Aberdeen Hospital. Antibiotic Susceptibility Patterns For Commonly Isolated Organisms For 2015

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1 Aberdeen Hospital Antibiotic Susceptibility Patterns For Commonly Isolated s For 2015 Services Laboratory Microbiology Department Aberdeen Hospital Nova Scotia Health Authority 835 East River Road New Glasgow, NS B2H 3S5 Developed with Dr. D Haldane, Director PPHLN

2 Number of isolates Clindaymcin Erythromycin Levofloxacin Oxacillin Penicillin Trimeth/Sulfa (TMP-SMZ) Vancomycin Number of isolates Amoxicillin\Clavinic Cephalothin Cefazolin Cefixime Cefoxitin Ceftazidime Ceftriaxone Ertapenem Gentamicin Tobramycin Meropenem Piperacillin/Tazobactam Trimeth/sulfa (TMP-SMZ) 2015 Microbiology Susceptibility Report (January 1, December 31, 2015) IN-PATIENT ISOLATES - % Susceptibility for GRAM NEGATIVE Isolates Escherichia coli Pseudomonas aeruginosa 24 NT NT NT NT NT NT 88 NT 74 IR NT 83 NT IR Klebsiella pneumoniae IR Proteus mirabilis IR 94 IR 72 NT = Not Tested * For use in Urinary Tract Infection only. IN-PATIENT ISOLATES- % Susceptibility for GRAM POSITIVE isolates Enterococcus species IR IR IR IR 100 Staphylococcus aureus MSSA** 42 IR DNU Staphylococcus aureus- MRSA *** 14² IR DNU NT = Not Tested DNU= Do not use. * For use in Urinary Tract Infection only. NOTE: MSSA/MRSA in urine often reflects systemic infection. **MSSA that is sensitive to Oxacillin is also susceptible to 1 st generation cephalosporins. ***Methicillin Resistant S.aureus is resistant to ALL penicillins, cephalosporins and carbapenems. ² s with less than 20 isolates should be interpreted with caution as results may be biased by particularly resistant or susceptible strains.

3 Number of isolates Clindamycin Erythromycin Levofloxacin Oxacillin Penicillin Trimeth/sulfa (TMP-SMZ) Number of isolates Amoxicillin\Clavulinic Cephalothin Cefixime Trimeth/Sulfa (TMP-SMZ) COMMUNITY ISOLATES - % Susceptibility for GRAM NEGATIVE Isolates Escherichia coli Klebsiella pneumoniae IR Proteus mirabilis IR IR 71 Pseudomonas aeruginosa 46 IR IR IR NT IR Klebsiella oxytoca IR Enterobacter cloacae 12 IR IR NT = Not Tested * For use in Urinary Tract Infection only. COMMUNITY ISOLATES - % Susceptibility for GRAM POSITIVE and Urine isolates Enterococcus species IR IR IR IR Staphylococcus aureus- MSSA** 69 IR DNU 100 IR Staph aureus MRSA*** 11² IR DNU 0 IR Coag Neg Staph 18² NT DNU 67 IR NT = Not Tested DNU= Do not use. * For use in Urinary Tract Infection only. NOTE: MSSA/MRSA in urine often reflects systemic infection. **MSSA that is sensitive to Oxacillin is also susceptible to 1 st generation cephalosporins ***Methicillin Resistant Staph aureus is resistant to ALL Penicillins, Cephalosporins and carbapenems. ² s with less than 20 isolates should be interpreted with caution as results may be biased by particularly resistant or susceptible strains.

