ArticleAnnals of African medicine2026
Assessing the Synergistic Potential of Ceftazidime-avibactam and Aztreonam against Metallo-beta-lactamase Producing Enterobacterales by Disc Elution and Disc E Strip - Synergy Method.
Article in Annals of African medicine, 2026. 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
introductionEmergence of carbapenem-resistant Gram-negative pathogens poses a significant challenge due to limited treatment options and higher mortality rates associated with infections caused by these pathogens. A combination of aztreonam (AT) and ceftazidime/avibactam (CZA-AVI) is an effective combination with synergistic activity against metallo-beta-lactamase (MBL) producing carbapenem resistant Enterobacterales (CRE). This study aimed to compare the disc elution and disc-E strip method for assessing the synergistic effect of aztreonam and ceftazidime/avibactam against MBL-producing CRE, with the potential to inform effective treatment strategies. METHODOLOGY: A total of 55 samples were isolated from clinical samples, in which 65.45% Klebsiella pneumoniae and 27.27% Escherichia coli were resistant to the tested carbapenem (meropenem) by the Vitek-2 compact system. Molecular detection of the New Delhi MBL, Verona integron-encoded MBL, or imipenemase gene was performed by conventional multiplex polymerase chain reaction. The synergy between aztreonam (30 µg) and ceftazidime-avibactam (30/20 µg) against MBL-producing CRE was assessed using both the disc elution and the disc-E strip synergy method.
resultsOut of the 55 carbapenem-resistant isolates, K. pneumoniae (65.4%) being the most common isolate, and urinary tract and bloodstream infections were the primary sources. Neutropenia was a significant risk factor, and high antibiotic resistance was observed, where 63.4% isolates were extensively drug-resistant, whereas 21% were pan-drug resistant, and 15.4% multidrug-resistant. With increasing awareness among clinicians, CZA-AVI + AT is being used. Comparison between disc elution and disc E-test showed 96.4% concordance.
conclusionThis study highlights the need to evaluate ATM and CAZ/AVI as potential therapeutic alternative for the treatment of infections caused by MBL-producing Enterobacterales . Hence, synergy testing should be incorporated into routine laboratory practises to save time and give appropriate targeted therapy.
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