JMI Laboratories, North Liberty, IA, USA.
J Antimicrob Chemother. 2021 Sep 15;76(10):2600-2605. doi: 10.1093/jac/dkab252.
Meropenem/vaborbactam has been approved in Europe for the treatment of hospital-acquired bacterial pneumonia, ventilator-associated pneumonia (VAP) and bacteraemia among other indications. Vaborbactam is an inhibitor of class A and C β-lactamases, including Klebsiella pneumoniae carbapenemase (KPC) enzymes, but not class B or D carbapenemases. We analysed the activity of meropenem/vaborbactam and comparators against 6846 Enterobacterales and 3567 Pseudomonas aeruginosa isolates from patients hospitalized with pneumonia (PHP), including VAP.
Isolates from PHP were consecutively collected during 2014-19 from 42 European hospitals located in 21 countries and susceptibility tested using the broth microdilution method. Carbapenem-resistant Enterobacterales (CRE) isolates were molecularly characterized to identify their carbapenem-resistance mechanisms. EUCAST (2020) interpretive criteria were used.
The most common Gram-negative pathogens isolated from PHP were P. aeruginosa (n = 3567), K. pneumoniae (n = 1877) and Escherichia coli (n = 1646). Overall, 98.0% of Enterobacterales and 82.1% of P. aeruginosa were susceptible to meropenem/vaborbactam, with 99.8% of Enterobacterales and 89.7% of P. aeruginosa in Western Europe (WE) and 92.7% of Enterobacterales and 69.1% of P. aeruginosa in Eastern Europe (EE). CRE were more common in EE (15.1%) than WE (2.1%). KPC was the most common carbapenemase in WE, while OXA-48-like was the most common carbapenemase in EE. Meropenem/vaborbactam susceptibility was 63.0% for all CRE (92.2% in WE and 51.5% in EE). Meropenem/vaborbactam inhibited 99.1% of KPC-producing isolates and 40.5% of OXA-48-like-producing isolates.
These in vitro data demonstrate that meropenem/vaborbactam has potent activity against isolates from PHP, including isolates producing KPC, and may be a useful treatment option for PHP, including VAP.
美罗培南/沃博巴坦已在欧洲获得批准，用于治疗医院获得性细菌性肺炎、呼吸机相关性肺炎（VAP）和菌血症等适应症。沃博巴坦是一种 A 类和 C 类β-内酰胺酶抑制剂，包括肺炎克雷伯菌碳青霉烯酶（KPC）酶，但不包括 B 类或 D 类碳青霉烯酶。我们分析了美罗培南/沃博巴坦和对照药物对 6846 株肠杆菌科和 3567 株铜绿假单胞菌分离株的活性，这些分离株来自患有肺炎（PHP）的住院患者，包括 VAP。
2014 年至 2019 年，连续从欧洲 42 家医院的 21 个国家收集 PHP 分离株，并使用肉汤微量稀释法进行药敏试验。采用分子方法对耐碳青霉烯肠杆菌科（CRE）分离株进行特征分析，以确定其碳青霉烯类耐药机制。采用欧盟药敏试验委员会（EUCAST）（2020 年）解释标准。
PHP 分离的最常见革兰氏阴性病原体是铜绿假单胞菌（n=3567）、肺炎克雷伯菌（n=1877）和大肠杆菌（n=1646）。总体而言，98.0%的肠杆菌科和 82.1%的铜绿假单胞菌对美罗培南/沃博巴坦敏感，其中 99.8%的肠杆菌科和 89.7%的铜绿假单胞菌在西欧（WE），92.7%的肠杆菌科和 69.1%的铜绿假单胞菌在东欧（EE）。EE 中 CRE 的检出率（15.1%）明显高于 WE（2.1%）。KPC 是 WE 中最常见的碳青霉烯酶，而 OXA-48 样酶是 EE 中最常见的碳青霉烯酶。所有 CRE 的美罗培南/沃博巴坦敏感性为 63.0%（WE 为 92.2%，EE 为 51.5%）。美罗培南/沃博巴坦抑制 99.1%的产 KPC 分离株和 40.5%的产 OXA-48 样分离株。
这些体外数据表明，美罗培南/沃博巴坦对 PHP 分离株，包括产 KPC 的分离株具有强大的活性，可能是 PHP，包括 VAP 的一种有用的治疗选择。
