In vitro activity of ceftazidime-avibactam, ceftolozane-tazobactam, and other comparable agents against clinically important Gram-negative bacilli: results from the 2017 Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART)

Shio-Shin Jean; Min-Chi Lu; Zhi-Yuan Shi; Shu-Hui Tseng; Ting-Shu Wu; Po-Liang Lu; Pei-Lan Shao; Wen-Chien Ko; Fu-Der Wang; Po-Ren Hsueh

doi:10.2147/IDR.S175679

In vitro activity of ceftazidime-avibactam, ceftolozane-tazobactam, and other comparable agents against clinically important Gram-negative bacilli: results from the 2017 Surveillance of Multicenter Antimicrobial Resistance in Taiwan (SMART)

Infect Drug Resist. 2018 Oct 26:11:1983-1992. doi: 10.2147/IDR.S175679. eCollection 2018.

Authors

Shio-Shin Jean^{1

2}, Min-Chi Lu³, Zhi-Yuan Shi⁴, Shu-Hui Tseng⁵, Ting-Shu Wu⁶, Po-Liang Lu⁷, Pei-Lan Shao⁸, Wen-Chien Ko⁹, Fu-Der Wang^{10

11}, Po-Ren Hsueh^{12

13}

Affiliations

¹ Department of Emergency Medicine and Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
² Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
³ Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan.
⁴ Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
⁵ Center for Disease Control and Prevention, Ministry of Health and Welfare, Taiwan.
⁶ Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
⁷ Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁸ Department of Pediatrics, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan.
⁹ Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
¹⁰ Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, fdwang@vghtpe.gov.tw.
¹¹ School of Medicine, National Yang-Ming University, Taipei, Taiwan, fdwang@vghtpe.gov.tw.
¹² Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
¹³ Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

Abstract

Objectives: We investigated the in vitro antimicrobial susceptibilities of clinically important Gram-negative bacteria (GNB) from 16 major teaching hospitals in Taiwan in 2017.

Materials and methods: Escherichia coli (n=686) and Klebsiella pneumoniae bloodstream isolates (n=673), non-typhoid Salmonella (NTS; n=221) from various sources, Shigella species (n=21) from fecal samples, and Neisseria gonorrhoeae (n=129) from the genitourinary tract were collected. Antibiotic minimum inhibitory concentrations (MICs) were determined using the broth microdilution method. Alleles encoding K. pneumoniae carbapenemases (KPCs), New Delhi metallo-β-lactamases (NDMs), Verona integron-encoded metallo-β-lactamase, imipenemase, _OXA-48-like, and mcr-1-5 genes were detected by molecular methods in Enterobacteriaceae isolates.

Results: Five (0.7%) E. coli isolates harbored mcr-1 alleles. Twenty-four (3.6%), seven (1.0%), four (0.6%), and one (0.15%) K. pneumoniae isolates contained bla _KPC, bla _OXA-48-like, mcr-1, and bla _NDM, respectively. Three (1.4%) NTS and no Shigella isolates harbored mcr-1 genes. Seventy-one (10.5%) K. pneumoniae isolates displayed non-susceptibility (NS) to carbapenem agent(s). Phenotypically extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae isolates showed significantly higher rates of ertapenem, tigecycline, and ceftolozane-tazobactam (CLZ- TAZ) NS (40.2%, 16.3%, and 71%-80%, respectively) than E. coli isolates exhibiting ESBL phenotypes (5.4%, 0.7%, and 18%-28%, respectively). All phenotypically ESBL-producing E. coli isolates were ceftazidime-avibactam (CAZ-AVB) susceptible. Two (8.3%) KPC-producing K. pneumoniae isolates showed CAZ-AVB NS. Hospital-acquired K. pneumoniae isolates were significantly less susceptible to ertapenem and CLZ-TAZ than hospital-acquired E. coli isolates.

Conclusion: Third-generation cephalosporins remain the optimal choice for treating NTS, Shigella, and gonococcal infections in Taiwan. Hospital-acquired and phenotypically ESBL-producing K. pneumoniae are a heavy resistance burden in Taiwan.

Keywords: Enterobacteriaceae; Neisseria gonorrhoeae; avibactam; carbapenemase; ceftazidime; ceftolozane-tazobactam; extended-spectrum β-lactamases.