2013-2015 Antibiogram

C&W Three-Year

Cumulative Antibiogram January 2013 – December 2015

Division of Microbiology, Virology & Infection Control Department of Pathology & Laboratory Medicine

Contents Comments and Limitations ...... 2 Contacts...... 2 Achromobacter species...... 3 Acinetobacter species ...... 3 Bacillus species...... 4 Burkholderia cepacia complex ...... 4 Campylobacter jejuni ...... 5 Chryseobacterium species...... 5 Citrobacter freundii ...... 6 Citrobacter koseri ...... 6 Corynebacterium species...... 7 Elizabethkingia species ...... 7 Enterobacter aerogenes...... 8 Enterobacter cloacae complex...... 8 Enterococcus faecalis...... 9 Enterococcus faecium ...... 9 Escherichia coli...... 10 Haemophilus influenzae ...... 10 Klebsiella oxytoca ...... 11 Klebsiella pneumoniae ...... 11 Morganella morganii...... 12 Pantoea species ...... 12 Propionibacterium species ...... 13 Proteus mirabilis ...... 13 Pseudomonas aeruginosa...... 14 Pseudomonas fluorescens group ...... 14 Pseudomonas putida group ...... 15 Serratia marcescens ...... 15 Salmonella species ...... 16 Staphylococcus aureus...... 17 Methicillin-Resistant Staphylococcus aureus ...... 17 Staphylococcus epidermidis ...... 18 Staphylococcus capitis (coagulase-negative)...... 18 Staphylococcus lugdunensis ...... 19 Stenotrophomonas maltophilia...... 19 Streptococcus pyogenes (Group A Strep) ...... 20 Streptococcus agalactiae (Group B Strep) ...... 20 Streptococcus dysgalactiae (Groups C & G) ...... 21 Streptococcus pneumoniae...... 21 Streptococcus mitis group (viridans Strep) ...... 22 Streptococcus anginosis group ...... 22

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Usage

 New technology in Microbiology (MALDI-TOF mass spectrometry) has reduced the time needed to identify organisms, but definitive susceptibility testing results still require a further 1-2 days. In the interim, antibiogram data may be useful in choosing or optimizing antibiotics to help ensure adequate coverage for the organism of interest.  Please keep in mind previous antimicrobial therapy in your patient, as this may select more resistant organisms.

Comments and Limitations

 Three years of data were pooled to get sufficient numbers of isolates for each species.  Most susceptibility patterns are relatively stable. For recent data on common isolates, please see the most recent annual antibiogram.  Data were collected on isolates, not patients, due to software limitations. There is often more than one isolate from each patient.  Some species are uncommon and the number of isolates is low. These are marked in red. Results are approximate, but are included to highlight typical treatment considerations or important resistance patterns.  The Y axis and the number above each column indicate the percentage of isolates of that species that were fully susceptible to the antibiotic.

Contacts

For further information on antimicrobial susceptibility testing, please contact the Microbiologist-on-call, or one of us at the numbers below:

 Ghada Al-Rawahi MD FRCPC (604) 875-2345 ext 2394 [email protected]  David Goldfarb MD FRCPC (604) 875-2345 ext 7688 [email protected]  Jocelyn Srigley MD FRCPC (604) 875-2345 ext 5208 [email protected]  Peter Tilley MD FRCPC (604) 875-2345 ext 6694 [email protected]

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Achromobacter species

Achromobacter species n=127

100

60 50 47 39 40 33

Percent Susceptible 19 20 16 7 0 0 0 2 0

Acinetobacter species

Acinetobacter species n=133 98 96 94 94 95 100 90 86 79 80

60 42 40

Percent Susceptible 20 15

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Bacillus species

Bacillus species n=23 96 100 87 80

57 60

Percent Susceptible 20 7 0

Note the small sample size. Results are approximate.

Burkholderia cepacia complex

Burkholderia cepacia complex n=23 100

80 70 64 60 43 40

17 Percent Susceptible 17 17 20 0 0 0 0 0

Note the small sample size. Results are approximate. B. cepacia complex organisms are resistant to aminoglycosides and colistin.

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Campylobacter jejuni

Campylobacter jejuni n=33 100 100

80 63 60

Percent Susceptible 20

Erythromycin result also applies to azithromycin (EUCAST).

