Table 3.
In vitro activity of ceftazidime-avibactam and comparator agents against β-lactamase-positive Enterobacterales isolates collected in the Latin American region as part of the ATLAS global surveillance program from 2017-2019.
| Organism, phenotype/genotype (no. of isolates) | Antimicrobial agent | MIC (µg/ml) |
Interpretation (CLSI) |
|||
|---|---|---|---|---|---|---|
| MIC50 | MIC90 | % Susceptible | % Intermediate | % Resistant | ||
| ESBL-positive (1816)a | Ceftazidime-avibactam | 0.25 | 0.5 | 99.8 | NA | 0.2 |
| Ceftazidime | 32 | 128 | 13.1 | 11.2 | 75.7 | |
| Cefepime | >16 | >16 | 4.4 | 20.2 | 75.4 | |
| Piperacillin-tazobactam | 8 | >64 | 76.0 | 11.7 | 12.3 | |
| Meropenem | ≤0.06 | ≤0.06 | 97.3 | 1.8 | 0.9 | |
| Levofloxacin | >8 | >8 | 18.9 | 10.2 | 70.8 | |
| Amikacin | 4 | 8 | 95.1 | 1.9 | 3.0 | |
| Colistin | 0.5 | 1 | NA | 97.2 | 2.8 | |
| Tigecycline | 0.25 | 1 | 97.7 | 1.9 | 0.4 | |
| AmpC-positive (49)b | Ceftazidime-avibactam | 0.12 | 0.25 | 100 | NA | 0 |
| Ceftazidime | 32 | 128 | 6.1 | 16.3 | 77.6 | |
| Cefepime | 0.25 | 2 | 91.8 | 8.2 | 0.0 | |
| Piperacillin-tazobactam | 4 | >64 | 85.7 | 2.0 | 12.2 | |
| Meropenem | ≤0.06 | 0.12 | 100 | 0 | 0 | |
| Levofloxacin | 8 | >8 | 28.6 | 8.2 | 63.3 | |
| Amikacin | 2 | 4 | 100 | 0 | 0 | |
| Colistin | 0.25 | >8 | NA | 85.7 | 14.3 | |
| Tigecycline | 0.25 | 1 | 95.9 | 2.0 | 2.0 | |
| ESBL-positive + AmpC-positive (23)c | Ceftazidime-avibactam | 0.25 | 2 | 100 | NA | 0 |
| Ceftazidime | 64 | >128 | 0 | 8.7 | 91.3 | |
| Cefepime | >16 | >16 | 8.7 | 13.0 | 78.3 | |
| Piperacillin-tazobactam | 16 | >64 | 56.5 | 17.4 | 26.1 | |
| Meropenem | ≤0.06 | 0.25 | 95.7 | 0 | 4.3 | |
| Levofloxacin | >8 | >8 | 21.7 | 8.7 | 69.6 | |
| Amikacin | 2 | 8 | 91.3 | 0 | 8.7 | |
| Colistin | 0.25 | 0.5 | NA | 95.7 | 4.3 | |
| Tigecycline | 0.25 | 1 | 95.7 | 4.3 | 0 | |
| KPC-positive (364)d | Ceftazidime-avibactam | 0.5 | 2 | 99.5 | NA | 0.5 |
| Ceftazidime | 64 | >128 | 9.1 | 5.8 | 85.2 | |
| Cefepime | >16 | >16 | 7.7 | 9.3 | 83.0 | |
| Piperacillin-tazobactam | >64 | >64 | 2.5 | 5.8 | 91.8 | |
| Meropenem | >8 | >8 | 6.3 | 5.5 | 88.2 | |
| Levofloxacin | >8 | >8 | 16.5 | 6.6 | 76.9 | |
| Amikacin | 4 | >32 | 76.9 | 12.9 | 10.2 | |
| Colistin | 0.5 | >8 | NA | 75.3 | 24.7 | |
| Tigecycline | 0.5 | 2 | 97.8 | 1.9 | 0.3 | |
| GES-type carbapenemase-positive (5)e | Ceftazidime-avibactam | – | – | 100 | NA | 0 |
| Ceftazidime | – | – | 0 | 0 | 100 | |
| Cefepime | – | – | 40.0 | 60.0 | 0 | |
| Piperacillin-tazobactam | – | – | 20.0 | 20.0 | 60.0 | |
| Meropenem | – | – | 100 | 0 | 0 | |
| Levofloxacin | – | – | 60.0 | 40.0 | 0 | |
| Amikacin | – | – | 40.0 | 60.0 | 0 | |
| Colistin | – | – | NA | 100 | 0 | |
| Tigecycline | – | – | 100 | 0 | 0 | |
| OXA-48-like-positive (27)f | Ceftazidime-avibactam | 0.5 | 1 | 100 | NA | 0 |
