title: Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009-2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART).
abstract: In 2009, the Study for Monitoring Antimicrobial Resistance Trends (SMART) was expanded to include surveillance of Gram-negative pathogens causing urinary tract infections (UTIs) in the Asia-Pacific region. A total of 1762 isolates were collected from 38 centers in 11 countries from patients with UTIs in 2009 and 2010. In vitro susceptibilities were determined by the broth microdilution method and susceptibility profiles were determined using minimum inhibitory concentration (MIC) interpretive criteria, as recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2010 (M100-S20), in 2011 (M100-S21), and in 2012 (M100-S22). Enterobacteriaceae comprised 86.0% of the isolates, of which Escherichia coli (56.5%) and Klebsiella pneumoniae (13.8%) were the two most common species. Amikacin was the most effective antibiotic (91.7%), followed by ertapenem (86.9%), imipenem (86.6%), and piperacillin-tazobactam (84.9%). Rates of susceptibility were 50.3% for cefoxitin and ranged from 50.3% to 74.2% for the third- and fourth-generation cephalosporins. For ciprofloxacin and levofloxacin, the susceptibility rates were 51.4% and 54.4%, respectively. Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae comprised 28.2% of all isolates. We also found a high rate of resistance to carbapenems among Acinetobacter baumannii and Pseudomonas aeruginosa causing UTI. Interestingly, according to 2012 CLSI breakpoints, approximately 33.4% of ESBL producers were still susceptible to ceftazidime. However, this in vitro efficacy of ceftazidime needs to be validated in vivo by clinical data. The lowered CLSI interpretive breakpoints for piperacillin-tazobactam, carbapenems, and some cephalosporins in 2011-2012 for Enterobacteriaceae resulted in an approximate 5% drop in susceptibility rates for each drug, with the exception of imipenem for which the susceptibility rate dropped from 99.4% according to 2010 criteria to 91.2% according to 2011 criteria. With the updated CLSI criteria, the antimicrobial resistance threat from UTI pathogens in the Asia Pacific area was revealed to be more prominent.
authors: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Po-Liang
authors: PL
authors: Lu
authors: Yung-Ching
authors: YC
authors: Liu
authors: Han-Siong
authors: HS
authors: Toh
authors: Yu-Lin
authors: YL
authors: Lee
authors: Yuag-Meng
authors: YM
authors: Liu
authors: Cheng-Mao
authors: CM
authors: Ho
authors: Chi-Chang
authors: CC
authors: Huang
authors: Chun-Eng
authors: CE
authors: Liu
authors: Wen-Chien
authors: WC
authors: Ko
authors: Jen-Hsien
authors: JH
authors: Wang
authors: Hung-Jen
authors: HJ
authors: Tang
authors: Kwok-Woon
authors: KW
authors: Yu
authors: Yao-Shen
authors: YS
authors: Chen
authors: Yin-Ching
authors: YC
authors: Chuang
authors: Yingchun
authors: Y
authors: Xu
authors: Yuxing
authors: Y
authors: Ni
authors: Yen-Hsu
authors: YH
authors: Chen
authors: Po-Ren
authors: PR
authors: Hsueh
mesh_terms: D000583:Amikacin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001208:Asia / Q000453:epidemiology; D044362:Australasia / Q000453:epidemiology; D015780:Carbapenems / Q000494:pharmacology; D002442:Ceftazidime / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D000077727:Ertapenem; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000201:enzymology / Q000302:isolation & purification / Q000472:pathogenicity; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D010878:Piperacillin / Q000494:pharmacology; D000077725:Piperacillin, Tazobactam Drug Combination; D015995:Prevalence; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; D000583:Amikacin; D010397:Penicillanic Acid; D002442:Ceftazidime; D001618:beta-Lactamases; D000077727:Ertapenem; D010878:Piperacillin