Division of Infectious Diseases, Universidade Federal de São Paulo (UNIFESP/EPM), São Paulo, Brazil.
Diagn Microbiol Infect Dis. 2012 Aug;73(4):354-60. doi: 10.1016/j.diagmicrobio.2012.04.007. Epub 2012 May 31.
This study updates the frequency and resistance rates of Gram-negative bacilli isolated from Latin American medical centers enrolled in the SENTRY Antimicrobial Surveillance Program. A total of 12,811 bacterial organisms, including 5704 Gram-negative bacilli (44.5%), were consecutively collected (1 per patient) between January 2008 and December 2010 from 10 Latin American medical centers located in Argentina, Brazil, Chile, and Mexico. Antimicrobial susceptibility testing was performed and interpreted by the Clinical and Laboratory Standards Institute broth microdilution method at a central laboratory. All Gram-negative organisms with reduced susceptibility to imipenem or meropenem (MIC, ≥ 2 μg/mL) were screened for carbapenemase production by the modified Hodge test and by polymerase chain reaction. ESBL rates were 18.1%, 12.8%, 23.8%, and 48.4% among Escherichia coli and 60.4%, 49.9%, 59.2%, and 33.3% among Klebsiella spp. from Argentina, Brazil, Chile, and Mexico, respectively. Meropenem-nonsusceptible Klebsiella spp. rate was highest in Brazil (11.1%), followed by Argentina (8.2%), Chile (5.0%), and Mexico (0.8%). Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was not detected in 2008, but emerged in 2009 (10 strains) and increased significantly in 2010 (44; P < 0.0001). bla(KPC-2) was detected in 54 (65.9%) of 85 carbapenem-nonsusceptible K. pneumoniae. Meropenem-nonsusceptible P. aeruginosa was observed in 53.8%, 46.7%, 33.3%, and 28.8% of strains from Argentina, Brazil, Chile, and Mexico, respectively. Imipenem-resistant Acinetobacter spp. rates increased from 6.4%, 12.6%, and 0.0% in the 1997-1999 period to 84.9%, 71.4%, and 50.0% in 2008-2010 in Argentina, Brazil, and Chile, respectively. Oxacillinase (OXA)-producing Acinetobacter spp. was documented in Argentina (OXA-23 and -24), Brazil (OXA-23), Chile (OXA-58), and Mexico (OXA-24). Only colistin showed >77% overall coverage against the 5 most frequently isolated Gram-negative bacilli from Latin American Medical centers participating in the SENTRY Program.
本研究更新了拉丁美洲医学中心参加 SENTRY 抗菌监测计划的分离革兰氏阴性杆菌的频率和耐药率。2008 年 1 月至 2010 年 12 月期间，从阿根廷、巴西、智利和墨西哥的 10 个拉丁美洲医学中心连续采集了 12811 株细菌，包括 5704 株革兰氏阴性杆菌（44.5%）。在一个中央实验室，使用临床和实验室标准协会肉汤微量稀释法进行抗菌药物敏感性试验和解释。所有对亚胺培南或美罗培南（MIC≥2μg/ml）敏感性降低的革兰氏阴性菌均通过改良 Hodge 试验和聚合酶链反应筛查碳青霉烯酶的产生。在阿根廷、巴西、智利和墨西哥，产 ESBL 的大肠埃希菌和肺炎克雷伯菌的比例分别为 18.1%、12.8%、23.8%和 48.4%和 60.4%、49.9%、59.2%和 33.3%。在巴西（11.1%），其次是阿根廷（8.2%）、智利（5.0%）和墨西哥（0.8%），美罗培南不敏感的肺炎克雷伯菌的比例最高。2008 年未检测到产肺炎克雷伯菌碳青霉烯酶（KPC）的肺炎克雷伯菌，但 2009 年（10 株）出现并在 2010 年显著增加（44 株；P<0.0001）。在 85 株耐碳青霉烯类肺炎克雷伯菌中，bla（KPC-2）检出 54 株（65.9%）。在阿根廷、巴西、智利和墨西哥，不敏感的铜绿假单胞菌的比例分别为 53.8%、46.7%、33.3%和 28.8%。在阿根廷、巴西和智利，耐亚胺培南的不动杆菌属的比例从 1997-1999 年的 6.4%、12.6%和 0.0%分别上升到 2008-2010 年的 84.9%、71.4%和 50.0%。在阿根廷、巴西、智利和墨西哥，产 OXA 的不动杆菌属分别为 OXA-23 和-24、OXA-23、OXA-58 和 OXA-24。只有黏菌素对拉丁美洲医学中心参加 SENTRY 计划的 5 种最常分离的革兰氏阴性杆菌的总体覆盖率>77%。
