Susceptibility to Ceftazidime-avibactam in pediatric bloodstream infections caused by multidrug-resistant Enterobacterales and Pseudomonas aeruginosa

Authors

• André Ricardo Araujo da Silva Silva Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brasil. https://orcid.org/0000-0002-3896-9226
• Luisa Benigno Barbosa Araujo da Silva Instituto Federal Fluminense, Rio de Janeiro, Rio de Janeiro, Brasil. https://orcid.org/0009-0009-1413-9859

DOI:

https://doi.org/10.17058/reci.v16i.20595

Keywords:

Child, Sepsis, Multi-Drug Resistance

Abstract

Background and Objectives: Ceftazidime–avibactam (CAZ–AVI) is one of the last-resort treatment options for carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa. The aim of this study was to describe the susceptibility profile of bloodstream isolates of Enterobacterales and Pseudomonas aeruginosa to ceftazidime-avibactam (CAZ-AVI) among strains resistant to third- and fourth-generation cephalosporins and/or carbapenems in children. Methods: A retrospective descriptive study was conducted at two pediatric hospitals in the city of Rio de Janeiro, Brazil, between January 2023 and February 2025. All bloodstream isolates resistant to third- and/or fourth-generation cephalosporins and/or carbapenems were tested for susceptibility to CAZ–AVI according to the BrCAST methodology. CAZ–AVI susceptibility, as well as the clinical characteristics and outcomes of the patients were described. Results: A total of 116 bloodstream isolates were analyzed. Of these, 107/116 (92.2%) were resistant to third- and/or fourth-generation cephalosporins but remained susceptible to carbapenems, while 9/116 (7.8%) were resistant to both third- and/or fourth-generation cephalosporins and carbapenems. Overall susceptibility to CAZ–AVI was observed in 107/116 (92.2%) isolates. The 116 bloodstream isolates corresponded to 73 bloodstream infection (BSI) episodes in 66 patients, including 66 single episodes and 7 persistent BSIs. Of the 73 infections, 69 (94.5%) were caused by Enterobacterales and 4 (5.5%) by Pseudomonas aeruginosa. Twenty-two (30.1%) infections were detected at hospital admission, and 51 (69.9%) were healthcare-associated infections. Five of 73 patients (6.8%) died. Length of hospital stay was significantly longer among non-survivors than among survivors (p = 0.01596). CAZ–AVI was prescribed to four patients with Enterobacterales or Pseudomonas aeruginosa bloodstream infections, all of whom achieved bloodstream clearance. Conclusion: Susceptibility to CAZ–AVI among bloodstream isolates from children was high, and this antibiotic could be an option for treating carbapenem-resistant infections caused by Enterobacterales and Pseudomonas aeruginosa.

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