Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016-2022).

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-06-06 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae087
Ángel Rodríguez-Villodres, Esperanza Lepe-Balsalobre, José Manuel Ortiz De La Rosa, Salvador Giner Almaraz, Elisa González De Herrero, Emilia Cercenado, Sergio García-Fernández, Rafael Benito, Ricardo Ponz Mir, Rafael Cantón, José Antonio Lepe
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Abstract

Objectives: To analyse the susceptibility profile to cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations in Enterobacter cloacae complex and Klebsiella aerogenes isolated from intra-abdominal, urinary, respiratory and bloodstream infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance study in Spain.

Methods: The susceptibilities of 759 isolates (473 E. cloacae complex and 286 K. aerogenes) collected in 11 Spanish hospitals from 2016 to 2022 were analysed following the EUCAST 2023 criteria. Molecular characterization looking for β-lactamase genes was performed through PCR and DNA sequencing analysis.

Results: E. cloacae complex showed resistance to third-generation cephalosporins in 25% of the cases, whereas K. aerogenes was resistant in 35%. Regarding cefepime, resistance in E. cloacae was higher (10%) than in K. aerogenes (2%). Carbapenems showed >85% activity in both microorganisms. Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam had good activity against these microorganisms (>95%). In contrast, the activity of ceftolozane/tazobactam was lower (80%). A high proportion of the isolates resistant to new β-lactam/β-lactamase inhibitor combinations carried a carbapenemase, mainly OXA-48-like and VIM-1.

Conclusions: Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam show high activity against both E. cloacae complex and K. aerogenes isolates recovered in the SMART-Spain study. In contrast, differences have been found in the case of cefepime, showing more activity against K. aerogenes than E. cloacae complex. These results are useful for antimicrobial stewardship programmes and for the implementation of local and national guidelines.

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头孢吡肟、碳青霉烯类和新型β-内酰胺/β-内酰胺酶抑制剂复合物对西班牙复合泄气肠杆菌和产气克雷伯菌的活性(SMART 2016-2022)。
目的分析西班牙 SMART(抗菌药耐药性趋势监测研究)监测研究中从腹腔、泌尿、呼吸道和血液感染中分离出的复合泄殖腔肠杆菌和产气克雷伯菌对头孢吡肟、碳青霉烯类和新型 β-内酰胺/β-内酰胺酶抑制剂组合的药敏谱:按照 EUCAST 2023 标准,分析了 2016 年至 2022 年期间在西班牙 11 家医院收集的 759 个分离菌株(473 个复合泄殖腔杆菌和 286 个产气荚膜杆菌)的药敏性。通过 PCR 和 DNA 测序分析对β-内酰胺酶基因进行了分子鉴定:结果表明:25%的病例中出现了对第三代头孢菌素的耐药性,而35%的病例中出现了对铜绿假单胞菌的耐药性。就头孢吡肟而言,衣藻埃希菌的耐药性(10%)高于产气荚膜杆菌(2%)。碳青霉烯类对这两种微生物的活性都大于 85%。头孢唑肟/阿维巴坦、亚胺培南/雷巴坦和美罗培南/伐巴坦对这些微生物具有良好的活性(>95%)。相比之下,头孢羟氨苄/他唑巴坦的活性较低(80%)。对新型β-内酰胺/β-内酰胺酶抑制剂组合产生耐药性的分离菌中有很大一部分携带碳青霉烯酶,主要是OXA-48-like和VIM-1:结论:头孢唑肟/阿维菌素、亚胺培南/雷贝拉坦和美罗培南/伐硼巴坦对在西班牙 SMART 研究中发现的泄殖腔杆菌复合菌和产气荚膜杆菌分离菌具有很高的活性。与此相反,头孢吡肟对克氏酵母菌的活性高于对复合物丁香杆菌的活性。这些结果对抗菌药物管理计划以及地方和国家指导方针的实施很有帮助。
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