Piperacillin/Tazobactam. Ceftriaxone

Transcription

1 Nova Scotia Health Authority Antibiotic : Eastern Zone January, 07 to December, 07 INPATIENT GRAM NEGATIVE ISOLATES: % SUSCEPTIBLE # tested ** Cefazolin (Cephalexin ) Ceftazidime Piperacillin/Tazobactam Ertapenem Meropenem Nitrofurantoin Tetracycline Gentamicin Tobramycin E. coli Klebsiella pneumoniae 67 R Klebsiella oxytoca 48 R Citrobacter freundii 7 R R R 6* 6* R Enterobacter cloacae 8 R R R R R Enterobacter aerogenes 5 7 R R R 65* 65* R R Serratia marcescens 0 R R R R R Morganella morganii 45 R R R R Proteus mirabilis R Afermenters Pseudomonas 75 R R R 86 R 8 R R aeruginosa Burkholderia cepacia 7 R R R 5 R R R R Acinetobacter baumannii complex 60 R R R Stenotrophomonas sp. R R R 5 R R R R 87 R R 9 * may develop resistance on treatment due to inducible AmpC Blactamase (not recommended for treatment for Enterobacter and Citrobacter) R intrinsically resistant or sensitivity <0% either not tested or not reported for uncomplicated UTI only (cephalexin and nitrofurantoin) includes isolates from Oct 04Sept 07 (due to low number of isolates) 4 Enterobacter aerogenes now called Klebsiella aerogenes <50% 5089% 90%

2 INPATIENT GRAM POSITIVE ISOLATES: % SUSCEPTIBILE (Jan. to Dec 07) # tested** Penicillin Oxacillin 7 Clindamycin Erythromycin Nitrofurantoin 8 Tetracycline 6 Vancomycin Staphylococcus aureus MRSA 0 R R R R R Coagulase negative Staphylococcus Enterococcus faecalis R R R R 00 Enterococcus faecium 5 R R R R R R R R R R 8 98 Streptococcus MRSA pyogenes 4,9 (Group A R 00 Streptococcus) Streptococcus pneumoniae 5, R intrinsically resistant or susceptibility < 0% either not tested or not reported MRSA = methicillin resistant Staphylococcus aureus inferred susceptibility from other agents. predicted susceptibility from literature 4 includes isolates from Oct 05 to Sept 07 5 noncsf isolates (CSF isolates may have higher resistance due to lower MIC breakpoints for penicillin and ceftriaxone) 6 7 cefazolin and cephalexin susceptibilities can be inferred from oxacillin 8 for uncomplicated UTI only 9 combined inpatient and outpatient data <50% 5089% 90%

3 OUTPATIENT GRAM NEGATIVE ISOLATES: % SUSCEPTIBLE (Jan. Dec. 07) # tested** Cefazolin (Cephalexin ) Ceftazidime Piperacillin/Tazobactam Ertapenem Meropenem Nitrofurantoin Tetracycline Gentamicin Tobramycin E. coli Klebsiella pneumoniae 6 R Klebsiella oxytoca 7 R Citrobacter freundii 7 R R R * * * Enterobacter cloacae 99 R R R * R* * Enterobacter aerogenes 9 R R R * R* * Serratia marcescens 66 R R R R R Morganella morganii 5 R R R Proteus mirabilis R Afermenters Pseudomonas aeruginosa 95 R R R 87 R 89 R 00 8 R R Burkholderia cepacia R R R 0 R R R 6 R R R R Stenotrophomonas R R R 6 R R R R 86 R R sp. Acinetobacter 4 R R R 5 85 R R baumannii complex * may develop resistance on treatment due to inducible AmpC Blactamase (not recommended for treatment for Enterobacter and Citrobacter) R intrinsically resistant or sensitivity <0% either not tested or not reported for uncomplicated UTI only (cephalexin and nitrofurantoin) Enterobacter aerogenes now called Klebsiella aerogenes <50% 5089% 90%

4 OUTPATIENT GRAM POSITIVE ISOLATES: % SUSCEPTIBLE (Jan. Dec. 07) # tested** Penicillin Oxacillin 8 Clindamycin Erythromycin Nitrofurantoin 9 Tetracycline 6 Vancomycin Staphylococcus aureus MRSA 8 R R R R R Coagulase negative Staphylococcus Enterococcus faecalis R R R 00 Enterococcus faecium R R R R 44 R R 6 00 Streptococcus MRSA pyogenes (Group A Streptococcus) 4, R 00 Streptococcus pneumoniae 5, R intrinsically resistant or susceptibility < 0% either not tested or reported MRSA = methicillin resistant Staphylococcus aureus inferred susceptibility from other agents. predicted susceptibility from literature 4 includes isolates from Oct 04 to Sept 06 5 noncsf isolates (CSF isolates may have higher resistance due to lower MIC breakpoints for penicillin and ceftriaxone) 6 7 may be susceptible but not reported (not better than ampicillin) 8 cefazolin and cephalexin susceptibilities can be inferred from oxacillin 9 for uncomplicated UTI only 0 combined inpatient and outpatient data <50% 5089% 90%

5 E. coli and Klebsiella pneumoniae (urinary isolates only): % Susceptible (Jan. Dec. 07) # tested Cefazolin (Cephalexin ) Ceftazidime Piperacillin/Tazobactam Ertapenem Meropenem Nitrofurantoin Tetracycline Gentamicin Tobramycin Inpatient Urine E. coli Klebsiella pneumoniae 9 R Outpatient Urine E. coli Klebsiella pneumoniae 5 R R intrinsically resistant or sensitivity <0% either not tested or not reported for uncomplicated UTI only (cephalexin and nitrofurantoin) doxycycline susceptibility inferred from tetracycline <50% 5089% 90%

6 Candida species: % Susceptible (0607) # tested Fluconazole (standard dose) Fluconazole (dose dependent ) Voriconazole Micafungin Candida albicans C. parapsilosis C. glabrata C. tropicalis C. krusei C. unspecified <50% 5089% 90% no data * data combined from 06 and 07 calendar years (includes both blood stream and nonblood stream isolates) a higher dose of Fluconazole would be indicated