title: Antibiotic resistance in gram-negative bacilli: a Singapore perspective.
abstract: BACKGROUND
  Antibiotic resistance in gram-negative bacilli is an area of increasing importance. This prospective study was performed to survey antibiotic resistance in Escherichia coli (E. coli), Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. over a 1-year period.
  
  
  METHODS
  Non-duplicate isolates of E. coli, Klebsiella spp., P. aeruginosa and Acinetobacter spp. were collected from participating Singapore hospitals during defined collection periods in 2006 and 2007. Confirmatory identification and antibiotic susceptibility testing were performed at Changi General Hospital. Minimum inhibitory concentrations (MIC) to a defined panel of antibiotics were determined using microbroth dilution methods. The presence of extended-spectrum beta lactamases and AmpC beta-lactamases in Enterobacteriaceae was determined by phenotypic methods, and susceptibility results were defined using current breakpoints from the Clinical Laboratory Standards Institute (CLSI).
  
  
  RESULTS
  Seven hundred and forty-six gram-negative bacilli were received for testing. Resistance to extended-spectrum cephalosporins was present in a third of Enterobacteriaceae isolates, and extended-spectrum beta-lactamases (ESBL) carriage was present in 19.6% and 30.1% of E. coli and Klebsiella pneumoniae, respectively. AmpC enzymes were also detected in 8.5% and 5.6% of E. coli and K. pneumoniae isolates respectively. All Enterobacteriaceae were susceptible to imipenem and meropenem. The most active antibiotics against P. aeruginosa were amikacin, meropenem and piperacillin-tazobactam. A third of P. aeruginosa showed reduced susceptibility to polymyxin B. Carbapenem resistance was significantly higher in Acinetobacter baumannii (70.5%) than in other Acinetobacter species (25.0%). The most active antibiotic against A. baumannii was polymyxin B.
  
  
  CONCLUSIONS
  Antibiotic resistance is prevalent in gram-negative bacilli isolated from Singapore hospitals. The MIC testing surveillance programme complemented susceptibility data from wider laboratory-based surveillance, and has revealed emerging mechanisms of antibiotic resistance.
authors.affiliation: Division of Laboratory Medicine, Changi General Hospital, Singapore. thean_yen_tan@cgh.com.sg
authors.forename: Thean Yen
authors.initials: TY
authors.lastname: Tan
authors.forename: Li Yang
authors.initials: LY
authors.lastname: Hsu
authors.forename: Tse Hsien
authors.initials: TH
authors.lastname: Koh
authors.forename: Lily S Y
authors.initials: LS
authors.lastname: Ng
authors.forename: Nancy W S
authors.initials: NW
authors.lastname: Tee
authors.forename: Prabha
authors.initials: P
authors.lastname: Krishnan
authors.forename: Raymond T P
authors.initials: RT
authors.lastname: Lin
authors.forename: Roland
authors.initials: R
authors.lastname: Jureen
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001426:Bacterial Proteins; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012846:Singapore; D001618:beta-Lactamases
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases