Antimicrobial susceptibility

Transcription

1 Antimicrobial susceptibility PATTERNS Microbiology Department Canterbury ealth Laboratories and Clinical Pharmacology Department Canterbury District ealth Board March 2011

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3 Contents Preface... Page 1 ANTIMICROBIAL SUSCEPTIBILITIES Gram positive organisms... Page 2 Gram negative organisms Enterobacteriaceae... Page 3 Pseudomonas aeruginosa/pseudomonas sp... Page 4 Acinetobacter sp... Page 4 non ferm Gram neg. bacilli... Page 4.influenzae, M.catarrhalis, N. meningitidis... Page 5 Mycobacterium tuberculosis... Page 6 Topical sensitivities S.aureus... Page 6 MRSA... Page 6 ANTIMICROBIAL SUSCEPTIBILITY TESTING STRATEGIES Enterobacteriaceae... Page 7 Staphylococcus species... Page 8 aemophilus influenzae/moraxella catarrhalis... Page 9 Pseudomonas aeruginosa/pseudomonas sp... Page 10 Topical Antibiotic Testing... Page 11 Contents

4 PRINCIPLES OF Antimicrobial USE This should be based on factors such as spectrum of activity, anticipated efficacy, safety, previous clinical experience and cost. Empirical therapy should be based on local sensitivity data and their patterns of antibiotic susceptibility and the preferred medicine list (PML) guidelines.. Antimicrobial therapy for known pathogens should include the most effective, least toxic,. narrowest spectrum agent available. Antimicrobial Susceptibility Testing The antibiotics selected for routine or first line testing, are chosen by the narrowest spectrum which will treat and contain an infection, cost & availability. This first line range of antibiotics tested is extended on request from clinical services by bacterial resistance, patient allergy or other needs. Anaerobic micro-organisms are not routinely tested and sensitivity is predicted from an international literature. Oxacillin with its better stability is used in place of flucloxacillin for sensitivity testing. The data presented is from tests performed between January to December Unless specifically indicated, sensitivities are for antibiotic / organism combinations where more than 30 isolates were tested with a 95% confidence interval of ± 15%. Percentage sensitivities marked with a * refer to combinations where 10 to 30 isolates were tested and the 95% confidence interval is ± 30%. Test methods are those recommended by the sub committee on susceptibility testing of the National Committee on Clinical Laboratory Standards, USA. CLSI M (2010). Performance Standards for Antimicrobial Disk Sensivity Tests Documents CLSI M02-A10 (2009). DEFINITIONS SENSITIVE Organisms should respond to antibiotic concentrations achieved with usual dosage regimens. INTERMEDIATE / MODERATE SUSCEPTIBILITY Organisms normally do not respond to antibiotics at usual doses, but may respond if higher doses are used. e.g. enterococci may be considered sensitive to high doses of penicillin or amoxycillin, but will require combined therapy with an aminoglycoside for serious infections like endocarditis. RESISTANT Organisms will not respond to treatment even with increased dosage regimens. A Microbiologist/Registrar is on call 24hrs a day, should further assistance or advice be required. Antimicrobial sensitivity patterns compiled by: Dr M. Schousboe, Medical Microbiologist, Canterbury ealth Laboratories Page 1

5 2010 GRAM POSITIVE COCCI AND BACILLUS ISOLATES PERCENTAGE SUSCEPTIBLE TO ANTIBIOTIC Amoxycillin Clindamycin Penicillin Methicillin/oxacillin Vancomycin Gentamicin Erythromycin Tetracycline Chloramphenicol Co-trimoxazole Trimethoprim Nitrofurantoin Fusidic acid Teiccplanin igh Level Gent resistant Ciprofloxacin Moxifloxacin Linezolid Quinupristin Rifampicin ORGANISM Staph.aureus (not MRSA) coag.neg.staph Enterococci sp alpha haem Streptococci Corynebact. sp. non J.K S. pneumoniae Streptococcus gra. - 96* * * Tested on 10 to 30 isolates Not tested or tested on less then 10 isolates see P8 for testing strategy See PML and Antibiotic Guidelines for treatment recommendations. Erythromycin = Clarythromycin sensitivites for Strep. pneumoniae. 1st Line antibiotic choice underlined. Page 2

6 2010 ENTEROBACTERIACEAE ISOLATES PERCENTAGE SUSCEPTIBLE TO ANTIBIOTIC Amoxycillin Amoxycillin/Clav Co-trimoxazole Trimethoprim Norfloxacin Celtriaxone Tetracycline Ciprofloxacin Nitrofurantoin Cefuroxime Gentamicin ORGANISM TOTAL ISOLATES (4403) Citrobacter freundii E.coli Enterobacter cloacae K.oxytoca K. pneumoniae Morganella morganii Proteus mirabilis Serratia marcescens Y. enterocolitica* * Tested on 10 to 30 isolates. - Not tested or tested on less then 10 isolates see P7 for testing strategy See PML and Antibiotic Guidelines for treatment recommendations. Page 3

7 2010 PSEUDOMONAS AERUGINOSA AND NON FERM GRAM NEGATIVE BACILLI ISOLATES PERCENTAGE SUSCEPTIBLE TO ANTIBIOTIC Cefuroxime Tazobactam/pip Ceftazidime Norfloxacin Ciprofloxacin Gentamicin Tobramycin Co-trimoxazole Colistin Cefepime Tetracycline Imipenem Meropenem Framycetin ORGANISM P.aeruginosa Acinetobacter. sp * * - Aeromonas Caviae* * Tested on 10 to 30 isolates..- Not tested or tested on less then 10 isolates see P7 for testing strategy See PML and Antibiotic Guidelines for treatment recommendations. Page 4

