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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 Eterobacteriaceae resistat to third or fourth geeratio cephalosporis due to the presece of Exteded Spectrum Beta Lactamases (ESBLs) Eterobacteriaceae resistat to third or fourth geeratio cephalosporis due to the presece of Plasmid Mediated AMPC productio (PAMPs) Eterobacteriaceae resistat to carbapeems due to the presece of a plasmid mediated carbapeamase (CPE) No Eterobacteriaceae (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. http://www.safetyadquality.gov.au/our-work/safety-i-e-health/atioal-safety-ad-quality-health-service-stadard-3-14-3/ 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 Ticarcilli-clavulaate Pipericilli-tazobactam Cefalexi Ceftriaxoe Ceftazidime Meropeem Getamici Amikaci Trimethoprim Nitrofuratoi Norfloxaci Ciprofloxaci Fusidic Acid Rifampici Getamici (High Level) Fosfomyci Quiupristi-dalfopristi Vacomyci All isolates 5439 100 Escherichia spp 2649 48.7 % 54 84 53 90 88 80 100 90 98 73 98 87 99 2649 *2231 *1017 *1144 2646 *1151 *1044 *1157 *1048 2649 2647 2649 *211 Klebsiella spp 633 11.6 % R 94 82 89 95 92 99 97 99 86 86 95 *522 *171 *227 633 *227 *174 *228 *174 633 631 633 Eterococcus spp 614 11.3 % 92 R 93 79 22 63 63 74 613 613 612 *68 *67 *68 *72 Pseudomoas aerugiosa 450 8.3 Proteus mirabilis 320 5.9 Eterobacter cloacae complex Staphylococcus aureus (ALL) Citrobacter koseri, amaloaticus Citrobacter freudii complex ß haemolytic Streptococci Group B 144 2.6 102 1.9 88 1.6 80 1.5 65 1.2 % R R 45 95 R R 95 94 94 91 R R 95 91 *363 449 449 *365 450 *366 *427 440 % 89 96 99 100 98 99 100 98 98 76 R 99 320 *263 *121 *150 319 *151 *122 *152 *123 320 320 % R R 44 63 R 62 98 88 97 69 85 90 *99 *120 *122 *109 *122 *110 144 144 144 % 9 37 85 100 58 97 100 100 102 102 *91 101 *84 *64 *64 *64 % R 93 81 94 93 88 100 97 100 97 92 100 *74 *26 *32 88 *32 *26 *32 *26 88 88 88 % R R 63 71 R 68 100 93 100 81 94 95 *48 *55 *56 *52 *56 *52 80 80 80 % 100 85 100 70 65 65 65 *53 Page: 4
Urie Atibiogram All SNP Nursig Home Orgaisms %Total Amoxicilli Amoxicilli-clavulaate Ticarcilli-clavulaate Pipericilli-tazobactam Cefalexi Ceftriaxoe Ceftazidime Meropeem Getamici Amikaci Trimethoprim Nitrofuratoi Norfloxaci Ciprofloxaci Fusidic Acid Rifampici Getamici (High Level) Fosfomyci Quiupristi-dalfopristi Vacomyci All isolates 5439 100 Morgaella spp 54 1.0 Coagulase egative Staphylococci 46 0.8 Eterobacter aerogees 40 0.7 Miscellaeous GPC 35 0.6 % R R 69 96 R 83 100 87 98 78 R 91 *45 54 54 *47 54 *47 54 54 % 20 70 54 98 73 45 46 46 46 44 % R R 56 54 R 54 96 100 100 93 78 95 *25 *28 *28 *26 *28 *26 40 40 40 % 100 3 97 94 34 *33 35 35 Page: 5
Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. Urie: Exteded spectrum beta lactamase producig Eterobacteriaceae (ESBL) Orgaism Name % of Strai Citrobacter freudii complex = 80 Citrobacter freudii 2 2.5 Citrobacter koseri, amaloaticus = 88 Citrobacter koseri 2 2.3 Eterobacter cloacae complex = 144 Eterobacter cloacae 11 7.6 Escherichia spp = 2649 Escherichia coli 219 8.3 Klebsiella spp = 633 Klebsiella oxytoca 1 0.2 Klebsiella peumoiae 8 1.3 Pseudomoas aerugiosa = 450 Pseudomoas aerugiosa 1 0.2 Urie: Plasmid mediated AMPC producig Eterobacteriaceae (PAMP) Orgaism Name % of Strai Citrobacter koseri, amaloaticus = 88 Citrobacter koseri 1 1.1 Eterobacter cloacae complex = 144 Eterobacter cloacae 1 0.7 Escherichia spp = 2649 Escherichia coli 107 4.0 Klebsiella spp = 633 Klebsiella oxytoca 2 0.3 Klebsiella peumoiae 3 0.5 Proteus mirabilis = 320 Proteus mirabilis 1 0.3 Raoultella spp = 6 Raoultella orithiolytica 1 16.7 Urie: Plasmid mediated Carbapeemase producig Eterobacteriaceae (CPE) Orgaism Name % of Strai Eterobacter cloacae complex = 144 Eterobacter cloacae 1 0.7 Escherichia spp = 2649 Escherichia coli 1 0.0 Page: 6
Urie: Plasmid mediated Carbapeemase producig No Eterobacteriaceae (CPNE) Orgaism Name % of Strai Urie: Vacomyci Resistat Eterococci (VRE) Orgaism Name % of Strai Eterococcus spp = 614 Eterococcus faecalis(vre) - VAN-A 1 0.2 Eterococcus faecium (VRE) - VAN-A 4 0.7 Eterococcus faecium (VRE) - VAN-A, VAN-B 1 0.2 Eterococcus faecium (VRE) - VAN-B 8 1.3 Urie: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Staphylococcus aureus (ALL) = 102 S.aureus (o-multiresistat MRSA) 30 29.4 Staphylococcus aureus (MRSA) 3 2.9 Staphylococcus aureus (UK EMRSA-15) 28 27.5 Page: 7
No-urie Atibiogram All SNP Nursig Home Orgaisms %Total Peicilli Amoxicilli Flucloxacilli Amoxicilli-clavulaate Ticarcilli-clavulaate Pipericilli-tazobactam Cefaloti Cefazoli Ceftriaxoe Ceftazidime Cefepime Meropeem Getamici Amikaci Sulpha-trimethoprim Ciprofloxaci Fusidic Acid Rifampici Erythromyci/Clarithromyci Clidamyci Tetracyclie Mupiroci Vacomyci All isolates 2821 100 Staphylococcus aureus % 15 74 74 74 97 80 95 100 77 79 94 99 100 (ALL) 1784 63.2 1783 1784 1784 1784 1784 *1631 *1632 *1632 1784 1783 1784 *1576 *1632 Pseudomoas % R R 59 96 R R 97 98 97 96 95 R 95 *501 675 676 653 676 675 *505 675 aerugiosa 676 24.0 Haemophilus ifluezae 84 3.0 Moraxella catarrhalis 53 1.9 ß haemolytic Streptococci Other (oa ob) 41 1.5 % 63 88 57 100 84 84 84 84 % 2 100 85 100 100 53 53 52 53 53 % 100 100 100 100 80 80 66 100 41 41 *14 41 41 41 41 *15 Page: 8
Sigal Resistaces: Where the tables below cotai o data o multiresistat orgaisms have bee detected. NoUrie: Exteded spectrum beta lactamase producig Eterobacteriaceae (ESBL) Orgaism Name % of Strai Escherichia spp = 25 Escherichia coli 5 20.0 Klebsiella spp = 15 Klebsiella oxytoca 1 6.7 Klebsiella peumoiae 1 6.7 NoUrie: Plasmid mediated AMPC producig Eterobacteriaceae (PAMP) Orgaism Name % of Strai Escherichia spp = 25 Escherichia coli 1 4.0 NoUrie: Plasmid mediated Carbapeemase producig Eterobacteriaceae (CPE) Orgaism Name % of Strai NoUrie: Plasmid mediated Carbapeemase producig No Eterobacteriaceae (CPNE) Orgaism Name % of Strai NoUrie: Vacomyci Resistat Eterococci (VRE) NoUrie: Methicilli Resistat Staphylococcus aureus (MRSA) Orgaism Name % of Strai Staphylococcus aureus (ALL) = 1784 S.aureus (o-multiresistat MRSA) 237 13.3 Staphylococcus aureus (MRSA) 29 1.6 Staphylococcus aureus (UK EMRSA-15) 199 11.2 Page: 9
NoUrie: Streptococcus peumoiae Peicilli Susceptibility ** (Oral peicilli V breakpoits) MIC category % of Strai Streptococcus peumoiae = 9 Itermediate 0.12-1 mg/l 4 44.4 Sesitive 0.06 mg/l 5 55.6 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 Eterobacteriaceae (ESBL) Orgaism Name % of Strai Blood Culture: Plasmid mediated AMPC producig Eterobacteriaceae (PAMP) Orgaism Name % of Strai Blood Culture: Plasmid mediated Carbapeemase producig Eterobacteriaceae (CPE) Orgaism Name % of Strai Eterobacter cloacae complex = 144 Eterobacter cloacae 1 0.7 Escherichia spp = 2649 Escherichia coli 1 0.0 Blood Culture: Plasmid mediated Carbapeemase producig No Eterobacteriaceae (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