Activity of ceftolozane-tazobactam and comparators against gram-negative bacilli: Results from the study for monitoring antimicrobial resistance trends (SMART – Brazil; 2016–2017)

Beirão, Elisa Maria; Rodrigues, Suellen da Silva; Andrade, Tarik Klain de; Serra, Fernando Brandão; Paula, Marina Della Negra de; Polis, Thales Jose Bueno; Gales, Ana Cristina

doi:10.1016/j.bjid.2020.05.010

Elisa Maria Beirão ^**Corresponding author. elisa.m.beirao@gmail.com

Conjunto Hospitalar do Mandaqui, São Paulo, SP, Brazil

https://orcid.org/0000-0002-2648-8767

Suellen da Silva Rodrigues

Global Medical Affairs, MSD in Brazil, São Paulo, SP, Brazil

Tarik Klain de Andrade

Global Medical Affairs, MSD in Brazil, São Paulo, SP, Brazil

Fernando Brandão Serra

Global Medical Affairs, MSD in Brazil, São Paulo, SP, Brazil

Marina Della Negra de Paula

Global Medical Affairs, MSD in Brazil, São Paulo, SP, Brazil

Thales Jose Bueno Polis

Global Medical Affairs, MSD in Brazil, São Paulo, SP, Brazil

Ana Cristina Gales

Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Divisão de Doenças Infecciosas, São Paulo, SP, Brazil

*Corresponding author. elisa.m.beirao@gmail.com

Figures (3)
Tables (3)

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Fig. 1
Distribution of isolates according to the bacterial species collected from participating Brazilian medical centers of the SMART Program (Brazil, 2016-2017).a. Acinetobacter spp. (53): A. baumannii (49), A. ursingii (1), A. guillouiae (1), A. nosocomialis (1), and A. pittii (1);b. Citrobacter spp. (47): C. amalonaticus (1), C. farmeri (3), C. freundii (30), and C. koseri (13);c. Enterobacter spp. (100): E. asburiae (13), E. cloacae (81), E. kobei (5), and Enterobacter spp. (1);d. Klebsiella spp. (537): K. aerogenes (65), K. oxytoca (19), K. pneumoniae (431), and K. variicola (22);e. Proteus spp. (96): P. hauseri (2), P. mirabilis (91), and P. vulgaris (3);f. Pseudomonas spp. (268): P. aeruginosa (265), P. mosselii (1), P. otitidis (1), and P. putida (1);g. Others (70): Achromobacter xylosoxidans (5), Aeromonas caviae (1), Aeromonas hydrophila (1), Burkholderia cenocepacia (3), Escherichia hermanii (1), Morganella morganii (20), Pluralibacter gergoviae (2), Providencia alcalifaciens (1), Providencoa rettgeri (4), Providencia stuartii (6), Raoultella ornithinolytica (1), and Raoutella planticola (1), Salmonella spp. (2), Stenotrophomonas maltophilia (22).

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Fig. 2
Distribution of bacterial species according to the type of infection (SMART Program- Brazil, 2016-2017).

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Fig. 3
Distribution frequency of beta-lactamase encoding genes according to participating Brazilian medical centers. The size and value of each rectangle is proportional to the frequency of each beta-lactamase encoding gene found in that respective medical center.

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Table 1
Antimicrobial susceptibility profile of the five most frequent pathogens causing infections at participating Brazilian medical centers of the SMART Program (Brazil, 2016-2017).

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Table 2
Susceptibility rates to distinct antimicrobial agents of the five most frequent pathogens according to the phenotype of resistance.

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Table 3
Distribution of beta-lactamase encoding genes according to bacterial species and medical center location.

Pathogen Antimicrobial Agents	Broth Microdiluition (µg/mL)		CLSI^a a CLSI, Clinical Laboratory Standards Institute; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MIC, minimal inhibitory concentration; R, Resistant; S, susceptible.		EUCAST^a a CLSI, Clinical Laboratory Standards Institute; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MIC, minimal inhibitory concentration; R, Resistant; S, susceptible.
Pathogen Antimicrobial Agents	MIC₅₀	MIC₉₀	S (%)	R (%)	S (%)	R (%)
Enterobacter cloacae (81)
Amikacin	≤ 4	≤ 4	98.8	1.2	98.8	1.2
Aztreonam	> 16	> 16	39.5	60.5	38.3	60.7
Cefepime	4	> 32	46.9	53.1	39.5	60.5
Ceftazidime	32	> 32	39.5	60.5	35.8	61.2
Ceftolozane-tazobactam	2	16	59.3	40.7	46.9	53.1
Ceftriaxone	> 32	> 32	38.3	61.7	38.3	60.7
Ciprofloxacin	≤ 0.25	> 2	61.7	38.3	61.7	38.3
Colistin	≤ 1	> 1	95.1	4.9	95.1	4.9
Ertapenem	≤ 0.12	1	77.8	22.2	77.8	22.2
Imipenem	≤ 0.5	1	96.3	3.7	98.8	1.2
Meropenem	≤ 0.12	0.25	98.8	1.2	98.8	1.2
Piperacillin-tazobactam	16	> 64	50.6	49.4	43.2	56.8

E. coli (494)
Amikacin	≤ 4	8	98.6	0.4	97.4	2.6
Aztreonam	≤ 1	> 16	80.0	20.0	71.5	28.5
Cefepime	≤ 1	> 32	76.5	23.5	73.3	26.7
Ceftazidime	≤ 1	16	84.4	15.6	78.1	21.9
Ceftolozane-tazobactam	0.25	0.5	96.8	3.2	94.7	5.3
Ceftriaxone	≤ 1	> 32	71.7	28.3	71.7	28.3
Ciprofloxacin	≤ 0.25	> 2	55.1	44.9	55.1	44.9
Colistin	≤ 1	≤ 1	99.4	0.6	99.4	0.6
Ertapenem	≤ 0.06	≤ 0.06	97.8	2.2	97.8	2.2
Imipenem	≤ 0.5	≤ 0.5	98.6	0.6	99.4	0.6
Meropenem	≤ 0.12	≤ 0.12	99.0	1.0	99.0	1.0
Piperacillin-tazobactam	≤ 2	8	93.3	6,7	90.9	9.1

K. pneumoniae (431)
Amikacin	≤ 4	32	89.6	10.4	85.9	14.1
Aztreonam	> 16	> 16	37.4	62.6	35.0	65.0
Cefepime	32	> 32	36.7	63.3	35.7	64.3
Ceftazidime	32	> 32	39.0	61.0	34.3	65.7
Ceftolozane-tazobactam	4	> 32	49.7	50.3	44.1	55.9
Ceftriaxone	> 32	> 32	36.2	63.8	36.2	63.8
Ciprofloxacin	> 2	> 2	31.6	68.4	31.6	68.4
Colistin	≤ 1	> 4	85.4	14.6	85.4	14.6
Ertapenem	0.25	> 4	55.2	44.8	55.2	44.8
Imipenem	≤ 0.5	> 32	61.0	39.0	62.2	37.8
Meropenem	≤ 0.12	> 16	58.7	42.3	60.1	39.9
Piperacillin-tazobactam	> 64	> 64	41.5	58.5	36.7	63.3

P. aeruginosa (265)
Amikacin	≤ 4	16	91.7	8.3	87.9	12.1
Aztreonam	8	> 16	52.5	47.5	67.6	32.4
Cefepime	8	32	68.3	31.7	68.3	31.7
Ceftazidime	4	> 32	66.8	33.2	66.8	33.2
Ceftolozane-tazobactam	1	4	90.9	9.1	90.9	9.1
Ciprofloxacin	≤ 0.25	> 2	69.8	30.2	69.8	30.2
Colistin	≤1	2	98.9	1.1	98.9	1.1
Imipenem	1	16	63.8	36.2	70.2	29.8
Meropenem	1	> 16	66.0	34.0	66.0	34.0
Piperacillin Tazobactam	16	> 64	59.6	40.4	59.6	40.4

