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In-Vitro Susceptibility of 1982 Respiratory Tract Pathogens and 1921 Urinary Tract Pathogens Against 19 Antimicrobial Agents: a Canadian Multicentre Study

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In-Vitro Susceptibility of 1982 Respiratory Tract Pathogens and 1921 Urinary Tract Pathogens Against 19 Antimicrobial Agents: a Canadian Multicentre Study Journal of Antimicrobial Chemotherapy (1999) 43, Suppl. A, 3–23 JAC In-vitro susceptibility of 1982 respiratory tract pathogens and 1921 urinary tract pathogens against 19 antimicrobial agents: a Canadian multicentre study Joseph M. Blondeaua*, Y. Yaschuka, M. Sutera, David Vaughanb and the Canadian Antimicrobial Study Group aDivision of Clinical Microbiology, Saskatoon District Health and St Paul’s Hospital (Grey Nuns) and the University of Saskatchewan, Saskatoon, Saskatchewan; bAnti-Infective Division, Bayer Health Care, Toronto, Ontario, Canada A total of 3903 pathogens from 48 Canadian medical centres were tested against 19 antimicro- bial agents. Five agents showed activity against 90% of all 1982 respiratory tract pathogens tested (ciprofloxacin, 90%; cefoperazone, 91%; ticarcillin/clavulanate, 92%; ceftazidime and imipenem, 93% each). Nine agents had 90% activity against Enterobacteriaceae from respira- tory tract infection (cefotaxime and ticarcillin/clavulanate, 90% each; aztreonam, ceftizoxime and ceftriaxone, 91% each; ceftazidime, 93%; ciprofloxacin, 97%; imipenem and netilmicin, 98% each). Similarly, five agents had activity against 90% of all 1921 urinary tract pathogens tested (ciprofloxacin and ticarcillin/clavulanate, 90% each; cefoperazone and netilmicin, 91% each; imipenem, 99%). Nine agents had 95% activity against Enterobacteriaceae from urinary tract infection (ciprofloxacin, 95%; cefotetan, 97%; aztreonam, cefotaxime, ceftazidime, ceftiz- oxime, ceftriaxone and netilmicin, 98% each; imipenem, 99%). Seventeen agents had activity against 95% of Staphylococcus aureus strains. Susceptibility of Pseudomonas aeruginosa isolates ranged from 2% to 91%. Introduction Urinary tract infections (UTI) represent a major health problem, affecting an estimated 10–20% of women at some Pneumonia is a significant cause of morbidity and mortal- point during their lifetime.3 In contrast, the prevalence of ity.1 These infections may be categorized into community- UTI in healthy men is ,0.1%. Up to 42% of all hospital- acquired or nosocomial pneumonia with the pathogenesis acquired infections are of the urinary tract.4 Escherichia and aetiology varying depending on age, co-morbid ill- coli is the organism most commonly isolated from UTI in nesses and predisposing risk factors, such as previous or both compromised and immunocompetent patients. Other current antimicrobial therapy. Therapeutic management is Enterobacteriaceae, Pseudomonas spp., Staphylococcus based on the type of pneumonia, duration of symptoms spp. and Enterococcus spp. are also significant causes of and, therefore, probable aetiology. Empirical treatment is UTI, their prevalence depending on the age and condition often initiated before availability of laboratory results, of the host.5 which may not yield a pathogen.2 Nonetheless, Haemo - Management of both pneumonia and UTI has become philus influenzae, Moraxella catarrhalis and Streptococcus complicated by increasing antimicrobial resistance.6–10 pneumoniae are commonly isolated from patients with Moreover, it has become important to define local, national either community- or hospital-acquired pneumonia.1 and international rates of resistance for a range of patho- Similarly, patients suffering from acute exacerbations gens. It is important to define resistance rates for pathogens of chronic bronchitis, acute or chronic otitis media, and recovered from a variety of infections since it has been sinusitis are often treated empirically for the same patho- shown that differential resistance rates exist for specific gens. pathogens and antimicrobial agents recovered from dif- *Corresponding address: Department of Clinical Microbiology, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8. Tel: 11-306-655-6943; Fax: 11-06-655-6947; E-mail: [email protected] 3 © 1999 The British Society for Antimicrobial Chemotherapy J. M. Blondeau et al. ferent types of infections11,12 and institutions.11–13 Finally, Results with increasing antimicrobial resistance, baseline data will serve as an important reference for monitoring changes in Respiratory tract pathogens resistance. There are limited national Canadian data on The total number of isolates and their susceptibility to 19 antimicrobial resistance amongst pathogens recovered antimicrobial agents are outlined in Table I. P. aeruginosa from respiratory tract infections (RTI) and UTI. In the (cumulative data from two studies), H. influenzae, S. current study, we determined the in-vitro susceptibility of aureus, Klebsiella spp., S. pneumoniae and Enterobacter approximately 3903 