- Email: [email protected]
P61 The relationship between the use of meropenem, a carbapenem antimicrobial agent, and the Pseudomonas aeruginosa resistance for meropenem
S60
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
of human enterococcal infection. Considering the association and correlation observed in this study between these two genes and between asa and ampicillin resistance, we suggest these genes may play an important but underestimated role in the pathogenesis of beach enterococci isolates. P59 Drug-susceptibilities of Neisseria gonorrhoeae strains isolated from male patients with gonococcal urethritis against antimicrobial agents K. Endo1 *, S. Onodera2 , H. Kiyota3 , H. Suzuki4 , T. Hosobe5 . 1 Urology, JR Tokyo General Hospital, Shibuya-Ku, 2 Urology, Fuji City Fuji Central Hospital, Fuji, 3 Urology, The Jikei University Katsushika Medical Center, Tokyo, 4 Urology, Shonan Hospital, Yokosuka, 5 Urology, Hosobe Clinic, Tokyo, Japan E-mail address : [email protected] Introduction: We investigated the drug susceptibilities (to penicillin G (PCG), clavulanic acid/amoxicillin (CVA/AMPC), cefixime (CFIX), cefteram (CFTM), ceftriaxone (CTRX), cefodizime (CDZM), aztreonam (AZT), spectinomycin (SPCM), tetracycline (TC), azithromycin (AZM) and levofloxacin (LVFX)) of 217 Neisseria gonorrhoeae strains (2006: 47 strains; 2007: 23 strains; 2008: 18 strains; 2009: 38 strains; 2010: 36 strains; 2011: 27 strains; 2012: 28 strains), which were isolated from male urethritis patients at The Jikei University School of Medicine and related hospital of the Metropolitan Area between 2005 and 2012. b-lactamase production by the strains was also examined. The antimicrobial activities of PCG, CVA/AMPC, CFTM, AZT, TC, and LVFX were consistently low during these 7 years. On the other hand, while the MIC50 and MIC90 of CFIX were 0.008 mg/ml and 0.03 mg/ml, respectively in 1999, the values [MIC50 and MIC90 ] increased to 0.06 mg/ml and 0.25 mg/ml, respectively in 2012, indicating the acquisition of CFIX-resistance. The MIC50 values of CTRX and CDZM were close to the MIC90 valuse, suggesting the potential emergence of CTRX/CDZM-resistant strains of N. gonorrhoeae in the near future. P60 Antimicrobial co-resistance among Enterobacteriaceae resistant or susceptible to third-generation cephalosporins T. Fujita1 *, S. Asahata1 , Y. Ainoda1 , Y. Hirai1 , A. Goto2 , K. Totsuka1 . 1 Department of infectious diseases, Tokyo Women’s Medical University, 2 Laboratory of microbiology, Tokyo Women’s Medical University, Tokyo, Japan E-mail address : [email protected] Introduction: Extended-spectrum beta-lactamase (ESBL) genes and AmpC genes have been spreading among the Enterobacteriaceae species worldwide. The phenotypic characteristic of the species carrying these genes is resistance to third generation cephalosporins. We compared the antimicrobial co-resistance of Enterobacteriaceae resistant to third-generation cephalosporins with that of the susceptible isolates towards non-beta-lactam antimicrobial agents. This analysis was performed to determine the impact of resistance to third generation cephalosporins on the likelihood of resistance in the microbial species to other antimicrobial classes in Japanese tertiary care university hospital. Methods: The clinical isolates of Escherichia coli and Klebsilla spp. were collected in our microbiology laboratory from 2007 to 2011 and were analyzed retrospectively. Identification and antimicrobial susceptibility testing of the isolates were performed by an automated microdilution system using MicroScan WalkAway 96 SI (Siemens Healthcare Diagnostics). Breakpoints were determined as per the recommendations of Clinical and Laboratory Standards Institution (CLSI) until 2010. Results: We collected 4021 isolates of E. coli , 2074 of Klebsiella pneumoniae , and of 790 Klebsiella oxytoca . Resistance of E. coli and K. pneumoniae to cefotaxime that was 3.1%, 2.9%, respectively, in 2007 increased to 13.5% and 6.9%, respectively in 2011. Among the cefotaxime (CTX)-sensitive strains, 747 (21%) out of 3605 E. coli , 37 (1.9%) out of 1909 K. pneumoniae , and 23 (3.3%) out of 695 K. oxytoca were resistant to levofloxacin (LVFX). However, among CTX-resistant
