Evaluation of Low-cost, Manual Techniques for Rapid Detection of Ceftazidime-avibactam Susceptibility against Carbapenem-Resistant Enterobacterales

Ali, Salah A.I.; Ghamry, Aya A.; El-Zayaat, Alyaa M.; Alsayaad, Fatma M.A.; Ibrahim, Fatma A.

doi:10.21608/ejmm.2025.347909.1417

Evaluation of Low-cost, Manual Techniques for Rapid Detection of Ceftazidime-avibactam Susceptibility against Carbapenem-Resistant Enterobacterales

Document Type : New and original researches in the field of Microbiology.

Authors

¹ Clinical Pathology Department, Faculty of Medicine, Zagazig University, Sharqia, Egypt

² Medical Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt

³ Anesthesia, Intensive Care, and Pain management Department, Faculty of Medicine, Zagazig University, Sharqia, Egypt

⁴ Internal Medicine Department, Faculty of Medicine, Zagazig University, Sharqia, Egypt

10.21608/ejmm.2025.347909.1417

Abstract

Background: Ceftazidime-avibactam (CAZ–AVI) is a new effective therapeutic combination that exhibits exceptional efficacy against clinically significant serine β-lactam-resistant bacteria. Emergence of CAZ–AVI resistance has been observed in carbapenem-resistant Enterobacterales (CRE). Therefore, rapid and accurate detection of CAZ–AVI susceptibility is time-saving for clinical treatment measures. Objective: To assess the efficacy and usage in clinical setting of two low-cost, rapid simple manual methods for screening of CAZ-AVI activity against CRE, to restrict spread of diseases and drug resistance through the implementation of rapid infection control programs. Methodology: The susceptibility of CAZ-AVI among CRE isolates was assessed using Rapid CAZ/AVI NP and Rapid ResaCeftazidime-avibactam-Enterobacterales NP tests along with broth microdilution method (BMD). Vitek- 2 compact was utilized to identify CRE isolates and CAZ/AVI sensitivity using GN and AST cards and Gene-Xpert system was used to determine the type of carbapenemase encoding genes. Results: This study utilized a total of 93 CRE isolates. Rapid CAZ/AVI NP test enabled the detection of CRE susceptibility to CAZ/AVI within three hours, with an overall percent agreement (OPA) of 97.9%, 2.8% major errors (MEs) and 0% very major errors (VMEs). In contrast, Rapid ResaCeftazidime-avibactam Enterobacterales NP test can be interpreted after 4 hours with an OPA of 98.9%, 1.4% MEs and 0% VMEs. Conclusion: These screening manual tests were rapid, simple, straightforward and easily applicable in routine microbiology laboratories. These tests are anticipated to be valuable tools for rapid clinical screening of CAZ-AVI susceptibility after further optimization of the test conditions in the near future.

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