In VitroActivity of Ceftazidime-Avibactam Combination inIn VitroCheckerboard Assays

Abstract

ABSTRACTTo evaluate thein vitroeffects of the combination of ceftazidime and avibactam on the MICs of both compounds, checkerboard assays were performed for 81 clinical strains, including 55Enterobacteriaceaestrains (32Klebsiella pneumoniae, 19Escherichia coli, 1Citrobacter freundii, and 3Enterobacter cloacae) and 26 strains ofPseudomonas aeruginosa, all with known resistance mechanisms such as extended-spectrum β-lactamases (ESBLs) and carbapenemases, phenotypically or molecularly determined. Phenotypically ceftazidime-resistant strains (n= 69) were analyzed in more detail. For theEnterobacteriaceaestrains, a concentration-dependent effect of avibactam was found for most strains with a maximum effect of avibactam at a concentration of 4 mg/liter, which decreased all ceftazidime MICs to ≤4 mg/liter. Avibactam alone also showed antibacterial activity (the MIC50and MIC90being 8 and 16 mg/liter, respectively). For the ceftazidime-resistantP. aeruginosastrains, considerable inhibition of β-lactamases by avibactam was acquired at a concentration of 4 mg/liter, which decreased all ceftazidime MICs except one to ≤8 mg/liter (the CLSI and EUCAST susceptible breakpoint). Increasing the concentration of avibactam further decreased the MICs, resulting in a maximum effect for most strains at 8 to 16 mg/liter. In summary, for most strains, the tested addition of avibactam of 4 mg/liter restored the antibacterial activity of ceftazidime to a level comparable to that of wild-type strains, indicating full inhibition, and strains became susceptible according to the EUCAST and CLSI criteria. Based on thesein vitrodata, avibactam is a promising inhibitor of different β-lactamases, including ESBLs and carbapenemases.