title: Carbapenem susceptibility among Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae isolates obtained from patients in intensive care units in Taiwan in 2005, 2007, and 2009.
abstract: To investigate the evolutionary trends in non-susceptibility of carbapenems against the isolates of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae from patients hospitalized in intensive care units (ICUs) of major teaching hospitals throughout Taiwan during 2005-2009, we applied the breakpoints of MICs recommended by Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing in 2013. Escalations in imipenem MIC levels for overall E. coli and E. cloacae isolates and extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae isolates were noted during this period. The overall MIC levels against imipenem and meropenem for subgroups of ESBL producers of 3 Enterobacteriaceae species were significantly higher than those of respective overall groups in 2007 and 2009. Compared with meropenem, we found that significant evidence of imipenem MIC creep and evidence of extraordinarily high rates of non-susceptibility to ertapenem among isolates of 3 species in 2009 existed. The prominent rises in rates of ertapenem non-susceptibility for ESBL-producing E. coli and K. pneumoniae during 2005-2009 and rate of ESBL positivity for E. cloacae between 4 years were notably found. Based on our findings, ertapenem should be used cautiously in management of the ICU infections caused by these potentially ESBL-producing Enterobacteriaceae isolates in Taiwan.
authors.affiliation: Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Shio-Shin
authors.initials: SS
authors.lastname: Jean
authors.affiliation: Division of infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wen-Sen
authors.initials: WS
authors.lastname: Lee
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Kuan-Jen
authors.initials: KJ
authors.lastname: Bai
authors.affiliation: Department of Internal Medicine, Pathology and Laboratory Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kwok-Woon
authors.initials: KW
authors.lastname: Yu
authors.affiliation: Department of Emergency and Critical Medicine, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
authors.forename: Chin-Wang
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Kwok-Woon
authors.initials: KW
authors.lastname: Yu
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Chun-Hsing
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center (NDMC), Taipei, Taiwan.
authors.forename: Feng-Yi
authors.initials: FY
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
authors.affiliation: School of Medical Technology, National Cheng-Kung University College of Medicine, Tainan, Taiwan.
authors.forename: Jiunn-Jong
authors.initials: JJ
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Kaohsiung Medical University Hospital, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaoshiung, Taiwan.
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung Medical College, Kaohsiung, Taiwan.
authors.forename: Jien-Wei
authors.initials: JW
authors.lastname: Liu
authors.affiliation: Department of Laboratory Medicine and Internal Medicine, Chung Shan Medical and Dental University, Taichung, Taiwan.
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Lu
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Cheng-Yi
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Department of Emergency and Critical Care Medicine, Taipei Municipal WanFang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.affiliation: Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D016972:Enterobacter cloacae / Q000187:drug effects* / Q000302:isolation & purification; D004755:Enterobacteriaceae; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D000077727:Ertapenem; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D006784:Hospitals, Teaching; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007362:Intensive Care Units; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000302:isolation & purification; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D013624:Taiwan; D013845:Thienamycins / Q000494:pharmacology; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D013845:Thienamycins; D047090:beta-Lactams; D015378:Imipenem; D000077731:Meropenem; D000077727:Ertapenem
keywords: Carbapenem; Enterobacteriaceae; Extended-spectrum β-lactamase; Intensive care unit; Non-susceptibility