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High ceftazidime-avibactam resistance rate in carbapenem-resistant gram-negative organisms in Pakistan's pediatric

Naima Mehdi1, Nadia Majeed2, Farwa Ali3

  • 1Naima Mehdi, M.Phil. Assistant Professor, Department of Microbiology, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.

Pakistan Journal of Medical Sciences
|March 19, 2025
PubMed

Insights

High resistance to Ceftazidime-Avibactam (CAZ-AVI) was observed in pediatric carbapenem-resistant gram-negative organisms in Pakistan. This highlights the urgent need for careful CAZ-AVI use and further research into antimicrobial resistance strategies.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Pharmacology

Background:

  • Carbapenem-resistant gram-negative organisms (GNOs) pose a significant global health threat.
  • The emergence of resistance to newer antibiotics like Ceftazidime-Avibactam (CAZ-AVI) is a growing concern, particularly in vulnerable pediatric populations.
  • Understanding resistance patterns is crucial for effective treatment strategies.

Purpose of the Study:

  • To investigate the prevalence and patterns of resistance to Ceftazidime-Avibactam (CAZ-AVI) in pediatric carbapenem-resistant gram-negative organisms (GNOs) in Pakistan.
  • To assess the susceptibility of common GNOs to CAZ-AVI.
  • To inform clinical decision-making regarding the use of CAZ-AVI.

Main Methods:

  • A prospective study was conducted from May to July 2023 at The Children's Hospital, Lahore.
  • 7491 specimens (blood, CSF, urine, pus, etc.) were analyzed for carbapenem-resistant GNOs.
  • Organisms were identified using Analytical Profile Index and tested for CAZ-AVI resistance via Kirby-Bauer disk diffusion.

Main Results:

  • Out of 217 carbapenem-resistant GNOs, 153 (70.5%) exhibited resistance to CAZ-AVI.
  • Klebsiella sp. showed the highest resistance rate (80% of resistant isolates), followed by Pseudomonas sp. (14%) and Escherichia coli (6%).
  • Pre-existing resistance mechanisms are suggested as a cause for CAZ-AVI resistance.

Conclusions:

  • High rates of CAZ-AVI resistance in pediatric carbapenem-resistant GNOs necessitate cautious use of this drug, especially as monotherapy.
  • Mandatory susceptibility testing for CAZ-AVI before empiric use is recommended.
  • The study underscores the challenges of combating emerging antimicrobial resistance and the need for adaptive treatment strategies.
Abstract

Keywords:
Antimicrobial resistanceCarbapenemasesCeftazidime-AvibactamESBLsGram-Negative Organisms

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