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Priyadharshini SRE, Ramalingam C, Ramesh B. Superintendence of antimicrobial resistance observed in bacterial flora isolated from human faecal carriage in Vellore, India. Saudi J Biol Sci 2018; 24:1679-1688. [PMID: 30294235 PMCID: PMC6169512 DOI: 10.1016/j.sjbs.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 11/12/2015] [Accepted: 11/17/2015] [Indexed: 11/17/2022] Open
Abstract
A frequent cross-sectional study was conducted to determine the patterns of antimicrobial resistance in 296 bacterial strains isolated from in-patient faecal samples of Government Vellore Medical College and Hospital, Vellore. Isolation and identification of bacterial strains were done using enrichment media, selective media, and biochemical tests. Antimicrobial susceptibility testing by the disc diffusion method and minimal inhibitory concentration method was conducted and the strains were subjected to extended spectrum beta-lactamases screening. Antibiotic sensitivity pattern of Staphylococcus spp. showed oxacillin resistance. Almost all the strains were sensitive to linezolid, vancomycin, gentamycin and chloramphenicol. In gram negative isolates ciprofloxacin and tobramycin showed better sensitivity and ceftazidime showed a higher percentage of resistance by MIC. Out of 250 isolates, Enterobacteriaceae showed positive for 86/250, 82/250 and 94/250 isolates and 3/10, 4/10 and 4/10 non-Enterobacteriaceae isolates were found to be positive for CTX-M gene, TEM gene and SHV gene, respectively. This study helps to assess/analyse the relation between the spectrum of microorganisms present in various grades of faecal carriage and their susceptibility pattern in this part of the Vellore town.
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Affiliation(s)
| | - Chidamabram Ramalingam
- School of Biosciences and Technology (SBST), Vellore Institute of Technology (VIT), Vellore, India
| | - Balasubramanian Ramesh
- Department of Biotechnology, Sri Sankara Arts and Science College, Enathur, Kanchipuram, India
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Epstein BJ, Gums JG, Turner PJ, Feldgarden M, Hou W. Integrating Susceptibility Data from Two Surveillance Programs with Unique Methodological Techniques: The Antibiogram Resistance Method or Isolate-Based Resistance Monitoring (ARMOR) Study Group. Hosp Pharm 2017. [DOI: 10.1310/hpj4205-435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - John G. Gums
- Colleges of Pharmacy and Medicine, University of Florida, Gainesville, FL
| | - Phillip J. Turner
- Infection Discovery Department, AstraZeneca, Alderley Park, Macclesfield, UK
| | | | - Wei Hou
- Department of Biostatistics, University of Florida, Gainesville, FL
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3
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Edwards JR. Dr Phillip John Turner, 9 June 1948–22 August 2016. J Antimicrob Chemother 2017. [DOI: 10.1093/jac/dkx019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Woappi Y, Gabani P, Singh A, Singh OV. Antibiotrophs: The complexity of antibiotic-subsisting and antibiotic-resistant microorganisms. Crit Rev Microbiol 2014; 42:17-30. [PMID: 24495094 DOI: 10.3109/1040841x.2013.875982] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Widespread overuse of antibiotics has led to the emergence of numerous antibiotic-resistant bacteria; among these are antibiotic-subsisting strains capable of surviving in environments with antibiotics as the sole carbon source. This unparalleled expansion of antibiotic resistance reveals the potent and diversified resistance abilities of certain bacterial strains. Moreover, these strains often possess hypermutator phenotypes and virulence transmissibility competent for genomic and proteomic propagation and pathogenicity. Pragmatic and prospicient approaches will be necessary to develop efficient therapeutic methods against such bacteria and to understand the extent of their genomic adaptability. This review aims to reveal the niches of these antibiotic-catabolizing microbes and assesses the underlying factors linking natural microbial antibiotic production, multidrug resistance, and antibiotic-subsistence.
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Affiliation(s)
- Yvon Woappi
- a Division of Biological and Health Sciences , University of Pittsburgh , Bradford , PA , USA and
| | - Prashant Gabani
- a Division of Biological and Health Sciences , University of Pittsburgh , Bradford , PA , USA and
| | - Arya Singh
- b Department of Computer Science , Texas State University , San Marcos , TX , USA
| | - Om V Singh
- a Division of Biological and Health Sciences , University of Pittsburgh , Bradford , PA , USA and
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Colardyn F. APPROPRIATE AND TIMELY EMPIRICAL ANTIMICROBIAL TREATMENT OF ICU INFECTIONS - A ROLE FOR CARBAPENEMS. Acta Clin Belg 2014; 60:51-62. [PMID: 16082989 DOI: 10.1179/acb.2005.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Treatment of serious nosocomial infections in the intensive care unit requires swift, effective, well-tolerated and appropriate therapy from the outset. The consequences of inappropriate treatment, i.e. the use of antibiotics that are ineffective against the causative pathogen(s) or delayed therapy, are numerous and impact negatively upon both the patient and the ever-dwindling healthcare resources in many hospitals. Although antibiotics have revolutionised the treatment of infections, their inappropriate and untimely use within the intensive care setting has led to the emergence and spread of antibiotic-resistant bacteria worldwide. Consequently, to ensure successful patient outcomes (reduce morbidity and mortality), it is important that any antibiotic treatment employed is right first time. Treatment of serious infections in the intensive care unit requires an empirical stratagem providing broad-spectrum coverage to a wide range of suspected or difficult-to-treat pathogens such as Pseudomonas aeruginosa. However, to prevent the errors of the past, this needs to be tailored as soon as the pathogen has been identified and resistance patterns are known. The carbapenems are potent parenteral antibiotics, with an ultra-broad spectrum of activity that encompasses multi-drug resistant and difficult-to-treat Gram-negative bacteria. Clinical trial data supports the clinical effectiveness of these agents in patients with difficult to treat pathogens.
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Affiliation(s)
- F Colardyn
- Intensive Care Department, Ghent University Hospital, Ghent, Belgium.
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Abstract
Extended spectrum β-lactamases (ESBLs) are enzymes produced by a variety of Gram negative bacteria which confer an increased resistance to commonly used antibiotics. They are a worrying global public health issue as infections caused by such enzyme-producing organisms are associated with a higher morbidity and mortality and greater fiscal burden. Coupled with increasing prevalence rates worldwide and an ever diminishing supply in the antibiotic armamentarium, these enzymes represent a clear and present danger to public health. This article aims to give an overview of the current situation regarding ESBLs, with a focus on the epidemiology and management of such infections.
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Rhomberg PR, Jones RN. Summary trends for the Meropenem Yearly Susceptibility Test Information Collection Program: a 10-year experience in the United States (1999-2008). Diagn Microbiol Infect Dis 2010; 65:414-26. [PMID: 19833471 DOI: 10.1016/j.diagmicrobio.2009.08.020] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program was a global, longitudinal antimicrobial resistance surveillance network of more than 100 medical centers worldwide monitoring the susceptibility of meropenem and selected other broad-spectrum comparator agents. In 1999, and from 2000 through 2008, a total of 10 or 15 United States (USA) medical centers each forwarded 200 nonduplicate clinical isolates from serious infections to a central processing laboratory. Over the 10-year period of this surveillance program, the activity of meropenem and an average of 11 other antimicrobial agents were assessed against a total of 27 289 bacterial isolates using Clinical and Laboratory Standards Institute reference methods. Meropenem consistently demonstrated low resistance rates against Enterobacteriaceae species isolates through 2008 and did not exhibit a widespread change in resistance rates over the monitored interval. In fact, the incidence of emerging carbapenemase-producing (KPC-type) Klebsiella spp. showed a decline in 2008 compared to the steeply increasing rates observed from 2004 to 2007. Moreover, the KPC serine carbapenemases have spread to other Enterobacteriaceae species monitored by the MYSTIC Program. Greatest increases in antimicrobial resistance rates were observed for the fluoroquinolones (ciprofloxacin, levofloxacin) among all species monitored by the MYSTIC Program. Current susceptibility rates for meropenem when tested against prevalent pathogens were Pseudomonas aeruginosa (439 strains, 85.4% susceptible), Enterobacteriaceae (1537 strains, 97.3% susceptible), methicillin-susceptible staphylococci (460 strains, 100.0% susceptible), Streptococcus pneumoniae (125 strains, 80.2% at meningitis susceptibility breakpoints), other streptococci (159 strains, 90.0-100.0% susceptible), and Acinetobacter spp. (127 strains, 45.7% susceptible), the widest spectrum among beta-lactams tested in 2008 and throughout the last decade. Continued local surveillance of broad-spectrum agents following the completion of the MYSTIC Program (USA) appears critical to detect emerging resistances among pathogens causing the most serious infections requiring carbapenem agents.
