國家衛生研究院 NHRI:Item 3990099045/8304

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Title:	Antimicrobial susceptibilities of Proteus mirabilis: A longitudinal nationwide study from the Taiwan surveillance of antimicrobial resistance (TSAR) program
Authors:	Wang, JT;Chen, PC;Chang, SC;Shiau, YR;Wang, HY;Lai, JF;Huang, IW;Tan, MC;Lauderdale, TL;TSAR Hospitals
Contributors:	Division of Infectious Diseases
Abstract:	BACKGROUND:Longitudinal nationwide data on antimicrobial susceptibility in Proteus mirabilis from different sources are rare. The effects of the revised Clinical and Laboratory Standards Institute (CLSI) beta-lactam breakpoints on susceptibility rates and on detecting extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase-producers in this species are also seldom evaluated. The present study analyzed data from the Taiwan Surveillance of Antimicrobial Resistance program to address these issues.METHODS:Isolates were collected biennially between 2002 and 2012 from 25 to 28 hospitals in Taiwan. Minimum inhibitory concentrations (MIC) were determined by reference broth microdilution method. All isolates with aztreonam, ceftazidime, or cefotaxime MIC[greater than or equal to]2mg/L were checked for the presence of ESBL by CLSI confirmatory test and subjected to ESBL and AmpC beta-lactamases gene detection by PCR. Univariate and multivariate analyses were performed.RESULTS:Between 2002 and 2012, a total of 1157 P. mirabilis were studied. Susceptibility to cefotaxime, ceftazidime, and ciprofloxacin decreased significantly during the past decade, from 92.6% to 81.7%, 100% to 95.2%, and 80.1% to 53.8%, respectively (P<0.01). The revised CLSI breakpoints had significant impact on susceptibility to cefazolin (2009 vs. current breakpoints, 71.9% vs. 0.9%) and imipenem (99.8% vs. 55.1%) (P<0.001 for both). However, using the 2014 cefazolin breakpoints for urinary tract infections, 81.2% of the urine isolates were susceptible. Susceptibilities of isolates from different specimen types were mostly similar but outpatient isolates were more susceptible than inpatient isolates. The overall prevalence of ESBL- and AmpC- producers was 8.2% and 4.7%, respectively, but AmpC carriage increased significantly over the years (from 0 to 7.0%, P<0.001). ESBL and AmpC beta-lactamase-producers were more likely to be found in elderly and ICU patients. The predominant ESBL and AmpC beta-lactamase genes were CTX-M- and CMY- types, respectively. CONCLUSIONS:A significant decrease in susceptibility to 3rd-generation cephalosporins and ciprofloxacin occurred in P. mirabilis from Taiwan in the past decade. The prevalence of ESBL remained stable but AmpC beta-lactamase-producing P. mirabilis increased significantly. Cefotaxime was a better surrogate than ceftazidime for predicting the presence of these beta-lactamases. Continuous surveillance on antimicrobial resistance and associated resistance mechanisms in P. mirabilis is warranted.
Date:	2014-09-05
Relation:	BMC Infectious Diseases. 2014 Sep 5;14:Article number 486.
Link to:	http://dx.doi.org/10.1186/1471-2334-14-486
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=1471-2334&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000341393300001
Cited Times(Scopus):	http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84906929482
Appears in Collections:	[Tsai-Ling Yang Lauderdale] Periodical Articles

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