All Hospitals Antibiogram Jan - Dec 2019

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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

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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

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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

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Urine Antibiogram All SNP Hospiltals Jan - Dec 2019

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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 Name Positive

Citrobacter koseri, amalonaticus group n = 138 Citrobacter koseri 2 1.4 Escherichia spp n = 4235 Escherichia coli 173 4.1 Klebsiella spp n = 938 Klebsiella oxytoca 2 0.2 Klebsiella pneumoniae 12 1.3

Urine: Plasmid mediated Carbapenemase producing Enterobacterales (CPE) No. % of Organism Group Organism Name Subtype Positive Strain

Enterobacter cloacae complexn = 231 Enterobacter cloacae IMP 6 2.6

Urine: Plasmid mediated Carbapenemase producing Non Enterobacterales (CPNE)

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No. Organism Group Organism Name % of Strain Positive

Urine: Vancomycin Resistant Enterococci (VRE) No. % of Strain Organism Group Organism Name Positive

Enterococcus faecalis(VRE) - VAN-B 1 0.1 Enterococcus spp n = 1356 Enterococcus faecium (VRE) - VAN-A 10 0.7 Enterococcus faecium (VRE) - VAN-B 21 1.5

Urine: Methicillin Resistant Staphylococcus aureus (MRSA) No. % of Strain Organism Group Organism Name Positive

S.aureus (non-multiresistant MRSA) 12 10.9 Staphylococcus aureus (ALL)n = 110 Staphylococcus aureus (UK EMRSA-15) 5 4.5

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Non-urine Antibiogram All SNP Hospiltals Jan - Dec 2019

Organism Group %Total No. Organisms Clarithromycin Metronidazole Penicillin Amoxicillin Flucloxacillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalotin Cefazolin Ceftriaxone Ceftazidime Cefepime Meropenem Gentamicin Amikacin Sulpha-trimethoprim Norfloxacin Ciprofloxacin Fusidic acid Rifampicin Gentamicin (High Level) Erythromycin/Clarithromycin Azithromycin Clindamycin Tetracyclines Quinupristin-dalfopristin Vancomycin All isolates 11575 100 Staphylococcus aureus % 18 88 88 88 R 98 94 94 100 83 85 97 100 3481 30.1 (ALL) n 3481 3481 3481 3481 3481 *3260 *3266 *3265 3481 3479 3481 *3290 Pseudomonas % R R 92 R R 94 96 98 97 99 R 92 R 2095 18.1 aeruginosa n 2093 2092 2003 2095 2094 *1560 2095 % 41 75 93 71 83 97 100 89 100 72 84 Escherichia spp 833 7.2 n 832 832 832 832 833 830 831 832 *722 832 832 Staphylococcus % 9 37 37 37 R 64 81 78 96 45 68 78 100 586 5.1 epidermidis n 580 579 579 579 583 561 569 571 583 582 584 576 % 60 83 94 72 R R 99 Haemophilus influenzae 419 3.6 n 419 419 *64 419 419 % 31 98 100 86 100 90 R 100 66 85 70 100 viridans Streptococci 400 3.5 n *13 400 *75 *308 *12 *83 *147 399 400 400 *311 % 82 R R R R R R 38 80 R R 29 50 92 Enterococcus spp 346 3.0 n 345 *48 *134 344 *309 345 % R 84 88 73 89 97 100 95 100 86 93 Klebsiella spp 299 2.6 n 299 299 299 299 299 299 299 *252 299 298 Enterobacter cloacae % R R 78 R R 73 96 100 90 99 82 91 267 2.3 complex n 265 267 265 266 267 *231 267 267

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Non-urine Antibiogram All SNP Hospiltals Jan - Dec 2019

