IHMA, Schaumburg, IL, 60173, USA.
Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, R3E 0J9, Canada.
J Med Microbiol. 2023 Feb;72(2). doi: 10.1099/jmm.0.001645.
Piperacillin/tazobactam and carbapenems are important agents for the treatment of serious Gram-negative infections in hospitalized patients. Resistance to both agents is a significant concern in clinical isolates of and ; new agents with improved activity are needed. Publication of current, region-specific data describing the activity of newer agents such as imipenem/relebactam (IMR) against piperacillin/tazobactam-resistant and carbapenem-resistant and are needed to support their clinical use. To describe the activity of IMR against non- (NME) and isolated from bloodstream, intra-abdominal and urinary tract infection samples by hospital laboratories in Western Europe with a focus on the activity of IMR against piperacillin/tazobactam-resistant and meropenem-resistant isolates. From 2018 to 2020, 29 hospital laboratories in six countries in Western Europe participated in the SMART global surveillance programme and contributed 9487 NME and 1004 . isolates. MICs were determined by CLSI broth microdilution testing and interpreted by EUCAST (2021) breakpoints. β-Lactamase genes were identified in selected isolate subsets (2018-2020) and sequenced in molecularly characterized (2020). IMR (99.4 % susceptible), amikacin (98.0 %), meropenem (97.7 %) and imipenem (97.6 %) were the most active agents against NME; 83.1 % of NME were piperacillin/tazobactam-susceptible. Relebactam increased imipenem susceptibility of NME from Italy by 8.3 %, from Portugal by 2.9 %, and from France, Germany, Spain and the UK by <1 %. In total, 96.4 % of piperacillin/tazobactam-resistant (=1601) and 73.7 % of meropenem-resistant (=152) NME were IMR-susceptible. Also, 0.4 % of NME were MBL-positive, 0.9 % OXA-48-like-positive (MBL-negative) and 1.5 % KPC-positive (MBL-negative). Amikacin (95.4 % susceptible) and IMR (94.1 %) were the most active agents against ; 81.7 % of isolates were imipenem-susceptible and 79.6 % were piperacillin/tazobactam-susceptible. Relebactam increased susceptibility to imipenem by 12.5 % overall (range by country, 4.3-17.5 %); and by 30.7 % in piperacillin/tazobactam-resistant and 24.3 % in meropenem-resistant . In total, 1.6 % of isolates were MBL-positive. Seven of eight molecularly characterized IMR-resistant isolates from 2020 were -deficient. IMR may be a potential treatment option for bloodstream, intra-abdominal and urinary tract infections caused by NME and in Western Europe, including infections caused by piperacillin/tazobactam-resistant and meropenem-resistant isolates.
哌拉西林/他唑巴坦和碳青霉烯类是治疗住院患者严重革兰氏阴性感染的重要药物。这两种药物的耐药性在 和 临床分离株中是一个重大问题；需要新的具有改善活性的药物。需要发表当前的、特定于地区的描述新型药物（如亚胺培南/雷巴坦（IMR）对哌拉西林/他唑巴坦耐药和耐碳青霉烯类 的 和 的 活性的相关数据，以支持其临床应用。
本研究旨在描述 IMR 对来自血流、腹腔和尿路感染样本的非 （NME）和 （包括对哌拉西林/他唑巴坦和 耐 菌株）的活性，重点关注 IMR 对哌拉西林/他唑巴坦耐药和 耐 菌株的活性。
2018 年至 2020 年，来自西欧 6 个国家的 29 家医院实验室参加了 SMART 全球监测计划，并提供了 9487 株 NME 和 1004 株 。通过 CLSI 肉汤微量稀释法测定 MIC，并按照 EUCAST（2021 年）的折点进行解释。在 2018-2020 年的选定分离株亚群中鉴定了 β-内酰胺酶基因，并在分子特征明确的 （2020 年）中进行了 测序。IMR（99.4%敏感）、阿米卡星（98.0%敏感）、美罗培南（97.7%敏感）和亚胺培南（97.6%敏感）是对 NME 最有效的药物；83.1%的 NME 对哌拉西林/他唑巴坦敏感。雷巴坦使来自意大利、葡萄牙和法国、德国、西班牙和英国的 NME 对亚胺培南的敏感性分别增加了 8.3%、2.9%和<1%。总的来说，96.4%的哌拉西林/他唑巴坦耐药（=1601）和 73.7%的美罗培南耐药（=152）NME 对 IMR 敏感。此外，0.4%的 NME 为 MBL 阳性，0.9%为 OXA-48 样阳性（MBL 阴性），1.5%为 KPC 阳性（MBL 阴性）。阿米卡星（95.4%敏感）和 IMR（94.1%敏感）是对 最有效的药物；81.7%的分离株对亚胺培南敏感，79.6%对哌拉西林/他唑巴坦敏感。雷巴坦使亚胺培南的敏感性总体增加了 12.5%（各国的范围为 4.3-17.5%）；在哌拉西林/他唑巴坦耐药和 耐 株中分别增加了 30.7%和 24.3%。总的来说，1.6%的 分离株为 MBL 阳性。2020 年从 8 株分子特征明确的 IMR 耐药 中分离出的 7 株均为 缺陷。
IMR 可能是治疗西欧血流、腹腔和尿路感染的 NME 和 的潜在治疗选择，包括对哌拉西林/他唑巴坦耐药和 耐 株引起的感染。
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