Global Trends in Carbapenem- and Difficult-to-Treat-Resistance Among World Health Organization Priority Bacterial Pathogens: ATLAS Surveillance Program 2018-2022

Mark G Wise; James A Karlowsky; Naglaa Mohamed; Elizabeth D Hermsen; Shweta Kamat; Andy Townsend; Adrian Brink; Alex Soriano; David L Paterson; Luke S P Moore; Daniel F Sahm

doi:10.1016/j.jgar.2024.03.020

Global Trends in Carbapenem- and Difficult-to-Treat-Resistance Among World Health Organization Priority Bacterial Pathogens: ATLAS Surveillance Program 2018-2022

J Glob Antimicrob Resist. 2024 Apr 10:S2213-7165(24)00072-9. doi: 10.1016/j.jgar.2024.03.020. Online ahead of print.

Authors

Affiliations

¹ IHMA, Schaumburg, IL, USA. Electronic address: mwise@ihma.com.
² IHMA, Schaumburg, IL, USA; Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
³ Pfizer Inc., New York, NY, USA.
⁴ Pfizer Ltd, Mumbai, India.
⁵ Pfizer Hospital Medical Affairs, Pfizer, Congleton, UK.
⁶ Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁷ Hospital Clinic of Barcelona, Barcelona, Spain.
⁸ ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁹ Clinical Infection Department, Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK; Imperial College Healthcare NHS Trust, North West London Pathology, London, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, London, UK.
¹⁰ IHMA, Schaumburg, IL, USA.

PMID: 38608936
DOI: 10.1016/j.jgar.2024.03.020

Abstract

Objectives: To report trends in carbapenem resistance and difficult-to-treat resistance (DTR) among clinical isolates of Gram-negative priority pathogens collected by the ATLAS global surveillance program from 2018 to 2022.

Methods: Reference broth microdilution testing was performed in a central laboratory for 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates collected by a constant set of 157 medical centres in 49 countries in Asia Pacific (APAC), Europe (EUR), Latin America (LATAM), Middle East-Africa (MEA), and North America (NA) regions. MICs were interpreted by 2023 CLSI M100 breakpoints. β-lactamase genes were identified for meropenem-nonsusceptible (MIC ≥2 mg/L) Enterobacterales isolates.

Results: Carbapenem-resistant Enterobacterales (CRE) detection increased (P <0.05) in APAC, EUR, LATAM, and MEA regions and decreased in NA, while annual DTR percentages increased in all five regions. Carbapenem-resistant P. aeruginosa (CRPA; decreased in MEA region) and carbapenem-resistant A. baumannii-calcoaceticus complex (CRAB; decreased in MEA region and increased in EUR) remained relatively stable over time in all regions, although notably, annual percentages of CRAB and DTR A. baumannii-calcoaceticus complex isolates were consistently >25 percentage points lower in NA than in other regions. For all regions except NA, the majority of changes in CRE percentages could be attributed to hospital-acquired infections. Among meropenem-nonsusceptible Enterobacterales, KPC was the most frequent carbapenemase in NA and EUR each year. NDM was the most prevalent carbapenemase detected in 2022 in other global regions.

Conclusion: CRE, CRPA, CRAB, and DTR rates vary among global regions over time highlighting the need for continuing surveillance to inform treatment strategies and antimicrobial stewardship.

Keywords: Acinetobacter baumannii-calcoaceticus complex; Enterobacterales; Pseudomonas aeruginosa; carbapenem resistance; difficult-to-treat resistance; surveillance.