Background: The Study for Monitoring Antimicrobial Resistance Trends (SMART) was begun
in 2002 to monitor international drug-resistance patterns among aerobic and facultative
gram-negative bacilli isolated from patients with intra-abdominal infections.
Methods: In 2002, 40 medical centers from 17 countries collected consecutive non-duplicate
isolates from intra-abdominal infections for susceptibility testing against 12 antimicrobial
agents using the broth microdilution methods recommended by the Clinical and Laboratory
Standards Institute (formerly the National Committee for Clinical Laboratory Standards).
Results: A total of 3,134 aerobic and facultative gram-negative bacilli were isolated. Enterobacteriaceae
accounted for 82% of the total and were most consistently susceptible to amikacin
and the carbapenems. Escherichia coli (45%) and Klebsiella spp. (17%) were the most common
species. The susceptibility rates of these organisms to the 12 antimicrobial agents differed
among geographic regions, with isolates from the Asia/Pacific and Latin American regions
usually having the highest rates of resistance. Ampicillin/sulbactam was the agent least frequently
active against E. coli (56% susceptible) and Klebsiella spp. (73% susceptible). Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically in 7% of E. coli, 13%
of Klebsiella spp., and 18% of Enterobacter spp. Producers of ESBL overall had a more antibiotic-resistant profile than non-producers but were usually susceptible to carbapenems.
Conclusions: Antimicrobial resistance rates among gram-negative bacilli isolated from intra-abdominal infections differed among geographic regions. The carbapenems were consistently
active in vitro against Enterobacteriaceae worldwide, including ESBL producers.
