In vitro activity of piperacillin/tazobactam and other broad-spectrum antibiotics against bacteria from hospitalised patients in the British Isles

被引:23
作者
Livermore, DM
Mushtaq, S
James, D
Potz, N
Walker, RA
Charlett, A
Warburton, F
Johnson, AP
Warner, M
Henwood, CJ
机构
[1] Cent Publ Hlth Lab, Antibiot Resistance Monitoring & Reference Lab, London NW9 5HT, England
[2] Wells Healthcare Commun Ltd, Tunbridge Wells YN4 0JB, Kent, England
[3] PHLS Stat Unit, London NW9 5HT, England
关键词
broad-spectrum antibiotics; piperacillin/tazobactam; resistance surveillance;
D O I
10.1016/S0924-8579(03)00108-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Piperacillin/tazobactam is used for empirical therapy of severe and complex infections. We assessed its activity, 9 years after launch, against consecutive, clinically significant isolates from in-patients in UK and Ireland. Standardised disc susceptibility tests were performed on 5031 isolates at 28 hospitals. For quality assurance purposes, 5% of these isolates were collected centrally for MIC tests, as were those with exceptional resistances. Compared with a similar pre-launch survey in 1991, there were major increases in the proportions of Staphylococcus aureus, Pseudomonas aeruginosa, beta-haemolytic streptococci and Enterococcus faecium isolates collected, balanced by decreases in Escherichia coli, Proteus mirabilis and coagulase-negative staphylococci. These changes in species prevalence mostly favoured organisms with inherent resistance(s) or-in the case of S. aureus-reflected the massive increase of MRSA, up from 0.7% of all isolates in 1991 to 14.8% in 2001. Based on the disc tests, piperacillin/tazobactam retained activity against 87% of Enterobacteriaceae isolates, 95% of P. aeruginosa, 99% of streptococci and 96% of Enterococcus faecalis. Resistance nevertheless had increased since 1991 in E. coli from 4 to 10%, Klebsiella spp. (5 to 21%) and in AmpC-inducible Enterobacteriaceae (17 to 23%), though not in P. mirabilis or P. aeruginosa. MIC tests confirmed most of the piperacillin/tazobactam resistance found by disc tests in Enterobacter spp., but indicated susceptibility for about half of the E. coli isolates recorded as resistant in disc tests. This situation might be remedied by reducing the zone breakpoint, but this would increase the 'false susceptible' rate unacceptably. Thus, if disc tests suggest that an isolate is marginally resistant to piperacillin/tazobactam and the drug is sought as therapy, it is recommended that MIC be determined with, e.g., an Etest. (C) 2003 Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved.
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页码:14 / 27
页数:14
相关论文
共 21 条
[1]   BSAC standardized disc susceptibility testing method [J].
Andrews, JM .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2001, 48 :43-57
[2]   EFFECT OF MEDIA COMPOSITION ON THE SUSCEPTIBILITY OF XANTHOMONAS-MALTOPHILIA TO BETA-LACTAM ANTIBIOTICS [J].
BONFIGLIO, G ;
LIVERMORE, DM .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1991, 28 (06) :837-842
[3]   MULTICENTER SURVEY OF THE COMPARATIVE IN-VITRO ACTIVITY OF PIPERACILLIN TAZOBACTAM AGAINST BACTERIA FROM HOSPITALIZED-PATIENTS IN THE BRITISH-ISLES [J].
CHEN, HY ;
BONFIGLIO, G ;
ALLEN, M ;
PIPER, D ;
EDWARDSON, T ;
MCVEY, D ;
LIVERMORE, DM .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1993, 32 (02) :247-266
[4]   DETECTION OF GLYCOPEPTIDE RESISTANCE GENOTYPES AND IDENTIFICATION TO THE SPECIES LEVEL OF CLINICALLY RELEVANT ENTEROCOCCI BY PCR (VOL 33, PG 25, 1995) [J].
DUTKAMALEN, S ;
EVERS, S ;
COURVALIN, P .
JOURNAL OF CLINICAL MICROBIOLOGY, 1995, 33 (05) :1434-1434
[5]   Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase [J].
French, GL ;
Shannon, KP ;
Simmons, N .
JOURNAL OF CLINICAL MICROBIOLOGY, 1996, 34 (02) :358-363
[6]   Bases of variation in resistance to beta-lactams in Klebsiella oxytoca isolates hyperproducing K1 beta-lactamase [J].
Gheorghiu, R ;
Yuan, MF ;
Hall, LMC ;
Livermore, DM .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1997, 40 (04) :533-541
[7]   EFFECT OF DIVALENT-CATIONS IN BACTERIOLOGICAL MEDIA ON THE SUSCEPTIBILITY OF XANTHOMONAS-MALTOPHILIA TO IMIPENEM, WITH SPECIAL REFERENCE TO ZINC IONS [J].
HAWKEY, PM ;
BIRKENHEAD, D ;
KERR, KG ;
NEWTON, KE ;
HYDE, WA .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1993, 31 (01) :47-55
[8]   Susceptibility of Gram-positive cocci from 25 UK hospitals to antimicrobial agents including linezolid [J].
Henwood, CJ ;
Livermore, DM ;
Johnson, AP ;
James, D ;
Warner, M ;
Gardiner, A .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2000, 46 (06) :931-940
[9]   The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting [J].
Ibrahim, EH ;
Sherman, G ;
Ward, S ;
Fraser, VJ ;
Kollef, MH .
CHEST, 2000, 118 (01) :146-155
[10]   Dominance of EMRSA-15 and-16 among MRSA causing nosocomial bacteraemia in the UK:: analysis of isolates from the European Antimicrobial Resistance Surveillance System (EARSS) -: J Antimicrob Chemother 2001;: 48:143-144 [J].
Johnson, AP ;
Aucken, HM ;
Cavendish, S ;
Ganner, M ;
Wale, MCJ ;
Warner, M ;
Livermore, DM ;
Cookson, BD .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2001, 48 (01) :143-144