Robert Badal

Oxford University Clinical Research Unit, Thành phố Hồ Chí Minh, Ho Chi Minh City, Vietnam

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Publications (151)277.13 Total impact

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    ABSTRACT: To investigate phenotypic and genotypic patterns of antimicrobial resistance among Gram negative bacilli pathogens associated with urinary tract and intra-abdominal infections in medical centers from Jordan and Lebanon. Gram-negative bacilli from the SMART study between the years 2011 to 2013 were first identified at local laboratories. These isolates were shipped to a central laboratory where re-identification, susceptibility testing and molecular characterization were performed as per standard methods. Among the 523 UTI-associated isolates, E. coli, K. pneumoniae, and P. mirabilis were the most frequent (70%, 14%, and 5% respectively). E. coli, K. pneumoniae, and P. aeruginosa were the most frequent species among the 527 IAI-associated isolates (46%, 14%, and 12%, respectively). Incidence rates of ESBL producers among UTI-associated E. coli, K. pneumoniae, and P. mirabilis were 43%, 54%, and 4%, respectively. Corresponding rates among IAI-associated isolates were, 49%, 56%, and 12%, respectively. A. baumannii and P. aeruginosa isolates showed very disturbing low susceptibility patterns. CTX-M-15 was the most prevalent ESBL produced. Seventeen isolates were non susceptible to carbapenems (estimated prevalence of 1.6%). The alarmingly high rates of ESBL production and emergence of carbapenemases emphasize the urgent need to develop antimicrobial stewardship initiatives, and to maintain antimicrobial resistance surveillance systems. Copyright © 2015. Published by Elsevier Ltd.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 04/2015; 35. DOI:10.1016/j.ijid.2015.04.011 · 2.33 Impact Factor
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    ABSTRACT: Enterobacteriaceae (3,235 isolates), Pseudomonas aeruginosa (476 isolates), and Acinetobacter baumannii (106 isolates) from inpatient intra-abdominal infections (IAIs) were collected for the 2010-2012 Study for Monitoring Antimicrobial Resistance Trends (SMART) program in the United States. This report evaluates the in vitro activity of several antimicrobial agents recommended for treatment of IAIs and compares profiles of isolates from intensive care units (ICUs) and non-intensive care units (non-ICUs). Gram-negative bacilli from hospitalized patients with IAIs were obtained each year from 2010-2012 from hospitals in the United States and tested for susceptibility to 12 antibiotics according to 2012 Clinical and Laboratory Standards Institute (CLSI) guidelines. The most active agents against members of the Enterobacteriaceae family from both ICUs and non-ICUs were amikacin, ertapenem, and imipenem-cilastatin, whereas the least active agent was ampicillin-sulbactam. Amikacin was the only agent with good activity against P. aeruginosa, whereas none of the agents tested exhibited substantial activity against A. baumannii. Amikacin, ceftazidime, ceftriaxone, ciprofloxacin, levofloxacin, and imipenem-cilastatin were significantly less active against Enterobacteriaceae from ICU patients, whereas cefepime and ceftazidime were significantly less active against P. aeruginosa from ICU patients. Intensive care unit isolates were more likely to be multi-drug-resistant than non-ICU isolates, although there was no difference in extended-spectrum β-lactamase (ESBL) production rates between the two patient groups. Despite increasing resistance trends, in this study amikacin, ertapenem, and imipenem-cilastatin were shown to have good in vitro activity against the most frequently isolated gram-negative bacilli from IAIs in ICU and non-ICU settings.