| Ceftazidime | 64 | >128 | 7.4 | 0 | 92.6 | |
| Cefepime | >16 | >16 | 14.8 | 0 | 85.2 | |
| Piperacillin-tazobactam | >64 | >64 | 0 | 7.4 | 92.6 | |
| Meropenem | 2 | >8 | 37.0 | 18.5 | 44.4 | |
| Levofloxacin | >8 | >8 | 18.5 | 7.4 | 74.1 | |
| Amikacin | 2 | 16 | 96.3 | 3.7 | 0 | |
| Colistin | 0.5 | 1 | NA | 100 | 0 | |
| Tigecycline | 1 | 2 | 100 | 0 | 0 | |
| MBL-positive (146)g | Ceftazidime-avibactam | >128 | >128 | 1.4 | NA | 98.6 |
| Ceftazidime | >128 | >128 | 0 | 0 | 100 | |
| Cefepime | >16 | >16 | 0 | 8.2 | 91.8 | |
| Piperacillin-tazobactam | >64 | >64 | 2.7 | 8.2 | 89.0 | |
| Meropenem | >8 | >8 | 4.8 | 2.1 | 93.2 | |
| Levofloxacin | 8 | >8 | 21.9 | 15.8 | 62.3 | |
| Amikacin | 32 | >32 | 49.3 | 6.8 | 43.8 | |
| Colistin | 0.5 | >8 | NA | 82.9 | 17.1 | |
| Tigecycline | 0.5 | 2 | 91.8 | 7.5 | 0.7 | |
ESBL-positive, isolates in which one or more acquired β-lactamase genes encoding an ESBL was detected by PCR; includes isolates that co-carry original (narrow) spectrum β-lactamases but does not include isolates that co-carry AmpC β-lactamases or KPC, GES-type, OXA-48-like or MBL carbapenemases.
AmpC-positive, isolates in which an acquired β-lactamase gene encoding an AmpC β-lactamase was detected by PCR; includes isolates that co-carry original (narrow) spectrum β-lactamases but does not include isolates that co-carry other serine β-lactamases or MBLs.
ESBL-positive and AmpC-positive, isolates in which acquired β-lactamase genes encoding ESBL and AmpC β-lactamases were detected by PCR; includes isolates that co-carry original (narrow) spectrum β-lactamases but does not include isolates that co-carry serine carbapenemases or MBLs.
KPC-positive, isolates in which a gene encoding a KPC carbapenemase was detected by PCR; includes isolates that co-carry other serine β-lactamases (including one isolate that co-carried KPC-2 and OXA-48) but does not include isolates that co-carry MBLs.
GES-type carbapenemase-positive, isolates in which a gene encoding GES-20 was detected by PCR; includes isolates that co-carry original (narrow) spectrum β-lactamases but does not include isolates that co-carry other serine β-lactamases or MBLs.
OXA-48-like positive, isolates in which a gene encoding an OXA-48-like enzyme (OXA-48, OXA-181, OXA-232, OXA-163, OXA-370) was detected by PCR; includes isolates that co-carry original (narrow) spectrum β-lactamases or ESBLs but does not include isolates that co-carry AmpC, GES-type or KPC serine β-lactamases or MBLs.
MBL-positive, isolates in which a gene encoding an NDM-type, IMP-type or VIM-type MBL was detected by PCR; includes isolates that co-carry serine β-lactamases (original (narrow) spectrum β-lactamases, ESBLs, AmpC β-lactamases, GES-type, KPC, and OXA-48-like β-lactamases) and one isolate that carried two MBLs (IMP-27 and NDM-1).