Antimicrobial Susceptibility Patterns
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1 Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH
2 Outline Methodology Overall KNH data Surgery department data: Common Isolates AMS patterns for Gram negatives AMS patterns for Gram Positives Key Messages
3 Methodology
4 KNH Isolates by Year 2016 (10%) 2013 (7%) n = (21%) 2015 (62%)
5 Patient Location (KNH) Location No. of Isolates % Medicine Pediatrics Intensive Care Unit (ICU) Surgery Critical care Units Newborn Unit Others Not Indicated TOTAL
6 KNH Isolates Distribution by Specimen Type Others 9% Urine 28% Tracheal Aspirates 15% n = 8683 Blood 20% Pus 28%
7 Organism Commonest Isolates in Surgery Department (n=756) S aureus E coli K pneumoniae 68 P aeruginosa 45 P mirabilis A baumannii S epidermidis Others Number of Isolates
8 Specimen Types (Surgery Dept.)
9 Isolates Isolates by Specimen Type (Surgery Dept.) Sau Eco Kpn Pae Pmi Aba Sep Ot. Pus Urine Tracheal Blood Other Total Sau=S. aureus, Eco=E. coli, Kpn=K. pneumoniae, P=P. aeruginosa Pmi=P. mirabilis, Aba=A. baumannii, Sep=S. epidermidis
10 Susceptibility Patterns for Common Gram negative Bacteria (Surgery Department) Escherichia coli Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Acinetobacter baumannii
11 E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Amikacin Amoxicillin/Clavulanic acid Ampicillin Ampicillin/Sulbactam Aztreonam Cefazolin Cefepime Cefotaxime Cefoxitin Cefpodoxime Ceftazidime Ceftriaxone Cefuroxime Cefuroxime axetil Cephalothin Ciprofloxacin Gentamicin Meropenem Nitrofurantoin Norfloxacin Piperacillin Piperacillin/Tazobactam Tobramycin TMP/SMX
12 Sensitivity to Cephalosporins E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Cefepime Cefotaxime Ceftazidime Ceftriaxone Cefuroxime
13 Sensitivity to Quinolones E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Ciprofloxacin Norfloxacin
14 Sensitivity to Penicillins & Monobactams E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Amoxi-Clav Ampicillin/Sulbactam Aztreonam Piperacillin/Tazobact
15 Sensitivity to Other Antibiotics E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Gentamicin Nitrofurantoin Tobramycin TMP/SMX
16 Sensitivity to Super-drugs E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Amikacin Meropenem
17 E coli Susceptibility Pattern (Surgery) Ampicillin TMP/SMX Amp/Sulbactam Cephalothin Cefuroxime Cefazolin Ciprofloxacin Norfloxacin Amoxi-Clav Ceftriaxone Cefotaxime Aztreonam Ceftazidime Cefpodoxime Gentamicin Cefepime Pip-Taz Nitrofurantoin Tobramycin Cefoxitin Meropenem Amikacin
18 P aeruginosa Susceptibility Pattern (Surgery) TMP/SMX (45) Nitrofurantoin (45) Cefuroxime (45) Ceftriaxone (40) Cefpodoxime (5) Cefoxitin (45) Cefotaxime (45) Cefazolin (40) Amp-Sulb (40) Amoxi-Clav (45) Aztreonam (32) Pip-Taz (45) Ceftazidime (45) Meropenem (45) Gentamicin (45) Cefepime (45) Ciprofloxacin (45) Tobramycin (5) Norfloxacin (5) Amikacin (45)
19 P aeruginosa Susceptibility Pattern (KNH) Chloramphenicol (5) Levofloxacin (5) Cefazolin (635) Cefotaxime (692) Nitrofurantoin (692) Ceftriaxone (640) Cefoxitin (692) Amoxi-Clav (692) Aztreonam (508) Meropenem (693) Gentamicin (692) Cefepime (697) Amikacin (692) Norfloxacin (57)
20 Susceptibility Patterns for Common Gram Positive Bacteria (Surgery Department) Staphylococcus aureus Staphylococcus epidermidis
21 S aureus S epidermidis Antibiotic name Number %S Number %S Ampicillin/Sulbactam Cefuroxime Cefuroxime axetil Clindamycin Erythromycin Fosfomycin Gentamicin Imipenem Levofloxacin Linezolid Moxifloxacin Nitrofurantoin Oxacillin Penicillin G Quinupristin/Dalfopristin Rifampin Teicoplanin Tetracycline Tobramycin Trimethoprim/Sulfamethoxazole Vancomycin Cefoxitin Screen (MRSA)
