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Therapeutic Alternatives for Drug-Resistant Cabapenemase- Producing Enterobacteria

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Therapeutic Alternatives for Drug-Resistant Cabapenemase- Producing Enterobacteria THERAPEUTIC ALTERNATIVES FOR MULTIDRUG-RESISTANT AND EXTREMELY All isolates resistant to carbapenems were evaluated Fig. 1: Susceptibility (%) of Carbapenemase-producing MDRE Fig. 3: Susceptibility (%) of VIM-producing MDRE to Alternative DRUG-RESISTANT CABAPENEMASE- for the presence of genes encoding carbapenemases to Alternative Antibiotics Antibiotics PRODUCING ENTEROBACTERIA OXA-48-like, KPC, GES, NDM, VIM, IMP and GIM. M. Almagro*, A. Kramer, B. Gross, S. Suerbaum, S. Schubert. Max Von Pettenkofer Institut, Faculty of Medicine. LMU Munich, München, Germany. RESULTS BACKROUND 44 isolates of CPE were collected: OXA-48 (n=29), VIM (n=9), NDM-1 (n=5), KPC (n=1) and GES (n=1). The increasing emergence and dissemination of carbapenem-resistant gram-negative bacilli has From the 44 CPE isolates, 26 isolates were identified reduced significantly the options for sufficient as Klebsiella pneumoniae (68% of the OXA-48 CPE), 8 Fig. 2: Susceptibility (%) of OXA-48-producing MDRE to Fig. 4: Susceptibility (%) of NDM-producing MDRE to Alternative antibiotic therapy. The genes encoding most of these as Escherichia coli, 6 as Enterobacter cloacae, 2 as Alternative Antibiotics Antibiotics carbapenemases reside on plasmids or transposons Citrobacter freundii,1 as Providencia stuartii and 1 as carrying additional resistance genes which confer Morganella morganii. multidrug resistance to the isolates. 31 isolates (70%) were causing an infection, including urinary tract infection (20%), respiratory tract MATERIALS AND METHODS infection (18%), abdominal infection (18%), bacteraemia (9%) and skin and soft tissue infection In the present study, we tested the in vitro activity of (5%). 13 isolates were believed to be colonizers. antimicrobial agents against a well-characterized c o l l e c t i o n o f c a r b a p e n e m a s e - p r o d u c i n g Isolates were classified as 32 MDRE and 13 XDRE. Enterobacteriaceae (CPE) collected from clinical The majority of the XDRE were OXA-48 encoding In vitro activity of MDRE and XDRE CRE to the antibiotics tested: Meropenem (MERO), Imipenem (IMI), Ertapenem (ERTA), Fosfomycin (FOSFO), Colistin (COL), Ceftazidime-Avibactam (CAZ- samples of a tertiary care hospital in Germany during AVI), Tygecicline (TYGE), Gentamycin (GENTA), Tobramycin (TOBRA), Amikacin (AMIKA), Ceftolozane-Tazobactam (CTT), Chloramphenicol (CHLOR) and Aztreonam (AZTRE) isolates (n=9). However, the NDM-1 encoding CPE 2016-2017. Multidrug resistant enterobacteria isolates showed higher resistance to a major number (MDRE) and extremely drug resistant enterobacteria of antimicrobials. Overall, the isolates showed high (XDRE) were defined following the ESCMID criteria. rates of resistance to many antimicrobial agents Ceftazidime-avibactam showed an outstanding CONCLUSIONS tested. The rank order of in vitro activity was as activity only against OXA-48 positive isolates (93%). The in vitro activity of the antimicrobial agents follows: colistin (89% susceptible), amikacin (82%), In this group colistin did also show a good activity. The remaining therapeutic options for CRE tested was determined using broth microdilution and fosfomycin (80%), ceftazidime-avibactam (70%), Overall fosfomycin was a good alternative drug. It infections are scarce, but still available. Overall E-Test methods. Susceptibility testing was chloramphenicol (58%), tigecycline (55%), was very active (MIC90, <16 μg/ml) against isolates colistin, amikacin, fosfomycin show the best activity. determined for all the antimicrobials needed for the meropenem (50%), gentamycin (41%), ceftolozane- carrying metallobetalactamases (93% susceptible), S u s c e p t i b i l i t y v a r i e s d e p e n d i n g o n t h e MDRE definitions, including ertapenem, imipenem, tazobactam, imipenem, aztreonam, tobramycin (23%) especially VIM-carbapenemases (100%). In this later carbapenemase-type. CRE were causing an infection meropenem, ceftazidime-avibactam, ceftolozane- and ertapenem (5%). group amikacin was also very active (100%). in most of the cases. tazobactam, fosfomycin, colistin, tigecycline, Surprisingly, chloramphenicol (80%) showed good gentamicin, tobramycin, amikacin, chloramphenicol S u s c e p t i b i l i t y p a t t e r n s d e p e n d e d o n t h e activity (MIC90, 12 μg/ml) against NDM-1 encoding and aztreonam. carbapenemase-type. CPE. Max Von Pettenkofer Institut o Faculty of Medicine of Ludwig Maximilian University of Munich (Germany) )o Contact us by E-mail: [email protected].
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