Poster Presentation Australian Society for Microbiology Annual Scientific Meeting 2019

Study for Monitoring Antimicrobial Resistance Trends (SMART) in Australia and New Zealand (ANZ) in a Regional and Global Context (#242)

Geoffrey Coombs 1 , Dragana Drinkovic 2 , Justin Ellem 3 , Narelle George 4 , Andree Hubber 5 , Tony Korman 6 , Sally Roberts 7 , Dan Sahm 8 , Susan Taylor 9 , Merrin Tulloch 5
  1. Murdoch University , Perth , WA , Australia
  2. North Shore Hospital , Auckland , New Zealand
  3. Westmead Hospital, Sydney , NSW, Australia
  4. Pathology Queensland , Brisbane , QLD, Australia
  5. MSD, Macquarie Park, NSW, Australia
  6. Monash Health , Melbourne, VIC , Australia
  7. Auckland City Hospital , Auckland , New Zealand
  8. IHMA Inc , Schaumberg, IL, USA
  9. Middlemore Hospital , Auckland, New Zealand

Background: SMART has monitored global in vitro antimicrobial susceptibility patterns of clinical Gram-negative bacilli isolates since 2002. This poster presents recent ANZ susceptibility data for UTI and IAI, and ANZ resistance mechanisms within the Asia-Pacific (AP) and global context.

Methods: Sites collected up to 250 consecutive Gram-negative isolates. Susceptibilities were determined by broth microdilution and MICs interpreted by EUCAST criteria. Multiplex PCR screening to detect beta-lactamase genes.

Results: Species distribution for 2017 ANZ UTI and IAI isolates largely reflected AP species distribution. Locally, the top three pathogens in IAI (n=604) were Escherichia coli (48%), Pseudomonas aeruginosa (13%) and Klebsiella pneumoniae (11%) and in UTI (n=666) were E. coli (50%), K. pneumoniae (14%) and P. aeruginosa (11%).

Susceptibilities for ANZ UTI and IAI isolates (2016 - 2017 combined) were as follows: amongst 1180 E. coli, rank-order susceptibility was carbapenems and colistin (100%), amikacin (99%), ceftolozane/tazobactam (97%), piperacillin/tazobactam (92%); for 329 K. pneumoniae: amikacin, carbapenems and colistin (99%), ceftolozane/tazobactam (91%), cefepime and aztreonam (80%), and ceftazidime, ceftriaxone and piperacillin/tazobactam (79%); for 296 P. aeruginosa: colistin (100%), ceftolozane/tazobactam (99%), amikacin (98%), cefepime (93%), carbapenems (92%) and ceftazidime and piperacillin/tazobactam (90%).

Rates of ESBLs in ANZ Enterobacterales (2017, all infection sources) were among the lowest in the AP region being 11.5% in ANZ E. coli (n=729) vs 25.6% for AP E. coli (n=2516), and 15.2% in ANZ K. pneumoniae (n=257) vs 24.5% for AP K. pneumoniae (n=1696).

In 2017, ANZ carbapenemase rates (0.7%, n=1564) were second lowest in AP (2.5%, n=5667). The carbapenemases identified in ANZ Enterobacterales (n=13) isolates were IMP (62%), NDM (23%) and OXA-48 like (15%); NDM was the most frequently detected across AP (52%). IMP carbapenemases were most frequently detected in AP Enterobacter cloacae. Globally, KPC is the dominant carbapenemase detected in Enterobacterales in the Americas while OXA-48 like is dominant in Europe, Africa and Middle East.

Discussion: ESBL and carbapenemase rates in ANZ are among the lowest in Asia Pacific.