IHMA, Schaumburg, IL, USA.
IHMA, Schaumburg, IL, USA; Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.
Braz J Infect Dis. 2023 May-Jun;27(3):102759. doi: 10.1016/j.bjid.2023.102759. Epub 2023 Mar 25.
The incidence of antimicrobial resistance is increasing in many parts of the world. The focus of this report is to examine changes in antimicrobial resistance epidemiology among clinical isolates of Enterobacterales and Pseudomonas aeruginosa collected in six Latin American countries as part of the Antimicrobial Testing Leadership and Surveillance (ATLAS) program from 2015 to 2020, with a focus on the in vitro activity of ceftazidime-avibactam against Multidrug-Resistant (MDR) isolates.
Non-duplicate, clinical isolates of Enterobacterales (n = 15,215) and P. aeruginosa (n = 4,614) collected by 40 laboratories in Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela, from 2015 to 2020, underwent centralized Clinical Lab Standards Institute (CLSI) broth microdilution susceptibility testing. Minimum Inhibitory Concentration (MIC) values were interpreted using 2022 CLSI breakpoints. An MDR phenotype was defined by resistance to ≥ 3 of seven sentinel agents.
In total, 23.3% of Enterobacterales and 25.1% of P. aeruginosa isolates were MDR. Annual percent MDR values for Enterobacterales were stable from 2015 to 2018 (21.3% to 23.7% year) but markedly increased in 2019 (31.5%) and 2020 (32.4%). Annual percent MDR values for P. aeruginosa were stable from 2015 to 2020 (23.0% to 27.6% year). Isolates were divided into two 3-year time-periods, 2015‒2017 and 2018‒2020, for additional analyses. For Enterobacterales, 99.3% of all isolates and 97.1% of MDR isolates from 2015‒2017 were ceftazidime-avibactam-susceptible compared to 97.2% and 89.3% of isolates, respectively, from 2018‒2020. For P. aeruginosa, 86.6% of all isolates and 53.9% of MDR isolates from 2015‒2017 were ceftazidime-avibactam-susceptible compared to 85.3% and 45.3% of isolates, respectively, from 2018‒2020. Among individual countries, Enterobacterales and P. aeruginosa collected in Venezuela showed the greatest reductions in ceftazidime-avibactam susceptibility over time.
MDR Enterobacterales increased in Latin America from 22% in 2015 to 32% in 2020 while MDR P. aeruginosa remained constant at 25%. Ceftazidime-avibactam remains highly active against all clinical isolates of both Enterobacterales (97.2% susceptible, 2018‒2020) and P. aeruginosa (85.3%), and inhibited more MDR isolates (Enterobacterales, 89.3% susceptible, 2018‒2020; P. aeruginosa, 45.3%) than carbapenems, fluoroquinolones, and aminoglycosides.
在世界许多地区，抗生素耐药性的发生率正在上升。本报告的重点是检查 2015 年至 2020 年期间在六个拉丁美洲国家收集的肠杆菌科和铜绿假单胞菌临床分离株的抗生素耐药性流行病学变化，重点是体外头孢他啶-阿维巴坦对多药耐药（MDR）分离株的活性。
2015 年至 2020 年，来自阿根廷、巴西、智利、哥伦比亚、墨西哥和委内瑞拉的 40 个实验室收集了非重复的肠杆菌科（n=15215）和铜绿假单胞菌（n=4614）临床分离株，进行了集中的临床实验室标准化协会（CLSI）肉汤微量稀释药敏试验。使用 2022 年 CLSI 断点解释最小抑菌浓度（MIC）值。MDR 表型定义为对 7 种监测药物中的≥3 种耐药。
共有 23.3%的肠杆菌科和 25.1%的铜绿假单胞菌分离株为 MDR。肠杆菌科的年 MDR 值从 2015 年到 2018 年保持稳定（21.3%至 23.7%），但在 2019 年（31.5%）和 2020 年（32.4%）显著增加。铜绿假单胞菌的年 MDR 值从 2015 年到 2020 年保持稳定（23.0%至 27.6%）。将分离物分为 2015-2017 年和 2018-2020 年两个 3 年时间期，进行进一步分析。对于肠杆菌科，与 2015-2017 年相比，2018-2020 年所有分离株和 97.1%的 MDR 分离株对头孢他啶-阿维巴坦敏感，分别为 99.3%和 97.2%。对于铜绿假单胞菌，与 2015-2017 年相比，2018-2020 年所有分离株和 53.9%的 MDR 分离株对头孢他啶-阿维巴坦敏感，分别为 86.6%和 85.3%。在个别国家中，委内瑞拉收集的肠杆菌科和铜绿假单胞菌的头孢他啶-阿维巴坦敏感性随着时间的推移呈最大幅度下降。
拉丁美洲的 MDR 肠杆菌科从 2015 年的 22%增加到 2020 年的 32%，而 MDR 铜绿假单胞菌保持在 25%不变。头孢他啶-阿维巴坦对所有肠杆菌科（2018-2020 年敏感率为 97.2%，敏感率为 97.2%）和铜绿假单胞菌（2018-2020 年敏感率为 85.3%）的临床分离株仍具有高度活性，并且比碳青霉烯类、氟喹诺酮类和氨基糖苷类药物抑制更多的 MDR 分离株（肠杆菌科，2018-2020 年敏感率为 89.3%；铜绿假单胞菌，敏感率为 45.3%）。