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Nicoletti G, Nicolosi D, Rossolini GM, Stefani S. Intra-abdominal infections: etiology, epidemiology, microbiological diagnosis and antibiotic resistance. J Chemother 2009; 21 Suppl 1:5-11. [PMID: 19622445 DOI: 10.1179/joc.2009.21.supplement-1.5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Intra-abdominal infections (IAIs) are commonly encountered in clinical practice. The etiology of these infections, often polymicrobial in nature, can be variable and usually includes organisms derived from the gut microbiota. in community-acquired IAIs enterobacteria predominate (mostly Escherichia coli) in combination with anaerobes (mostly Bacteroides fragilis). In nosocomial IAIs, which can complicate abdominal surgery, other pathogens can also play a role, such as Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus spp. and Candida spp. Diagnostic microbiology of IAIs is complex and plays a relevant role, especially in some situations (e.g. presence of foreign bodies, potential presence of resistant or uncommon pathogens, nosocomial infections in subjects with risk factors). Antibiotic resistance issues are currently encountered in most pathogenic species causing IAIs. Resistance affects all major classes of antimicrobial agents, often involving multiple classes and resulting in complex resistance phenotypes for which only a very limited number of drugs remain active.
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Affiliation(s)
- G Nicoletti
- Dipartimento di Scienze Microbiologiche e Science Ginecologiche, Università degli Studi di Catania, Italy
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Hoban DJ, Bouchillon SK, Hawser SP, Badal RE. Trends in the frequency of multiple drug-resistant Enterobacteriaceae and their susceptibility to ertapenem, imipenem, and other antimicrobial agents: data from the Study for Monitoring Antimicrobial Resistance Trends 2002 to 2007. Diagn Microbiol Infect Dis 2009; 66:78-86. [PMID: 19733993 DOI: 10.1016/j.diagmicrobio.2009.06.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 06/11/2009] [Accepted: 06/15/2009] [Indexed: 11/28/2022]
Abstract
The management of patients with complicated intra-abdominal infections has increased in complexity because of the evolution of antibiotic resistance and the development of multidrug-resistant (MDR) Enterobacteriaceae implicated in this clinical infectious process. The Study for Monitoring Antimicrobial Resistance Trends study 2002 to 2007 monitored the susceptibility of Enterobacteriaceae from intra-abdominal infections to a panel of appropriate antimicrobials. During 2002 to 2007, 6644 MDR (resistant to 2 or more antimicrobial classes) Enterobacteriaceae species were isolated and tested against selected antimicrobials from varying classes. The carbapenems were the most consistently active agents. Escherichia coli was the most commonly isolated MDR pathogen. The susceptibility of E. coli to the quinolone (8-21.6%), cephalosporin (30.2-70.7%), aminoglycoside (81.0-92.1%), and carbapenem (91.9-99.3%) agents varied by year. Susceptibilities of other Enterobacteriaceae were similar to those of E. coli. Surveillance of pathogens responsible for intra-abdominal infections is useful in the monitoring of changing susceptibility patterns and in the formulation of more effective treatment modalities.
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Affiliation(s)
- Daryl J Hoban
- International Health Management Associates, Inc., Schaumburg, IL 60173, USA.
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Baquero F, Hsueh PR, Paterson DL, Rossi F, Bochicchio GV, Gallagher G, Lantz K, Villasenor JB, McCarroll K, Abramson MA, Chow JW. In Vitro Susceptibilities of Aerobic and Facultatively Anaerobic Gram-Negative Bacilli Isolated from Patients with Intra-Abdominal Infections Worldwide: 2005 Results from Study for Monitoring Antimicrobial Resistance Trends (SMART). Surg Infect (Larchmt) 2009; 10:99-104. [DOI: 10.1089/sur.2008.0020] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Po-Ren Hsueh
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Flávia Rossi
- Hospital das Clinicas da Faculdade de Medicina, São Paulo, Brazil
| | | | | | - Keith Lantz
- Merck & Co., Inc., North Wales, Pennsylvania
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Turner PJ. MYSTIC Europe 2007: activity of meropenem and other broad-spectrum agents against nosocomial isolates. Diagn Microbiol Infect Dis 2008; 63:217-22. [PMID: 19070453 DOI: 10.1016/j.diagmicrobio.2008.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 08/25/2008] [Accepted: 11/05/2008] [Indexed: 11/28/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program is a longitudinal antimicrobial surveillance study that has been in existence since 1997 in centers that are actively prescribing meropenem. This report examines the results from the study in Europe in 2007. A total of 5208 isolates were examined for activity (MIC) of meropenem and other broad-spectrum antibacterial comparators. Cumulative susceptibility rates using Clinical and Laboratory Standards Institute criteria against all methicillin-susceptible staphylococci were imipenem (97.7%) > meropenem (97.3%) > piperacillin/tazobactam (96.2%) > tobramycin (94.2%) > gentamicin (92.0%) > ciprofloxacin (84.0%) > ceftazidime (39.8%). Against all species of Enterobacteriaceae, the rates were meropenem (99.4%) > imipenem (98.3%) > tobramycin (92.0%) > gentamicin (89.5%) > ceftazidime (86.2%) > piperacillin/tazobactam (85.5%) > ciprofloxacin (84.2%). Meropenem was most effective against the nonfermenters, although multidrug-resistant Acinetobacter spp. and imipenem-resistant Pseudomonas aeruginosa strains were reported. The continued need for surveillance studies such as MYSTIC is exemplified, and results from these types of surveillance can, hopefully, help in the correct choice of empiric therapy.
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Affiliation(s)
- Philip J Turner
- Infection Discovery Department, AstraZeneca, SK10 4TF Macclesfield, UK.
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12
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Ishii Y, Yamaguchi K. Evaluation of the susceptibility trends to meropenem in a nationwide collection of clinical isolates in Japan: a longitudinal analysis from 2002 to 2006. Diagn Microbiol Infect Dis 2008; 61:346-50. [DOI: 10.1016/j.diagmicrobio.2008.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 01/23/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
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Comparative activity of meropenem in US medical centers (2007): initiating the 2nd decade of MYSTIC program surveillance. Diagn Microbiol Infect Dis 2008; 61:203-13. [DOI: 10.1016/j.diagmicrobio.2008.01.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 01/16/2008] [Accepted: 01/17/2008] [Indexed: 11/18/2022]
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14
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Patzer JA, Dzierzanowska D, Turner PJ. Trends in antimicrobial susceptibility of Gram-negative isolates from a paediatric intensive care unit in Warsaw: results from the MYSTIC programme (1997-2007). J Antimicrob Chemother 2008; 62:369-75. [PMID: 18445575 DOI: 10.1093/jac/dkn184] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) programme is a longitudinal global surveillance study to monitor in vitro data on microbial susceptibility in centres that prescribe meropenem. This overview provides data on the susceptibility of Gram-negative bacteria (n = 1300) isolated from clinical specimens of children hospitalized in a paediatric intensive care unit (ICU) during 1997-2007. METHODS MICs of meropenem and eight other antibiotics were determined using the CLSI agar dilution method. RESULTS Meropenem, imipenem and ciprofloxacin were most active (>90% susceptibility) against the tested isolates. A greater proportion of Pseudomonas aeruginosa isolates was susceptible to meropenem compared with imipenem. Antibiotic susceptibility of Enterobacteriaceae and Acinetobacter baumannii showed an increase in 2007. Only susceptibility of P. aeruginosa to ceftazidime and cefepime increased. The incidence of extended-spectrum beta-lactamase (ESBL) producers among Enterobacteriaceae isolates decreased from 37% in 1997 to 21.8% in 2007, and AmpC beta-lactamase producers decreased from 24.6% to 5.7%. Consumption of cephalosporins remained the same and piperacillin/tazobactam increased 3-fold. During 11 years, despite an increase in carbapenem consumption, meropenem and imipenem have retained excellent activity against the majority of isolates studied. CONCLUSIONS The comparison of antibiotic susceptibility of Gram-negative isolates in 1997 and 2007 showed a trend of increase, and the number of beta-lactamase-producing isolates among Enterobacteriaceae showed a trend of decrease possibly related to changes in antibiotic policy.
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Affiliation(s)
- Jan A Patzer
- Department of Clinical Microbiology and Immunology, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.
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Lundin JI, Dargatz DA, Wagner BA, Lombard JE, Hill AE, Ladely SR, Fedorka-Cray PJ. Antimicrobial Drug Resistance of Fecal Escherichia coli and Salmonella spp. Isolates from United States Dairy Cows. Foodborne Pathog Dis 2008; 5:7-19. [DOI: 10.1089/fpd.2007.0018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica I. Lundin
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - David A. Dargatz
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - Bruce A. Wagner
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - Jason E. Lombard
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - Ashley E. Hill
- Animal Population Health Institute, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Scott R. Ladely
- Bacterial Epidemiology and Antimicrobial Resistance Unit, Agriculture Research Service, United States Department of Agriculture, Athens, Georgia
| | - Paula J. Fedorka-Cray
- Bacterial Epidemiology and Antimicrobial Resistance Unit, Agriculture Research Service, United States Department of Agriculture, Athens, Georgia
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Turner PJ. Meropenem activity against European isolates: report on the MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) 2006 results. Diagn Microbiol Infect Dis 2008; 60:185-92. [DOI: 10.1016/j.diagmicrobio.2007.09.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 08/13/2007] [Accepted: 09/10/2007] [Indexed: 01/16/2023]
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Villegas M, Kattan J, Quinteros M, Casellas J. Prevalence of extended-spectrum β-lactamases in South America. Clin Microbiol Infect 2008; 14 Suppl 1:154-8. [DOI: 10.1111/j.1469-0691.2007.01869.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bochicchio GV, Baquero F, Hsueh PR, Paterson DL, Rossi F, Snyder TA, McCarroll K, Satishchandran V, Dinubile MJ, Chow JW. In vitro susceptibilities of Escherichia coli isolated from patients with intra-abdominal infections worldwide in 2002-2004: results from SMART (Study for Monitoring Antimicrobial Resistance Trends). Surg Infect (Larchmt) 2007; 7:537-45. [PMID: 17233571 DOI: 10.1089/sur.2006.7.537] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since 2002, the worldwide Study for Monitoring Antimicrobial Resistance Trends (SMART) has tracked resistance patterns among aerobic and facultative gram-negative bacilli isolated from patients with intra-abdominal infections. Escherichia coli has been by far the most frequently isolated species. METHODS Antimicrobial susceptibilities for consecutive non-duplicate isolates of aerobic and facultative gram-negative bacilli recovered from intra-abdominal infections were determined by standard broth microdilution techniques. A subanalysis was performed for E. coli isolates from the first three years of the study. RESULTS A total of 7,002 E. coli isolates were recovered, most commonly from the peritoneal cavity followed by the biliary tract. Susceptibility rates to the 12 antimicrobial agents tested differed among geographic regions, with isolates from Asia/Pacific generally having the highest resistance rates. Overall, extended-spectrum beta-lactamase (ESBL)-producers had a more antibiotic-resistant profile than non-ESBL-producers but usually were susceptible to the carbapenems and amikacin. Community-acquired E. coli strains comprised slightly more than one-half of the isolates and were susceptible to the agents tested more frequently than were hospital-acquired E. coli. CONCLUSIONS The prevalence of antimicrobial resistance among E. coli isolated from intraabdominal infections is not inconsequential, especially in the Asia/Pacific region. The carbapenems and amikacin were consistently active in vitro against E. coli isolates worldwide, including ESBL-producers.
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Pascual A, Perea E, Alvarez M, Casal M, Garcia de Lomas J, Garcia Rodríguez JA, Martin R, Soria G, Zapardiel J. The Meropenem Yearly Susceptibility Test Information Collection antimicrobial susceptibility program in Spain: a 5-year analysis. Diagn Microbiol Infect Dis 2007; 57:195-200. [PMID: 17052882 DOI: 10.1016/j.diagmicrobio.2006.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 07/25/2006] [Accepted: 08/17/2006] [Indexed: 10/24/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection program is a global study providing in vitro surveillance data on antimicrobial susceptibility in centers prescribing meropenem. This study summarizes data on the activity of meropenem and 5 comparators against 4022 clinical isolates from 7 centers in Spain (1999-2003). Those bacteria intrinsically resistant to meropenem were excluded. Among Enterobacteriaceae, 100% of Enterobacter spp., Citrobacter spp., and Serratia spp. were susceptible to meropenem. Escherichia coli and Klebsiella pneumoniae susceptibilities to carbapenems were 100% and > or =98%, respectively. Extended-spectrum beta-lactamase-producing Enterobacteriaceae were 3.8% of isolates, and all of them were susceptible to meropenem. Ciprofloxacin resistance in E. coli was around 20%. Meropenem and piperacillin/tazobactam were the most active agents against Pseudomonas aeruginosa. Acinetobacter baumannii were 61-90% susceptible to carbapenems, but only 6-21% susceptible to ciprofloxacin. In this period, around 100% of oxacillin-susceptible staphylococci were susceptible to meropenem. There was no significant decrease in susceptibility to the carbapenems throughout the 5-year period. The clinical use of meropenem in 7 Spanish centers did not increase bacterial resistance to this agent in the microorganisms evaluated.
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Burkhardt O, Derendorf H, Welte T. Ertapenem: the new carbapenem 5 years after first FDA licensing for clinical practice. Expert Opin Pharmacother 2007; 8:237-56. [PMID: 17257093 DOI: 10.1517/14656566.8.2.237] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ertapenem, a parenteral broad-spectrum 1-beta-methyl-carbapenem, was licensed 5 years ago for clinical practice in the US and Europe. The substance has a good in vitro activity against many common aerobic and anaerobic Gram-positive and -negative bacteria. Its in vitro activity against Enterobacteriaceae carrying plasmid- or chromosomal-mediated beta-lactamases, including AmpC- and extended-spectrum beta-lactamases, is especially clinically significant. Advantages concerning in vitro activity and low potential for so-called 'collateral damage', and development of own resistance during therapy, as shown in several randomized, controlled clinical trials, make ertapenem an excellent treatment choice for complicated aerobic and anaerobic mix infections caused by ertapenem-sensitive bacteria. On the other hand, due to its limited activity against Acinetobacter spp., enterococci and Pseudomonas aeruginosa, it is less suitable for late-onset nosocomial infections. International guidelines recommend the initial empirical use of ertapenem for intra-abdominal infections, skin and skin-structure infections, acute pelvic infections, complicated urinary tract infections and pneumonia (both community-acquired and 'early-onset' nosocomial) in a dose of 1.0 g administered once daily. However, recent results from pharmacokinetic/pharmacodynamic modelling studies in critically ill patients with ventilator-associated pneumonia and adipose volunteers with a body mass index of > or = 20 kg/m(2) showed that the standard dose of 1.0 g/day may not provide adequate free, protein-unbound drug concentrations in plasma and organ tissues. Therefore, a shortening of the dosage interval or continuous infusion of ertapenem should be considered to ensure optimal free concentrations in these particular populations.
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Affiliation(s)
- Olaf Burkhardt
- Department of Pulmonary Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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21
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Abstract
The first beta-lactamase was identified in an isolate of Escherichia coli in 1940. To date, there are >130 TEM-type and >50 sulfhydryl variable (SHV)-type beta-lactamases, mainly in E. coli, Klebsiella pneumoniae, and Proteus mirabilis but also in other members of the Enterobacteriaceae family and in some nonenteric organisms, such as Acinetobacter species. The incidence of expanded-spectrum beta-lactamases (ESBLs) varies, depending on which area of the globe the isolates originate from. ESBLs render the oxyimino-cephalosporins ineffective, and ESBL-producing organisms frequently also possess resistance factors to other classes of antibiotics, such as aminoglycosides and fluoroquinolones, and possibly also piperacillin-tazobactam and cefepime. These results suggest that microbiology laboratories should routinely test for the presence of these strains among their isolates and that the antibiotics of choice for infections believed to be caused by these types of organisms are the carbapenems.
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Turner PJ. Meropenem and imipenem activity against Pseudomonas aeruginosa isolates from the MYSTIC Program. Diagn Microbiol Infect Dis 2006; 56:341-4. [PMID: 17049798 DOI: 10.1016/j.diagmicrobio.2006.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 07/18/2006] [Accepted: 07/26/2006] [Indexed: 11/29/2022]
Abstract
This article examines the activity of meropenem and imipenem against Pseudomonas aeruginosa isolates from the Meropenem Yearly Susceptibility Test Information Collection program between 1997 and 2005. In particular, it examines the activity of meropenem against imipenem-resistant strains and vice versa. Meropenem proved to be active against up to a 3rd of imipenem-resistant strains.
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Affiliation(s)
- Philip J Turner
- Infection Discovery Department, AstraZeneca, SK10 4TG Macclesfield, Cheshire, UK.
