Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics

2015 Antibiotic Susceptibility Report

GRAM-NEGATIVE ORGANISMS

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 2015 Gram-Negative  

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Non-Urine Organisms The number of isolates is listed along with the percent of

susceptible strains. Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens Stenotrophomonas No. Isolates 23 7 41 46 21 30 39 23 104 21 19 Amikacin 100 100 100 100 100 100 100 98 100 Amoxicillin/Clav (Augmentin) IR IR IR 95 IR IR Ampicillin IR IR IR 69 52 IR IR 82 IR IR Ampicillin/Sulbactam (Unasyn) IR IR IR 76 76 94 91 IR IR Aztreonam * Cefazolin IR IR IR 89 66 97 82 IR IR Cefepime 100 100 100 100 100 100 100 96 100 Cefoxitin IR IR IR NT NT NT NT IR IR Ceftazidime - 3rd Generation 86 100 97 97 100 100 100 97 100 36 Ceftriaxone - 3rd Generation 91 100 96 97 100 100 100 100 IR 100 Ciprofloxacin 100 100 100 84 100 97 78 89 100 Gentamicin 100 100 100 89 96 100 82 94 100 Levofloxacin 100 100 100 84 100 100 97 78 87 100 94 Meropenem (Merrem) 100 100 100 100 100 100 100 96 100 Piperacillin/Tazo (Zosyn) 90 100 97 100 98 100 100 96 96 Ticarcillin/Clav (Timentin) * 44 Tobramycin 100 100 100 91 96 100 82 98 90 Trimethoprim/Sulfa (Bactrim) 100 100 100 82 100 94 78 IR NT 100

: Cumulative data for 2012 – 2015 IR: Intrinsically Resistant (per CLSI M100-S25 Guidelines) NT: Not Tested (per CLSI M100-S25, FDA, or VITEK Manufacturer Guidelines) *: If clinically indicated, susceptibility available by request Stenotrophomonas maltophilia is intrinsically resistant to tetracycline, but not to doxycycline, minocycline, or tigecycline.

Enterobactoer and Serratia may develop resistance during prolonged therapy with 3rd generation cephalosporins. Isolates that are initially susceptible may become resistant within 3-4 days.

Enterobacteriaceae are intrinsically resistant to clindamycin, daptomycin, fusidic acid, glycopeptides (vancomycin, teicoplanin), linezolid, quinupristin-dalfopristin, rifampin, and macrolides (erythromycin, clarithromycin, and azithromycin). However, there are some exceptions with macrolides (ie, Salmonella and Shigella spp. with azithromycin) Page 1 of 5 v6

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GRAM-POSITIVE ORGANISMS

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2015 Gram- Positive

Non-Urine

Group B Group

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Organisms  –

The number of isolates is listed along Staph with the percent of susceptible strains. Agalactiae Pneumonia

hemolytic Strep (Groups A, C,hemolytic G) F, A, Strep (Groups - Enterococcus Species (GroupD. Enterococcus) Staph. Aureus, MSSA Staph. Aureus, MRSA Coag. Negative Staph. lugdunensis Strep. Strep Beta

No. Isolates 36 110 50 35 61 58 97 55 Ampicillin 94 NT NT NT NT NT 100 100 Cefotaxime - 3rd Generation IR NT NT NT NT NT 100 100 Ceftriaxone - 3rd Generation IR NT NT NT NT 100 100 Ceftriaxone (mening) 86 Ceftriaxone (nonmen) 96 Ciprofloxacin 87 40 80 100 NT NT NT Clindamycin IR 80 82 68 90 85 59 81 Erythromycin IR 67 12 60 88 NT 58 80 Gentamicin 100 100 97 100 NT NT NT Levofloxacin 91 42 80 100 98 NT Linezolid 100 100 NT NT NT Oxacillin NT 100 0 68 98 NT NT NT Penicillin 94 0 0 0 0 100 100 Penicillin (mening) 72 Penicillin (nonmen) 74 Tetracycline 99 98 85 96 NT NT NT Trimethoprim/Sulfa (Bactrim) IR 95 96 100 100 NT NT NT Vancomycin 97 100 100 100 100 100 100 100 : Cumulative data for 2012 - 2015 IR: Intrinsically Resistant (per CLSI M100-S25 Guidelines) NT: Not Tested (per CLSI M100-S25, FDA, or VITEK Manufacturer Guidelines) *: If clinically indicated, susceptibility available by request ‡: Synercid used for Vancomycin Resistant Enterococcus faecium only – intrinsic resistance shown with other Enterococcus species

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GRAM-NEGATIVE ORGANISMS

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osa

2015 Gram-Negative

Urine Organisms The number of isolates is listed along with the percent of

susceptible strains. freundii Citrobacter aerogenes Enterobacter coli Escherichia oxytoca Klebsiella pneumoniae Klebsiella mirabilis Proteus aerugin Pseudomonas No. Isolates 36 37 935 26 102 34 29 Amikacin * * * * * * * Ampicillin IR IR 66 IR IR 73 IR Ampicillin/Sulbactam (Unasyn) IR IR 71 73 87 85 IR Cefazolin IR IR 96 76 97 91 IR Cefepime 100 100 98 96 98 94 96 Cefoxitin IR IR 94 96 97 100 NT Ceftazidime - 3rd Generation 100 82 98 96 98 94 96 Ceftriaxone - 3rd Generation 100 86 98 96 98 94 IR Ciprofloxacin 100 100 91 100 99 82 89 Gentamicin 100 100 95 100 100 73 96 Levofloxacin 100 *NT 91 100 99 85 89 Meropenem (Merrem) * * * * * * 92 Nitrofurantoin (Macrobid) 83 2 96 80 29 IR NT Piperacillin/Tazo (Zosyn) * 100 97 99 100 100 Tobramycin 100 100 96 100 100 76 100 Trimethoprim/Sulfa (Bactrim) NT 100 85 92 89 82 IR

: Cumulative data for 2012 - 2015 IR: Intrinsically Resistant (per CLSI M100-S25 Guidelines) NT: Not Tested (per CLSI M100-S25, FDA, or VITEK Manufacturer Guidelines) *: If clinically indicated, susceptibility available by request

Cefazolin results predict results for the oral agents cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime axetil, cephalexin, and loracarbef when used for therapy of uncomplicated UTIs due to E.coli, K. pneumoniae, and P. mirabilis.

