C&W Three-Year Cumulative Antibiogram January 2013 December 2015

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1 C&W Three-Year Cumulative Antibiogram January 213 December 215 Division of Microbiology, Virology & Infection Control Department of Pathology & Laboratory Medicine Contents Comments and Limitations... 2 Contacts... 2 Achromobacter species... 3 Acinetobacter species... 3 Bacillus species... 4 Burkholderia cepacia complex... 4 Campylobacter jejuni... 5 Chryseobacterium species... 5 Citrobacter freundii... 6 Citrobacter koseri... 6 Corynebacterium species... 7 Elizabethkingia species... 7 Enterobacter aerogenes... 8 Enterobacter cloacae complex... 8 Enterococcus faecalis... 9 Enterococcus faecium... 9 Escherichia coli... 1 Haemophilus influenzae... 1 Klebsiella oxytoca Klebsiella pneumoniae Morganella morganii Pantoea species Propionibacterium species Proteus mirabilis Pseudomonas aeruginosa Pseudomonas fluorescens group Pseudomonas putida group Serratia marcescens Salmonella species Staphylococcus aureus Methicillin-Resistant Staphylococcus aureus Staphylococcus epidermidis Staphylococcus capitis (coagulase-negative) Staphylococcus lugdunensis Stenotrophomonas maltophilia Streptococcus pyogenes (Group A Strep)... 2 Streptococcus agalactiae (Group B Strep)... 2 Streptococcus dysgalactiae (Groups C & G) Streptococcus pneumoniae Streptococcus mitis group (viridans Strep) Streptococcus anginosis group July 28 th, 216 1

2 Usage New technology in Microbiology (MALDI-TOF mass spectrometry) has reduced the time needed to identify organisms, but definitive susceptibility testing results still require a further 1-2 days. In the interim, antibiogram data may be useful in choosing or optimizing antibiotics to help ensure adequate coverage for the organism of interest. Please keep in mind previous antimicrobial therapy in your patient, as this may select more resistant organisms. Comments and Limitations Three years of data were pooled to get sufficient numbers of isolates for each species. Most susceptibility patterns are relatively stable. For recent data on common isolates, please see the most recent annual antibiogram. Data were collected on isolates, not patients, due to software limitations. There is often more than one isolate from each patient. Some species are uncommon and the number of isolates is low. These are marked in red. Results are approximate, but are included to highlight typical treatment considerations or important resistance patterns. The Y axis and the number above each column indicate the percentage of isolates of that species that were fully susceptible to the antibiotic. Contacts For further information on antimicrobial susceptibility testing, please contact the Microbiologist-on-call, or one of us at the numbers below: Ghada Al-Rawahi MD FRCPC (64) ext 2394 David Goldfarb MD FRCPC (64) ext 7688 Jocelyn Srigley MD FRCPC (64) ext 528 Peter Tilley MD FRCPC (64) ext 6694 July 28 th, 216 2

3 Achromobacter species Achromobacter species n= Acinetobacter species Acinetobacter species n= July 28 th, 216 3

4 Bacillus species Bacillus species n= Note the small sample size. Results are approximate. Burkholderia cepacia complex Burkholderia cepacia complex n= Note the small sample size. Results are approximate. B. cepacia complex organisms are resistant to aminoglycosides and colistin. July 28 th, 216 4

5 Campylobacter jejuni Campylobacter jejuni n= Erythromycin result also applies to azithromycin (EUCAST). Chryseobacterium species Chryseobacterium species n= Chryseobacteria are environmental organisms which carry metalo-beta-lactamases, rendering them resistant to most penicillins, cephalosporins and carbapenems. Treatment options are limited. Kirby, Journal of Clinical Microbiology 24. July 28 th, 216 5

6 Citrobacter freundii Citrobacter freundii n= *Note that Citrobacter freundii has a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, it may become resistant during therapy (Choi, Antimicrob Agents Chemother 52;3:995-28). For this reason, carbapenems are often used to treat invasive C. freundii infections. Citrobacter koseri Citrobacter koseri n= July 28 th, 216 6

7 Corynebacterium species 8 82 Corynebacterium species n= Note the small sample size. Results are approximate. Elizabethkingia species 8 Elizabethkingia species n= Elizabethkingia (previously named Flavibacterium and Chryseobacterium) are environmental organisms which carry metalo - beta-lactamases, rendering them resistant to most penicillins, cephalosporins and carbapenems. Treatment options are limited. July 28 th, 216 7

