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. 2019 Apr;32(2):145-155.
Epub 2019 Feb 13.

Monitoring the antimicrobial susceptibility of Gram-negative organisms involved in intraabdominal and urinary tract infections recovered during the SMART study (Spain, 2016 and 2017)

R Cantón  1 , E Loza, J Aznar, F J Castillo, E Cercenado, P A Fraile-Ribot, F González-Romo, J L López-Hontangas, J Rodríguez-Lozano, A I Suárez-Barrenechea, F Tubau, J Díaz-Regañón, D López-Mendoza; SMART-Spain Working Group
Affiliations

Monitoring the antimicrobial susceptibility of Gram-negative organisms involved in intraabdominal and urinary tract infections recovered during the SMART study (Spain, 2016 and 2017)

R Cantón et al. Rev Esp Quimioter. 2019 Apr.

Abstract
in English, Spanish

Objective: Continuous antimicrobial resistance surveillance is recommended by Public Health authorities. We up-dated data from the SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance study in Spain.

Methods: The antimicrobial susceptibility data and extended-spectrum beta-lactamase (ESBL) production in isolates recovered from intra-abdominal (IAI) (n=1,429) and urinary tract (UTI) (n=937) infections during the 2016- 2017 SMART study in 10 Spanish hospitals were analysed.

Results: Escherichia coli was the most frequently microorganism isolated (48.3% and 53.7%) followed by Klebsiella spp. (11.5% and 21.9%) in IAIs and UTIs, respectively. Figures for Pseudomonas aeruginosa were 9.0% and 6.1%, being more frequently recovered from patients with nosocomial infections. Overall, 9.9% (IAI) and 14.0% (UTI) of E. coli, Klebsiella spp. and Proteus mirabilis isolates were ESBL-producers, being Klebsiella pneumoniae (34.5%) from UTI of nosocomial origin the most frequent. ESBL-producers were higher in patients >60 years in both IAIs and UTIs. As in previous years, amikacin (96.3%-100% susceptibility), ertapenem (84.2%-100%) and imipenem (70.3%- 100%) were the most active antimicrobials tested among Enterobacterales species. The activity of amoxicillin-clavulanic, piperacillin-tazobactam, and ciprofloxacin susceptibility was lower, particularly among ESBL-producers. Ertapenem susceptibility (88.9%-100%) was retained in ESBL-E. coli isolates that were resistant to these antimicrobials but decreased (28.6%-100%) in similar isolates of K. pneumoniae.

Conclusions: Continuous antimicrobial resistance surveillance from the SMART study reveals overall maintenance of ESBL-producers in Spain, although with higher presence in isolates from UTIs than from IAIs. Moreover, ertapenem activity was high in E. coli irrespective of ESBL production but decreased in K. pneumoniae, particularly among ESBL-producers.

Introducción: Las autoridades de Salud Pública recomiendan la vigilancia continua de la resistencia a los antimicrobianos. Se actualizan los datos del estudio SMART (Study for Monitoring Antimicrobial Resistance Trends) en España.

Material y métodos: Se analizaron los datos de sensibilidad antimicrobiana y la producción de betalactamasas de espectro extendido (BLEE) en aislamientos obtenidos en el estudio SMART de infecciones intraabdominales (IIA) (n=1.429) y del tracto urinario (ITU) (n=937) durante 2016-2017 en 10 hospitales españoles.

Resultados: Escherichia coli fue el microorganismo más frecuente (54,5% y 57,5%, respectivamente), seguido de Klebsiella spp. (18,4% y 25,4%) en IIA y en ITU. En Pseudomonas aeruginosa estas cifras fueron 9% y 6%, siendo más frecuente en la infección nosocomial. El 9,9% (IIA) y el 14% (ITU) del total de los aislados de E. coli, Klebsiella spp. y Proteus mirabilis producían BLEE, obteniéndose la tasa más alta en Klebsiella pneumoniae (34.5%) en ITU nosocomial. El mayor porcentaje de aislados con BLEE se observó en pacientes >60 años, tanto en IIA como en ITU. Como en años anteriores, amikacina (sensibilidad 96,3%-100%), ertapenem (84,2%-100%) e imipenem (70,3%-100%) fueron los antimicrobianos más activos en Enterobacterales. La sensibilidad a amoxicilina-ácido clavulánico, piperacilina-tazobactam y ciprofloxacino fue menor, en particular en los productores de BLEE. La sensibilidad a ertapenem (88,9%-100%) se mantuvo en E. coli con BLEE resistente a estos antimicrobianos, pero disminuyó (28,6%-100%) en aislados similares de K. pneumoniae.

Conclusiones: La vigilancia continua de la resistencia a los antimicrobianos en el estudio SMART revela el mantenimiento de la frecuencia de aislados productores de BLEE en España, pero con mayor presencia en las ITUs que en las IIAs. Además, la sensibilidad a ertapenem fue alta en E. coli con independencia de la producción de BLEE, pero disminuyó en K. pneumoniae, sobre todo en los productores de BLEE.

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Conflict of interest statement

Rafael Cantón has collaborated in educational meetings sponsored by MSD and Pfizer. He has also had research grants from MSD. F. Javier Castillo has collaborated in educational meetings sponsored by MSD. All other authors declare that they have no conflicts of interest regarding this publication.

Figures

Figure 1
Figure 1
Percentage of Escherichia coli and Klebsiella pneumoniae isolates with extended spectrum β-lactamases by origin of acquisition of infection in the SMART study in Spain comparing intra-abdominal (IAI) and urinary tract infections (UTI) infections.
Figure 2
Figure 2
Frequency of Enterobacterales (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis) with extended spectrum β-lactamases according to age of the patients in the SMART study in Spain comparing intra-abdominal (IAI) and urinary tract infections (UTI) infections.
Figure 3
Figure 3
Percentage of susceptibility of different antimicrobials used in intra-abdominal (A) and urinary tract infections (B) against ESBL producing and non-ESBL-producing Escherichia coli and Klebsiella pneumoniae in the SMART study in Spain (2016-2017). A/C: amoxicillin-clavulanic acid, P/T: piperacillin/tazobactam; CTX: cefotaxime; CAZ: ceftazidime; FEP: cefepime; IPM: imipenem; ETP: ertapenem; AK: amikacin; CIP: ciprofloxacin
See this image and copyright information in PMC

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