Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand.
Int J Antimicrob Agents. 2012 Apr;39(4):311-6. doi: 10.1016/j.ijantimicag.2012.01.002. Epub 2012 Mar 3.
Resistance rates amongst Gram-negative pathogens are increasing in the Asia-Pacific region. The Comparative Activity of Carbapenem Testing (COMPACT) II study surveyed the carbapenem susceptibility and minimum inhibitory concentrations (MICs) of doripenem, imipenem and meropenem against 1260 major Gram-negative pathogens isolated from hospitalised patients at 20 centres in five Asia-Pacific countries (New Zealand, the Philippines, Singapore, Thailand and Vietnam) during 2010. Pseudomonas aeruginosa (n=625), Enterobacteriaceae (n=500), and other Gram-negative pathogens including Acinetobacter baumannii (n=135) were collected from patients with bloodstream infection (32.2%), nosocomial pneumonia including ventilator-associated pneumonia (58.1%), and complicated intra-abdominal infection (9.7%), with 36.7% being isolated from patients in an Intensive Care Unit. As high as 29.8% of P. aeruginosa and 73.0% of A. baumannii isolates were not susceptible to at least a carbapenem, whereas the majority of Enterobacteriaceae (97.2%) were susceptible to all carbapenems. Respective MIC(50)/MIC(90) values (MICs for 50% and 90% of the organisms, respectively) of doripenem, imipenem and meropenem were: 0.38/8, 1.5/32 and 0.38/16 mg/L for P. aeruginosa; 0.023/0.094, 0.25/0.5 and 0.032/0.094 mg/L for Enterobacteriaceae; and 32/64, 32/128 and 32/64 mg/L for A. baumannii. Doripenem and meropenem had comparable activity against P. aeruginosa, both being more active than imipenem. All carbapenems were highly potent against Enterobacteriaceae, although imipenem demonstrated higher MIC values than doripenem and meropenem. The three carbapenems showed less activity against A. baumannii. The high prevalence of carbapenem resistance amongst important nosocomial pathogens (P. aeruginosa and A. baumannii) warrants rigorous infection control measures and appropriate antimicrobial use in the Asia-Pacific region.
亚太地区革兰氏阴性病原体的耐药率正在上升。比较碳青霉烯类药物检测（COMPACT）II 研究调查了多利培南、亚胺培南和美罗培南对来自亚太地区五个国家（新西兰、菲律宾、新加坡、泰国和越南）20 个中心住院患者中 1260 种主要革兰氏阴性病原体的药敏率和最低抑菌浓度（MIC）。从血流感染（32.2%）、医院获得性肺炎（包括呼吸机相关性肺炎，58.1%）和复杂的腹腔内感染（9.7%）患者中收集了铜绿假单胞菌（625 株）、肠杆菌科（500 株）和其他革兰氏阴性病原体，包括鲍曼不动杆菌（135 株），其中 36.7%来自重症监护病房的患者。高达 29.8%的铜绿假单胞菌和 73.0%的鲍曼不动杆菌分离株对至少一种碳青霉烯类药物不敏感，而大多数肠杆菌科（97.2%）对所有碳青霉烯类药物敏感。多利培南、亚胺培南和美罗培南的相应 MIC（50）/MIC（90）值（分别为 50%和 90%的生物体的 MIC）为：铜绿假单胞菌 0.38/8、1.5/32 和 0.38/16mg/L；肠杆菌科 0.023/0.094、0.25/0.5 和 0.032/0.094mg/L；鲍曼不动杆菌 32/64、32/128 和 32/64mg/L。多利培南和美罗培南对铜绿假单胞菌具有相当的活性，均优于亚胺培南。所有碳青霉烯类药物对肠杆菌科均具有高度活性，尽管亚胺培南的 MIC 值高于多利培南和美罗培南。三种碳青霉烯类药物对鲍曼不动杆菌的活性较低。重要医院获得性病原体（铜绿假单胞菌和鲍曼不动杆菌）中碳青霉烯类药物耐药率高，需要在亚太地区采取严格的感染控制措施和适当的抗菌药物使用。