    Surgical Infections 04/2015; 16(3). DOI:10.1089/sur.2014.060 · 1.72 Impact Factor
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    ABSTRACT: The Study for Monitoring Antimicrobial Resistance Trends has monitored the in vitro activity of several recommended antimicrobials used in the management of intra-abdominal infections (IAIs) globally since 2002. In this report, we document the changing susceptibility patterns to recommended antimicrobials in Klebsiella pneumoniae isolates from patients with IAIs in 11 Latin American countries between 2008 and 2012 and describe the beta-lactamases encoded by phenotypically extended-spectrum beta-lactamase (ESBL)-positive and ertapenem-nonsusceptible isolates. Overall, the incidence of phenotypically ESBL-positive K. pneumoniae did not change significantly from 2008 (40.4%) to 2012 (41.2%) (P>0.05). However, trend analysis documented an increase in isolates encoding K. pneumoniae carbapenemase (KPC) or both KPC and an ESBL. Decreasing susceptibility (P<0.05) was noted for cefepime, ceftazidime, ceftriaxone, ertapenem, and imipenem among all K. pneumoniae, as well as for cefepime, cefotaxime, cefoxitin, ceftriaxone, ertapenem, and imipenem among ESBL-positive isolates, while susceptibility of ESBL-negative isolates to ampicillin-sulbactam actually increased (P<0.05). Copyright © 2015. Published by Elsevier Inc.
    Diagnostic microbiology and infectious disease 04/2015; 82(3). DOI:10.1016/j.diagmicrobio.2015.03.025 · 2.57 Impact Factor
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    ABSTRACT: Antimicrobial resistance in Enterobacteriaceae, including to carbapenems, is increasing worldwide. However, using 2009-2013 United States SMART data, no statistically significant decreasing susceptibility trends were found for Escherichia coli overall from patients with intra-abdominal infections. In the subset of isolates from community-associated infections, susceptibility to levofloxacin decreased significantly, and the increasing rate of multi-drug-resistant E. coli approached statistical significance. In 2013, ertapenem, imipenem, and amikacin showed the highest susceptibility (≥99%), and fluoroquinolones the lowest (<70%). The ten ertapenem-non-susceptible isolates (0.3% of all E. coli) encoded one or more of carbapenemases, ESBLs, AmpCs, and non-ESBL β-lactamases. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 03/2015; 59(6). DOI:10.1128/AAC.05186-14 · 4.45 Impact Factor
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    ABSTRACT: The prevalence of carbapenemase enzymes continues to increase. Among the Ambler class B enzymes is the New Delhi metallo-β-lactamase (NDM). This particular enzyme is capable of hydrolyzing nearly all β-lactam antimicrobial agents and has spread rapidly, becoming a global problem. Therapeutic treatment options for patients infected with isolates which produce this enzyme are difficult to manage as cross-resistance to other antimicrobial classes is common. The Study for Monitoring Antimicrobial Resistance Trends (SMART) is a global surveillance study evaluating antimicrobial susceptibility of numerous Gram-negative bacterial species recovered from intra-abdominal and urinary tract infections. Clinical and Laboratory Standards Institute methods and molecular analysis identified 134 isolates of Enterobacteriaceae (nine species) and one Acinetobacter sp. with blaNDM genes. These isolates were collected in nine countries, and >95% of the isolates possessed the NDM-1 variant. MIC90 values were >4mg/L and >8mg/L for ertapenem and imipenem, respectively. No tested β-lactam or β-lactamase-inhibitor combination had activity against these isolates. Resistance to amikacin (79.9%) and levofloxacin (82.8 %) was common. Nearly all isolates encoded additional enzymes including AmpC cephalosporinases and extended-spectrum β-lactamases (ESBLs). There is an urgent need for infection control and continued global monitoring of isolates which harbor this enzyme as evidenced by recent outbreaks. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
    Antimicrobial Agents and Chemotherapy 11/2014; 59(2). DOI:10.1128/AAC.03938-14 · 4.45 Impact Factor
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    ABSTRACT: We characterized Escherichia coli ST131 isolates among 116 carbapenemase-producing strains. Of isolates from 16 countries collected during 2008-2013, 35% belonged to ST131 and were associated with blaKPC, H30 lineage, and virotype C. This study documents worldwide incidents of resistance to "last resort" antimicrobial drugs among a common pathogen in a successful sequence type.
