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

J Med Microbiol. 2017 Jan;66(1):61-69. doi: 10.1099/jmm.0.000421. Epub 2017 Feb 22.

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.

MeSH terms

  • Acinetobacter baumannii / drug effects
  • Acinetobacter baumannii / isolation & purification
  • Amikacin / pharmacology
  • Anti-Infective Agents / pharmacology*
  • Asia / epidemiology
  • Carbapenems / pharmacology
  • Cephalosporins / pharmacology
  • Drug Resistance, Multiple, Bacterial*
  • Enterobacter / drug effects
  • Enterobacter / isolation & purification
  • Ertapenem
  • Gram-Negative Bacteria / drug effects*
  • Gram-Negative Bacteria / isolation & purification
  • Hospitalization
  • Humans
  • Imipenem / pharmacology
  • Intraabdominal Infections / drug therapy
  • Intraabdominal Infections / epidemiology*
  • Intraabdominal Infections / microbiology
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / isolation & purification
  • Levofloxacin / pharmacology
  • Microbial Sensitivity Tests
  • Penicillanic Acid / analogs & derivatives
  • Penicillanic Acid / pharmacology
  • Piperacillin / pharmacology
  • Piperacillin, Tazobactam Drug Combination
  • Pseudomonas aeruginosa / drug effects
  • Pseudomonas aeruginosa / isolation & purification
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / epidemiology*
  • Urinary Tract Infections / microbiology
  • beta-Lactamases / pharmacology
  • beta-Lactams / pharmacology

Substances

  • Anti-Infective Agents
  • Carbapenems
  • Cephalosporins
  • beta-Lactams
  • Piperacillin, Tazobactam Drug Combination
  • Levofloxacin
  • Imipenem
  • Amikacin
  • Penicillanic Acid
  • beta-Lactamases
  • Ertapenem
  • Piperacillin