Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA.
Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut, USA.
J Clin Microbiol. 2019 Jul 26;57(8). doi: 10.1128/JCM.00535-19. Print 2019 Aug.
, a frequent pathogen in the intensive care unit (ICU), has the propensity to develop antibiotic resistance. In particular, carbapenem-nonsusceptible (NS) poses tremendous challenges, and new antibiotics will be needed to treat this phenotype. Here we determine carbapenem nonsusceptibility rates for contemporary isolates from U.S. ICUs and activities of new β-lactam combination agents. Between July 2017 and June 2018, consecutive nonduplicate isolates from blood and respiratory tract sources were recovered from patients admitted to the ICUs of 36 geographically diverse U.S. hospitals. Antimicrobial susceptibility to the following antipseudomonal agents was tested: ceftazidime, imipenem, meropenem, ceftazidime-avibactam, and imipenem-relebactam (an investigational β-lactam/β-lactamase inhibitor). MICs and susceptibility rates were measured using Clinical and Laboratory Standards Institute reference broth microdilution methodology. Among the 538 consecutive ICU isolates collected, carbapenem nonsusceptibility was observed for 35% of the isolates and was more common among respiratory tract versus bloodstream specimens. Susceptibility rates, MIC values, and MIC values were as follows: ceftazidime-avibactam, 92.8%, 2 μg/ml, and 8 μg/ml; imipenem-relebactam, 91.5%, 0.25 μg/ml, and 2 μg/ml; ceftazidime, 77.1%, 4 μg/ml, and 64 μg/ml; meropenem, 72.7%, 1 μg/ml, and 16 μg/ml; imipenem, 67.1%, 2 μg/ml, and 16 μg/ml. Most (>75%) of the carbapenem-NS isolates were susceptible to ceftazidime-avibactam and imipenem-relebactam. In these U.S. hospital ICUs, carbapenem-NS isolates from respiratory sources were frequently observed. Novel β-lactam combination agents appear to retain active susceptibility profiles against these isolates and may play a role in the treatment of infections caused by carbapenem-NS strains.
在重症监护病房（ICU）中，是一种常见的病原体，具有产生抗生素耐药性的倾向。特别是，耐碳青霉烯（NS）对治疗这种表型构成了巨大的挑战，需要新的抗生素来治疗。在这里，我们确定了来自美国 ICU 的当代 分离株的碳青霉烯类药物不敏感性率以及新型β-内酰胺联合制剂的 活性。在 2017 年 7 月至 2018 年 6 月期间，从 36 家地理位置不同的美国医院 ICU 住院患者的血液和呼吸道来源中连续分离出非重复的 分离株。测试了以下抗假单胞菌药物的抗菌敏感性：头孢他啶、亚胺培南、美罗培南、头孢他啶-阿维巴坦和亚胺培南-雷巴坦（一种研究用β-内酰胺/β-内酰胺酶抑制剂）。使用临床和实验室标准协会参考肉汤微量稀释方法测量 MIC 和药敏率。在收集的 538 株连续 ICU 分离株中，35%的分离株对碳青霉烯类药物不敏感，呼吸道标本比血标本更常见。药敏率、MIC 值和 MIC 值如下：头孢他啶-阿维巴坦，92.8%，2μg/ml，8μg/ml；亚胺培南-雷巴坦，91.5%，0.25μg/ml，2μg/ml；头孢他啶，77.1%，4μg/ml，64μg/ml；美罗培南，72.7%，1μg/ml，16μg/ml；亚胺培南，67.1%，2μg/ml，16μg/ml。大多数（>75%）耐碳青霉烯类药物的 分离株对头孢他啶-阿维巴坦和亚胺培南-雷巴坦敏感。在美国这些医院的 ICU 中，经常从呼吸道来源中观察到耐碳青霉烯类药物的 分离株。新型β-内酰胺联合制剂似乎对这些分离株保持着有效的 敏感性谱，可能在治疗耐碳青霉烯类药物的 菌株引起的感染方面发挥作用。