    Emerging infectious diseases 11/2014; 20(11):1928-31. DOI:10.3201/eid2011.141388 · 7.33 Impact Factor
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    ABSTRACT: Background: IAI and SW infections present major challenges for hospitalized patients. Monitoring the resistance profiles expressed by the causative organisms is important. Therefore, data from the Tigecycline European Surveillance Trial (TEST) program were analyzed for the resistance patterns observed throughout Europe. Methods: Isolates were collected and tested locally by broth microdilution according to appropriate CLSI guidelines. Results of this study were based on isolates tested from 26 European countries from 2004 2013. Results: Antimicrobial: Percent Susceptible: IAI/SWa Organism (n): IAI/SW TIG AK AMP CFT LEV MER PT VAN Acinetobacter spp 163/1546 na/na 66/70 na/na 28/35 50/58 53/70 45/55 na/na Enterobacter spp 615/2478 96/96 98/98 2/4 53/65 84/89 96/98 68/78 na/na E. coli 1122/1748 100/100 99/99 38/32 84/76 74/64 99/100 91/90 na/na ESBL 128/311 100/100 94/96 na/na na/na 25/22 98/99 74/73 na/na K. pneumoniae 485/1156 97/96 96/95 2/3 75/67 79/73 95/93 78/76 na/na ESBL 82/266 94/96 88/88 na/na 4/0 89/34 89/88 32/43 na/na P. aeruginosa 367/2439 na/na 93/93 na/na na/na 70/67 65/76 76/75 na/na S. marcescens 101/861 94/96 99/98 5/4 78/83 93/93 96/99 87/94 na/na E. faecalis 366/1067 100/100 na/na 98/99 na/na 74/8 na/na na/na 98/99 E. faecium 381/356 100/100 na/na 21/17 na/na 17/17 na/na na/na 91/90 S. aureus, MSSA 100/3250 100/100 na/na na/na na/na 95/92 na/na na/na 100/100 S. aureus, MRSA 42/1302 100/100 na/na na/na na/na 12/16 na/na na/na 100/100 S. agalactiae 27/955 100/100 100/100 100/100 100/100 100/98 100/100 na/na 100/100 A na = breakpoints not defined or non-applicable, TIG (tigecycline; FDA breakpoints), AK (amikacin), AMP (ampicillin), CFT (Ceftriaxone), MER (meropenem), LEV (levofloxacin) PT (piperacillin/tazobactam), VAN (vancomycin) Conclusion: Against Enterobacteriaceae, including ESBL-producers, TIG, AK and MER were the most active agents; against gram-positive cocci TIG resistance was not encountered. For Acinetobacter spp. all agents demonstrated poor activity; against P. aeruginosa AK and PT were the most active agents. Given the propensity of the bacteria associated with IAI and SW infections, continued monitoring of antimicrobial activity in Europe is warranted.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Enterobacteriaceae play a significant role in LRT infections in at risk patients, especially in the healthcare associated environment. Treatment options are increasingly limited due to increased resistance to cephalosporins and other antimicrobials, thus warranting careful monitoring of resistance trends. The purpose of this study was to determine the in vitro activity of Tigecycline and other key antibiotics against LRT isolates of Enterobacteriaceae obtained from patients in North American and European hospitals. Methods: From 2009-2013 8,361 Enterobacteriaceae from LRT specimens were obtained from geographically distributed sites as part of the multi-year Tigecycline Evaluation Surveillance Trial (TEST). MICs were determined by the local laboratory using supplied microdilution panels and interpreted according to CLSI guidelines. Results: Percent Susceptible 2009 2010 2011 2012 2013 NAa EUa NA EU NA EU NA EU NA EU Drug n = 440 601 576 1472 537 1100 943 1683 390 619 Amikacin 98.0 97.5 97.9 97.4 98.3 95.8 98.3 98.5 98.7 99.0 Cefepime 92.7 91.4 93.6 90.0 92.0 86.9 93.4 88.5 90.8 90.6 Ceftriaxone 73.9 72.1 72.1 67.7 75.6 69.7 80.3 71.0 78.2 71.1 Levofloxacin 83.4 84.2 86.6 82.1 84.4 81.4 87.6 83.6 85.4 83.4 Meropenem 96.4 97.2 96.2 98.7 97.8 96.5 97.3 97.0 96.2 97.7 Pip-Tazob 83.4 80.4 85.2 78.9 83.6 79.3 86.2 83.1 88.2 85.0 Tigecycline 98.0 94.7 96.4 96.4 96.8 97.7 96.3 97.0 96.2 97.0 aNA: North America, EU: Europe; Pip-Tazo = piperacillin/tazobactam Conclusion: Tigecycline, amikacin and meropenem consistently demonstrated the highest % susceptibility (> 95%) against LRT isolates of Enterobacteriaceae regardless of study year or geographic region. Ceftriaxone was less active against European isolates than against North American isolates overall irrespective of study year possibly due to extended-spectrum β-lactamase prevalence in Europe vs. North America. Levofloxacin susceptibility was stable in the mid-80% range over all years. Tigecycline is not indicated for lower respiratory tract infections caused by Enterobacteriaceae.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Because of their resistance to many antimicrobials, Pseudomonas aeruginosa and Acinetobacter baumannii remain pathogens of interest in intra-abdominal infections (IAI), representing approximately 10% and 3%, respectively, of aerobic gram-negative pathogens in IAI globally. This report from the Study for Monitoring Antimicrobial Resistance Trends (SMART) evaluates the susceptibility of P. aeruginosa and A. baumannii from IAI in the USA between 2009 and 2013. Methods: 27 US laboratories each collected up to 100 consecutive aerobic or facultative gram-negative isolates from IAI each year. Susceptibility was determined using the CLSI broth microdilution method and breakpoints. Linear trends in susceptibility were assessed with the Cochran-Armitage test. Results: Susceptibility trends and prevalence of 967 P. aeruginosa and 199 A. baumannii isolates are shown below. N and % of all gram-negative pathogens are listed in the legend. A sensitivity analysis was conducted for P. aeruginosa susceptibility using only the 12 sites that submitted isolates in all 5 years. The significant increasing trends for ceftazidime and piperacillin-tazobactam were confirmed, the trend for cefepime approached significance (p=0.08), and an additional significant increasing trend was found for levofloxacin (p=0.03). Conclusion: P. aeruginosa's prevalence was stable at around 12% of gram-negative pathogens isolated from IAI in the USA from 2009 to 2013. Its susceptibility to cefepime, ceftazidime and piperacillin-tazobactam showed statistically significant change (p<0.05), with these drugs demonstrating increasing susceptibility. A. baumanniis prevalence was lower and decreased significantly over the 5 years, but its susceptibility remained stable for all tested drugs between 2009 and 2013. Resistance does not appear to be increasing in these difficult-to-treat IAI pathogens.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Pathogens in some long-term care (LTC) facilities have been reported to have high antimicrobial resistance with a large proportion of multi-drug resistant (MDR) strains. Using data from the Tigecycline Evaluation and Surveillance Trial (TEST), Enterobacteriaceae from LTC settings were compared to other inpatient and outpatient settings in Europe and North America. Methods: 512 Enterobacteriaceae isolates from various specimen sources were collected from LTC facilities, and 27,569 Enterobacteriaceae from inpatient and outpatient settings in 15 countries in Europe and North America from 2011 to 2013. MICs were determined at each site using CLSI broth microdilution method and interpreted according to CLSI/FDA guidelines. Isolates were categorized as MDR if resistant to ≥3 drug classes. Results: MIC90 (mcg/ml), % susceptible (%S), and % MDR among Enterobacteriaceae from each setting are shown below. %S values ≥ 90% are shaded. Of the species with n >10, Enterobacter cloacae had the highest proportion of MDR strains in LTC and inpatient settings (41.4% and 39.8%, respectively), whereas Citrobacter freundii had the highest for outpatients (34.7%). Conclusion: A significantly higher proportion of Enterobacteriaceae were MDR in LTC settings than in inpatients and outpatients. All study drugs showed lower susceptibility in LTC isolates than in the other two settings. Amikacin, meropenem, and tigecycline were the only drugs studied that showed only minor differences in %S between the three settings. These three agents also demonstrated the highest in vitro activity against Enterobacteriaceae, with susceptibility >90% in all three settings. Empiric therapy decisions should take into account the high proportion of MDR isolates in LTC settings.