Antimicrobial Activity Profiles and Potential Antimicrobial Regimens against Carbapenem-Resistant Enterobacterales Isolated from Multi-Centers in Western Thailand

Antibiotics

Worapong Nasomsong¹  Manat Pongchaidecha²  Parnrada Nulsopapon²  Wichai Santimaleeworagun²  Pitimon Polwichai³  Sirilada Suphankong³  Siriwan Chaisomboonpan³  Pantip Sirichote³ 

[1] Department of Internal Medicine, Division of Infectious Diseases, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand;Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon Pathom 73000, Thailand;The Regional Medical Sciences Center 5, Samutsongkhram 75000, Thailand;

关键词: CRE;    Enterobacteriaceae;    mcr-1;    NDM;    OXA-48;   

DOI  :  10.3390/antibiotics11030355

来源: DOAJ

【 摘 要 】

The spread of carbapenem-resistant Enterobacterales (CRE) constitutes a global health burden. Antimicrobial susceptibility and types of carbapenemase differ by geographic region. This study aimed to (1) examine the minimum inhibitory concentrations (MICs) and antibiotic resistance genes and (2) investigate antibiotic dosing regimens against CRE using Monte Carlo simulation. Clinical carbapenem-resistant Klebsiella pneumoniae (CRKP), Escherichia coli (CREC), and Enterobacter cloacae (CREclo) isolates were collected from various hospitals in western Thailand. Broth microdilution was performed, and the types of carbapenemase and mcr-1 genes were detected using polymerase chain reaction (PCR). Monte Carlo simulation was used to establish optimal antimicrobial dosing regimens meeting the criterion of a cumulative fraction of response (CFR) >90%. A total of 150 CRE isolates from 12 hospitals were included. The proportion of CRKP (76%) was greater than that of CREC (22%) and CREclo (2%). Regional hospitals reported higher rates of resistance than general hospitals. Most isolates were resistant to aztreonam and ceftazidime/avibactam, whereas they were highly susceptible to aminoglycosides. Most carbapenemases were NDM (47.33%), OXA-48 (43.33%) and NDM plus OXA-48 (6.67%); five OXA-48 positive isolates carried mcr-1 genes. Currently, high-dose tigecycline is the only optimal regimen against CRE isolates. Further extensive research on antibiotic synergism or new antibiotics should be conducted.

【 授权许可】

Unknown