Chryseobacterium species

Chryseobacterium species n=96 98 100

80 70 65 60

Percent Susceptible 20 5 6 5 2 0 0 0

Chryseobacteria are environmental organisms which carry metalo-beta-lactamases, rendering them resistant to most penicillins, cephalosporins and carbapenems. Treatment options are limited. Kirby, Journal of Clinical Microbiology 2004.

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Citrobacter freundii

Citrobacter freundii n=46 98 100 100 100 93 96 85 87 78 80

Percent Susceptible 20 0 0 0 0

*Note that Citrobacter freundii has a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, it may become resistant during therapy (Choi, Antimicrob Agents Chemother 52;3:995-1000 2008). For this reason, carbapenems are often used to treat invasive C. freundii infections.

Citrobacter koseri

Citrobacter koseri n=35 100 100 100 100 100 100 100 100 94 94

60 46 38 40

Percent Susceptible 20 0 0

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Corynebacterium species

Corynebacterium species n=28 100 100 82 80

60 44 40 40

20 Percent Susceptible

Note the small sample size. Results are approximate.

Elizabethkingia species

Elizabethkingia species n=18 100 100 83 87 80

Percent Susceptible 20 11 0 0 0 0 0 0 0 0

Elizabethkingia (previously named Flavibacterium and Chryseobacterium) are environmental organisms which carry metalo- beta-lactamases, rendering them resistant to most penicillins, cephalosporins and carbapenems. Treatment options are limited.

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Enterobacter aerogenes

Enterobacter aerogenes n=42 100 100 100 95 98 98 100

80 64 64 60

40 23 20 Percent Susceptible 0 2 0 0

Note that Enterobacter species have a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, they become resistant during therapy in about 10-20% of cases (Chow, Annals Int Med 115:585-590 1991). For this reason, carbapenems are often used to treat invasive Enterobacter infections.

Enterobacter cloacae complex

Enterobacter cloacae complex n=335 97 98 98 99 100 94 81 83 80

Percent Susceptible 20 1 4 1 0

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Enterococcus faecalis

Enterococcus faecalis n=814 100 100 97 99 100 83 80 80 69 60

20 Percent Susceptible 0 1 0

* Please note that E. faecalis is resistant to all cephalosporins and quinupristin/dalfopristin. Meropenem has poor activity (Edwards, Journal of Anticrobial Chemotherapy 1995).

Enterococcus faecium

Enterococcus faecium n=18 100 89 83 78 80 60 39 39 40 20 9 0 0

0 Percent Susceptible

Please note that E. faecium is resistant to all cephalosporins. Meropenem has poor activity (Edwards, Journal of Anticrobial Chemotherapy 1995). Results are from 2015 only with ARO/VRE screening specimens excluded. Note small sample size. Results are approximate.

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Escherichia coli

Escherichia coli n=2229

97 100 100 98 100 89 90 90 85 87 79 80 70

60 50 47

Percent Susceptible 20

Haemophilus influenzae

Haemophilus influenzae n=441 99 100 100 96

80 72 66 60

Percent Susceptible 20

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Klebsiella oxytoca

Klebsiella oxytoca n=183 99 99 99 100 98 100 95 92 93 93 89 79 80

60 51

Percent Susceptible 20 0 0

Klebsiella pneumoniae

Klebsiella pneumoniae n=272 98 99 99 96 96 94 100 92 94 90 86 88 82 80

60 48

Percent Susceptible 20 0 0

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Morganella morganii

Morganella morganii n=46 100 100 100 89 80 80 80 80 80 74

Percent Susceptible 20 0 0 0 0 0 0 0

Pantoea species

Pantoea species n=23

100 100 100 100 100 100 100 100

60 50

40 26

Percent Susceptible 20 4 0

Note the small sample size. Results are approximate.

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Propionibacterium species

Propionibacterium species 100 n=13 100 92

Percent Susceptible 20 0 0

Note the small sample size. Results are approximate.

Proteus mirabilis

Proteus mirabilis n=120

99 100 100 100 89 91 91 89 84 80 80 68

60 38 40 27

Percent Susceptible 20 5 0 0

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Pseudomonas aeruginosa

Pseudomonas aeruginosa n=797 97 100 93 90 88 85 82 80 80 75

Percent Susceptible 20 4 0 0

Please note that cefotaxime, ceftriaxone and SXT are NOT effective for treatment of Pseudomonas aeruginosa infections. Data include patients with cystic fibrosis.

