Ertapenem non-susceptibility and independent predictors of the carbapenemase production among the enterobacteriaceae isolates causing intra-abdominal infections in the asia-pacific region: Results from the study for monitoring antimicrobial resistance trends (SMART)

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Abstract

Objectives: This study investigated the prevalence rates of carbapenemase positivity, antibiotic susceptibility, and independent predictors of carbapenemase producers among the Enterobacteriaceae isolates recovered from patients with intra-abdominal infections (IAI) in the Asia-Pacific region between 2008 and 2014. Materials and methods: Multiplex PCR was used for the detection of specific β-lactamases, while the broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of antibiotics among the IAI-related Enterobacteriaceae isolates. We studied the abovementioned parameters in 484 ertapenem-non-susceptible (Erta-NS) isolates and explored the independent predictors of carbapenemase-producing Enterobacteriaceae (CPE) isolates. Results: Eighty (16.5%) Erta-NS-IAI Enterobacteriaceae isolates were found to be CPE. Vietnam and the Philippines had the highest CPE prevalence rates. The IAI isolates of Enterobacter species and Klebsiella pneumoniae followed by Escherichia coli were the three major pathogens with 77.4%, 40.9%, and 11.7% Erta-NS prevalence rates, respectively. Furthermore, the highest CPE prevalence (35%) was noted among the Erta-NS-K. pneumoniae isolates. The CPE isolates harboring the blaNDM, blaKPC, or blaOXA-48-like alleles had higher imipenem MIC levels than those harboring the blaIMP alleles. Using multivariate logistic regression analysis, we concluded that Erta-NS-IAI isolates with an imipenem non-susceptible phenotype (OR, 56.4), with cefepime MIC >8 µg/mL (OR, 4.4), cultured from the peritoneal space samples (tissue or abscess; OR, 3.3), and harboring the extended-spectrum β-lactamase encoding allele (OR, 11.5) are independent predictors of CPE. Conclusion: Imipenem non-susceptibility, cefepime MIC >8 μg/mL, and the peritoneal space as a culture site are independent clinical predictors of CPE among the Erta-NS-IAI Enterobacteriaceae isolates in the Asia-Pacific region.

Original languageEnglish
Pages (from-to)1881-1891
Number of pages11
JournalInfection and Drug Resistance
Volume11
DOIs
Publication statusPublished - Jan 1 2018

Fingerprint

Intraabdominal Infections
Enterobacteriaceae
Microbial Sensitivity Tests
Imipenem
Alleles
Klebsiella pneumoniae
ertapenem
carbapenemase
Anti-Bacterial Agents
Enterobacter
Philippines
Vietnam
Multiplex Polymerase Chain Reaction
Abscess
Cross-Sectional Studies
Logistic Models

Keywords

  • Antimicrobial susceptibility
  • Carbapenemase-producing enterobacteriaceae
  • Ertapenem-non-susceptible
  • Intra-abdominal infection

ASJC Scopus subject areas

  • Pharmacology
  • Infectious Diseases
  • Pharmacology (medical)

Cite this

@article{21fe6befeea24c91b2dc40f8abdbbae5,
title = "Ertapenem non-susceptibility and independent predictors of the carbapenemase production among the enterobacteriaceae isolates causing intra-abdominal infections in the asia-pacific region: Results from the study for monitoring antimicrobial resistance trends (SMART)",
abstract = "Objectives: This study investigated the prevalence rates of carbapenemase positivity, antibiotic susceptibility, and independent predictors of carbapenemase producers among the Enterobacteriaceae isolates recovered from patients with intra-abdominal infections (IAI) in the Asia-Pacific region between 2008 and 2014. Materials and methods: Multiplex PCR was used for the detection of specific β-lactamases, while the broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of antibiotics among the IAI-related Enterobacteriaceae isolates. We studied the abovementioned parameters in 484 ertapenem-non-susceptible (Erta-NS) isolates and explored the independent predictors of carbapenemase-producing Enterobacteriaceae (CPE) isolates. Results: Eighty (16.5{\%}) Erta-NS-IAI Enterobacteriaceae isolates were found to be CPE. Vietnam and the Philippines had the highest CPE prevalence rates. The IAI isolates of Enterobacter species and Klebsiella pneumoniae followed by Escherichia coli were the three major pathogens with 77.4{\%}, 40.9{\%}, and 11.7{\%} Erta-NS prevalence rates, respectively. Furthermore, the highest CPE prevalence (35{\%}) was noted among the Erta-NS-K. pneumoniae isolates. The CPE isolates harboring the blaNDM, blaKPC, or blaOXA-48-like alleles had higher imipenem MIC levels than those harboring the blaIMP alleles. Using multivariate logistic regression analysis, we concluded that Erta-NS-IAI isolates with an imipenem non-susceptible phenotype (OR, 56.4), with cefepime MIC >8 µg/mL (OR, 4.4), cultured from the peritoneal space samples (tissue or abscess; OR, 3.3), and harboring the extended-spectrum β-lactamase encoding allele (OR, 11.5) are independent predictors of CPE. Conclusion: Imipenem non-susceptibility, cefepime MIC >8 μg/mL, and the peritoneal space as a culture site are independent clinical predictors of CPE among the Erta-NS-IAI Enterobacteriaceae isolates in the Asia-Pacific region.",
keywords = "Antimicrobial susceptibility, Carbapenemase-producing enterobacteriaceae, Ertapenem-non-susceptible, Intra-abdominal infection, Antimicrobial susceptibility, Carbapenemase-producing enterobacteriaceae, Ertapenem-non-susceptible, Intra-abdominal infection",
author = "Jean, {Shio Shin} and Lee, {Wen Sen} and Hsueh, {Po Ren}",
year = "2018",
month = "1",
day = "1",
doi = "10.2147/IDR.S181085",
language = "English",
volume = "11",
pages = "1881--1891",
journal = "Infection and Drug Resistance",
issn = "1178-6973",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Ertapenem non-susceptibility and independent predictors of the carbapenemase production among the enterobacteriaceae isolates causing intra-abdominal infections in the asia-pacific region

