Evidence map›Paper›PMID 41001706›Full record

ArticleThe Journal of antimicrobial chemotherapy2025

Comparative evaluation of disc diffusion and broth microdilution methods for aztreonam/avibactam susceptibility testing in Enterobacterales.

Ioannis Baltas, Deny Tsakri, Sofia Vourli, Himani Solanki, Evelyn Murrell, Eftychia Kiousi, Zacharias Tsakris, Gabriella Kuczmar, Nikoletta Smyrni, Ioannis Skiadas and 6 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of antimicrobial chemotherapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Ioannis BaltasInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.ORCID 0000-0002-8008-4835
Deny TsakriInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.
Sofia VourliInstitute of Biosciences and Applications, NCSR 'Demokritos', Athens, Greece.
Himani SolankiInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.
Evelyn MurrellInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.
Eftychia KiousiInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.
Zacharias TsakrisInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.
Gabriella KuczmarDepartment of Clinical Microbiology, Great Ormond Street Hospital for Children, London, UK.
Nikoletta SmyrniPfizer Hellas, Athens, Greece.
Ioannis SkiadasPfizer Hellas, Athens, Greece.
Vassilios GrammelisPfizer Hellas, Athens, Greece.
James HatcherInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.ORCID 0000-0003-2417-346X
Damianos MenegasPfizer Hellas, Athens, Greece.
Athanasios TsakrisDepartment of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Georgia VrioniDepartment of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Louis GrandjeanInfection, Immunity & Inflammation Department, UCL Institute of Child Health, London, UK.

Funding

Using the Mycobacterium tuberculosis Genome to Predict Tuberculosis Pathology, Drug Resistance Acquisition and Identify Community Transmission SitesR01AI146338 · NIAID · JOHNS HOPKINS UNIVERSITY · PI GILMAN, ROBERT H · 2020 to 2024
$3.3M
GOSH/ICH Biomedical Research CentreNational Institute of Allergy and Infectious DiseasesNIAID NIH HHS R01 AI146338NIH HHS 1R01AI146338Wellcome TrustWellcome Trust 226007/Z/22/Z
6 · The paper itself

Abstract

backgroundAztreonam/avibactam is a novel β-lactam/β-lactamase inhibitor (BL/BLI) combination active against carbapenem-resistant Enterobacterales (CRE), including MBL-producing isolates. In May 2024, EUCAST published Enterobacterales breakpoints for aztreonam/avibactam. This study aimed to assess the performance of commercially available disc diffusion (DD) against broth microdilution (BMD) using the latest EUCAST breakpoints.

methodsWe tested 278 CRE causing infections in 17 Greek ICUs between 2021 and 2023, using 30/20 μg aztreonam/avibactam discs and BMD according to EUCAST methodology and EUCAST version 15.0 breakpoints.

resultsMost isolates were identified as Klebsiella pneumoniae (97.8%), and 98.9% produced carbapenemases, including 46.4% KPC, 20.1% NDM, 5.4% VIM and 27% multiple carbapenemases. Using BMD, 94.2% of isolates were susceptible to aztreonam/avibactam. Conversely, using DD, 66.9% were susceptible, 33.1% resistant and 27% within the area of technical uncertainty (ATU). Most isolates in the ATU were KPC-producing (68%) or KPC and MBL-producing (29.3%). All isolates in the ATU (22-24 mm) tested susceptible by BMD (MIC ≤ 4 mg/L). One isolate exhibited resistance by DD (20 mm), but was susceptible by BMD. Categorical agreement (CA) was 72.7%, with 29% major errors (MEs) and 0% very major errors (VMEs). Using a breakpoint of 22 mm, CA, ME and VME were 99.6%, 0.4% and 0%, respectively.

conclusionsAztreonam/avibactam showed potent in vitro activity against MBL- and KPC-producing Enterobacterales. Using the 2025 EUCAST breakpoint, all isolates in the ATU tested susceptible by BMD, leading to high MEs of the DD method. A 22 mm breakpoint would have corrected this discrepancy in our cohort.

Indexed as

Anti-Bacterial AgentsAzabicyclo CompoundsAztreonambeta-Lactamase InhibitorsDisk Diffusion Antimicrobial TestsEnterobacteriaceaebeta-LactamasesCarbapenem-Resistant EnterobacteriaceaeDrug CombinationsEnterobacteriaceae InfectionsGreeceHumansMicrobial Sensitivity TestsAnti-Bacterial AgentsavibactamAzabicyclo CompoundsAztreonambeta-Lactamase Inhibitorsbeta-LactamasesDrug Combinations

Identifiers

PMID41001706
PMCPMC12670149

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.