Table 2.
Prevalence and primary resistance mechanisms expected in P. aeruginosa in Spain.
| Antimicrobiala | % I+R (R)a | In order of frequency implicated mechanisms of resistanceb |
|---|---|---|
| PIP-TZ | 20-30 | ↑AmpC (++), ↑MexAB (+), MBL (+), OXAs and other ESBL (+) |
| CAZ | 20-30 | ↑AmpC (++), ↑ MexAB (+), MBL (+), OXAs and other ESBL (+) |
| FEP | 20-30 | ↑MexAB/XY (++), ↑AmpC (++), MBL (+), OXAs and other ESBL (+) |
| TOL-TZ | 1-5 | MBL (+), OXAs and other ESBL (+) ↑AmpC+mut AmpC (-/+) |
| ATM | >50 (20-30) | ↑MexAB/XY (+++) ↑AmpC (++), OXAs and other ESBL (+) |
| IMP | 20-30 (20-30) | OprD (+++), MBL (+) |
| MER | 20-30 (5-20) | OprD (+++), ↑MexAB (++), MBL (+) |
| CIP | 30-50 | QRDR (+++), ↑MexAB/XY (++), ↑MexCD/EF (+) |
| TOB | 20-30 | Modified enzyme AMG (++) ↑MexXY (+) |
| AMK | 5-20 (1-5) | ↑MexXY (++),modified enzyme AMG (+) |
| COL | 1-2 | pmrAB/phoPQ/parRS (-/+) |
PIP-TZ: piperacillin-tazobactam; CAZ: ceftazidime; FEP: cefepime; TOL-TZ: ceftolozane-tazobactam; ATM: aztreonam; IMP: imipenem; MER: meropenem; CIP: ciprofloxacin; TOB: tobramycin; AMK: amikacin; COL: colistin
Prevalence of primary resistance expected in Spain, according to 2017 EUCAST breakpoints. When there is an intermediate susceptibility category, prevalence of non-susceptible strains (I+R) is shown and prevalence of resistant strains are in parenthesis. Data estimated using available information from EARS-Net (https://ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/ears-net), multicenter studies (29;33;101;237) and microbiology department in several Spanish hospitals (H. Son Espases, Palma de Mallorca; H. Clinic, Barcelona; H. A Coruña, A Coruña).
Relative frequency of resistance mechanisms: +++ (20-30%), ++ (5-20%), + (1-5%), -/+ (<1%).