Abstrakt

Aim: Escherichia coli is one of the Gram-negative bacteria, known to cause many nosocomial infections. Multi-drug (MDR) and extensively-drug resistant (XDR). E. coli are of particular note, due to significant limitations in antibiotic therapy. Ceftolozane-tazobactam and ceftazidime-avibactam are novel therapeutic options against Gram-negative bacteria; hence the aim of this study was to evaluate and compare the in vitro activity of ceftolozane-tazobactam and ceftazidime-avibactam against MDR and XDR clinical E. coli isolates. Material/Methods: The study included 100 non-replicate E. coli isolates derived from clinical samples of patients hospitalized in teaching hospitals. Bacteria were identified by applying mass spectrometry in the MALDI Biotyper system (Bruker). ESBL (bla_CTX-M-1group, bla_CTX-M-9group) and carbapenemase (bla_KPC, bla_VIM, bla_NDM, bla_OXA-48, bla_OXA-181) genes were detected using the eazyplex® SuperBug CRE test, based on a loop-mediated isothermal amplification (LAMP). The in vitro susceptibility to ceftolozane-tazobactam and ceftazidime-avibactam was tested using validated MIC Test strips (Liofilchem). Results: All 84 extended-spectrum β-lactamase-producing (ESBL) E. coli isolates were susceptible to ceftazidime-avibactam and 83 to ceftolozane-tazobactam. Among 17 E. coli isolates with resistance to at least one of the carbapenems, three (17.6%) were susceptible to ceftolozane-tazobactam and ceftazidime-avibactam. All 14 blaVIM gene-positive E. coli isolates were resistant to both ceftolozane-tazobactam and ceftazidime-avibactam. Both antibiotics were active against bla_CTX-M-9group and bla_OXA-48 gene-positive E. coli isolates, but they were not active against bla_CTX-M-1group and bla_VIM gene-positive isolates. Conclusions: Ceftolozane-tazobactam and ceftazidime-avibactam are alternative, non-carbapenem therapeutic options for ESBL-positive E. coli strains, and they are promising in the treatment of carbapenem-resistant E. coli strains, but not for those carrying the metallo-β-lactamase enzymes. Both drug combinations have comparable activity against ESBL, however, lower MIC values were found for ceftazidime-avibactam.

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