目的:本研究旨在研究碳青霉烯类非敏感铜绿假单胞菌(CNSPA)和鲍曼不动杆菌(CNSAB)对头孢地洛的体外敏感性。新型β-内酰胺酶抑制剂(BLI)组合,新的四环素类似物,和其他比较抗生素。
方法:总共,在2018年至2020年期间,从台湾16家医院收集了405个非重复菌血症CNSPA(n=150)和CNSAB(n=255)分离株。使用肉汤微量稀释法测定最小抑制浓度(MIC),根据相关指南或根据以前的研究结果和非物种相关的药代动力学/药效学数据解释药敏性.
结果:在测试的分离株中,头孢地洛对CNSPA(MIC50/90,0.25/1mg/L;100%的分离株在≤4mg/L时被抑制)和CNSAB(MIC50/90,0.5/2mg/L;94.9%的分离株在≤4mg/L时被抑制)。超过80%的CNSPA分离株对头孢地洛敏感,头孢他啶/阿维巴坦,头孢洛赞/他唑巴坦,和阿米卡星,基于临床和实验室标准研究所建立的断点。新BLI组合的活性差异显著。四环素类似物,包括替加环素(MIC50/90,1/2mg/L;≤2mg/L时抑制了92.5%的CNSAB分离株)和埃拉环素(MIC50/90,0.5/1mg/L;在≤2mg/L时抑制了99.6%的CNSAB分离株)的体外抗CNSAB活性强于omadacycline(MIC50/90,4/8mg/L)
结论:CNSPA和CNSAB的传播对全球卫生构成了重大挑战。甚至在新试剂变得可商购之前就开发出显著的抗性。开发这些新型药物的现场抗微生物药敏试验具有重要的临床意义。
OBJECTIVE: This study aimed to investigate the in vitro susceptibilities of carbapenem-non-susceptible Pseudomonas aeruginosa (CNSPA) and Acinetobacter baumannii (CNSAB) isolates to cefiderocol, novel β-lactamase inhibitor (BLI) combinations, new tetracycline analogues, and other comparative antibiotics.
METHODS: In total, 405 non-duplicate bacteremic CNSPA (n = 150) and CNSAB (n = 255) isolates were collected from 16 hospitals in Taiwan between 2018 and 2020. Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method, and susceptibilities were interpreted according to the relevant guidelines or in accordance with results of previous studies and non-species-related pharmacokinetic/pharmacodynamic data.
RESULTS: Among the isolates tested, cefiderocol demonstrated potent in vitro activity against CNSPA (MIC50/90, 0.25/1 mg/L; 100% of isolates were inhibited at ≤4 mg/L) and CNSAB (MIC50/90, 0.5/2 mg/L; 94.9% of isolates were inhibited at ≤4 mg/L) isolates. More than 80% of CNSPA isolates were susceptible to cefiderocol, ceftazidime/avibactam, ceftolozane/tazobactam, and amikacin, based on breakpoints established by the Clinical and Laboratory Standards Institute. Activities of new BLI combinations varied significantly. Tetracycline analogues, including tigecycline (MIC50/90, 1/2 mg/L; 92.5% of CNSAB isolates were inhibited at ≤2 mg/L) and eravacycline (MIC50/90, 0.5/1 mg/L; 99.6% of CNSAB isolates were inhibited at ≤2 mg/L) exhibited more potent in vitro activity against CNSAB than omadacycline (MIC50/90, 4/8 mg/L).
CONCLUSIONS: The spread of CNSPA and CNSAB poses a major challenge to global health. Significant resistance be developed even before a novel agent becomes commercially available. The development of on-site antimicrobial susceptibility tests for these novel agents is of great clinical importance.