DeRyke C Andrew, Wise Mark G, Bauer Karri A, Siddiqui Fakhar, Young Katherine, Motyl Mary R, Sahm Daniel F
IHMA, Schaumburg, Illinois, USA.
Merck & Co., Inc., Rahway, New Jersey, USA.
J Pediatric Infect Dis Soc. 2025 Jan 20;14(1). doi: 10.1093/jpids/piae134.
To evaluate the in vitro susceptibility of recent Gram-negative pathogens collected from pediatric patients to imipenem/relebactam (IMI/REL) and comparator agents.
From 2018 to 2022 254 hospitals in 62 countries collected Enterobacterales or Pseudomonas aeruginosa isolates from patients <18 years old as part of the SMART global surveillance program. Minimum inhibitory concentrations (MIC)s were determined using CLSI broth microdilution and interpreted with 2024 CLSI breakpoints. Most isolates non-susceptible to IMI/REL were queried for their acquired β-lactamase content.
Overall, 96.8% of all non-Morganellaceae Enterobacterales (NME) isolates from pediatric patients (n = 12 060) were IMI/REL-susceptible. Most NME were also susceptible to imipenem alone (93.9%), meropenem (96.0%), and ertapenem (94.4%); isolates were less susceptible to piperacillin/tazobactam (82.8%), cefepime (76.3%), and ceftazidime (74.4%). Non-Morganellaceae Enterobacterales collected in Asia were the least susceptible to IMI/REL (91.6%), while those from Australia/New Zealand were the most (99.3%). Imipenem/relebactam was equally potent against NME isolates regardless of infection source, hospital ward, age, and length of hospitalization. In total, 90.8% of all Pseudomonas aeruginosa isolates (n = 3046) were IMI/REL-susceptible; ceftolozane/tazobactam also inhibited >90% of the P. aeruginosa. Regionally, P. aeruginosa isolates from Eastern Europe were least susceptible to IMI/REL. Molecular characterization revealed that, globally, most resistance to IMI/REL among the NME could be attributed to the presence of NDM-type metallo-β-lactamases, while no acquired β-lactamases were detected in approximately half the IMI/REL non-susceptible P. aeruginosa examined.
Based on in vitro data, IMI/REL represents a good therapeutic option for most hospitalized pediatric patients infected with common Gram-negative pathogens.
评估从儿科患者中分离出的近期革兰氏阴性病原体对亚胺培南/瑞来巴坦（IMI/REL）及对照药物的体外敏感性。
作为全球SMART监测项目的一部分，2018年至2022年期间，62个国家的254家医院收集了18岁以下患者的肠杆菌科细菌或铜绿假单胞菌分离株。使用CLSI肉汤微量稀释法测定最低抑菌浓度（MIC），并根据2024年CLSI折点进行解释。对大多数对IMI/REL不敏感的分离株检测其获得性β-内酰胺酶含量。
总体而言，儿科患者中所有非摩根菌属肠杆菌科细菌（NME）分离株（n = 12060）的96.8%对IMI/REL敏感。大多数NME对单独使用亚胺培南（93.9%）、美罗培南（96.0%）和厄他培南（94.4%）也敏感；分离株对哌拉西林/他唑巴坦（82.8%）、头孢吡肟（76.3%）和头孢他啶（74.4%）的敏感性较低。在亚洲收集的非摩根菌属肠杆菌科细菌对IMI/REL的敏感性最低（91.6%），而来自澳大利亚/新西兰的分离株敏感性最高（99.3%）。无论感染源、医院病房、年龄和住院时间如何，亚胺培南/瑞来巴坦对NME分离株的效力相同。所有铜绿假单胞菌分离株（n = 3046）中，90.8%对IMI/REL敏感；头孢洛扎/他唑巴坦也能抑制>90%的铜绿假单胞菌。在区域上，来自东欧的铜绿假单胞菌分离株对IMI/REL的敏感性最低。分子特征分析显示，在全球范围内，NME中对IMI/REL的大多数耐药性可归因于NDM型金属β-内酰胺酶的存在，而在大约一半检测的对IMI/REL不敏感的铜绿假单胞菌中未检测到获得性β-内酰胺酶。
基于体外数据，IMI/REL是大多数感染常见革兰氏阴性病原体的住院儿科患者的良好治疗选择。
