INFECTIOUS DISEASES DIAGNOSTIC LABORATORY NEWSLETTER University of Minnesota Health University of Minnesota Medical Center University of Minnesota Masonic Children s Hospital May 2017 Printed herein are the latest cumulative antibiotic susceptibility results from University of Minnesota Medical Center from January 1, 2016-December 31, 2016 except where noted otherwise. These data should provide some guidelines in selecting the appropriate antibiotics for your patient. Data are for bacteria isolated from diverse sources, including bloods. Results listed are based on the Vitek Automated Microbiology System or a microdilution minimum inhibitory concentration (MIC) procedure. Yeast and Anaerobic susceptibility results are based on the Etest method. The figures listed indicate the percentages of organisms that are susceptible; figures in parentheses indicate the number of strains tested. If you have any questions or for susceptibilities of infrequently isolated organisms, please call the laboratory at (612) 273-3665. Patricia Ferrieri, M.D., Medical Director Laura Phillip, B.A., MLS, Tech. Supervisor Sue Johnson, MLS, Lead Tech 385
Fusobacterium Propionibacterium Anaerobic gram-positive cocci (not Strep ) Veillonella Actinomyces Bacteroides fragilis group* Bacteroides fragilis Prevotella, Porphyromonas, Bact. sp.- (not frag.)** Clostridium perfringens Clostridium sp., not perfringens Capnocytophaga AIBIOGRAM - AEROBIC BACTERIA (Etest method) Cefotaxime (88) Chloramphenicol Clindamycin (103) Metronidazole 21% (94) Penicillin (112) Meropenem (6) Imipenem (13) 1999-2016 1999-2016 1999-2016 1999-2016 1999-2016 1999-2016 1999-2016 26% (54) 64% (28) (128) (59) (19) (21) 67% (110) (48) (84) 68% (38) (50) 76% (67) (66) (71) 18% (16) 65% (85) (89) 63% (87) (26) (56) (32) (26) (27) (35) (38) (5) (9) (24) 61% (33) 7 56% (36) (33) 47% (17) (12) Cefotaxime (35) Chloramphenicol (13) Clindamycin Metronidazole (47) Penicillin (45) Meropenem (10) 1999-2016 1999-2016 1999-2016 1999-2016 (908) (98) (936) (119) (5) 75% (129) 76% (136) (1149) (126) (9) (4) 17% (12) (286) (18) Imipenem * This data includes members of Bacteroides fragilis group excluding Bacteroides fragilis. Members of the Bacteroides fragilis group include: B. distasonis, B. ovatus, B. thetaiotamicron, B. vulgatus, B. uniformis, B. caccae, B. eggerthii, B. stercoris and B. splanctinicus. ** This data includes the Bacteroides (not fragilis group), Prevotella and Porphyromonas. % = percent susceptible strains () = number of strains tested = not tested 386
Staphylococcus aureus (MSSA) Staphylococcus aureus (MRSA) Coagulase Negative Staph Enterococcus Enterococcus (VRE) Streptococcus viridians group* Streptococcus group B Strep pneumoniae (non-meningitis) Strep pneumoniae (meningitis) AIBIOGRAM - GRAM-POSITIVE BACTERIA Ampicillin 4% (1776) (356) (375) (919) Azithromycin 42% Cefotaxime (381) Ceftriaxone (381) (898) (127) (128) Clindamycin 75% 46% 52% 81% 59% (2801) (1261) (1108) (373) (901) (108) Erythromycin 68% (2801) 15% (1261) 34% (1107) 67% (317) 5 (882) Gentamicin (2919) (1335) (1890) Ciprofloxacin 87% 27% 54% 67% (2919) (1333) (1871) (1622) (344) Levofloxacin 9 28% 54% 68% (2918) (1334) (1871) (1614) (343) (127) Meropenem 87% (15) (57) (57) Oxacillin** 41% (2919) (1335) (1890) Penicillin (2907) (1335) (1889) (1776) 4% (356) (376) (918) (126) 67% (127) Tetracycline (2917) Trimeth/Sulfa (2917) Vancomycin (2923) Nitrofurantoin (2622) (1334) (1334) (1336) (1224) (1866) 55% (1284) (1889) (1798) 26% 7% (1704) (344) (1838) (1689) (487) 21% (338) (381) (921) (130) (130) Linezolid (2905) Synercid (2911) (1333) (1328) (1856) (1854) (1692) 16% (1760) (355) (355) * Here, Streptococcus viridans group includes S. anginosus, S. constellatus, S. intermedius, and S. mitis group ** Oxacillin data are representative of all semi-synthetic penicillins (nafcillin, methicillin) There are different MIC interpretation breakpoints for this antibiotic for nonmeningitis and meningitis sources. Coag negative Staph includes S. epidermidis, S. capitis, S. haemolyticus, S. hominis, and S. saprophyticus. % = susceptible strains; ( ) = number of strains tested; = not tested 387
Acinetobacter baumanii Citrobacter freundii aerogenes cloacae E. coli oxytoca pneumoniae Morganella morganii Proteus mirabilis aeruginosa* aeruginosa** Burkholderia cepacia Serratia marcescens Stenotrophomonas maltophilia AIBIOGRAM - GRAM-NEGATIVE BACTERIA Antibiotics Amikacin (98) (257) (175) (538) (5834) Ampicillin 58% (6735) 63% (5993) (292) (1318) (541) 67% (297) (1349) (550) (1122) 4 Aztreonam 53% Cefazolin (6708) Cefepime 71% (6716) 59% (323) (324) (1432) (186) 85% (1206) 43% Cefotaxime Cefoxitin (5889) Ceftazidime 77% Ceftriaxone 51% Ciprofloxacin 81% (6729) (6730) (6732) (171) (324) (323) (1027) 44% 84% (387) 71% (1206) 62% 22% (195) (1205) 37% 32% (438) Gentamicin (6736) 9 87% (1207) 25% Imipenem 48% Levofloxacin 9 9 73% 69% 39% (279) (6728) (323) (1206) Meropenem (257) (177) (539) (5844) (292) (1321) (540) 81% (1119) 55% (1393) Piperacillin 6 (1391) * Non-cystic fibrosis cultures ** Cystic fibrosis cultures (581) (6723) (1185) 64% 3% 73% (194) (186) 7 (445) (185) 388
Acinetobacter baumanii Citrobacter freundii aerogenes cloacae E. coli oxytoca pneumoniae Morganella morganii Proteus mirabilis aeruginosa* aeruginosa** Burkholderia cepacia Serratia marcescens Stenotrophomo nas maltophilia Gram Negative Bacteria, continued. Antibiotics Tobramycin Trimeth/Sulfa 76% (279) Nitrofurantoin 6 (282) 21% (125) 4 (258) (6734) 77% (6733) (5916) 87% (171) (1434) 39% (1205) 57% 35% (89) 9 (195) (446) (1029) * Non-cystic fibrosis cultures ** Cystic fibrosis cultures 6.3% of the E. coli, 8. of the K. pneumoniae, 8. of the K. oxytoca, and 0.8% of the P. mirabilis tested in 2016 were positive for ESBL. These statistics are for ESBL negative organisms only. % = percent susceptible strains ( ) = Number of strains tested = not tested = Intrinsically resistant Haemophilus influenzae Ampicillin* 7 (156) Amoxicillin/Clav (167) Ceftriaxone (167) Levofloxacin (167) * Ampicillin resistance for Haemophilus influenzae type b is common nationwide. The data here do not distinguish between H. influenzae type b or non-type b strains. Yeasts/Fungi (2012 through 2016) Candida albicans/ Candida Candida Candida Candida Cryptococcus dubliniensis glabrata krusei tropicalis parapsilosis Neoformans Amphotericin B** Fluconazole 16% * (226) (153) (42) (109) Itraconazole** 5-fluorocytosine Voriconazole (213) Micafungin (222) 5% (142) (143) 69% (29) 9 (30) (39) (40) Note: For some Candida, not listed above, susceptibility to these drugs is variable. * Candida krusei isolates are intrinsically resistant to Fluconazole. **There are no official interpretation guidelines for Amphotericin B or Itraconzole for yeast/fungi or for Cryptococcus for any antifungals. These are designated as. (103) (104) 389