Epidemiologic Trends, Occurrence of Extended-Spectrum β-Lactamase Production, and Performance of Ertapenem and Comparators in Patients with Intra-Abdominal Infections: Analysis of Global Trend Data from 2002-2007 from the SMART Study

Background: The Study for Monitoring Antimicrobial Resistance Trends (SMART) is an ongoing surveillance study to monitor worldwide resistance trends among aerobic and facultative anaerobic gram-negative bacilli isolated from intra-abdominal infections (IAIs). Results from SMART in 2002 through 2005 have been reported; this report summarizes aggregated data from SMART 2002-2007 to identify epidemiologic trends over time. Methods: A cumulative total of 446 sites were involved, of which 119, 166, 66, 28, and 67 were in Asia/Pacific, Europe, Latin America, Middle East/Africa, and North America, respectively. Results: A total of 34,635 isolates were collected from IAIs during 2002-2007, of which 32,113 (92.7%) were from 12 species. The organisms isolated most commonly were Escherichia coli (47.6%), Klebsiella pneumoniae (12.9%), and Pseudomonas aeruginosa (9.5%). The most frequent infection source associated with the 12 most common organisms consistently was peritoneal (46%), followed by intestine (15.8%) and liver (3.2%), with the majority of the organisms originating from inpatients (90.7%), followed by outpatients (4.3%) and undetermined sources (5.0%). Approximately 52% of these isolates were from patients with a hospital stay of >= 48 h, with 45.5% from patients with a hospital stay of <48 h. Overall, ertapenem and imipenem consistently were the most effective antibiotics, whereas resistance to other agents was more common. Conclusions: Escherichia coli was the organism isolated most frequently from IAIs, of which the majority were from peritoneal and intestinal sources. Only the carbapenems maintained good activity against the majority of clinical isolates.