Pseudomonas fluorescens group

Pseudomonas fluorescens group n=68 100 100 100 96 100

80 74 75 65 60

20 Percent Susceptible

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Pseudomonas putida group

Pseudomonas putida group n=30 100 100 100 100 97 100 93

80 76

40 28

Percent Susceptible 20 0 0

Serratia marcescens

Serratia marcescens n=82 99 100 99 100 90 85 88 80 63 60

Percent Susceptible 20 0 4 0 0 0

*Note that Serratia marcescens has a chromosomal AmpC beta-lactamase. While appearing susceptible to 3rd generation cephalosporins (such as cefotaxime) on testing, there is concern that it may become resistant during therapy, although this is rare (Choi, Antimicrob Agents Chemother 52;3:995-1000 2008). For critically ill patients, meropenem may be a better option. If cefotaxime or ceftriaxone are used, and patient response is less than expected, please repeat cultures.

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Salmonella species

Salmonella species n=41 97 97 100 88 90

80 70

Percent Susceptible 20 0 0 0

Please note that first and second generation cephalosporins (e.g. cefazolin, cefuroxime) and aminoglycosides are ineffective against Salmonella species. Resistance against fluoroquinolones is increasing rapidly.

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Staphylococcus aureus

Staph aureus n=1861 100 98 100 100 100 91 91 91 91 91 93 80 80 73

20 Percent Susceptible 0 0

2015 data only shown. Clinical isolates only - MRSA screens excluded *Note that penicillin susceptibility is not reported at C&W due to its rarity and the subjectivity of the test. .

Methicillin-Resistant Staphylococcus aureus

MRSA n=175 100 98 100 100 100 83 80 72

60 37 40

Percent Susceptible 20 0 0 0 0 0 0 0

Clinical isolates only. 2015 only. MRSA screens excluded.

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Staphylococcus epidermidis (most common coagulase-negative Staphylococcus)

Staphylococcus epidermidis n=221 100 100 100

80 71

40 33 27 27 27 27 27

Percent Susceptible 18 20

Staphylococcus capitis (coagulase-negative)

Staphylococcus capitis n=70 100 100 100 100

40 33 33 33 33 33 35 27

Percent Susceptible 20

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Staphylococcus lugdunensis

Staphylococcus lugdunensis n=44 100 100 100 100 93 93 93 93 83 80

60 60

40 Percent Susceptible 20

Stenotrophomonas maltophilia

Stenotrophomonas maltophilia n=262 100 87

80 70

20 Percent Susceptible 0 0 0 0

S. maltophilia carries chromosomal carbapenemases, and is resistant to meropenem and imipenem.

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Streptococcus pyogenes (Group A Strep)

Streptococcus pyogenes (Gp A Strep) n=412 100 100 100 89 89

Percent Susceptible 20

*Penicillin or vancomycin resistance has not been reported for Streptococcus pyogenes.

Streptococcus agalactiae (Group B Strep)

Streptococcus agalactiae (Gp B Strep) n=840

100 100 100 100 97 100

80 63 57 60

Percent Susceptible 20

Inducible MLSB resistance testing is performed at C&W Microbiology before reporting clindamycin results.

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Streptococcus dysgalactiae (Groups C & G)

Streptococcus dysgalactiae n=40 100 100 100 83 77 80

Percent Susceptible 20

Streptococcus pneumoniae

Streptococcus pneumoniae n=153 100 100 97 98 100 100 92 80 80 73 60 40 20

Percent Susceptible 0

*Note that lower interpretive breakpoints are used for CSF isolates reflecting lower antibiotic levels. Erythromycin resistance also applies to azithromycin and clarithromycin.

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Streptococcus mitis group (viridans Strep)

Streptococcus mitis group n=57 100 100 89

80 69

Percent Susceptible 20

Streptococcus anginosis group

Streptococcus anginosis group n=158

100 100 100 100 83 80

Percent Susceptible 20

Streptococcus anginosis group includes S. anginosis, constellatus and intermedius.

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