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2018-04-01

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Antimicrobial susceptibility trends and evolution of isolates with extended spectrum beta-lactamases among Gram-negative organisms recovered during the SMART study in Spain (2011-2015)

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Objective: The SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance study monitors antimicrobial susceptibility and extended spectrum β-lactamases (ESBLs) in Gram-negative bacilli recovered from intra-abdominal infections (IAI). Methods: Antimicrobial susceptibility of 5,343 isolates from IAI recovered in 11 centres during the 2011-2015 SMART-Spain program was analysed by standard microdilution (EUCAST criteria) and compared with that from 2002-2010. ESBLs were phenotypically detected. Results: Escherichia coli, the most common isolate, significantly decreased in community acquired IAI (60.9% 2002-2010 vs. 56.1% 2011-2015, P=0.0003). It was followed in prevalence by Klebsiella pneumoniae that increased both in the community (8.9% vs. 10.8%, P=0.016) and nosocomial (9.2% vs. 10.8%, P=0.029) IAI and P. aeruginosa, which significantly increased in community acquired IAI (5.6% vs. 8.0%, P=0.0003). ESBLs were more prevalent in K. pneumoniae (16.3%) than in E. coli (9.5%) of nosocomial origin and were more frequently isolated from elderly patients (>60 years). Considering all Enterobacteriaceae, ertapenem (92.3-100%) and amikacin (95.5%-100%) were the most active antimicrobials. Ertapenem activity, unlike amoxicillin-clavulanate or piperacillin-tazobactam, remained virtually unchanged in ESBL (100%) and non-ESBL (98.8%) E. coli producers. Its activity decreased in ESBL-K. pneumoniae (74.7%) but was higher than that of amoxicillin-clavulanate (14.0%) and piperacillin-tazobactam (24.0%). Interestingly, ertapenem susceptibility was maintained in >60% of ESBL isolates that were resistant to amoxicillin-clavulanate, piperacillin-tazobactam or fluoroquinolones. Conclusions: SMART-Spain results support current guidelines which include ertapenem as empiric treatment in mild-moderate community-acquired IAI, particularly with ESBL producers. These recommendations will need to be updated with the recently introduction of new antimicrobials.

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Medicaments antibacterians, Infeccions per escheríchia coli, Bacteris gramnegatius

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Antibacterial agents, Escherichia coli infections, Gram-negative bacteria

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Articles publicats en revistes (Patologia i Terapèutica Experimental)
Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))

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CANTÓN, Rafael, LOZA, Elena, AZNAR, Javier, BARRÓN-ADÚRIZ, Rubén, CALVO, Jorge, CASTILLO, F. javier, CERCENADO, Emilia, CISTERNA, Ramón, GONZÁLEZ ROMO, Fernando, LÓPEZ HONTANGAS, Jose luis, SUÁREZ BARRENECHEA, Ana isabel, TUBAU, Fe, MOLLOY, Brian, LÓPEZ MENDOZA, Diego, SMART-SPAIN Working Group, DOMÍNGUEZ LUZÓN, Ma. ángeles (maría ángeles). Antimicrobial susceptibility trends and evolution of isolates with extended spectrum beta-lactamases among Gram-negative organisms recovered during the SMART study in Spain (2011-2015). _Revista Espanola de Quimioterapia_. 2018. Vol. 31, núm. 2, pàgs. 136-145. [consulta: 21 de gener de 2026]. ISSN: 0214-3429. [Disponible a: https://hdl.handle.net/2445/199201]

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