4 GUIDELINES FOR INTERPRETATION OF GRAM STAIN RESULTS: Gram-Positive Cocci (GPC) Pairs, chains, clusters: Staphylococcus sp Pairs, chains: Streptococcus sp Enterococcus sp Gram-Negative Cocci (GNC) Diplococci Pairs: Neisseria meningitidis Neisseria gonorrhoeae Moraxella catarrhalis Acinetobacter sp Gram-Positive Bacilli (GPB) Diphtheroids: Small, pleomorphic: > Corynebacterium sp > Propionibacterium (anaerobe) Large, with spores: Clostridium sp Bacillus sp Branching, beaded, rods: Nocardia sp Actinomyces sp (anaerobe) Listeria sp (Blood/cerebrospinal fluid) Lactobacillus sp (Vaginal/blood) Gram-Negative Bacilli (GNB) Enterobacteriaceae: Escherichia coli Serratia sp Klebsiella sp Enterobacter sp Citrobacter spp. Afermenters: Pseudomonas spp. Stenotrophomonas maltophilia Haemophilus influenzae Bacteroides fragilis group (Anaerobe) Fusiform (long, pointed): Fusobacterium sp (anaerobe) Capnocytophaga spp. These guidelines are not definitive but reflect the morphology of common isolates on gram stain. Treatment will depend on the quality of the specimen and appropriate clinical evaluation.

5 Aberdeen Hospital Microbiology Laboratory Antibiogram Guidelines: 1. Figures for organisms with less than 20 isolates should be interpreted with caution as results may be biased by particularly resistant or susceptible strains. 2. Specific susceptibilities should be consulted when available. When the antibiogram indicates sensitivity to an antibiotic is 85 % or less it is no longer recommended for empiric treatment. 3. Cephalexin may be used in place of cephalothin. 4. Cefazolin may be used in place of cephalexin or cephalothin. 5. Cefotaxime may be used in place of ceftriaxone. 6. is NOT the drug of choice for gram positive organisms. 7. Levofloxacin is effective against most pathogens from respiratory sites. 8. Nitrofurantoin is used for urinary tract infection only. 9. Vancomycin should be used ONLY in serious infections due to beta-lactam/methicillin resistant gram positive organisms or p.o. in Clostridium difficile associated colitis that is severe or unresponsive to metronidazole. Drug Levels should be monitored and levels over 20mg/L should be avoided. 10. Enterococcus spp is always resistant to aminoglycosides, cephalosporins, clindamycin and trimethoprimsulfamethoxazole. Combination therapy of ampicillin, penicillin or vancomycin plus gentamicin is usually indicated for serious enterococcal infections such as endocarditis. 11. Streptococcus pyogenes (Group A Streptococcus): penicillin is the treatment of choice for most infections. 12. Clostridium difficile is susceptible to metronidazole and vancomycin even when relapse occurs. 13. Klebsiella spp is resistant to ampicillin and by extension amoxicillin. 14. MRSA is resistant to all penicillins, cephalosporins and carbapenems. 15. Haemophilus influenzae is about 25% resistant to ampicillin but is susceptible to quinolones, doxycycline and macrolides. 16. Moraxella catarrhalis is generally susceptible to trimethoprim/sulfamethoxazole, erythromycin and tetracycline. 17. Staphylococcus saprophyticus is generally susceptible to nitrofurantoin and trimethoprim/sulfamethazole. 18. Staphylococcus lugdunensis has virulence factors that resemble S. aureus and can cause similarly aggressive infections. 19. Streptococcus agalactiae (Group B Streptococcus) can be considered susceptible to penicillin, ampicillin, amoxicillin and all cephalosporins. For individuals with minor penicillin allergies, cefazolin is the drug of choice. Clindamycin or vancomycin are the preferred agents for patients with a high risk for anaphylaxis. 20. Pasteurella spp: penicillin is effective, and amoxicillin/clavulanate can be used where mixed infections including Pasteurella spp is anticipated (e.g. dog, cat or human bites). Pasteurella spp is resistant to 1 st generation cephalosporins, cloxacillin and clindamycin. 21. Morganella spp, Proteus vulgaris, Providencia spp and Serratia spp are always resistant to ampicillin, cefazolin and nitrofurantoin. 22. Candida albicans is usually susceptible to fluconazole; C. glabrata may be resistant to fluconazole; C. krusei is intrinsically resistant to fluconazole. 23. Most gram negative anaerobes and gram positive anaerobic rods are susceptible to metronidazole. Anaerobic gram positive cocci, e.g. Peptostreptococcus spp, are often resistant, but are usually susceptible to penicillin.

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