strains, 312 (75%) out of 415 E. coli , 30 (18%) out of 164 K. pneumoniae , and 42 (44%) out of 95 K. oxytoca were resistant to LVFX. Coresistance of the strains to gentamicin, amikacin, and trimethoprimsulfamethoxazole showed a similar pattern. Of CTX-resistant E. coli , 16.9% were resistant to fofsfomycin; this drug showed best preserved sensitivity to CTX-resistant E. coli among the orally available agents. Conclusion: The resistance of Enterobacteriaceae, especially E. coli , to cefotaxime has shown rapid increase in 5 years in our institute. The current high number of Enterobacteriaceae resistant to third-generation cephalosporins associated with high rates of resistance to fluoroquinolones, aminoglycosides, and trimethoprimsulfamethoxazole limits the alternatives for the empirical treatment and definitive therapy of infections caused by these microorganisms. Fosfomycin can be considered as an alternative agent for treating infections caused by third generation cephalosporin-resistant Enterobacteriaceae . Clinical data of fosfomycin as a treatment agent for moderate to severe infections are required. P61 The relationship between the use of meropenem, a carbapenem antimicrobial agent, and the Pseudomonas aeruginosa resistance for meropenem M. Hashimoto1 *, N. Maniwa2 , Y. Katsuyama1 , A. Mimura3 , E. Kasuga4 , T. Matsumoto4 , S. Kanai4 , T. Honda4 , A. Takano2 , Y. Momose1 , S. Yamaori1 , S. Ohmori1 . 1 Department of Pharmacy, Shinshu University Hospital, Matsumoto, 2 Laboratory of Kampo Medicine and Pharmacognosy, Showa Pharmaceutical University, Machida, 3 Clinical Trial Research Center, 4 Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan E-mail address : [email protected] Introduction: Emergence of multi-drug resistant Pseudomonas aeruginosa is a severe clinical problem in Japan and other countries. Numerous factors such as antimicrobial use density (AUD) and time above minimum inhibitory concentration (%T> MIC) are considered to be responsible for antimicrobial resistance in antimicrobial use. However these findings are controversial. Objectives: In this study, we retrospectively reviewed the use of meropenem (MEPM) and the microbiological data at Shinshu University Hospital to clarify the correlation between antimicrobial use and resistance of P. aeruginosa and also to determine risk factors for the resistance. Methods: 1. Correlation between the use of MEPM in each diagnosis and treatment department and the P. aeruginosa resistance for MEPM. Antimicrobial use surveillancedata such as AUD, %T> MIC, and mean administration period of MEPM were reviewed retrospectively in inpatients treated with MEPMduring the period April 2011 through March 2012. In addition, the incidence of MEPM-resistant P. aeruginosa isolated from clinical specimens was calculated. 2. Determination of risk factors for the P. aeruginosa resistance for MEPM. Data on patients harboring P. aeruginosa strains sensitive to MEPM were reviewed retrospectively during the period April 2009 through March 2012. Antimicrobial use issues of patients harboring P. aeruginosa strains sensitive to MEPM after the administration of MEPM (sensitive group) was compared with those of patients harboring MEPM-resistant strains after the administration of MEPM (resistant group). Results: 1. The rates of P. aeruginosa resistance for MEPM did not significantly correlate with %T> MIC of MEPM used in 25 diagnosis and treatment departments (r = −0.155, p = 0.650). On the other hand, the P. aeruginosa resistance rate tended to correlate with AUD (r = 0.436, p = 0.180) and the mean administration period of MEPM (r = 0.490, p = 0.125). 2. The mean administration period of MEPM in a resistant group (10.0 days) was significantly longer than that in a sensitive group (5.0 days) (p = 0.011). In contrast, %T> MIC was not significantly different between resistant (55.0%) and sensitive (61.7%) groups (p = 0.353), which was not consistent with previous reports. Conclusion: In this study, a long administration period of MEPM was found to be a risk factor for the P. aeruginosa resistance for MEPM. These results suggest that shortening the administration period of MEPM may be important for appropriate antimicrobial therapy.