8 Enterobacter aerogenes 8 6 Enterobacter aerogenes n= Note that Enterobacter species have a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, they become resistant during therapy in about 1-2% of cases (Chow, Annals Int Med 115: ). For this reason, carbapenems are often used to treat invasive Enterobacter infections. Enterobacter cloacae complex Enterobacter cloacae complex n= Note that Enterobacter species have a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, they become resistant during therapy in about 1-2% of cases (Chow, Annals Int Med 115: ). For this reason, carbapenems are often used to treat invasive Enterobacter infections. Enterobacter cloacae complex includes E. cloacae, asburiae, kobei, hormaechei, ludwigii, nimipressuralis. July 28 th, 216 8

9 Enterococcus faecalis Enterococcus faecalis n= * Please note that E. faecalis is resistant to all cephalosporins and quinupristin/dalfopristin. Meropenem has poor activity (Edwards, Journal of Anticrobial Chemotherapy 1995). Enterococcus faecium Enterococcus faecium 89 n= Please note that E. faecium is resistant to all cephalosporins. Meropenem has poor activity (Edwards, Journal of Anticrobial Chemotherapy 1995). Results are from 215 only with ARO/VRE screening specimens excluded. Note small sample size. Results are approximate. July 28 th, 216 9

10 Escherichia coli Escherichia coli n= Haemophilus influenzae Haemophilus influenzae 96 n= July 28 th, 216 1

11 Klebsiella oxytoca Klebsiella oxytoca n= Klebsiella pneumoniae Klebsiella pneumoniae n= July 28 th,

12 Morganella morganii 8 8 Morganella morganii n= Pantoea species Pantoea species n= Note the small sample size. Results are approximate. July 28 th,

13 Propionibacterium species Propionibacterium species n= Note the small sample size. Results are approximate. Proteus mirabilis Proteus mirabilis n= July 28 th,

14 Pseudomonas aeruginosa 8 Pseudomonas aeruginosa n= Please note that cefotaxime, ceftriaxone and SXT are NOT effective for treatment of Pseudomonas aeruginosa infections. Data include patients with cystic fibrosis. Pseudomonas fluorescens group Pseudomonas fluorescens group n=68 75 July 28 th,

15 Pseudomonas putida group Pseudomonas putida group 93 n= Serratia marcescens 8 6 Serratia marcescens 99 9 n= *Note that Serratia marcescens has a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, there is concern that it may become resistant during therapy, although this is rare (Choi, Antimicrob Agents Chemother 52;3:995-28). For critically ill patients, meropenem may be a better option. If cefotaxime or ceftriaxone are used, and patient response is less than expected, please repeat cultures. July 28 th,

16 Salmonella species 88 Salmonella species n= Please note that first and second generation cephalosporins (e.g. cefazolin, cefuroxime) and aminoglycosides are ineffective against Salmonella species. Resistance against fluoroquinolones is increasing rapidly. July 28 th,

17 Staphylococcus aureus Staph aureus n= data only shown. Clinical isolates only - MRSA screens excluded *Note that penicillin susceptibility is not reported at C&W due to its rarity and the subjectivity of the test. Methicillin-Resistant Staphylococcus aureus 8 MRSA n= Clinical isolates only. 215 only. MRSA screens excluded. July 28 th,

18 Staphylococcus epidermidis (most common coagulase-negative Staphylococcus) Staphylococcus epidermidis n= Staphylococcus capitis (coagulase-negative) Staphylococcus capitis n= July 28 th,

19 Staphylococcus lugdunensis 8 6 Staphylococcus lugdunensis n= Stenotrophomonas maltophilia Stenotrophomonas maltophilia n= S. maltophilia carries chromosomal carbapenemases, and is resistant to meropenem and imipenem. July 28 th,

20 Streptococcus pyogenes (Group A Strep) Streptococcus pyogenes (Gp A Strep) n= *Penicillin or vancomycin resistance has not been reported for Streptococcus pyogenes. Streptococcus agalactiae (Group B Strep) Streptococcus agalactiae (Gp B Strep) n= Inducible MLSB resistance testing is performed at C&W Microbiology before reporting clindamycin results. July 28 th, 216 2

21 Streptococcus dysgalactiae (Groups C & G) Streptococcus dysgalactiae n= Streptococcus pneumoniae 8 Streptococcus pneumoniae 8 n= *Note that lower interpretive breakpoints are used for CSF isolates reflecting lower antibiotic levels. Erythromycin resistance also applies to azithromycin and clarithromycin. July 28 th,

22 Streptococcus mitis group (viridans Strep) Streptococcus mitis group n= Streptococcus anginosis group Streptococcus anginosis group n= Streptococcus anginosis group includes S. anginosis, constellatus and intermedius. July 28 th,

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