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Community-associated (CA) and hospital-associated (HA) intra-abdominal infections (IAI) are a major cause of morbidity and, if not properly treated, mortality. The Study for Monitoring Antimicrobial Resistance Trends (SMART) has tracked epidemiology and susceptibility of aerobic gram-negative pathogens (GNP) causing IAI since 2002; this report summarizes the findings for pediatric patients in the U.S. during 2010-2013. Methods: 23 U.S. hospitals each collected up to 100 non-selected, consecutive GNP per year, including 300 pediatric GNP in 2010-2013. Organisms were classified as either CA or HA if isolated <48h or ≥48h from admission. Susceptibility and ESBL phenotypes were determined using CLSI broth microdilution. Results: Shown below is the susceptibility of the top 4 species and of all GNP combined (using appropriate CLSI breakpoints and assuming 0% susceptible for species with no breakpoints for any given drug). Only selected agents are shown (one agent per major drug class tested). Analysis of extended-spectrum β-lactamase (ESBL) phenotypes showed 4%, 6%, and 4% of E. coli and 13%, 13%, and 0% of K. pneumoniae (albeit with small n's) to be ESBL-positive in all, HA, and CA IAI, respectively. Conclusion: Although the top 4 species found in HA and CA IAI were identical, the proportion of E. coli was significantly different: 41% in HA IAI vs. 55% in CA IAI. P. aeruginosa and E. cloacae tended to be more prevalent in HA IAI. Susceptibility was frequently lower in HA than CA. Of the agents tested, AMK had the highest in vitro activity vs. all GNP. ETP showed excellent activity vs. Enterobacteriaceae. Differences in species prevalence and susceptibility between HA and CA pediatric IAI indicate a need for different treatment options for these infections.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: Background: Ceftaroline (CPT), the active metabolite of ceftaroline fosamil, is a cephalosporin with in vitro activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), streptococci, and common Enterobacteriaceae (excluding strains producing serine β-lactamases). This report from AWARE, a global surveillance program, summarizes the in vitro activity of CPT and comparators against respiratory tract infection (RTI) pathogens collected in Latin America from 2012-13. Methods: RTI pathogens were collected from 17 medical centres in Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela 2012-13. Sources included: sputum, endotracheal aspirate, bronchoalveolar lavage and bronchial brushings. MICs were determined by broth microdilution as specified by the CLSI and the results interpreted by CLSI breakpoints. Results: Susceptibility % for selected drugs and species are shown in the table below; values >=90% are shaded; na=no breakpoints, and "-" indicates not tested. Conclusions: Ceftaroline demonstrated excellent in vitro activity against S. pneumoniae with activity comparable to LVX, MXF and LZD. Activity against H. influenzae isolates was also excellent and comparable to AMX, CRO, and LVX. Ceftaroline activity against S. aureus was 79% (100% of MSSA isolates were susceptible). Ceftaroline activity against E. coli and K. pneumoniae was similar to AMX while ceftaroline had no activity against K. pneumoniae or E. coli producing serine β-lactamases (data not shown).
    54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC),, Washington, DC; 09/2014
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    ABSTRACT: C-760 In Vitro Activity of Ceftaroline against Contemporary Staphylococcus aureus Isolates (2013) from Latin American Countries: AWARE Surveillance Program D. Hoban1, M. Hackel1, R. Badal1, E. Reiszner2 and J. Ambler2 1IHMA Inc. Schaumburg, IL. USA 2AstraZeneca Pharmaceuticals, Waltham, MA, USA Background: Ceftaroline (CPT), the active metabolite of ceftaroline fosamil is the first cephalosporin with enhanced anti-staphylococcal activity (including methicillin-resistant S. aureus [MRSA]) indicated for the treatment of adults with complicated skin and soft tissue infections (cSSTI) and community-acquired pneumonia (CAP). This report from AWARE, a global CPT surveillance program, summarizes the in vitro activity of CPT against S. aureus isolates collected in Latin America (LA). Methods: Susceptibility testing of 1,182 S. aureus isolates (488 methicillin-susceptible S. aureus, 694 MRSA) collected in 2013 from 22 hospitals, in 6 LA countries (Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela). Isolates were sourced from specimens from patients with SSTI (abscess, burn, carbuncle, cellulitis/erysipelas, decubitus, furuncle, impetiginous lesions, skin ulcer, wound) and lower respiratory tract infections (bronchial washing, bronchial alveolar lavage, endotracheal aspirate, sputum). Testing was performed by broth microdilution and MIC results were interpreted according to CLSI performance standards. Results: Of the 1,182 S. aureus tested 88.4% were CPT susceptible. All MSSA isolates were CPT susceptible (MIC range 0.06-0.5 mg/L, MIC90 0.25 mg/L). CPT activity against MRSA isolates is summarized in the table. Conclusions: All MSSA isolates were susceptible in vitro to CPT. Marked diversity in susceptibility across LA countries was observed in vitro with MRSA (%S ranged from 31.2% in Chile to 100% in Colombia). Across the LA region 80.3% of MRSA were reported as susceptible, 19.6% as intermediate and 0.1% (1 isolate) as resistant with an MIC of 4 mg/L.
    54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC),, Washington DC; 09/2014
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    ABSTRACT: Treatment options for multidrug-resistant pathogens remain problematic in many regions and individual countries, warranting ongoing surveillance and analysis. Limited antimicrobial susceptibility information is available for pathogens from Vietnam. This study determined the bacterial susceptibility of aerobic gram-negative pathogens of intra-abdominal infections (IAIs) among patients in Vietnam during 2009–2011. A total of 905 isolates were collected from four medical centers in this investigation as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) rates among the appropriate species were determined by a central laboratory using Clinical and Laboratory Standards Institute (CLSI) methods. Among the species collected, Escherichia coli (48.1% ESBL-positive), and Klebsiella pneumoniae (39.5% ESBL-positive) represented the majority (46.4%) of the isolates submitted for this study. Ertapenem MIC90 values were lowest for these two species at 0.12 and 0.25 μg/ml, and remained unchanged for ESBL-positive isolates. Imipenem MIC90 values were also the same for all isolates and ESBL-positive strains at 0.25 and 0.5 μg/ml, respectively. Ertapenem MIC90 values for additional species with sufficient numbers for analysis, including Enterobacter cloacae, Proteus mirabilis, Acinetobacter baumannii, and Pseudomonas aeruginosa, were 1, 0.06, >4, and >4 μg/ml, respectively. Analysis of beta-lactamases in a subset of 132 phenotypically ESBL-positive Enterobacteriaceae demonstrated that CTX-M variants, particularly CTX-M-27 and −15, were the predominant enzymes. High resistance rates in Vietnam hospitals dictate continuous monitoring as antimicrobial inactivating enzymes continue to spread throughout Asia and globally.
    Diagnostic Microbiology and Infectious Disease 08/2014; 79(4). DOI:10.1016/j.diagmicrobio.2014.05.009 · 2.57 Impact Factor
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    ABSTRACT: The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide.
