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Original Article
Evaluation of the in vitro efficacy of ceftazidime-avibactam against Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates from respiratory tract cultures in intensive care units
Abstract
Aims: Worldwide, an increase in multidrug resistance is observed in Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), and Pseudomonas aeruginosa (P. aeruginosa) isolates, leading to challenges in the treatment of infections caused by these pathogens. This study aims to investigate the in vitro efficacy of ceftazidime-avibactam (CZA) against isolates containing K. pneumoniae, E. coli, and P. aeruginosa strains obtained from respiratory tract samples sent from intensive care units.
Methods: A retrospective analysis was conducted on 653 Enterobacterales (E. coli, K. pneumoniae) and P. aeruginosa isolates obtained from respiratory tract cultures, including sputum, tracheal aspirates, and bronchial lavage, from patients over 18 years old admitted to the intensive care units of Ordu University Training and Research Hospital between May 1, 2021, and May 1, 2024. Automated systems were used to identify the pathogens and perform antibiotic susceptibility testing. Discriptive data analysis was conducted using SPSS version 24.0.
Results: A total of 653 isolates from respiratory tract samples were included in the study, consisting of 368 Enterobacteriaceae [61 E. coli (9.3%) and 307 K. pneumoniae (47%)] and 285 P. aeruginosa (43.7%). These samples were isolated from endotracheal aspirate (69.5%), sputum (27.9%), and bronchoalveolar lavage (2.6%). Among all isolates, 364 (55.7%) were found to be sensitive to carbapenems, while 289 (44.3%) were carbapenem-resistant. Of the samples, 631 (96.6%) were sensitive to CZA, while 22 (3.4%) were resistant. Although resistance to CZA was detected in 3.6% of K. pneumoniae isolates and 3.9% of P. aeruginosa isolates, no resistance was detected in E. coli. Colistin resistance was observed in 15.3% of K. pneumoniae and 5.6% of P. aeruginosa isolates, but was absent in E. coli isolates. Resistance rates to other antibiotics were as follows for E. coli, K. pneumoniae, and P. aeruginosa isolates, respectively: amikacin (3.3%, 46.6%, 8.1%), ciprofloxacin (73.8%, 73.6%, 85.9%), ceftazidime (67.2%, 77.8%, 35.8%), piperacillin-tazobactam (26.2%, 70%, 37.2%), and trimethoprim-sulfamethoxazole (52.5%, 66.4%, 0%).
Conclusion: In our study, CZA was found to be the most effective antibiotic against multidrug-resistant Enterobacterales and P. aeruginosa isolates, followed by colistin.

Keywords : Multidrug resistance, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, ceftazidime-avibactam