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Unal S, Garcia-Rodriguez JA. Activity of meropenem and comparators against Pseudomonas aeruginosa and Acinetobacter spp. isolated in the MYSTIC Program, 2002-2004. Diagn Microbiol Infect Dis 2006; 53:265-71. [PMID: 16360550 DOI: 10.1016/j.diagmicrobio.2005.10.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 10/16/2005] [Indexed: 02/06/2023]
Abstract
This study examines the susceptibilities of meropenem and other broad-spectrum antimicrobials tested against bacterial isolates collected from hospitalized patients during 2002-2004 from worldwide medical centers participating in the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program. The in vitro activity of meropenem and 5 comparator antimicrobial agents was assessed against Pseudomonas aeruginosa and Acinetobacter spp. Generally, the susceptibility of Australasian and North American isolates was higher than that of the European and South American isolates. The rank order of activity of the antimicrobial agents tested against a worldwide collection of P. aeruginosa was piperacillin/tazobactam (77.7% susceptible) > meropenem (75.4%) > ceftazidime (70.0%) > imipenem (69.7%) > gentamicin (66.1%) > ciprofloxacin (62.0%). Against a worldwide collection of Acinetobacter spp. meropenem (76.1% susceptible) was the most active compound followed by imipenem (74.7%) > gentamicin (51.9%) > ciprofloxacin (40.5%) > piperacillin/tazobactam (39.8%) > ceftazidime (38.1%). The carbapenems appear to be a valuable option for the treatment of serious nosocomial infections caused by P. aeruginosa or Acinetobacter spp. over a broad geographical region.
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Affiliation(s)
- Serhat Unal
- Section of Infectious Diseases, Department of Internal Medicine, Medical Faculty, Hacettepe University, Ankara 06100, Turkey.
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Jones RN, Mendes C, Turner PJ, Masterton R. An overview of the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program: 1997-2004. Diagn Microbiol Infect Dis 2006; 53:247-56. [PMID: 16360548 DOI: 10.1016/j.diagmicrobio.2005.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 10/16/2005] [Indexed: 12/29/2022]
Abstract
This overview provides a summary of the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program over an 8-year period from 1997 to 2004. The evolution of the MYSTIC Program is described, as well as its design compared with other surveillance programs. In addition, the global MYSTIC Program data, published to date, are summarized, and the empiric use of carbapenems, their current indications, and meropenem usage versus resistance was discussed. From 1997 to 2004, 120 medical centers that were actively prescribing meropenem in 32 countries worldwide participated in the program. The MYSTIC Program results demonstrate the sustained potency and continued effectiveness of meropenem globally against clinically relevant Gram-negative and Gram-positive pathogens including extended spectrum beta-lactamase- and AmpC beta-lactamase-producing organisms, which may also display resistance to the fluoroquinolones and/or aminoglycosides. Furthermore, in centers actively prescribing meropenem, resistance to meropenem is not increasing despite greater resistance among the comparator antimicrobial agents. Thus, antipseudomonal carbapenems such as meropenem and imipenem remain an effective treatment option.
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Turner PJ. Use of a program-specific website to disseminate surveillance data obtained from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Study. Diagn Microbiol Infect Dis 2006; 53:273-9. [PMID: 16360551 DOI: 10.1016/j.diagmicrobio.2005.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 10/16/2005] [Indexed: 11/25/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program is a multicenter, longitudinal surveillance study initiated in 1997 that compares the activity of meropenem and comparator antimicrobials in centers that are actively prescribing meropenem. Antimicrobial surveillance programs, such as MYSTIC, provide important information on the emergence of bacterial resistance and the nature of the underlying mechanisms in different geographical regions. Data concerning these mechanisms and patterns of antimicrobial resistance allow the implementation of changes in antimicrobial prescribing practices and infection control interventions. Therefore, it is important that data from surveillance programs be analyzed and accessible to clinicians within reasonable, clinically useful, intervals. In this article, the use of a website designed to disseminate data collected from the MYSTIC program is described. This web-based program allows specific surveillance data to be examined in a timely manner and can assist the clinician when choosing the most appropriate antibiotic for the situation encountered and hopefully maximize successful clinical outcomes.
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Affiliation(s)
- Philip J Turner
- Infection Discovery Department, AstraZeneca, Alderley Park, Macclesfield, Cheshire SK10 4TF, UK.
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Masterton RG, Turner PJ. Trends in antimicrobial susceptibility in UK centres: the MYSTIC Programme (1997–2002). Int J Antimicrob Agents 2006; 27:69-72. [PMID: 16343857 DOI: 10.1016/j.ijantimicag.2005.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 09/09/2005] [Indexed: 10/25/2022]
Abstract
Trends in antimicrobial susceptibilities in three UK centres participating in the MYSTIC Programme were examined from 1997 to 2002. Isolates were tested using standard methodology to determine the susceptibility breakpoints of meropenem and several other antimicrobial agents including imipenem, ceftazidime, piperacillin/tazobactam, ciprofloxacin and gentamicin. Data are grouped in 2-year blocks. The carbapenems were the most active agents tested against the Enterobacteriaceae (99-100% and 98-100% susceptibility to meropenem and imipenem, respectively) and non-fermenters, including Pseudomonas spp. and Acinetobacter spp. With the exception of susceptibility to ciprofloxacin, which decreased among Enterobacteriaceae at the end of the 6-year period, all antibiotics tested retained their levels of activity. The proportion of extended-spectrum beta-lactamase (ESBL)- and AmpC-producing Enterobacteriaceae increased during the study (4.8% and 11.3% in 1997-1998; 7.4% and 16.7% in 2001-2002, respectively). Both meropenem and imipenem retained their potency against these ESBL- and AmpC-producing isolates (100% for all time periods). All the other antimicrobial agents tested had much lower susceptibility against these resistant isolates and this decreased further over the 6-year period, with the exception of tazobactam, which maintained its low levels. Although all antibiotics tested retained acceptable activity, the carbapenems remained the most active antimicrobial agents against Gram-negative bacteria, including ESBL- and AmpC-producing isolates.
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Kronvall G, Larsson M, Borén C, Kahlmeter G, Bartoloni A, Rossolini GM, Grape M, Kristiansson C, Karlsson I. Extended antimicrobial resistance screening of the dominant faecal Escherichia coli and of rare resistant clones. Int J Antimicrob Agents 2005; 26:473-8. [PMID: 16280241 DOI: 10.1016/j.ijantimicag.2005.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 09/03/2005] [Indexed: 10/25/2022]
Abstract
Fifty faecal samples from healthy adults were grown on MacConkey agar and three pink colonies were subcultured, identified to species level and their antimicrobial susceptibility determined. Forty-seven samples yielded 141 isolates of Escherichia coli that were susceptible to most antimicrobials. Resistance was noted for ampicillin (30.5%), chloramphenicol (12.1%), tetracycline (23.4%), trimethoprim (24.8%) and co-trimoxazole (22.7%). A direct faecal plating method was used for extended resistance screening with E. coli as the indicator organism. Zone breakpoints were determined using normalised resistance interpretation and gave similar susceptibility results. Eighty-eight isolates of E. coli from within the zones of inhibition revealed four times more antimicrobial resistance. Extended antimicrobial resistance screening both provides the susceptibility profile of the dominant E. coli isolate and detects greater resistance in rare isolates.
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Affiliation(s)
- Göran Kronvall
- Clinical Microbiology - MTC, Karolinska Institute, Karolinska Hospital L2:02, SE-17176 Stockholm, Sweden.
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Chow JW, Satishchandran V, Snyder TA, Harvey CM, Friedland IR, Dinubile MJ. In Vitro Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli Isolated from Patients with Intra- Abdominal Infections Worldwide: The 2002 Study for Monitoring Antimicrobial Resistance Trends (SMART). Surg Infect (Larchmt) 2005; 6:439-48. [PMID: 16433608 DOI: 10.1089/sur.2005.6.439] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Study for Monitoring Antimicrobial Resistance Trends (SMART) was begun in 2002 to monitor international drug-resistance patterns among aerobic and facultative gram-negative bacilli isolated from patients with intra-abdominal infections. METHODS In 2002, 40 medical centers from 17 countries collected consecutive non-duplicate isolates from intra-abdominal infections for susceptibility testing against 12 antimicrobial agents using the broth microdilution methods recommended by the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards). RESULTS A total of 3,134 aerobic and facultative gram-negative bacilli were isolated. Enterobacteriaceae accounted for 82% of the total and were most consistently susceptible to amikacin and the carbapenems. Escherichia coli (45%) and Klebsiella spp. (17%) were the most common species. The susceptibility rates of these organisms to the 12 antimicrobial agents differed among geographic regions, with isolates from the Asia/Pacific and Latin American regions usually having the highest rates of resistance. Ampicillin/sulbactam was the agent least frequently active against E. coli (56% susceptible) and Klebsiella spp. (73% susceptible). Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically in 7% of E. coli, 13% of Klebsiella spp., and 18% of Enterobacter spp. Producers of ESBL overall had a more antibiotic-resistant profile than non-producers but were usually susceptible to carbapenems. CONCLUSIONS Antimicrobial resistance rates among gram-negative bacilli isolated from intra-abdominal infections differed among geographic regions. The carbapenems were consistently active in vitro against Enterobacteriaceae worldwide, including ESBL producers.
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Affiliation(s)
- Joseph W Chow
- Merck Research Laboratories, West Point, Pennsylvania 19486-0004, USA.
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Masterton RG, Turner PJ. Overview of the Meropenem Yearly Susceptibility Test Information Collection (1997–2004). Diagn Microbiol Infect Dis 2005. [DOI: 10.1016/j.diagmicrobio.2005.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Goossens H, Grabein B. Prevalence and antimicrobial susceptibility data for extended-spectrum β-lactamase– and AmpC-producing Enterobacteriaceae from the MYSTIC Program in Europe and the United States (1997–2004). Diagn Microbiol Infect Dis 2005; 53:257-64. [PMID: 16360549 DOI: 10.1016/j.diagmicrobio.2005.10.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 10/16/2005] [Indexed: 11/21/2022]
Abstract
This article presents prevalence and susceptibility data from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program in Europe (1997-2004) and the United States (1999-2004) for Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) and/or AmpC beta-lactamases. For ESBL-producing isolates, the prevalence of Escherichia coli and Klebsiella spp. in Europe and Enterobacter spp. in the United States increased over time. For AmpC-producing isolates, the prevalence of Enterobacter spp. and Citrobacter spp. decreased over time in Europe and the United States, respectively. Compared with other antimicrobial agents, meropenem and imipenem had greatest activity against ESBL-producing E. coli and Klebsiella spp. in both Europe (96.9-100.0%) and the United States (100.0%). Such activity was also found for AmpC-producing Enterobacteriaceae in Europe (50.0-100.0%), and Enterobacter spp. and Citrobacter spp. from the United States (100.0% for both). The continued efficacy of carbapenems such as meropenem confirms that these remain first-line agents for treatment of nosocomial infections caused by Enterobacteriaceae-producing ESBL or AmpC beta-lactamases.
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Affiliation(s)
- Herman Goossens
- Department of Microbiology, University Hospital Antwerp, Edegem-Antwerp, B-2650, Belgium.
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Tellado JM, Wilson SE. Empiric Treatment of Nosocomial Intra-Abdominal Infections: A Focus on the Carbapenems. Surg Infect (Larchmt) 2005; 6:329-43. [PMID: 16201943 DOI: 10.1089/sur.2005.6.329] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Serious nosocomial intra-abdominal infections are associated with high morbidity and mortality and represent a substantial drain on healthcare resources. Effective management of this type of infection requires the early use of appropriate, broad-spectrum empiric antimicrobial therapy. The consequences of delayed or inappropriate antimicrobial treatment can be severe-leading to an increased risk of death, re-operation, or prolonged hospitalization. Therefore, it is necessary to begin treatment as soon as possible with the most appropriate regimen, in terms of spectrum, timing, and duration. METHODS Review of pertinent English-language literature. RESULTS Serious nosocomial intra-abdominal infections require broad-spectrum coverage because of the wide range of possible pathogens, which include difficult-to-treat organisms such as Pseudomonas aeruginosa and Bacteroides spp., and resistant strains of Klebsiella spp., Escherichia coli, and methicillin-resistant Staphylococcus aureus acquired from the hospital flora. The early use of appropriate, broad-spectrum empiric antimicrobial therapy for treating high-risk patients with intra-abdominal infections is considered, and appropriate use of the carbapenems, meropenem, and imipenem/cilastatin, is described. CONCLUSION The carbapenems meropenem and imipenem/cilastatin have a spectrum of antimicrobial activity that covers the majority of expected pathogens, including anaerobes, as well as difficult-to-treat and resistant gram-negative strains. Early and appropriate use can reduce mortality and morbidity. Data from published clinical trials support the clinical effectiveness of these two carbapenems in intra-abdominal infections.
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Affiliation(s)
- Jose M Tellado
- Department of Surgery CGI, Hospital Universitario Gregorio Marañon, Madrid, Spain. jtellado.hgugm@salud
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Stelling JM, Travers K, Jones RN, Turner PJ, O'Brien TF, Levy SB. Integrating Escherichia coli antimicrobial susceptibility data from multiple surveillance programs. Emerg Infect Dis 2005; 11:873-82. [PMID: 15963282 PMCID: PMC3367601 DOI: 10.3201/eid1106.041160] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Collaboration between networks presents opportunities to increase analytical power and cross-validate findings. Multivariate analyses of 2 large, international datasets (MYSTIC and SENTRY) from the Global Advisory on Antibiotic Resistance Data program explored temporal, geographic, and demographic trends in Escherichia coli resistance from 1997 to 2001. Elevated rates of nonsusceptibility were seen in Latin America, southern Europe, and the western Pacific, and lower rates were seen in North America. For most antimicrobial drugs considered, nonsusceptibility was higher in isolates from men, older patients, and intensive care unit patients. Nonsusceptibility to ciprofloxacin was higher in younger patients, rose with time, and was not associated with intensive care unit status. In univariate analyses, estimates of nonsusceptibility from MYSTIC were consistently higher than those from SENTRY, but these differences disappeared in multivariate analyses, which supports the epidemiologic relevance of findings from the 2 programs, despite differences in surveillance strategies.
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Affiliation(s)
- John M Stelling
- Alliance for the Prudent Use of Antibiotics, Boston, Massachusetts 02115, USA.
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Turner PJ. Trends in antimicrobial susceptibilities among bacterial pathogens isolated from patients hospitalized in European medical centers: 6-year report of the MYSTIC Surveillance Study (1997-2002). Diagn Microbiol Infect Dis 2005; 51:281-9. [PMID: 15808320 DOI: 10.1016/j.diagmicrobio.2004.11.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 11/09/2004] [Indexed: 11/21/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program provides antimicrobial susceptibility data. The activity of meropenem and 7 broad-spectrum antimicrobials have been examined against 12645 bacterial isolates from 14 European centers between 1997 and 2002. Cumulative susceptibility rates against all species of Enterobacteriaceae combined were ranked as follows: meropenem (99.9%) > imipenem (97.7%) > ciprofloxacin (86.0%) > piperacillin-tazobactam (85.6%) > ceftazidime (85.4%) > gentamicin (85.4%) > tobramycin (85.0%) > cefotaxime (83.8%). The carbapenems were also found to be the most active of the classes tested against nonfermentative Gram-negative bacilli. Against methicillin-susceptible Staphylococcus aureus and coagulase-negative staphylococci, all beta-lactams tested (except ceftazidime) had susceptibility rates of > or = 99.0% and > or = 94.3%, respectively. Over the 6-year period, there was no loss of activity or increase in resistance rate for either carbapenem against any of the species tested. These data confirm the continued potency and broad-spectrum activity of meropenem in units where it is actively being prescribed.
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Affiliation(s)
- Philip J Turner
- Infection Therapy Area, AstraZeneca, Macclesfield, SK10 4TG Cheshire, UK.
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Paterson DL, Rossi F, Baquero F, Hsueh PR, Woods GL, Satishchandran V, Snyder TA, Harvey CM, Teppler H, Dinubile MJ, Chow JW. In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART). J Antimicrob Chemother 2005; 55:965-73. [PMID: 15849262 DOI: 10.1093/jac/dki117] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance programme was begun in 2002 to monitor antimicrobial resistance trends among aerobic and facultative Gram-negative bacilli (GNB) isolated from intra-abdominal infections worldwide. METHODS In 2003, 74 medical centres from 23 countries collected isolates for testing. Antimicrobial susceptibility testing was performed using broth microdilution according to the NCCLS guidelines for MIC testing. RESULTS A total of 5658 aerobic and facultative GNB were isolated from intra-abdominal infections. Enterobacteriaceae composed 84% of the total isolates. Among the agents tested, the carbapenems were the most consistently active against the Enterobacteriaceae. E. coli was the most common isolate (46%), and the susceptibility rate to the quinolone (70-90% susceptible), cephalosporin (80-97% susceptible), aminoglycoside (77-100% susceptible) and carbapenem (99-100% susceptible) agents tested varied among geographic regions, with isolates from the Asia/Pacific region generally being the most resistant. Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically in 9% of E. coli, 14% of Klebsiella spp., and 14% of Enterobacter spp. worldwide. ESBL producers generally had a more antibiotic-resistant profile than non-ESBL producers. CONCLUSIONS Antimicrobial resistance among GNB isolated from intra-abdominal infections is a problem worldwide, especially in the Asia/Pacific region. The carbapenems ertapenem, meropenem and imipenem are highly active in vitro against Enterobacteriaceae isolated from intra-abdominal sites, including organisms that produce ESBLs.
