1887

Abstract

Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are responsible for increases in antimicrobial-resistant infections worldwide. We determined in vitro susceptibilities to eight parenteral antimicrobial agents using Clinical and Laboratory Standards Institute broth microdilution methodology for Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal infections (IAIs) (n=3052) and urinary tract infections (UTIs) (n=1088) in 11 Asia-Pacific countries/regions from 2013 to 2015. Amikacin (98.3, 96.4 %), imipenem (97.1, 95.5 %) and ertapenem (95.3, 93.2 %) demonstrated the highest rates of susceptibility for isolates of K. pneumoniae from IAI and UTI, respectively, whereas susceptibility to advanced-generation cephalosporins was <84 and <71 %, respectively. K. pneumoniae with an extended-spectrum β-lactamase-positive phenotype were more common in UTI (27.1 %) than IAI (16.2 %). Imipenem and amikacin were the most active agents against extended-spectrum β-lactamase-positive K. pneumoniae from IAI (95.1, 91.8 %) and UTI (94.9, 92.3 %), respectively, whereas <54 % were susceptible to piperacillin–tazobactam. Against Enterobacter spp. and P. aeruginosa, amikacin demonstrated the highest rates of susceptibility for isolates from IAI (99.7, 95.5 %) and UTI (90.9, 91.5 %), respectively. K. pneumoniae, Enterobacter spp. and P. aeruginosa from urine demonstrated lower susceptibility to levofloxacin (74.1, 81.8 and 73.8 %) than from IAI (87.6, 91.8 and 85.4 %). For A. baumannii, rates of susceptibility to all agents tested were <43 %. We conclude that the studied Gram-negative ESKAPE pathogens demonstrated reduced susceptibility to commonly prescribed advanced-generation cephalosporins, piperacillin–tazobactam and levofloxacin, while amikacin and carbapenems were the most active. Ongoing surveillance to monitor evolving resistance trends and the development of novel antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are mandatory.

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2017-02-20
2019-10-14
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References

  1. Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis 2008;197:1079–1081 [CrossRef][PubMed]
    [Google Scholar]
  2. Pogue JM, Kaye KS, Cohen DA, Marchaim D. Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens. Clin Microbiol Infect 2015;21:302–312 [CrossRef][PubMed]
    [Google Scholar]
  3. Bodro M, Sabé N, Tubau F, Lladó L, Baliellas C et al. Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation 2013;96:843–849 [CrossRef][PubMed]
    [Google Scholar]
  4. Rice LB. Progress and challenges in implementing the research on ESKAPE pathogens. Infect Control Hosp Epidemiol 2010;31:S7–S10 [CrossRef][PubMed]
    [Google Scholar]
  5. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1–12 [CrossRef][PubMed]
    [Google Scholar]
  6. Biedenbach D, Bouchillon S, Hackel M, Hoban D, Kazmierczak K et al. Dissemination of NDM metallo-β-lactamase genes among clinical isolates of Enterobacteriaceae collected during the SMART global surveillance study from 2008 to 2012. Antimicrob Agents Chemother 2015;59:826–830 [CrossRef][PubMed]
    [Google Scholar]
  7. Paterson DL, Rossi F, Baquero F, Hsueh P-R, Woods GL et al. In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART). J Antimicrob Chemother 2005;55:965–973 [CrossRef][PubMed]
    [Google Scholar]
  8. Sheng WH, Badal RE, Hsueh PR. Distribution of extended-spectrum β-lactamases, AmpC β-lactamases, and carbapenemases among Enterobacteriaceae isolates causing intra-abdominal infections in the Asia-Pacific region: results of the Study for Monitoring Antimicrobial Resistance Trends (SMART). Antimicrob Agents Chemother 2013;57:2981–2988 [CrossRef][PubMed]
    [Google Scholar]
  9. Lu P-L, Liu Y-C, Toh H-S, Lee Y-L, Liu Y-M et al. Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009–2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents 2012;40:S37–S43 [CrossRef][PubMed]
    [Google Scholar]
  10. Liu Y-M, Chen Y-S, Toh H-S, Huang C-C, Lee Y-L et al. In vitro susceptibilities of non-Enterobacteriaceae isolates from patients with intra-abdominal infections in the Asia-Pacific region from 2003 to 2010: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents 2012;40:S11–S17 [CrossRef][PubMed]
    [Google Scholar]
  11. Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing Twenty-Fifth Informational Supplement M100-S25 Wayne, PA, USA: CLSI; 2015
    [Google Scholar]
  12. Clinical and Laboratory Standards Institute Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically, 10th ed, Approved Standard M07-A10. Wayne, PA, USA: CLSI; 2015
    [Google Scholar]
  13. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010;50:133–164 [CrossRef][PubMed]
    [Google Scholar]
  14. Jean S-S, Coombs G, Ling T, Balaji V, Rodrigues C et al. Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract infections in the Asia-Pacific region: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010–2013. Int J Antimicrob Agents 2016;47:328–334 [CrossRef][PubMed]
    [Google Scholar]
  15. Hawser SP, Bouchillon SK, Hackel M, Chen M, Kim EC. Trending 7 years of in vitro activity of tigecycline and comparators against Gram-positive and Gram-negative pathogens from the Asia-Pacific region: Tigecycline Evaluation Surveillance Trial (TEST) 2004–2010. Int J Antimicrob Agents 2012;39:490–495 [CrossRef][PubMed]
    [Google Scholar]
  16. Rossi F, Baquero F, Hsueh PR, Paterson DL, Bochicchio GV et al. In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends). J Antimicrob Chemother 2006;58:205–210 [CrossRef][PubMed]
    [Google Scholar]
  17. Walsh TR. Emerging carbapenemases: a global perspective. Int J Antimicrob Agents 2010;36:S8–S14 [CrossRef][PubMed]
    [Google Scholar]
  18. Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int J Antimicrob Agents 2016;47:317–323 [CrossRef][PubMed]
    [Google Scholar]
  19. Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care 2011;1:47 [CrossRef][PubMed]
    [Google Scholar]
  20. Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalized in intensive care units in United States and European hospitals (2009-2011). Diagn Microbiol Infect Dis 2014;78:443–448 [CrossRef][PubMed]
    [Google Scholar]
  21. Lob SH, Biedenbach DJ, Badal RE, Kazmierczak KM, Sahm DF. Antimicrobial resistance and resistance mechanisms of Enterobacteriaceae in ICU and non-ICU wards in Europe and North America: SMART 2011–2013. J Glob Antimicrob Resist 2015;3:190–197 [CrossRef][PubMed]
    [Google Scholar]
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