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. 2023 Jun;36(3):302-309.
doi: 10.37201/req/007.2023. Epub 2023 Mar 22.

Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020

S García-Fernández  1 , J Calvo, E Cercenado, A I Suárez-Barrenechea, M Fernández-Billón, F J Castillo, L Gálvez-Benítez, F Tubau, R E Figueroa Cerón, A Hernández-Cabezas, F González Romo, M C Fariñas, M Gómez, J Díaz-Regañón, R Cantón
Affiliations

Activity of imipenem/relebactam against Enterobacterales and Pseudomonas aeruginosa in Spain. SMART 2016-2020

S García-Fernández et al. Rev Esp Quimioter. 2023 Jun.

Abstract
in English, Spanish

Objective: To determine susceptibility to the novel β-lactam/β-lactamase inhibitor combination imipenem/relebactam in clinical isolates recovered from intra-abdominal (IAI), urinary (UTI), respiratory (RTI) and bloodstream (BSI) infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) study in SPAIN during 2016 - 2020.

Methods: Broth microdilution MICs for imipenem/relebactam and comparators were determined by a central laboratory against isolates of Enterobacterales and Pseudomonas aeruginosa. MICs were interpreted using EUCAST-2021 breakpoints.

Results: In total, 5,210 Enterobacterales and 1,418 P. aeruginosa clinical isolates were analyzed. Imipenem/relebactam inhibited 98.8% of Enterobacterales. Distinguishing by source of infection susceptibility was 99.1% in BSI, 99.2% in IAI, 97.9% in RTI, and 99.2% in UTI. Of intensive care unit isolates (ICU) 97.4% were susceptible and of non-ICU isolates 99.2% were susceptible. In Enterobacterales, activity against Class A, Class B and Class D carbapenemases was 96.2%, 15.4% and 73.2%, respectively. In P. aeruginosa, imipenem/relebactam was active in 92.2% of isolates. By source of infection it was 94.8% in BSI, 92.9% in IAI, 91.7% in RTI, and 93.1% in UTI. An 88.7% of ICU isolates and 93.6% of non-ICU isolates were susceptible to imipenem/relebactam. Imipenem/relebactam remained active against P. aeruginosa ceftazidime-resistant (76.3%), cefepime-resistant (73.6%), imipenem-resistant (71.5%) and piperacillin-resistant (78.7%) isolates. Of all multidrug-resistant or difficult-to-treat resistance P. aeruginosa isolates, 75.1% and 46.2%, respectively, were susceptible to imipenem/relebactam.

Conclusions: Imipenem/relebactam showed high rates of susceptibility in Enterobacterales and P. aeruginosa isolates from different sources of infection as well as depending on patients' location (ICU or non-ICU scenarios).

Objetivos: Determinar la sensibilidad a la nueva combinación deβ-lactámico e inhibidor de β-lactamasas imipenem/ relebactam en aislados clínicos procedentes de infecciones intraabdominales (IIA), urinarias (ITU), respiratorias (ITR) y bacteriemias del estudio SMART (Study for Monitoring Antimicrobial Resistance Trends) en ESPAÑA durante 2016 - 2020.

Métodos: Se determinó la CMI mediante microdilución en caldo de imipenem/relebactam y antibióticos comparadores frente a aislados de Enterobacterales y Pseudomonas aeruginosa. Las CMI se analizaron empleando los puntos de corte EUCAST-2021.

Resultados: En total, se incluyeron 5.210 aislados de Enterobacterales y 1.418 aislados de P. aeruginosa. Imipenem/ relebactam fue activo frente al 98,8% de los Enterobacterales. Distinguiendo por foco de infección, la sensibilidad fue del 99,1% en bacteriemia, del 99,2% en IIA, del 97,9% en ITR y del 99,2% en ITU. El 97,4% de los aislados procedentes de unidades de cuidados intensivos (UCI) fueron sensibles, y el 99,2% de los aislados no procedentes de UCI. En Enterobacterales, la sensibilidad frente a carbapenemasas de clase A, clase B y clase D fue del 96,2%, 15,4% y 73,2%, respectivamente. En P. aeruginosa, imipenem/relebactam fue activo en el 92,2% de los aislados. Distinguiendo por foco de infección, la sensibilidad frente a P. aeruginosa fue del 94,8% en bacteriemia, 92,9% en IIA, 91,7% en ITR y 93,1% en ITU. El 88,7% de los aislados de la UCI y el 93,6% de los aislados no procedentes de UCI fueron sensibles a imipenem/relebactam. Imipenem/relebactam fue activo frente a aislados de P. aeruginosa resistentes a ceftazidima (76,3%), cefepima (73,6%), imipenem (71,5%) y piperacilina/tazobactam (78,7%). Frente a los aislados de P. aeruginosa clasificados como MDR o DTR, el 75,1% y el 46,2%, respectivamente, fueron sensibles a imipenem/relebactam.

Conclusiones: Imipenem/relebactam mostró elevada sensibilidad frente a los aislados de Enterobacterales y P. aeruginosa procedentes de diferentes focos de infección, así como en función de la localización de los pacientes (UCI o no UCI).

Keywords: Imipenem/relebactam; Intensive Care Unit; Multidrug-resistant; Spain; β-lactam/β-lactamase inhibitor combination.

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Conflict of interest statement

RC has participated in an educational program sponsored by GSK, Pfizer, MSD and Shionogi. RC has research grants funded by MSD, Shionogi and Venatorx. JDR and MG are employees of MSD Spain. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Distribution of species and MDR/DTR frequencies included in the study: a)Distribution of species included by source of infection. b) Frequencies of MDR and DTR isolates by species. c) Frequencies of MDR and DTR in ICU or non-ICU scenarios. MDR, multidrug-resistant; DTR, difficult-to-treat resistance; ICU, intensive care unit
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