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Turner PJ. Susceptibility of meropenem and comparators tested against 30,634 Enterobacteriaceae isolated in the MYSTIC Programme (1997-2003). Diagn Microbiol Infect Dis 2005; 50:291-3. [PMID: 15582303 DOI: 10.1016/j.diagmicrobio.2004.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Accepted: 07/13/2004] [Indexed: 11/24/2022]
Abstract
A total of 30,634 global Enterobacteriaceae isolates collected from the MYSTIC (Meropenem Yearly Surveillance Test Information Collection) Programme were tested using a reference methodology against meropenem and seven other broad-spectrum agents commonly used in the hospital setting (1997-2003). The most active compound was meropenem (99.6% susceptible), followed by imipenem (98.4%), cefepime (94.0%), gentamicin (86.8%), piperacillin/tazobactam (85.8%), ceftazidime (85.0%), ciprofloxacin (84.6%), and tobramycin (84.5%). Continued surveillance of antimicrobial compounds' in vitro activity is necessary to recommend regimens that are likely to be effective in clinical practice.
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Affiliation(s)
- Philip J Turner
- AstraZeneca, Alderley Park, Macclesfield, Cheshire, United Kingdom.
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36
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Jones RN, Deshpande L, Fritsche TR, Sader HS. Determination of epidemic clonality among multidrug-resistant strains of Acinetobacter spp. and Pseudomonas aeruginosa in the MYSTIC Programme (USA, 1999–2003). Diagn Microbiol Infect Dis 2004; 49:211-6. [PMID: 15246512 DOI: 10.1016/j.diagmicrobio.2004.03.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2004] [Accepted: 03/22/2004] [Indexed: 11/24/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme was initiated in 1997 (1999 for the United States). This program monitors resistance in participant medical centers where carbapenems are prescribed and drug use data can be obtained. An earlier report found antimicrobial use was not a clear cause of local or aggregate changes in resistance rates. This study addresses the role of dissemination of resistant clones on susceptibility rates for nonfermentors, Acinetobacter spp. (ACB) and Pseudomonas aeruginosa (PSA). Carbapenem (CARB)-multidrug-resistant strains (MDR) from among 236 ACB and 1,111 PSA were tested by reference broth microdilution methods, automated ribotyping, and pulsed field gel electrophoresis to determine possible clonal dissemination. Each strain was also tested for metallo-beta-lactamases (MbetaL) (phenotypic and polymerase chain reaction); and then analyzed by CARB-R rate and defined daily dose (DDD)/100 days use groupings (high, moderate, and low). For the aggregate 15 sites in the MYSTIC Programme each year, the CARB-resistant rate decreased over 5 years; but other drug-resistance rates generally escalated. Changes were not related to antimicrobial use calculations. The discovered clonally spread MDR-PSA strains were more frequent in high- (1.8 clones/site) and moderate-resistance (0.6 clones/site) rate centers (21.7% to 29.5% were clonal), compared with unique strains in low-resistance hospitals. ACB clonality was extreme in one geographic area, with dissemination of 5 different clones (931.7/B, C, or D; 1090.2/A; 167.5/A) in 4 centers (02, 04, 06, and 18). Resistance rates in ACB and PSA were clearly related to clonal occurrence and spread, and one MbetaL (VIM-7) was detected. Decreased CARB resistance rates from 1999 through 2002 were directly attributed to the disappearance of resistance clones in some locations. In conclusion, ACB and PSA CARB and MDR resistance rates in MYSTIC Programme institutions have been greatly influenced by clonal dissemination and less by antimicrobial use patterns. The most serious examples of resistance were the clonality observed among ACB in New York City and the documented endemic nature of VIM-7-producing PSA (0.09% of all PSA isolates). Meropenem remained the most active antimicrobial agent tested in the program, and surveillance networks must implement epidemiologic typing to accurately assess the role of clonal spread on the study results.
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Affiliation(s)
- Ronald N Jones
- The JONES Group/JMI Laboratories, North Liberty, Iowa, USA.
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Unal S, Masterton R, Goossens H. Bacteraemia in Europe—antimicrobial susceptibility data from the MYSTIC surveillance programme. Int J Antimicrob Agents 2004; 23:155-63. [PMID: 15013041 DOI: 10.1016/j.ijantimicag.2003.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2003] [Accepted: 07/03/2003] [Indexed: 10/26/2022]
Abstract
The in vitro antimicrobial susceptibility of organisms isolated from bacteraemic versus non-bacteraemic patients was evaluated using data (1997-2001) from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme. Minimum inhibitory concentration values and susceptibility breakpoints of meropenem and other broad-spectrum antimicrobials were determined using standard methodology. Three thousand one hundred and thirty-six blood culture (BC) isolates and 17261 non-BC isolates were obtained from 51 European MYSTIC centres. Gram-positive bacteria appeared to be more prevalent in BC isolates compared with other sources. Escherichia coli, methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa were isolated most frequently. Antimicrobial susceptibility of isolates from bacteraemic versus non-bacteraemic patients was similar. Meropenem and imipenem were the most active agents against the majority of the Gram-positive and Gram-negative organisms. Ceftazidime, gentamicin and ciprofloxacin generally exhibited the lowest activities against the most commonly isolated organisms. Meropenem was most active against P. aeruginosa and showed the highest potency and activity against all extended-spectrum and AmpC beta-lactamase producers. These results are relevant to the choice of initial, empirical therapy for patients with suspected bacteraemia.
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Affiliation(s)
- Serhat Unal
- Department of Internal Medicine, Medical Faculty, Hacettepe University, Ankara 06100, Turkey.
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Masterton R, Drusano G, Paterson DL, Park G. Appropriate antimicrobial treatment in nosocomial infections—the clinical challenges. J Hosp Infect 2003; 55 Suppl 1:1-12. [PMID: 14623198 DOI: 10.1016/s0195-6701(03)00294-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Resistance to antimicrobial agents is emerging in a wide variety of pathogens, particularly those that cause nosocomial infections. As a consequence of this increasing resistance, morbidity and mortality in nosocomial infections is also increasing. It is therefore critical to treat nosocomial infections appropriately by starting antimicrobial treatment early in the course of infection, using the correct agent, at the most appropriate dose, and for an adequate duration. Indeed, early 'appropriate' antibiotic prescribing has been shown significantly to reduce mortality, length of intensive care unit and hospital stay and overall costs. Early use of the correct antibiotic at the appropriate dose and for an adequate duration are key to initial appropriate antibiotic prescribing. Choosing the right antibiotic depends mainly on the likely pathogen(s) and the expected local susceptibility patterns. Selection of appropriate antimicrobial therapy requires a thorough understanding of the likely microbial cause of the infection, including local susceptibility patterns, as well as the properties of the antimicrobials available for treating these infections, namely spectrum of activity and potency (including activity versus known resistance mechanisms), pharmacokinetic profile and tolerability and safety. This review, based on a series of presentations at the 5th International Conference of the Hospital Infection Society (Edinburgh, 2002) examines the importance of appropriate antimicrobial therapy in nosocomial infections, and provides guidance on how to achieve this.
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Affiliation(s)
- R Masterton
- Ayrshire and Arran Acute Hospitals NHS Trust, Crosshouse Hospital, Crosshouse, Kilmarnock, Ayrshire, KA2 0BE, UK.
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Goossens H. Susceptibility of multi-drug-resistant Pseudomonas aeruginosa in intensive care units: results from the European MYSTIC study group† †The Meropenem Yearly Susceptibility Test information Collection. Clin Microbiol Infect 2003; 9:980-3. [PMID: 14616692 DOI: 10.1046/j.1469-0691.2003.00690.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The MYSTIC program monitors worldwide in vitro susceptibilities of clinical bacterial isolates from centers that prescribe meropenem. This report focuses on 107 isolates of multi-drug resistant (MDR) Pseudomonas aeruginosa, which commonly causes infections that are difficult to treat in hospitalized patients. We chose samples from patients from 33 European intensive care units (ICUs). There was considerable inter-country variation in the proportion of P. aeruginosa that were MDR, ranging from 50% in Turkey to < or =3% in Spain, the UK, Germany, Bulgaria and Malta. Amongst the MDR isolates, the percentage resistance (MIC50/90 in mg/L) to the antibiotics tested were amikacin 18.7% (32/>128), meropenem 29.1% (8/64), imipenem 44.9% (16/64), cefepime 49.5% (32/64) and piperacillin/tazobactam 57.9% (128/>128).
