Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates; Department of Medical Microbiology and Immunology, Faculty of Medicine, University of Pécs, Pécs, Hungary.
Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Int J Infect Dis. 2020 Oct;99:253-259. doi: 10.1016/j.ijid.2020.07.050. Epub 2020 Jul 29.
Our aim was to assess the susceptibility of carbapenem-resistant Enterobacterales (CRE) from the Arabian Peninsula to a broad spectrum of antibiotics, including fosfomycin, ceftazidime-avibactam, and aztreonam-avibactam.
1192 non-repeat CRE isolated in 2009-2017 from 33 hospitals in five countries of the Arabian Peninsula were tested. The minimum inhibitory concentration of 14 antibiotics was determined. Carbapenemase and 16S methylase genes were detected by PCR. Clonality was assessed by PFGE.
The highest rate of susceptibility was detected to aztreonam-avibactam (95.5%) followed by colistin (79.8%), fosfomycin (71.8%) and tigecycline (59.9%). Isolates co-producing two carbapenemases (12.4%) were the least susceptible. Aminoglycoside susceptibility was affected by the frequent production of a 16S methylase. Susceptibility to ceftazidime-avibactam was impacted by the high rate of metallo-beta-lactamase producers (46.3%), while aztreonam-avibactam resistance occurred mostly in clonally unrelated, carbapenemase non-producing Escherichia coli.
Of the currently available drugs: colistin, tigecycline, and ceftazidime-avibactam co-administered with aztreonam appear to be the most effective to treat CRE infections. However, the presence of non-clonal CRE isolates, in which avibactam does not lower the aztreonam MIC below the clinical breakpoint, is of notable concern. Based on the relatively high rate of fosfomycin susceptibility, it would be desirable to license parenteral fosfomycin in the region.
我们旨在评估来自阿拉伯半岛的碳青霉烯类耐药肠杆菌科（CRE）对包括磷霉素、头孢他啶-阿维巴坦和氨曲南-阿维巴坦在内的广谱抗生素的敏感性。
对 2009 年至 2017 年间来自阿拉伯半岛五个国家的 33 家医院的 1192 株非重复 CRE 进行了检测。测定了 14 种抗生素的最小抑菌浓度。通过 PCR 检测碳青霉烯酶和 16S 甲基酶基因。通过 PFGE 评估克隆性。
对氨曲南-阿维巴坦（95.5%）的敏感性最高，其次是多粘菌素（79.8%）、磷霉素（71.8%）和替加环素（59.9%）。同时产生两种碳青霉烯酶的分离株（12.4%）的敏感性最低。氨基糖苷类药物的敏感性受到频繁产生 16S 甲基酶的影响。头孢他啶-阿维巴坦的敏感性受金属β-内酰胺酶产生率高的影响（46.3%），而氨曲南-阿维巴坦的耐药性主要发生在无克隆相关性、不产碳青霉烯酶的大肠埃希菌中。
在目前可用的药物中：多粘菌素、替加环素和与氨曲南联合使用的头孢他啶-阿维巴坦似乎是治疗 CRE 感染最有效的药物。然而，非克隆 CRE 分离株的存在（其中阿维巴坦未能将氨曲南的 MIC 降低到临床折点以下）值得关注。基于磷霉素相对较高的敏感性，在该地区获得磷霉素的许可将是理想的。