Organism Group %Total No. Organisms Clarithromycin Metronidazole Penicillin Amoxicillin Flucloxacillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalotin Cefazolin Ceftriaxone Ceftazidime Cefepime Meropenem Gentamicin Amikacin Sulpha-trimethoprim Norfloxacin Ciprofloxacin Fusidic acid Rifampicin Gentamicin (High Level) Erythromycin/Clarithromycin Azithromycin Clindamycin Tetracyclines Quinupristin-dalfopristin Vancomycin All isolates 11575 100 Coagulase negative % 21 54 54 54 R 81 81 72 99 50 71 87 100 225 1.9 Staphylococci (other) n 221 223 223 223 224 218 217 218 224 223 225 219 % 83 96 96 93 Campylobacter spp 180 1.6 n 180 180 180 180 % 15 49 49 49 R 72 90 78 100 44 64 79 99 Staphylococcus hominis 174 1.5 n 172 168 168 168 172 *164 167 167 173 172 172 170 % 17 53 53 53 R 97 76 96 100 75 78 95 100 Staphylococcus capitis 169 1.5 n 168 169 169 169 166 *159 163 163 169 169 169 168 % 100 1 100 99 100 100 Moraxella catarrhalis 149 1.3 n 149 148 149 149 149 149 Stenotrophomonas % R R R R R R 74 R R R 96 R 149 1.3 maltophilia n *19 149 % R 18 88 R 93 100 65 100 100 96 97 99 Aeromonas spp 144 1.2 n *60 *131 138 *134 *133 139 *118 144 *122 138 KDHPRO\WLF % 100 100 100 100 99 99 82 82 79 100 Streptococci Other 136 1.2 136 136 *89 *35 136 *75 136 136 136 *90 (nonA nonB) n % 95 97 99 100 99 97 97 91 93 Salmonella spp 124 1.1 n 124 119 118 *113 124 *111 118 *23 *14

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Non-urine Antibiogram All SNP Hospiltals Jan - Dec 2019

Organism Group %Total No. Organisms Clarithromycin Metronidazole Penicillin Amoxicillin Flucloxacillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalotin Cefazolin Ceftriaxone Ceftazidime Cefepime Meropenem Gentamicin Amikacin Sulpha-trimethoprim Norfloxacin Ciprofloxacin Fusidic acid Rifampicin Gentamicin (High Level) Erythromycin/Clarithromycin Azithromycin Clindamycin Tetracyclines Quinupristin-dalfopristin Vancomycin All isolates 11575 100 KDHPRO\WLF % 100 100 100 99 100 92 93 82 100 119 1.0 Streptococci Group A n 119 116 *79 119 *81 119 119 119 *82 Streptococcus % 72 97 98 75 100 69 77 75 100 118 1.0 pneumoniae n *81 115 *89 116 *77 117 116 118 *86 % R R 98 R 100 100 100 99 99 100 97 Serratia spp 112 1.0 n 112 112 111 112 112 *98 112 112 Staphylococcus % 61 97 97 97 100 100 98 100 91 91 97 100 101 0.9 lugdunensis n 100 100 100 100 101 *94 *94 *94 101 101 101 *95 % 19 43 90 83 100 Helicobacter spp 81 0.7 n 81 80 80 80 81 % 48 91 62 58 89 32 22 89 100 Corynebacterium spp 75 0.6 n 73 *11 *39 *24 *19 *41 73 *70 *61 % 15 86 100 87 51 96 99 Spore forming GPB 75 0.6 n 72 *22 *56 *23 72 *67 73 % 92 95 100 89 99 100 100 95 100 86 95 Proteus mirabilis 74 0.6 n 74 74 73 74 74 73 74 74 *58 74 74 % 4 73 86 2 20 50 93 44 33 94 53 73 Non fermenting GNB 70 0.6 n 68 *64 *63 *62 *60 *56 *61 *62 *45 69 68 *11

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Non-urine Antibiogram All SNP Hospiltals Jan - Dec 2019