Posters / International Journal of Antimicrobial Agents 42S2 (2013) S41–S159
of human enterococcal infection. Considering the association and correlation observed in this study between these two genes and between asa and ampicillin resistance, we suggest these genes may play an important but underestimated role in the pathogenesis of beach enterococci isolates. P59 Drug-susceptibilities of Neisseria gonorrhoeae strains isolated from male patients with gonococcal urethritis against antimicrobial agents K. Endo1 *, S. Onodera2 , H. Kiyota3 , H. Suzuki4 , T. Hosobe5 . 1 Urology, JR Tokyo General Hospital, Shibuya-Ku, 2 Urology, Fuji City Fuji Central Hospital, Fuji, 3 Urology, The Jikei University Katsushika Medical Center, Tokyo, 4 Urology, Shonan Hospital, Yokosuka, 5 Urology, Hosobe Clinic, Tokyo, Japan E-mail address : [email protected] Introduction: We investigated the drug susceptibilities (to penicillin G (PCG), clavulanic acid/amoxicillin (CVA/AMPC), cefixime (CFIX), cefteram (CFTM), ceftriaxone (CTRX), cefodizime (CDZM), aztreonam (AZT), spectinomycin (SPCM), tetracycline (TC), azithromycin (AZM) and levofloxacin (LVFX)) of 217 Neisseria gonorrhoeae strains (2006: 47 strains; 2007: 23 strains; 2008: 18 strains; 2009: 38 strains; 2010: 36 strains; 2011: 27 strains; 2012: 28 strains), which were isolated from male urethritis patients at The Jikei University School of Medicine and related hospital of the Metropolitan Area between 2005 and 2012. b-lactamase production by the strains was also examined. The antimicrobial activities of PCG, CVA/AMPC, CFTM, AZT, TC, and LVFX were consistently low during these 7 years. On the other hand, while the MIC50 and MIC90 of CFIX were 0.008 mg/ml and 0.03 mg/ml, respectively in 1999, the values [MIC50 and MIC90 ] increased to 0.06 mg/ml and 0.25 mg/ml, respectively in 2012, indicating the acquisition of CFIX-resistance. The MIC50 values of CTRX and CDZM were close to the MIC90 valuse, suggesting the potential emergence of CTRX/CDZM-resistant strains of N. gonorrhoeae in the near future. P60 Antimicrobial co-resistance among Enterobacteriaceae resistant or susceptible to third-generation cephalosporins T. Fujita1 *, S. Asahata1 , Y. Ainoda1 , Y. Hirai1 , A. Goto2 , K. Totsuka1 . 1 Department of infectious diseases, Tokyo Women’s Medical University, 2 Laboratory of microbiology, Tokyo Women’s Medical University, Tokyo, Japan E-mail address : [email protected] Introduction: Extended-spectrum beta-lactamase (ESBL) genes and AmpC genes have been spreading among the Enterobacteriaceae species worldwide. The phenotypic characteristic of the species carrying these genes is resistance to third generation cephalosporins. We compared the antimicrobial co-resistance of Enterobacteriaceae resistant to third-generation cephalosporins with that of the susceptible isolates towards non-beta-lactam antimicrobial agents. This analysis was performed to determine the impact of resistance to third generation cephalosporins on the likelihood of resistance in the microbial species to other antimicrobial classes in Japanese tertiary care university hospital. Methods: The clinical isolates of Escherichia coli and Klebsilla spp. were collected in our microbiology laboratory from 2007 to 2011 and were analyzed retrospectively. Identification and antimicrobial susceptibility testing of the isolates were performed by an automated microdilution system using MicroScan WalkAway 96 SI (Siemens Healthcare Diagnostics). Breakpoints were determined as per the recommendations of Clinical and Laboratory Standards Institution (CLSI) until 2010. Results: We collected 4021 isolates of E. coli , 2074 of Klebsiella pneumoniae , and of 790 Klebsiella oxytoca . Resistance of E. coli and K. pneumoniae to cefotaxime that was 3.1%, 2.9%, respectively, in 2007 increased to 13.5% and 6.9%, respectively in 2011. Among the cefotaxime (CTX)-sensitive strains, 747 (21%) out of 3605 E. coli , 37 (1.9%) out of 1909 K. pneumoniae , and 23 (3.3%) out of 695 K. oxytoca were resistant to levofloxacin (LVFX). However, among CTX-resistant
