2. Academic Validation
  3. Can aztreonam/avibactam combined with fosfomycin be a treatment option for infections caused by NDM-producing Pseudomonas aeruginosa?

Can aztreonam/avibactam combined with fosfomycin be a treatment option for infections caused by NDM-producing Pseudomonas aeruginosa?

  • Indian J Med Microbiol. 2026 May 14:62:101146. doi: 10.1016/j.ijmmb.2026.101146.
Rosemol Nelson 1,  Yamuna Devi Bakthavatchalam 2,  Binesh Lal Yesudason 3,  Yuvasri Manokaran 4,  Baby Abirami Shankar 5,  Sangeetha Nithya 6,  Rajiv Karthik 7,  Balaji Veeraraghavan 8
Affiliations

Affiliations

  • 1 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
  • 2 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
  • 3 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
  • 4 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
  • 5 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
  • 6 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
  • 7 Department of Infectious Diseases, Christian Medical College, Vellore, 632004, India. Electronic address: [email protected].
  • 8 Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. Electronic address: [email protected].
PMID: 42140317 DOI: 10.1016/j.ijmmb.2026.101146
Abstract

In India, most carbapenem-resistant Pseudomonas aeruginosa strains produce metallo-β lactamases, and cefiderocol, the sole reliable treatment option, is currently not available. This study evaluated aztreonam/avibactam with fosfomycin as an alternative in 85 MBL-producing isolates. Aztreonam/avibactam and fosfomycin inhibited 7.1% and 27.1% of isolates at 8 and 32 mg/L, respectively, while cefiderocol at 4 mg/L inhibited 78.8%. Time-kill assays on 10 isolates showed synergy in 7/10 and enhanced activity in 6/10 with the combination versus monotherapy. These findings warrant further in vitro and in vivo pharmacokinetic/pharmacodynamic studies to evaluate the therapeutic potential of aztreonam/avibactam plus fosfomycin against MBL-producing P. aeruginosa.

Keywords

Aztreonam/Avibactam; Fosfomycin; NDM; Pseudomonas aeruginosa.

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