2019 年台湾地区复杂腹腔内感染和尿路感染相关的重要革兰氏阴性菌和耐碳青霉烯类肠杆菌科细菌及铜绿假单胞菌分离株对抗生素的非敏感性，以及对亚胺培南-雷巴他定、美罗培南-沃巴坦的非敏感性。
Non-susceptibilities to antibiotics against important Gram-negative bacteria, and imipenem-relebactam, meropenem-vaborbactam against carbapenem non-susceptible Enterobacterales and Pseudomonas aeruginosa isolates implicated in complicated intra-abdominal and urinary tract infections in Taiwan, 2019.
机构信息
Department of Emergency and Critical Care Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan; Department of Pharmacy, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan.
出版信息
Int J Antimicrob Agents. 2022 Mar;59(3):106521. doi: 10.1016/j.ijantimicag.2022.106521. Epub 2022 Jan 20.
INTRODUCTION
Susceptibility of isolates of top-ranking Enterobacterales species and Pseudomonas aeruginosa implicated in complicated intra-abdominal infections (cIAI) and urinary tract infections (cUTI) to important antibiotics, including imipenem-relebactam (IMR) and meropenem-vaborbactam (MVB), in Taiwan in 2019 were evaluated.
METHODS
MICs to various antibiotics were determined using broth microdilution method. Susceptibility results were interpreted mainly based on the MIC breakpoints of the Clinical and Laboratory Standards Institute (CLSI) 2021, but susceptibilities of IMR and MVB were interpreted based on the CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2021. Resistance genes amongst carbapenem-non-susceptible (NS) Gram-negative bacteria (GNB) were investigated using multiplex polymerase chain reaction (PCR). Escherichia coli (n = 356), Klebsiella pneumoniae (n = 165) and Enterobacter cloacae complex (n = 42) isolates accounted for 85.3% of the 660 Enterobacterales isolates.
RESULTS
The non-susceptibility rates of imipenem (IPM), IMR against isolates of non-Morganellaceae Enterobacterales, and meropenem (MEM), MVB against all Enterobacterales isolates were 92.2%/94.8%, 98.4-98.7%/98.4-99%, 95%/98.2% and 98.8-100%/99.4-100% for the cIAI/cUTI subgroups, respectively. Amongst the 40 IPM-NS-non-Morganellaceae Enterobacterales isolates, when the CLSI 2021 criteria were applied, 10 were NS to IMR, and four Klebsiella pneumoniae isolates (harbouring bla but neither bla nor bla-like genes) were NS to IMR and MVB. Amongst the 93 Pseudomonas aeruginosa isolates under evaluation, the addition of relebactam (4 mg/L) resulted in a 4-to-16-fold reduction in the MICs of IPM in all 15 IPM-NS-Pseudomonas aeruginosa isolates (including 10 porin-deficient ones) not harbouring bla/bla-like genes. Contrastingly, the addition of vaborbactam (8 mg/L) improved the non-susceptibility to MEM in one (20%) of five IPM/MEM-NS Pseudomonas aeruginosa isolates.
CONCLUSION
Continuous monitoring of susceptibility to clinically important GNB is warranted.
简介
本研究评估了 2019 年在台湾引起复杂腹腔内感染（cIAI）和尿路感染（cUTI）的顶级肠杆菌科和铜绿假单胞菌分离株对重要抗生素（包括亚胺培南-雷巴他定[IMR]和美罗培南-沃巴坦[MVB]）的敏感性。
方法
采用肉汤微量稀释法测定各种抗生素的 MIC。主要基于临床和实验室标准协会（CLSI）2021 年的 MIC 折点来解释药敏结果，但 IMR 和 MVB 的药敏结果基于 CLSI 和欧洲抗菌药物敏感性试验委员会（EUCAST）2021 年的标准来解释。采用多重聚合酶链反应（PCR）检测耐碳青霉烯类非敏感（NS）革兰氏阴性菌（GNB）的耐药基因。660 株肠杆菌科分离株中，大肠埃希菌（n=356）、肺炎克雷伯菌（n=165）和阴沟肠杆菌复合体（n=42）占 85.3%。
结果
非-Morganellaceae 肠杆菌科分离株对亚胺培南（IPM）、IMR 的不敏感率，以及所有肠杆菌科分离株对美罗培南（MEM）、MVB 的不敏感率分别为 92.2%/94.8%、98.4-98.7%/98.4-99%、95%/98.2%和 98.8-100%/99.4-100%，用于 cIAI/cUTI 亚组。在 40 株 IPM-NS-非-Morganellaceae 肠杆菌科分离株中，应用 CLSI 2021 标准时，10 株对 IMR 耐药，4 株肺炎克雷伯菌（携带 bla 但不携带 bla 或 bla 样基因）对 IMR 和 MVB 耐药。在 93 株评估的铜绿假单胞菌中，添加雷巴他定（4mg/L）使所有 15 株 IPM-NS-铜绿假单胞菌（包括 10 株孔蛋白缺失株）的 IPM MIC 降低了 4 至 16 倍，这些分离株均不携带 bla/bla 样基因。相比之下，添加沃巴坦（8mg/L）使 5 株 IPM/MEM-NS 铜绿假单胞菌中的 1 株（20%）对 MEM 的不敏感率降低。
结论
需要持续监测临床重要 GNB 的敏感性。
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