Organism Group %Total No. Organisms Clarithromycin Metronidazole Penicillin Amoxicillin Flucloxacillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalotin Cefazolin Ceftriaxone Ceftazidime Cefepime Meropenem Gentamicin Amikacin Sulpha-trimethoprim Norfloxacin Ciprofloxacin Fusidic acid Rifampicin Gentamicin (High Level) Erythromycin/Clarithromycin Azithromycin Clindamycin Tetracyclines Quinupristin-dalfopristin Vancomycin All isolates 11575 100 KDHPRO\WLF % 100 100 100 100 100 100 70 73 30 100 64 0.6 Streptococci Group B n 64 *59 *58 *36 64 *54 64 64 64 *57 % R R 94 R 94 98 100 98 100 94 94 Morganella spp 51 0.4 n 51 51 51 51 51 *42 51 51 % 100 100 100 100 100 100 100 Pasteurella spp 48 0.4 n *21 48 48 *23 47 *20 48 % 91 100 100 96 94 100 93 96 100 81 89 100 91 Miscellaneous GPC 47 0.4 n 46 *25 *26 *26 *17 *25 *30 *25 *25 *26 *28 *26 45 Citrobacter koseri, % R 90 98 86 93 100 100 98 100 95 98 42 0.4 amalonaticus group n 42 42 42 41 42 42 42 *37 42 42 % R R 61 R 63 98 98 98 100 95 95 Klebsiella aerogenes 41 0.4 n 41 41 41 41 41 *36 41 41 % R 14 80 R 96 100 97 97 100 25 94 Pseudomonas spp 36 0.3 n 36 35 *23 *31 35 35 *25 36 35

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Signal Resistances: Where the tables below contain no data no multiresistant organisms have been detected. NonUrine: Extended spectrum beta lactamase producing Enterobacterales (ESBL) No. % of Strain Organism Group Organism Name Positive

Citrobacter freundii complexn = 24 Citrobacter freundii 2 8.3 Citrobacter koseri, amalonaticus group n = 42 Citrobacter koseri 1 2.4 Enterobacter cloacae complexn = 267 Enterobacter cloacae 27 10.1 Escherichia spp n = 833 Escherichia coli 121 14.5 Klebsiella aerogenes n = 41 Enterobacter aerogenes 2 4.9 Klebsiella spp n = 299 Klebsiella oxytoca 2 0.7 Klebsiella pneumoniae 23 7.7 Proteus mirabilis n = 74 Proteus mirabilis 2 2.7 Proteus spp other n = 11 Proteus vulgaris 1 9.1

NonUrine: Plasmid mediated AMPC producing Enterobacterales (PAMP) No. % of Strain Organism Group Organism Name Positive

Citrobacter koseri, amalonaticus group n = 42 Citrobacter koseri 1 2.4 Escherichia spp n = 833 Escherichia coli 54 6.5 Klebsiella spp n = 299 Klebsiella pneumoniae 5 1.7 Klebsiella oxytoca 3 1.0 Salmonella spp n = 124 Salmonella Typhimurium 1 0.8

NonUrine: Plasmid mediated Carbapenemase producing Enterobacterales (CPE)

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No. % of Organism Group Organism Name Subtype Positive Strain

Klebsiella aerogenes n = 41 Enterobacter aerogenes IMP 1 2.4 Enterobacter cloacae complexn = 267 Enterobacter cloacae IMP 7 2.6 Klebsiella spp n = 299 Klebsiella pneumoniae IMP 2 0.7 Escherichia spp n = 833 Escherichia coli OXA48 1 0.1

NonUrine: Plasmid mediated Carbapenemase producing Non Enterobacterales (CPNE) No. % of Strain Organism Group Organism Name Positive

NonUrine: Vancomycin Resistant Enterococci (VRE) No. % of Strain Organism Group Organism Name Positive

Enterococcus faecalis(VRE) - VAN-B 1 0.3 Enterococcus spp n = 346 Enterococcus faecium (VRE) - VAN-A 3 0.9 Enterococcus faecium (VRE) - VAN-B 12 3.5

NonUrine: Methicillin Resistant Staphylococcus aureus (MRSA) No. % of Strain Organism Group Organism Name Positive

