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.
IHMA, 2122 Palmer Drive, Schaumburg, IL, 60173, USA.
Int J Antimicrob Agents. 2023 May;61(5):106772. doi: 10.1016/j.ijantimicag.2023.106772. Epub 2023 Mar 4.
Multidrug-resistant (MDR) Pseudomonas aeruginosa infections compromise both empirical and definitive antimicrobial therapies. The Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program identified 943 MDR P. aeruginosa (from a total of 4086 P. aeruginosa isolates [23.1%]) collected at 32 clinical laboratories in six countries in Western Europe from 2017 to 2020. Minimum inhibitory concentrations (MICs) for ceftolozane/tazobactam and 10 comparator agents were determined by broth microdilution and interpreted using 2021 EUCAST breakpoints. β-lactamase genes were identified in selected isolate subsets. Most isolates of P. aeruginosa in Western Europe (93.3%) were ceftolozane/tazobactam-susceptible. A total of 23.1% of P. aeruginosa isolates were MDR. Of these, 72.0% were ceftolozane/tazobactam-susceptible, which is similar to that for ceftazidime/avibactam (73.6%) but >40% higher than for carbapenems, piperacillin/tazobactam, third- and fourth-generation cephalosporins, and levofloxacin. Metallo-β-lactamases (MBLs) were carried by 8.8% of molecularly characterized MDR P. aeruginosa, and 7.6% of molecularly characterized MDR isolates carried Guiana Extended Spectrum (GES) carbapenemases. MBLs were identified in isolates from all six countries, ranging from 3.2% of all P. aeruginosa isolates from Italy to 0.4% of all isolates from the United Kingdom. Acquired β-lactamases were not identified in 80.0% of molecularly characterized MDR P. aeruginosa isolates. Percentages of MDR isolates without detected β-lactamases were higher in the United Kingdom (97.7%), Spain (88.2%), France (88.1%), and Germany (84.7%) than in Portugal (63.0%) and Italy (61.3%), where carbapenemases were more prevalent. Ceftolozane/tazobactam is an important treatment option for patients infected with MDR P. aeruginosa that are not susceptible to first-line antipseudomonal agents.
耐多药（MDR）铜绿假单胞菌感染会影响经验性和明确性抗菌治疗。监测抗菌药物耐药趋势（SMART）监测计划在 2017 年至 2020 年期间从西欧六个国家的 32 个临床实验室收集了 4086 株铜绿假单胞菌（占总数的 23.1%），发现了 943 株 MDR 铜绿假单胞菌。采用肉汤微量稀释法测定头孢他唑巴坦和 10 种比较剂的最低抑菌浓度（MIC），并根据 2021 年 EUCAST 折点进行解释。在选定的分离株亚群中鉴定了β-内酰胺酶基因。西欧地区大多数铜绿假单胞菌（93.3%）对头孢他唑巴坦/他唑巴坦敏感。共有 23.1%的铜绿假单胞菌分离株为 MDR。其中，72.0%对头孢他唑巴坦/他唑巴坦敏感，与头孢他啶/阿维巴坦（73.6%）相似，但高于碳青霉烯类、哌拉西林/他唑巴坦、三代和四代头孢菌素以及左氧氟沙星的 40%以上。分子特征鉴定的 MDR 铜绿假单胞菌中有 8.8%携带金属β-内酰胺酶（MBLs），7.6%的分子特征鉴定的 MDR 分离株携带圭亚那扩展谱（GES）碳青霉烯酶。MBLs 存在于来自六个国家的所有分离株中，从意大利所有铜绿假单胞菌分离株的 3.2%到英国所有分离株的 0.4%不等。在 80.0%的分子特征鉴定的 MDR 铜绿假单胞菌分离株中未发现获得性β-内酰胺酶。在英国（97.7%）、西班牙（88.2%）、法国（88.1%）和德国（84.7%），没有检测到β-内酰胺酶的 MDR 分离株比例高于葡萄牙（63.0%）和意大利（61.3%），其中碳青霉烯酶更为普遍。头孢他唑巴坦是治疗不适合一线抗假单胞菌药物的 MDR 铜绿假单胞菌感染的重要治疗选择。
