In Practice

Using ceftazidime-avibactam for persistent carbapenem-resistant Serratia marcescens infection highlights antimicrobial stewardship challenges with new beta-lactam-inhibitor combination antibiotics

H D Tootla, J Copelyn, A Botha, A J Brink, B Eley

Abstract


The newer beta-lactam-inhibitor combination (BLIC) antibiotics are available in South Africa (SA) for the treatment of carbapenem-resistant Enterobacterales infections. We describe the successful use of ceftazidime-avibactam (CA) for the treatment of a child with persistent carbapenem-resistant Serratia marcescens bacteraemia, and the challenges faced using this lifesaving antibiotic, including access to susceptibility testing, procurement process, cost and complexity of deciding when, how and for how long to use it. Furthermore, the burden of carbapenem resistance is increasing in SA, and inappropriate use of CA and other newer BLIC antibiotics, such as ceftolozane-tazobactam, will inevitably endanger their longevity. A careful balance must be struck between removing unnecessary obstacles and delays in initiating these antibiotics for life-threatening infections, and additional antimicrobial stewardship-guided interventions aimed at preserving their therapeutic use.


Authors' affiliations

H D Tootla, Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, and Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa

J Copelyn, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, and Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

A Botha, Western Cape Department of Health, Red Cross War Memorial Children’s Hospital Pharmacy, Cape Town, South Africa

A J Brink, Microbiology Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, and Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa

B Eley, Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, and Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa

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Keywords

Ceftazadime-avibactam; CA; CAZ-AVI; Stewardship; Carbapenem-resistant; Enterobacterales; CRE

Cite this article

South African Medical Journal 2021;111(8):729-731. DOI:10.7196/SAMJ.2021.v111i8.15762

Article History

Date submitted: 2021-08-02
Date published: 2021-08-02

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