First Study of Antimicrobial Activity of Ceftazidime-Avibactam and Ceftolozane-Tazobactam Against Pseudomonas aeruginosa Isolated from Patients with Urinary Tract Infection in Tehran, Iran

Figures & data

Table 1 The List of Primer Sequences Used for PCR Conditions

Target	Primer Sequence (5′–3′)	Size (bp)	Annealing Temp (°C)	References
blaVIM	GATGGTGTTTGGTCGCATA CGAATGCGCAGCACCAG	390	61°	[^Citation14]
blaIMP	GGAATAGAGTGGCTTAAYTCTC GGTTTAAYAAAACAACCACC	232	55°	[^Citation14]
blaNDM	GGTTTGGCGATCTGGTTTTC CGGAATGGCTCATCACGATC	621	56°	[^Citation14]
blaSPM	CCTACAATCTAACGGCGACC TCGCCGTGTCCAGGTATAAC	674	60°	[^Citation15]
blaOXA48	GCGTGGTTAAGGATGAACAC CATCAAGTTCAACCCAACCG	438	55°	[^Citation14
blaOXA2	AAGAAACGCTACTCGCCTGC CCACTCAACCCATCCTACCC	478	56°	[^Citation16]
blaOXA10	CCGAAGCCGTCAATGGTG CCAACCCACCATGCGACA	571	61°	[^Citation12]
blaCTX-M	CGCTTTGCGATGTGCAG ACCGCGATATCGTTGGT	550	51°	[^Citation17]
blaPER	ATGAATGGTCATTATAAAAGC AATTTGGGCTTAGGGCAGAA	580	43°	[^Citation18]
blaGES	ATGCGCTTCATTCACGCAC CTATTTGTCCGTGCTCAGG	846	56°	[^Citation19]

Table 2 Resistance Patterns of Ceftazidime-Avibactam and Ceftolozane-Tazobactam Resistant P. aeruginosa Isolates

Antibiotics	R	I	S	Resistant (%)	Sensitive (%)
Imipenem	14	0	2	87.5	12.5
Ertapenem	14	0	2	87.5	12.5
Gentamicin	15	0	1	93.8	6.2
Amikacin	12	3	1	75	6.2
Cefotaxime	16	0	0	100	0
Ceftazidime	13	3	0	81.2	0
Cefoxitin	16	0	0	100	0
Aztreonam	16	0	0	100	0
Cefepime	15	0	1	93.8	6.2
Fosfomycin	10	0	6	62.5	37.5
Nitrofurantoin	16	0	0	100	0
Ciprofloxacin	15	0	1	93.8	6.2
Levofloxacin	15	0	1	93.8	6.2

Abbreviations: R, resistant; I, intermediate; S, sensitive.

Table 3 Antibiotic Resistance Patterns of the 16 Resistant Isolates to CZA and C/T

Patterns	Antibiotics	Isolate No.
AP1	IMI, ETP, GM, AK, CTX, CAZ, FOT, ATM, CPM, NI, CRO, LEV	1, 2, 3, 9, 11, 13
AP2	IMI, ETP, GM, AK, CTX, CAZ, FOT, ATM, CPM, FOX, NI, CRO, LEV	4, 6, 10, 16
AP3	IMI, ETP, GM, CTX, CAZ, FOT, ATM, FOX, CPM, NI, CRO, LEV	5, 7
AP4	CTX, FOX, ATM, FOT, NI	8
AP5	GM, CTX, CAZ, FOX, ATM, CPM, FOT, NI, CRO, LEV	12
AP6	IMI, ETP, GM, AK, CTX, FOX, ATM, CPM, FOT, NI, CRO, LEV	14, 15

Abbreviations: IMI, imipenem; CAZ, ceftazidime; AK, amikacin; ATM, aztreonam; CRO, ciprofloxacin; GM, gentamicin; FOT, fosfomycin; NI, nitrofurantoin; FOX, cefoxitin; ETP, ertapenem; CPM, cefepime; CTX, cefotaxime; LEV, levofloxacin; AP, antibiotic pattern.

Table 4 Distribution of the Resistance Genes Among the Isolates and Their Relationships with Production of ESBL and MBL

Isolate	MBL	ESBL	MIC (µg/mL)								Gene (s)	IP/OP
			CZA	C/T	IMI		CAZ	AK	ATM	CRO
1	+	–	16	16		64	>256	256	32	16	OXA2, OXA10	IP
2	–	–	16	32		32	>256	64	64	16	OXA2, OXA10, VIM	OP
3	+	+	>32	>32		64	>256	64	>128	4	PER, OXA2, OXA10, VIM, OXA48	IP
4	+	–	16	16		>64	64	>256	64	8	OXA10, VIM	IP
5	+	–	32	32		>64	>256	32	>128	64	OXA10, VIM	OP
6	–	–	16	16		64	128	64	128	8	OXA2, OXA10	OP
7	+	+	>32	16		64	>256	32	64	64	PER, OXA10	IP
8	–	–	16	16		2	16	16	64	1	OXA10	IP
9	+	–	32	32		64	>256	128	>128	16	OXA10, OXA48	IP
10	+	–	16	16		32	>256	64	32	16	OXA10, OXA48	IP
11	+	–	32	32		8	64	128	64	8	OXA10, VIM, NDM, OXA48	OP
12	–	–	16	16		1	>256	32	>128	16	OXA10	IP
13	+	+	32	32		32	>256	64	32	32	OXA10, CTXM	OP
14	+	+	>32	>32		>64	16	>256	32	64	OXA10, CTXM, VIM, NDM, OXA48	IP
15	+	–	32	16		>64	16	>256	64	64	OXA10, VIM	IP
16	+	+	32	32		>64	>256	>256	128	64	OXA10, VIM	OP

Abbreviations: CZA, ceftazidime-avibactam; C/T, ceftolozan-tazobactam; IMI, Imipenem; CAZ, ceftazidime; AK, amikacin; ATM, aztreonam; CRO, ciprofloxacin; MBL, metallo beta lactamase; ESBL, extended-spectrum β-lactamase; MIC, minimum inhibitory concentration; IP, inpatient; OP, outpatient.

Figure 1 Genomic analysis of the isolates using PFGE. Dendrogram was constructed based on UPGMA by using Dice coefficient with a 1.0% band position tolerance. The scale above the dendrogram shows percentage of similarity and the dotted line indicates 85% similarity.

Abbreviations: OP, outpatient; ICU, intensive care unit.

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