Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China

doi:10.1186/s12879-018-3405-1

. 2018 Sep 29;18(1):493.

doi: 10.1186/s12879-018-3405-1.

Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China

Hui Zhang¹, Haishen Kong², Yunsong Yu³, Anhua Wu⁴, Qiong Duan⁵, Xiaofeng Jiang⁶, Shufang Zhang⁷, Ziyong Sun⁸, Yuxing Ni⁹, Weiping Wang¹⁰, Yong Wang¹¹, Kang Liao¹², Huayin Li¹³, Chunxia Yang¹⁴, Wenxiang Huang¹⁵, Bingdong Gui¹⁶, Bin Shan¹⁷, Robert Badal¹⁸, Qiwen Yang¹⁹, Yingchun Xu²⁰

Affiliations

¹ Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
² Department of Microbiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China.
³ Department of Infectious Diseases, SirRunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
⁴ Infection Control Center, Xiangya Hospital, Central South University, Changsha, 410008, China.
⁵ Microbiology Laboratory, Jilin Province People's Hospital, Changchun, 130021, China.
⁶ The Fourth Hospital of Harbin Medical University, No. 37 Yiyuan Road, Nangang District, Harbin, China.
⁷ Division of Microbiology, Haikou People's Hospital, Haikou, 570208, China.
⁸ Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
⁹ Division of Microbiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
¹⁰ Nanjing General Hospital, No. 305 Zhongshan Dong Road, Nanjing, China.
¹¹ Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China.
¹² Division of Microbiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
¹³ Zhongshan Hospital Affiliated to Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
¹⁴ Beijing Chao-yang Hospital, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
¹⁵ Division of Microbiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
¹⁶ Clinical laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
¹⁷ First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China.
¹⁸ Division of Microbiology, International Health Management Associates, Schaumburg, IL, 60173-3817, USA.
¹⁹ Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China. yangqiwen81@163.com.
²⁰ Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China. xycpumch@139.com.

PMID: 30268102
PMCID: PMC6162895
DOI: 10.1186/s12879-018-3405-1

Carbapenem susceptibilities of Gram-negative pathogens in intra-abdominal and urinary tract infections: updated report of SMART 2015 in China

Hui Zhang et al. BMC Infect Dis. 2018.

. 2018 Sep 29;18(1):493.

doi: 10.1186/s12879-018-3405-1.

Authors

Affiliations

¹ Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China.
² Department of Microbiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China.
³ Department of Infectious Diseases, SirRunRun Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
⁴ Infection Control Center, Xiangya Hospital, Central South University, Changsha, 410008, China.
⁵ Microbiology Laboratory, Jilin Province People's Hospital, Changchun, 130021, China.
⁶ The Fourth Hospital of Harbin Medical University, No. 37 Yiyuan Road, Nangang District, Harbin, China.
⁷ Division of Microbiology, Haikou People's Hospital, Haikou, 570208, China.
⁸ Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
⁹ Division of Microbiology, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
¹⁰ Nanjing General Hospital, No. 305 Zhongshan Dong Road, Nanjing, China.
¹¹ Department of Laboratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China.
¹² Division of Microbiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
¹³ Zhongshan Hospital Affiliated to Fudan University, No. 180 Fenglin Road, Shanghai, 200032, China.
¹⁴ Beijing Chao-yang Hospital, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
¹⁵ Division of Microbiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
¹⁶ Clinical laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
¹⁷ First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming, 650032, China.
¹⁸ Division of Microbiology, International Health Management Associates, Schaumburg, IL, 60173-3817, USA.
¹⁹ Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China. yangqiwen81@163.com.
²⁰ Division of Microbiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Wangfujing Street, Beijing, 100730, China. xycpumch@139.com.

PMID: 30268102
PMCID: PMC6162895
DOI: 10.1186/s12879-018-3405-1

Abstract

Background: To evaluate the susceptibility rates of aerobic and facultative Gram-negative bacterial isolates from Chinese intra-abdominal infections (IAI) and urinary tract infections (UTI) focusing on carbapenems and comparing their effectiveness between 2014 and 2015.

Methods: A total of 2318 strains in 2015 (1483 from IAI and 835 from UTI) and 2374 strains in 2014 (1438 from IAI and 936 from UTI) were included in the analysis. Antimicrobial susceptibilities were determined at a central laboratory using CLSI broth microdilution and interpretive standards. Hospital acquired (HA) IAI and UTI were defined as isolates sampled > 48 h and community acquired (CA) as isolates sampled < 48 h after admission.

Results: The main species derived from IAI and UTI in 2015 were Escherichia coli (50.86%) and Klebsiella pneumoniae (19.20%). Susceptibilities of Escherichia coli IAI and UTI strains to imipenem (IPM) and ertapenem (ETP) were > 90% in 2014 and 2015, while the susceptibilities to IPM and ETP of Klebsiella pneumoniae IAI strains were > 80% in 2014 but dropped to ≤80% in 2015 for UTI strains. Susceptibilities of IAI Enterobacteriaceae strains to IPM and ETP in 2015 were lowest in the colon and abscesses, and Enterobacteriaceae susceptibilities of UTI and IAI isolates to IPM and ETP were lowest in medical, pediatric and surgery intensive care units (ICUs) in 2015.

Conclusions: IPM and ETP were effective in vitro against Enterobacteriaceae isolated from IAIs and UTIs in 2014 and 2015, but susceptibility to carbapenems in UTIs markedly decreased in 2015.

Keywords: Carbapenem; ertapenem; Enterobacteriaceae; Imipenem; Intra-abdominal infection; Urinary tract infection.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The Human Research Ethics Committee of Peking Union Medical College Hospital approved this study and waived the need for consent (Ethics Approval Number: S-K238).

Consent for publication

Not applicable.

Competing interests

Robert Badal received financial support in the form of salaries from International Health Management Associates, who receive funding from MSD to administer the SMART program and for SMART-related travel and consultation expenses.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
Distribution of isolates acquired from IAI pathogens in different organ groups in 2015

**Fig. 2**
Distribution of *E. coli*, *K. pneumoniae* and other *Enterobacteriaceae* strains derived from HA and CA a) IAIs and b) UTIs in different age groups in 2015. * P < 0.05, *** P < 0.001

**Fig. 3**
Comparison of *E. coli* and *K. pneumonia* isolate susceptibilities (IAI and UTI) to 12 common antibiotics between 2014 and 2015. a *E. coli* isolated from IAI. b *E. coli* isolated from UTI patients. c *K. pneumoniae* isolated from IAI patients. d *K. pneumoniae* isolated from UTI patients. Dotted lines show the indicated percentages throughout the columns for comparison

**Fig. 4**
Susceptibility based on OSWIA in IAI isolates. a OSWIA susceptibility of *Enterobacteriaceae* IAI to ETP. b OSWIA susceptibility of *Enterobacteriaceae* IAI to IPM. c Susceptibilities of *Enterobacteriaceae* UTI and IAI strains to ETP. d to IPM. e *Enterobacteriaceae* susceptibilities of HA and CA IAI and UTI to ETP. f *Enterobacteriaceae* susceptibilities of HA and CA IAI and UTI to IPM. *** P < 0.001

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References

1. Yang Q, Zhang H, Wang Y, Xu Y, Chen M, Badal RE, Wang H, Ni Y, Yu Y, Hu B, et al. A 10 year surveillance for antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae in community- and hospital-associated intra-abdominal infections in China. J Med Microbiol. 2013;62(Pt 9):1343–1349. doi: 10.1099/jmm.0.059816-0. - DOI - PubMed
1. Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the study for monitoring antimicrobial resistance trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel) 2013;6(11):1335–1346. doi: 10.3390/ph6111335. - DOI - PMC - PubMed
1. Yang Q, Zhang H, Wang Y, Xu Z, Zhang G, Chen X, Xu Y, Cao B, Kong H, Ni Y, et al. Antimicrobial susceptibilities of aerobic and facultative gram-negative bacilli isolated from Chinese patients with urinary tract infections between 2010 and 2014. BMC Infect Dis. 2017;17(1):192. doi: 10.1186/s12879-017-2296-x. - DOI - PMC - PubMed
1. Liao K, Chen Y, Wang M, Guo P, Yang Q, Ni Y, Yu Y, Hu B, Sun Z, Huang W, et al. Molecular characteristics of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing intra-abdominal infections from 9 tertiary hospitals in China. Diagn Microbiol Infect Dis. 2017;87(1):45–48. doi: 10.1016/j.diagmicrobio.2016.10.007. - DOI - PubMed
1. Hebert C, Ridgway J, Vekhter B, Brown EC, Weber SG, Robicsek A. Demonstration of the weighted-incidence syndromic combination antibiogram: an empiric prescribing decision aid. Infect Control Hosp Epidemiol. 2012;33(4):381–388. doi: 10.1086/664768. - DOI - PubMed

