1596. Epidemiology and Susceptibility of Pathogens from Hospital- and Community-Associated Urinary Tract Infection in Latin America: SMART 2010-2012
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: The Study for Monitoring Antimicrobial Resistance Trends (SMART) has monitored gram-negative pathogens (GNP) from urinary tract infections (UTI) since late 2009. To help with empiric therapy decisions in Latin America (LA), this report summarizes occurrence and susceptibility of pathogens (including extended-spectrum β-lactamase [ESBL] producers) in hospital- (HA) and community-associated (CA) UTI in 2010-2012 in this region.

Methods: Labs in 11 countries collected up to 50 consecutively isolated GNP per year from hospitalized patients with UTI. Susceptibility and ESBL phenotypes were determined by microdilution per CLSI guidelines for 3,581 GNP. A UTI was defined as HA or CA if cultured ≥48 hours or <48 hours post admission, respectively.

Results:

The top 10 species (comprising 97% of all isolated species) are shown below with ESBL and susceptibility rates for selected drugs. Values ≥90% are bolded.

 

n

% ESBL

% Susceptible

 

 

Amikacin

Cefotaxime

Ceftazidime

Cipro

Ertapenem

Pip-Tazo

Row Labels

HA

CA

HA

CA

HA

CA

HA

CA

HA

CA

HA

CA

HA

CA

HA

CA

E. coli

978

1244

32

22

96

98

65

76

72

80

47

57

99

100

88

92

K. pneumoniae

291

245

48

35

86

89

43

61

46

64

46

59

87

93

58

73

P. aeruginosa

129

87

66

53

NB

NB

62

60

52

36

NB

NB

59

61

P. mirabilis

98

95

14

8

96

97

81

86

96

92

77

81

100

1001

94

97

E. cloacae

61

31

87

90

38

45

46

45

62

45

79

87

66

65

A. baumannii

32

19

25

21

9

5

16

26

13

16

NB

NB

13

16

M. morganii

25

17

96

100

72

71

92

76

56

65

100

100

100

100

E. aerogenes

21

17

90

100

57

59

67

65

81

94

95

100

76

82

C. freundii

21

16

100

94

52

69

71

75

52

63

95

94

76

94

S. marcescens

21

13

86

100

62

85

71

92

81

85

90

100

71

100

Top 10 species2

1677

1784

 

 

90

93

55

69

66

76

50

57

87

93

78

87

1 Rounded up (99.6%).

2Susceptibility was calculated for 10 top species combined; 0% susceptibility assumed for species with no breakpoints for any given drug.

NB=No breakpoint.

Conclusion:

  • ESBL rates were higher in HA than CA infections in Latin America, but even CA rates were high compared to global rates reported previously.
  • Susceptibility was almost always lower in HA UTI GNP.
  • Due to high ESBL rates in the two most frequently isolated UTI GNP, options for empiric UTI therapy are limited, especially in HA infections. Of the drugs studied, only amikacin was active against ≥90% of both HA and CA pathogens, and ertapenem (and imipenem; data not shown) against ≥90% of CA pathogens.
Sibylle Lob, MD, MPH1, Robert Badal, B.S.1, Daryl Hoban, PhD1, Samuel Bouchillon, MD1, Meredith Hackel, PhD, MPH1, Douglas Biedenbach, BS1, Stephen Hawser, PhD2 and Ian Morrissey, PhD2, (1)International Health Management Associates, Inc., Schaumburg, IL, (2)IHMA Europe SÓrl, Epalinges, Switzerland

Disclosures:

S. Lob, Merck & Co., Inc.: Research Contractor,

R. Badal, Merck & Co., Inc.: Research Contractor,

D. Hoban, Merck & Co., Inc.: Research Contractor and Speaker's Bureau, Grant recipient and Salary from IHMA, which receives grant from Merck

S. Bouchillon, Merck & Co., Inc.: Research Contractor, Salary from IHMA, which receives grant from Merck

M. Hackel, Merck & Co., Inc.: Research Contractor,

D. Biedenbach, Merck & Co., Inc.: Research Contractor,

S. Hawser, Merck & Co., Inc.: Research Contractor,

I. Morrissey, Merck & Co., Inc.: Research Contractor,

Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.