22 Beta-lactams vs Staph spp. S aureus S epidermidis Antibiotic name N %S N %S Ampicillin/Sulbactam Oxacillin Penicillin G Cefuroxime
23 Methicillin-resistant S. aureus (MRSA) 8% 27% 73% 92% Outer ring = KNH (Overall) Inner Ring = Surgery Dept Red = Resistant Grey = Susceptible
24 Quinolones vs. Staph spp. S aureus S epidermidis Antibiotic name N %S N %S Levofloxacin Moxifloxacin
25 Macrolides, Lincosamines, Streptogramins & Glycopeptides S aureus S epidermidis Antibiotic name n %S n %S Clindamycin Erythromycin Teicoplanin
26 Aminoglycosides vs Staph. Spp. S aureus S epidermidis Antibiotic name N %S N %S Gentamicin Tobramycin
27 Other Antibiotics vs Staph. Spp. S aureus S epidermidis Antibiotic name N %S N %S Nitrofurantoin TMP/SMX
28 Super-drugs vs Staph. Spp. S aureus S epidermidis Antibiotic name n %S n %S Imipenem Linezolid Vancomycin
29 S aureus Susceptibility Pattern (Surgery) Penicillin G TMP/SMX Tetracycline Oxacillin Erythromycin Cefuroxime Cefoxitin Screen Levofloxacin Moxifloxacin Tobramycin Gentamicin Vancomycin Clindamycin Nitrofurantoin Linezolid Teicoplanin Quinupristin/Dalfopristin Imipenem Ampicillin/Sulbactam
30 Penicillin G Oxacillin Cefoxitin Screen TMP/SMX Erythromycin Levofloxacin Moxifloxacin Tetracycline Tobramycin Rifampin Gentamicin Teicoplanin Nitrofurantoin Linezolid Clindamycin Vancomycin S epidermidis Susceptibility Pattern (Surgery)
31 AKUH 2015 P aeruginosa Susceptibility (%) Amikacin 79.5 Ceftazidime 70.9 Cefepime 72.6 Gentamicin 72.6 Meropenem 64.1 Pip-Taz 64.5 Ciprofloxacin 71.8 Kassim & Omuse et al. Ann Clin Microbiol Antimicrob (2016) 15:21
32 AKUH (2015) E coli Kassim & Omuse et al. Ann Clin Microbiol Antimicrob (2016) 15:21
33 Post-op Fever Often non-infectious if within it occurs 48 hours 5Ws: Wind, Water, Weins, Wound, What did we do? Infectious causes: Catheter-related UTI Hospital-acquired Pneumonia Surgical Site Infection Catheter-related Blood Stream Infections Staphylococcal Toxic Shock Syndrome
34 Risk factors for MDR Infection Hospitalization for > 5 days Admission from another facility Antibiotic use within 3 months prior to admission Immunosuppression Reported high frequency of MDR organisms in the unit
35 Key Messages Antibiotic Resistance is high and rising Super-drugs are not spared Appropriate antimicrobial use Infection control Sustained Surveillance Dissemination
36 Care Bundles Central vascular catheter maintenance care Catheter associated urinary tract care bundle Peripheral vascular catheter care bundle Surgical site infection prevention care bundle Clostridium difficile infection care bundle Ventilator associated pneumonia care bundle
37
38 Pertinent Questions Etiology: What are the common bugs in surgery? Empiric therapy: Which drugs? Prophylaxis: Who/When/Which drugs? Infection control: Are we doing enough? Outcomes: Morbidity/mortality in patients with MDROs Cost: What is economic burden of MDROs?
39 ACKNOWLEDGEMENT Dr. Loice Achieng School of Medicine, UoN Dr. Dorothy Aywak Pharmacy Department, KNH Dr. Rugendo Birichi Pharmacy Department, KNH Dr. Paul Etau Medicine Department, KNH Dr. Andrew Gachii Laboratory Medicine, KNH Prof. Anastasia Guantai School of Pharmacy, UoN Dr. Rosalina Kinuthia Pharmacy Department, KNH Dr. Tom Menge Pharmacy Department, KNH Mrs. Beatrice Museve Microbiology Lab, KNH Mrs. Rosemary Mutua Nursing Department, KNH Mrs. Teresia Mwangi Infection Prevention and Control Unit, KNH Dr. Peter Mwathi Microbiology, KNH Dr. Elizabeth Odera Diagnostic Services & Health Information, KNH Dr. Enock Omonge School of Medicine, UoN Dr. Sylvia Opanga School of Pharmacy, UoN
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