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1. Cerceo E, Deitelzweig SB, Sherman BM, Amin AN. Multidrug-resistant gram-negative bacterial infections in the hospital setting: overview, implications for clinical practice, and emerging treatment options. Microbial Drug Resistance. 2016;22(5):412-431. doi:10.1089/mdr.2015. 0220
2. Bilgin M, İşler H, Başbulut E, Görgün S. Genişlemiş spektrumlu beta-laktamaz üreten Enterobacteriaceae izolatlarına karşı seftazidim-avibaktamin in vitro etkinliğinin araştırılması. J Immunol Clin Microbiol. 2023;8(1):17-23. doi:10.58854/jicm.1249716
3. van Duin D, Bonomo RA. Ceftazidime/avibactam and ceftolozane/tazobactam: second-generation β-lactam/β-lactamase inhibitor combinations. Clin Infect Dis. 2016;63(2):234-241. doi:10.1093/cid/ciw243
4. Ayhan M. New therapeutic options for treatment of multi-drug resistant gram-negative microorganisms. J Ankara Univ Fac Med. 2020;73(2):96-101. doi:10.4274/atfm.galenos.2020.92408
5. Kaya F, Ölçü M. Yoğun bakım ünitelerinde çoklu ilaca dirençli Klebsiella pneumoniae, Escherichia coli ve Pseudomonas aeruginosa suşlarında seftazidim-avibactam direnç oranlarının değerlendirilmesi. Flora J Infec Dis Clin Microbiol. 2024;29(1):45-51. doi:10.5578/flora.202401843
6. Wong D, van Duin D. Novel beta-lactamase inhibitors: unlocking their potential in therapy. Drugs. 2017;77(6):615-628. doi:10.1007/s40265-017- 0725-1
7. Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018;8:4. doi:10.3389/fcimb.2018.00004
8. Zhang W, Guo Y, Li J, et al. In vitro and in vivo bactericidal activity of ceftazidime-avibactam against carbapenemase-producing Klebsiella pneumoniae. Antimicrob Resist Infect Control. 2018;7(1):142. doi:10.1186/s13756-018-0435-9
9. Liao CH, Lee NY, Tang HJ, et al. Antimicrobial activities of ceftazidim-avibactam, ceftolozane-tazobactam, and other agents against Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa isolated from intensive care units in Taiwan: results from the surveillance of multicenter antimicrobial resistance in Taiwan in 2016. Infect Drug Resist. 2019;12:545-552. doi:10.2147/IDR.S193638
10. Chen D, Xiao L, Hong D, et al. Epidemiology of resistance of carbapenemase-producing Klebsiella pneumoniae to ceftazidime-avibactam in a Chinese hospital. J Appl Microbiol. 2022;132(1):237-243. doi:10.1111/jam.15166
11. Kahraman EP, Karakeçe E, Erdoğan F, Uluyurt H, Köroğlu M, Çiftci İH. The evaluation of antibiotic resistance status of Klebsiella pneumoniae. Ortadoğu Tıp Derg. 2017;9(1):12-18. doi:10.21601/ortadogutipdergisi. 291133
12. Tanrıverdi Çaycı Y, Bıyık İ, Çınar C, Birinci A. Antimicrobial resistance of carbapenem-resistant enterobacteriaceae isolates between the years of 2015-2018. Turk Mikrobiyol Cemiy Derg. 2020;50(3):134-140. doi:10. 5222/TMCD.2020.134
13. Altay Koçak A, Yayla B, Üsküdar Güçlü A, et al. Evaluation of respiratory pathogens isolated in a university hospital in Adana and their antibiotic resistance profiles. Turk Mikrobiyol Cemiy Derg. 2019;49(4):226-232. doi:10.5222/TMCD.2019.226
14. Haciseyitoğlu D, Çağ Y, Başgönül S, Özer S. Antibiotic resistance patterns of Escherichia coli and Klebsiella pneumoniae strains isolated from clinical specimens. Turk Mikrobiyol Cemiy Derg. 2014;44(3):101-106. doi:10.5222/TMCD.2014.101
15. Tuna A, Bulut H. Yoğun bakım ünitesinden izole edilen karbapenem dirençli Pseudomonas ve Klebsiella suşlarının seftazidim/avibaktam duyarlılıklarının saptanması. KÜ Tıp Fak Derg. 2023;25(3):408-413. doi: 10.24938/kutfd.1318977
16. FDA. Drug safety communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. Press release. Silver Spring: US Food and Drug Administration; 2016.
17. Özkul Koçak C, Çetin Hazırolan G. Colistin resitance in carbapenem resistant K. pneumoniae clinical isolates. Turk Mikrobiyol Cemiy Derg. 2019;49(1):17-23. doi:10.5222/TMCD.2019.017