P. mirabilis (91)
Amikacin	≤ 4	8	97.8	2.2	95.6	4.4
Aztreonam	≤ 1	2	94.5	5.5	83.5	16.5
Cefepime	≤ 1	32	82.4	17.6	80.2	19.8
Ceftazidime	≤ 1	2	95.6	4.4	85.7	14.3
Ceftolozane-tazobactam	0.5	0.5	98.9	1.1	97.8	2.2
Ceftriaxone	≤ 1	> 32	78.0	22.0	78.0	22.0
Ciprofloxacin	≤ 0.25	> 2	72.5	27.5	72.5	27.5
Ertapenem	≤ 0.06	≤ 0.06	95.6	4.4	95.6	4.4
Imipenem	1	2	55.0	45.0	92.3	7.7
Meropenem	≤ 0.12	≤ 0.12	98.9	1.1	98.9	1.1
Piperacillin-tazobactam	≤ 2	≤2	97.8	2.2	96.7	3.3

E. cloacae non susceptible to ceftazidime (52)	Broth Microdiluition µg/mL		CLSI^a		EUCAST^a
E. cloacae non susceptible to ceftazidime (52)	MIC₅₀	MIC₉₀	S (%)	R (%)	S (%)	R (%)
Amikacin	≤ 4	≤ 4	97.9	2.1	98.0	2.0
Aztreonam	> 16	> 16	0	100	3.8	96.2
Cefepime	16	> 32	12.2	87.8	5.7	94;3
Ceftazidime	> 32	> 32	0	100.0	0	100.0
Ceftolozane-tazobactam	8	32	32.6	67.4	19.2	80.8
Ceftriaxone	> 32	> 32	0	100	5.7	94.3
Ciprofloxacin	2	> 2	42.8	57.2	44.2	55.8
Colistin	≤ 1	≤ 1	94.2	5.8	94.2	5.8
Ertapenem	0.5	2	63.2	37.8	65.3	34,7
Imipenem	≤ 0.5	1	95.9	4.1	98.0	2.0
Meropenem	≤ 0.12	0.25	97.9	2.1	98.0	2.0
Piperacillin-tazobactam	64	> 64	20.4	79.6	11.5	88.5

ESBL-producing E. coli (102)
Amikacin	≤ 4	8	97.1	2.9	94.1	2.9
Aztreonam	> 16	> 16	22.6	77.4	2.9	97.1
Cefepime	32	> 32	5.8	94.2	0	100.0
Ceftazidime	8	32	37.3	62.7	21.5	78.5
Ceftolozane-tazobactam	0.5	2	92.2	7.8	87.2	12.8
Ceftriaxone	> 32	> 32	0	100.0	0	100.0
Ciprofloxacin	> 2	> 2	19.6	80.4	19.6	80.4
Colistin	≤ 1	≤ 1	99.0	1.00	99.0	1.00
Ertapenem	≤ 0.06	0.12	97.1	2.9	97.0	3.0
Imipenem	≤ 0.5	≤ 0.5	99.0	1.0	99.0	1.0
Meropenem	≤ 0.12	≤ 0.12	99.0	1.0	99.0	1.0
Piperacillin-tazobactam	4	32	86.3	13.7	80.3	19.7