pathogens to 19 antimicrobial agents spp. were the most frequently recovered organisms. Of the recovered from patients with RTI or UTI. isolates tested, 1533 were Gram-negative and 449 Gram- positive; 1188 were from inpatients and 620 were from outpatients (the patient location for 174 P. aeruginosa iso- Materials and methods lates was not available). Five agents had activity against >90% of all isolates tested: these were ciprofloxacin The pathogens reported in this study represent the cumula- (90%), cefoperazone (91%), ticarcillin/clavulanate (92%), tive data from two studies. Initially, a total of 15 medical ceftazidime and imipenem (93% each). Isolates from centres, representing all ten Canadian provinces and nearly patients with cystic fibrosis were excluded. all major population areas in Canada, were recruited to As expected, activity against Gram-negative respiratory provide geographical sampling. Each centre tested approx- tract pathogens depended on the agent tested. All agents imately 100 strains of bacteria from patients with RTI and except carbenicillin (88%), mezlocillin (86%), and ticar- an additional 100 isolates from patients with UTI. In total, cillin (87%) had activity against >95% of Haemophilus 1507 clinical isolates from patients with RTI and 1499 clin- spp. All agents had activity against >97% of M. catarrhalis. ical isolates from patients with UTI were collected between Similarly, all antimicrobials had activity against >90% of October 1993 and April 1994. A maximum of 50 E. coli Klebsiella spp. except carbenicillin (2%), chloramphenicol isolates from patients with UTI were collected from each (83%), mezlocillin (67%) and ticarcillin (7%). Susceptibil- site. For subsequent collection of Pseudomonas aeruginosa ity of Enterobacter spp. to the agents tested was variable, isolates, 48 medical centres representing all ten Canadian with only three agents having .90% activity: ciprofloxacin provinces, the Northwest Territories and nearly all major (97%), imipenem (98%) and netilmicin (97%). The activ- population areas were recruited. This increased the total ity of the third-generation cephalosporins against Entero - number of tested pathogens from RTI to 1982 and from bacter spp. was comparable, with rates varying from 78% to UTI to 1921. All additional P. aeruginosa isolates were 83%. Only ciprofloxacin (100%) and imipenem (100%) shipped to and tested at the study coordinator’s (J.M.B.) had activity against >90% of Citrobacter spp., whereas laboratory. Only fresh clinical isolates were eligible for activity varied from 31% to 88% for the other agents inclusion in the study, and duplicate isolates from the same tested. Susceptibility ranged from 2% to 91% for P. aeru - patient were not permitted. The clinical validity of the ginosa and the following seven agents had >84% activity: isolates was determined by local laboratory criteria, and carbenicillin, 92%; ceftazidime, 89%; cefoperazone, 84%; organisms were identified by reference or comparable ciprofloxacin, 86%; imipenem, 90%; ticarcillin and ticar- methods. There was no selection process in the study cillin/clavulanate, 91% each. Overall, nine agents had design that would increase the likelihood of collecting >90% activity against the Enterobacteriaceae: cefotaxime resistant isolates. Following testing, all isolates were stored. and ticarcillin/clavulanate, 90% each; aztreonam, cefti- All sites used the same protocol for in-vitro suscepti- zoxime and ceftriaxone, 91% each; ceftazidime, 93%; bility testing, and all supplies and media were provided by ciprofloxacin, 97%, imipenem and netilmicin, 98% each. the study coordinator. Following testing, the susceptibility Against Streptococcus pyogenes, all agents except aztre- results and the organisms were shipped to the study coordi- onam and ciprofloxacin (78%) had >90% activity. Simi- nator. MICs were determined for all isolates by the larly, >96% of all agents except aztreonam and mezlocillin Microscan MIC Plus Type 2 Panel with the following 19 (71%) had greater activity against >96% of S. aureus. antibiotics: amoxycillin/clavulanate, ampicillin/sulbactam, Susceptibility rates of S. pneumoniae to all agents were aztreonam, carbenicillin, cefamandole, cefonicid, cefo- 93%, except for aztreonam and ciprofloxacin (80%). taxime, cefoperazone, cefotetan, ceftazidime, ceftizoxime, ceftriaxone, chloramphenicol, ciprofloxacin, imipenem, Urinary tract pathogens mezlocillin, netilmicin, ticarcillin and ticarcillin/clavu- lanate.11 Testing was performed according to the manufac- E. coli, P. aeruginosa, Enterococcus spp. and Klebsiella spp. turers’ instructions, and interpretation was in accordance were the most frequently recovered urinary tract patho- with MIC interpretive criteria published by the NCCLS.14 gens (Table II). There were 1592 Gram-negative and For Haemophilus spp., M. catarrhalis, S. pneumoniae 329 Gram-positive isolates tested, including 1033 from and Streptococcus
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