Hackel Meredith A, Badal Robert E, Bouchillon Samuel K, Biedenbach Douglas J, Hoban Daryl J
International Health Management Associates, Inc., Schaumburg, Illinois.
Surg Infect (Larchmt). 2015 Jun;16(3):298-304. doi: 10.1089/sur.2014.060. Epub 2015 Apr 20.
Enterobacteriaceae (3,235 isolates), Pseudomonas aeruginosa (476 isolates), and Acinetobacter baumannii (106 isolates) from inpatient intra-abdominal infections (IAIs) were collected for the 2010-2012 Study for Monitoring Antimicrobial Resistance Trends (SMART) program in the United States. This report evaluates the in vitro activity of several antimicrobial agents recommended for treatment of IAIs and compares profiles of isolates from intensive care units (ICUs) and non-intensive care units (non-ICUs).
Gram-negative bacilli from hospitalized patients with IAIs were obtained each year from 2010-2012 from hospitals in the United States and tested for susceptibility to 12 antibiotics according to 2012 Clinical and Laboratory Standards Institute (CLSI) guidelines.
The most active agents against members of the Enterobacteriaceae family from both ICUs and non-ICUs were amikacin, ertapenem, and imipenem-cilastatin, whereas the least active agent was ampicillin-sulbactam. Amikacin was the only agent with good activity against P. aeruginosa, whereas none of the agents tested exhibited substantial activity against A. baumannii. Amikacin, ceftazidime, ceftriaxone, ciprofloxacin, levofloxacin, and imipenem-cilastatin were significantly less active against Enterobacteriaceae from ICU patients, whereas cefepime and ceftazidime were significantly less active against P. aeruginosa from ICU patients. Intensive care unit isolates were more likely to be multi-drug-resistant than non-ICU isolates, although there was no difference in extended-spectrum β-lactamase (ESBL) production rates between the two patient groups.
Despite increasing resistance trends, in this study amikacin, ertapenem, and imipenem-cilastatin were shown to have good in vitro activity against the most frequently isolated gram-negative bacilli from IAIs in ICU and non-ICU settings.
2010 - 2012年美国开展监测抗菌药物耐药性趋势（SMART）项目，收集了住院患者腹腔内感染（IAIs）分离出的肠杆菌科细菌（3235株）、铜绿假单胞菌（476株）和鲍曼不动杆菌（106株）。本报告评估了几种推荐用于治疗IAIs的抗菌药物的体外活性，并比较了重症监护病房（ICU）和非重症监护病房（非ICU）分离菌株的情况。
2010 - 2012年每年从美国医院获取患有IAIs的住院患者的革兰氏阴性杆菌，并根据2012年临床和实验室标准协会（CLSI）指南检测其对12种抗生素的敏感性。
针对ICU和非ICU中肠杆菌科细菌，活性最强的药物是阿米卡星、厄他培南和美罗培南 - 西司他丁，而活性最弱的药物是氨苄西林 - 舒巴坦。阿米卡星是唯一对铜绿假单胞菌具有良好活性的药物，而所测试的药物中没有一种对鲍曼不动杆菌表现出显著活性。阿米卡星、头孢他啶、头孢曲松、环丙沙星、左氧氟沙星和美罗培南 - 西司他丁对ICU患者分离的肠杆菌科细菌活性明显较低，而头孢吡肟和头孢他啶对ICU患者分离的铜绿假单胞菌活性明显较低。ICU分离菌株比非ICU分离菌株更可能具有多重耐药性，尽管两组患者的超广谱β - 内酰胺酶（ESBL）产生率没有差异。
尽管耐药性呈上升趋势，但在本研究中，阿米卡星、厄他培南和美罗培南 - 西司他丁对ICU和非ICU环境中IAIs最常分离出的革兰氏阴性杆菌显示出良好的体外活性。
