IHMA, Schaumburg, IL 60173, USA.
IHMA, Schaumburg, IL 60173, USA.
J Glob Antimicrob Resist. 2022 Jun;29:527-533. doi: 10.1016/j.jgar.2021.11.011. Epub 2021 Dec 8.
Antimicrobial resistance is one of the top 10 global public-health threats. Especially high rates of resistance have been reported for isolates from ICU patients, requiring expanded treatment options in this setting. We evaluated the activity of ceftolozane/tazobactam and comparators against Gram-negative isolates collected from patients with lower respiratory tract infections (LRTIs) in ICUs in seven Asian countries.
In 2017-2019, up to 100 consecutive, aerobic Gram-negative LRTI isolates were collected per year at each of 37 hospitals. MICs were determined using the Clinical and Laboratory Standards Institute reference broth microdilution method.
Overall, ceftolozane/tazobactam was active against 72% of 1408 Enterobacterales and 86% of 761 Pseudomonas aeruginosa isolates. Susceptibility to the non-carbapenem β-lactam comparators, including piperacillin/tazobactam, was 52-67% among Enterobacterales isolates, and the activity of all β-lactam comparators, including meropenem, was 57-70% among P. aeruginosa. Ceftolozane/tazobactam maintained activity against 61% of meropenem-nonsusceptible and 64% of piperacillin/tazobactam-nonsusceptible P. aeruginosa. At the country-level, ceftolozane/tazobactam activity ranged from >90% against Enterobacterales from Hong Kong and South Korea to <64% in Thailand and Vietnam, and from >90% against P. aeruginosa from South Korea, Malaysia, Philippines and Taiwan to <75% in Thailand and Vietnam. Correspondingly, the proportions of carbapenemase-positive isolates among Enterobacterales and P. aeruginosa isolates were highest in Thailand and Vietnam.
Ceftolozane/tazobactam provides a potential treatment option for ICU patients in Asia, which is especially important considering the reduced activity of commonly used β-lactams against the studied ICU isolates. Knowledge of local resistance patterns should inform empirical therapy decision-making.
抗微生物药物耐药性是全球 10 大公共卫生威胁之一。重症监护病房（ICU）患者分离株的耐药率尤其高，因此需要在此类环境中扩大治疗选择。我们评估了头孢洛扎/他唑巴坦和其他比较药物对来自亚洲 7 个国家 ICU 下呼吸道感染（LRTI）患者的革兰氏阴性分离株的活性。
在 2017 年至 2019 年期间，每年在每个 37 家医院收集 100 株连续的、需氧的革兰氏阴性 LRTI 分离株。使用临床和实验室标准协会参考肉汤微量稀释法测定 MIC。
总体而言，头孢洛扎/他唑巴坦对 1408 株肠杆菌科和 761 株铜绿假单胞菌的分离株的敏感性分别为 72%和 86%。肠杆菌科分离株对非碳青霉烯类β-内酰胺类比较药物（包括哌拉西林/他唑巴坦）的敏感性为 52-67%，所有β-内酰胺类比较药物（包括美罗培南）对铜绿假单胞菌的活性为 57-70%。头孢洛扎/他唑巴坦对美罗培南不敏感和哌拉西林/他唑巴坦不敏感的铜绿假单胞菌的活性分别为 61%和 64%。在国家层面，头孢洛扎/他唑巴坦对来自中国香港和韩国的肠杆菌科的活性范围为>90%，而在泰国和越南则<64%，对来自韩国、马来西亚、菲律宾和中国台湾的铜绿假单胞菌的活性范围为>90%，而在泰国和越南则<75%。相应地，肠杆菌科和铜绿假单胞菌分离株中碳青霉烯酶阳性分离株的比例在泰国和越南最高。
头孢洛扎/他唑巴坦为亚洲 ICU 患者提供了一种潜在的治疗选择，考虑到常用的β-内酰胺类药物对研究的 ICU 分离株的活性降低，这一点尤为重要。了解当地的耐药模式应有助于指导经验性治疗决策。
