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. 2025 Apr;30(14):2400399.
doi: 10.2807/1560-7917.ES.2025.30.14.2400399.

The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020

Rebecca L Guy  1 , Katie L Hopkins  2   1 , Emma L Budd  1 , Kate Wilson  1 , Holly Fountain  1 , Danièle Meunier  2   1 , Rachel Pike  2 , Sarah M Gerver  1 , Roshina Gnanadurai  3 , Colin S Brown  1 , Susan Hopkins  1 , Berit Muller-Pebody  1
Affiliations

The importance of monitoring a new antibiotic: ceftazidime/avibactam usage and resistance experience from England, 2016 to 2020

Rebecca L Guy et al. Euro Surveill. 2025 Apr.

Abstract

BackgroundCeftazidime/avibactam, launched in the United Kingdom (UK) in March 2017, is an antibiotic against multidrug-resistant Gram-negative pathogens. It was selected for the government's subscription model pilot, for incentivising new antibiotic development, which began in December 2020.AimAhead of the pilot, we assessed ceftazidime/avibactam testing, resistance (2016-2020) and usage (2017-2020) levels in England, as baselines for future surveillance.MethodsFrom routine surveillance samples, we retrieved reported ceftazidime/avibactam resistance categorisation. From reference laboratory samples, we reviewed minimum inhibitory concentration (MICs) and molecular data. Among surveillance samples, per cent resistance was estimated. Referred samples' MICs, by carbapenemase gene presence, were investigated. Ceftazidime/avibactam hospital use was measured in defined daily doses (DDDs).ResultsOverall, 6.3% (4,200/66,914; 95% confidence interval (95%CI): 6.1-6.4%) of surveillance-reported ceftazidime/avibactam-tested Gram-negative bacteria were resistant. Percentage resistance per bacterial species varied over time, somewhat stabilising as testing was established, with between April 2019 and March 2020, 1.3% Escherichia coli (288/22,736; 95%CI: 1.1-1.4%), 12.6% Pseudomonas aeruginosa (690/5,495; 95%CI: 11.7-13.5%) and 6.1% of Klebsiella pneumoniae (314/5,179; 95%CI: 5.4-6.7%) being resistant. For 8,437 referred Enterobacterales, MIC determination found 11.5% (968/8,437; 95%CI: 10.8-12.2%) resistant. Among resistant isolates, 89.3% (864/968; 95%CI: 87.1-91.1%) had metallo-β-lactamase (MBL) genes. Of 908 MBL-negative isolates, producing ≥ 1 non-metallo-carbapenemase(s), 2.1% (19/908; 95%CI: 1.3-3.2%) were resistant. Since March 2017, 69.5% (105/151) of English National Health Service Trusts used ceftazidime/avibactam. Monthly usage progressed from 21 to 744 DDDs in March 2020.ConclusionFor appropriate treatment, carbapenemase gene detection and variant identification in ceftazidime/avibactam surveillance matters. Detecting emerging resistant pathogens and preventing spread within healthcare settings requires vigilance.

Keywords: AMR; AMS; AMU; CPE; Enterobacterales; carbapenemase; ceftazidime/avibactam; emerging resistance; new antimicrobial.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Hospital admission rate of infections with bacteria tested for susceptibility to ceftazidime/avibactam by (A) all and (B) main bacterial species, based on routine diagnostic-laboratory surveillance data, England, April 2016–March 2020 (n = 67,535a bacterial isolates)
Figure 2
Figure 2
Number of Enterobacterales for which ceftazidime/avibactam MIC was determined including the number of resistant, UKHSA AMRHAI Reference Unit, England, April 2016–March 2020 (n = 8,437 isolates tested)
Figure 3
Figure 3
Ceftazidime/avibactam and colistin use in DDDs per 1,000 admissions in NHS Trusts by month, England, March 2017–March 2020
See this image and copyright information in PMC

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