Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016-2022)

doi:10.1093/jacamr/dlae087

. 2024 Jun 6;6(3):dlae087.

doi: 10.1093/jacamr/dlae087. eCollection 2024 Jun.

Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016-2022)

Ángel Rodríguez-Villodres^{1

2

3}, Esperanza Lepe-Balsalobre⁴, José Manuel Ortiz De La Rosa^{1

2

3}, Salvador Giner Almaraz⁵, Elisa González De Herrero^{3

6}, Emilia Cercenado^{7

8}, Sergio García-Fernández^{3

9}, Rafael Benito¹⁰, Ricardo Ponz Mir¹¹, Rafael Cantón^{3

12}, José Antonio Lepe^{1

2

3

13}

Affiliations

¹ Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Seville, Spain.
² Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain.
³ Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
⁴ Servicio de Laboratorio, Hospital de Riotinto, Huelva, Spain.
⁵ Servicio de Microbiología, Hospital Universitari y Politécnic La Fe, Valencia, Spain.
⁶ Servicio de Microbiología, Hospital Son Espases, IdISBa, CIBERINFEC, Palma de Mallorca, Mallorca, Spain.
⁷ Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain.
⁸ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁹ Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
¹⁰ Hospital Clínico Universitario Lozano Blesa, Zaragoza, Departamento de Microbiología, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
¹¹ Departamento Médico, MSD, Madrid, Spain.
¹² Servicio de Microbilogía, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
¹³ Department of Microbiology, University of Seville, Seville, Spain.

PMID: 38847006
PMCID: PMC11154015
DOI: 10.1093/jacamr/dlae087

Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016-2022)

Ángel Rodríguez-Villodres et al. JAC Antimicrob Resist. 2024.

. 2024 Jun 6;6(3):dlae087.

doi: 10.1093/jacamr/dlae087. eCollection 2024 Jun.

Authors

Affiliations

¹ Clinical Unit of Infectious Diseases, Microbiology and Parasitology, University Hospital Virgen del Rocío, Seville, Spain.
² Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain.
³ Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
⁴ Servicio de Laboratorio, Hospital de Riotinto, Huelva, Spain.
⁵ Servicio de Microbiología, Hospital Universitari y Politécnic La Fe, Valencia, Spain.
⁶ Servicio de Microbiología, Hospital Son Espases, IdISBa, CIBERINFEC, Palma de Mallorca, Mallorca, Spain.
⁷ Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain.
⁸ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁹ Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Spain.
¹⁰ Hospital Clínico Universitario Lozano Blesa, Zaragoza, Departamento de Microbiología, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
¹¹ Departamento Médico, MSD, Madrid, Spain.
¹² Servicio de Microbilogía, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
¹³ Department of Microbiology, University of Seville, Seville, Spain.

PMID: 38847006
PMCID: PMC11154015
DOI: 10.1093/jacamr/dlae087

Abstract

Objectives: To analyse the susceptibility profile to cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations in Enterobacter cloacae complex and Klebsiella aerogenes isolated from intra-abdominal, urinary, respiratory and bloodstream infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance study in Spain.

Methods: The susceptibilities of 759 isolates (473 E. cloacae complex and 286 K. aerogenes) collected in 11 Spanish hospitals from 2016 to 2022 were analysed following the EUCAST 2023 criteria. Molecular characterization looking for β-lactamase genes was performed through PCR and DNA sequencing analysis.

Results: E. cloacae complex showed resistance to third-generation cephalosporins in 25% of the cases, whereas K. aerogenes was resistant in 35%. Regarding cefepime, resistance in E. cloacae was higher (10%) than in K. aerogenes (2%). Carbapenems showed >85% activity in both microorganisms. Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam had good activity against these microorganisms (>95%). In contrast, the activity of ceftolozane/tazobactam was lower (80%). A high proportion of the isolates resistant to new β-lactam/β-lactamase inhibitor combinations carried a carbapenemase, mainly OXA-48-like and VIM-1.

Conclusions: Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam show high activity against both E. cloacae complex and K. aerogenes isolates recovered in the SMART-Spain study. In contrast, differences have been found in the case of cefepime, showing more activity against K. aerogenes than E. cloacae complex. These results are useful for antimicrobial stewardship programmes and for the implementation of local and national guidelines.

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References

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1. Cassini A, Högberg LD, Plachouras D et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56–66. 10.1016/S1473-3099(18)30605-4 - DOI - PMC - PubMed
1. Tacconelli E, Cataldo MA, Dancer SJ et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1: 1–55. 10.1111/1469-0691.12427 - DOI - PubMed
1. Cantón R, Gottlieb T, Coombs GW et al. Antimicrobial surveillance: a 20-year history of the SMART approach to addressing global antimicrobial resistance into the future. Int J Antimicrob Agents 2023; 62: 107014. 10.1016/j.ijantimicag.2023.107014 - DOI - PubMed
1. Paterson DL, Rossi F, Baquero F et al. 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). J Antimicrob Chemother 2005; 55: 965–73. 10.1093/jac/dki117 - DOI - PubMed

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[1] Antimicrobial Resistance Collaborators . Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399: 629–55. 10.1016/S0140-6736(21)02724-0 - DOI - PMC - PubMed

[2] Antimicrobial Resistance Collaborators . Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399: 629–55. 10.1016/S0140-6736(21)02724-0 - DOI - PMC - PubMed

[3] Cassini A, Högberg LD, Plachouras D et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56–66. 10.1016/S1473-3099(18)30605-4 - DOI - PMC - PubMed

[4] Cassini A, Högberg LD, Plachouras D et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European economic area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19: 56–66. 10.1016/S1473-3099(18)30605-4 - DOI - PMC - PubMed

[5] Tacconelli E, Cataldo MA, Dancer SJ et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1: 1–55. 10.1111/1469-0691.12427 - DOI - PubMed

[6] Tacconelli E, Cataldo MA, Dancer SJ et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1: 1–55. 10.1111/1469-0691.12427 - DOI - PubMed

[7] Cantón R, Gottlieb T, Coombs GW et al. Antimicrobial surveillance: a 20-year history of the SMART approach to addressing global antimicrobial resistance into the future. Int J Antimicrob Agents 2023; 62: 107014. 10.1016/j.ijantimicag.2023.107014 - DOI - PubMed

[8] Cantón R, Gottlieb T, Coombs GW et al. Antimicrobial surveillance: a 20-year history of the SMART approach to addressing global antimicrobial resistance into the future. Int J Antimicrob Agents 2023; 62: 107014. 10.1016/j.ijantimicag.2023.107014 - DOI - PubMed

[9] Paterson DL, Rossi F, Baquero F et al. 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). J Antimicrob Chemother 2005; 55: 965–73. 10.1093/jac/dki117 - DOI - PubMed

[10] Paterson DL, Rossi F, Baquero F et al. 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). J Antimicrob Chemother 2005; 55: 965–73. 10.1093/jac/dki117 - DOI - PubMed

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Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016-2022)

Affiliations

Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016-2022)

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