2011 年美国收集的腹腔内病原体中革兰氏阴性需氧杆菌对抗菌药物的敏感性。

Susceptibility of gram-negative aerobic bacilli from intra-abdominal pathogens to antimicrobial agents collected in the United States during 2011.

机构信息

IHMA Europe Sàrl, 1066 Epalinges, Switzerland.

出版信息

J Infect. 2014 Jan;68(1):71-6. doi: 10.1016/j.jinf.2013.09.001. Epub 2013 Sep 7.

DOI:10.1016/j.jinf.2013.09.001

PMID:24016768

Abstract

OBJECTIVES

During 2011, a total of 1442 gram-negative pathogens from intra-abdominal infections were collected as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 19 hospital sites within the United States. Susceptibility to ertapenem and comparators and molecular analysis of ertapenem resistant isolates was performed.

METHODS

Extended-spectrum beta-lactamase ESBL (ESBL) isolates were determined using the Clinical and Laboratory Standards Institute's recommended phenotypic test. Isolates were identified to the species level, and tested for antimicrobial susceptibility using custom MicroScan dehydrated broth microdilution panels ESBLs and carbapenemases were characterized using the Check-Points microarray. Strain typing of Klebsiella pneumoniae was performed by rep-PCR on the DiversiLab System.

RESULTS

The majority of isolates were Escherichia coli (36%), K. pneumoniae (18.6%), Pseudomonas aeruginosa (12.1%) and Enterobacter cloacae (8.4%). Incidence of ESBL-positive isolates was 12.7%, 9.7%, 3.6% and 3.1% for K. pneumoniae, E. coli, Proteus mirabilis and Klebsiella oxytoca, respectively. Against the majority of isolates and species tested, the most active antibiotics were amikacin, ertapenem, and imipenem, with the carbapenems being the most active in vitro, including against ESBL-positive isolates of E. coli. All other antibiotics exhibited diminished activity. Against K. pneumoniae, the carbapenems were notably less active against ESBL-positive isolates though their activity against this sub-population was still the highest of all antibiotics tested; however, 41.1% (14 of 34) of the phenotypically ESBL-positive K. pneumoniae co-produced a carbapenemase (KPC2 or KPC3), and >90% of the isolates producing only an ESBL remained susceptible to ertapenem.

CONCLUSIONS

Further monitoring of susceptibility of intra-abdominal isolates is warranted due to limited therapeutic options available to physicians.

摘要

目的

2011 年，在美国 19 家医院共收集了 1442 株腹腔感染的革兰氏阴性病原体，作为监测抗菌药物耐药趋势（SMART）研究的一部分。对厄他培南及其他药物的敏感性以及厄他培南耐药分离株的分子分析进行了研究。

方法

采用临床和实验室标准协会推荐的表型试验确定超广谱β-内酰胺酶（ESBL）分离株。将分离株鉴定到种的水平，并使用定制的 MicroScan 脱水肉汤微量稀释板进行抗菌药物敏感性测试。使用 Check-Points 微阵列对 ESBL 和碳青霉烯酶进行特征分析。肺炎克雷伯菌的菌株分型采用 DiversiLab 系统的重复 PCR 进行。

结果

大多数分离株为大肠埃希菌（36%）、肺炎克雷伯菌（18.6%）、铜绿假单胞菌（12.1%）和阴沟肠杆菌（8.4%）。产 ESBL 阳性分离株的发生率分别为肺炎克雷伯菌 12.7%、大肠埃希菌 9.7%、奇异变形杆菌 3.6%和产酸克雷伯菌 3.1%。对于大多数分离株和测试的物种，最有效的抗生素是阿米卡星、厄他培南和亚胺培南，碳青霉烯类在体外最具活性，包括对产 ESBL 的大肠埃希菌。所有其他抗生素的活性均降低。对于肺炎克雷伯菌，碳青霉烯类对产 ESBL 阳性分离株的活性明显降低，但它们对该亚群的活性仍然是所有测试抗生素中最高的；然而，41.1%（34 株中的 14 株）表型上产 ESBL 的肺炎克雷伯菌同时产生一种碳青霉烯酶（KPC2 或 KPC3），而仅产生 ESBL 的分离株中超过 90%仍对厄他培南敏感。