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    ABSTRACT: Activity of ceftaroline and comparators against Streptococcus pneumoniae from multiple specimen sources in the European region 2012: assessing worldwide antimicrobial resistance evaluation (AWARE) programme Hoban D.; Badal R.; Biedenbach D.; Hackel M.; Bouchillon S.; Ambler J. Objectives: Streptococcus pneumoniae (SP) remains a significant pathogen isolated from many infectious processes. Increasing penicillin, macrolide and cephalosporin resistance in SP increases the need for new effective antimicrobials. Ceftaroline, the active metabolite of ceftaroline fosamil, is a cephalosporin with in vitro activity against Gram-positive pathogens and common Gram-negative pathogens. The in vitro activity of ceftaroline and comparators against SP including resistant strains isolated across the European region in 2012 from the AWARE programme are reported. Methods: 62 medical centers in 17 European countries (Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Hungary, Italy, Portugal, Romania, Russia, Spain, Sweden, Netherlands, Turkey and United Kingdom) collected 815 SP isolates from multiple specimen sources. MICs were performed as specified by CLSI using prepared broth microdilution panels and interpreted according to EUCAST guidelines and breakpoints. Results: The in vitro activity of ceftaroline and 7 comparator agents are shown in the table. Drugs % Susceptible/MIC90 (mg/L) All SP PSSP PISP PRSP MRSP CROSP Isolate # 815 556 206 53 228 17 CPT 99.1/0.12 100/0.008 100/0.12 86.8/0.5 96.9/0.12 58.8/0.5 CRO 85.4/1 99.8/0.03 68.5/2 0/>4 59.7/2 0/>4 CLI 80.5/>1 93.0/0.06 59.7/>1 30.1/>1 35.1/>1 41.2/>1 ERY 71.4/>1 89.0/1 37.9/>1 17.0/>1 0/>1 11.8/>1 LVX 99.3/1 100/1 97.1/1 100/1 98.3/1 100/1 LZD 100/1 100/1 100/1 100/1 100/1 100/2 MXF 99.4/0.25 100/0.25 98.1/0.25 98.1/0.25 97.8/0.25 100/0.25 PEN 68.2/2 100/0.03 0/2 0/>8 25.0/4 0/>8 CPT ceftaroline, CRO ceftriaxone, CLI clindamycin, ERY erythromycin, LVX levofloxacin, LZD linezolid, MXF moxifloxacin, PEN penicillin ALL SP: All S. pneumoniae, PSSP: penicillin-susceptible SP (penicillin MIC<=0.06 mg/L), PISP: penicillin-intermediate SP (penicillin MIC=0.12-2 mg/L), PRSP: penicillin-resistant SP (penicillin MIC>2mg/L), MRSP: macrolide-resistant SP (erythromycin MIC >0.5mg/L), CROSP: ceftriaxone-resistant SP (ceftriaxone MIC>2mg/L). Conclusions: Ceftaroline demonstrated excellent in vitro activity against SP with percent susceptible =>99% for penicillin-susceptible and intermediate strains. Activity was reduced for penicillin- (86.8%) and ceftriaxone-resistant (58.8%) strains. Overall, the susceptibility of SP to ceftaroline was comparable to levofloxacin and moxifloxacin at their respective EUCAST breakpoints.
    24th European Congress of Clinical Microbiology and Infectious Diseases, Barcelona, Spain; 05/2014
  • 05/2014; 2(4). DOI:10.1016/j.jgar.2014.04.003
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    ABSTRACT: The Study for Monitoring Antimicrobial Resistance Trends has been monitoring the activity of antimicrobials indicated for the treatment of intra-abdominal infections since 2004. This report documents the in vitro activity of several recommended antimicrobials against 3449 gram-negative bacilli isolated from the 30 and 25 participating sites in North America in 2010-2011, respectively, and characterizes the extended-spectrum beta-lactamases (ESBL) identified in ESBL-positive and ertapenem-non-susceptible isolates of Enterobacteriaceae. Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Proteus mirabilis, Klebsiella oxytoca, Citrobacter freundii, Enterobacter aerogenes, Serratia marcescens, and Morganella morgannii were the most common species isolated. The incidence of beta-lactamase production was 8.8% and 8.9% for E. coli and K. pneumoniae, respectively. Overall the most active antimicrobials were amikacin, piperacillin-tazobactam, imipenem, and ertapenem, although beta-lactamase production reduced the activity of most agents. Characterization of beta-lactamase genes determined that blaSHV, blaCTX-M, blaAmpC, and blaKPC were commonly found in most beta-lactamase-positive isolates.
