Program Schedule

424
Characterization and Profiling of Multi-Drug Resistant (MDR) Enterobacteriaceae From Latin America

Session: Poster Abstract Session: Surveillance of Antimicrobial Resistance
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background: Enterobacteriaceae species are important pathogens responsible for a wide variety of serious infections.  The tendency of these organisms to develop or acquire resistance to key antimicrobials can lead to MDR strains for which the therapeutic choices are limited.  Therefore, tracking and profiling MDR strains is an important aspect of any surveillance initiative.   In this study data from The Tigecycline Evaluation Surveillance Trial (TEST) program were analyzed to evaluate the profiles and characteristics of MDR populations from Latin America.

 

Methods: Between 2008 and 2013 8,907 isolates of Enterobacteriaceae from Argentina, Brazil, Chile, Colombia, El Salvador, Guatemala, Honduras, Mexico, Panama, and Venezuela were locally  collected, identified, and susceptibility tested (broth microdilution) according to  CLSI guidelines.   The data were centralized at IHMA for analysis of the MDR populations.   MDR was defined as resistance to drugs from three or more different antimicrobial classes.

Results:   Of the 8,907 Enterobacteriaceae isolates 4,077 (45.8%) had a MDR phenotype; of those MDR   77.7% were from inpatients,  21.8% were blood isolates, 18.2%  were from urinary tract specimens, 16.4% were from respiratory tract specimens, 7% were from intra-abdominal infections and 8.7% were from wounds.  By species, 33.3 % of MDR were E. coli, 28.9% were K. pneumoniae, 21% were E. cloacae, and 9.1% were S. marcescens.  The individual antimicrobial profiles for all Enterobacteriaceae and the MDR population were as follow:

                                All Enterobacteriaceae (8907)

MDR (4077)

Drug

%S

MIC50

MIC90

%S

MIC50

MIC90

Amikacin

89.95

2

32

79.22

4

64

Cefepime

77.09

≤ 0.5

> 32

52.86

8

> 32

Ceftazidime

0

≤ 8

> 32

0

16

> 32

Levofloxacin

64.12

0.25

> 8

33.87

8

> 8

Meropenem

95

≤ 0.06

0.5

89.38

≤ 0.06

2

Pip-tazo

74.59

4

> 128

48.71

32

> 128

Tigecyclinea

96.68

0.5

2

93.3

0.5

2

aFDA breakpoints used for tigecycline

Conclusion:   The MDR rate among Enterobacteriaceae is very high in Latin America, especially among inpatient isolates.  The MDR phenotype was also prevalent among isolates from the key infection sites.  Meropenem and tigecycline were the most active drugs against the MDR population.  The critical importance of this phenotype warrants careful and ongoing surveillance.

Martha Renteria, MD1, Dan Sahm, PhD1, Samuel Bouchillon, MD1 and Heidi Leister-Tebbe, BS2, (1)International Health Management Associates, Inc., Schaumburg, IL, (2)Pfizer Inc., Collegeville, PA

Disclosures:

M. Renteria, Pfizer: Independent Contractor, Consulting fee

D. Sahm, Pfizer: Independent Contractor, Consulting fee

S. Bouchillon, Pfizer: Independent Contractor, Consulting fee

H. Leister-Tebbe, Pfizer: Employee, Salary

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