Skip to main content Accessibility help
×
×
Home

Resistance in Enterobacteriaceae: Results of a Multicenter Surveillance Study, 1995-2000

  • Ian Friedland (a1), Lue Stinson (a1), Margaretmary Ikaiddi (a1), Sandra Harm (a1) and Gail L. Woods (a1)...

Abstract

Objectives:

To assess changes over time in susceptibility of Enterobacteriaceae from patients in ICUs, compare susceptibility rates of isolates from patients in ICUs with those from inpatients outside ICUs, and explore phenotypic patterns of cross-resistance and co-resistance.

Design:

From 1995 to 2000, centers participating in the ICU Surveillance Study tested 100 to 200 consecutive nosocomial gram-negative bacilli by broth microdilution.

Setting:

Each year, 42 to 97 U.S. hospitals tested isolates.

Results:

In all years, imipenem was the most potent agent tested, followed by amikacin and ertapenem. Extended-spectrum beta-lactam and monobactam agents had good activity against Escherichia coli and Klebsiella species, but limited activity against Enterobacter species. Susceptibility to imipenem and amikacin did not fluctuate during the analysis period, whereas susceptibility to ceftazidime, ceftriaxone, and ciprofloxacin decreased 2% to 5%. The decline was most pronounced for susceptibility of Escherichia coli to ciprofloxacin: 98.7% of ICU isolates were susceptible in 1995 versus 93.2% in 2000. Susceptibility of ICU isolates was lower than that of non-ICU isolates, except for ciprofloxacin, for which the reverse was true. Cross-resistance was common among extended-spectrum cephalosporins and penicillins, but uncommon between imipenem and ertapenem. Only imipenem and ertapenem remained highly active against Enterobacteriaceae with a phenotype suggesting possible production of an extended-spectrum beta-lactamase and those with a phenotype suggesting possible Amp C hyperproduction.

Conclusions:

Imipenem was the most active agent against nosocomial Enterobacteriaceae. Susceptibility to ciprofloxacin decreased from 1995 to 2000, particularly in Escherichia coli, and, in contrast to other agents, was lower among non-ICU isolates.

Copyright

Corresponding author

Merck & Co., Inc., 10 Sentry Parkway, BL3-4, Blue Bell, PA 19422

References

Hide All
1.Ibrahim, EH, Sherman, G, Ward, S, et al.The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146155.
2.Kollef, MH, Sherman, G, Ward, S, et al.Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462474.
3.Paterson, DL, Mulazimoglu, L, Casellas, JM, et al.Epidemiology of ciprofloxacin resistance and its relationship to extended-spectrum β-lactamase production in Klebsiella pneumoniae isolates causing bacteremia. Clin Infect Dis 2000;30:473478.
4.Kim, Y-K, Pai, H, Lee, H-J, et al.Bloodstream infections by extended-spectrum ß-lactamase producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:14811491.
5.Kaye, KS, Cosgrove, S, Harris, A, et al.Risk factors for emergence of resistance to broad-spectrum cephalosporins among Enterobacter spp. Antimicrob Agents Chemother 2001;45:26282630.
6.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 5th ed. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Document M7-A5.
7.National Committee for Clinical Laboratory Standards. Performance Standard for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002. Document M100-S12.
8.Diekema, DJ, Pfaller, MA, Jones, RN, et al.Survey of bloodstream infections due to gram-negative bacilli: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, and Latin America for the SENTRY Antimicrobial Surveillance Program, 1997. Clin Infect Dis 1999;29:595607.
9.Pfaller, MA, Jones, RN, Biedenbach, DJ, et al.Antimicrobial resistance trends in medical centers using carbapenems: report of 1999 and 2000 results from the MYSTIC Program (USA). Diagn Microbiol Infect Dis 2001;41:177182.
10.Karlowsky, JA, Kelly, LJ, Thornsberry, C, et al.Susceptibility to fluoroquinolones among commonly isolated gram-negative bacilli in 2000: TRUST and TSN data for the United States. Int J Antimicrob Agents 2002;19:2131.
11.Garcia-Rodriguez, J-A, Jones, RN, MYSTIC Programme Study Group. Antimicrobial resistance in gram-negative isolates from European intensive care units: data from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme. J Chemother 2002;14:2532.
12.Ahmad, M, Urban, C, Mariano, N, et al.Clinical characteristics and molecular epidemiology associated with imipenem-resistant Klebsiella pneumoniae. Clin Infect Dis 1999;29:352355.
13.Itokazu, GS, Quinn, JP, Bell-Dixon, C, et al.Antimicrobial resistance rates among aerobic gram-negative bacilli recovered from patients in intensive care units: evaluation of a national postmarketing surveillance program. Clin Infect Dis 1996;23:779784.
14.Fridkin, SK, Hill, HA, Volkova, NV, et al.Temporal changes in prevalence of antimicrobial resistance in 23 U.S. hospitals. Emerg Infect Dis 2002;8:697701.
15.Goettsch, W, van Pelt, W, Nagelkerke, N, et al.Increasing resistance to fluoroquinolones in Escherichia coli from urinary tract infections in the Netherlands. J Antimicrob Chemother 2000;46:223228.
16.Livermore, DM, James, D, Reacher, M, et al.Trends in fluoroquinolone (ciprofloxacin) resistance in Enterobacteriaceae from bacteremias, England and Wales, 1990-1999. Emerg Infect Dis 2002;8:473478.
17.Pfaller, MA, Jones, RN, MYSTIC Study Group (Europe). Antimicrobial susceptibility of inducible AmpC ß-lactamase-producing Enterobacteriaceae from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Programme, Europe 1997-2000. Int J Antimicrob Agents 2002;19:383388.
18.Fridkin, SK, Steward, CD, Edwards, JR, et al.Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: Project ICARE phase 2. Clin Infect Dis 1999;29:245252.
19.Chow, JW, Fine, MJ, Shlaes, DM, et al.Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115:585590.
20.Cosgrove, SE, Kaye, KS, Eliopoulous, GM, Carmeli, Y. Health and economic outcomes of the emergence of third-generation cephalosporin resistance in Enterobacter species. Arch Intern Med 2002;162:185190.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed