Rafael Cantón, Servicio de Microbiología, Hospital Universitario Ramón y Cajal. Madrid. Carretera de Colmenar Km 9,1. 28034-Madrid. Spain.
Rev Esp Quimioter. 2021 Jun;34(3):228-237. doi: 10.37201/req/019.2021. Epub 2021 Mar 1.
To analyse the susceptibility to ceftolozane-tazobactam and comparators in Enterobacterales and Pseudomonas aeruginosa isolates recovered from intraabdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream infection (BSI) in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study.
The susceptibility of 5,351 isolates collected in 11 Spanish hospitals (2016-2018) were analysed (EUCAST-2020 criteria) by broth microdilution and were phenotypically studied for the presence of extended-spectrum beta-lactamases (ESBL). Ceftolozane-tazobactam and/or carbapenem resistant isolates were genetically characterized for ESBL and carbapenemases.
Escherichia coli was the most frequent pathogen (49.3% IAI, 54.9% UTI, 16.7% RTI and 50% BSI), followed by Klebsiella pneumoniae (11.9%, 19.1%, 13.1% and 15.4%, respectively). P. aeruginosa was isolated in 9.3%, 5.6%, 32% and 9%, respectively. The frequency of isolates with ESBLs (2016-2017) was: 30.5% K. pneumoniae, 8.6% E. coli, 2.3% Klebsiella oxytoca and 0.7% Proteus mirabilis. Ceftolozane-tazobactam was very active against non-ESBL-(99.3% susceptible) and ESBL-(95.2%) producing E. coli being less active against K. pneumoniae (98% and 43.1%, respectively) isolates. CTX-M-15 was the most prevalent ESBL in E. coli (27.5%) and K. pneumoniae (51.9%) frequently associated with OXA-48-like carbapenemase. Overall, 93% of P. aeruginosa isolates were susceptible to ceftolozane-tazobactam, preserving this activity (>75%) in isolates resistant to other beta-lactams except in those resistant to meropenen or ceftazidime-avibactam. GES-5, PER-1, VIM-1/2 were the most prevalent enzymes in isolates resistant to ceftolozane-tazobactam.
Ceftolozane-tazobactam showed high activity rates against isolates recovered in the SMART study although it was affected in K. pneumoniae and P. aeruginosa isolates with ESBL and/or carbapenemases.
分析 SMART 研究中从腹腔内（IAI）、尿路感染（UTI）、呼吸道（RTI）和血流感染（BSI）中分离的肠杆菌科和铜绿假单胞菌对头孢洛扎他唑巴坦和比较药物的敏感性。
分析了 11 家西班牙医院 2016-2018 年收集的 5351 株分离株的药敏情况（EUCAST-2020 标准），并通过肉汤微量稀释法进行了表型研究，以检测是否存在超广谱β-内酰胺酶（ESBL）。对头孢洛扎他唑巴坦和/或碳青霉烯类耐药株进行 ESBL 和碳青霉烯酶的基因特征分析。
大肠埃希菌是最常见的病原体（IAI 为 49.3%，UTI 为 54.9%，RTI 为 16.7%，BSI 为 50%），其次是肺炎克雷伯菌（11.9%，19.1%，13.1%和 15.4%）。铜绿假单胞菌的分离率分别为 9.3%、5.6%、32%和 9%。2016-2017 年分离株中 ESBL 的频率为：肺炎克雷伯菌 30.5%，大肠埃希菌 8.6%，奇异变形杆菌 2.3%，普通变形杆菌 0.7%。头孢洛扎他唑巴坦对非 ESBL（99.3%敏感）和 ESBL（95.2%敏感）产大肠埃希菌具有很强的活性，对肺炎克雷伯菌的活性较低（分别为 98%和 43.1%）。CTX-M-15 是大肠埃希菌（27.5%）和肺炎克雷伯菌（51.9%）中最常见的 ESBL，通常与 OXA-48 样碳青霉烯酶相关。总体而言，93%的铜绿假单胞菌分离株对头孢洛扎他唑巴坦敏感，除对美罗培南或头孢他啶-阿维巴坦耐药的分离株外，对其他β-内酰胺类药物耐药的分离株仍保持着这种活性（>75%）。对头孢洛扎他唑巴坦耐药的分离株中，GES-5、PER-1、VIM-1/2 是最常见的酶。
头孢洛扎他唑巴坦对 SMART 研究中分离的菌株表现出高活性率，尽管它对产 ESBL 和/或碳青霉烯酶的肺炎克雷伯菌和铜绿假单胞菌的分离株有影响。
