JAC Advance Access originally published online on April 22, 2005
Journal of Antimicrobial Chemotherapy 2005 55(6):965-973; doi:10.1093/jac/dki117
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In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART)
1 University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2 Hospital das Clinicas da Faculdade de Medicina, São Paulo, Brazil; 3 Hospital Ramon y Cajal, Madrid, Spain; 4 National Taiwan University Hospital, Taipei, Taiwan; 5 ARUP Laboratories and University of Utah, Salt Lake City, UT, USA; 6 Merck Research Laboratories, West Point, PA, USA
* Corresponding author. Email: joseph_chow{at}merck.com
Objectives: The SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance programme was begun in 2002 to monitor antimicrobial resistance trends among aerobic and facultative Gram-negative bacilli (GNB) isolated from intra-abdominal infections worldwide.
Methods: In 2003, 74 medical centres from 23 countries collected isolates for testing. Antimicrobial susceptibility testing was performed using broth microdilution according to the NCCLS guidelines for MIC testing.
Results: A total of 5658 aerobic and facultative GNB were isolated from intra-abdominal infections. Enterobacteriaceae composed 84% of the total isolates. Among the agents tested, the carbapenems were the most consistently active against the Enterobacteriaceae. E. coli was the most common isolate (46%), and the susceptibility rate to the quinolone (70–90% susceptible), cephalosporin (80–97% susceptible), aminoglycoside (77–100% susceptible) and carbapenem (99–100% susceptible) agents tested varied among geographic regions, with isolates from the Asia/Pacific region generally being the most resistant. Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically in 9% of E. coli, 14% of Klebsiella spp., and 14% of Enterobacter spp. worldwide. ESBL producers generally had a more antibiotic-resistant profile than non-ESBL producers.
Conclusions: Antimicrobial resistance among GNB isolated from intra-abdominal infections is a problem worldwide, especially in the Asia/Pacific region. The carbapenems ertapenem, meropenem and imipenem are highly active in vitro against Enterobacteriaceae isolated from intra-abdominal sites, including organisms that produce ESBLs.
Keywords: extended spectrum ß-lactamases , ESBLs , carbapenems , ertapenem , Enterobacteriaceae
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