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.