    Diagnostic microbiology and infectious disease 04/2014; DOI:10.1016/j.diagmicrobio.2014.03.026 · 2.57 Impact Factor
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    ABSTRACT: The study for monitoring antimicrobial resistance trends (SMART) surveillance program monitors the epidemiology and trends in antibiotic resistance of intra-abdominal pathogens to currently used therapies. The current report describes such trends during 2010-2011. A total of 25 746 Gram-negative clinical isolates from intra-abdominal infections were collected and classified as hospital-associated (HA) if the hospital length of stay (LOS) at the time of specimen collection was ≧48 hours, community-associated (CA) if LOS at the time of specimen collection was <48 hours, or unknown (no designation given by participating centre). A total of 92 different species were collected of which the most common was Escherichia coli: 39% of all isolates in North America to 55% in Africa. Klebsiella pneumoniae was the second most common pathogen: 11% of all isolates from Europe to 19% of all isolates from Asia. Isolates were from multiple intra-abdominal sources of which 32% were peritoneal fluid, 20% were intra-abdominal abscesses, and 16·5% were gall bladder infections. Isolates were further classified as HA (55% of all isolates), CA (39% of all isolates), or unknown (6% of all isolates). The most active antibiotics tested were imipenem, ertapenem, amikacin, and piperacillin-tazobactam. Resistance rates to all other antibiotics tested were high. Considering the current data set and high-level resistance of intra-abdominal pathogens to various antibiotics, further monitoring of the epidemiology of intra-abdominal infections and their susceptibility to antibiotics through SMART is warranted.
    Journal of chemotherapy (Florence, Italy) 02/2014; 27(2):1973947814Y0000000164. DOI:10.1179/1973947814Y.0000000164 · 1.07 Impact Factor
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    ABSTRACT: A sub-set of Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae and Proteus mirabilis collected for the Study for Monitoring Antimicrobial Resistance Trends (SMART) that were positive for the CLSI extended-spectrum beta-lactamase (ESBL) phenotypic confirmatory test (N=3,245) or had an ertapenem MIC of ≥0.5μg/ml (N=293) or both (N=467) were analyzed for ESBL genes. Most ESBL phenotype E. coli or K. pneumoniae possessed an ESBL gene (95.8% & 88.4%, respectively) or 93.1% if carbapenem non-susceptible K. pneumoniae were removed. This rate was lower for P. mirabilis (73.4%) and K. oxytoca (62.5%). Virtually all ESBL-positive isolates (99.5%) were cefotaxime non-susceptible (CLSI or EUCAST breakpoints). Fewer (82%) were ceftazidime non-susceptible (CLSI breakpoints). Also 21.1% of E. coli, 25% of K. oxytoca and 78.7% of P. mirabilis were ceftazidime-susceptible but ESBL-positive. This suggests CLSI breakpoints for ceftazidime are too high to detect ESBLs. The lower EUCAST breakpoints detected ESBLs in E. coli and K. oxytoca better, but 59.6% of ESBL-positive isolates of P. mirabilis were ceftazidime-susceptible. For isolates with ertapenem MIC ≥ 0.5μg/ml, more accurate ESBL phenotype analysis was observed for E. coli and K. pneumoniae (sensitivity >95% for both, specificity 94.4% and 54.1%, respectively). If carbapenemase-positive K. pneumoniae were excluded specificity increased to 78%. The positive predictive values for the ESBL phenotypic test with E. coli and K. pneumoniae were 97.6% and 81.8%, respectively and negative predictive values were 75.9% and 95.2%, respectively. We therefore suggest it would be prudent to confirm phenotypic ESBL-positive P. mirabilis, K. pneumoniae and K. oxytoca with molecular analysis.
    Journal of Medical Microbiology 01/2014; 63. DOI:10.1099/jmm.0.068981-0 · 2.27 Impact Factor

Publication Stats

721 Citations
277.13 Total Impact Points

Institutions

  • 2008
    • Oxford University Clinical Research Unit
      Thành phố Hồ Chí Minh, Ho Chi Minh City, Vietnam
    • National Institute of Animal Health
      Edo, Tōkyō, Japan