In vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli from patients with intra-abdominal infections worldwide from 2005–2007: results from the SMART study

doi:10.1016/j.ijantimicag.2009.07.013

International Journal of Antimicrobial Agents

Volume 34, Issue 6, December 2009, Pages 585-588

https://doi.org/10.1016/j.ijantimicag.2009.07.013 Get rights and content

Abstract

SMART (Study for Monitoring Antimicrobial Resistance Trends) is an ongoing multiyear surveillance study to monitor worldwide antimicrobial resistance trends among aerobic and facultative anaerobic Gram-negative bacilli (GNB) isolated from intra-abdominal infections. During 2005–2007, a total of 255 laboratories from 37 countries in five global regions collected intra-abdominal GNB for antimicrobial susceptibility testing using broth microdilution according to Clinical and Laboratory Standards Institute guidelines. A total of 19 703 GNB were isolated from intra-abdominal infections, comprising 5476, 6633 and 7594 GNB were isolated in the years 2005, 2006 and 2007 from 75, 84 and 96 medical centres, respectively. The most frequently isolated organisms were Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae, of which 18.0% of E. coli and 26.2% of K. pneumoniae were positive for extended-spectrum β-lactamase (ESBL). Overall, resistance among GNB increased during 2005–2007 and resistance rates in 2007 were generally higher than data from previous years. Ertapenem and imipenem were the only agents that maintained consistent activity against GNB, including most ESBL-producing isolates.

Introduction

The Study for Monitoring Antimicrobial Resistance Trends (SMART) monitors the activity of ertapenem, imipenem, amikacin, cefepime, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, ciprofloxacin, levofloxacin, ampicillin/sulbactam and piperacillin/tazobactam against Gram-negative bacteria from intra-abdominal infections (IAIs). This programme was initiated in 2002 and has grown from 40 participating hospitals in the first year to nearly 120 in 2008. The primary goal of the study is to ensure that current susceptibility patterns of these organisms are well understood and widely disseminated, ultimately leading to the most effective choice of therapy for IAIs whilst helping prevent further spread of resistance through inappropriate use of antimicrobials.

Data from SMART in 2003–2004 [1], [2] and from 2005 [3] have been published previously. In both of the earlier reports, Enterobacteriaceae were the most commonly isolated organisms, of which Escherichia coli was the most prevalent. Antimicrobial resistance was observed worldwide in both studies. The current report summarises results from SMART for the 3-year period 2005–2007.

Section snippets

Methods

During 2005–2007, 255 medical sites from 37 countries in five global regions collected intra-abdominal Gram-negative bacilli (GNB). The number of centres from Asia/Pacific, Europe, North America, Middle East/Africa and Latin America were 79 (31.0%), 99 (38.8%), 26 (10.2%), 17 (6.7%) and 34 (13.3%), respectively. A complete breakdown of centres by region and country is shown in Table 1.

Collection of organisms from IAIs was performed as previously reported [1]. Antimicrobial susceptibility

Results and discussion

A total of 19 703 GNB were isolated from IAIs from the 255 participating centres in 37 countries worldwide during 2005–2007. Of these, 1398, 6426, 7844, 2513 and 1522 isolates originated from the Middle East/Africa, Asia/Pacific, Europe, Latin America and North America, respectively.

The 10 most commonly isolated organisms are given in Table 2. Escherichia coli was the most frequently isolated organism (n = 9486), of which 1704 (18.0%) were ESBL-positive. The highest rate of ESBL-positive E. coli

Acknowledgments

The authors thank all of the investigators and centres involved in the study. They thank Dr Joseph Chow of Merck & Co. for his excellent scientific and editorial support.

Funding: This study was funded by Merck & Company. The authors are all employed by International Health Management Associates, Inc. and affiliates (IHMA). IHMA is under contract with, and compensated by, Merck & Co. to manage the Study for Monitoring Antimicrobial Resistance Trends (SMART).

Competing interests: SKB, DJH and REB

References (11)

K. Bush
Extended-spectrum β-lactamases in North America, 1987–2006
Clin Microbiol Infect
(2008)
M.H. Nicolas-Chanoine et al.
Extended-spectrum β-lactamases in long-term-care facilities
Clin Microbiol Infect
(2008)
J.D. Pitout et al.
Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern
Lancet Infect Dis
(2008)
D.L. Paterson et al.
In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART)
J Antimicrob Chemother
(2005)
F. Rossi et al.
In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends)
J Antimicrob Chemother
(2006)

There are more references available in the full text version of this article.

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Short communicationIn vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli from patients with intra-abdominal infections worldwide from 2005–2007: results from the SMART study

Abstract

Introduction

Section snippets

Methods

Results and discussion

Acknowledgments

Clin Microbiol Infect

Clin Microbiol Infect

Lancet Infect Dis

In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART)

J Antimicrob Chemother

In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends)

J Antimicrob Chemother

Short communication
In vitro susceptibilities of aerobic and facultative anaerobic Gram-negative bacilli from patients with intra-abdominal infections worldwide from 2005–2007: results from the SMART study