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Ceftazidime-avibactam, meropenen-vaborbactam, and imipenem-relebactam in combination with aztreonam against multidrug-resistant, metallo-β-lactamase-producing Klebsiella pneumoniae

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Abstract

The spread of multidrug-resistant (MDR), metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae represents a major therapeutic challenge. The newly introduced β-lactam-β-lactamase inhibitors (BLBLIs), ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (M/V), and imipenem/relebactam (I/R) are inactive against MBLs. The aim of this study was to evaluate the in vitro efficacy of aztreonam (ATM) in combination with CAZ/AVI, M/V, and I/R against 40 MDR, MBL-producing, and serine-β-lactamases co-producing Klebsiella pneumoniae using the Etest method. Synergy was defined as a fractional inhibitory concentration index ≤0.5. All isolates were resistant to ATM, CAZ/AVI, and I/R and 38/40 (95%) were resistant to M/V. Synergy was observed in 97.5% in the combinations CAZ/AVI-ATM, and I/R-ATM and in 72.5% in the combination M/V-ATM. Further clinical studies are required to confirm the efficacy of these antimicrobial combinations.

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Authors and Affiliations

  1. Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece

    Sofia Maraki, Panagiotis Moraitis, Dimitra Stafylaki & Anna Kasimati

  2. University of Crete Medical School, Heraklion, Crete, Greece

    Viktoria Eirini Mavromanolaki

  3. Laboratory of Clinical Microbiology and Molecular Microbiology, School of Medicine, University of Crete, Crete, Greece

    Eleni Magkafouraki & Effie Scoulica

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  1. Sofia Maraki
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Correspondence to Sofia Maraki.

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Ethical approval was waived by the local Ethics Committee of the University Hospital of Heraklion in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Maraki, S., Mavromanolaki, V.E., Moraitis, P. et al. Ceftazidime-avibactam, meropenen-vaborbactam, and imipenem-relebactam in combination with aztreonam against multidrug-resistant, metallo-β-lactamase-producing Klebsiella pneumoniae. Eur J Clin Microbiol Infect Dis 40, 1755–1759 (2021). https://doi.org/10.1007/s10096-021-04197-3

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