Antimicrobial susceptibilities of the ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales isolates causing intra-abdominal infections in the Asia-Pacific region during 2008–2014: Results from the Study for Monitoring the Antimicrobial Resistance Trends (SMART). (June 2020)

• Record Type: Journal Article
• Authors: Jean, Shio-Shin; Hsueh, Po-Ren
• Is Part Of: Journal of global antimicrobial resistance. Volume 21(2020)
• Page Start: 91
• Page End: 98
• Publication Date: 2020-06
• Subjects: Ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales -- Intra-abdominal infection -- Imipenem -- Cefepime -- Ciprofloxacin; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2019.10.004
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: We investigated isolates of Proteus mirabilis, Proteus vulgaris, Providencia stuartii, Providencia rettgeri, and Morganella morganii causing intra-abdominal infections and urinary tract infections. CTX-M-1, CTX-M2, and CTX-M-15 were the dominant CTX-M-type ESBLs in P. mirabilis isolates and CMY ( n = 14), which included CMY-2 ( n = 6), was the most common AmpC β-lactamase. Isolates from hospital-associated infections had more complicated β-lactamase combinations than isolates from community-acquired infections. Abstract: Objectives: To investigate the susceptibility profiles amongst ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales (ETP-NS-non-CPE) isolates. Methods: Minimum inhibitory concentrations (MICs) of 404 ETP-NS-non-CPE isolates collected from different intra-abdominal infection (IAI) sites amongst patients in the Asia-Pacific region during 2008–2014 were determined using the broth microdilution method. The susceptibility results were interpreted according to the MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2018. The MICs data of several agents were evaluated based on their published pharmacokinetic/pharmacodynamic (PK/PD) profiles. Results: The majority (>84%) of IAI-ETP-NS-non-CPE isolates – including Escherichia coli ( n = 83), Klebsiella pneumoniae ( n = 91) and Enterobacter species ( n = 210) – were susceptible to imipenem and amikacin. The 193 hepatobiliary ETP-NS-non-CPE isolates exhibited a trend of lower cefepime MIC (≤4 mg/L) distribution than those ( n = 145) cultured from the peritoneal space ( P = 0.058). Amongst the ETP-NS-non-CP Enterobacter isolates, 65.7% displayed a cefepime MIC ≤ 4 mg/L. In addition, compared with Escherichia coli and Klebsiella pneumoniae isolates, 82.9% and 72.9% of the ETP-NS-non-CP Enterobacter isolates were susceptible to levofloxacin and ciprofloxacin, respectively. Of note, 74.5% and 70.3% of the ETP-NS-non-CP Enterobacter isolates cultured from the hepatobiliary tract and peritoneal space exhibited a ciprofloxacin MIC ≤ 2 mg/L and ≤0.25 mg/L, respectively. Imipenem and amikacin showed good in vitro susceptibility rates against the IAI-ETP-NS-non-CPE isolates. The hepatobiliary ETP-NS-non-CPE displayed lower cefepime MICs than those cultured from the peritoneal space. Additionally, a significant fraction of IAI-ETP-NS-non-CP Enterobacter isolates exhibited ciprofloxacin MIC ≤ 2 mg/L. Conclusion: Based upon the PK/PD analyses, ciprofloxacin, imipenem and cefepime are probably effective against IAI-ETP-NS-non-CPE isolates.