular methods. CAZ-AVI was not used in any of the patients.
140 carbapenem-resistant Klebsiella pneumoniae were isolated from 57 patients. Resistance to CAZ-AVI was found in 76 (54.3%) strains. Out of 57 patients, 31 (54.4%) isolates could be reached. Meropenem MIC level was ≥ 32 µg/mL in 26 (83.9%), and colistin MIC level was ≥ 4 µg/mL in 17 (54.8%) isolates. Enzyme analysis revealed NDM in 20 (64.5%), OXA-48 in 17 (54.8%), and KPC in seven (22.6%). NDM + OXA-48 was determined in 10 (32.2%) strains. NDM was determined in all CAZ-AVI resistant strains, OXA-48 in 16.1% (2/5) strains. Seven genotypes were detected. The largest cluster was genotype 3 clusters (11 isolates). Of 31 patients, 22 (71.0%) died. CAZ-AVI was susceptible in one of the patients who survived and four who died.
Before using a new antibiotic, each center should determine the basal data and phenotypic/genotypic resistance ratios specific to that antibiotic. While a high NDM rate and low CAZ-AVI sensitivity limit the use of the drug in our center, it is clear that CAZ-AVI use in sensitive strains will decrease mortality.
为确保在我院新引入的头孢他啶-阿维巴坦（CAZ-AVI）的合理使用，我们旨在确定菌株的药敏率、酶分析和克隆关系，并结合临床数据进行研究。
在 2021 年 6 月 1 日至 9 月 30 日期间，记录了患者的人口统计学和微生物学数据。通过分子方法研究了从 57 名患者中获得的样本中的美罗培南和黏菌素最小抑菌浓度（MIC）水平、碳青霉烯耐药基因和克隆关系。在任何患者中均未使用 CAZ-AVI。
从 57 名患者中分离出 140 株耐碳青霉烯类肺炎克雷伯菌。76 株（54.3%）对 CAZ-AVI 耐药。在 57 名患者中，有 31 名（54.4%）可获得分离株。26 株（83.9%）的美罗培南 MIC 水平≥32μg/ml，17 株（54.8%）的黏菌素 MIC 水平≥4μg/ml。酶分析显示 20 株（64.5%）产 NDM，17 株（54.8%）产 OXA-48，7 株（22.6%）产 KPC。10 株（32.2%）检测到 NDM+OXA-48。所有 CAZ-AVI 耐药株均检出 NDM，16.1%（2/5）株检出 OXA-48。检测到 7 种基因型。最大的簇是基因型 3 簇（11 株）。在 31 名患者中，22 名（71.0%）死亡。在存活和死亡的患者中，CAZ-AVI 对 1 名和 4 名患者敏感。
在使用新抗生素之前，每个中心都应确定该抗生素特有的基础数据和表型/基因型耐药率。虽然我院 NDM 检出率高，CAZ-AVI 敏感性低限制了该药物的使用，但 CAZ-AVI 对敏感株的使用显然会降低死亡率。