ESBL-producing K. pneumoniae (144)
Amikacin	≤ 4	16	92.4	7.6	88,9	11.1
Aztreonam	> 16	> 16	2.1	97.9	0.7	99.3
Cefepime	> 32	> 32	0.7	99.3	0.7	99.3
Ceftazidime	> 32	> 32	4.2	95.8	0.7	99.3
Ceftolozane-tazobactam	16	> 32	36.1	63.9	22.9	77.1
Ceftriaxone	> 32	> 32	0.7	99.3	0.7	99.3
Ciprofloxacin	> 2	> 2	2.1	97.9	2.1	97.9
Colistin	≤ 1	> 4	79.9	20.1	79.9	20.1
Ertapenem	0.5	> 4	53.5	46.5	53.5	46.5
Imipenem	≤ 0.5	> 32	63.2	36.8	66.0	44.0
Meropenem	≤ 0.12	> 16	60.4	39.6	63.2	36.8
Piperacillin-tazobactam	> 64	> 64	22.2	77.8	13.2	86.8
K. pneumoniae non susceptible to imipenem (168)
Amikacin	≤ 4	> 32	79.2	20.8	69.9	30.1
Aztreonam	> 16	> 16	1.2	98.8	0.0	100.0
Cefepime	> 32	> 32	0.6	99.4	0.0	100.0
Ceftazidime	> 32	> 32	2.4	97.6	0.6	99.4
Ceftolozane-tazobactam	> 32	> 32	1.2	98.8	0.6	99.4
Ceftriaxone	> 32	> 32	0.0	100.0	0.0	100.0
Ciprofloxacin	> 2	> 2	3.0	97.0	2.5	97.5
Colistin	≤ 1	> 4	71.4	28.6	71.4	28.6
Ertapenem	> 4	> 4	1.2	98.8	0.6	99.4
Imipenem	32	> 32	0.0	100.0	0.0	100.0
Meropenem	> 16	> 16	1.8	98.2	0.6	99.4
Piperacillin-tazobactam	> 64	> 64	1.2	98.8	0.6	99.4

P. aeruginosa non susceptible to ceftazidime (88)
Amikacin	≤ 4	> 32	85.2	14.8	77.3	22.7
Aztreonam	> 16	> 16	11.4	88.6	29.6	70.4
Cefepime	32	> 32	19.3	80.7	19.3	80.7
Ceftazidime	> 32	> 32	0.0	100.0	0.0	100.0
Ceftolozane-tazobactam	4	32	73.9	26.1	73.9	26.1
Ciprofloxacin	1	> 2	47.7	52.3	47.7	52.3
Colistin	≤ 1	2	96.6	3.4	96.6	3.4
Imipenem	2	32	50.0	50.0	53.4	46.6
Meropenem	4	> 16	44.3	55.7	44.3	55.7
Piperacillin-tazobactam	> 64	> 64	8.0	92.0	8.0	92.0

P. aeruginosa non susceptible to imipenem (96)
Amikacin	≤ 4	> 32	86.5	13.5	77.2	22.8
Aztreonam	16	> 16	30.2	69.8	46.8	53.2
Cefepime	8	> 32	50.0	50.0	43.0	57.0
Ceftazidime	8	> 32	54.2	45.8	48.1	51.9
Ceftolozane-tazobactam	2	16	82.3	17.7	79.8	20,2
Ciprofloxacin	0.5	> 2	53.1	46.9	48.1	51.9
Colistin	≤ 1	2	99.0	1.0	99.0	1.0
Imipenem	8	32	0.0	82.3	0.0	100,0
Meropenem	16	> 16	13.5	86.5	3.8	96.2
Piperacillin-tazobactam	32	> 64	41.7	58.3	32.9	67.1

P. mirabilis ESBL (10)
Amikacin	≤ 4	8	100.0	0.0	100.0	0.0
Aztreonam	2	16	70.0	30.0	30.0	30.0
Cefepime	32	> 32	0.0	100.0	0,0	100.0
Ceftazidime	2	8	80.0	20.0	40.0	60,0
Ceftolozane-tazobactam	0.5	1	100.0	0.0	90.0	10.0
Ceftriaxone	> 32	> 32	0.0	100.0	0.0	100,0
Ciprofloxacin	> 2	> 2	0.0	100.0	0.0	100.0
Ertapenem	≤ 0.06	≤ 0.06	100.0	0.0	100.0	0,0
Imipenem	1	2	60.0	40.0	100.0	0.0
Meropenem	≤ 0.12	≤ 0.12	100.0	0.0	100.0	0.0
Piperacillin-tazobactam	≤ 2	8	100.0	0.0	90.0	0.0

