Introduction to the CANWARD Study (2007–2009)

Polymyxin B3-Tobramycin Hybrids with Pseudomonas aeruginosa-Selective Antibacterial Activity and Strong Potentiation of Rifampicin, Minocycline, and Vancomycin

There is an urgent need to develop novel antibacterial agents able to eradicate drug-resistant Gram-negative pathogens such as Pseudomonas aeruginosa. Antimicrobial hybrids have emerged as a promising strategy to combat bacterial resistance, as a stand-alone drug but also as an adjuvant in combination with existing antibiotics. Herein, we report for the first time the synthesis and biological evaluation of polymyxin-aminoglycoside heterodimers composed of polymyxin B₃ covalently linked to tobramycin via an aliphatic hydrocarbon linker. The polymyxin B₃-tobramycin hybrids demonstrate potent activity against carbapenem-resistant as well as multidrug- or extensively drug-resistant (MDR/XDR) P. aeruginosa clinical isolates. Furthermore, the most potent hybrid was able to synergize with currently used antibiotics against wild-type and MDR/XDR P. aeruginosa but also against Acinetobacter baumannii as well. The promising biological activity described herein warrants additional studies into design and development of new antimicrobial hybrids able to surmount the problem of antimicrobial resistance.

Characterization of Acinetobacter baumannii and meropenem-resistant Pseudomonas aeruginosa in Canada: results of the CANWARD 2007-2009 study

A total of 66 (0.35% of overall isolates) Acinetobacter baumannii and 102 (0.55%) meropenem-resistant Pseudomonas aeruginosa were identified among 18 538 isolates collected from medical centers across Canada during the 2007-2009 period. A. baumannii was most frequently recovered from patients in intensive care units (ICUs; 42.4%) and was isolated mostly from blood cultures (53.0%) and respiratory tract specimens (33.3%). Colistin, meropenem, and amikacin were the most active agents against A. baumannii strains (≥ 92.4% coverage). Gentamicin, levofloxacin, and tigecycline were also active against this bacterial species (MIC(50) 1, 0.12, and 0.5 μg/mL, respectively). Multidrug resistance (MDR; resistance to ≥ 3 antimicrobial classes) was noted in only 4 strains (6.1%), and molecular typing revealed 6 clusters of 2 isolates per cluster that displayed >85% similarity on the dendrogram. Meropenem-resistant P. aeruginosa isolates were primarily obtained from patients in ICUs (40.2%) and the most prevalent specimen types were those collected from the respiratory tract (63.7%), followed by blood cultures (18.6%). Most of the meropenem-resistant P. aeruginosa were resistant to all antimicrobial agents tested, and low susceptibility rates were observed for levofloxacin (8.8%) and gentamicin (28.4%). Amikacin and colistin were active against 67.7% and 88.2% of the isolates, respectively. A total of 68.6% (n = 70) of meropenem-resistant P. aeruginosa were MDR. Pulsed-field gel electrophoresis analysis revealed 94 unique isolates and 2 small clusters (6 and 4 isolates, 1 hospital each). In summary, MDR A. baumannii are rare in Canada and, conversely, meropenem-resistant P. aeruginosa were mostly MDR; however, there was minimal clonal spread among these nonfermentative bacilli.

Prevalence and characterization of extended-spectrum β-lactamase- and AmpC β-lactamase-producing Escherichia coli: results of the CANWARD 2007-2009 study

The national prevalence of extended-spectrum β-lactamase (ESBL)-producing (2007: 3.4%, 2008: 4.9%, 2009: 4.3%) and AmpC β-lactamase (AmpC)-producing (2007: 0.8%, 2008: 3.2%, 2009: 2.7%) Escherichia coli in Canadian hospitals have fluctuated from 2007 to 2009. Rates of co-resistance to non-lactam agents are elevated, and multidrug-resistant (MDR) phenotype were observed among E. coli strains producing ESBLs (83.3% MDR) and AmpCs (31.0%). The majority (>98%) of isolates remained susceptible to colistin, tigecycline, amikacin, and the carbapenems. CMY-2 encoding gene was detected in 52.9% of AmpC-producing strains, while bla(CTX-M-15) (65.2%) was the predominant ESBL genotype. A total of 50.3% of ESBL-producing E. coli and 21.4% of AmpC producers belonged to the ST131 clone. In conclusion, ESBL- and AmpC-producing E. coli are established in Canadian hospitals; and although the prevalence rates of these isolates remain low, they are often MDR and associated with the ST131 clone.

Prevalence of antimicrobial resistant pathogens from blood cultures from Canadian hospitals: results of the CANWARD 2007-2009 study

This study assessed the epidemiology and antimicrobial resistance of pathogens associated with bloodstream infections in Canadian hospitals between 2007 and 2009. Tertiary-care medical centers representing 8 of 10 Canadian provinces submitted bloodstream infection pathogens from patients attending hospital clinics, emergency rooms, medical/surgical wards, and intensive care units. Over 8,000 blood culture pathogens were collected. The 10 most common pathogens (representing 80.9% of all isolates) were Escherichia coli (1856 [22.6%]), Staphylococcus aureus (1457 [17.7%] including 1101 methicillin-susceptible Staphylococcus aureus and 356 methicillin-resistant Staphylococcus aureus), coagulase-negative staphylococci (907 [11.0%]), Klebsiella pneumoniae (600 [7.3%]), Streptococcus pneumoniae (470 [5.7%]), Enterococcus faecalis (360 [4.4%]), Pseudomonas aeruginosa (333 [4.0%]), viridans group streptococci (321 [3.9%]), Enterobacter cloacae (193 [2.3%]), and Streptococcus pyogenes (159 [1.9%]). The most active agents against Gram-negative bacilli were carbapenems (e.g., meropenem and ertapenem) and piperacillin-tazobactam, while for Gram-positive cocci, they were vancomycin, linezolid, and daptomycin.