IHMA, Schaumburg, IL.
IHMA, Schaumburg, IL; Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
J Glob Antimicrob Resist. 2024 Jun;37:168-175. doi: 10.1016/j.jgar.2024.03.020. Epub 2024 Apr 10.
To report trends in carbapenem resistance and difficult-to-treat resistance (DTR) among clinical isolates of Gram-negative priority pathogens collected by the ATLAS global surveillance program from 2018 to 2022.
Reference broth microdilution testing was performed in a central laboratory for 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates collected by a constant set of 157 medical centres in 49 countries in Asia Pacific (APAC), Europe (EUR), Latin America (LATAM), Middle East-Africa (MEA), and North America (NA) regions. MICs were interpreted by 2023 CLSI M100 breakpoints. β-lactamase genes were identified for meropenem-nonsusceptible (MIC ≥2 mg/L) Enterobacterales isolates.
Carbapenem-resistant Enterobacterales (CRE) detection increased (P < 0.05) in APAC, EUR, LATAM, and MEA regions and decreased in NA, while annual DTR percentages increased in all five regions. Carbapenem-resistant P. aeruginosa (CRPA; decreased in MEA region) and carbapenem-resistant A. baumannii-calcoaceticus complex (CRAB; decreased in MEA region and increased in EUR) remained relatively stable over time in all regions, although notably, annual percentages of CRAB and DTR A. baumannii-calcoaceticus complex isolates were consistently >25 percentage points lower in NA than in other regions. For all regions except NA, the majority of changes in CRE percentages could be attributed to hospital-acquired infections. Among meropenem-nonsusceptible Enterobacterales, KPC was the most frequent carbapenemase in NA and EUR each year. NDM was the most prevalent carbapenemase detected in 2022 in other global regions.
CRE, CRPA, CRAB, and DTR rates vary among global regions over time highlighting the need for continuing surveillance to inform treatment strategies and antimicrobial stewardship.
报告 2018 年至 2022 年期间，ATLAS 全球监测计划从亚太地区（APAC）、欧洲（EUR）、拉丁美洲（LATAM）、中东-非洲（MEA）和北美（NA）地区的 49 个国家的 157 家医疗中心收集的革兰氏阴性优先病原体临床分离株中碳青霉烯类耐药和治疗困难耐药（DTR）的趋势。
在一个中央实验室对 79214 株肠杆菌科、30504 株铜绿假单胞菌和 13500 株鲍曼不动杆菌-醋酸钙复合菌属分离株进行了参考肉汤微量稀释试验，这些分离株是由亚太地区（APAC）、欧洲（EUR）、拉丁美洲（LATAM）、中东-非洲（MEA）和北美（NA）地区的 157 家医疗中心采用一套固定方法收集的。MIC 采用 2023 年 CLSI M100 断点进行解释。对美罗培南不敏感（MIC≥2mg/L）的肠杆菌科分离株进行了β-内酰胺酶基因鉴定。
在 APAC、EUR、LATAM 和 MEA 地区，碳青霉烯类耐药肠杆菌科（CRE）的检出率有所上升（P＜0.05），而在 NA 地区则有所下降，而所有五个地区的年度 DTR 百分比均有所上升。铜绿假单胞菌（CRPA；MEA 地区下降）和鲍曼不动杆菌-醋酸钙复合菌属（CRAB；MEA 地区下降，EUR 地区上升）的碳青霉烯类耐药率在所有地区均相对稳定，尽管值得注意的是，在 NA 地区，CRAB 和 DTR 鲍曼不动杆菌-醋酸钙复合菌属分离株的年度百分比始终比其他地区低 25 个百分点以上。除了 NA 地区，CRE 百分比的大多数变化都归因于医院获得性感染。在美罗培南不敏感的肠杆菌科中，KPC 是每年 NA 和 EUR 中最常见的碳青霉烯酶。在其他全球地区，2022 年检测到的最常见的碳青霉烯酶是 NDM。
CRE、CRPA、CRAB 和 DTR 的发生率在不同的全球地区随时间而变化，这突出表明需要继续监测，以提供治疗策略和抗菌药物管理信息。
