In Vitro Susceptibility of Global Surveillance Isolates of Pseudomonas aeruginosa to Ceftazidime-Avibactam (INFORM 2012 to 2014)

Broth microdilution antimicrobial susceptibility testing was performed for ceftazidime-avibactam and comparator agents against 7,062 clinical isolates of Pseudomonas aeruginosa collected from 2012 to 2014 in four geographic regions (Europe, Asia/South Pacific, Latin America, Middle East/Africa) as part of the International Network for Optimal Resistance Monitoring (INFORM) global surveillance program. The majority of isolates were susceptible to ceftazidime-avibactam, with the proportions susceptible differing marginally across the four regions (MIC90, 8 to 16 mu g/ml; 88.7 to 93.2% susceptible), in contrast to lower susceptibilities to the following comparator beta-lactam agents: ceftazidime (MIC90, 32 to 64 mu g/ml; 71.5 to 80.8% susceptible), meropenem (MIC90,> 8 mu g/ml; 64.9 to 77.4% susceptible), and piperacillin-tazobactam (MIC90,> 128 mu g/ml; 62.3 to 71.3% susceptible). Compared to the overall population, susceptibility to ceftazidime-avibactam of isolates that were nonsusceptible to ceftazidime (n = 1,627) was reduced to between 56.8% (Middle East/Africa; MIC90, 64 mu g/ml) and 68.9% (Asia/South Pacific; MIC90, 128 mu g/ml), but these percentages were higher than susceptibilities to other beta-lactam agents (0 to 44% susceptible, depending on region and agent; meropenem MIC90,> 8 mu g/ml; 26.5 to 43.9% susceptible). For this subset of isolates, susceptibilities to amikacin (MIC90,> 32 mu g/ml; 53.2 to 80.0% susceptible) and colistin (MIC90, 1 mu g/ml; 98.5 to 99.5% susceptible) were comparable to or higher than that of ceftazidime-avibactam. A similar observation was made with isolates that were nonsusceptible to meropenem (n = 1,926), with susceptibility to ceftazidime-avibactam between 67.8% (Middle East/Africa; MIC90, 64 mu g/ml) and 74.2% (Europe; MIC90, 32 mu g/ml) but again with reduced susceptibility to comparators except for amikacin (MIC90,> 32 mu g/ml; 56.8 to 78.7% susceptible) and colistin (MIC90, 1 mu g/ml; 98.9 to 99.3% susceptible). Of the 8% of isolates not susceptible to ceftazidime-avibactam, the nonsusceptibility of half could be explained by their possession of genes encoding metallo-beta-lactamases. The data reported here are consistent with results from other country-specific and regional surveillance studies and show that ceftazidime-avibactam demonstrates in vitro activity against globally collected clinical isolates of P. aeruginosa, including isolates that are resistant to ceftazidime and meropenem.