Jean Shio-Shin, Lee Wen-Sen, Bai Kuan-Jen, Yu Kwok-Woon, Hsu Chin-Wang, Yu Kwok-Woon, Liao Chun-Hsing, Chang Feng-Yi, Ko Wen-Chien, Wu Jiunn-Jong, Chen Yen-Hsu, Chen Yao-Shen, Liu Jien-Wei, Lu Min-Chi, Liu Cheng-Yi, Chen Ray-Jade, Hsueh Po-Ren
Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Division of infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Diagn Microbiol Infect Dis. 2015 Apr;81(4):290-5. doi: 10.1016/j.diagmicrobio.2014.09.027. Epub 2014 Oct 5.
To investigate the evolutionary trends in non-susceptibility of carbapenems against the isolates of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae from patients hospitalized in intensive care units (ICUs) of major teaching hospitals throughout Taiwan during 2005-2009, we applied the breakpoints of MICs recommended by Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing in 2013. Escalations in imipenem MIC levels for overall E. coli and E. cloacae isolates and extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae isolates were noted during this period. The overall MIC levels against imipenem and meropenem for subgroups of ESBL producers of 3 Enterobacteriaceae species were significantly higher than those of respective overall groups in 2007 and 2009. Compared with meropenem, we found that significant evidence of imipenem MIC creep and evidence of extraordinarily high rates of non-susceptibility to ertapenem among isolates of 3 species in 2009 existed. The prominent rises in rates of ertapenem non-susceptibility for ESBL-producing E. coli and K. pneumoniae during 2005-2009 and rate of ESBL positivity for E. cloacae between 4 years were notably found. Based on our findings, ertapenem should be used cautiously in management of the ICU infections caused by these potentially ESBL-producing Enterobacteriaceae isolates in Taiwan.
为了研究2005 - 2009年期间台湾各大教学医院重症监护病房（ICU）住院患者中分离出的大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对碳青霉烯类抗生素不敏感性的进化趋势，我们采用了临床和实验室标准协会及欧洲抗菌药物敏感性试验委员会2013年推荐的最低抑菌浓度（MIC）断点。在此期间，观察到总体大肠埃希菌和阴沟肠杆菌分离株以及产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌分离株对亚胺培南的MIC水平升高。2007年和2009年，3种肠杆菌科细菌ESBL产生菌亚组对亚胺培南和美罗培南的总体MIC水平显著高于各自总体组。与美罗培南相比，我们发现2009年3种细菌分离株中存在亚胺培南MIC漂移的显著证据以及对厄他培南不敏感率极高的证据。特别发现2005 - 2009年期间产ESBL的大肠埃希菌和肺炎克雷伯菌对厄他培南不敏感率显著上升，以及4年间阴沟肠杆菌ESBL阳性率上升。基于我们的研究结果，在台湾，对于这些可能产ESBL的肠杆菌科细菌分离株引起的ICU感染，应谨慎使用厄他培南进行治疗。
