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All Hospitals Antibiogram Jan - Dec 2019

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All Hospitals Antibiogram Jan - Dec 2019 All Hospitals Antibiogram Jan - Dec 2019 All Hospitals Antibiogram Jan - Dec 2019 Page: 1 All Hospitals Antibiogram Jan - Dec 2019 Cumulative antibiograms specific for individual health care facilities can be a useful resource for local antimicrobial stewardship groups to inform empirical therapy recommendations and formulary management. The provision of yearly antibiograms by health care facilities is now required in the National Safety and Quality Health Service (NS&QHS) Standard 3 (3.14.3).ï Antibiogram summary: This document contains the yearly cumulative antibiogram for all hospitals combined serviced by Sullivan Nicolaides Pathology. It is divided into three parts 1. Urinary Antibiogram 2. Non Urinary Antibiogram 3. Blood Culture Antibiogram xOrganisms are listed in descending order of frequency. x2UJDQLVPVDUHFRORXUFRGHGDFFRUGLQJWRZKHWKHUWKH\DUH*UDP3RVLWLYHRU*UDP1HJDWLYHEDFWHULD xOnly the first isolate of a given species per patient per year per subtype (e.g urine, non urine, blood cultures) is included. xScreening isolates collected for infection control purposes have been removed. xSince 2012, susceptibility testing to produce these antibiograms is performed using EUCAST microbroth dilution and disc diffusion methods.ð xExpert EUCAST rules in Antimicrobial Susceptibility testing have been applied.ñ xWhere the total number of isolates tested is < 30, results are considered statistically invalid in accordance with CLSI M39-A4. Ї xWhere only a subset (< 95%) of isolates from a particular organism group have been tested, reported susceptibilities are usually not indicative of the true susceptibility because of the selective nature of testing only more resistant isolates. These occasions are marked with an * and susceptibility results should be interpreted with caution. xFor cefazolin, the EUCAST-approved Australian National Antimicrobial Susceptibility Testing Committee guidelines were used. xFor amoxicillin±FODYXODQLFDFLG&/6,EUHDNSRLQWVZHUHXVHGEHFDXVHWKH&/6,IRUPXODWLRQIRUWKLVDJHQWZDVXVHGLQWKH9LWHNVXVFHSWLELOLW\FDUGV Signal resistances: At the end of each antibiogram, signal resistances are summarised even if the organism occurs at a frequency too low (< 30) to appear in either the urinary, non-urinary or blood culture antibiograms. These organisms include xEnterobacterales resistant to third or fourth generation cephalosporins due to the presence of Extended Spectrum Beta Lactamases (ESBLs) xEnterobacterales resistant to third or fourth generation cephalosporins due to the presence of Plasmid mediated AMPC production (PAMPs) xEnterobacterales resistant to carbapenems due to the presence of a plasmid mediated carbapenamase (CPE) xNon Enterobacterales (e.g Acinetobacter spp; Pseudomonas aeruginosa) resistant to carbapenems due to the presence of a plasmid mediated carbapenamase (CPNE) xVancomycin resistant Enterococci (VRE) xMethicillin resistant Staphylococcus aureus (MRSA) xVancomycin heteroresistant, intermediate and resistant Staphylococcus aureus (hVISA, VISA, VRSA) xPenicillin intermediate and resistant Streptococcus pneumoniae noting that breakpoints differ according to clinical condition (meningitis, pneumonia, other) and mode of administration xPenicillin intermediate and resistant viridans Streptococci Page: 2 All Hospitals Antibiogram Jan - Dec 2019 Changes in 2019: xOrganisms tested with the EUCAST antimicrobial susceptibility method from 2019 are considered susceptible if the organism tests either "susceptible, standard dosing regimen (S)" or "susceptible, increased exposure (I)". Previous iterations of these antibiograms only included ³susceptible, standard dosing regimen´(S).ð The current EUCAST interpretations are: xS - Susceptible, standard dosing regimen: A microorganism is categorised as "Susceptible, standard dosing regimen", when there is a high likelihood of therapeutic success using a standard dosing regimen of the agent. xI ±Susceptible, increased exposure*: A microorganism is categorised as "Susceptible, Increased exposure*" when there is a high likelihood of therapeutic success because exposure to the agent is increased by adjusting the dosing regimen or by its concentration at the site of infection. xR - Resistant: A microorganism is categorised as "Resistant" when there is a high likelihood of therapeutic failure even when there is increased exposure. xDosing and modes of administration related to S, I and R of agents are available in the last TAB of the EUCAST breakpoint table.ð References: 1. Australian Commission on Safety and Quality in Health Care: Specification for a Hospital Cumulative Antibiogram: Sydney: ACSQHC; 2019 2. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters, version 9.0 2019. 3. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Intrinsic Resistance and Exceptional Phenotypes Tables: EUCAST; 2011 [Available from: http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Expert_Rules/Expert_rules_intrinsic_exceptional_V3.1.pdf. 4. Clinical and Laboratory Standards Institute (CLSI). Guideline for Analysis and Presentation of Cumulative Antimicrobial Susceptibility (M39-A4). Pennsylvania: CLSI; 2014. Colour coding for all antibiograms tables is shown below. of isolates susceptible (S) or susceptible increased exposure of isolates susceptible (S) or susceptible increased exposure Gram Positive Organism (I) (I) (where sample size <95% of total isolates tested) 70-89% of isolates susceptible (S) or susceptible increased 70-89% of isolates susceptible (S) or susceptible increased Gram Negative Organism exposure (I) exposure (I) (where sample size <95% of total isolates tested) Antibiotic Not recommended to be used in children without <70% of isolates susceptible (S) or susceptible increased exposure <70% of isolates susceptible (S) or susceptible increased exposure specialist advice (I) (I) (where sample size <95% of total isolates tested) Intrinsic Resistance is present with this organism-antibiotic Restricted or 2nd Line Antibiotics Sample size <95% of the total isolates tested R combination * Restricted or 2nd Line Antibiotics and Antibiotic Not recommended Percentage of isolates susceptible (S) or susceptible increased Number of isolates tested with this antibiotic to be used in children without specialist advice % exposure (I) to this particular antibiotic n Page: 3 All Hospitals Antibiogram Jan - Dec 2019 Urine Antibiogram All SNP Hospiltals Jan - Dec 2019 Organism Group %Total No. Organisms Amoxicillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalexin Ceftriaxone Ceftazidime Meropenem Gentamicin Amikacin Trimethoprim Nitrofurantoin Norfloxacin Ciprofloxacin Fusidic Acid Rifampicin Fosfomycin Vancomycin All isolates 8887 100 % 54 91 94 86 91 100 94 100 75 99 87 98 Escherichia spp 4235 47.7 n 4235 4235 4063 4231 4084 *2711 4083 *2719 4235 4235 4235 *422 % 88 R 90 83 32 97 Enterococcus spp 1356 15.3 n 1356 1356 1356 *958 *1267 % R 95 94 90 94 100 97 100 87 81 93 Klebsiella spp 938 10.6 n 938 895 937 898 *544 899 *544 938 938 938 Pseudomonas % R R 93 R R 96 99 98 99 R R 96 94 716 8.1 aeruginosa n 716 716 *470 716 *472 *642 715 % 87 99 100 97 100 100 98 100 86 R 99 Proteus mirabilis 378 4.3 n 378 378 *356 378 360 *223 360 *224 378 378 Enterobacter cloacae % R R 64 R 61 98 88 100 73 77 86 231 2.6 complex n 230 230 *178 230 *178 231 231 231 Citrobacter koseri, % R 93 98 90 96 100 100 100 96 97 98 138 1.6 amalonaticus group n 138 132 138 132 *87 132 *87 138 138 138 KDHPRO\WLF % 100 93 99 84 122 1.4 Streptococci Group B n 122 122 122 *67 % R R 93 R 95 100 99 100 89 R 98 Morganella spp 112 1.3 n 112 112 *91 112 *91 112 112 Staphylococcus aureus % 17 85 92 100 88 97 100 100 110 1.2 (ALL) n 109 110 106 107 105 *36 *36 *36 Page: 4 All Hospitals Antibiogram Jan - Dec 2019 Urine Antibiogram All SNP Hospiltals Jan - Dec 2019 Organism Group %Total No. Organisms Amoxicillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalexin Ceftriaxone Ceftazidime Meropenem Gentamicin Amikacin Trimethoprim Nitrofurantoin Norfloxacin Ciprofloxacin Fusidic Acid Rifampicin Fosfomycin Vancomycin All isolates 8887 100 % R R 72 R 75 100 100 100 93 59 94 Klebsiella aerogenes 95 1.1 n 92 92 *72 92 *72 95 95 95 Citrobacter freundii % R R 83 R 78 98 91 100 86 97 94 79 0.9 complex n 78 79 *58 79 *59 79 79 79 Coagulase negative % 16 47 60 100 74 73 93 100 74 0.8 Staphylococci (other) n 73 74 73 73 73 *15 *15 *15 % R R 96 R 96 100 100 97 95 R 98 Serratia spp 56 0.6 n 55 56 *36 56 *36 56 56 Staphylococcus % 10 43 37 100 73 63 95 100 51 0.6 epidermidis n *48 51 51 51 51 *19 *19 *19 % 93 73 100 viridans Streptococci 30 0.3 n 30 30 30 Page: 5 All Hospitals Antibiogram Jan - Dec 2019 Signal Resistances: Where the tables below contain no data no multiresistant organisms have been detected. Urine: Extended spectrum beta lactamase producing Enterobacterales (ESBL) No. % of Strain Organism Group Organism Name Positive Citrobacter freundii complexn = 79 Citrobacter freundii 6 7.6 Citrobacter sedlakii 1 1.3 Citrobacter koseri, amalonaticus group n = 138 Citrobacter amalonaticus 1 0.7 Citrobacter koseri 1 0.7 Enterobacter cloacae complexn = 231 Enterobacter cloacae 22 9.5 Escherichia spp n = 4236 Escherichia coli 302 7.1 Klebsiella aerogenes n = 95 Enterobacter aerogenes 2 2.1 Klebsiella spp n = 938 Klebsiella oxytoca 3 0.3 Klebsiella pneumoniae 41 4.4 Pseudomonas aeruginosa n = 716 Pseudomonas aeruginosa 1 0.1 Urine: Plasmid mediated AMPC producing Enterobacterales (PAMP) No. % of Strain Organism Group Organism
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