Cantón, RafaelLoza, ElenaAznar, JavierBarrón-Adúriz, RubénCalvo, JorgeCastillo, F. JavierCercenado, EmiliaCisterna, RamónGonzález Romo, FernandoLópez Hontangas, Jose LuisSuárez Barrenechea, Ana IsabelTubau, FeMolloy, BrianLópez Mendoza, DiegoSMART-SPAIN Working GroupDomínguez Luzón, Ma. Ángeles (María Ángeles)2023-06-132023-06-132018-04-010214-3429https://hdl.handle.net/2445/199201Objective: 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.10 p.application/pdfeng(c) Sociedad Española de Quimioterapia, 2018Medicaments antibacteriansInfeccions per escheríchia coliBacteris gramnegatiusAntibacterial agentsEscherichia coli infectionsGram-negative bacteriainfo:eu-repo/semantics/article7113072023-06-13info:eu-repo/semantics/openAccess29532655