亚胺培南/瑞来巴坦对哌拉西林/他唑巴坦耐药及美罗培南耐药的非摩根菌属肠杆菌科细菌的活性，这些细菌从西欧下呼吸道感染患者中收集：SMART 2018 - 20数据。
activity of imipenem/relebactam against piperacillin/tazobactam-resistant and meropenem-resistant non-Morganellaceae Enterobacterales and collected from patients with lower respiratory tract infections in Western Europe: SMART 2018-20.
作者信息
Karlowsky James A, Lob Sibylle H, Akrich Brune, DeRyke C Andrew, Siddiqui Fakhar, Young Katherine, Motyl Mary R, Hawser Stephen P, Sahm Daniel F
机构信息
IHMA, 2122 Palmer Drive, Schaumburg, IL, 60173, USA.
Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada.
出版信息
JAC Antimicrob Resist. 2023 Jan 20;5(1):dlad003. doi: 10.1093/jacamr/dlad003. eCollection 2023 Feb.
OBJECTIVES
To describe the activity of imipenem/relebactam against non-Morganellaceae Enterobacterales (NME) and recently isolated from lower respiratory tract infection samples by hospital laboratories in Western Europe.
METHODS
From 2018 to 2020, 29 hospital laboratories in six countries in Western Europe participated in the SMART global surveillance programme and contributed 4414 NME and 1995 isolates. MICs were determined using the CLSI broth microdilution method and interpreted by EUCAST (2021) breakpoints. β-Lactamase genes were identified in selected isolate subsets (2018-20) and sequenced in molecularly characterized (2020).
RESULTS
Imipenem/relebactam (99.1% susceptible), amikacin (97.2%), meropenem (96.1%) and imipenem (95.9%) were the most active agents tested against NME; by country, relebactam increased imipenem susceptibility from <1% (France, Germany, UK) to 11.0% (Italy). A total of 96.0% of piperacillin/tazobactam-resistant (= 990) and 81.1% of meropenem-resistant (= 106) NME were imipenem/relebactam-susceptible. Only 0.5% of NME were MBL positive, 0.9% were OXA-48-like-positive (MBL negative) and 2.8% were KPC positive (MBL negative). Amikacin (91.5% susceptible) and imipenem/relebactam (91.4%) were the most active agents against ; 72.3% of isolates were imipenem-susceptible. Relebactam increased susceptibility to imipenem by 34.4% (range by country, 39.1%-73.5%) in piperacillin/tazobactam-resistant and by 37.4% (3.1%-40.5%) in meropenem-resistant . Only 1.8% of isolates were MBL positive. Among molecularly characterized imipenem/relebactam-resistant isolates from 2020, 90.9% (30/33) were oprD deficient.
CONCLUSIONS
Imipenem/relebactam appears to be a potential treatment option for lower respiratory tract infections caused by piperacillin/tazobactam- and meropenem-resistant NME and in Western Europe.
目的
描述亚胺培南/瑞来巴坦对非摩根菌科肠杆菌目细菌（NME）的活性，这些细菌是西欧医院实验室最近从下呼吸道感染样本中分离出来的。
方法
2018年至2020年，西欧六个国家的29家医院实验室参与了SMART全球监测项目，提供了4414株NME和1995株分离菌。采用CLSI肉汤微量稀释法测定最低抑菌浓度（MIC），并根据欧盟CAST（2021年）的断点进行解释。在选定的分离菌亚组（2018 - 20年）中鉴定β-内酰胺酶基因，并对分子特征明确的菌株（2020年）进行测序。
结果
亚胺培南/瑞来巴坦（99.1%敏感）、阿米卡星（97.2%）、美罗培南（96.1%）和亚胺培南（95.9%）是针对NME测试的活性最强的药物；按国家划分，瑞来巴坦使亚胺培南的敏感性从<1%（法国、德国、英国）提高到11.0%（意大利）。总共96.0%的哌拉西林/他唑巴坦耐药（=990株）和81.1%的美罗培南耐药（=106株）NME对亚胺培南/瑞来巴坦敏感。只有0.5%的NME产金属β-内酰胺酶（MBL）阳性，0.9%为OXA - 48样阳性（MBL阴性），2.8%为KPC阳性（MBL阴性）。阿米卡星（91.5%敏感）和亚胺培南/瑞来巴坦（91.4%）是针对[此处原文缺失相关内容]活性最强的药物；72.3%的分离菌对亚胺培南敏感。在哌拉西林/他唑巴坦耐药菌株中，瑞来巴坦使亚胺培南的敏感性提高了34.4%（各国范围为39.1% - 73.5%），在美罗培南耐药菌株中提高了37.4%（3.1% - 40.5%）。只有1.8%的[此处原文缺失相关内容]分离菌产MBL阳性。在2020年分子特征明确的亚胺培南/瑞来巴坦耐药[此处原文缺失相关内容]分离菌中，90.9%（30/33）存在oprD缺陷。
结论
在西欧，亚胺培南/瑞来巴坦似乎是治疗由哌拉西林/他唑巴坦和美罗培南耐药的NME引起的下呼吸道感染的一种潜在治疗选择。
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