UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Intern Med J. 2024 Apr;54(4):535-544. doi: 10.1111/imj.16374. Epub 2024 Apr 8.
Carbapenemase-producing gram-negative bacteria (CP-GNB) infections threaten public health with high mortality, morbidity and treatment costs. Although frequencies remain low in Australia (total number of CP-GNB infections reported was 907 in 2022), bla has established low levels of endemicity in many states. Imipenemase metallo-β-lactamase types alone accounted for more than half of all carbapenemases in carbapenemase-producing Enterobacterales isolates in Australia, particularly in Enterobacter cloacae complex. New Delhi metallo-β-lactamase constitutes almost 25% of all carbapenemases in Australia and was identified predominantly in Escherichia coli. The OXA-48-like carbapenemases include almost 10% of all carbapenemases and are mainly seen in Klebsiella pneumoniae and E. coli. Although K. pneumoniae carbapenemase-type carbapenemases are rare in Australia, some local outbreaks have occurred. Most carbapenem-resistant (CR) Pseudomonas aeruginosa strains in Australia do not produce carbapenemases. Finally, OXA-23-like carbapenemases are overwhelmingly positive in CR-Acinetobacter baumannii strains in Australia. Treatment of CR-GNB infections challenges physicians. Of 10 new antibiotics active against at least some CR-GNB infections that are approved by the US Food and Drug Administration, just three are approved for use in Australia. In this context, there is still an unmet need for novel antibacterials that can be used for the treatment of CR-GNB infections in Australia, as well as a pressing requirement for new mechanisms to 'de-link' antibiotic sales from their availability. In this narrative review, we aim to overview the epidemiology and clinical significance of carbapenem resistance in Australia as it pertains to Enterobacterales, P. aeruginosa and A. baumannii.
产碳青霉烯酶革兰氏阴性菌 (CP-GNB) 感染具有高死亡率、发病率和治疗费用，威胁着公众健康。尽管在澳大利亚的频率仍然较低（2022 年报告的 CP-GNB 感染总数为 907 例），但 bla 在许多州已建立了低水平的地方性。在澳大利亚，产碳青霉烯酶肠杆菌科分离株中，仅碳青霉烯酶中的亚胺培南酶金属β-内酰胺酶类型就超过了一半，尤其是在阴沟肠杆菌复合菌中。新德里金属β-内酰胺酶几乎占澳大利亚所有碳青霉烯酶的 25%，主要在大肠埃希菌中发现。OXA-48 样碳青霉烯酶几乎占所有碳青霉烯酶的 10%，主要见于肺炎克雷伯菌和大肠埃希菌。虽然在澳大利亚，产碳青霉烯酶肺炎克雷伯菌型碳青霉烯酶很少见，但也发生了一些局部暴发。大多数耐碳青霉烯类铜绿假单胞菌在澳大利亚不产生碳青霉烯酶。最后，在澳大利亚耐碳青霉烯类鲍曼不动杆菌株中，OXA-23 样碳青霉烯酶呈压倒性阳性。治疗耐碳青霉烯类革兰氏阴性菌感染对医生来说是一个挑战。在美国食品和药物管理局批准的 10 种针对至少部分耐碳青霉烯类革兰氏阴性菌感染的新型抗生素中，只有 3 种在澳大利亚获得批准使用。在这种情况下，澳大利亚仍然需要新型抗菌药物来治疗耐碳青霉烯类革兰氏阴性菌感染，并且迫切需要新的机制将抗生素销售与其可获得性“脱钩”。在本叙述性综述中，我们旨在概述澳大利亚肠杆菌科、铜绿假单胞菌和鲍曼不动杆菌中碳青霉烯类耐药的流行病学和临床意义。
