title: Antimicrobial susceptibility of Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Asia-Pacific countries: SMART 2013-2015.
abstract: Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are responsible for increases in antimicrobial-resistant infections worldwide. We determined in vitro susceptibilities to eight parenteral antimicrobial agents using Clinical and Laboratory Standards Institute broth microdilution methodology for Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal infections (IAIs) (n=3052) and urinary tract infections (UTIs) (n=1088) in 11 Asia-Pacific countries/regions from 2013 to 2015. Amikacin (98.3, 96.4 %), imipenem (97.1, 95.5 %) and ertapenem (95.3, 93.2 %) demonstrated the highest rates of susceptibility for isolates of K. pneumoniae from IAI and UTI, respectively, whereas susceptibility to advanced-generation cephalosporins was <84 and <71 %, respectively. K. pneumoniae with an extended-spectrum β-lactamase-positive phenotype were more common in UTI (27.1 %) than IAI (16.2 %). Imipenem and amikacin were the most active agents against extended-spectrum β-lactamase-positive K. pneumoniae from IAI (95.1, 91.8 %) and UTI (94.9, 92.3 %), respectively, whereas <54 % were susceptible to piperacillin-tazobactam. Against Enterobacter spp. and P. aeruginosa, amikacin demonstrated the highest rates of susceptibility for isolates from IAI (99.7, 95.5 %) and UTI (90.9, 91.5 %), respectively. K. pneumoniae, Enterobacter spp. and P. aeruginosa from urine demonstrated lower susceptibility to levofloxacin (74.1, 81.8 and 73.8 %) than from IAI (87.6, 91.8 and 85.4 %). For A. baumannii, rates of susceptibility to all agents tested were <43 %. We conclude that the studied Gram-negative ESKAPE pathogens demonstrated reduced susceptibility to commonly prescribed advanced-generation cephalosporins, piperacillin-tazobactam and levofloxacin, while amikacin and carbapenems were the most active. Ongoing surveillance to monitor evolving resistance trends and the development of novel antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are mandatory.
authors.affiliation: Department of Medical Microbiology, College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Karlowsky
authors.affiliation: International Health Management Associates, Inc., 2122 Palmer Drive, Schaumburg, IL 60173, USA.|Department of Medical Microbiology, College of Medicine, University of Manitoba, 745 Bannatyne Avenue, Winnipeg, Manitoba R3E 0J9, Canada.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Hoban
authors.affiliation: International Health Management Associates, Inc., 2122 Palmer Drive, Schaumburg, IL 60173, USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Hackel
authors.affiliation: International Health Management Associates, Inc., 2122 Palmer Drive, Schaumburg, IL 60173, USA.
authors.forename: Sibylle H
authors.initials: SH
authors.lastname: Lob
authors.affiliation: International Health Management Associates, Inc., 2122 Palmer Drive, Schaumburg, IL 60173, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Sahm
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects / Q000302:isolation & purification; D000583:Amikacin / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology*; D001208:Asia / Q000453:epidemiology; D015780:Carbapenems / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology; D024901:Drug Resistance, Multiple, Bacterial; D004754:Enterobacter / Q000187:drug effects / Q000302:isolation & purification; D000077727:Ertapenem; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D059413:Intraabdominal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification; 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; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001618:beta-Lactamases / Q000494:pharmacology; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000890:Anti-Infective Agents; D015780:Carbapenems; D002511:Cephalosporins; D047090:beta-Lactams; D000077725:Piperacillin, Tazobactam Drug Combination; D064704:Levofloxacin; D015378:Imipenem; D000583:Amikacin; D010397:Penicillanic Acid; D001618:beta-Lactamases; D000077727:Ertapenem; D010878:Piperacillin