Stenotrophomonas maltophilia is intrinsically resistant to tetracycline, but not to doxycycline, minocycline, or tigecycline.

Enterobacter and Serratia may develop resistance during prolonged therapy with 3rd generation cephalosporins. Isolates that are initially susceptible may become resistant within 3-4 days.

Enterobacteriaceae are intrinsically resistant to clindamycin, daptomycin, fusidic acid, glycopeptides (vancomycin, teicoplanin), linezolid, quinupristin-dalfopristin, rifampin, and macrolides (erythromycin, clarithromycin, and azithromycin). However, there are some exceptions with macrolides (ie, Salmonella and Shigella spp. with azithromycin)

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GRAM-POSITIVE ORGANISMS

and MRSA and

Group B Group

– 2015 Gram-Positive Urine Agalactiae

Organisms The number of isolates is listed along

with the percent of susceptible strains. Enterococcus faecalis MSSA Aureus, Staph. Staph Negative Coag. Strep No. Isolates 44 15 96 35 Ampicillin 100 NT NT 100 Ciprofloxacin 100 60 78 NT Gentamicin 100 98 NT Levofloxacin 100 66 78 100 Nitrofurantoin (Macrobid) 97 92 98 NT Oxacillin NT 60 56 NT Penicillin 100 6 8 100 Tetracycline 100 86 NT Trimethoprim/Sulfa (Bactrim) IR 100 NT NT Vancomycin 100 100 100 100

STAPHYLOCOCCUS: PENICILLINASE-LABILE PENICILLINS Penicillin-susceptible staphylococci are also susceptible to other ß-lactam agents with established clinical efficacy for staphylococcal infections. Penicillin-resistant staphylococci are resistant to penicillinase-labile penicillins, including ampicillin, amoxicillin, azlocillin, carbenicillin, mezlocillin, piperacillin, and tiarcillin. PENICILLINASE-STABLE PENICILLINS Oxacillin results can be applied to the other penicillinase-stable penicillins (cloxacillin, dicloxacillin, flucloxacillin, methicillin, and nafcillin). For agents with established clinical efficacy and considering site of infection and appropriate dosing, oxacillin susceptible staphylococci can be considered susceptible to: • ß-lactam/ß-lactamase inhibitor combinations (amoxicillin-clavulanate, ampicillin-sulbactam, piperacillin-tazobactam, ticarcillin- clavulanate) • Oral cephems (cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime, loracarbef) • Parenteral cephems including cephalosporins I, II, III, and IV (cefamandole, cefazolin, cefepime, cefmatazole, cefonicid, cefoperazone, cefotaxime, cefotetan, ceftizoxime, ceftriaxone, cefuroxime, cephalothin, ceftaroline, moxalactam) • Carbapenems (doripenem, ertapenem, imipenem, meropenem) Oxacillin-resistant staphylococci are resistant to all currently available B-lactam antimicrobial agents, with the exception of the newer cephalosporins with anti-MRSA activity. Thus, susceptibility or resistance to a wide array of B-lactam antimicrobial agents may be deduced from testing only penicillin and oxacillin. Routine testing of other B-lactam agents, except those with anti-MRSA activity, is not advised. ENTEROCOCCUS: The results of ampicillin susceptibility tests should be used to predict the activity of amoxicillin. Ampicillin results may be used to predict susceptibility to amoxicillin clavulanate, ampicillin-sulbactam, pipercillin, and piperacillin-tazobactam among non-B-lactamase –producing enterococci. Ampicillin susceptibility can be used to predict imipenem susceptibility, providing the species is confirmed to be E. faecalis.

Enterococci susceptible to penicillin are predictably susceptible to ampicillin, amoxicillin, ampicillin-sulbactam, amoxicillin-clavulanate, pipercillin and piperacillin-tazobactam for non-B-lactamase-producing entercocci. However, enterococci susceptible to ampicillin cannot be assumed to be susceptible to penicillin. If penicillin results are needed, testing of penicillin is required. FLUOROQUINOLONES Enterococcus spp. and Staphylococcus spp. May develop resistance during prolonged therapy with quinolones. Therefore, isolates that are initially susceptible may become resistant within three to four days after initiation of therapy. Testing of repeat isolates may be warranted.

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TETRACYCLINES Organisms that are susceptible to tetracycline are also considered susceptible to doxycycline and minocycline. However, some organisms that are intermediate or resistant to tetracycline may be susceptible to doxcycline, minocycline, or both

2015 Empiric Urine Treatment Guide

The number of isolates is listed along with the percent of

susceptible strains. Gram combined Isolates All Negative Gram and Positive No. Isolates 1300 Ampicillin 61 Ampicillin/sublactam 73 Cefazolin 92 Ciprofloxacin 90 Levofloxacin 90 Nitrofurantoin (Macrobid) 87 Trimethoprim/Sulfa (Bactrim) 85

Reviewed by Dr. Ray 06/2016

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