Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH
Outline Methodology Overall KNH data Surgery department data: Common Isolates AMS patterns for Gram negatives AMS patterns for Gram Positives Key Messages
Methodology
KNH Isolates by Year 2016 (10%) 2013 (7%) n = 8683 2014 (21%) 2015 (62%)
Patient Location (KNH) Location No. of Isolates % Medicine 1461 17 Pediatrics 1426 16 Intensive Care Unit (ICU) 1026 12 Surgery 756 9 Critical care Units 601 7 Newborn Unit 591 7 Others 2420 28 Not Indicated 402 5 TOTAL 8683 100
KNH Isolates Distribution by Specimen Type Others 9% Urine 28% Tracheal Aspirates 15% n = 8683 Blood 20% Pus 28%
Organism Commonest Isolates in Surgery Department (n=756) S aureus E coli 161 169 K pneumoniae 68 P aeruginosa 45 P mirabilis A baumannii S epidermidis 33 29 35 Others 216 0 50 100 150 200 250 Number of Isolates
Specimen Types (Surgery Dept.)
Isolates Isolates by Specimen Type (Surgery Dept.) 250 200 150 100 50 0 Sau Eco Kpn Pae Pmi Aba Sep Ot. Pus 156 107 35 24 32 19 13 122 Urine 0 50 27 9 3 5 2 53 Tracheal 8 1 2 11 0 3 0 7 Blood 3 0 2 0 0 5 6 10 Other 2 3 2 1 0 1 8 24 Total 169 161 68 45 35 33 29 216 Sau=S. aureus, Eco=E. coli, Kpn=K. pneumoniae, P=P. aeruginosa Pmi=P. mirabilis, Aba=A. baumannii, Sep=S. epidermidis
Susceptibility Patterns for Common Gram negative Bacteria (Surgery Department) Escherichia coli Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Acinetobacter baumannii
E coli K pneumoniae P aeruginosa P mirabilis A baumannii Antibiotic n %S n %S n %S n %S n %S Amikacin 155 99 70 80 45 80 35 97 26 73 Amoxicillin/Clavulanic acid 155 37 70 21 45 0 35 71 32 6 Ampicillin 155 6 70 0 45 0 35 20 32 0 Ampicillin/Sulbactam 144 11 62 7 40 0 35 54 26 23 Aztreonam 144 45 62 18 32 44 35 83 26 0 Cefazolin 144 35 62 15 40 0 35 34 26 0 Cefepime 155 62 70 39 45 71 35 57 32 6 Cefotaxime 155 39 70 17 45 0 35 46 32 3 Cefoxitin 155 78 70 69 45 0 35 89 32 0 Cefpodoxime 11 55 8 13 5 0 6 0 Ceftazidime 155 50 70 17 45 64 35 83 32 6 Ceftriaxone 144 38 62 18 40 0 35 51 26 0 Cefuroxime 155 35 70 13 45 0 35 40 32 0 Cefuroxime axetil 155 34 70 13 45 0 35 40 32 0 Cephalothin 11 18 8 13 5 0 6 0 Ciprofloxacin 155 36 70 44 45 73 35 80 32 38 Gentamicin 155 62 70 31 45 71 35 60 32 19 Meropenem 155 97 70 77 45 67 35 94 26 23 Nitrofurantoin 155 67 70 16 45 0 35 0 32 0 Norfloxacin 11 36 8 75 5 80 6 17 Piperacillin 11 18 8 13 5 40 6 0 Piperacillin/Tazobactam 156 65 70 34 45 58 35 94 30 10 Tobramycin 11 73 8 13 5 80 6 50 TMP/SMX 155 10 70 11 45 0 35 23 32 9
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 155 62 70 39 45 71 35 57 32 6 Cefotaxime 155 39 70 17 45 0 35 46 32 3 Ceftazidime 155 50 70 17 45 64 35 83 32 6 Ceftriaxone 144 38 62 18 40 0 35 51 26 0 Cefuroxime 155 35 70 13 45 0 35 40 32 0
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 155 36 70 44 45 73 35 80 32 38 Norfloxacin 11 36 8 75 5 80 6 17
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 155 37 70 21 45 0 35 71 32 6 Ampicillin/Sulbactam 144 11 62 7 40 0 35 54 26 23 Aztreonam 144 45 62 18 32 44 35 83 26 0 Piperacillin/Tazobact 156 65 70 34 45 58 35 94 30 10
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 155 62 70 31 45 71 35 60 32 19 Nitrofurantoin 155 67 70 16 45 0 35 0 32 0 Tobramycin 11 73 8 13 5 80 6 50 TMP/SMX 155 10 70 11 45 0 35 23 32 9
