Abstract
To provide direction for clinical application and pharmaceutical exploitation, the in vitro activity of sulbactam compounds and PIP/TAZ 8 : 1 against clinical isolates of Gram-negative bacteria (GNB, n = 976) was evaluated according to Clinical and Laboratory Standards Institute (CLSI) 2019. By minimal inhibitory concentrations (MICs), the resistance rate of all GNB to AMP/SBT 2 : 1 (56.9-100%) was significantly higher than other drugs, except the resistance rate of Acinetobacter baumannii (Aba, n = 204) to piperacillin/tazobactam (PIP/TAZ 8 : 1, 78.4%) which was close to it (76.5%). Additionally, the resistance rate of Aba to other compounds except AMP/SBT 2 : 1 differed greatly, but that of Klebsiella pneumonia (Kpn, n = 205) varied rarely. In addition, Escherichia coli (Eco, n = 204) and Kpn demonstrated low and high resistance rates, respectively. Compared with cefoperazone/sulbactam (CPZ/SBT 2 : 1), PIP/TAZ 8 : 1 had advantage in anti-Eco (RR = 0.5and OR = 2.17) and anti-Kpn activity (RR = 0.88and OR = 1.27), while its activity against Pseudomonas aeruginosa (Pae: n = 194, RR = 0.91, and OR = 1.12), Aba (RR = 1.31 and OR = 0.41), and other Enterobacteriaceae (other Ebc: n = 169, RR = 1.40, and OR = 0.62) was not better than CPZ/SBT 2 : 1. Although it had advantage against Eco (RR = 0.60 and OR = 1.78), Pae (RR = 0.67 and OR = 1.63), and Aba (RR = 0.70 and OR = 2.05), the inhibition effect of piperacillin/sulbactam (PIP/SBT 2 : 1) against Kpn (RR = 0.94 and OR = 1.12) and other Ebc was just similar with CPZ/SBT 2 : 1 (RR = 0.93 and OR = 1.10). Furthermore, the anti-Eco (RR = 0.70 and OR = 1.50), anti-Kpn (RR = 0.89 and OR = 1.24), and anti-Pae (RR = 0.74 and OR = 1.46) activities of ceftazidime/sulbactam (CAZ/SBT 1 : 1) had a weak advantage, while its activity against Aba (RR = 0.94 and OR = 1.15) and other Ebc (RR = 0.79 and OR = 1.36) was just close to CPZ/SBT 2 : 1. Moreover, the inhibitory effect of PIP/SBT 1 : 1 against all tested clinical species was more active than CPZ/SBT 2 : 1, while that of CAZ/SBT 2 : 1 against all species of bacteria analyzed was weaker than the controls.
Highlights
The emergence of clinically resistant bacteria increases the difficulty of curing infectious diseases [1,2,3]
Data from the China Antimicrobial Resistance Surveillance System (CARSS) from October 2017 to September 2018 showed that the total number of bacteria that could be included in the analysis of bacterial resistance reached 3,234,372 after removing duplicate strains based on the principle of retaining the first strain of the same bacteria in the same patient, of which Gram-negative bacteria (GNB) accounted for the majority (70.6%) (NHC, 2019)
This research could provide a direction for the clinical treatment of bacterial infections in adults and elders, but it might not be extended to the infections in children
Summary
The emergence of clinically resistant bacteria increases the difficulty of curing infectious diseases [1,2,3]. Gram-negative bacteria (GNB) are one of the most important public health problems in the world due to the high resistance to antibiotics. These microorganisms have important clinical significance in hospitals because since patients in the intensive care unit (ICU) are at high risk and GNB cause high morbidity and mortality [4,5,6]. To overcome the resistance of β-lactamase, medical institutions gradually advocate combining the β-lactam antibiotics and β-lactamase inhibitors to improve their antimicrobial activity. From the Status Report on Antimicrobial Administration and Antimicrobial Resistance in China [8], the proportion of cephalosporins/enzyme inhibitors, penicillin/enzyme inhibitors, and other β-lactams in the main antimicrobial applications of general hospitals was not low in 2018 (12%, 8%, and 6%, respectively)
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