2020 - 2022年抗菌检测领导力与监测项目中四个全球区域住院患者耐美罗培南肠杆菌科细菌碳青霉烯酶编码基因分布、药敏性以及对头孢他啶 - 阿维巴坦、美罗培南 - 伏巴拉坦和氨曲南 - 阿维巴坦最低抑菌浓度的地理差异
Geographic variations in distributions of carbapenemase-encoding genes, susceptibilities, and minimum inhibitory concentrations of inpatient meropenem-resistant Enterobacterales to ceftazidime-avibactam, meropenem-vaborbactam, and aztreonam-avibactam across four global regions: 2020-2022 data from the Antimicrobial Testing Leadership and Surveillance.
作者信息
Jean Shio-Shin, Lai Chih-Cheng, Ho Sung-Jung, Liu I-Min, Hsieh Po-Chuen, Hsueh Po-Ren
机构信息
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 Internal Medicine, Division of Hospital Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
出版信息
Int J Antimicrob Agents. 2025 Jul;66(1):107500. doi: 10.1016/j.ijantimicag.2025.107500. Epub 2025 Mar 31.
PURPOSE
To evaluate the susceptibility profiles of regional inpatient meropenem-resistant (MEM-R) carbapenemase-producing Enterobacterales (CPE) isolates and their MIC values to ceftazidime-avibactam (CZA), meropenem-vaborbactam (MVB), and aztreonam-avibactam (ATM-AVI) METHODS: The 2020-2022 Antimicrobial Testing Leadership and Surveillance database were analyzed. Carbapenemase-encoding genes in CPE isolates were identified using multiplex PCR and Sanger sequencing. Susceptibility breakpoints for CZA and MVB recommended by CLSI 2024 and EUCAST 2025 against Enterobacterales were applied.
RESULTS
A total of 2,318 CPE isolates (78.2% were Klebsiella pneumoniae) were tested globally. Notable diversity in carbapenemase-encoding gene distributions was observed among CPE isolates from Africa/the Middle East (10 countries; n=361), Asia (7 countries, excluding India and Pakistan; n=182), Europe (17 countries; n=1,002), and Latin America (10 countries; n=773). Metallo-β-lactamase-encoding genes, predominantly bla, were more frequently detected in CPE isolates from Africa/the Middle East (75.3%, except bla in Kuwait) and Asia (67%, except bla in Taiwan) compared to other regions. Among KPC variants, the KPC-2 enzyme was the predominant one in CPE isolates in Europe (43.4%, except for KPC-3 prevalent specifically in Italy) and in Latin America (62.1%). The susceptibility rates of all analyzed CPE isolates harboring only a single bla gene to CZA and MVB were 99.4% and 93.5%, respectively, based on the CLSI 2024 susceptibility breakpoints. The MIC values of CPE isolates to ATM-AVI were 0.12/0.25 mg/L and 0.5/1 mg/L, respectively, regardless of collection region, dual carbapenemase production, or infection source.
CONCLUSIONS
The trends in resistance to novel antibiotics among contemporary CPE isolates need close monitoring.
目的
评估区域住院患者中耐美罗培南（MEM-R）的产碳青霉烯酶肠杆菌科细菌（CPE）分离株的药敏谱及其对头孢他啶-阿维巴坦（CZA）、美罗培南-伏巴坦（MVB）和氨曲南-阿维巴坦（ATM-AVI）的MIC值。方法：分析2020 - 2022年抗菌药物检测领导与监测数据库。使用多重PCR和桑格测序法鉴定CPE分离株中的碳青霉烯酶编码基因。应用CLSI 2024和EUCAST 2025推荐的针对肠杆菌科细菌的CZA和MVB药敏断点。
结果
全球共检测了2318株CPE分离株（78.2%为肺炎克雷伯菌）。在来自非洲/中东（10个国家；n = 361）、亚洲（7个国家，不包括印度和巴基斯坦；n = 182）、欧洲（17个国家；n = 1002）和拉丁美洲（10个国家；n = 773）的CPE分离株中观察到碳青霉烯酶编码基因分布存在显著差异。与其他地区相比，编码金属β-内酰胺酶的基因，主要是bla，在来自非洲/中东（75.3%，科威特除外的bla）和亚洲（67%，台湾除外的bla）的CPE分离株中更频繁地被检测到。在KPC变体中，KPC-2酶是欧洲（43.4%，意大利除外的KPC-3特别流行）和拉丁美洲（62.1%）的CPE分离株中的主要变体。根据CLSI 2024药敏断点，所有仅携带单个bla基因的分析CPE分离株对CZA和MVB的药敏率分别为99.4%和93.5%。无论采集地区、是否产双碳青霉烯酶或感染源如何，CPE分离株对ATM-AVI的MIC值分别为0.12/0.25 mg/L和0.5/1 mg/L。
结论
当代CPE分离株对新型抗生素的耐药趋势需要密切监测。
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