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Affiliation(s)
- H Goossens
- Department of Microbiology, University Hospital, Edegem-Antwerp, Belgium.
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Jones RN, Pfaller MA. Antimicrobial activity against strains of Escherichia coli and Klebsiella spp. with resistance phenotypes consistent with an extended-spectrum beta-lactamase in Europe. Clin Microbiol Infect 2003; 9:708-12. [PMID: 12925113 DOI: 10.1046/j.1469-0691.2003.00555.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extended-spectrum beta-lactamases (ESBLs) have continued to evolve after their initial detection in Europe nearly two decades ago. The summary results from the MYSTIC Program (31 medical centers) were utilized to assess the extent of ESBL occurrence in Europe from 1997 to 2000. ESBL phenotype rates in Klebsiella spp. (32.8%) and Escherichia coli (14.4%) were generally stable, but extensive hospital-to-hospital and unit-to-unit variations were noted. The highest ESBL rates were found in eastern Europe (including Turkey) and in intensive care unit patient populations. Carbapenems remained active against the ESBL-producing strains (meropenem MIC90, 0.25-1 mg/L), while some other agents, such as aminoglycosides, fluoroquinolones, and piperacillin-tazobactam, were significantly less effective. International surveillance initiatives should be maintained to monitor future progression of this important resistance.
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Affiliation(s)
- R N Jones
- Tufts University School of Medicine, Jones Group/JMI Laboratories, 345 Beaver Kreek Center, Suite A, North Liberty, Iowa 52317, USA.
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Kronvall G, Kahlmeter G, Myhre E, Galas MF. A new method for normalized interpretation of antimicrobial resistance from disk test results for comparative purposes. Clin Microbiol Infect 2003; 9:120-32. [PMID: 12588332 DOI: 10.1046/j.1469-0691.2003.00546.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate a calibration method for disk diffusion antibiotic susceptibility tests, using zone diameter values generated in the individual laboratory as the internal calibrator for combinations of antibiotic and bacterial species. METHODS The high-zone side of zone histogram distributions was first analyzed by moving averages to determine the peak position of the susceptible population. The accumulated percentages of isolates for the high zone diameter values were calculated and converted into probit values. The normal distribution of the ideal population of susceptible strains was then determined by using the least-squares method for probit values against zone diameters, and the ideal population was thereby defined, including mean and standard deviation. Zone diameter values were obtained from laboratories at the Karolinska Hospital (KS) and Växjö Hospital (VX), and from two laboratories (LabA, LabB) in Argentina. The method relies on well standardized disk tests, but is independent of differences in MIC limits and zone breakpoints, and does not require the use of reference strains. Resistance was tentatively set at below 3 SD from the calculated, ideal mean zone diameter of the susceptible population. RESULTS The method, called normalized interpretation of antimicrobial resistance, was tested on results from the KS and VX clinical microbiology laboratories, using the disk diffusion method for antimicrobial susceptibility tests, and for two bacterial species, Staphylococcus aureus and Escherichia coli. In total, 114 217 test results were included for the clinical isolates, and 3582 test results for control strains. The methodology at KS and VX followed the standard of the Swedish Reference Group for Antibiotics (SRGA). Zone diameter histograms for control strains were first analyzed to validate the procedure, and a comparison of actual means with the calculated means showed a correlation coefficient of r = 0.998. Results for clinical isolates at the two laboratories showed an excellent agreement for 54 of 57 combinations of antibiotic and bacterial species between normalized interpretations and the interpretations given by the laboratories. There were difficulties with E. coli and mecillinam, and S. aureus and tetracycline and rifampicin. The method was also tested on results from two laboratories using the NCCLS standard, and preliminary results showed very good agreement with quality-controlled laboratory interpretations. CONCLUSIONS The normalized resistance interpretation offers a new approach to comparative surveillance studies whereby the inhibition zone diameter results from disk tests in clinical laboratories can be used for calibration of the test.
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Affiliation(s)
- G Kronvall
- Department of Microbiology and Tumor Biology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
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Jones RN, Rhomberg PR, Varnam DJ, Mathai D. A comparison of the antimicrobial activity of meropenem and selected broad-spectrum antimicrobials tested against multi-drug resistant Gram-negative bacilli including bacteraemic Salmonella spp.: initial studies for the MYSTIC programme in India. Int J Antimicrob Agents 2002; 20:426-31. [PMID: 12458136 DOI: 10.1016/s0924-8579(02)00210-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The evolution in India of multi-drug resistant pathogens possessing extended-spectrum beta-lactamases (ESBLs) threatens to compromise the clinical utility of third-generation cephalosporins and monobactams. Using selected resistant strains from a recent Indian 10 centre surveillance study that measured the prevailing incidence of resistance to beta-lactam antibiotics, the potential clinical utility of meropenem was assessed against nine other antimicrobial agents. A total of 212 Gram-negative bacilli were tested, of which 125 were confirmed by reference methods to be ESBL-producers. Meropenem was the most active of the test antimicrobials against these strains and the rank order of susceptibility was meropenem (99.1% susceptible) > piperacillin/tazobactam (76.9%) > ciprofloxacin (42.5%) > aminoglycosides (34.4-39.6%) = other beta-lactams (30.0-39.6%). Of the tested strains only two (Acinetobacter spp. and Pseudomonas putida) showed an intermediate susceptibility (8 mg/l) to meropenem. Of the 57 tested strains of Salmonella spp., three had an ESBL phenotype, confirmed two of the strains. This study confirms the high levels of resistance to beta-lactams agents in India reported elsewhere and also demonstrates, for Escherichia coli and Klebsiella spp., high levels of co-resistance between the tested beta-lactam agents and ciprofloxacin and the aminoglycosides, gentamicin and tobramycin. However, carbapenems such as meropenem, remain a therapeutic option.
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Affiliation(s)
- Ronald N Jones
- JMI Laboratories/The JONES Group, 345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317, USA.
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Fontana R, Lo Cascio G, Giacobone E, Romero E, Cipriani P, Sessa R, Franchino L. Resistance surveillance in Italy: four-year results from the MYSTIC program. J Chemother 2002; 14:323-31. [PMID: 12420847 DOI: 10.1179/joc.2002.14.4.323] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The MYSTIC program is an international, multicenter surveillance study that compares the activity of meropenem, in centers that are prescribers, with that of imipenem, ceftazidime, piperacillin/tazobactam, ciprofloxacin and gentamicin. These Italian data are from 3 centers (neutropenia, cystic fibrosis and intensive care units). A total of 2,072 (238 Gram-positive and 1,834 Gram-negative) aerobic microorganisms were collected during the study. Pseudomonas aeruginosa (33.4%) was the most isolated species followed by Escherichia coli (14.4%). All except one Enterobacteriaceae strain isolated were fully susceptible to meropenem. Moreover, the activity of meropenem against Enterobacteriaceae was about eight-fold greater than that of imipenem and four- to eight-fold more active than that of ceftazidime. Meropenem was highly active against non-fermentative Gram-negative microorganisms, exceeding the activity of most of the other antimicrobial agents tested. Moreover, meropenem showed increasing activity during the 4 years of study (starting from 86.2% in 1997 to 94.0% in 2000). In conclusion, our results indicate that meropenem has excellent potency and spectrum of activity despite being prescribed for the treatment of seriously ill patients, and appears to be a reliable option for the initial empirical treatment of serious nosocomial infections.
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Affiliation(s)
- R Fontana
- Dipartimento di Patologia, Università di Verona, Italy
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Ramphal R. A position paper on the treatment of hospital acquired pneumonia (HAP): do we need guidelines? Acta Clin Belg 2002; 57:202-6. [PMID: 12462796 DOI: 10.1179/acb.2002.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- R Ramphal
- Department of Medicine, Division of Infectious Diseases, University of Florida, Gainesville, Florida, USA.
