Evaluation of the in vitro activity of 9 antimicrobials agains bacterial strains isolated from patients in intensive care units in Brazil: MYSTIC antimicrobial surveillance program

ABSTRACT

Multi-resistant bacterial strains are increasingly prevalent in hospital environments. Bacterial resistance is an important problem, especially for practitioners in intensive care units (ICUs) because of the selective pressure on the prevalente bacteria in these environments. The MYSTIC (Meropenen Yearly Susceptibility Test Information Collection) study has been monitoring the performance of carbapenems and otherantibiotics in different hospitals for at least 3 years. The in vitro activities of meropenem, imipenem, ceftazidime, cefepime, cefotaxime, ciprofloxacin, piperacilin/tazobactam, gentamicin, and tobramycin were compared against 452 recent clinical aerobic isolates. The isolates consisted of 19 species of Gram-negative bacteria (n=290) including K. pneumoniae (n=49), E. coli (n=48), A. baumannii (n=47), Enterobacter spp. (n=41), and P. aeruginosa (n=33) and 9 species of Gram-positive bacteria (n=162) including Staphylococcus aureus (n=63), Enterococcus faecalis (n=22), Streptococcus pneumoniae (n=22) and coagulase negative Staphylococci (n=21). All isolates were collected from ICU patients. Minimal inhhibitory concentrations (MICs) were determined by Etest methodology, using standardized and controlled procedures. Meropenem and imipenem showed the lowest MIC for all species tested. Gram-negative isolates showed the following overall resistance percentages to the other 7 drugs tobramycin (43.1 por cento), cefotaxime (38.6 por cento), gentamicin (34.1 por cento), ceftazidime (31.7 por cento), ciprofloxacin (25.5 por cento), piperacillin/tazobactam (26.9 por cento), and cefepime (18.6 por cento). Carbapenems were the most active drugs overall and only P. aeruginosa presented some degree of resistance(18.2 por cento). We also evaluated the production of extended spectrum B-lactamase (ESBL) among all Enterobacteriaceae members (n=176) by Etest/ESBL, strip. ESBL production was detected in 51 strains (29.0 por cento). Among them, Klebsiella pneumoniae was the most prevalent at 59.2 porcento, followed by Enterobacter spp (19.5 porcento) and E. coli (14.6 por cento). The high level of resistance against several antimicrobialsand the alarming rate of ESBL production may restrict therapeutic choice to the carbapenems in this selected group of patients.