Multicenter Study Journal Article Epublish 1 citation
PubMed: 38047021 DOI: 10.7717/peerj.16393
A multicentre study to determine the efficacy of flomoxef against extended-spectrum beta-lactamase producing in Malaysia.
PeerJ 11:e16393
Authors: Polly Soo Xi Yap, Chun Wie Chong, Sasheela Ponnampalavanar, Ramliza Ramli, Azian Harun, Tengku Zetty Maztura Tengku Jamaluddin, Anis Ahmed Khan, Soo Tein Ngoi, Yee Qing Lee, Min Yi Lau, Shiang Chiet Tan, Zhi Xian Kong, Jia Jie Woon, Siew Thong Mak, Kartini Abdul Jabar, Rina Karunakaran, Zalina Ismail, Sharifah Azura Salleh, Siti Suraiya Md Noor, Siti Norbaya Masri, Niazlin Mohd Taib, Azmiza Syawani Jasni, Loong Hua Tee, Kin Chong Leong, Victor Kok Eow Lim, Sazaly Abu Bakar, Cindy Shuan Ju Teh
Affiliations
- Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
- Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia.
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
- School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia.
- Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Kuala Lumpur, Malaysia.
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
- Shionogi Singapore, Singapore, Singapore.
- Tropical Infectious Diseases Research and Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia.
Abstract
Background
The high burden of extended-spectrum beta-lactamase-producing (ESBL)-producing Enterobacterales worldwide, especially in the densely populated South East Asia poses a significant threat to the global transmission of antibiotic resistance. Molecular surveillance of ESBL-producing pathogens in this region is vital for understanding the local epidemiology, informing treatment choices, and addressing the regional and global implications of antibiotic resistance.
Methods
Therefore, an inventory surveillance of the ESBL- (ESBL-EC) isolates responsible for infections in Malaysian hospitals was conducted. Additionally, the efficacy of flomoxef and other established antibiotics against ESBL-EC was evaluated.
Results
A total of 127 non-repetitive ESBL-EC strains isolated from clinical samples were collected during a multicentre study performed in five representative Malaysian hospitals. Of all the isolates, 33.9% were isolated from surgical site infections and 85.8% were hospital-acquired infections. High rates of resistance to cefotaxime (100%), cefepime (100%), aztreonam (100%) and trimethoprim-sulfamethoxazole (100%) were observed based on the broth microdilution test. Carbapenems remained the most effective antibiotics against the ESBL-EC, followed by flomoxef. Antibiotic resistance genes were identified by PCR. The was the most prevalent ESBL gene, with 28 isolates (22%) harbouring only, 27 isolates (21.3%) co-harbouring and , and ten isolates (7.9%) co-harbouring and . A generalised linear model showed significant antibacterial activity of imipenem against different types of infection. Besides carbapenems, this study also demonstrated a satisfactory antibacterial activity of flomoxef (81.9%) on ESBL-EC, regardless of the types of ESBL genes.
MeSH
Infections, Beta-Lactamases, Genes, Trimethoprim, Sulfamethoxazole Drug Combination