A multicentre study to determine the in vitro efficacy of flomoxef against extended-spectrum beta-lactamase producing Escherichia coli in Malaysia
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
Polly Soo Xi Yap
Jeffrey Cheah School of Medicine and Health Science, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
Chun Wie Chong
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
Sasheela Ponnampalavanar
Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Ramliza Ramli
Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia
Azian Harun
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
Tengku Zetty Maztura Tengku Jamaluddin
Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Anis Ahmed Khan
School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
Soo Tein Ngoi
Department of Anesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Kuala Lumpur, Malaysia
Yee Qing Lee
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Min Yi Lau
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Shiang Chiet Tan
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Zhi Xian Kong
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Jia Jie Woon
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Siew Thong Mak
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Kartini Abdul Jabar
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Rina Karunakaran
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
Zalina Ismail
Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia
Sharifah Azura Salleh
Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Kuala Lumpur, Malaysia
Siti Suraiya Md Noor
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
Siti Norbaya Masri
Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Niazlin Mohd Taib
Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Azmiza Syawani Jasni
Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
Loong Hua Tee
Shionogi Singapore, Singapore, Singapore
Kin Chong Leong
Shionogi Singapore, Singapore, Singapore
Victor Kok Eow Lim
School of Medicine, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
Sazaly Abu Bakar
Tropical Infectious Diseases Research and Education Centre (TIDREC), Universiti Malaya, Kuala Lumpur, Malaysia
Cindy Shuan Ju Teh
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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-Escherichia coli (ESBL-EC) isolates responsible for infections in Malaysian hospitals was conducted. Additionally, the in vitro 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 blaCTX-M-1 was the most prevalent ESBL gene, with 28 isolates (22%) harbouring blaCTX-M-1 only, 27 isolates (21.3%) co-harbouring blaCTX-M-1 and blaTEM, and ten isolates (7.9%) co-harbouring blaCTX-M-1, blaTEM and blaSHV. 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.