Bacterial Species/ β-lactamase encoding genes (Number)	Number of Isolates detected by geographic location (Number)	Other β-lactamase encoding genes
E. coli (52)
ESBL (37)
bla_CTX-M-2 (8)	SP (⁷7 CLSI. M100Ed29E. Performance Standards for Antimicrobial Susceptibility Testing: 29th Informational Supplement. Wayne, PA: Clinical and Laboratory Standards Institute; 2019.), RJ (1)
bla_CTX-M-8 (11)	SP (⁹9 EUCAST. Breakpoint tables for interpretation of MIC’s and zone diameters, version 8.0, January 2019. Växjö, Sweden:European Committee on Antimicrobial Susceptibility Testing;2019, http//www.eucast.org/fileadmin/src/media/PDFs/EUCAST files/Breakpoint tables/v 9.0 Breakpoint Tables.pdf. http//www.eucast.org/fileadmin/src/media... ), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)
bla_CTX-M-9 (2)	RJ (2)
bla_CTX-M-14 (3)	SP (3)
bla_CTX-M-15 (13)	SP (¹¹11 Sader HS, Rhomberg PR, Fuhrmeister AS, Mendes RE, Flamm RK, Jones RN. Antimicrobial Resistance Surveillance and New Drug Development. Open Forum Infect Dis. 2019;6(Suppl 1):S5-S13. https://doi.org/10.1093/ofid/ofy345... ), RJ (2)
Carbapenemase (4)
bla_KPC-2(4)	SP (²2 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (²2 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)

E. cloacae (12)
ESBL (12)
bla_CTX-M-15 (11)	SP (¹¹11 Sader HS, Rhomberg PR, Fuhrmeister AS, Mendes RE, Flamm RK, Jones RN. Antimicrobial Resistance Surveillance and New Drug Development. Open Forum Infect Dis. 2019;6(Suppl 1):S5-S13. https://doi.org/10.1093/ofid/ofy345... ), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)
Bla_SHV-12(1)	SP (1)
Carbapenemase (1)
bla_KPC-2(1)	Salvador (1)
P. mirabilis (3)
ESBL (3)
bla_CTX-M-2 (1)	RJ (1)
bla_CTX-M-8 (1)	SP (1)
bla_CTX-M-15 (1)	SP (1)

K. pneumoniae (238)
ESBL (173)
bla_CTX-M-2 (43)	SP (43)	bla_KPC-2 (32)
bla_CTX-M-3 (1)	SP (1)
bla_CTX-M-8 (6)	SP (⁴4 Boletim Segurança do Paciente e Qualidade em Serviços de Saúde nº 17: Avaliação dos indicadores nacionais das infecções relacionadas à assistência à saúde (IRAS) e resistência microbiana do ano de 2017. Published on April 29th, 2019 https://app.powerbi.com/view?r=eyJrIjoiZTFiOGRhOTYtYzZjOS00NmZmLWE5MWUtN2RkNDhiZGJiOGE1IiwidCI6ImI2N2FmMjNmLWMzZjMtNGQzNS04MGM3LWI3MDg1ZjVlZGQ4MSJ. Last accessed on September 23rd, 2019. https://app.powerbi.com/view?r=eyJrIjoiZ... ), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)	bla_KPC-2 (2)
bla_CTX-M-9 (3)	SP (3)
bla_CTX-M-14 (34)	SP (34)	bla_KPC-2 (33)
bla_CTX-M-15 (84)	SP (56), RJ (¹⁷17 Popejoy MW, Paterson DL, Cloutier D, Huntington JA, Miller B, Bliss CA, et al. Efficacy of ceftolozane/tazobactam against urinary tract and intra-abdominal infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae: a pooled analysis of Phase 3 clinical trials. J Antimicrob Chemother. 2017;72(1):268-272. https://doi.org/10.1093/jac/dkw374... ), Salvador (11)	bla_KPC-2 (38); bla_NDM-1(2)
bla_CTX-M-35 (2)	SP (2)
bla_CTX-M-141 (1)	Salvador (1)	bla_KPC-2 (1)

