ABSTRACT:
Background The emergence of antimicrobial resistance in Gram-negative bacteria (GNB) is a major global concern. Ceftazidime–avibactam (CAZ–AVI) has been identified as a potential treatment option for complicated infections. Objectives This meta-analysis aimed to evaluate the global resistance proportions of GNB to CAZ–AVI comprehensively. Methods Studies were searched in Scopus, PubMed, and EMBASE (until September 2024), and statistical analyses were conducted using STATA software (version 20.0). Results CAZ–AVI resistance proportions were determined in 136 studies, with 25.8% (95% CI 22.2–29.7) for nonfermentative gram-negative bacilli and 6.1% (95% CI 4.9–7.4) for Enterobacterales. The CAZ–AVI resistance proportion significantly increased from 5.6% (95% CI 4.1–7.6) of 221,278 GNB isolates in 2015–2020 to 13.2% (95% CI 11.4–15.2) of 285,978 GNB isolates in 2021–2024. Regionally, CAZ–AVI resistance was highest in Asia 19.3% (95% CI 15.7–24.23.4), followed by Africa 13.6% (95% CI 5.6–29.2), Europe 11% (95% CI 7.8–15.2), South America 6.1% (95% CI 3.2–11.5) and North America 5.3% (95% CI 4.2–6.7). Among GNB resistance profiles, colistin-resistant isolates and XDR isolates exhibited the highest resistance proportions (37.1%, 95% CI 14–68 and 32.1%, 95% CI 18.5–49.6), respectively), followed by carbapenem-resistant isolates and MDR isolates [(25.8%, 95% CI 22.6–29.3) and (13%, 95% CI 9.6, 17.3)]. Conclusion A high proportion of GNB isolates from urinary tract infections remained susceptible to CAZ–AVI, indicating its potential as a suitable treatment option. However, the increasing resistance trends among GNB are concerning and warrant continuous monitoring to maintain CAZ–AVI’s effectiveness against GNB infections.