Epidemiology and susceptibility of Gram-negative appendicitis pathogens: SMART 2008-2010.

Abstract

BACKGROUND:

The Study for Monitoring Antimicrobial Resistance Trends (SMART) has tracked the in vitro activity of ertapenem and comparators against aerobic gram-negative bacteria from intra-abdominal infections since 2002. This report describes the epidemiology and susceptibility for clinical isolates associated with appendicitis, collected from 2008 to 2010.

METHODS:

A total of 1,720 gram-negative bacilli were collected from patients with appendicitis in 122 hospitals in 39 countries worldwide; of these, 23% of isolates were from pediatric patients (≤ 17 years old). Minimum inhibitory concentrations (MICs) and extended-spectrum β-lactamase (ESBL) phenotypes were determined by broth microdilution and interpreted using Clinical and Laboratory Standards Institute guidelines.

RESULTS:

The global ESBL-positive rate was 16.3%, ranging from 2.2% for Proteus mirabilis to 16.6% for Escherichia coli and 20.1% for Klebsiella pneumoniae. The ESBL-positive rates differed by age group (17.7% in adults vs. 11.4% in children) and by geographic region, with significantly higher rates in Asia/Pacific (28.0%) and significantly lower rates in North America (9.1%), Africa/Middle East (4.8%), and Europe (4.4%). Amikacin, imipenem-cilastatin, piperacillin-tazobactam, and ertapenem were the most active of the tested agents against aerobic gram-negative appendicitis pathogens across pediatric and adult age groups and across geographic regions, including ESBL-positive isolates. Cefepime and ceftazidime were active against ≥ 90% of global pediatric isolates. E. coli, by far the most frequently isolated species (68% in adults and 75% in pediatric patients), was significantly less susceptible in adults than in pediatric patients (p<0.05; Fisher exact test) to all tested agents except amikacin, ertapenem, imipenem-cilastatin, piperacillin-tazobactam, and ampicillin-sulbactam (with the latter showing low activity in both age groups).

CONCLUSIONS:

These in vitro data suggest that amikacin, imipenem-cilastatin, piperacillin-tazobactam, and ertapenem would perform well against aerobic gram-negative bacilli associated with appendicitis in both adults and children, especially in regions with high rates of ESBL-positive E. coli.

• Authors: Sibylle H Lob, Robert E Badal, Samuel K Bouchillon, Stephen P Hawser, Meredith A Hackel, Daryl J Hoban
• Journal: Surgical infections (Surg Infect (Larchmt)) Vol. 14 Issue 2 Pg. 203-8 (Apr 2013) ISSN: 1557-8674 [Electronic] United States
• PMID: 23540793 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Anti-Bacterial Agents (pharmacology)
• Appendicitis (epidemiology, microbiology)
• Child
• Cohort Studies
• Drug Resistance, Bacterial
• Epidemiological Monitoring
• Global Health
• Gram-Negative Bacteria (drug effects, isolation & purification)
• Gram-Negative Bacterial Infections (epidemiology, microbiology)
• Humans
• Microbial Sensitivity Tests
• Public Health Surveillance (methods)