Multicenter evaluation of antimicrobial resistance to six broad-spectrum beta-lactams in Colombia using the Etest method. The Colombian Antimicrobial Resistance Study Group

Diagn Microbiol Infect Dis. 1997 Dec;29(4):265-72. doi: 10.1016/s0732-8893(97)00157-0.

Abstract

The need for comprehensive and quantitative accurate antimicrobial resistance surveillance systems has become acute as a guide to problem recognition and to focus local interventions. A multilaboratory (10 medical centers) Colombia surveillance project was initiated in early 1997 to monitor the potency and spectrum of six (cefepime, cefotaxime, ceftazidime, cefoperazone/sulbactam, aztreonam, and imipenem) broad-spectrum antimicrobial agents tested against 100 organisms per participant center (802 strains). Ten groups of organisms were tested by a reference-quality method (Etest; AB BIODISK, Solna, Sweden) with results validated by concurrent quality control and additional challenge strain analysis. Results from nine qualifying medical centers were tabulated, and 95.7 to 96.8% of quality assurance tests were within expected ranges. Only cefepime (90.1-100.0% susceptible) and imipenem (96.3-100.0%) were active against all Enterobacteriaceae at > 90% of susceptible isolates using the breakpoint concentrations recommended by the National Committee for Clinical Laboratory Standards. Among ceftazidime- (or cefotaxime- or aztreonam-) resistant Enterobacter spp. and Citrobacter freundii, cefepime remained active, but not cefoperazone with sulbactam. Escherichia coli and Klebsiella spp. strains having resistance phenotypes consistent with extended spectrum beta-lactamase production were discovered in approximately 5 to 10% of isolates. All tested drugs except ceftazidime (31.8-57.7% susceptible) were active against > 94% of oxacillin-susceptible staphylococci. Similar rates of resistance (9.1-14.8%) were observed in Pseudomonas aeruginosa for five of six drugs (not cefotaxime; 15.9% of strains were susceptible). Acinetobacter spp. isolates were most susceptible to imipenem (95.8%), cefepime (86.1%), and cefoperazone/sulbactam (83.3%). Overall for the 1997 order of antimicrobial spectrums for these tested compounds was: imipenem (96.6%) > cefepime (93.6%) > cefoperazone/sulbactam (90.5%) > cefotaxime (74.9%) > aztreonam (74.3% for Gram-negative bacilli only) > ceftazidime (73.2%). These data should be used to guide empiric regimens in Colombia, and additionally will provide a resistance statistical baseline to which future studies in this nation can be compared.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Aztreonam / pharmacology
  • Cefepime
  • Cefoperazone / pharmacology
  • Cefotaxime / pharmacology
  • Ceftazidime / pharmacology
  • Cephalosporinase / biosynthesis
  • Cephalosporins / pharmacology
  • Cohort Studies
  • Colombia
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / enzymology
  • Gram-Negative Bacteria / drug effects*
  • Humans
  • Imipenem / pharmacology
  • Microbial Sensitivity Tests
  • Reproducibility of Results
  • Staphylococcus / drug effects*
  • Sulbactam / pharmacology
  • beta-Lactam Resistance / physiology*

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • Imipenem
  • Cefoperazone
  • Cefepime
  • Ceftazidime
  • Cephalosporinase
  • Aztreonam
  • Cefotaxime
  • Sulbactam