Journal of Antimicrobial Chemotherapy (2000) 46, 25-37
© 2000 The British Society for Antimicrobial Chemotherapy
MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) results from the Americas: resistance implications in the treatment of serious infections
CAST Laboratories and the Division of Medical Microbiology, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242, USA
The Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) programme aims to provide in vitro surveillance data for geographically diverse institutions where meropenem is available for use. The in vitro activity of meropenem and eight comparator antimicrobial agents against 2340 significant pathogens obtained in 1999 was assessed and compared in 14 study centres in Brazil, Mexico and the USA. Isolates were further characterized for production of extended-spectrum ß-lactamases (ESBLs), AmpC ß-lactamases and carbapenemases. Carbapenems demonstrated their broad spectrum and potency, inhibiting 
95% of all isolates irrespective of the geographical region or centre type. The overall order of activity of the nine agents tested against all pathogens in 1999 was meropenem (96%) > imipenem (95%) > cefepime (92%) > gentamicin (89%) > piperacillin/tazobactam (88%) > ceftazidime = tobramycin (86%) > cefotaxime (84%) > ciprofloxacin (83%). Thus far, the results from the Americas indicate that meropenem has excellent potency and spectrum of activity despite being prescribed for the treatment of seriously ill patients. In contrast, other ESBLs, fluoroquinolones and aminoglycosides have lost activity in many institutions as a result of the selection of strains producing ESBLs or having AmpC and other resistance determinants. Carbapenem resistance was observed rarely and at a prevalence similar to those reported in earlier studies. Carbapenems appear to be a continuing reliable option for the treatment of serious nosocomial infection.
* Correspondence address. Medical Microbiology Division, C606 GH, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242, USA. Tel: +1-319-384-9566; Fax: +1-319-356-4916; E-mail: michael-pfaller{at}uiowa.edu
USA: M. D. Anderson Cancer Center (K. Ralston), Houston, TX; Columbia Presbyterian Medical Center (P. Della-Latta), New York, NY; Arkansas Children's Hospital (T. Beavers-May, R. Jacobs), Little Rock, AR; Winthorp University Hospital (P. Shoch), Mineola, NY; Spectrum Health (R. Fader), Grand Rapids, MI; New York University Medical Center (P. Tierno), New York, NY; Children's Hospital (J. Bradley), San Diego, CA; University Hospitals of Cleveland (M. Jacobs), Cleveland, OH; Penrose Hospital (M. Reynolds), Colorado Springs, CO; and Northwestern Memorial Hospital (L. Peterson), Chicago, IL. Brazil: HCFMUSP/Laboratório Fleury (C. Mendes), São Paulo; FAC Medicina–UFSC (C. Zocolli) Florianópolis; FAC Medicina (I. Mimica) São Paulo. Mexico: Centro Medico ‘La Raza’ (G. Barriga), Mexico City.
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