Activity of aztreonam in combination with ceftazidime-avibactam against serine- and metallo-β-lactamase-producing Pseudomonas aeruginosa

Abstract

Existing data support the combination of aztreonam and ceftazidime-avibactam against serine-β-lactamase (SBL)- and metallo-β-lactamase (MBL)-producing Enterobacterales, although there is a paucity of data against SBL- and MBL-producing Pseudomonas aeruginosa. In this study, 5 SBL- and MBL-producing P. aeruginosa (1 IMP, 4 VIM) were evaluated against aztreonam and ceftazidime-avibactam alone and in combination via broth microdilution and time-kill analyses. All 5 isolates were nonsusceptible to aztreonam, aztreonam-avibactam, and ceftazidime-avibactam. Combining aztreonam with ceftazidime-avibactam at subinhibitory concentrations produced synergy and restored bactericidal activity in 4/5 (80%) isolates tested. These results suggest that the combination of aztreonam and ceftazidime-avibactam may be a viable treatment option against SBL- and MBL-producing P. aeruginosa.

Keywords: Aztreonam; Ceftazidime–avibactam; IMP; Metallo-β-lactamase; Synergy; VIM.