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Mutnick AH, Turner PJ, Jones RN. Emerging antimicrobial resistances among Proteus mirabilis in Europe: report from the MYSTIC Program (1997-2001). Meropenem Yearly Susceptibility Test Information Collection. J Chemother 2002; 14:253-8. [PMID: 12120879 DOI: 10.1179/joc.2002.14.3.253] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Resistance patterns that are currently problematic in Europe can vary greatly within the same species over time, among various patient populations and among geographic regions on the same continent. The results from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program, which monitors carbapenem resistance rates in institutions using meropenem, were used to determine resistance differences among Proteus mirabilis. MIC results from 688 P. mirabilis strains were classified into 4 patient care groups: ICU (n=426), neutropenia patients (NP; n=145), general wards (n=97) and cystic fibrosis patients (CF; n=20). A total of 40 centers from 12 European countries have participated since 1997, divided into 3 geographic regions (East, North, South). All testing was performed by NCCLS reference methods and interpretive criteria, including screening of extended-spectrum beta-lactamase (ESBL) phenotypes. Over the monitored interval the resistance rates varied for each agent without a clear trend toward a greater rate. Rank order of susceptibility was: meropenem (99%) > piperacillin/tazobactam (TAZ; 96%) > cefepime (95%) > ceftazidime (CAZ; 94%) > imipenem (IPM; 92%). Ciprofloxacin (CIP) was the least active agent tested (MIC90 4 microg/ml; 86% susceptible). Unexpectedly, 3.6% of P. mirabilis were imipenem-resistant (MIC, > or = 16 microg/ml). Greater rates of resistance were found for strains from NP and CF patients, and from eastern or southern European sites, usually associated with epidemic clusters. Generally susceptible species such as P. mirabilis have recently emerged as therapeutic problems in European medical centers following mutations that compromise CIP, CAZ and aminoglycoside use. Imipenem also showed decreased susceptibility of greater than 7% compared to less than 1% for meropenem. Continued surveillance by the MYSTIC Program appears to be a prudent practice to focus effective empiric treatment regimens.
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Affiliation(s)
- A H Mutnick
- The JONES Group/JMI Laboratories, North Liberty, Iowa 52317, USA.
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Garcia-Rodriguez JA, Jones RN. Antimicrobial resistance in gram-negative isolates from European intensive care units: data from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) programme. J Chemother 2002; 14:25-32. [PMID: 11892895 DOI: 10.1179/joc.2002.14.1.25] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Susceptibility data were collected for 6243 gram-negative isolates from 29 European ICUs participating in the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme (1997-2000). The most commonly isolated bacteria were Pseudomonas aeruginosa (22.5%), Escherichia coli (19.8%), Klebsiella pneumoniae (10.4%), and Enterobacter cloacae (7.7%). The incidence of extended-spectrum beta-lactamase-producers was higher in Turkish, Russian and Italian ICUs (27.9-39.6%) than in other countries (2.5-10.8%). The frequency of AmpC-cephalosporin hyper-producers was 16.8-55.4%. Meropenem was more active against Proteus mirabilis than imipenem (99.0% versus 88.8% susceptibility, respectively). Against Acinetobacter baumannii, meropenem (79.6% susceptible) and imipenem (82.2%) were more active than comparators (34.3-51.6%). Meropenem and imipenem exhibited good activity against P. aeruginosa (76.1% and 68.2%, respectively; but with inter-country variation). Ciprofloxacin resistance in E. coli and K. pneumoniae increased and needs close monitoring. Meropenem (98.2-99.8% susceptibility) and imipenem (88.8-99.4%) remained potent against important species of gram-negative bacteria from European ICUs actively using meropenem.
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Kato K, Iwai S, Kumasaka K, Horikoshi A, Inada S, Inamatsu T, Ono Y, Nishiya H, Hanatani Y, Narita T, Sekino H, Hayashi I. Survey of antibiotic resistance in Pseudomonas aeruginosa by The Tokyo Johoku Association of Pseudomonas Studies. J Infect Chemother 2001; 7:258-62. [PMID: 11810595 DOI: 10.1007/s101560170024] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2000] [Accepted: 04/10/2001] [Indexed: 10/27/2022]
Abstract
Pseudomonas aeruginosa resistance (minimum inhibitory concentration [MIC], > or =16 microg/ml defined as resistant) to meropenem, imipenem, panipenem, piperacillin, ceftazidime, cefozopran, cefoperazone, sulbactam/cefoperazone, amikacin, and tobramycin, as well as cross-resistance profiles, were investigated in P. aeruginosa strains isolated at eight hospitals in the Johoku area, Tokyo, during November 1998. Overall, 8.3% of isolates were imipenem-resistant and 4.6% were ceftazidime-resistant. However, the incidence of antibiotic-resistant P. aeruginosa was distinctly different at each hospital. P. aeruginosa resistance to imipenem ranged from (MIC) 1 to 64 microg/ml (MIC90 32 microg/ml), and its resistance to ceftazidime ranged from 2 to more than 128 microg/ml (MIC90, 64 microg/ml). Meropenem (MIC range, < or =0.25 to 16 microg/ml) was more active than panipenem (MIC range, 2 to 64 microg/ml). Cefozopran was more active than piperacillin, cefoperazone, or sulbactam/cefoperazone, but many strains were resistant to cefoperazone (17/57). Our analysis found cross-resistance to many beta-lactams, but the degree of cross-resistance was very variable.
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Affiliation(s)
- K Kato
- Third Department of Surgery, Nihon University School of Medicine, 30-1 Oyaguchi, Itabashi-ku, Tokyo 173-8610, Japan.
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Abstract
Antimicrobial surveillance programs provide important information on the development of bacterial resistance mechanisms in different geographical regions. Data concerning these mechanisms and patterns of antimicrobial resistance allows the implementation of changes in antimicrobial prescribing practices and infection control interventions. The three most widely known global surveillance programs currently in active operation are: The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC), The SENTRY Antimicrobial Surveillance Program, and The Alexander Project. This presentation reviews these surveillance programs, using a set of key criteria in order to assess the significance of each program in monitoring the spread of antimicrobial resistance. The content of the MYSTIC Program monitors the in vitro performance of meropenem in hospital units in which this drug is actively prescribed. This distinguishes the MYSTIC Program from the other two major surveillance programs as it seeks to correlate antimicrobial resistance data, collected from high carbapenem usage institutions, with antimicrobial prescribing patterns over time. The MYSTIC Program and other assessed networks appear to be both valuable and complementary in their design and function.
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Affiliation(s)
- R N Jones
- JMI Laboratories, North Liberty, IA, USA.
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Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program is a global study providing in-vitro surveillance data on microbial susceptibility in centers that prescribe meropenem. This paper summarizes data on the activity of meropenem and five comparator agents against 13,793 clinical isolates from 31 centers in 10 European countries, 1997-2000. Meropenem and imipenem demonstrated broad-spectrum activity against the tested organisms, including beta-lactamase-producing strains that were co-resistant to quinolones and aminoglycosides. The carbapenems were active against the most frequently isolated pathogens including staphylococci (98-100% susceptible), Pseudomonas aeruginosa (65-82% susceptible) and Klebsiella pneumoniae (98-100% susceptible). Resistance to penicillins and cephalosporins was observed, particularly among Enterobacter species in Southern and Eastern Europe. Eastern Europe showed a high prevalence of AmpC beta-lactamase and extended-spectrum beta-lactamase-producing strains in Russia (2000); 47% and 28% of Enterobacteriaceae isolates were AmpC or ESBL-producers, respectively. There was no significant decrease in susceptibility to the carbapenems throughout the four-year period. Meropenem and imipenem appear to remain reliable options for the treatment of serious nosocomial infections.
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Affiliation(s)
- H Goossens
- Department of Microbiology, University Hospital, Antwerp, Belgium
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Mendes C, Turner PJ. Unit differences in pathogen occurrence arising from the MYSTIC program European database (1997-2000). Diagn Microbiol Infect Dis 2001; 41:191-6. [PMID: 11777658 DOI: 10.1016/s0732-8893(01)00321-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program is a longitudinal global antimicrobial surveillance study that compares the activity of meropenem and comparator antimicrobial agents against pathogens isolated from intensive care, neutropenic or cystic fibrosis patients, and general wards. Data from the different European MYSTIC Program units (1997-2000) showed that the most prevalent isolates tested overall were methicillin-susceptible Staphylococcus aureus (MSSA; in accordance with study design methicillin-resistant S. aureus was not tested), Pseudomonas aeruginosa and Escherichia coli. In all the unit types, E. coli (approximately 20% having an extended spectrum beta-lactamase phenotype) and MSSA were highly susceptible to meropenem (97-99% susceptibility). Isolates of MSSA showed lower levels of susceptibility to ciprofloxacin (61-77% susceptibility) in both cystic fibrosis and neutropenia patients, and particularly high levels of resistance to ceftazidime (38% susceptibility) in cystic fibrosis units. Ciprofloxacin (54% susceptibility) and gentamicin (46% susceptibility) demonstrated low levels of activity against P. aeruginosa (frequently encountered in cystic fibrosis units). Meropenem and piperacillin/tazobactam were the most active agents against P. aeruginosa in all the unit types. Carbapenems and piperacillin/tazobactam have sustained > 90% susceptibility rates overall against the most frequently isolated pathogens. The analysis of specific units that house patients with a high-risk of contracting antimicrobial-resistant pathogens remains very important for the optimal selection of empiric regimens.
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Affiliation(s)
- C Mendes
- Laboratório Fleury, São Paulo, Brazil
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