T2 - Results from the study for monitoring antimicrobial resistance trends (SMART)

AU - Jean, Shio Shin

AU - Lee, Wen Sen

AU - Hsueh, Po Ren

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: This study investigated the prevalence rates of carbapenemase positivity, antibiotic susceptibility, and independent predictors of carbapenemase producers among the Enterobacteriaceae isolates recovered from patients with intra-abdominal infections (IAI) in the Asia-Pacific region between 2008 and 2014. Materials and methods: Multiplex PCR was used for the detection of specific β-lactamases, while the broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of antibiotics among the IAI-related Enterobacteriaceae isolates. We studied the abovementioned parameters in 484 ertapenem-non-susceptible (Erta-NS) isolates and explored the independent predictors of carbapenemase-producing Enterobacteriaceae (CPE) isolates. Results: Eighty (16.5%) Erta-NS-IAI Enterobacteriaceae isolates were found to be CPE. Vietnam and the Philippines had the highest CPE prevalence rates. The IAI isolates of Enterobacter species and Klebsiella pneumoniae followed by Escherichia coli were the three major pathogens with 77.4%, 40.9%, and 11.7% Erta-NS prevalence rates, respectively. Furthermore, the highest CPE prevalence (35%) was noted among the Erta-NS-K. pneumoniae isolates. The CPE isolates harboring the blaNDM, blaKPC, or blaOXA-48-like alleles had higher imipenem MIC levels than those harboring the blaIMP alleles. Using multivariate logistic regression analysis, we concluded that Erta-NS-IAI isolates with an imipenem non-susceptible phenotype (OR, 56.4), with cefepime MIC >8 µg/mL (OR, 4.4), cultured from the peritoneal space samples (tissue or abscess; OR, 3.3), and harboring the extended-spectrum β-lactamase encoding allele (OR, 11.5) are independent predictors of CPE. Conclusion: Imipenem non-susceptibility, cefepime MIC >8 μg/mL, and the peritoneal space as a culture site are independent clinical predictors of CPE among the Erta-NS-IAI Enterobacteriaceae isolates in the Asia-Pacific region.

AB - Objectives: This study investigated the prevalence rates of carbapenemase positivity, antibiotic susceptibility, and independent predictors of carbapenemase producers among the Enterobacteriaceae isolates recovered from patients with intra-abdominal infections (IAI) in the Asia-Pacific region between 2008 and 2014. Materials and methods: Multiplex PCR was used for the detection of specific β-lactamases, while the broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of antibiotics among the IAI-related Enterobacteriaceae isolates. We studied the abovementioned parameters in 484 ertapenem-non-susceptible (Erta-NS) isolates and explored the independent predictors of carbapenemase-producing Enterobacteriaceae (CPE) isolates. Results: Eighty (16.5%) Erta-NS-IAI Enterobacteriaceae isolates were found to be CPE. Vietnam and the Philippines had the highest CPE prevalence rates. The IAI isolates of Enterobacter species and Klebsiella pneumoniae followed by Escherichia coli were the three major pathogens with 77.4%, 40.9%, and 11.7% Erta-NS prevalence rates, respectively. Furthermore, the highest CPE prevalence (35%) was noted among the Erta-NS-K. pneumoniae isolates. The CPE isolates harboring the blaNDM, blaKPC, or blaOXA-48-like alleles had higher imipenem MIC levels than those harboring the blaIMP alleles. Using multivariate logistic regression analysis, we concluded that Erta-NS-IAI isolates with an imipenem non-susceptible phenotype (OR, 56.4), with cefepime MIC >8 µg/mL (OR, 4.4), cultured from the peritoneal space samples (tissue or abscess; OR, 3.3), and harboring the extended-spectrum β-lactamase encoding allele (OR, 11.5) are independent predictors of CPE. Conclusion: Imipenem non-susceptibility, cefepime MIC >8 μg/mL, and the peritoneal space as a culture site are independent clinical predictors of CPE among the Erta-NS-IAI Enterobacteriaceae isolates in the Asia-Pacific region.

KW - Antimicrobial susceptibility

KW - Carbapenemase-producing enterobacteriaceae

KW - Ertapenem-non-susceptible

KW - Intra-abdominal infection

KW - Antimicrobial susceptibility

KW - Carbapenemase-producing enterobacteriaceae

KW - Ertapenem-non-susceptible

KW - Intra-abdominal infection

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