Garcinuño P, Santibañez M, Gimeno L, Sánchez-Bautista A, Coy J, Sánchez-Paya J, Boix V, Merino E, Portilla J, Rodríguez J C
S. Microbiología, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España.
Universidad de Cantabria, Santander, Spain.
Eur J Clin Microbiol Infect Dis. 2016 Nov;35(11):1851-1855. doi: 10.1007/s10096-016-2737-2. Epub 2016 Aug 9.
The increase in the number of clinical isolates of multiresistant Enterobacteriaceae and Pseudomonas aeruginosa raises problems in decision-making on empirical treatments for severe Gram-negative bacilli-associated infections. The aim of our study is to determine the resistance of meropenem in our setting and the co-resistance of a combination of this compound with two antibiotics from different families: amikacin and ciprofloxacin. Between 2009 and 2013, a total of 81,310 clinical isolates belonging to the main species of Enterobacteriaceae and 39,191 clinical isolates of P. aeruginosa isolated in 28 hospitals in the Valencian Community on the South East Mediterranean Coast of Spain were analyzed using data provided by RedMiva (microbiological surveillance network of the Valencian Community). Meropenem resistance in Enterobacteriaceae increased from 0.16 % in 2009 to 1.25 % in 2013. Very few Enterobacteriaceae strains resistant to meropenem were sensitive to ciprofloxacin; in contrast, the combination of meropenem and amikacin led to a marked decrease in the risk of the microorganisms being resistant to both drugs (RR = 34 in 2013). In the case of P. aeruginosa, meropenem resistance also increased (from 14.32 % in 2009 to 24.52 % in 2013). Most meropenem-resistant P. aeruginosa isolates were also resistant to fluoroquinolones. However, the addition of amikacin led to a more than three-fold decrease in the risk of resistance. In our setting, empirical treatment with meropenem is adequate in enterobacterial infections, but poses difficulties when infection due to P. aeruginosa is suspected, in which case a combination of meropenem and amikacin has been shown to have a higher microbiological success rate.
多重耐药肠杆菌科细菌和铜绿假单胞菌临床分离株数量的增加，给严重革兰氏阴性杆菌相关感染的经验性治疗决策带来了问题。我们研究的目的是确定美罗培南在我们环境中的耐药性，以及该化合物与来自不同类别（阿米卡星和环丙沙星）的两种抗生素联合使用时的共同耐药性。2009年至2013年期间，利用西班牙东南部地中海沿岸巴伦西亚自治区28家医院提供的数据，对总共81310株属于肠杆菌科主要菌种的临床分离株和39191株铜绿假单胞菌临床分离株进行了分析（巴伦西亚自治区微生物监测网络RedMiva）。肠杆菌科细菌对美罗培南的耐药率从2009年的0.16%上升至2013年的1.25%。对美罗培南耐药的肠杆菌科菌株中，对环丙沙星敏感的极少；相反，美罗培南与阿米卡星联合使用，使微生物对两种药物均耐药的风险显著降低（2013年相对危险度为34）。对于铜绿假单胞菌，美罗培南耐药率也有所上升（从2009年的14.32%升至20适用于肠道细菌感染，但在怀疑是铜绿假单胞菌引起的感染时则存在困难，在这种情况下，美罗培南与阿米卡星联合使用已显示出更高的微生物学成功率。 3年的24.52%）。大多数对美罗培南耐药的铜绿假单胞菌分离株也对氟喹诺酮类耐药。然而，加入阿米卡星使耐药风险降低了三倍多。在我们的环境中，美罗培南的经验性治疗在肠道细菌感染中是足够的，但在怀疑是铜绿假单胞菌引起的感染时则存在困难，在这种情况下，美罗培南与阿米卡星联合使用已显示出更高的微生物学成功率。