S.aureus (non-multiresistant MRSA) 323 9.3 Staphylococcus aureus (ALL)n = 3481 Staphylococcus aureus (MRSA) 23 0.7 Staphylococcus aureus (UK EMRSA-15) 80 2.3

NonUrine: Streptococcus pneumoniae Penicillin Susceptibility (Non-meningitis breakpoints)

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No. % of Organism Group MIC category Strain

Streptococcus pneumoniae n = 117 Sensitive mg/L 66 56.4 Intermediate 0.12 - 2 mg/L 48 41.0 Resistant > 2 mg/L 3 2.6

NonUrine: Streptococcus pneumoniae Ceftriaxone Susceptibility No. % of Organism Group MIC category Strain

Streptococcus pneumoniae n = 117 Sensitive mg/L 26 22.2 Intermediate 1 - 2 mg/L 6 5.1 Resistant > 2 mg/L 1 0.9

NonUrine: Streptococcus alpha haem (viridans Streptococci) Penicillin Susceptibility No. % of Organism Group MIC category Strain

viridans Streptococcin = 400 Sensitive mg/L 352 88.0 Intermediate 0.5 - 2 mg/L 40 10.0 Resistant > 2 mg/L 8 2.0

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All SNP Hospiltals Blood Culture Antibiogram Jan - Dec 2019

Organism Group %Total No. Organisms Penicillin Amoxicillin Flucloxacillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalotin Cefazolin Ceftriaxone Ceftazidime Cefepime Meropenem Gentamicin Amikacin Sulpha-trimethoprim Ciprofloxacin Fusidic Acid Rifampicin Gentamicin (High Level) Erythromycin/Clarithromycin Clindamycin Tetracyclines Quinupristin-dalfopristin Vancomycin All isolates 2211 100.0 % 45 81 95 81 92 99 100 92 100 70 89 Escherichia spp 418 18.9 n 418 418 418 418 418 418 418 418 *329 418 418 Staphylococcus % 6 31 31 31 R 56 76 76 98 43 65 76 100 303 13.7 epidermidis n 298 296 296 296 300 *287 292 295 300 299 301 298 Staphylococcus aureus % 22 93 93 93 R 99 94 94 100 89 91 98 100 254 11.5 (ALL) n 254 254 254 254 254 *226 *229 *229 254 254 254 254 % 12 45 45 45 R 66 90 77 100 44 61 79 99 Staphylococcus hominis 138 6.2 n 136 132 132 132 136 *129 132 132 137 136 136 135 % 96 100 84 81 R 100 51 82 72 100 viridans Streptococci 134 6.1 n 134 *17 132 *26 *121 134 134 134 132 % R 92 94 86 96 100 100 99 100 88 95 Klebsiella spp 123 5.6 n 123 123 123 123 123 123 123 *90 123 122 Pseudomonas % R R 85 R R 91 97 98 99 100 R 93 R 107 4.8 aeruginosa n 107 106 107 107 107 *83 107 % 21 58 58 58 R 97 75 98 100 72 76 94 100 Staphylococcus capitis 106 4.8 n 105 106 106 106 103 *96 *100 *100 106 106 106 105 % 80 R R 30 85 R R 25 61 92 Enterococcus spp 90 4.1 n 90 *10 *82 89 *72 90

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All SNP Hospiltals Blood Culture Antibiogram Jan - Dec 2019

