Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract infections in the Asia-Pacific region: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010-2013

Shio Shin Jean, Geoffrey Coombs, Thomas Ling, V. Balaji, Camilla Rodrigues, Hiroshige Mikamo, Min Ja Kim, Datin Ganeswrie Rajasekaram, Myrna Mendoza, Thean Yen Tan, Pattarachai Kiratisin, Yuxing Ni, Barry Weinman, Yingchun Xu, Po Ren Hsueh

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102 Citations (Scopus)


A total of 9599 isolates of Gram-negative bacteria (GNB) causing urinary tract infections (UTIs) were collected from 60 centres in 13 countries in the Asia-Pacific region from 2010-2013. These isolates comprised Enterobacteriaceae species (mainly Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Klebsiella oxytoca, Enterobacter cloacae and Morganella morganii) and non-fermentative GNB species (predominantly Pseudomonas aeruginosa and Acinetobacter baumannii). In vitro susceptibilities were determined by the agar dilution method and susceptibility profiles were determined using the minimum inhibitory concentration (MIC) interpretive breakpoints recommended by the Clinical and Laboratory Standards Institute in 2015. Production of extended-spectrum β-lactamases (ESBLs) amongst E. coli, K. pneumoniae, P. mirabilis and K. oxytoca isolates was determined by the double-disk synergy test. China, Vietnam, India, Thailand and the Philippines had the highest rates of GNB species producing ESBLs and the highest rates of cephalosporin resistance. ESBL production and hospital-acquired infection (isolates obtained ≥48 h after admission) significantly compromised the susceptibility of isolates of E. coli and K. pneumoniae to ciprofloxacin, levofloxacin and most β-lactams, with the exception of imipenem and ertapenem. However, >87% of ESBL-producing E. coli strains were susceptible to amikacin and piperacillin/tazobactam, indicating that these antibiotics might be appropriate alternatives for treating UTIs due to ESBL-producing E. coli. Fluoroquinolones were shown to be inappropriate as empirical therapy for UTIs. Antibiotic resistance is a serious problem in the Asia-Pacific region. Therefore, continuous monitoring of evolutionary trends in the susceptibility profiles of GNB causing UTIs in Asia is crucial.

Original languageEnglish
Pages (from-to)328-334
Number of pages7
JournalInternational Journal of Antimicrobial Agents
Issue number4
Publication statusPublished - 2016 Apr

