Use of Ceftazidime-Avibactam in Infants and Children

Marcia L. Buck, PharmD, FCCP, FPPAG, BCPPS


Pediatr Pharm. 2019;25(5) 

In This Article

Bacterial Resistance

While the results of the INFORM surveillance program are promising, there are already reports of resistance to ceftazidime-avibactam. The resistant strains identified to date have been most frequently the result of an amino acid substitution at or near the omega loop of the KPC enzyme.[4,7] In an early release from The Journal of Antimicrobial Chemotherapy, Hemarajata and Humphries described resistance occurring after use of ceftazidime-avibactam in a patient with end-stage renal and liver disease on dialysis while awaiting liver transplantation.7 On hospital day 35, the patient was placed on cefepime and vancomycin for ventilator-associated pneumonia. Three days later, a KPC-2 producing strain of K. pneumoniae was identified and treatment was changed to ceftazidime-avibactam and gentamicin. Twelve days later, K. pneumoniae was again isolated from a blood culture. This isolate contained a single L169P mutation in the KPC-2 enzyme which significantly reduced susceptibility to ceftazidime-avibactam and necessitated a change to meropenem for another 13 days until clinical cure was achieved.