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 155 99 70 80 45 80 35 97 26 73 Meropenem 155 97 70 77 45 67 35 94 26 23
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 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
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) 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
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) 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
Susceptibility Patterns for Common Gram Positive Bacteria (Surgery Department) Staphylococcus aureus Staphylococcus epidermidis
S aureus S epidermidis Antibiotic name Number %S Number %S Ampicillin/Sulbactam 11 100 1 0 Cefuroxime 11 91 1 100 Cefuroxime axetil 11 91 1 100 Clindamycin 165 98 29 93 Erythromycin 165 90 29 45 Fosfomycin 132 98 28 100 Gentamicin 154 96 28 79 Imipenem 11 100 1 100 Levofloxacin 165 93 29 55 Linezolid 165 99 29 93 Moxifloxacin 165 93 29 59 Nitrofurantoin 165 99 29 93 Oxacillin 154 90 28 14 Penicillin G 154 12 28 4 Quinupristin/Dalfopristin 11 100 1 100 Rifampin 153 99 28 79 Teicoplanin 165 99 29 86 Tetracycline 165 81 29 66 Tobramycin 154 96 28 75 Trimethoprim/Sulfamethoxazole 165 50 29 38 Vancomycin 164 98 29 97 Cefoxitin Screen (MRSA) 154 92 28 21
Beta-lactams vs Staph spp. S aureus S epidermidis Antibiotic name N %S N %S Ampicillin/Sulbactam 11 100 1 0 Oxacillin 154 90 28 14 Penicillin G 154 12 28 4 Cefuroxime 11 91 1 100
Methicillin-resistant S. aureus (MRSA) 8% 27% 73% 92% Outer ring = KNH (Overall) Inner Ring = Surgery Dept Red = Resistant Grey = Susceptible
Quinolones vs. Staph spp. S aureus S epidermidis Antibiotic name N %S N %S Levofloxacin 165 93 29 55 Moxifloxacin 165 93 29 59
Macrolides, Lincosamines, Streptogramins & Glycopeptides S aureus S epidermidis Antibiotic name n %S n %S Clindamycin 165 98 29 93 Erythromycin 165 90 29 45 Teicoplanin 165 99 29 86
Aminoglycosides vs Staph. Spp. S aureus S epidermidis Antibiotic name N %S N %S Gentamicin 154 96 28 79 Tobramycin 154 96 28 75
Other Antibiotics vs Staph. Spp. S aureus S epidermidis Antibiotic name N %S N %S Nitrofurantoin 165 99 29 93 TMP/SMX 165 50 29 38
Super-drugs vs Staph. Spp. S aureus S epidermidis Antibiotic name n %S n %S Imipenem 11 100 1 100 Linezolid 165 99 29 93 Vancomycin 164 98 29 97
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 0 10 20 30 40 50 60 70 80 90 100
Penicillin G Oxacillin Cefoxitin Screen TMP/SMX Erythromycin Levofloxacin Moxifloxacin Tetracycline Tobramycin Rifampin Gentamicin Teicoplanin Nitrofurantoin Linezolid Clindamycin Vancomycin S epidermidis Susceptibility Pattern (Surgery) 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95100
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
AKUH (2015) E coli Kassim & Omuse et al. Ann Clin Microbiol Antimicrob (2016) 15:21
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
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
Key Messages Antibiotic Resistance is high and rising Super-drugs are not spared Appropriate antimicrobial use Infection control Sustained Surveillance Dissemination
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
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?
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