f CMY-2 is a plasmid-encoded Ambler class C cephalosporinase that is widely disseminated in Enterobacteriaceae and is responsible for expanded-spectrum cephalosporin resistance. As a result of resistance to both ceftazidime and -lactamase inhibitors in strains carrying bla CMY , novel -lactam--lactamase inhibitor combinations are sought to combat this significant threat to -lactam therapy. Avibactam is a bridged diazabicyclo [3.2.1]octanone non--lactam -lactamase inhibitor in clinical development that reversibly inactivates serine -lactamases. To define the spectrum of activity of ceftazidime-avibactam, we tested the susceptibilities of Escherichia coli clinical isolates that carry bla CMY-2 or bla CMY-69 and investigated the inactivation kinetics of CMY-2. Our analysis showed that CMY-2-containing clinical isolates of E. coli were highly susceptible to ceftazidime-avibactam (MIC 90 , <0.5 mg/liter); in comparison, ceftazidime had a MIC 90 of >128 mg/liter. More importantly, avibactam was an extremely potent inhibitor of CMY-2 -lactamase, as demonstrated by a second-order onset of acylation rate constant (k 2 /K) of (4.9 ؎ 0.5) ؋ 10 4 M ؊1 s ؊1 and the off-rate constant (k off ) of (3.7 ؎ 0.4) ؋10 ؊4 s ؊1 . Analysis of the reaction of avibactam with CMY-2 using mass spectrometry to capture reaction intermediates revealed that the CMY-2-avibactam acylenzyme complex was stable for as long as 24 h. Molecular modeling studies raise the hypothesis that a series of successive hydrogen-bonding interactions occur as avibactam proceeds through the reaction coordinate with CMY-2 (e.g., T316, G317, S318, T319, S343, N346, and R349). Our findings support the microbiological and biochemical efficacy of ceftazidime-avibactam against E. coli containing plasmid-borne CMY-2 and CMY-69.
Biochemical studies of avibactam have shown that this inhibitor inactivates -lactamases with second-order acylation rate constants (k 2 /K) ranging from 1,400 to 160,000 M Ϫ1 s Ϫ1 (1-6). The highest acylation rates were those for class A enzymes, while the lowest were those for class D -lactamases. Dissociation rate constants (k off ) ranged from (1.9 Ϯ 0.6) ϫ 10 Ϫ3 to (1.2 Ϯ 0.4) ϫ 10 Ϫ5 s Ϫ1 and were lowest for class D -lactamases (6). Most importantly, avibactam combined with either ceftazidime, ceftaroline (the active metabolite of ceftaroline fosamil), or ceftarolinefosamil was effective in murine models of infection due to highly resistant extended-spectrum -lactamase (ESBL)-producing, non-ESBL-producing, and Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae and Pseudomonas aeruginosa isolates (7-10).CMY-2 -lactamase is the most prevalent and widely disseminated plasmid-borne cephalosporinase (11, 12). As such, Escherichia coli strains possessing bla CMY pose one of the most important challenges to the efficacy of -lactam therapy in both community-and hospital-acquired infections. Inhibition studies with CMY-2 and tazobactam, for example, were important in helping to understand the path to the inhibition of...