Robert Badal

Chinese Academy of Medical Sciences, Peping, Beijing, China

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Publications (157)292.78 Total impact

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    ABSTRACT: Objective: To evaluate the antimicrobial susceptibility of gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013. Methods: We determined susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase : ESBL) status of 3540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth micro dilution and interpretive standards. Results: Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P=0.031), K. pneumoniae (P=0.017), and Proteus mirabilis (P=0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of Enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3%-100%, 81.3%-100%, 64.7%-100%, and 83.1%-100%, respectively, but imipenem was ineffective against P. mirabilis (<20%). Although most ESBL-positive hospital-acquired isolates were resistant to third and fourth generation cephalosporins, the majority were susceptible to cefoxitin (47.9%-83.9%). Susceptibilities of ESBL-positive isolates to ampicillin-sulbactam (<10%) were low, whereas susceptibilities to ciprofloxacin (0%-54.6%) and levofloxacin (0%-63.6%) varied substantially. The prevalences of cephalosporin-susceptible E. coli and K. pneumoniae were higher in the northeastern and southern regions than in the central and eastern regions, reflecting the ESBL-positive rates in these areas, and were lowest in the Jiang-zhe area where also the rates of carbapenem resistance were highest. Conclusions: Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially for those caused by E. coli or K. pneumoniae. Resistances to cephalosporins and carbapenems is more common in the Jang-zhe area than in other regions in China.
    No preview · Article · Oct 2015 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: Intensive care units (ICUs) are often described as hotbeds of antimicrobial resistance, with high rates of extended-spectrum β-lactamase (ESBL)-producing and multidrug-resistant (MDR) Enterobacteriaceae. Data from the SMART study were used to examine differences between the susceptibility of Enterobacteriaceae from ICU and non-ICU wards in Europe and North America. In total, 21,470 Enterobacteriaceae isolates from intra-abdominal and urinary tract infections were collected at 90 sites in 20 European and North American countries in 2011–2013. Susceptibility and ESBL phenotypes were determined using the CLSI broth microdilution method and breakpoints. Susceptibility was lower and ESBL and MDR rates were higher in ICUs, with much greater ICU/non-ICU differences in Europe than North America. Susceptibility was lower and ESBL and MDR rates were higher in Europe than in North America in both patient locations. Resistance among Enterobacteriaceae in Europe was largely driven by Klebsiella pneumoniae, which had high rates of ESBLs (41.2% in ICUs; mostly CTX-M) and carbapenemases (13.2%; mostly KPC and OXA). For all Enterobacteriaceae combined, only ertapenem and amikacin inhibited >90% of isolates in ICUs in both regions. In North America, ertapenem, imipenem and amikacin inhibited >90% of K. pneumoniae from ICUs, whereas in Europe only amikacin did. ESBL and MDR rates varied considerably within Europe. Antimicrobial resistance was higher in Europe than North America, especially in ICUs. Further surveillance at the country, hospital and even patient ward level, and investigation of reasons for these findings, would be useful for the development of effective strategies to reduce antimicrobial resistance in ICUs.
    No preview · Article · Jul 2015 · Journal of Global Antimicrobial Resistance
  • S. Lob · M. Hackel · D. Biedenbach · D. Sahm · R. Badal

    No preview · Conference Paper · May 2015
  • S. Lob · D. Biedenbach · M. Hackel · D. Sahm · R. Badal

    No preview · Conference Paper · May 2015
  • D. Biedenbach · S. Lob · R. Badal · D. Sahm

    No preview · Conference Paper · May 2015

  • No preview · Conference Paper · May 2015
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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.
    Full-text · Article · Apr 2015 · International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases
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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.
    No preview · Article · Apr 2015 · Surgical Infections
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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.
    No preview · Article · Apr 2015 · Diagnostic microbiology and infectious disease
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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.
    No preview · Article · Mar 2015 · Antimicrobial Agents and Chemotherapy
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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.
    Full-text · Article · Nov 2014 · Antimicrobial Agents and Chemotherapy
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    ABSTRACT: Escherichia coli sequence type 131 (ST131) was identified as pathogenic to humans in 2008; retrospective research suggests that its isolates have been present since at least 2003. The group has spread extensively and has been linked to the rapid global increase in the prevalence of antimicrobial resistance among E. coli strains (1). The intercontinental dissemination of this sequence type has contributed immensely to the worldwide emergence of fluoroquinolone-resistant and CTX-M-producing E. coli (1,2). Recent surveillance studies have shown that its overall prevalence ranges from 12.5% to 30% of all E. coli clinical isolates, from 70% to 80% of fluoroquinolone-resistant isolates, and from 50% to 60% of extended spectrum betalactamase- producing isolates (3). The development of resistance to carbapenems among E. coli is of particular concern because these agents are often the last line of effective therapy available for the treatment of persons with serious infections (4). New Delhi metallo-β-lactamase (NDM) and carbapenem-hydrolyzing oxacillinase-48 (OXA-48) are the most common carbapenemases among E. coli worldwide (5). © 2014, Centers for Disease Control and Prevention (CDC). All Rights Reserved.
    Full-text · Article · Nov 2014 · Emerging infectious diseases
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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.
    No preview · Conference Paper · Oct 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.
    No preview · Conference Paper · Oct 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.
    No preview · Conference Paper · Oct 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.
    No preview · Conference Paper · Oct 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.
    No preview · Conference Paper · Oct 2014
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    D. Hoban · M. Hackel · R. Badal · E. Reiszner · J. Ambler
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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).
    Full-text · Conference Paper · Sep 2014
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    D. Hoban · M. Hackel · R. Badal · E. Reiszner · J. Ambler
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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.
    Full-text · Conference Paper · Sep 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.
    No preview · Article · Aug 2014 · Diagnostic Microbiology and Infectious Disease

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Institutions

  • 2014
    • Chinese Academy of Medical Sciences
      Peping, Beijing, China
  • 2008
    • Oxford University Clinical Research Unit
      Thành phố Hồ Chí Minh, Ho Chi Minh City, Vietnam
    • National Institute of Animal Health
      Edo, Tōkyō, Japan