Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Laboratory Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Int J Antimicrob Agents. 2024 Nov;64(5):107341. doi: 10.1016/j.ijantimicag.2024.107341. Epub 2024 Sep 18.
Carbapenem-resistant bacteria (CRB), including carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbapenem-resistant Enterobacterales (CRE), pose a considerable threat to public health in China. Eravacycline, aztreonam/avibactam and colistin are important antimicrobial agents for the treatment of serious infections caused by CRB. This study aimed to evaluate the prevalence of CRB strains, and the susceptibility of commonly used clinical antimicrobial agents against strains with different carbapenemase genes.
In total, 7194 gram-negative bacteria strains were collected from different regions of China, and 924 carbapenem-resistant strains were identified. All strains were from confirmed infections. Antimicrobial susceptibility testing, covering 21 antimicrobial agents including aztreonam/avibactam, eravacycline, colistin and other comparators, was performed using the broth microdilution method. Carbapenemase genes (bla, bla, bla, bla and bla) were screened using polymerase chain reaction amplification and sequence analysis. All statistical analyses were performed using Statistical Package for the Social Sciences Version 23.0.
The isolation rates of CRE, CRAB and CRPA were 6.31% (332/5265), 62.95% (440/699) and 15.20% (152/1000), respectively. The predominant carbapenemase in carbapenem-resistant Escherichia coli (CRECO) was NDM, while in carbapenem-resistant Klebsiella pneumoniae (CRKP), it was KPC. All CRAB produced OXA-23, and 85.52% of CRPA did not produce any of the following carbapenemases: NDM, KPC, VIM, IMP and OXA. Aztreonam/avibactam, colistin and eravacycline exhibited high antimicrobial activity against different species producing various carbapenemases. Compared with ceftazidime/avibactam, aztreonam/avibactam demonstrated superior antimicrobial activity, particularly pronounced in CRECO and strains producing metallo-beta-lactamases. In comparisons between tigecycline and eravacycline, the latter maintained higher antimicrobial activity across different species. Antimicrobial agents exhibited varying levels of activity against strains with different resistance mechanisms.
Using aztreonam/avibactam, eravacycline and colistin to treat infections caused by CRB offers significant advantages. These findings will guide clinical practice and optimize antimicrobial administration.
碳青霉烯类耐药菌（包括碳青霉烯类耐药鲍曼不动杆菌（CRAB）、碳青霉烯类耐药铜绿假单胞菌（CRPA）和碳青霉烯类耐药肠杆菌科细菌（CRE））对中国的公共卫生构成了重大威胁。依拉环素、氨曲南/阿维巴坦和黏菌素是治疗碳青霉烯类耐药菌引起的严重感染的重要抗菌药物。本研究旨在评估中国不同地区碳青霉烯类耐药菌的流行情况，以及不同碳青霉烯酶基因的菌株对常用临床抗菌药物的敏感性。
共收集中国不同地区的 7194 株革兰氏阴性菌，鉴定出 924 株碳青霉烯类耐药菌。所有菌株均来自确诊感染。采用肉汤微量稀释法对 21 种抗菌药物（包括氨曲南/阿维巴坦、依拉环素、黏菌素等对照药物）进行药敏试验。采用聚合酶链反应扩增和序列分析筛选碳青霉烯酶基因（bla、bla、bla、bla 和 bla）。所有统计分析均采用 SPSS 23.0 统计软件进行。
CRE、CRAB 和 CRPA 的分离率分别为 6.31%（332/5265）、62.95%（440/699）和 15.20%（152/1000）。碳青霉烯类耐药大肠埃希菌（CRECO）中主要的碳青霉烯酶为 NDM，而碳青霉烯类耐药肺炎克雷伯菌（CRKP）中主要的碳青霉烯酶为 KPC。所有 CRAB 均产生 OXA-23，85.52%的 CRPA 不产生任何以下碳青霉烯酶：NDM、KPC、VIM、IMP 和 OXA。氨曲南/阿维巴坦、黏菌素和依拉环素对不同种属产生不同碳青霉烯酶的菌株具有较高的抗菌活性。与头孢他啶/阿维巴坦相比，氨曲南/阿维巴坦具有更好的抗菌活性，尤其是在 CRECO 和产金属β-内酰胺酶的菌株中。替加环素与依拉环素比较，后者对不同种属的抗菌活性保持较高水平。抗菌药物对不同耐药机制的菌株表现出不同的活性水平。
使用氨曲南/阿维巴坦、依拉环素和黏菌素治疗碳青霉烯类耐药菌感染具有显著优势。这些发现将指导临床实践并优化抗菌药物的应用。
