ArticleJAC-antimicrobial resistance2025
Antimicrobial susceptibility of Enterobacterales causing infection in the elderly: focus on aztreonam-avibactam and recently approved β-lactamase inhibitor combinations.
Article in JAC-antimicrobial resistance, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The US elderly population (≥65 years old) increased markedly in the last decades, and infections are responsible for approximately one-third of all deaths in this population. We evaluated the antimicrobial susceptibility of Enterobacterales causing infection in elderly patients in US hospitals. Methods: Unique patient clinical isolates were consecutively collected from 72 US hospitals in 2021-2023 and tested for susceptibility by broth microdilution. Results for 10 574 Enterobacterales from elderly patients were analysed and compared with 9793 isolates from adult patients (18-64 years old). Carbapenem-resistant Enterobacterales (CRE) were screened for carbapenemases by whole-genome sequencing. Results: All isolates from elderly patients were inhibited at aztreonam-avibactam MIC of ≤8 mg/L (>99.9% susceptible at ≤4 mg/L). Ceftazidime-avibactam and meropenem-vaborbactam were very active against Enterobacterales overall (≥99.7% susceptible) but exhibited limited activity against CRE (70.4%-71.6% susceptible). The most active agents against CRE were aztreonam-avibactam (98.8% susceptible), cefiderocol (96.3% susceptible) and tigecycline (96.3% susceptible). Susceptibility rates of isolates from the elderly were comparable (±≤ 2.6%) with those from the adult population; however, the frequencies of CRE and MDR phenotypes were lower among the elderly than adults. The most common carbapenemase among CREs from elderly patients were Conclusions: Enterobacterales causing infections in the elderly population showed a similar antimicrobial resistance profile but a lower frequency of CRE and MDR isolates to those causing infection in the adults.
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