8 2010.INFLUENZAE, N. MENINGITIDIS ISOLATES PERCENTAGE SUSCEPTIBLE TO ANTIBIOTIC ORGANISM Amoxycillin Augmentin Penicillin Cefuroxime Co-trimoxazole Erythromycin Clarithromycin Tetracycline Chloramphenicol Rifampicin.influenzae N.meningitidis* * Tested on 10 to 30 isolates Not tested or tested on less then 10 isolates see P9 for testing strategy See PML and Antibiotic Guidelines for treatment recommendations PERCENTAGE OF BETA-LACTAMASE POSITIVE ORGANISMS ORGANISM. NUMBER TESTED... % POSITIVE M. catarrhalis influenzae No. of patients with ESBL producing organism per year (% of isolates) Year E.coli K.pneumoniae K.oxytoca (1.4) 8 (3.4) 5 (3.7) (1.2) 4 (1.2) (1.4) 9 (3) (1.8) 12 (3.6) 1 (0.7) (2.0) 22 (5.5) 1 (0.7) Page 5

9 MYCOBACTERIUM TUBERCULOSIS COMPLEX SUSCEPTIBILITY PATTERN 2010 ANTIBIOTIC.. NUMBER TESTED.. % SENSITIVE Ethambutol Isoniazid 0.1 mcg/ml Rifampicin Pyrazinimide Streptomycin STAPYLOCOCCUS AUREUS TOPICAL SUSCEPTIBILITIES 2010 Not MRSA ANTIBIOTIC % SENSITIVE Bacitracin 99 Mupirocin 94 Chloramphenicol 99 Framycetin MRSA ISOLATES, PERCENTAGE SUSCEPTIBLE TO ANTIBIOTIC ANTIBIOTIC.. NUMBER TESTED.. % SENSITIVE Clindamycin Chloramphenicol Co-trimoxazole Erythromycin Fusidic acid Gentamicin Methicillin Penicillin Rifampicin Mupirocin Vancomycin Ciprofloxacin Bacitracin MRSA constituted 3.7% of Staphylococcus aureus isolates Page 6

10 REPORTING SUSCEPTIBILITY TESTING STRATEGY OF BACTERIAL ISOLATES ENTEROBACTERIACEAE ANTIBIOTIC URINE ASPIRATE/ BLOOD CSF... SPUTUM/ CULTURE... SWAB Ampi/Amoxycillin Augmentin Cefotaxime Ceftriaxone Ceftazidime... Cefuroxime Cefepime. Chloramphenicol... Ciprofloxacin. Co-trimoxazole Gentamicin Imipenem. Nalidixic acid# Nitrofurantoin+ Norfloxacin Tobramycin. Trimethoprim Tazocin. 1st Gen. Cephalosporin. Routine or first line testing Second line or routine testing in some clinical areas + Not Proteus, Morganella, Providencia species # Also sensitive to 2nd and 3rd generation quinolones Page 7

11 REPORTING SUSCEPTIBILITY TESTING STRATEGY OF BACTERIAL ISOLATES STAPYLOCOCCUS SPECIES ANTIBIOTIC URINE ASPIRATE/ BLOOD CSF... SPUTUM/ CULTURE... SWAB Amox-Clav Cefuroxime. Cefepime.... Chloramphenicol... Ciprofloxacin. Clarithromycin.. Co-trimoxazole. Erythromycin. Fusidic Acid.... Imip/Meropenem. Nitrofurantoin Norfloxacin Oxa/Flucloxacillin Penicillin Rifampicin. Tetracycline Teicoplanin Trimethoprim Vancomycin Gentamicin Routine or first line testing Second line or routine testing in some clinical areas Page 8

12 REPORTING SUSCEPTIBILITY TESTING STRATEGY OF BACTERIAL ISOLATES AEMOPILUS INFLUENZAE / MORAXELLA CATARRALIS** ANTIBIOTIC ASPIRATE/SPUTUM BLOOD CSF.. /SWAB CULTURE.. Ampi/Amoxycillin Augmentin B-Lactamase Cefaclor Ceftazidime.. Ceftriaxone/Cefotax Cefuroxime. Chloramphenicol Ciprofloxacin Clarithromycin Co-trimoxazole Imip/Meropenem Rifampicin Tetracycline Ceftriaxone Routine or first line testing Second line or routine testing in some clinical areas ** Beta-lactamase only Page 9

13 REPORTING SUSCEPTIBILITY TESTING STRATEGY OF BACTERIAL ISOLATES PSEUDOMONAS AERUGINOSA / PSEUDOMONAS SPECIES ANTIBIOTIC URINE ASPIRATE/ BLOOD CSF... SPUTUM/ CULTURE... SWAB Ceftazidime. Ciprofloxacin. Cefepime. Co-trimoxazole.. Gentamicin Imip/Meropenem. Norfloxacin Tobramycin Tazocin Colistin. Routine or first line testing Second line or routine testing in some clinical areas Stenotrophomonas maltophilia all sites Mino cycline Page 10

14 REPORTING TOPICAL SUSCEPTIBILITY TESTING STRATEGY OF BACTERIAL ISOLATES.. AEMOPILUS PSEUDOMONAS ENTERO- STAPYLOCOCCUS.. INFLUENZAE AERUGINOSA BACTERIACEAE SPECIES Chloramphenicol. Framycetin Fusidic Acid.... Mupirocin... Polymyxin Tetracycline.. Routine or first line testing Second line or routine testing in some clinical areas Page 11

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