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)

doi:10.1016/S0924-8579(12)70008-0

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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)
Authors:	Lu, Po-Liang Liu, Yung-Ching Toh, Han-Siong Lee, Yu-Lin Liu, Yuag-Meng Ho, Cheng-Mao Huang, Chi-Chang Liu, Chun-Eng Ko, Wen-Chien Wang, Jen-Hsien Tang, Hung-Jen Yu, Kwok-Woon Chen, Yao-Shen Chuang, Yin-Ching Xu, Yingchun Ni, Yuxing Chen, Yen-Hsu Hsueh, Po-Ren
Contributors:	保健營養系
Keywords:	Smart Asia-Pacific Region Urinary Tract Infections Extended-Spectrum Beta-Lactamase (Esbl) Fluoroquinolone Resistance Carbapenems Interpretive Susceptibility Criteria
Date:	2012-06
Issue Date:	2014-03-21 16:15:57 (UTC+8)
Publisher:	Elsevier Science Bv
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 beta-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. (C) 2012 Elsevier B. V. and the International Society of Chemotherapy. All rights reserved.
Relation:	International Journal of Antimicrobial Agents, v.40 S1 pp.S37-S43
Appears in Collections:	[Dept. of Health and Nutrition (including master's program)] Periodical Articles

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