Antimicrobial Susceptibility of E. coli Isolates from Intra-Abdominal Infections in the Asia-Pacific Region: Trends in Ciprofloxacin, Ceftriaxone, Cefepime, and Piperacillin/Tazobactam Susceptibility

Chia-Hung Tsai; Yu-Chin Chen; Po-Yu Chen; Chih-Cheng Lai; Hung-Jen Tang; Yin-Ching Chuang; Chi-Chung Chen; Chung-Han Ho; Wei-Yun Hsu; Tu-Hsuan Chang

doi:10.2147/IDR.S422203

Antimicrobial Susceptibility of E. coli Isolates from Intra-Abdominal Infections in the Asia-Pacific Region: Trends in Ciprofloxacin, Ceftriaxone, Cefepime, and Piperacillin/Tazobactam Susceptibility

Infect Drug Resist. 2023 Aug 25:16:5599-5611. doi: 10.2147/IDR.S422203. eCollection 2023.

Authors

Chia-Hung Tsai^#¹, Yu-Chin Chen^#², Po-Yu Chen³, Chih-Cheng Lai^{4

5}, Hung-Jen Tang¹, Yin-Ching Chuang⁶, Chi-Chung Chen^{6

7}, Chung-Han Ho^{6

8}, Wei-Yun Hsu^#⁹, Tu-Hsuan Chang^#⁹

Affiliations

¹ Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
² Department of Pediatrics, Chi Mei Medical Center, Chiali, Tainan, Taiwan.
³ Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
⁴ Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁵ School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
⁶ Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
⁷ Department of Food Science, National Chiayi University, Chiayi, Taiwan.
⁸ Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
⁹ Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan.

^# Contributed equally.

Abstract

Purpose: To investigate the antibiotic susceptibility of Escherichia coli isolates in patients diagnosed with intra-abdominal infections (IAIs) in the Asia-Pacific region.

Patients and methods: This study was conducted at 50 medical hospitals across 9 countries/regions as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program from 2014 to 2018. Nonduplicate isolates of aerobic and facultative gram-negative bacilli were collected and processed for further antimicrobial susceptibility testing.

Results: A total of 10,709 isolates were collected, with E. coli (n=4737, 44.2%) being the leading pathogen causing IAIs, followed by Klebsiella pneumoniae (n=2429, 22.7%) and Pseudomonas aeruginosa (n=931, 8.7%). Community-associated (CA) E. coli isolates generally exhibited higher susceptibility rates for most antibiotics than hospital-associated (HA) isolates. In countries/regions other than Hong Kong, South Korea, and Singapore, HA isolates displayed lower susceptibility rates for multiple classes (≥4) of antibiotics. Among the commonly used antibiotics in IAIs, the overall susceptibility rate for ciprofloxacin was low, with an average of 41.3%. Ceftriaxone susceptibility rates in all selected countries were below 80% starting in 2018, ranging from 23.3% to 75.8%. The cefepime susceptibility rates varied across regions, with consistently reduced susceptibility ranging from 45.5% to 57.8% in India, Thailand, and Vietnam. Piperacillin/tazobactam demonstrated effectiveness against E. coli isolates in almost all countries except India, with a downward trend observed in the Philippines and Taiwan. Carbapenems remained effective against more than 90% of E. coli isolates, except in India.

Conclusion: Prudent use of fluoroquinolones and ceftriaxone is advised when treating both CA and HA IAIs in the Asia-Pacific region. The low susceptibility rate of cefepime in India, Thailand, and Vietnam needs careful consideration in its administration. Moreover, the increase in nonsusceptibility to piperacillin/tazobactam in the Philippines and Taiwan poses a potential risk that should be closely monitored.

Keywords: Asia-Pacific; E. coli; antibiotic susceptibility; intra-abdominal infection.