AmpC (2)
bla_CMY-2 (1)	SP (1)
bla_CMY-141(1)	SP (1)

Carbapenemase (165)
bla_KPC-2 (163)	SP (148), RJ (⁷7 CLSI. M100Ed29E. Performance Standards for Antimicrobial Susceptibility Testing: 29th Informational Supplement. Wayne, PA: Clinical and Laboratory Standards Institute; 2019.), Salvador (8)
bla_KPC-3 (1)	SP (1)
bla_KPC-30 (1)	SP (1)
bla_NDM-1 (2)	RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)

P. aeruginosa (104)
PDC (104)
PDC-1 (4)	SP (²2 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)
PDC-3 (11)	SP (⁸8 Brazilian Committee on Antimicrobial Susceptibility Testing – BrCAST. http://brcast.org.br/documentos/. http://brcast.org.br/documentos/... ), RJ (3)
PDC-5 (15)	SP (¹³13 Yin D, Wu S, Yang Y, et al. Results from the China Antimicrobial Surveillance Network (CHINET) in 2017 of the In Vitro Activities of Ceftazidime-Avibactam and Ceftolozane-Tazobactam against Clinical Isolates of Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2019;63(4), e02431-18. Published 2019 Mar 27. doi:10.1128/AAC.02431-18. https://doi.org/10.1128/AAC.02431-18.... ), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)	bla_IMP-1 in SP (1); bla_SPM-1 in SP (2)
PDC-6 (1)	SP (1)
PDC-8 (8)	SP (8)
PDC-10 (1)	SP (1)
PDC-11 (3)	SP (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)
PDC-12 (3)	SP (3)
PDC-16 (11)	SP (⁹9 EUCAST. Breakpoint tables for interpretation of MIC’s and zone diameters, version 8.0, January 2019. Växjö, Sweden:European Committee on Antimicrobial Susceptibility Testing;2019, http//www.eucast.org/fileadmin/src/media/PDFs/EUCAST files/Breakpoint tables/v 9.0 Breakpoint Tables.pdf. http//www.eucast.org/fileadmin/src/media... ), Salvador (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.), RJ (¹1 CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.)
PDC-19A (8)	SP (⁶6 Van Duin D, Doi Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence. 2017;8(4):460-469.), Salvador (2)	bla_VIM-2 in SP (1)
PDC-24 (2)	SP (2)
PDC-31 (1)	RJ (1)
PDC-35 (19)	SP (19)	bla_IMP-74 in SP (1); bla_CTX-M-2 in SP (3); bla_GES-1 in SP (2);
PDC-36 (1)	SP (1)
PDC-37 (4)	SP (3), Salvador (1)	bla_KPC-2 in SP (1)
PDC-45 (1)	SP (1)
PDC-55 (1)	Salvador (1)
PDC-59 (1)	SP (1)	bla_CTX-M-2 in SP (1)
PDC-109 (1)	SP (1)
PDC-115 (2)	SP (2)
PDC-120 (1)	SP (1)
PDC-124 (1)	SP (1)
PDC-194 (1)	SP (1)
PDC-218 (1)	SP (1)
PDC-252 (1)	SP (1)
PDC-253 (1)	SP (1)

[1] *Corresponding author. elisa.m.beirao@gmail.com

Brasil

Brasil

Activity of ceftolozane-tazobactam and comparators against gram-negative bacilli: Results from the study for monitoring antimicrobial resistance trends (SMART – Brazil; 2016–2017)

Abstract

Methods

Results

Conclusion