Residential Aged Care Antibiogram Jan - Dec 2017 Residential Aged Care Antibiogram Jan - Dec 2017

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2 Cumulative atibiograms specific for idividual health care facilities ca be a useful resource for local atimicrobial stewardship groups to iform empirical therapy recommedatios ad formulary maagemet. The provisio of yearly atibiograms by health care facilities is ow required i the Natioal Safety ad Quality Health Service (NS&QHS) Stadard 3 (3.14.3).¹ This documet cotais the yearly cumulative atibiogram for your Residetial Aged Care Facility (RACF). It is divided ito three parts 1. Uriary Atibiogram 2. No Uriary Atibiogram 3. Blood Culture Atibiogram Orgaisms are listed i descedig order of frequecy. Orgaisms are colour coded accordig to whether they are Gram or Gram Negative orgaisms. Oly the first isolate of a give species per patiet per year per subtype (e.g urie, o urie, blood cultures) is icluded. Screeig isolates collected for ifectio cotrol purposes have bee removed. Sice 2012, susceptibility testig to produce these atibiograms is performed usig EUCAST microbroth dilutio ad disc diffusio.² Expert EUCAST rules i Atimicrobial Susceptibility testig have bee applied.³ Where the total umber of isolates tested is < 30, results are cosidered statistically ivalid i accordace with CLSI M39-A4⁴ ad have therefore ot bee icluded. Where oly a subset (< 95%) of isolates from a particular orgaism group have bee tested, reported susceptibilities are usually ot idicative of the true susceptibility because of the selective ature of testig oly more resistat isolates. These occasios are marked with a * ad susceptibility results should be iterpreted with cautio. The % susceptibility has ot bee colour coded. Sigal resistaces: At the ed of each atibiogram, sigal resistaces are summarised eve if the orgaism occurs at a frequecy too low (< 30) to appear i either the uriary, o-uriary or blood culture atibiograms. These orgaisms iclude Eterobacteriaceae resistat to third or fourth geeratio cephalosporis due to the presece of Exteded Spectrum Beta Lactamases (ESBLs) Eterobacteriaceae resistat to third or fourth geeratio cephalosporis due to the presece of Plasmid Mediated AMPC productio (PAMPs) Eterobacteriaceae resistat to carbapeems due to the presece of a plasmid mediated carbapeamase (CPE) No Eterobacteriaceae (e.g Acietobacter spp; Pseudomoas aerugiosa) resistat to carbapeems due to the presece of a plasmid mediated carbapeamase (CPNE) Vacomyci resistat Eterococci (VRE) Methicilli resistat Staphylococcus aureus (MRSA) Vacomyci itermediate ad vacomyci resistat Staphylococcus aureus (hvisa, VISA, VRSA) Peicilli itermediate ad resistat Streptococcus peumoiae otig that breakpoits differ accordig to cliical coditio (meigitis, peumoia, other) ad mode of admiistratio Peicilli itermediate ad resistat viridas Streptococci Page: 2

3 Colour codig for all atibiograms tables is show below. Gram Orgaism Gram Negative Orgaism Atibiotic Not recommeded to be used i childre without specialist advice 90% of isolates susceptible 70-89% of isolates susceptible <70% of isolates susceptible 90% of isolates susceptible (where sample size <95% of total isolates tested) 70-89% of isolates susceptible (where sample size <95% of total isolates tested) <70% of isolates susceptible (where sample size <95% of total isolates tested) Restricted or 2d Lie Atibiotics R Itrisic Resistace is preset with this orgaism-atibiotic combiatio * Sample size <95% of the total isolates tested Restricted or 2d Lie Atibiotics ad Atibiotic Not recommeded to be used i childre without specialist advice % Percetage of isolates sesitive to this particular atibiotic Number of isolates tested with this atibiotic Refereces: Cliical ad Laboratory Stadards Istitute (CLSI). Guidelie for Aalysis ad Presetatio of Cumulative Atimicrobial Susceptibility (M39-A4). 3rd ed. Pesylvaia: CLSI, Page: 3

4 Urie Atibiogram All SNP Nursig Home Orgaisms %Total Amoxicilli Amoxicilli-clavulaate Ticarcilli-clavulaate Pipericilli-tazobactam Cefalexi Ceftriaxoe Ceftazidime Meropeem Getamici Amikaci Trimethoprim Nitrofuratoi Norfloxaci Ciprofloxaci Fusidic Acid Rifampici Getamici (High Level) Fosfomyci Quiupristi-dalfopristi Vacomyci All isolates Escherichia spp % *2231 *1017 * *1151 *1044 *1157 * *211 Klebsiella spp % R *522 *171 * *227 *174 *228 * Eterococcus spp % 92 R *68 *67 *68 *72 Pseudomoas aerugiosa Proteus mirabilis Eterobacter cloacae complex Staphylococcus aureus (ALL) Citrobacter koseri, amaloaticus Citrobacter freudii complex ß haemolytic Streptococci Group B % R R R R R R * * *366 * % R *263 *121 * *151 *122 *152 * % R R R *99 *120 *122 *109 *122 * % * *84 *64 *64 *64 % R *74 *26 *32 88 *32 *26 *32 * % R R R *48 *55 *56 *52 *56 * % *53 Page: 4

