2016-2020 年拉丁美洲、非洲-中东和亚洲儿科患者革兰氏阴性分离株的抗菌药物敏感性与 2011-2015 年相比：来自 ATLAS 监测研究的结果。
Antimicrobial Susceptibility Among Gram-Negative Isolates in Pediatric Patients in Latin America, Africa-Middle East, and Asia From 2016-2020 Compared to 2011-2015: Results From the ATLAS Surveillance Study.
机构信息
Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Pfizer Ltd., Mumbai, India.
出版信息
J Pediatric Infect Dis Soc. 2023 Aug 31;12(8):459-470. doi: 10.1093/jpids/piad055.
BACKGROUND
Antimicrobial resistance (AMR) data in the pediatric population are limited, particularly in developing countries. This study assessed the AMR profile and key resistance phenotypes and genotypes for Gram-negative bacteria (GNB) isolates collected as part of the Antimicrobial Testing Leadership and Surveillance program from pediatric patients in Latin America, Africa-Middle East, and Asia in 2016-2020 versus 2011-2015.
METHODS
Minimum inhibitory concentrations by broth microdilution methodology were interpreted per the Clinical and Laboratory Standards Institute. European Committee on Antimicrobial Susceptibility Testing breakpoints were used for interpreting colistin activity. β-lactamase genes were screened by polymerase chain reaction and sequencing.
RESULTS
For Acinetobacter baumannii, low susceptibility (<60.0%) was observed for all antimicrobials, except colistin (≥92.9%), across regions and year periods. Ceftazidime-avibactam, amikacin, colistin, and meropenem were mostly active (78.6%-100.0%) against Enterobacter cloacae, Escherichia coli, and Klebsiella pneumoniae. For Pseudomonas aeruginosa, susceptibility to ceftazidime-avibactam, amikacin, and colistin was ≥85.9%. Among resistance phenotypes, carbapenem-resistant (CR, ≥44.8%) and difficult-to-treat resistant (DTR, ≥37.1%) rates were the highest in A. baumannii. A consistent increase in CR and DTR K. pneumoniae was noted across regions over time. Extended-spectrum β-lactamases (ESBL)-producing K. pneumoniae (32.6%-55.6%) were more frequent than ESBL-producing E. coli (25.3%-37.1%). CTX-M was the dominant ESBL among Enterobacterales. NDM-positive Enterobacterales species and VIM-positive P. aeruginosa were identified across regions.
CONCLUSIONS
This study identified high susceptibility to few agents for key GNB in pediatric patients. Continued surveillance of resistance phenotypes and genotypes at regional levels may help to guide appropriate treatment decisions.
背景
儿科人群中的抗菌药物耐药（AMR）数据有限，特别是在发展中国家。本研究评估了 2016-2020 年与 2011-2015 年期间，拉丁美洲、非洲-中东和亚洲的儿科患者中收集的革兰氏阴性菌（GNB）分离株的 AMR 谱以及关键耐药表型和基因型。
方法
采用肉汤微量稀释法测定最低抑菌浓度，按临床和实验室标准协会（CLSI）进行解释。使用欧洲抗菌药物敏感性试验委员会（EUCAST）折点解释多粘菌素的活性。通过聚合酶链反应（PCR）和测序筛选β-内酰胺酶基因。
结果
在所有地区和年份，鲍曼不动杆菌对除多粘菌素（≥92.9%）以外的所有抗菌药物的低敏感性（<60.0%）。头孢他啶-阿维巴坦、阿米卡星、多粘菌素和美罗培南对阴沟肠杆菌、大肠埃希菌和肺炎克雷伯菌的活性最高（78.6%-100.0%）。对于铜绿假单胞菌，头孢他啶-阿维巴坦、阿米卡星和多粘菌素的敏感性≥85.9%。在耐药表型中，碳青霉烯耐药（CR，≥44.8%）和治疗困难耐药（DTR，≥37.1%）率在鲍曼不动杆菌中最高。随着时间的推移，不同地区的肺炎克雷伯菌 CR 和 DTR 率呈持续上升趋势。产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌（32.6%-55.6%）比产 ESBL 的大肠埃希菌（25.3%-37.1%）更为常见。CTX-M 是肠杆菌科中主要的 ESBL。在不同地区发现了耐碳青霉烯肠杆菌科和耐碳青霉烯铜绿假单胞菌。
结论
本研究发现儿科患者的关键 GNB 对少数药物具有较高的敏感性。在区域层面上持续监测耐药表型和基因型可能有助于指导合理的治疗决策。
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