18. Aygar İS. In Vitro evaluation of the increase in MIC value of colistin in the carbapenem resistant klebsiella pneumoniae strains over the years. Turk Mikrobiyol Cemiy Derg. 2020;50(3):164-171. doi:10.5222/TMCD. 2020.164
19. Sagmak-Tartar A, Ozer AB, Ulu R, Akbulut A. Microbiological evaluation of the pathogens isolated from the endotracheal aspirate samples of the patients followed in the intensive care units: a one-year retrospective analysis. Klimik J. 2018;31(1):56-60. doi:10.5152/kd.2018.14
20. Gaibani P, Re MC, Campoli C, Viale PL, Ambretti S. Bloodstream infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam: epidemiology and genomic characterization. Clin Microbiol Infect. 2020;26(4):516.e1-516.e4. doi:10.1016/j.cmi.2019. 11.011
21. Balandín B, Ballesteros D, Pintado V, et al. Multicentre study of ceftazidime/avibactam for Gram-negative bacteria infections in critically ill patients. Int J Antimicrob Agents. 2022;59(3):106536. doi:10. 1016/j.ijantimicag.2022.106536
22. Isler B, Aslan AT, Akova M, Harris P, Paterson DL. Treatment strategies for OXA-48-like and NDM producing Klebsiella pneumoniae infections. Expert Rev Anti Infect Ther. 2022;20(11):1389-1400. doi:10.1080/14787210.2022.2128764
23. Öztaş S, ER DK, Dündar D. Karbapenemlere dirençli ve duyarlı Klebsiella pneumoniae izolatlarının çeşitli antimikrobiyallere direnç oranları. KOU Sag Bil Derg. 2022;8(3):229-232. doi:10.30934/kusbed.1163427
24. Di Bella S, Giacobbe DR, Maraolo AE, et al. Resistance to ceftazidime/avibactam in infections and colonisations by KPC-producing Enterobacterales: a systematic review of observational clinical studies. J Glob Antimicrob Resist. 2021;25:268-281. doi:10.1016/j.jgar.2021.04.001
25. Akbaş E, Keskin BH, Kayman H, et al. Çok ilaca dirençli gram negatif bakterilerdeki seftazidim-avibaktam duyarlılığının araştırılması. ANKEM Derg. 2023;37(3):103-108. doi:10.54962/ankemderg.1406287
26. Stone GG, Seifert H, Nord CE. In vitro activity of ceftazidime-avibactam against gram-negative isolates collected in 18 European countries, 2015-2017. Int J Antimicrob Agents. 2020;56(3):106045. doi:10.1016/j.ijantimicag.2020.106045
27. Shields RK, Chen L, Cheng S, et al. Emergence of Ceftazidime-Avibactam Resistance Due to Plasmid-Borne blaKPC-3 Mutations during Treatment of Carbapenem-Resistant Klebsiella pneumoniae Infections. Antimicrob Agents Chemother. 2017;61(3):e02097-16. doi:10. 1128/AAC.02097-16
28. Hoşbul T, Aydoğan C, Kaya S, Bedir O, Özcan H, Gümral R. In vitro activity of ceftazidime-avibactam and colistin against carbapenem-resistant Pseudomonas aerugınosa clinical isolates. J Ist Faculty Med. 2022;85(3):355-361. doi:10.26650/IUITFD.1092556
29. Wu G, Abraham T, Lee S. Ceftazidime-avibactam for treatment of carbapenem-resistant Enterobacteriaceae Bacteremia: table 1. Clin Infect Dis. 2016;63(8):1147-1148. doi:10.1093/cid/ciw491
30. Camargo JF, Simkins J, Beduschi T, et al. Successful treatment of carbapenemase-producing pandrug-resistant Klebsiella pneumoniae bacteremia. Antimicrob Agents Chemother. 2015;59(10):5903-5908. doi: 10.1128/AAC.00655-15
31. Akalın H. Karbapenem dirençli Enterobacteriaceae enfeksiyonlarının tedavisi. Görenek L, editör. Karbapenem dirençli gram-negatif bakteri enfeksiyonları. 1. Baskı. Ankara: Türkiye Klinikleri; 2023;45-60.
Article available in :
Volume 8, Issue 1, 2025
Page : 80-84
https://doi.org/10.32322/jhsm.1583801
Article Information
Received : 19 Kas 2024
Accepted : 11 Ara 2024
Published : 12 Oca 2025
Corresponding Author :

Emine Serap Yılmaz: Department of Chest Diseases, Faculty of Medicine, Ordu University, Ordu, Turkiye

[email protected]
Citation : Yılmaz ES, Kalaycı HÖ. Evaluation of the in vitro efficacy of ceftazidime-avibactam against Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolates from respiratory tract cultures in intensive care units. J Health Sci Med. 2025;8(1):80-84.

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