ASSESSING PHENOTYPIC SYNERGISTIC ACTIVITY OF CEFTAZIDIMEAVIBACTAM AND AZTREONAM AGAINST CARBAPENEMASE PRODUCING MULTIDRUG RESISTANT GRAM-NEGATIVE ORGANISMS IN A TERTIARY CARE HOSPITAL, NAVI MUMBAI.
Bibliographic record
Abstract
Introduction: Multidrug resistance organisms have become a great concern globally. Ceftazidime-avibactam (CAZ/AVI) has a broad-spectrum activity against Ambler molecular Class A (narrow-spectrum & extended-spectrum beta-lactamases (ESBLs), serine carbapenemase including KPC). It also has activity against some Class C (KPC) and Class D carbapenemase including OXA-48-like enzymes in Enterobacteriaceae. The study aims to identify clinically relevant sy Aim: nergy between CAZ/AVI+Aztreonam (ATM) for multidrug resistant isolates (MDR) using E-test/disc method. A total of 60 non- Material & Methods: duplicate clinical isolates of different clinical specimens (blood, pus, sputum, urine, and sterile body uids) were collected prospectively over 3- month period (January – March 2022). Antimicrobial susceptibility determined by Kirby-Bauer disc diffusion method. CAZ/AVI+ATM synergy was determined using E- test/disc method. NMIC 500 BD phoenix automated system conrmed the presence of class of enzymes. Of Results: the 60 MDR isolates, Klebsiella (n=35; 58.3%) was the most common followed by E. coli (n=17; 28.3%). CAZ/AVI was susceptible for 25% (n= 15) of the isolates and the remaining 45(75%) were resistant. CLSI guidelines used for interpretation. Using qualitative E-test/disc diffusion method, addition of aztreonam to CAZ/AVI showed susceptibility for 66% (n=30/45) of CAZ/AVI resistant isolates demonstrating a Reverse D synergy. The remaining 15 (out of 45) isolates showed resistance to the above combination and thereby showing no synergy. The most common class of enzymes were Class D (n=25/60) followed by Class B (n=19/60). In screening for CZA Conclusion: /AVI +ATM synergy, the E-test/disc method provides a quick and practical approach for the real world screening and for the targeted use in the patients. This approach would be more relevant considering NDM and its coproduction prevalence is on the rise with limited antibiotic options for such infections.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".