Resistance among Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Latin American countries: SMART 2013–2015

Abstract

Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are important etiologic agents of nosocomial infection that are frequently resistant to broad-spectrum antimicrobial agents. Gram-negative ESKAPE pathogens were collected from hospitalized patients in 11 Latin American countries from 2013 to 2015 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) global surveillance program. In total, 2113 isolates from intra-abdominal infections (IAI) and 970 isolates from urinary tract infections (UTI) were tested against antimicrobial agents using standardized CLSI broth microdilution methodology. Of the agents tested, amikacin demonstrated the highest rates of susceptibility (%) for K. pneumoniae (92.2, 92.3), Enterobacter spp. (97.5, 92.1), and P. aeruginosa (85.3, 75.2) isolates from both IAI and UTI, respectively. Ertapenem (68.5, 62.6) and imipenem (79.2, 75.9) showed substantially higher rates of susceptibility (%) than other β-lactams, including piperacillin-tazobactam (35.9, 37.4) against ESBL-positive isolates of K. pneumoniae from IAI and UTI, respectively. Rates of susceptibility to all agents tested against A. baumannii were ≤30.9%. Gram-negative ESKAPE pathogens isolated from Latin America demonstrated compromised in vitro susceptibility to commonly prescribed broad-spectrum, parenteral antimicrobial agents. Continued surveillance is warranted. New antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are urgently needed.

In Vitro Activity of Ceftazidime-Avibactam against Clinical Isolates of Enterobacteriaceae and Pseudomonas aeruginosa Collected in Latin American Countries: Results from the INFORM Global Surveillance Program, 2012 to 2015

“…Previous surveillance studies testing clinical isolates of Enterobacteriaceae have consistently reported ESBL rates in many Latin American countries to be 20% to Ͼ40% for both E. coli and K. pneumoniae, and have also reported rates of carbapenem-resistant Enterobacteriaceae that approach and often exceed 10%, particularly for K. pneumoniae and Enterobacter spp. (5,(7)(8)(9). The distribution of ESBL and carbapenemase types observed in the current study was in general agreement with previous reports for Latin America (3,15,20).…”

“…In the current study, we found that ceftazidime-avibactam inhibited 99.9% of ESBL-positive isolates, 99.7% of ceftazidime-nonsusceptible isolates, 99.5% of meropenem-nonsusceptible isolates, 99.0% of AmpC-positive isolates, 99.6% of MDR isolates, and 99.2% of colistinresistant isolates of Enterobacteriaceae that were concurrently MBL-negative. Among clinical isolates of P. aeruginosa from Latin American countries, other investigators have reported country-specific percentages of susceptibility to ceftazidime that ranged from 50% to 80%, while 60% to 70% of isolates were carbapenem susceptible (7,9), similar to our findings in the current study.…”

Pharmacokinetics, Safety, and Tolerability of Single and Multiple Doses of Relebactam, a β-Lactamase Inhibitor, in Combination with Imipenem and Cilastatin in Healthy Participants

“…Gram-negative bacteria are a common cause of serious infections, including intra-abdominal infections (IAIs), urinary tract infections (UTIs), nosocomial pneumonia, and bacteremia (1–4). Antibiotic-resistant bacteria are considered a global health threat by the Centers for Disease Control and Prevention and the World Health Organization (5–7) and are associated with increased mortality, hospital readmissions, and costs (8–10).…”

Avaliação da eficácia de agentes fí­sicos e químicos contra biofilmes produzidos por clones de bactérias multirresistentes de importância clínica e epidemiológica no Brasil

“…Bactérias multirresistentes pertencentes ao grupo ESKAPE são importantes patógenos de infecções relacionadas à assistência à saúde, sendo frequentemente identificados em infecções associadas a biofilmes e infecções crônicas, como a fibrose cística, endocardite, osteomielite, infecção urinária por cateter vesical, ou outros procedimentos invasivos associados ao uso de cateteres e sondas (LIN et al, 2018;REEN et al, 2018;DE ANGELIS et al, 2018;VELÁZQUEZ-ACOSTA et al, 2018;OTTON et al, 2017;ROSSI et al, 2017;JAIN et al, 2017;PARKER et al, 2017;SABIR et al, 2017;VUOTTO et al, 2017;VALIZADEH et al, 2017;BARDBARI et al, 2017;KRZYŚCIAK et al, 2017;HE et al, 2017;MAKOVCOVA, et al, 2017;KARLOWSKY et al, 2017). Embora, o fenótipo MR decorra da expressão de mecanismos mediados por genes intrínsecos e/ou adquiridos, o crescimento bacteriano na forma de biofilme contribui para um importante fenômeno fisiológico de resistência, o qual é inespecífico quanto ao substrato antimicrobiano (LIN et al, 2018;REEN et al, 2018;DE ANGELIS et al, 2018;VELÁZQUEZ-ACOSTA et al, 2018;MAUNDERS;WELCH, 2017).…”

“…Tendo em vista a complexidade e o custo do tratamento de infecções crônicas associadas à formação de biofilme, a busca de novas alternativas terapêuticas contra esse tipo de crescimento bacteriano tem sido considerada um desafio urgente para a medicina humana e veterinária (LIN et al, 2018;REEN et al, 2018;DE ANGELIS et al, 2018;VELÁZQUEZ-ACOSTA et al, 2018;BARDBARI et al, 2017;KRZYŚCIAK et al, 2017;HE et al, 2017;MAKOVCOVA, et al, 2017;OTTON et al, 2017;ROSSI et al, 2017;Jain et al, 2017;PARKER et al, 2017;SABIR et al, 2017;VUOTTO et;KRZYŚCIAK et al, 2017;KARLOWSKY et al, 2017;SWANSON et al, 2014;BAYNE, 2014).…”