Organism Group %Total No. Organisms Penicillin Amoxicillin Flucloxacillin Amoxicillin-clavulanate Piperacillin-tazobactam Cefalotin Cefazolin Ceftriaxone Ceftazidime Cefepime Meropenem Gentamicin Amikacin Sulpha-trimethoprim Ciprofloxacin Fusidic Acid Rifampicin Gentamicin (High Level) Erythromycin/Clarithromycin Clindamycin Tetracyclines Quinupristin-dalfopristin Vancomycin All isolates 2211 100.0 Coagulase negative % 21 44 44 44 R 70 72 87 99 45 71 85 100 88 4.0 Staphylococci (other) n 84 86 86 86 87 86 85 86 87 86 88 88 Enterobacter cloacae % R R 90 R 88 100 100 98 97 76 96 49 2.2 complex n 48 49 48 48 49 *33 49 49 % 16 100 100 83 47 95 98 Spore forming GPB 48 2.2 n *45 *12 *36 *12 *45 *41 47 KDHPRO\WLF % 100 100 100 100 100 100 73 73 36 100 33 1.5 Streptococci Group B n 33 *30 32 32 33 *30 33 33 33 *31 % 94 100 100 94 92 100 100 100 100 72 89 100 88 Miscellaneous GPC 32 1.4 n 32 *17 *17 *18 *13 *17 *19 *17 *17 *18 *18 *18 32 KDHPRO\WLF % 100 100 100 100 100 100 81 81 77 100 Streptococci Other (nonA 31 1.4 nonB) n 31 31 30 *29 31 *15 31 31 31 *29 Signal Resistances: Where the tables below contain no data no multiresistant organisms have been detected.

Blood Culture: Extended spectrum beta lactamase producing Enterobacterales (ESBL)

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No. % of Strain Organism Group Organism Name Positive

Enterobacter cloacae complexn = 49 Enterobacter cloacae 1 2.0 Escherichia spp n = 418 Escherichia coli 30 7.2 Klebsiella aerogenes n = 11 Enterobacter aerogenes 1 9.1 Klebsiella spp n = 123 Klebsiella pneumoniae 3 2.4 Proteus mirabilis n = 21 Proteus mirabilis 1 4.8

Blood Culture: Plasmid mediated AMPC producing Enterobacterales (PAMP) No. % of Strain Organism Group Organism Name Positive

Escherichia spp n = 418 Escherichia coli 12 2.9 Klebsiella spp n = 123 Klebsiella pneumoniae 2 1.6 Salmonella spp n = 22 Salmonella Typhimurium 1 4.5

Blood Culture: Plasmid mediated Carbapenemase producing Enterobacterales (CPE) No. % of Organism Group Organism Name Subtype Positive Strain

Klebsiella aerogenes n = 11 Enterobacter aerogenes IMP 1 9.1 Klebsiella spp n = 123 Klebsiella pneumoniae IMP 1 0.8

Blood Culture: Plasmid mediated Carbapenemase producing Non Enterobacterales (CPNE) No. % of Strain Organism Group Organism Name Positive

Blood Culture: Vancomycin Resistant Enterococci (VRE) No. % of Strain Organism Group Organism Name Positive

Enterococcus spp n = 90 Enterococcus faecium (VRE) - VAN-B 5 5.6

Blood Culture: Methicillin Resistant Staphylococcus aureus (MRSA)

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No. % of Strain Organism Group Organism Name Positive

S.aureus (non-multiresistant MRSA) 10 3.9 Staphylococcus aureus (ALL)n = 254 Staphylococcus aureus (MRSA) 1 0.4 Staphylococcus aureus (UK EMRSA-15) 7 2.8

Blood Culture: Streptococcus pneumoniae Penicillin Susceptibility (Non-meningitis breakpoints) No. % of Organism Group MIC category Strain

Streptococcus pneumoniae n = 23 Sensitive mg/L 18 78.3 Intermediate 0.12 - 2 mg/L 4 17.4 Resistant > 2 mg/L 1 4.3

Blood Culture: Streptococcus pneumoniae Ceftriaxone Susceptibility No. % of Organism Group MIC category Strain

Streptococcus pneumoniae n = 25 Sensitive mg/L 24 104.3 Intermediate 1 - 2 mg/L 1 4.3

Blood Culture: Streptococcus alpha haem (viridans Streptococci) Penicillin Susceptibility No. % of Organism Group MIC category Strain

viridans Streptococcin = 134 Sensitive mg/L 106 79.1 Intermediate 0.5 - 2 mg/L 22 16.4 Resistant > 2 mg/L 6 4.5

Miscellaneous organism groupings detail report.

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