Monday, 5 May 2025

P CEFTAZIDIME /AVIBACTAM

 A

Here is a summary in bullet points of the study titled:

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

πŸ” Study Aims and Context

  • The UK piloted a novel antibiotic subscription model in December 2020 to incentivize new antibiotic development.

  • Ceftazidime/avibactam was selected as one of the antibiotics in this model.

  • Study aimed to provide baseline data on usage, resistance, and testing patterns before the pilot launch.

πŸ’Š About Ceftazidime/Avibactam

  • A Ξ²-lactam/Ξ²-lactamase inhibitor combination, licensed in the UK in 2017.

  • Effective against many resistant Gram-negative bacteria, especially those producing ESBLs, KPC, and OXA-48-like enzymes.

  • Not effective against metallo-Ξ²-lactamases (NDM, VIM, IMP).

πŸ“ˆ Usage and Testing Trends (2016–2020)

  • Susceptibility testing increased significantly: from just 5 specimens in 2016 to over 10,000 in early 2020.

  • 67,549 specimens tested from 51,949 patients; 94% were Enterobacterales or P. aeruginosa.

  • Most tested species: E. coli, P. aeruginosa, K. pneumoniae.

🧬 Resistance Findings

  • Resistance was generally low but present, sometimes linked to carbapenemase genes.

  • Resistance mechanisms included:

    • Mutations in Ξ²-lactamase enzymes.

    • Increased gene copy numbers.

    • Efflux pumps and porin changes reducing drug entry.

  • Some cases showed resistance emerging during treatment.

πŸ₯ Public Health Implications

  • Essential to test for carbapenemase genes prior to using ceftazidime/avibactam.

  • Resistance can emerge during therapy—monitoring is crucial.

  • Individualized treatment plans and national surveillance are key to preserving efficacy.

πŸ§ͺ Data Sources

  • Routine surveillance from SGSS (covers ~98% of labs in England).

  • Reference lab testing by UKHSA’s AMRHAI Unit for deeper resistance analysis.

  • Drug usage data from hospital pharmacy systems via IQVIA.

πŸ“Œ Conclusions

  • Growing use of ceftazidime/avibactam was observed ahead of the NHS subscription pilot.

  • Resistance remained low but not negligible; mechanisms are complex and evolving.

  • The study underscores the need for sustained surveillance and tailored antibiotic stewardship.

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