strains, 312 (75%) out of 415 E. coli , 30 (18%) out of 164 K. pneumoniae , and 42 (44%) out of 95 K. oxytoca were resistant to LVFX. Coresistance of the strains to gentamicin, amikacin, and trimethoprimsulfamethoxazole showed a similar pattern. Of CTX-resistant E. coli , 16.9% were resistant to fofsfomycin; this drug showed best preserved sensitivity to CTX-resistant E. coli among the orally available agents. Conclusion: The resistance of Enterobacteriaceae, especially E. coli , to cefotaxime has shown rapid increase in 5 years in our institute. The current high number of Enterobacteriaceae resistant to third-generation cephalosporins associated with high rates of resistance to fluoroquinolones, aminoglycosides, and trimethoprimsulfamethoxazole limits the alternatives for the empirical treatment and definitive therapy of infections caused by these microorganisms. Fosfomycin can be considered as an alternative agent for treating infections caused by third generation cephalosporin-resistant Enterobacteriaceae . Clinical data of fosfomycin as a treatment agent for moderate to severe infections are required. P61 The relationship between the use of meropenem, a carbapenem antimicrobial agent, and the Pseudomonas aeruginosa resistance for meropenem M. Hashimoto1 *, N. Maniwa2 , Y. Katsuyama1 , A. Mimura3 , E. Kasuga4 , T. Matsumoto4 , S. Kanai4 , T. Honda4 , A. Takano2 , Y. Momose1 , S. Yamaori1 , S. Ohmori1 . 1 Department of Pharmacy, Shinshu University Hospital, Matsumoto, 2 Laboratory of Kampo Medicine and Pharmacognosy, Showa Pharmaceutical University, Machida, 3 Clinical Trial Research Center, 4 Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan E-mail address : [email protected] Introduction: Emergence of multi-drug resistant Pseudomonas aeruginosa is a severe clinical problem in Japan and other countries. Numerous factors such as antimicrobial use density (AUD) and time above minimum inhibitory concentration (%T> MIC) are considered to be responsible for antimicrobial resistance in antimicrobial use. However these findings are controversial. Objectives: In this study, we retrospectively reviewed the use of meropenem (MEPM) and the microbiological data at Shinshu University Hospital to clarify the correlation between antimicrobial use and resistance of P. aeruginosa and also to determine risk factors for the resistance. Methods: 1. Correlation between the use of MEPM in each diagnosis and treatment department and the P. aeruginosa resistance for MEPM. Antimicrobial use surveillancedata such as AUD, %T> MIC, and mean administration period of MEPM were reviewed retrospectively in inpatients treated with MEPMduring the period April 2011 through March 2012. In addition, the incidence of MEPM-resistant P. aeruginosa isolated from clinical specimens was calculated. 2. Determination of risk factors for the P. aeruginosa resistance for MEPM. Data on patients harboring P. aeruginosa strains sensitive to MEPM were reviewed retrospectively during the period April 2009 through March 2012. Antimicrobial use issues of patients harboring P. aeruginosa strains sensitive to MEPM after the administration of MEPM (sensitive group) was compared with those of patients harboring MEPM-resistant strains after the administration of MEPM (resistant group). Results: 1. The rates of P. aeruginosa resistance for MEPM did not significantly correlate with %T> MIC of MEPM used in 25 diagnosis and treatment departments (r = −0.155, p = 0.650). On the other hand, the P. aeruginosa resistance rate tended to correlate with AUD (r = 0.436, p = 0.180) and the mean administration period of MEPM (r = 0.490, p = 0.125). 2. The mean administration period of MEPM in a resistant group (10.0 days) was significantly longer than that in a sensitive group (5.0 days) (p = 0.011). In contrast, %T> MIC was not significantly different between resistant (55.0%) and sensitive (61.7%) groups (p = 0.353), which was not consistent with previous reports. Conclusion: In this study, a long administration period of MEPM was found to be a risk factor for the P. aeruginosa resistance for MEPM. These results suggest that shortening the administration period of MEPM may be important for appropriate antimicrobial therapy.