Antimicrobial Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli from Intra-abdominal Infections in Patients from Seven Regions in China in 2012 and 2013.
To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (<20%). Although most ESBL-positive hospital-acquired isolates were resistant to third- and fourth-generation cephalosporins, the majority were susceptible to cefoxitin (47.9% to 83.9%). Susceptibilities of ESBL-positive isolates to ampicillin-sulbactam (<10%) were low, whereas susceptibilities to ciprofloxacin (0% to 54.6%) and levofloxacin (0% to 63.6%) varied substantially. The prevalences of cephalosporin-susceptible E. coli and K. pneumoniae were higher in the northeastern and southern regions than in the central and eastern regions, reflecting the ESBL-positive rates in these areas, and were lowest in the Jiangsu-Zhejiang (Jiang-Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.
Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Hui
H
Zhang
Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
Qiwen
Q
Yang
First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
Kang
K
Liao
Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Yuxing
Y
Ni
Sir RunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Yunsong
Y
Yu
Zhong Shan Hospital of Fu Dan University, Shanghai, China.
Bijie
B
Hu
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ziyong
Z
Sun
First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Wenxiang
W
Huang
Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Yong
Y
Wang
Xiangya Hospital, Central Southern University, Changsha, China.
Anhua
A
Wu
First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Xianju
X
Feng
The General Hospital of People's Liberation Army, Beijing, China.
Yanping
Y
Luo
General Hospital of Tianjin Medical University, Tianjin, China.
Zhidong
Z
Hu
First Affiliated Hospital of Chinese Medical University, Shenyang, China.
Yunzhuo
Y
Chu
First Affiliated Hospital of Harbin Medical College, Harbin, China.
Shulan
S
Chen
Chaoyang Hospital of Capital Medical College, Beijing, China.
Bin
B
Cao
Friendship Hospital of Capital Medical College, Beijing, China.
Jianrong
J
Su
Second Affiliated Hospital of Nanchang University, Nanchang, China.
Bingdong
B
Gui
People's Hospital of Jilin Province, Jilin, China.
Qiong
Q
Duan
People's Hospital of Haikou City, Haikou, China.
Shufang
S
Zhang
General Hospital of Nanjing Military Command, Nanjing, China.
Haifeng
H
Shao
First Affiliated Hospital of Zhejiang University, Hangzhou, China.
Haishen
H
Kong
International Health Management Associates, Schaumburg, Illinois, USA.
Robert E
RE
Badal
Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China xycpumch@139.com.
Yingchun
Y
Xu
D000583:Amikacin / Q000494:pharmacology; D000667:Ampicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002440:Cefoxitin / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D002939:Ciprofloxacin / Q000494:pharmacology; D017714:Community-Acquired Infections; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D000077727:Ertapenem; D015870:Gene Expression; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D059413:Intraabdominal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D064704:Levofloxacin / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000494:pharmacology; D010878:Piperacillin / Q000494:pharmacology; D000077725:Piperacillin, Tazobactam Drug Combination; D013407:Sulbactam / Q000494:pharmacology; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism; D047090:beta-Lactams / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; D002939:Ciprofloxacin; C035444:sultamicillin; D064704:Levofloxacin; D002440:Cefoxitin; D015378:Imipenem; D000667:Ampicillin; D000583:Amikacin; D010397:Penicillanic Acid; D001618:beta-Lactamases; D000077727:Ertapenem; D013407:Sulbactam; D010878:Piperacillin