对新型抗生素的敏感性和产碳青霉烯酶肠杆菌的遗传特征：头孢地罗对产ndm分离菌的低活性。

IF 4.6 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Antimicrobial Agents Pub Date : 2025-06-18 DOI:10.1016/j.ijantimicag.2025.107553

Lisa Faxén , Vilhelm Müller , Margarita Chatzopoulou , Oskar Karlsson Lindsjö , Pernilla Lagerbäck , Karin Westmo , Anna Åkerlund , Thomas Tängdén , Inga Fröding

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引用次数: 0

摘要

背景：产碳青霉烯酶肠杆菌（cpe）构成严重的医学威胁。近年来，一些针对碳青霉烯耐药革兰氏阴性菌的新抗生素被引入，包括头孢多罗、头孢他啶-阿维巴坦、亚胺培南-勒布巴坦和美罗培南-瓦波巴坦。然而，常规没有对药敏水平进行系统监测，这对新抗生素的合理使用和有效性提出了挑战，因为有迅速出现耐药性的风险。目的：评估瑞典针对碳青霉烯耐药革兰氏阴性菌的新型抗生素对cpe的敏感性。方法：纳入2022年通过瑞典国家微生物监测计划收集的所有CPE分离株。除头孢多洛和磷霉素采用EUCAST盘片扩散法外，其余药物均采用微量肉汤稀释法进行药敏试验。进行全基因组测序进行遗传表征。结果：共纳入286例cpe。oxa -48样产菌株对头孢他啶-阿维巴坦的敏感性较高（n=116,≥95%），对KPC/ imi产菌株对头孢他啶-阿维巴坦和美罗培宁-瓦博巴坦的敏感性较高（n=22,≥90%）。产mbl肠杆菌对头孢地罗的敏感性较低，大肠埃希菌为0%(0/76)，肺炎克雷伯菌为6%(3/54)，耐药率分别为93%（71/76）和39%（21/54）。blaNDM-5的存在与最高水平的抗性相关。结论：在瑞典收集的新引入的抗生素对cpe的易感性存在相当大的差异。有必要继续进行监测，以指导合理使用这些新的最后手段抗生素。

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Antibiotic susceptibility to new antibiotics and genetic characterisation of carbapenemase-producing Enterobacterales: Low activity of cefiderocol against NDM-producing isolates

Objectives

Carbapenemase-producing Enterobacterales (CPEs) pose a serious medical threat. In recent years, several new antibiotics targeting carbapenem-resistant Gram-negative bacteria have been introduced, including cefiderocol, ceftazidime-avibactam, imipenem-relebactam and meropenem-vaborbactam. However, no systematic monitoring of susceptibility levels is routinely performed, which challenges rational use and the effectiveness of the new antibiotics due to the risk of rapid emergence of resistance. The objective of this study was to assess the susceptibility of new antibiotics targeting carbapenem-resistant Gram-negative bacteria against CPEs in Sweden.

Methods

All CPE isolates collected through Sweden's national microbial surveillance programme in 2022 were included. Susceptibility testing for the new antibiotics and other agents relevant to CPEs was performed with broth microdilution for all drugs except for cefiderocol and fosfomycin, for which EUCAST disk diffusion was applied. Whole-genome sequencing was performed for genetic characterisation.

Results

In total, 286 CPEs were included in the study. Susceptibility rates were high for ceftazidime-avibactam in OXA-48-like producing isolates (n = 116, >95%) and for ceftazidime-avibactam and meropenem-vaborbactam against KPC/IMI-producing isolates (n = 22, ≥90%). In contrast, susceptibility to cefiderocol was low in MBL-producing Enterobacterales according to disk diffusion: 0% (0/76) of Escherichia coli and 6% (3/54) of Klebsiella pneumoniae were classified susceptible, and 93% (71/76) and 39% (21/54), respectively, were resistant. The presence of bla_NDM-5 was associated with the highest level of resistance.

Conclusions

Considerable variability was observed in the susceptibility rates of the newly introduced antibiotics against CPEs collected in Sweden. Continued surveillance is warranted to guide rational use of these new last-resort antibiotics.

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来源期刊

International Journal of Antimicrobial Agents 医学-传染病学

CiteScore

21.60

自引率

0.90%

发文量

176

审稿时长

36 days

期刊介绍： The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.