title: Antimicrobial susceptibility of pathogens isolated from patients with complicated intra-abdominal infections at five medical centers in Taiwan that continuously participated in the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2006 to 2010.
abstract: The Study for Monitoring Antimicrobial Resistance Trends (SMART) is a worldwide surveillance program designed to longitudinally monitor the in vitro activity of antimicrobial agents against pathogens that cause intra-abdominal infections (IAIs). In this study, trends in antimicrobial resistance during the period 2006 to 2010 were analyzed at five tertiary-care hospitals in Taiwan. Enterobacteriaceae accounted for the majority (80.9%) of the 2417 Gram-negative isolates, and the two most common species were Escherichia coli (38.8%) and Klebsiella pneumoniae (23.5%). The rates of susceptibility of Enterobacteriaceae isolates to cephalosporins decreased during the study period. Although carbapenems, fluoroquinolones, piperacillin-tazobactam, and amikacin were active in vitro against more than 80% of the Enterobacteriaceae isolates, the activity of carbapenems declined during the study period. Extended-spectrum β-lactamase (ESBL) production in E. coli was steady, but that in K. pneumoniae decreased during the study period. The rate of ESBL-producing species was three-fold higher among patients with nosocomial IAIs than among patients with community-acquired IAIs. The majority of isolates from liver were K. pneumoniae (69%) and very few of those isolates were ESBL producers (0.9%). Pseudomonas aeruginosa (9.3%) and Acinetobacter baumannii (3.8%) were the two most common non-Enterobacteriaceae. P. aeruginosa showed improved susceptibility, whereas A. baumannii showed a rapid development of resistance during the study period. There was marked geographic variation in resistance patterns of the isolates obtained during the study period. Northern Taiwan had the highest rate of ESBL producers and the highest rate of ceftazidime resistance among P. aeruginosa isolates. Central Taiwan had the lowest rate of ESBL producers but the highest rates of carbapenem resistance among P. aeruginosa and A. baumannii isolates. Continuous monitoring and regular updates of epidemiological data are needed to guide appropriate empiric antimicrobial therapy.
authors: Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors: Yu-Lin
authors: YL
authors: Lee
authors: Yao-Shen
authors: YS
authors: Chen
authors: Han-Siong
authors: HS
authors: Toh
authors: Chi-Chang
authors: CC
authors: Huang
authors: Yuag-Meng
authors: YM
authors: Liu
authors: Cheng-Mao
authors: CM
authors: Ho
authors: Po-Liang
authors: PL
authors: Lu
authors: Wen-Chien
authors: WC
authors: Ko
authors: Yen-Hsu
authors: YH
authors: Chen
authors: Jen-Hsien
authors: JH
authors: Wang
authors: Hung-Jen
authors: HJ
authors: Tang
authors: Kwok-Woon
authors: KW
authors: Yu
authors: Yung-Ching
authors: YC
authors: Liu
authors: Yin-Ching
authors: YC
authors: Chuang
authors: Chun-Eng
authors: CE
authors: Liu
authors: Po-Ren
authors: PR
authors: Hsueh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification / Q000472:pathogenicity; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D059413:Intraabdominal Infections / Q000453:epidemiology / Q000382:microbiology*; D008107:Liver Diseases / Q000453:epidemiology / Q000382:microbiology; D008137:Longitudinal Studies; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases