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Cumulative atibiograms specific for idividual health care facilities ca be a useful resource for local atimicrobial stewardship groups to iform empirical therapy recommedatios ad formulary maagemet. The provisio of yearly atibiograms by health care facilities is ow required i the Natioal Safety ad Quality Health Service (NS&QHS) Stadard 3 (3.14.3).¹ This documet cotais the yearly cumulative atibiogram for your Residetial Aged Care Facility (RACF). It is divided ito three parts 1. Uriary Atibiogram 2. No Uriary Atibiogram 3. Blood Culture Atibiogram Orgaisms are listed i descedig order of frequecy. Orgaisms are colour coded accordig to whether they are Gram or Gram Negative orgaisms. Oly the first isolate of a give species per patiet per year per subtype (e.g urie, o urie, blood cultures) is icluded. Screeig isolates collected for ifectio cotrol purposes have bee removed. Sice 2012, susceptibility testig to produce these atibiograms is performed usig EUCAST microbroth dilutio ad disc diffusio.² Expert EUCAST rules i Atimicrobial Susceptibility testig have bee applied.³ Where the total umber of isolates tested is < 30, results are cosidered statistically ivalid i accordace with CLSI M39-A4⁴ ad have therefore ot bee icluded. Where oly a subset (< 95%) of isolates from a particular orgaism group have bee tested, reported susceptibilities are usually ot idicative of the true susceptibility because of the selective ature of testig oly more resistat isolates. These occasios are marked with a * ad susceptibility results should be iterpreted with cautio. The % susceptibility has ot bee colour coded. Sigal resistaces: At the ed of each atibiogram, sigal resistaces are summarised eve if the orgaism occurs at a frequecy too low (< 30) to appear i either the uriary, o-uriary or blood Culture atibiograms. These orgaisms iclude Eterobacterales resistat to third or fourth geeratio cephalosporis due to the presece of Exteded Spectrum Beta Lactamases (ESBLs) Eterobacterales resistat to third or fourth geeratio cephalosporis due to the presece of Plasmid Mediated AMPC productio (PAMPs) Eterobacterales resistat to carbapeems due to the presece of a plasmid mediated carbapeamase (CPE) No Eterobacterales (e.g Acietobacter spp; Pseudomoas aerugiosa) resistat to carbapeems due to the presece of a plasmid mediated carbapeamase (CPNE) Vacomyci resistat Eterococci (VRE) Methicilli resistat Staphylococcus aureus (MRSA) Vacomyci itermediate ad vacomyci resistat Staphylococcus aureus (hvisa, VISA, VRSA) Peicilli itermediate ad resistat Streptococcus peumoiae otig that breakpoits differ accordig to cliical coditio (meigitis, peumoia, other) ad mode of admiistratio Peicilli itermediate ad resistat viridas Streptococci Page: 2
Colour codig for all atibiograms tables is show below. Gram Orgaism Gram Negative Orgaism Atibiotic Not recommeded to be used i childre without specialist advice 90% of isolates susceptible 70-89% of isolates susceptible <70% of isolates susceptible 90% of isolates susceptible (where sample size <95% of total isolates tested) 70-89% of isolates susceptible (where sample size <95% of total isolates tested) <70% of isolates susceptible (where sample size <95% of total isolates tested) Restricted or 2d Lie Atibiotics R Itrisic Resistace is preset with this orgaism-atibiotic combiatio * Sample size <95% of the total isolates tested Restricted or 2d Lie Atibiotics ad Atibiotic Not recommeded to be used i childre without specialist advice % Percetage of isolates sesitive to this particular atibiotic Number of isolates tested with this atibiotic Refereces: 1. https://www.safetyadquality.gov.au/our-work/safety-i-e-health/ 2. http://www.eucast.org/cliical_breakpoits/ 3. http://www.eucast.org/expert_rules_ad_itrisic_resistace/ 4. Cliical ad Laboratory Stadards Istitute (CLSI). Guidelie for Aalysis ad Presetatio of Cumulative Atimicrobial Susceptibility (M39-A4). 3rd ed. Pesylvaia: CLSI, 2014 5. www.sp.com.au Page: 3
Urie Atibiogram All SNP Nursig Home Orgaisms %Total Amoxicilli Amoxicilli-clavulaate Piperacilli-tazobactam Cefalexi Ceftriaxoe Ceftazidime Meropeem Getamici Amikaci Trimethoprim Nitrofuratoi Norfloxaci Ciprofloxaci Fusidic acid Rifampici Getamici (High Level) Fosfomyci Quiupristi-dalfopristi Vacomyci All isolates 5072 100 Escherichia spp 2543 50.1 % 54 85 91 87 78 100 90 99 72 98 86 99 2541 2542 *1071 2542 *1072 *978 *1076 *979 2542 2541 2543 *228 Eterococcus spp 566 11.2 % 93 R R R 94 84 R 12 75 39 79 565 563 565 *58 *61 *61 *61 Klebsiella spp 564 11.1 % R 94 86 94 92 100 96 99 87 85 93 564 *207 563 *208 *167 *208 *167 564 562 564 Pseudomoas aerugiosa 366 7.2 Proteus mirabilis 311 6.1 Eterobacter cloacae complex Staphylococcus aureus (ALL) Citrobacter koseri, amaloaticus group ß haemolytic Streptococci Group B Citrobacter freudii complex 131 2.6 95 1.9 78 1.5 69 1.4 53 1.0 % R R 93 R R 95 94 96 95 R R 96 94 365 366 *286 366 *286 *346 364 % 87 96 99 97 97 100 99 100 72 R 100 311 311 *137 311 *137 *120 *138 *120 311 311 % R R 60 R 62 95 94 98 73 78 91 *113 *114 *99 *114 *99 131 131 131 % 11 46 79 100 59 88 100 100 95 95 *90 95 91 *50 *50 *50 % R 96 96 94 85 100 96 100 96 95 100 78 *25 78 *26 *17 *26 *17 78 78 78 % 100 88 100 73 69 68 69 *52 % R R 60 R 56 100 93 100 81 94 91 *43 *43 *39 *43 *40 53 53 53 Page: 4
Urie Atibiogram All SNP Nursig Home Orgaisms %Total Amoxicilli Amoxicilli-clavulaate Piperacilli-tazobactam Cefalexi Ceftriaxoe Ceftazidime Meropeem Getamici Amikaci Trimethoprim Nitrofuratoi Norfloxaci Ciprofloxaci Fusidic acid Rifampici Getamici (High Level) Fosfomyci Quiupristi-dalfopristi Vacomyci All isolates 5072 100 Morgaella spp 51 1.0 Klebsiella aerogees 46 0.9 Coagulase egative Staphylococci 46 0.9 Aerococcus spp 34 0.7 % R R 98 R 90 100 96 100 75 R 90 50 50 *41 50 *41 51 51 % R R 70 R 73 100 97 100 93 59 93 *37 *37 *32 *37 *32 46 46 46 % 24 72 R 41 100 72 46 46 46 46 46 % 100 17 97 97 34 *30 34 33 Page: 5
Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. Urie: Exteded spectrum beta lactamase producig Eterobacterales (ESBL) Orgaism Name % of Strai Citrobacter freudii complex = 53 Citrobacter freudii 2 3.8 Citrobacter koseri, amaloaticus group = 78 Citrobacter koseri 2 2.6 Eterobacter cloacae complex = 131 Eterobacter cloacae 5 3.8 Escherichia spp = 2543 Escherichia coli 219 8.6 Klebsiella spp = 564 Klebsiella oxytoca 1 0.2 Klebsiella peumoiae 13 2.3 Proteus spp other = 16 Proteus vulgaris 1 6.3 Urie: Plasmid mediated AMPC producig Eterobacterales (PAMP) Orgaism Name % of Strai Escherichia spp = 2543 Escherichia coli 97 3.8 Klebsiella spp = 564 Klebsiella oxytoca 1 0.2 Klebsiella peumoiae 5 0.9 Proteus mirabilis = 311 Proteus mirabilis 2 0.6 Urie: Plasmid mediated Carbapeemase producig Eterobacterales (CPE) Orgaism Name % of Strai Eterobacter cloacae complex = 131 Eterobacter cloacae 1 0.8 Urie: Plasmid mediated Carbapeemase producig No Eterobacterales (CPNE) Orgaism Name % of Strai Page: 6
Urie: Vacomyci Resistat Eterococci (VRE) Orgaism Name % of Strai Eterococcus spp = 566 Eterococcus faecium (VRE) - VAN-A 1 0.2 Eterococcus faecium (VRE) - VAN-B 3 0.5 Urie: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Staphylococcus aureus (ALL) = 95 S.aureus (o-multiresistat MRSA) 24 25.3 Staphylococcus aureus (MRSA) 2 2.1 Staphylococcus aureus (UK EMRSA-15) 22 23.2 Page: 7
No-urie Atibiogram All SNP Nursig Home Orgaisms %Total Peicilli Amoxicilli Flucloxacilli Amoxicilli-clavulaate Piperacilli-tazobactam Cefaloti Cefazoli Ceftriaxoe Ceftazidime Cefepime Meropeem Getamici Amikaci Sulpha-trimethoprim Ciprofloxaci Fusidic Acid Rifampici Erythromyci/Clarithromyci Clidamyci Tetracyclies Mupiroci Vacomyci All isolates 2592 100 Staphylococcus aureus % 15 72 72 72 R 97 83 95 100 77 79 93 96 100 1623 1622 1621 1623 1623 *1468 *1472 *1473 1623 1622 1623 *1460 *1476 (ALL) 1623 62.6 Pseudomoas % R R 96 R R 97 98 98 97 98 R 95 R 648 651 *618 650 651 *490 650 aerugiosa 651 25.1 Haemophilus ifluezae 85 3.3 ß haemolytic Streptococci Other (oa ob) 56 2.2 Moraxella catarrhalis 54 2.1 % 76 92 65 99 85 85 84 85 % 100 100 100 100 91 91 79 100 56 55 *22 56 56 56 56 *25 % 2 100 94 100 100 54 54 54 54 54 Page: 8
Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. NoUrie: Exteded spectrum beta lactamase producig Eterobacterales (ESBL) Orgaism Name % of Strai Escherichia spp = 15 Escherichia coli 2 13.3 Klebsiella spp = 9 Klebsiella peumoiae 1 11.1 NoUrie: Plasmid mediated AMPC producig Eterobacterales (PAMP) Orgaism Name % of Strai NoUrie: Plasmid mediated Carbapeemase producig Eterobacterales (CPE) Orgaism Name % of Strai NoUrie: Plasmid mediated Carbapeemase producig No Eterobacterales (CPNE) Orgaism Name % of Strai NoUrie: Vacomyci Resistat Eterococci (VRE) NoUrie: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Staphylococcus aureus (ALL) = 1622 S.aureus (o-multiresistat MRSA) 291 17.9 Staphylococcus aureus (MRSA) 33 2.0 Staphylococcus aureus (UK EMRSA-15) 128 7.9 NoUrie: Streptococcus peumoiae Peicilli Susceptibility (No-meigitis breakpoits) Page: 9
MIC category % of Strai Streptococcus peumoiae = 8 Itermediate 0.12-2 mg/l 2 25.0 NoUrie: Streptococcus peumoiae Ceftriaxoe Susceptibility Sesitive 0.06 mg/l 6 75.0 Blood Cultures: There are o isolates where is 30 or greater. Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. Blood Culture: Exteded spectrum beta lactamase producig Eterobacterales (ESBL) Orgaism Name % of Strai Blood Culture: Plasmid mediated AMPC producig Eterobacterales (PAMP) Orgaism Name % of Strai Blood Culture: Plasmid mediated Carbapeemase producig Eterobacterales (CPE) Orgaism Name % of Strai Eterobacter cloacae complex = 131 Eterobacter cloacae 1 0.8 Blood Culture: Plasmid mediated Carbapeemase producig No Eterobacterales (CPNE) Orgaism Name % of Strai Page: 10
Blood Culture: Vacomyci Resistat Eterococci (VRE) Orgaism Name % of Strai Blood Culture: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Miscellaeous orgaism groupigs detail report. Page: 11