英格兰一个大型中心产碳青霉烯酶肠杆菌的耐药性概况:我们是否已经失去了头孢菌素?

IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Journal of Antimicrobial Chemotherapy Pub Date : 2024-11-06 DOI:10.1093/jac/dkae367
Ioannis Baltas, Trupti Patel, Ana Lima Soares
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引用次数: 0

摘要

背景:产碳青霉烯酶肠杆菌(CPE)给治疗带来了挑战。我们旨在了解本中心 CPE 的抗菌药耐药性概况:方法:我们对英格兰一家大型教学信托机构在 2020 年 8 月 1 日至 2023 年 8 月 31 日期间分离的所有非重复 CPE 进行了回顾性研究。采用圆盘扩散法进行头孢哌酮抗菌药敏感性检测(AST),采用圆盘扩散法和梯度扩散法进行头孢唑肟/阿维菌素检测,采用双圆盘扩散法进行头孢唑肟/阿维菌素阿曲霉素协同检测。使用的是 EUCAST 14.0 版断点:结果:共从 136 名患者中分离出 158 例 CPE。大多数患者都有 CPE 定植,但只有 16.9% 的患者有活动性感染。30 天内全因死亡率为 10.3%,感染患者的死亡率上升至 13%,菌血症患者的死亡率上升至 18.2%。OXA-48 是最常见的碳青霉烯酶(48.1%),其次是 NDM(38%)。所有分离菌株均表现出 MDR 特征,其中对美罗培南的耐药性较高(41.1%)。在 69.7% 产生 NDM 的分离菌株中发现了对头孢哌酮的耐药性,另有 18.2% 的分离菌株存在技术不确定性。87.5%的分离菌株对头孢唑肟/阿维菌素和阿兹曲南有协同作用,而对可乐定和磷霉素的敏感性仍然很高(分别为98.1%和97.2%)。所有产生 OXA-48 的分离菌株都对头孢他啶/阿维巴坦敏感,15.3% 的分离菌株对头孢克洛耐药。没有患者曾接触过头孢克洛,而有三名患者曾接触过头孢他啶/阿维巴坦。CPE分离最常见的风险因素是出国旅行和接受国外医疗服务,尤其是在亚洲:结论:我们发现,在未接触过头孢他啶的CPE分离株中,头孢他啶的耐药率很高。我们的研究结果禁止在我们的环境中经验性地使用头孢克洛治疗 CPE 感染。
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Resistance profiles of carbapenemase-producing Enterobacterales in a large centre in England: are we already losing cefiderocol?

Background: Carbapenemase-producing Enterobacterales (CPE) pose difficult therapeutic challenges. We aimed to characterize antimicrobial resistance profiles of CPE in our centre.

Methods: All non-duplicate CPE isolates between 1 August 2020 and 31 August 2023 in a large teaching trust in England were retrospectively studied. Cefiderocol antimicrobial susceptibility testing (AST) was performed using disc diffusion, ceftazidime/avibactam using disc diffusion and gradient diffusion, and ceftazidime/avibactam aztreonam synergy using the double disc diffusion method. EUCAST version 14.0 breakpoints were used.

Results: A total of 158 CPE from 136 patients were isolated. Most patients were colonized with CPE, but only 16.9% had active infections. Thirty-day all-cause mortality was 10.3%, increasing to 13% for patients with infections and to 18.2% for bacteraemias. OXA-48 was the most prevalent carbapenemase (48.1%), followed by NDM (38%). All isolates exhibited MDR profiles, with high levels of resistance to meropenem (41.1%). Resistance to cefiderocol was found in 69.7% of NDM-producing isolates, with a further 18.2% in the area of technical uncertainty. Ceftazidime/avibactam and aztreonam synergy was seen in 87.5% of isolates, whereas colistin and fosfomycin susceptibility remained high (98.1% and 97.2%, respectively). All OXA-48-producing isolates were susceptible to ceftazidime/avibactam, and 15.3% were resistant to cefiderocol. No patients had been exposed to cefiderocol beforehand, whereas three had been exposed to ceftazidime/avibactam. The most common risk factor for CPE isolation was travel and receiving healthcare abroad, especially in Asia.

Conclusions: We found high rates of resistance to cefiderocol in CPE isolates without prior cefiderocol exposure. Our results prohibit empirical use of cefiderocol for the treatment of CPE infections in our setting.

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来源期刊
CiteScore
9.20
自引率
5.80%
发文量
423
审稿时长
2-4 weeks
期刊介绍: The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
期刊最新文献
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