Bibliographical note

Funding Information:
The authors thank all of the investigators in the Asia-Pacific region for their participation in the SMART programme. The Asia-Pacific SMART team included Tony Korman (Monash Medical Center, Clayton, VIC, Australia), Justin Ellem (Westmead Hospital, Westmead, NSW, Australia), Narelle George (Royal Brisbane Hospital, Brisbane, QLD, Australia), Geoffrey Coombs (Royal Perth Hospital, Perth, WA, Australia), Wenxiang Huang (Chongqing Medical University Affiliated No. 1 Hospital, Chongqing, China), Haifeng Shao (Nanjing General Hospital of Nanjing Military Command, Nanjing, China), Bingdong Gui (2nd Affiliated Hospital of Nanchang University, Nanchang, China), Shufang Zhang (Haikou Hospital of Xiang, Central South University, Haikou, China), Bin Cao (Beijing Chaoyang Hospital, Beijing, China), Qiong Duan (Jilin Province People's Hospital, Changchun, China), Kong Haishen (1st Affiliated Hospital of Zhejiang University, Hangzhou, China), Ziyong Sun (Tongji Hospital, Tongji Medical College, Wuhan, China), Yuxing Ni (Ruijin Hospital, Shanghai, China), Ying-chun Xu (Peking Union Medical College Hospital, Beijing, China), Jin Yan (Provincial Hospital Shandong University, Jinan, China), Huang Xun (Xiangya Hospital of Central South University, Changsha, China), Kang Liao (1st Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China), Zhidong Hu (General Hospital of Tianjin Medical University, Tianjin, China), Lin Jie (Sir Run Run Shaw Hospital, Hangzhou, China), Bi Jie Hu (Fudan University Affiliated Zhongshan Hospital, Shanghai, China), Xuefei Duan (The Fourth Affiliated Hospital of Harbin Medical University, Nangang, China), Thomas Ling (Prince of Wales Hospital, Shatin, New Territories, Hong Kong), Owen Tsang [Princess Margaret Hospital (PMH), Hong Kong], D.S. Chitnis (Choithram Hospital & Research Centre, Indore, India), V. Balaji (Christian Medical College, Vellore, India), Sangeeta Joshi (Manipal Hospital, Bangalore, India), Bhaskar N. Chaudhuri (Fortis Hospital Anandapur, Kolkata, India), Camilla Rodrigues (P.D. Hinduja National Hospital & Medical Research Center, Mumbai, India), Indranil Roy (Calcutta Medical Research Institute, Kolkata, India), Hiroshige Mikamo (Aichi Medical University Hospital, Nagakute, Japan), Shinya Kusachi (Toho University, Tokyo, Japan), Tetsu Mizutani (Osaka Police Hospital, Osaka City, Japan), Min-Ja Kim (Korea University Anam Hospital, Seoul, South Korea), In-Gyu Bae (Gyeongsang National University Hospital, Jinju, South Korea), Nurulhuda Binti Umur (Hospital Kuala Lumpur, Kuala Lumpur, Malaysia), Datin Ganeswrie Rajasekaram (Hospital Sultanah Aminah Johin Bahru, Johor Bahru, Malaysia), Susan Taylor (Middlemore Hospital at Counties Manukau District, Otahuhu, New Zealand), Sally Roberts (Auckland City Hospital, Grafton, New Zealand), Koen van der Werff (Wellington Hospital, Wellington, New Zealand), Dragana Drinkovic (North Shore Hospital, Auckland, New Zealand), Evelina Lagamayo (St Luke's Medical Center, Quezon City, The Philippines), Myrna Mendoza (Philippine General Hospital, Manila, The Philippines), Thean Yen Tan (Changi General Hospital, Singapore), Prabha Krishnan (Tan Tock Seng Hospital, Singapore), Ellie Wang (National Cheng Kung University Hospital, Tainan, Taiwan), Po-Ren Hsueh (National Taiwan University Hospital, Taipei, Taiwan), Po-Liang Lu (Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan), Chun-Eng Liu (Changhua Christian Hospital, Changhua City, Taiwan), Kenneth Yin-Ching Chuang (Chi-Mei Medical Center, Tainan City, Taiwan), Kwok-Woon Yu (Taipei Veterans General Hospital, Taipei, Taiwan), Yao-Shen Chen (Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan), Min-Chi Lu (Chung Shan Medical University Hospital, Taichung City, Taiwan), Siripen Panthuwong (Songklanakarin Hospital, Songkhla Province, Thailand), Pattarachai Kiratisin (Siriraj Hospital, Bangkok-Noi, Thailand), Nguyen Tran My Phoung (Binh Dan Hospital, Ho Chi Minh City, Vietnam), Doan Mai Phuong (Bach Mai Hospital, Hanoi, Vietnam), Nguyen Thi Van (Benh Vien Viet Duc Hospital, Hanoi, Vietnam) and Tran Thi Thanh Nga (Cho Ray Hospital, Ho Chi Minh City, Vietnam). Funding: This study was supported by Merck Sharp & Dohme . Competing interests: P-RH has received honoraria for speaking at symposia that received educational support from Merck Sharp & Dohme. All other authors declare no competing interests. Ethical approval: This study was approved by the Institutional Review Board of National Taiwan University Hospital (Taipei, Taiwan) [NTUH 9561709108].

Publisher Copyright:
© 2016 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.


  • ESBL
  • Extended-spectrum β-lactamase
  • Gram-negative bacteria
  • Hospital-acquired
  • Susceptibility
  • Urinary tract infection

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)


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