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[1] Yang Q, Zhang H, Wang Y, Xu Y, Chen M, Badal RE, Wang H, Ni Y, Yu Y, Hu B, et al. A 10 year surveillance for antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae in community- and hospital-associated intra-abdominal infections in China. J Med Microbiol. 2013;62(Pt 9):1343–1349. doi: 10.1099/jmm.0.059816-0. - DOI - PubMed

[2] Yang Q, Zhang H, Wang Y, Xu Y, Chen M, Badal RE, Wang H, Ni Y, Yu Y, Hu B, et al. A 10 year surveillance for antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae in community- and hospital-associated intra-abdominal infections in China. J Med Microbiol. 2013;62(Pt 9):1343–1349. doi: 10.1099/jmm.0.059816-0. - DOI - PubMed

[3] Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the study for monitoring antimicrobial resistance trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel) 2013;6(11):1335–1346. doi: 10.3390/ph6111335. - DOI - PMC - PubMed

[4] Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the study for monitoring antimicrobial resistance trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel) 2013;6(11):1335–1346. doi: 10.3390/ph6111335. - DOI - PMC - PubMed

[5] Yang Q, Zhang H, Wang Y, Xu Z, Zhang G, Chen X, Xu Y, Cao B, Kong H, Ni Y, et al. Antimicrobial susceptibilities of aerobic and facultative gram-negative bacilli isolated from Chinese patients with urinary tract infections between 2010 and 2014. BMC Infect Dis. 2017;17(1):192. doi: 10.1186/s12879-017-2296-x. - DOI - PMC - PubMed

[6] Yang Q, Zhang H, Wang Y, Xu Z, Zhang G, Chen X, Xu Y, Cao B, Kong H, Ni Y, et al. Antimicrobial susceptibilities of aerobic and facultative gram-negative bacilli isolated from Chinese patients with urinary tract infections between 2010 and 2014. BMC Infect Dis. 2017;17(1):192. doi: 10.1186/s12879-017-2296-x. - DOI - PMC - PubMed

[7] Liao K, Chen Y, Wang M, Guo P, Yang Q, Ni Y, Yu Y, Hu B, Sun Z, Huang W, et al. Molecular characteristics of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing intra-abdominal infections from 9 tertiary hospitals in China. Diagn Microbiol Infect Dis. 2017;87(1):45–48. doi: 10.1016/j.diagmicrobio.2016.10.007. - DOI - PubMed

[8] Liao K, Chen Y, Wang M, Guo P, Yang Q, Ni Y, Yu Y, Hu B, Sun Z, Huang W, et al. Molecular characteristics of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing intra-abdominal infections from 9 tertiary hospitals in China. Diagn Microbiol Infect Dis. 2017;87(1):45–48. doi: 10.1016/j.diagmicrobio.2016.10.007. - DOI - PubMed

[9] Hebert C, Ridgway J, Vekhter B, Brown EC, Weber SG, Robicsek A. Demonstration of the weighted-incidence syndromic combination antibiogram: an empiric prescribing decision aid. Infect Control Hosp Epidemiol. 2012;33(4):381–388. doi: 10.1086/664768. - DOI - PubMed

[10] Hebert C, Ridgway J, Vekhter B, Brown EC, Weber SG, Robicsek A. Demonstration of the weighted-incidence syndromic combination antibiogram: an empiric prescribing decision aid. Infect Control Hosp Epidemiol. 2012;33(4):381–388. doi: 10.1086/664768. - DOI - PubMed

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