Monitoring Ceftazidime-Avibactam and Aztreonam Concentrations in the Treatment of a Bloodstream Infection Caused by a Multidrug-Resistant Enterobacter sp. Carrying Both Klebsiella pneumoniae Carbapenemase-4 and New Delhi Metallo-β-Lactamase-1

Clin Infect Dis. 2020 Aug 14;71(4):1095-1098. doi: 10.1093/cid/ciz1155.


In an infection with an Enterobacter sp. isolate producing Klebsiella pneumoniae Carbapenemase-4 and New Delhi Metallo-β-Lactamase-1 in the United States, recognition of the molecular basis of carbapenem resistance allowed for successful treatment by combining ceftazidime-avibactam and aztreonam. Antimicrobial synergy testing and therapeutic drug monitoring assessed treatment adequacy.

Keywords: KPC; NDM; aztreonam; carbapenemase; ceftazidime-avibactam.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Azabicyclo Compounds / therapeutic use
  • Aztreonam / therapeutic use
  • Bacteremia* / drug therapy
  • Bacterial Proteins
  • Ceftazidime / therapeutic use
  • Drug Combinations
  • Enterobacter
  • Humans
  • Klebsiella Infections* / drug therapy
  • Klebsiella pneumoniae / genetics
  • Microbial Sensitivity Tests
  • United States
  • beta-Lactamases / genetics


  • Anti-Bacterial Agents
  • Azabicyclo Compounds
  • Bacterial Proteins
  • Drug Combinations
  • avibactam, ceftazidime drug combination
  • Ceftazidime
  • beta-Lactamases
  • beta-lactamase NDM-1
  • carbapenemase
  • Aztreonam