In the past 3 decades, classical extended-spectrum β-lactamases (ESBLs) have probably been the main contributors to gram-negative antimicrobial resistance in Singapore. These appear to be being replaced by the newer CTX-M ESBLs. Metallo-β-lactamases are found in Pseudomonas aeruginosa but do not seem to have spread widely in Acinetobacter spp. and Enterobacteriaceae. Carbapenem-hydrolysing oxacillinases are prevalent in multidrug-resistant Acinetobacter spp. More insidious developments include the emergence of plasmid AmpC β-lactamases and multifactorial quinolone resistance in Enterobacteriaceae.
Standardised antimicrobial susceptibility testing was first introduced to Singapore in the mid-1970s. The earliest Singapore antibiogram the author is aware of was published in 1974 by Tan et al (Fig. 1) based on a limited number of isolates from sterile and non-sterile sites at the Department of Pathology, Ministry of Health.
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