Jean Shio-Shin, Ko Wen-Chien, Liu I-Min, Hsieh Po-Chuen, Hsueh Po-Ren
Department of Pharmacy, College of Pharmacy and Health Care, Tajen University, Pingtung, Taiwan; Departments of Internal Medicine and Critical Care Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan.
Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Int J Antimicrob Agents. 2024 Dec;64(6):107363. doi: 10.1016/j.ijantimicag.2024.107363. Epub 2024 Oct 24.
To evaluate the susceptibility profiles of regional meropenem-resistant potential non-class B carbapenemase-producing Enterobacterales (CPE) isolates (without confirmation by phenotypic tests) against important antibiotics, we extracted data from the 2018-2022 Antimicrobial Testing Leadership and Surveillance. This data included susceptibility information of meropenem-resistant potential non-class B CPE isolates against indicated antibiotics - amikacin, gentamicin, ceftazidime-avibactam, colistin, meropenem-vaborbactam, and tigecycline - from sepsis patients hospitalized in intensive care units across six major regions. Carbapenemase-encoding genes of the tested CPE isolates, determined by multiplex PCR and Sanger sequencing, were also analyzed. Susceptibility breakpoints recommended by Clinical and Laboratory Standards Institute 2024 and US FDA criteria (for tigecycline only) against Enterobacterales were employed. A total of 1500 potential non-class B CPE isolates (89% of which were Klebsiella pneumoniae) were tested globally. Resistance rates to amikacin and gentamicin against the evaluated isolates were statistically higher in Africa/the Middle East, Europe, and India compared to other regions. A similar pattern was observed in the susceptibility of these potential CPE isolates to ceftazidime-avibactam and meropenem-vaborbactam. High colistin resistance rates were noted in Asia, Latin America, and Europe (29%-35%). Furthermore, the proportions of potential CPE isolates carrying genes encoding bla variants were notably higher among the tested CPE isolates in India, Europe, and Africa/the Middle East regions (99.2%, 53.3%, and 96.7%, respectively) compared to other regions. Trends in resistance to important antibiotics among potential non-class B CPE isolates warrant close monitoring.
为评估区域内耐美罗培南的潜在非B类碳青霉烯酶产生肠杆菌科细菌（CPE）分离株（未经表型试验确认）对重要抗生素的敏感性谱，我们从2018 - 2022年抗菌药物检测领导力与监测项目中提取了数据。这些数据包括在六个主要地区的重症监护病房住院的脓毒症患者中，耐美罗培南的潜在非B类CPE分离株对指定抗生素（阿米卡星、庆大霉素、头孢他啶 - 阿维巴坦、黏菌素、美罗培南 - 巴尼巴坦和替加环素）的敏感性信息。还分析了通过多重PCR和桑格测序确定的受试CPE分离株的碳青霉烯酶编码基因。采用了临床和实验室标准协会2024年推荐的敏感性断点以及美国食品药品监督管理局（仅针对替加环素）针对肠杆菌科细菌的标准。全球共检测了1500株潜在非B类CPE分离株（其中89%为肺炎克雷伯菌）。与其他地区相比，非洲/中东、欧洲和印度的受试分离株对阿米卡星和庆大霉素的耐药率在统计学上更高。这些潜在CPE分离株对头孢他啶 - 阿维巴坦和美罗培南 - 巴尼巴坦的敏感性也观察到类似模式。在亚洲、拉丁美洲和欧洲观察到较高的黏菌素耐药率（29% - 35%）。此外，与其他地区相比，在印度、欧洲和非洲/中东地区的受试CPE分离株中，携带编码bla变体基因的潜在CPE分离株比例显著更高（分别为�9.2%、53.3%和96.7%）。潜在非B类CPE分离株对重要抗生素的耐药趋势值得密切监测。
