Antimicrobial susceptibilities of the ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales isolates causing intra-abdominal infections in the Asia-Pacific region during 2008-2014: Results from the Study for Monitoring the Antimicrobial Resistance Trends (SMART).

Abstract

OBJECTIVES:

To investigate the susceptibility profiles amongst ertapenem-non-susceptible non-carbapenemase-producing Enterobacterales (ETP-NS-non-CPE) isolates.

METHODS:

Minimum inhibitory concentrations (MICs) of 404 ETP-NS-non-CPE isolates collected from different intra-abdominal infection (IAI) sites amongst patients in the Asia-Pacific region during 2008-2014 were determined using the broth microdilution method. The susceptibility results were interpreted according to the MIC breakpoints recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2018. The MICs data of several agents were evaluated based on their published pharmacokinetic/pharmacodynamic (PK/PD) profiles.

RESULTS:

The majority (>84%) of IAI-ETP-NS-non-CPE isolates - including Escherichia coli (n=83), Klebsiella pneumoniae (n=91) and Enterobacter species (n=210) - were susceptible to imipenem and amikacin. The 193 hepatobiliary ETP-NS-non-CPE isolates exhibited a trend of lower cefepime MIC (≤4mg/L) distribution than those (n=145) cultured from the peritoneal space (P=0.058). Amongst the ETP-NS-non-CP Enterobacter isolates, 65.7% displayed a cefepime MIC≤4mg/L. In addition, compared with Escherichia coli and Klebsiella pneumoniae isolates, 82.9% and 72.9% of the ETP-NS-non-CP Enterobacter isolates were susceptible to levofloxacin and ciprofloxacin, respectively. Of note, 74.5% and 70.3% of the ETP-NS-non-CP Enterobacter isolates cultured from the hepatobiliary tract and peritoneal space exhibited a ciprofloxacin MIC≤2mg/L and ≤0.25mg/L, respectively. Imipenem and amikacin showed good in vitro susceptibility rates against the IAI-ETP-NS-non-CPE isolates. The hepatobiliary ETP-NS-non-CPE displayed lower cefepime MICs than those cultured from the peritoneal space. Additionally, a significant fraction of IAI-ETP-NS-non-CP Enterobacter isolates exhibited ciprofloxacin MIC ≤ 2mg/L.

CONCLUSION:

Based upon the PK/PD analyses, ciprofloxacin, imipenem and cefepime are probably effective against IAI-ETP-NS-non-CPE isolates.

• Authors: Shio-Shin Jean, Po-Ren Hsueh, SMART Asia-Pacific Group
• Journal: Journal of global antimicrobial resistance (J Glob Antimicrob Resist) Vol. 21 Pg. 91-98 (06 2020) ISSN: 2213-7173 [Electronic] Netherlands
• PMID: 31627023 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 International Society for Antimicrobial Chemotherapy. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Ciprofloxacin
• Imipenem
• Amikacin
• Ertapenem

Topics

• Amikacin (pharmacokinetics, pharmacology)
• Asia
• Ciprofloxacin (pharmacokinetics, pharmacology)
• Drug Resistance, Bacterial
• Enterobacter (drug effects, isolation & purification)
• Enterobacteriaceae (classification, drug effects, isolation & purification)
• Enterobacteriaceae Infections (diagnosis)
• Ertapenem (pharmacology)
• Escherichia coli (drug effects, isolation & purification)
• Humans
• Imipenem (pharmacokinetics, pharmacology)
• Intraabdominal Infections (microbiology)
• Klebsiella pneumoniae (drug effects, isolation & purification)
• Microbial Sensitivity Tests
• Pacific Islands
• Population Surveillance