Antimicrobial resistance patterns of ESKAPEE pathogens and in vitro coverage of combination regimens based on antibiogram data at Le Huu Trac National Burn Hospital, 2023 - 2024
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Abstract
Objectives: To describe antimicrobial resistance patterns of major ESKAPEE pathogens and preliminarily evaluate in vitro combination regimen coverage using a direct antibiogram approach at a burn center.
Subjects and methods: Cross-sectional, retrospective study of 160 first-isolate strains from burn and chronic wound patients (Jan 2023 - Dec 2024). Identification and MICs were determined by VITEK 2 Compact and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) 2023 guidelines. To ensure uniform comparisons and avoid biases from missing data, all in-depth analyses were restricted to isolates with complete susceptibility results, including colistin, yielding 19 Acinetobacter baumannii and 30 Pseudomonas aeruginosa. Combination coverage was directly calculated for these isolates (complete-case analysis).
Results: S. aureus (31.3%), P. aeruginosa (29.4%), and A. baumannii (23.1%) predominated. Complete antibiogram data were available for 96.3% of blood cultures versus 28.6% of wound specimens. In the main analysis group, meropenem susceptibility rates were notably low, at 15.8% for A. baumannii and 16.7% for P. aeruginosa, respectively. Colistin retained high in vitro activity (100% in A. baumannii, 90.0% in P. aeruginosa). Meropenem plus colistin achieved 100% and 90.0% coverage, respectively, which did not differ from colistin alone, indicating that the addition of carbapenem did not further increase in vitro coverage. MRSA accounted for 82.0% (41/50), all were susceptible to vancomycin (100%) and 96.0% (48/50) to linezolid.
Conclusions: Preliminary in vitro data suggest that Colistin-based combinations provide the highest coverage, but this coverage is primarily driven by the activity of colistin monotherapy. These findings must be interpreted with caution given the non-reference Colistin testing method, limited sample size, and the nature of this in vitro coverage analysis without synergy or clinical outcome assessment.
Keywords
Direct combination antibiogram, multidrug resistance, ESKAPEE, carbapenem resistance, burns
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References
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