5 Urie Atibiogram All SNP Nursig Home Orgaisms %Total Amoxicilli Amoxicilli-clavulaate Ticarcilli-clavulaate Pipericilli-tazobactam Cefalexi Ceftriaxoe Ceftazidime Meropeem Getamici Amikaci Trimethoprim Nitrofuratoi Norfloxaci Ciprofloxaci Fusidic Acid Rifampici Getamici (High Level) Fosfomyci Quiupristi-dalfopristi Vacomyci All isolates Morgaella spp Coagulase egative Staphylococci Eterobacter aerogees Miscellaeous GPC % R R R R 91 * *47 54 * % % R R R *25 *28 *28 *26 *28 * % * Page: 5

6 Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. Urie: Exteded spectrum beta lactamase producig Eterobacteriaceae (ESBL) Orgaism Name % of Strai Citrobacter freudii complex = 80 Citrobacter freudii Citrobacter koseri, amaloaticus = 88 Citrobacter koseri Eterobacter cloacae complex = 144 Eterobacter cloacae Escherichia spp = 2649 Escherichia coli Klebsiella spp = 633 Klebsiella oxytoca Klebsiella peumoiae Pseudomoas aerugiosa = 450 Pseudomoas aerugiosa Urie: Plasmid mediated AMPC producig Eterobacteriaceae (PAMP) Orgaism Name % of Strai Citrobacter koseri, amaloaticus = 88 Citrobacter koseri Eterobacter cloacae complex = 144 Eterobacter cloacae Escherichia spp = 2649 Escherichia coli Klebsiella spp = 633 Klebsiella oxytoca Klebsiella peumoiae Proteus mirabilis = 320 Proteus mirabilis Raoultella spp = 6 Raoultella orithiolytica Urie: Plasmid mediated Carbapeemase producig Eterobacteriaceae (CPE) Orgaism Name % of Strai Eterobacter cloacae complex = 144 Eterobacter cloacae Escherichia spp = 2649 Escherichia coli Page: 6

7 Urie: Plasmid mediated Carbapeemase producig No Eterobacteriaceae (CPNE) Orgaism Name % of Strai Urie: Vacomyci Resistat Eterococci (VRE) Orgaism Name % of Strai Eterococcus spp = 614 Eterococcus faecalis(vre) - VAN-A Eterococcus faecium (VRE) - VAN-A Eterococcus faecium (VRE) - VAN-A, VAN-B Eterococcus faecium (VRE) - VAN-B Urie: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Staphylococcus aureus (ALL) = 102 S.aureus (o-multiresistat MRSA) Staphylococcus aureus (MRSA) Staphylococcus aureus (UK EMRSA-15) Page: 7

8 No-urie Atibiogram All SNP Nursig Home Orgaisms %Total Peicilli Amoxicilli Flucloxacilli Amoxicilli-clavulaate Ticarcilli-clavulaate Pipericilli-tazobactam Cefaloti Cefazoli Ceftriaxoe Ceftazidime Cefepime Meropeem Getamici Amikaci Sulpha-trimethoprim Ciprofloxaci Fusidic Acid Rifampici Erythromyci/Clarithromyci Clidamyci Tetracyclie Mupiroci Vacomyci All isolates Staphylococcus aureus % (ALL) *1631 *1632 * *1576 *1632 Pseudomoas % R R R R R 95 * * aerugiosa Haemophilus ifluezae Moraxella catarrhalis ß haemolytic Streptococci Other (oa ob) % % % * *15 Page: 8

9 Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. NoUrie: Exteded spectrum beta lactamase producig Eterobacteriaceae (ESBL) Orgaism Name % of Strai Escherichia spp = 25 Escherichia coli Klebsiella spp = 15 Klebsiella oxytoca Klebsiella peumoiae NoUrie: Plasmid mediated AMPC producig Eterobacteriaceae (PAMP) Orgaism Name % of Strai Escherichia spp = 25 Escherichia coli NoUrie: Plasmid mediated Carbapeemase producig Eterobacteriaceae (CPE) Orgaism Name % of Strai NoUrie: Plasmid mediated Carbapeemase producig No Eterobacteriaceae (CPNE) Orgaism Name % of Strai NoUrie: Vacomyci Resistat Eterococci (VRE) NoUrie: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Staphylococcus aureus (ALL) = 1784 S.aureus (o-multiresistat MRSA) Staphylococcus aureus (MRSA) Staphylococcus aureus (UK EMRSA-15) Page: 9

10 NoUrie: Streptococcus peumoiae Peicilli Susceptibility ** (Oral peicilli V breakpoits) MIC category % of Strai Streptococcus peumoiae = 9 Itermediate mg/l Sesitive 0.06 mg/l Blood Cultures: There are o isolates where is 30 or greater. Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. Blood Culture: Exteded spectrum beta lactamase producig Eterobacteriaceae (ESBL) Orgaism Name % of Strai Blood Culture: Plasmid mediated AMPC producig Eterobacteriaceae (PAMP) Orgaism Name % of Strai Blood Culture: Plasmid mediated Carbapeemase producig Eterobacteriaceae (CPE) Orgaism Name % of Strai Eterobacter cloacae complex = 144 Eterobacter cloacae Escherichia spp = 2649 Escherichia coli Blood Culture: Plasmid mediated Carbapeemase producig No Eterobacteriaceae (CPNE) Orgaism Name % of Strai Page: 10

11 Blood Culture: Vacomyci Resistat Eterococci (VRE) Orgaism Name % of Strai Blood Culture: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Miscellaeous orgaism groupigs detail report. Page: 11

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