{"title":"腹腔和尿路感染中头孢曲松耐药肠杆菌的纵向分子流行病学：台湾地区长达10年的SMART监测研究（2009-2019）。","authors":"Yu-Hsun Li, Po-Liang Lu, Shang-Yi Lin, Po-Ren Hsueh, Wen-Chien Ko, Chun-Eng Liu, Hung-Jen Tang, Fu-Der Wang, Yao-Shen Chen, Shih-Ming Tsao, Mao-Wang Ho, Ya-Ting Chang","doi":"10.1016/j.jmii.2025.08.020","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Third-generation cephalosporin-resistant Enterobacterales is a recognized global concern. This study investigated the molecular epidemiology of β-lactamase genes and antimicrobial susceptibility patterns among ceftriaxone-resistant Enterobacterales causing intra-abdominal and urinary tract infections in Taiwan between 2009 and 2019.</p><p><strong>Methods: </strong>Data from the SMART surveillance program were analyzed, including Enterobacterales isolates with ceftriaxone minimum inhibitory concentrations ≥4 μg/mL. β-lactamase genes were detected using multiplex polymerase chain reaction assays.</p><p><strong>Results: </strong>The overall ceftriaxone-resistant rate among Enterobacterales was 28.2 %, with a significant annual increase in ceftriaxone-resistant Klebsiella pneumoniae in both community- and hospital-acquired infections. Among the 2614 ceftriaxone-resistant isolates, the most common species were Escherichia coli (58.4 %), K. pneumoniae (16.3 %), and Enterobacter cloacae (9.9 %). Of all ceftriaxone-resistant isolates, 27.8 % carried only AmpC genes, 38.8 % carried only ESBL genes, and 16.2 % harbored both. High carriage rates of AmpC-encoding genes were observed in E. coli (38.9 %) and K. pneumoniae (48.9 %), with an overall prevalence of 44 %. The most common genotypes were bla<sub>CMY</sub> (41.2 %), bla<sub>DHA</sub> (31.8 %), and bla<sub>ACT</sub>/bla<sub>MIR</sub> (27 %). Ceftolozane/tazobactam showed poor susceptibility against ceftriaxone-resistant isolates carrying only AmpC (20.1 %) and most ceftriaxone-resistant Enterobacterales (<55 %), except E. coli. Ertapenem demonstrated low susceptibility to K. pneumoniae, E. cloacae (both approximately 50 %), and isolates harboring only AmpC genes (57.9 %).</p><p><strong>Conclusions: </strong>A high prevalence and diversity of AmpC genes were observed in E. coli and K. pneumoniae. The limited activity of ertapenem and ceftolozane/tazobactam suggests that the molecular mechanisms underlying ceftriaxone-resistant Enterobacterales in Taiwan are complex and likely involve factors beyond AmpC and ESBL carriage.</p>","PeriodicalId":56117,"journal":{"name":"Journal of Microbiology Immunology and Infection","volume":" ","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Longitudinal molecular epidemiology of ceftriaxone-resistant enterobacterales in intra-abdominal and urinary tract infections: A decade-long SMART surveillance study in Taiwan (2009-2019).\",\"authors\":\"Yu-Hsun Li, Po-Liang Lu, Shang-Yi Lin, Po-Ren Hsueh, Wen-Chien Ko, Chun-Eng Liu, Hung-Jen Tang, Fu-Der Wang, Yao-Shen Chen, Shih-Ming Tsao, Mao-Wang Ho, Ya-Ting Chang\",\"doi\":\"10.1016/j.jmii.2025.08.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Third-generation cephalosporin-resistant Enterobacterales is a recognized global concern. This study investigated the molecular epidemiology of β-lactamase genes and antimicrobial susceptibility patterns among ceftriaxone-resistant Enterobacterales causing intra-abdominal and urinary tract infections in Taiwan between 2009 and 2019.</p><p><strong>Methods: </strong>Data from the SMART surveillance program were analyzed, including Enterobacterales isolates with ceftriaxone minimum inhibitory concentrations ≥4 μg/mL. β-lactamase genes were detected using multiplex polymerase chain reaction assays.</p><p><strong>Results: </strong>The overall ceftriaxone-resistant rate among Enterobacterales was 28.2 %, with a significant annual increase in ceftriaxone-resistant Klebsiella pneumoniae in both community- and hospital-acquired infections. Among the 2614 ceftriaxone-resistant isolates, the most common species were Escherichia coli (58.4 %), K. pneumoniae (16.3 %), and Enterobacter cloacae (9.9 %). Of all ceftriaxone-resistant isolates, 27.8 % carried only AmpC genes, 38.8 % carried only ESBL genes, and 16.2 % harbored both. High carriage rates of AmpC-encoding genes were observed in E. coli (38.9 %) and K. pneumoniae (48.9 %), with an overall prevalence of 44 %. The most common genotypes were bla<sub>CMY</sub> (41.2 %), bla<sub>DHA</sub> (31.8 %), and bla<sub>ACT</sub>/bla<sub>MIR</sub> (27 %). Ceftolozane/tazobactam showed poor susceptibility against ceftriaxone-resistant isolates carrying only AmpC (20.1 %) and most ceftriaxone-resistant Enterobacterales (<55 %), except E. coli. Ertapenem demonstrated low susceptibility to K. pneumoniae, E. cloacae (both approximately 50 %), and isolates harboring only AmpC genes (57.9 %).</p><p><strong>Conclusions: </strong>A high prevalence and diversity of AmpC genes were observed in E. coli and K. pneumoniae. The limited activity of ertapenem and ceftolozane/tazobactam suggests that the molecular mechanisms underlying ceftriaxone-resistant Enterobacterales in Taiwan are complex and likely involve factors beyond AmpC and ESBL carriage.</p>\",\"PeriodicalId\":56117,\"journal\":{\"name\":\"Journal of Microbiology Immunology and Infection\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-08-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Microbiology Immunology and Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jmii.2025.08.020\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Microbiology Immunology and Infection","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jmii.2025.08.020","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Longitudinal molecular epidemiology of ceftriaxone-resistant enterobacterales in intra-abdominal and urinary tract infections: A decade-long SMART surveillance study in Taiwan (2009-2019).
Background: Third-generation cephalosporin-resistant Enterobacterales is a recognized global concern. This study investigated the molecular epidemiology of β-lactamase genes and antimicrobial susceptibility patterns among ceftriaxone-resistant Enterobacterales causing intra-abdominal and urinary tract infections in Taiwan between 2009 and 2019.
Methods: Data from the SMART surveillance program were analyzed, including Enterobacterales isolates with ceftriaxone minimum inhibitory concentrations ≥4 μg/mL. β-lactamase genes were detected using multiplex polymerase chain reaction assays.
Results: The overall ceftriaxone-resistant rate among Enterobacterales was 28.2 %, with a significant annual increase in ceftriaxone-resistant Klebsiella pneumoniae in both community- and hospital-acquired infections. Among the 2614 ceftriaxone-resistant isolates, the most common species were Escherichia coli (58.4 %), K. pneumoniae (16.3 %), and Enterobacter cloacae (9.9 %). Of all ceftriaxone-resistant isolates, 27.8 % carried only AmpC genes, 38.8 % carried only ESBL genes, and 16.2 % harbored both. High carriage rates of AmpC-encoding genes were observed in E. coli (38.9 %) and K. pneumoniae (48.9 %), with an overall prevalence of 44 %. The most common genotypes were blaCMY (41.2 %), blaDHA (31.8 %), and blaACT/blaMIR (27 %). Ceftolozane/tazobactam showed poor susceptibility against ceftriaxone-resistant isolates carrying only AmpC (20.1 %) and most ceftriaxone-resistant Enterobacterales (<55 %), except E. coli. Ertapenem demonstrated low susceptibility to K. pneumoniae, E. cloacae (both approximately 50 %), and isolates harboring only AmpC genes (57.9 %).
Conclusions: A high prevalence and diversity of AmpC genes were observed in E. coli and K. pneumoniae. The limited activity of ertapenem and ceftolozane/tazobactam suggests that the molecular mechanisms underlying ceftriaxone-resistant Enterobacterales in Taiwan are complex and likely involve factors beyond AmpC and ESBL carriage.
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