Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Infect. 2011 Apr;62(4):280-91. doi: 10.1016/j.jinf.2011.02.009. Epub 2011 Mar 5.
The Study for Monitoring Antimicrobial Resistance Trends (SMART) was intended to reveal the evolving profiles of antimicrobial resistance among Gram-negative pathogens causing intra-abdominal infections (IAIs) from Asia-Pacific region in 2009.
A total of 3577 aerobic and facultative Gram-negative bacilli associated with IAIs were collected from 32 centers in 12 countries. The in vitro susceptibilities of these isolates to 12 antimicrobial agents were determined using the broth microdilution method. Susceptibility results for selected species of Enterobacteriaceae were also compared using different MIC interpretive criteria recommended by the Clinical and Laboratory Standards Institute in 2009 (M100-S19), in January 2010 (M100-S20), in June 2010 (M100-S20-U) and the European Committee on Antimicrobial Susceptibility Testing in 2010 (EUCAST-2010).
Enterobacteriaceae comprised 89.5% of the isolates of which Escherichia coli was the most common species (56.7%). Enterobacteriaceae showed poor susceptibility to ampicillin-sulbactam in China (25.3%) and India (19%), and to fluoroquinolones in India (23.4%) and China (37.7%). The rates of extended-spectrum β-lactamase (ESBL)-producing E. coli (36.8%) and Klebsiella pneumoniae (26.3%) remained high. The resistance of ESBL-producing K. pneumoniae to carbapenems also increased, especially to ertapenem (9.9%). Using M100-S20 criteria, 19% of ESBL-producing E. coli and 9% of ESBL-producing K. pneumoniae were susceptible to ceftazidime; 5% and 10% were susceptible to cefepime, respectively. Using M100-S20-U guidelines, the susceptibility rates of ESBL-producing K. pneumoniae (88%) and Enterobacter cloacae (69%) to ertapenem were substantially decreased from those determined using M100-S20.
These up-to-date epidemiology and antimicrobial resistance surveillance data are crucial to select appropriate treatment of IAIs.
监测抗菌药物耐药趋势研究（SMART）旨在揭示 2009 年亚太地区引起腹腔内感染（IAI）的革兰氏阴性病原体的抗菌药物耐药演变情况。
从 12 个国家的 32 个中心共收集 3577 株与 IAI 相关的需氧和兼性革兰氏阴性杆菌。采用肉汤微量稀释法测定这些分离株对 12 种抗菌药物的体外药敏性。根据临床和实验室标准协会（CLSI）2009 年（M100-S19）、2010 年 1 月（M100-S20）、2010 年 6 月（M100-S20-U）和欧洲抗菌药物敏感性测试委员会（EUCAST）2010 年推荐的不同 MIC 解释标准，对所选肠杆菌科菌种的药敏结果进行了比较。
肠杆菌科占分离株的 89.5%，其中大肠埃希菌最常见（56.7%）。在中国（25.3%）和印度（19%），肠杆菌科对氨苄西林-舒巴坦的敏感性较差，在印度（23.4%）和中国（37.7%）对氟喹诺酮类药物的敏感性较差。产超广谱β-内酰胺酶（ESBL）大肠埃希菌（36.8%）和肺炎克雷伯菌（26.3%）的检出率仍然很高。产 ESBL 肺炎克雷伯菌对碳青霉烯类药物的耐药性也有所增加，尤其是厄他培南（9.9%）。根据 M100-S20 标准，19%的产 ESBL 大肠埃希菌和 9%的产 ESBL 肺炎克雷伯菌对头孢他啶敏感；分别有 5%和 10%对头孢吡肟敏感。使用 M100-S20-U 指南，与 M100-S20 相比，产 ESBL 肺炎克雷伯菌（88%）和阴沟肠杆菌（69%）对厄他培南的敏感性显著降低。
这些最新的流行病学和抗菌药物耐药监测数据对于选择治疗 IAI 的合适治疗方法至关重要。
