IHMA, Schaumburg, USA; University of Manitoba, Max Rady College of Medicine, Department of Medical Microbiology and Infectious Diseases, Winnipeg, Manitoba, Canada.
IHMA, Schaumburg, USA.
Braz J Infect Dis. 2023 May-Jun;27(3):102775. doi: 10.1016/j.bjid.2023.102775. Epub 2023 May 8.
Carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa are being isolated from patient specimens with increasing frequency in Latin America and worldwide. The current study provides an initial description of the in vitro activity of imipenem/relebactam (IMR) against non-Morganellaceae Enterobacterales (NME) and P. aeruginosa infecting hospitalized patients in Latin America. From 2018 to 2020, 37 clinical laboratories in nine Latin American countries participated in the SMART global surveillance program and contributed 15,466 NME and 3408 P aeruginosa isolates. MICs for IMR and seven comparators were determined using CLSI broth microdilution and interpreted by CLSI M100 (2022) breakpoints. β-lactamase genes were identified in selected isolate subsets. IMR (96.9% susceptible), amikacin (95.9%), meropenem (90.7%), and imipenem (88.7%) were the most active agents against NME. Among piperacillin/tazobactam-nonsusceptible NME (n = 4124), 90.4% of isolates were IMR-susceptible (range by country, 97.2 [Chile] to 67.0% [Guatemala]) and among meropenem-nonsusceptible NME isolates (n = 1433), 74.0% were IMR-susceptible (94.1% [Puerto Rico] to 5.1% [Guatemala]). Overall, 6.3% of all collected NME isolates carried a KPC (metallo-β-lactamase [MBL]-negative), 1.8% an MBL, 0.4% an OXA-48-like carbapenemase (MBL-negative), and 0.1% a GES carbapenemase (MBL-negative). Amikacin (85.2% susceptible) and IMR (80.1%) were the most active agents against P. aeruginosa; only 56.5% of isolates were imipenem-susceptible. Relebactam increased susceptibility to imipenem by 22.0% (from 23.9% to 45.9%) in piperacillin/tazobactam-nonsusceptible isolates (n = 1031) and by 35.5% (from 5.5% to 41.0%) in meropenem-nonsusceptible isolates (n = 1128). Overall, 7.6% of all collected P. aeruginosa isolates were MBL-positive and 0.7% carried a GES carbapenemase. In conclusion, in 2018‒2020, almost all NME (97%) and most P. aeruginosa (80%) isolates from Latin America were IMR-susceptible. Continued surveillance of the in vitro activities of IMR and comparator agents against Gram-negative pathogens, and monitoring for β-lactamase changes (in particular for increases in MBLs), is warranted.
耐碳青霉烯肠杆菌科细菌和铜绿假单胞菌在拉丁美洲和全球范围内从患者标本中分离的频率越来越高。本研究初步描述了亚胺培南/雷巴他定（IMR）对拉丁美洲住院患者感染的非摩根菌属肠杆菌科细菌（NME）和铜绿假单胞菌的体外活性。2018 年至 2020 年，来自九个拉丁美洲国家的 37 个临床实验室参加了 SMART 全球监测计划，并提供了 15466 株非摩根菌属肠杆菌科细菌和 3408 株铜绿假单胞菌。使用 CLSI 肉汤微量稀释法测定 IMR 和七种对照药物的 MIC，并按照 CLSI M100（2022）标准进行解释。在选定的分离物亚群中鉴定了β-内酰胺酶基因。IMR（96.9%敏感）、阿米卡星（95.9%）、美罗培南（90.7%）和亚胺培南（88.7%）对 NME 最具活性。在哌拉西林/他唑巴坦不敏感的 NME（n=4124）中，90.4%的分离株对 IMR 敏感（各国范围，97.2%[智利]至 67.0%[危地马拉]），在美罗培南不敏感的 NME 分离株中（n=1433），74.0%对 IMR 敏感（94.1%[波多黎各]至 5.1%[危地马拉]）。总体而言，所有收集的 NME 分离株中，6.3%携带 KPC（金属β-内酰胺酶[MBL]-阴性），1.8%携带 MBL，0.4%携带 OXA-48 样碳青霉烯酶（MBL-阴性），0.1%携带 GES 碳青霉烯酶（MBL-阴性）。阿米卡星（85.2%敏感）和 IMR（80.1%）对铜绿假单胞菌最具活性；只有 56.5%的分离株对亚胺培南敏感。雷巴他定使哌拉西林/他唑巴坦不敏感的分离株（n=1031）对亚胺培南的敏感性增加了 22.0%（从 23.9%增加到 45.9%），使美罗培南不敏感的分离株（n=1128）对亚胺培南的敏感性增加了 35.5%（从 5.5%增加到 41.0%）。总体而言，所有收集的铜绿假单胞菌分离株中，7.6%为 MBL 阳性，0.7%携带 GES 碳青霉烯酶。总之，2018 年至 2020 年，拉丁美洲几乎所有的 NME（97%）和大多数铜绿假单胞菌（80%）分离株对 IMR 敏感。需要继续监测 IMR 和对照药物对革兰氏阴性病原体的体外活性，并监测β-内酰胺酶变化（特别是 MBL 增加）。
