In Vitro Activity of Imipenem/Relebactam and Ceftolozane/Tazobactam Against Clinical Isolates of Gram-negative Bacilli With Difficult-to-Treat Resistance and Multidrug-resistant Phenotypes-Study for Monitoring Antimicrobial Resistance Trends, United States 2015-2017
In Vitro Activity of Imipenem/Relebactam and Ceftolozane/Tazobactam Against Clinical Isolates of Gram-negative Bacilli With Difficult-to-Treat Resistance and Multidrug-resistant Phenotypes-Study for Monitoring Antimicrobial Resistance Trends, United States 2015-2017
复制标题
DOI：
10.1093/cid/ciaa381
复制
发表时间：
2021-06-15
影响因子：
11.8
通讯作者：
Sahm, Daniel F.
中科院分区：
文献类型：
--
作者：
Karlowsky, James A.;Lob, Sibylle H.;Sahm, Daniel F.
背景通常使用Magiorakos等人[Clin Microbiol Infect 2012;18：268-81]建立的标准定义多药耐药（MDR）细菌。难治性耐药（DTR）[Kadri et al，Clin Infect Dis 2018;67：1803-14]是一种定义革兰氏阴性杆菌耐药的新方法，重点是对一线药物（所有β-内酰胺类和氟喹诺酮类）的治疗限制性耐药。临床和实验室标准化研究所定义的微量肉汤稀释法最低抑菌浓度（MIC）测定了亚胺培南/曲马巴坦、头孢洛扎/他唑巴坦和对照药物对2015- 2017年在26家美国医院收集的呼吸道、腹腔内和尿液分离的肠球菌（n = 10 516）和铜绿假单胞菌（n = 2732）的MIC。在所有肠杆菌目中，1.0%的分离株为DTR，15.6%为MDR;铜绿假单胞菌分离株中8.4%为DTR，32.4%为MDR。在重症监护病房（ICU）中收集的分离株的肠球菌和DTR的MDR率以及铜绿假单胞菌的MDR率显著高于非ICU（P <0.05），呼吸道分离株的MDR率显著高于腹腔内或泌尿道分离株。此外，82.4%的DTR和92.1%的MDR肠球菌、62.2%的DTR和82.2%的MDR铜绿假单胞菌对亚胺培南/头孢巴坦敏感; 1.5%的DTR和65.8%的MDR肠球菌、67.5%的DTR和84.0%的MDR铜绿假单胞菌对头孢洛扎/他唑巴坦敏感。使用Magiorakos标准定义的MDR表型可能会忽略革兰阴性杆菌的治疗限制性耐药。在美国，DTR肠球菌不常见，而MDR肠球菌分离株以及DTR和MDR铜绿假单胞菌常见。亚胺培南/曲马巴坦（肠球菌目，铜绿假单胞菌）和头孢洛扎/他唑巴坦（铜绿假单胞菌）保留了对大多数DTR和MDR分离株的体外活性。
Background. Multidrug-resistant (MDR) bacteria are frequently defined using the criteria established by Magiorakos et al [Clin Microbiol Infect 2012;18:268-81]. Difficult-to-treat resistance (DTR) [Kadri et al, Clin Infect Dis 2018;67:1803-14] is a novel approach to defining resistance in gram-negative bacilli focusing on treatment-limiting resistance to first-line agents (all beta-lactams and fluoroquinolones).Methods. Clinical and Laboratory Standards Institute-defined broth microdilution minimum inhibitory concentrations (MICs) were determined for imipenem/relebactam, ceftolozane/tazobactam, and comparators against respiratory, intraabdominal, and urinary isolates of Enterobacterales (n = 10 516) and Pseudomonas aeruginosa (n = 2732) collected in 26 US hospitals in 2015-2017.Results. Among all Enterobacterales, 1.0% of isolates were DTR and 15.6% were MDR; 8.4% of P. aeruginosa isolates were DTR and 32.4% were MDR. MDR rates for Enterobacterales and DTR and MDR rates for P. aeruginosa were significantly higher (P < .05) in isolates collected in intensive care units (ICUs) than in non-ICUs and in respiratory tract isolates than in intraabdominal or urinary tract isolates. In addition, 82.4% of DTR and 92.1% of MDR Enterobacterales and 62.2% of DTR and 82.2% of MDR P. aeruginosa were imipenem/relebactam-susceptible, and 1.5% of DTR and 65.8% of MDR Enterobacterales and 67.5% of DTR and 84.0% of MDR P. aeruginosa were ceftolozane/tazobactam-susceptible.Conclusions. MDR phenotypes defined using the Magiorakos criteria may overcall treatment-limiting resistance in gram-negative bacilli. In the US, DTR Enterobacterales were infrequent, while MDR Enterobacterales isolates and DTR and MDR P. aeruginosa were common. Imipenem/relebactam (Enterobacterales, P. aeruginosa) and ceftolozane/tazobactam (P. aeruginosa) retained in vitro activity against most DTR and MDR isolates.