title: Susceptibility to cephalosporin combinations and aztreonam/avibactam among third-generation cephalosporin-resistant Enterobacteriaceae recovered on hospital admission.
abstract: As part of the multicentre Antibiotic Therapy Optimisation Study (ATHOS), minimum inhibitory concentrations (MICs) were determined for cephalosporins alone and in combination with the β-lactamase inhibitors tazobactam, clavulanic acid and avibactam against third-generation cephalosporin-resistant Escherichia coli, Klebsiella spp. and Enterobacter spp. isolates collected in German hospitals. MIC50/90values were 0.25-4 mg/L for cefepime/tazobactam, 0.25-2 mg/L for ceftazidime/avibactam, 0.125-0.5 mg/L for ceftaroline/avibactam, 0.5-4 mg/L for cefpodoxime/clavulanic acid and 0.25-1 mg/L for aztreonam/avibactam, depending on the underlying resistance mechanism and organism. Based on in vitro testing, β-lactam antibiotics play an important role in the treatment of infections due to β-lactamase-producing organisms.
authors.affiliation: German Center for Infection Research (DZIF), Germany; Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: alexander.mischnik@uniklinik-freiburg.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mischnik
authors.affiliation: German Center for Infection Research (DZIF), Germany; Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Baumert
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Hamprecht
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital Berlin, Berlin, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Rohde
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Peter
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Feihl
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Knobloch
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany.
authors.forename: Hanna
authors.initials: H
authors.lastname: Gölz
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital Berlin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kola
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Obermann
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Querbach
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Willmann
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany.
authors.forename: Friedemann
authors.initials: F
authors.lastname: Gebhardt
authors.affiliation: German Center for Infection Research (DZIF), Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany.
authors.forename: Evelina
authors.initials: E
authors.lastname: Tacconelli
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital Berlin, Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: German Center for Infection Research (DZIF), Germany; Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Seifert
authors.affiliation: German Center for Infection Research (DZIF), Germany; Division of Infectious Diseases, Department of Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany.
authors.forename: Winfried V
authors.initials: WV
authors.lastname: Kern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D053961:Azabicyclo Compounds / Q000494:pharmacology*; D001398:Aztreonam / Q000494:pharmacology*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D019818:Clavulanic Acid / Q000494:pharmacology; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D005858:Germany; D006761:Hospitals; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D000078142:Tazobactam; D055815:Young Adult; D065093:beta-Lactamase Inhibitors / Q000494:pharmacology*
chemical_list: D000900:Anti-Bacterial Agents; D053961:Azabicyclo Compounds; D002511:Cephalosporins; D065093:beta-Lactamase Inhibitors; D019818:Clavulanic Acid; C543519:avibactam; D010397:Penicillanic Acid; D001398:Aztreonam; D000078142:Tazobactam
keywords: AmpC; Avibactam; ESBL; Extended-spectrum β-lactamase; β-Lactam