Antimicrobial susceptibility to polymyxin B and other comparators against Gram-negative bacteria isolated from bloodstream infections in China: Results from CARVIS-NET program

Abstract

ObjectiveTo investigate the bacterial distribution and antimicrobial resistance profile of clinical isolates from Gram-negative bacteria bloodstream infections (GNBSI) in China.MethodsThe clinical bacterial strains isolated from blood culture were collected during April 2019 to December 2021 in 21 member hospitals of China Bloodstream Gram-negative Pathogens Antimicrobial Resistance and Virulence Surveillance Network (CARVIS-NET). Antibiotic susceptibility test was conducted by broth microdilution method recommended by Clinical and Laboratory Standards Institute (CLSI, United States). WHONET 2021 and SPSS 22.0 were used to analyze data.ResultsDuring the study period, 1939 Gram-negative bacteria were collected from 21 hospitals, among which 1,724 (88.9%) were Enterobacteriaceae, 207 (10.7%) were non-fermenting Gram-negative bacteria and 8 (0.4%) were others. The top five bacterial species were Escherichia coli (46.2%), Klebsiella pneumoniae (31.6%), Pseudomonas aeruginosa (4.9%), Acinetobacter baumannii (4.2%) and Enterobacter cloacae (3.0%). For K. pneumoniae, antibiotic resistance was mainly prevalent in hospital-associated bloodstream infections, while for A. baumannii, antibiotic resistance was mainly prevalent in community-associated bloodstream infections. It is worth mentioning that 94.1% of the 1939 Gram-negative isolates were susceptible to polymyxin B. The sensitivity of the strains involved in our investigation to polymyxin B is highly correlated with their sensitivity to colistin.ConclusionThe surveillance results in CARVIS-NET-2021 showed that the main pathogens of GNBSI in China were Enterobacteriaceae, while E. coli was the most common pathogen. The resistance rates of K. pneumonia, P. aeruginosa, A. baumannii, and E. cloacae to multiple antibiotics kept on a high level. In many cases, polymyxin B and colistin has become the last-resort agents to combat bloodstream infections caused by multidrug-resistant (MDR) Gram-negative bacteria.

Comparative pharmacokinetics of polymyxin B in critically ill elderly patients with extensively drug-resistant gram-negative bacteria infections

“…Similarly to our study, Wang et al found that the mean AUC ss, 24 h of PMB in their renal insufficiency group was higher than in their normal renal function group, with marginal significance ( Wang et al, 2021a ). Moreover, some clinical studies have demonstrated that the patients with PMB-associated AKI had higher AUC ss, 0–24 h ( Xu et al, 2022 ; Yang et al, 2022 ), higher baseline serum creatinine levels, or lower baseline glomerular filtration rates compared to patients without PMB-associated nephrotoxicity ( John et al, 2017 ; Xi et al, 2022 ; Xu et al, 2022 ). These results support the speculation that patients with renal dysfunction are more likely to develop higher PMB exposure and that the dosing regimen of PMB should be adjusted in patients with renal dysfunction.…”

“…The emergence of extensively drug-resistant Gram-negative bacteria (XDR-GNB) has become a major global health challenge because of the rapid resistance transmission, increasing treatment difficulties, and association with high morbidity and mortality rates ( Borer et al, 2009 ; Cassini et al, 2019 ). Polymyxins including colistin and polymyxin B (PMB) have excellent antibacterial activity against the majority of XDR-GNB as reported by recent surveillance surveys ( Diekema et al, 2019 ; Xi et al, 2022 ) and have been revived as the last-resort therapeutic opinion for XDR-GNB infections ( Katip et al, 2020 ; Katip et al, 2021 ; Liu et al, 2023 ). PMB is an active drug without requiring conversion to colistin after its administration, whereas colistin must be administered as an inactive prodrug, colistin methanesulfonate, to then be converted to colistin in vivo , which could be slow and incomplete.…”

A Cost-Effectiveness Analysis Comparing Ceftazidime-Avibactam with Meropenem for the Treatment of Hospital-Acquired Pneumonia (Including Ventilator-Associated Pneumonia)

“…The assumed second-line regimen of intravenous polymyxin B combined with high-dose meropenem was applied to both the intervention and comparator groups. c The data were sourced from the study by Peiyao Jia et al [22] d The data were sourced from the study by Jingyuan Xi et al [23] The model took antibiotic resistance into account in assessing outcomes. Table 1 summarizes the baseline pathogen distribution and resistance rates to ceftazidime-avibactam and meropenem among major pathogens causing HAP/VAP.…”

Intrathecal Injection of Polymyxin B in a Child with Meningitis Caused by Carbapenem-Resistant Pseudomonas aeruginosa: A Case Report and Literature Review

“… 1 Another investigation reported a rate of 4.9% for P. aeruginosa among 1939 isolated gram-negative bacteria from 21 hospitals in China between April 2019 and December 2021. 2 Notably, most of the bacteriological susceptibility tests from various tissue samples indicated that the strain was sensitive to polymyxin B, indicating that the minimum inhibitory concentration (MIC) of polymyxin B against this strain was less than 2 mg/L. 2 Polymyxins B was initially employed in the 1940s but was swiftly discontinued due to concerns of neurotoxicity and nephrotoxicity.…”

“… 2 Notably, most of the bacteriological susceptibility tests from various tissue samples indicated that the strain was sensitive to polymyxin B, indicating that the minimum inhibitory concentration (MIC) of polymyxin B against this strain was less than 2 mg/L. 2 Polymyxins B was initially employed in the 1940s but was swiftly discontinued due to concerns of neurotoxicity and nephrotoxicity. However, it has been re-recommended, particularly for carbapenem-resistant gram-negative organisms that retain high antimicrobial susceptibility to polymyxins B, in recent years.…”