Incidence and Antimicrobial Susceptibility of Escherichia coli and Klebsiella pneumoniae with Extended-Spectrum β-Lactamases in Community- and Hospital-Associated Intra-Abdominal Infections in Europe: Results of the 2008 Study for Monitoring Antimicrobial Resistance Trends (SMART) ▿

From 2002 to 2008, there was a significant increase in extended-spectrum beta-lactamase (ESBL)-positive Escherichia coli isolates in European intra-abdominal infections, from 4.3% in 2002 to 11.8% in 2008 (P < 0.001), but not for ESBL-positive Klebsiella pneumoniae isolates (16.4% to 17.9% [P > 0.05]). Hospital-associated isolates were more common than community-associated isolates, at 14.0% versus 6.5%, respectively, for E. coli (P < 0.001) and 20.9% versus 5.3%, respectively, for K. pneumoniae (P < 0.01). Carbapenems were consistently the most active drugs tested

Emergence of High Levels of Extended-Spectrum-β-Lactamase-Producing Gram-Negative Bacilli in the Asia-Pacific Region: Data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) Program, 2007▿

Of 3,004 gram-negative bacilli collected from intra-abdominal infections in the Asia-Pacific region during 2007, 42.2% and 35.8% of Escherichia coli and Klebsiella spp., respectively, were extended-spectrum β-lactamase (ESBL) positive. Moreover ESBL rates in India for E. coli, Klebsiella pneumoniae, and Klebsiella oxytoca were 79.0%, 69.4%, and 100%, respectively. ESBL-positive E. coli rates were also relatively high in China (55.0%) and Thailand (50.8%). Ertapenem and imipenem were the most active drugs tested, inhibiting over 90% of all species, including ESBL-positive isolates with the exception of Pseudomonas aeruginosa isolates (<90% susceptible to all study drugs) and ESBL-positive Klebsiella pneumoniae isolates (<90% susceptible to all study drugs except imipenem). Quinolones achieved 90% inhibition levels only against ESBL-negative K. pneumoniae and ESBL-negative K. oxytoca. A decline in ampicillin-sulbactam activity was noted, with only 34.5% of all Enterobacteriaceae inhibited in this study

Susceptibility of Klebsiella pneumoniae Isolates from Intra-Abdominal Infections and Molecular Characterization of Ertapenem-Resistant Isolates

A total of 2,841 clinical isolates of Klebsiella pneumoniae from intra-abdominal infections worldwide were collected in the Study for Monitoring Antimicrobial Resistance Trends (SMART) during 2008 and 2009. Overall, 22.4% of isolates had extended-spectrum β-lactamases (ESBLs). The most active antibiotics among the 11 tested were imipenem, amikacin, and ertapenem, though even these, like all other comparators, were less consistently active against ESBL-positive isolates than against ESBL-negative isolates. Globally, 6.5% of isolates were ertapenem resistant based on the June 2010 clinical breakpoints published by the Clinical and Laboratory Standards Institute, with MICs of ≥1 μg/ml. Molecular characterization of 43 isolates with ertapenem MICs of ≥4 μg/ml showed that they variously produced CTX-M or SHV ESBLs combined with altered impermeability and/or had KPC (n = 28), OXA-48 (n = 3), or VIM (n = 1) carbapenemases. Further monitoring of ertapenem susceptibility and molecular characterization of ertapenem-resistant isolates are needed

Antimicrobial susceptibility profiles of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region according to currently established susceptibility interpretive criteria

Objectives: The Study for Monitoring Antimicrobial Resistance Trends (SMART) was intended to reveal the evolving profiles of antimicrobial resistance among Gram-negative pathogens causing intra-abdominal infections (IAIs) from Asia-Pacific region in 2009

Monitoring the global in vitro activity of ertapenem against Escherichia coli from intra-abdominal infections: SMART 2002-2010

During 2002-2010, a total of 30 840 Escherichia coli clinical isolates from intra-abdominal infections were collected globally in the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance programme. The incidence of extended-spectrum beta-lactamase (ESBL)-producing isolates ranged from 9.2% in 2002 to 21.2% in 2010. The highest rates were observed in Asia (38.3%) and Latin America (22.9%) and the lowest rates in Africa (6.3%), North America (6%) and South Pacific (5.8%). Global susceptibility trends showed that there were only minor fluctuations in susceptibility to ertapenem and imipenem, with no significant decrease over time. Against ESBL-positive isolates, ertapenem susceptibility significantly increased during 2002-2010 globally. Moreover, susceptibility to ertapenem in the different geographical regions studied was also high, with only minor fluctuations generally observed. Notably, in Asia where the highest ESBL-positives rates (38.3%) were observed, susceptibility to ertapenem had actually significantly increased in this population during the 9-year study period. By contrast, susceptibility to amikacin, cephalosporins, fluoroquinolones and beta-lactam/beta-lactamase inhibitor combinations generally decreased over time. Further monitoring of the susceptibility to ertapenem and other antibiotics through SMART is warranted. (C) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved