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Background  Ceftazidime-avibactam was approved in China in 2019 for treating complicated intra-abdominal infections, hospital-acquired pneumonia, ventilator-associated pneumonia, and infections caused by  Enterobacterales  and  Pseudomonas aeruginosa  for which treatment options are limited. However, no currently available commercial systems have been approved for antimicrobial susceptibility testing of ceftazidime-avibactam in China. Here, we evaluated the Etest and disk diffusion method for detecting the activity of ceftazidime-avibactam against  Enterobacterales  and  P. aeruginosa  in China.    Results  In total, 194  Enterobacterales  and 77  P. aeruginosa  isolates, which were divided into a random selection group (140  Enterobacterales  and 46  P. aeruginosa  isolates) and stock group (54  Enterobacterales  and 31  P. aeruginosa  isolates), were assessed by the Etest, disk diffusion and broth microdilution methods. Minimum inhibitory concentrations and zone diameters were interpreted according to the CLSI supplement M100 30th edition. For all 271 tested isolates, no very major errors were found by using Etest, whereas the overall major error rate was 2.0% (4/203). The overall categorical agreement rates of Etest for  Enterobacterales  and  P. aeruginosa  were 99.5% (193/194) and 96.1% (74/77), respectively, and the essential agreement rates were 95.9% (186/194) and 94.8% (73/77), respectively. The disk diffusion method showed that the very major error and major error rates were 1.5% (3/204) and 2.5% (5/203), respectively. Overall categorical agreement rates values of the disk diffusion method for  Enterobacterales  and  P. aeruginosa  were 98.5% (191/194) and 93.5% (72/77) compared with broth microdilution, respectively.    Conclusions  For  Enterobacterales  and  P. aeruginosa , both the Etest and disk diffusion method showed acceptable performance as alternatives to the standard broth microdilution method for clinical treatment interpretation. Application of the disk diffusion method in  Enterobacterales  was slightly better than that in  P. aeruginosa .

bmc microbiology

Evaluation of the Etest and disk diffusion method for detection of the activity of ceftazidime-avibactam against Enterobacterales and Pseudomonas aeruginosa in China