Mehdi Naima, Majeed Nadia, Ali Farwa, Aroob Iqra
Naima Mehdi, M.Phil. Assistant Professor, Department of Microbiology, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.
Nadia Majeed, FCPS. Assistant Professor, Department of Infectious Diseases, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.
Pak J Med Sci. 2025 Mar;41(3):788-791. doi: 10.12669/pjms.41.3.9978.
This study investigates resistance to a newly available drug Ceftazidime-Avibactam (CAZ-AVI) in carbapenem-resistant gram-negative organisms (GNOs) in the Pakistan's pediatric population.
This was a prospective study carried out in the Department of Microbiology at The Children's Hospital, Lahore from May 2023 to July 2023. A sum of 7491 specimens of blood, cerebrospinal fluid (CSF), urine, pus, nasal swabs, central venous catheter (CVP) tips and tracheal secretion were analyzed for presence of carbapenem resistant gram-negative organisms which were then further screened for CAZ-AVI resistance. Analytical profile index and Kirby-Bauer disk diffusion methods were used for the identification of organisms.
A total of 217(n) carbapenem-resistant bacterial species, including 165(n) sp., 32(n) ., and 20(n) () strains, were tested for sensitivity against CAZ-AVI. Approximately, 70.5% (153 out of 217) of carbapenem-resistant bacteria exhibited resistance to CAZ-AVI. Among the resistant bacterial species, 80% (122/153) were sp., 14% (21/153) were sp., and 6% (10/153) were . These findings suggest pre-existing resistance mechanisms may be responsible for exhibiting resistance to CAZ-AVI in these organisms.
Taking into account the results of this study, which depicted high resistance rates to CAZ-AVI among carbapenem resistant GNOs, and the high cost of this drug, it is suggested that a cautious selection for its use as monotherapy in sepsis and other infections should be made. It should be made mandatory to check the resistance to CAZ-AVI before its empiric use. The findings of the study also emphasize the challenges of combating new drug resistance and further research to adapt treatment strategies to the evolving antimicrobial resistance in the region.
本研究调查了巴基斯坦儿科人群中耐碳青霉烯类革兰氏阴性菌（GNOs）对新上市药物头孢他啶-阿维巴坦（CAZ-AVI）的耐药性。
这是一项于2023年5月至2023年7月在拉合尔儿童医院微生物科进行的前瞻性研究。对7491份血液、脑脊液（CSF）、尿液、脓液、鼻拭子、中心静脉导管（CVP）尖端和气管分泌物标本进行分析，以检测耐碳青霉烯类革兰氏阴性菌的存在，然后进一步筛选对CAZ-AVI的耐药性。采用分析谱指数法和 Kirby-Bauer 纸片扩散法鉴定细菌。
共检测了217株耐碳青霉烯类细菌，包括165株 菌、32株 菌和20株 菌，以检测其对CAZ-AVI的敏感性。约70.5%（217株中的153株）的耐碳青霉烯类细菌对CAZ-AVI耐药。在耐药菌株中，80%（122/153）为 菌，14%（21/153）为 菌，6%（10/153）为 菌。这些发现表明，预先存在的耐药机制可能是这些生物体对CAZ-AVI耐药的原因。
考虑到本研究结果显示耐碳青霉烯类GNOs对CAZ-AVI的耐药率较高，且该药物成本高昂，建议在脓毒症和其他感染中谨慎选择将其作为单一疗法使用。在经验性使用前必须检查对CAZ-AVI的耐药性。该研究结果还强调了应对新出现的耐药性以及进一步开展研究以调整治疗策略以适应该地区不断演变的抗菌药物耐药性的挑战。
