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Antimicrobial Susceptibilities *

* †

7 of Selected Pathogens, 1999 8

e

† a 2 ✔ ✔ † 3 ✔ † 4 5 6 culosis * r 1

urium spp. m spp. Sampling Methodology 2 † all isolates tested * ~ 20% sample of statewide isolates received at MDH spp. ~10% sample of statewide isolates received at MDH Salmonella ** all isolates tested from 7-county metropolitan area oup A streptococci ✔ oup B streptococci r isolates from a normally sterile site r Other (non-typhoidal) G Campylobacter Salmonella typhi Shigella G Streptococcus pneumoni Mycobacterium tube No. of Isolates Tested 131 160 43 20 250 55 162 192 559 163

123456 123456% Susceptib123456le 123456123456

123456 123451623456 123451623456

ampicillin 1234561234566012345686 123456 15123456123456 100 100 123456123456

123451623451623451623451623456 123456 penicillin 123456123456123456123456123456 98100 100 76 123456 123456123456123456123456123456123456123456123456 123456

123451623451623451623456 123451623451623456 123456

cefuroxime sodium 123456123456123456123456 100123456123456123456 81 123456

123456123456123456123456123456123456123456123456 123456 cefotaxime 123451623451623451623451623456 100 100100 83 123456 123456123456123456123456123456 123456123456123456123456

123456 123456123456123456123456

ceftriaxone 123456 100 95 100 100 100 123451623456123456123456

-lactam antibiotics 123456123456123456123456123456 123456123456123456123456 β

123451623451623451623451623456 123451623456 123456

meropenem 123456123456123456123456123456 100 123456123456 83 123456

123456123456123456123456123456123456123456123456 123456

123456123456123456123456123456123456123456123456 123456

levofloxacin 123456123456123456123456123456123456123456123456123456100 123456

123451623451623451623456 ciprofloxacin 82 100 100 100 100100 123451623456123456123456 123456 123456 123456123456123456123456

123456 123456 123451623456 123456

chloramphenicol 12345612345675123456 95 12345680123456123456100 123456123456 98 123456

123451623451623451623451623451623456 123456 clindamycin 123456123456123456123456123456123456 100 87 98 123456 123456123456123456123456123456123456 123456

123451623451623451623451623456 123456

erythromycin 100 123456123456123456123456123456 95 79 78 123456

123456123456123456123456123456123456123456123456123456 gentamicin 98 123451623451623451623451623451623451623451623451623456 123456123456123456123456123456123456123456123456123456 Other antibiotics 123451623451623451623451623451623451623456 123456

tetracycline 48 123456123456123456123456123456123456123456 91 123456

123456123456123456123456123456123456123456123456 123456 123456 96 100 75 123456 56 123451623456 67 123456 trimethoprim/sulfamethoxazole 123456123456123456123456123456123456123456123456 123456

123451623451623451623451623451623456 123456

vancomycin 123456123456123456123456123456123456 100100100 123456

123456123456123456123456123456123456123456123456123456123456

123451623451623451623451623451623451623451623451623456 ethambutol 123456123456123456123456123456123456123456123456123456 98 123456123456123456123456123456123456123456123456123456

123451623451623451623451623451623451623451623451623456

isoniazid 123456123456123456123456123456123456123456123456123456 88

123451623451623451623451623451623451623451623451623456 pyrazinamide 123456123456123456123456123456123456123456123456123456 99 123456123456123456123456123456123456123456123456123456 123451623451623451623451623456 100 123451623451623456 98 rifampin 123456123456123456123456123456123456123456123456123456

123451623451623451623451623451623451623451623451623456 TB antibiotics streptomycin 123456123456123456123456123456123456123456123456123456 89 123456123456123456123456123456123456123456123456123456 Trends, Comments and Other Pathogens < 20% of isolates from patients returning from foreign travel were susceptible to 1 Campylobacter spp. quinolones. Susceptibilities were determined using 1999 NCCLS breakpoints for . Susceptibility for erythromycin was based on an MIC <4 µg/ml. Antibiotic treatment for enteric generally is not recommended. 2/43 2 Salmonella spp. Salmonella spp. isolates were intermediate to ceftriaxone. 250 isolates comprise 8.8% of total (2,835) cases reported. Also, all isolates tested 3 Neisseria gonorrhoeae were susceptible to cefpodoxime, cefixime and spectinomycin. Provisional breakpoints from CDC. MIC <0.06 to penicillin considered susceptible. One 4 Neisseria meningitidis isolate had a MIC of 0.12, which is considered intermediate to penicillin. Susceptibility testing was also done on 514 pharyngeal (non-invasive) GAS isolates 5 Group A streptococci from five clinical labs (three were in metro area). 100% were susceptible to clindamycin and 98% were susceptible to erythromycin. 83% early-onset and late-onset infant cases, invasive maternal cases, and 84% of other 6 Group B streptococci (GBS) invasive GBS cases tested. 86% (38/44) of infant and maternal isolates were susceptible to clindamycin and 80% (35/44) were susceptible to erythromycin. 8% had intermediate-level and 16% had high-level resistance to penicillin; 13% had 7 Streptococcus pneumoniae intermediate-level and 4% had high-level resistance to cefotaxime. National guidelines recommend initial 4-drug therapy where resistance to isoniazid (INH) 8 Mycobacterium tuberculosis (TB) exceeds 4% . In Minnesota, 12% of M. tuberculosis isolates were INH-resistant. Four cases of multi-drug resistant TB (i.e., resistant to INH and rifampin) were identified. The first erythromycin-resistant B. pertussis in MN was identified in 1999. The remaining 80 isolates were susceptible to erythromycin by provisional CDC breakpoints. Erythromycin remains the drug of choice for treatment and prophylaxis of pertussis. O157:H7 Antibiotic treatment for E. coli O157:H7 infection is not recommended. MRSA isolates were submitted in 1999 from sentinel hospitals. No vancomycin resistance has been identified. Community-acquired MRSA infections have been Methicillin-resistant Staphylococcus observed; isolates were generally susceptible to many antibiotic classes except beta- aureus (MRSA) lactams/, and many were non-susceptible to erythromycin. Serious cases of community-acquired MRSA should be reported to MDH. The MDH Antibiogram is available on the MDH Web site (http://www.health.state.mn.us). Laminated copies can be ordered from: Antibiogram, Minnesota Dept. of Health, Acute Disease Epidemiology Section, 717 Delaware St. SE, Minneapolis, MN 55414. Invasive Bacterial Diseases Reportable Diseases, MN Rule #4605.7040 influenzae disease (all invasive disease) b,c Antimicrobial Susceptibilities Meningitis (caused by b, Neisseria Foodborne, Vectorborne and Zoonotic Diseases meningitidis b,g, Streptococcus pneumoniae b, or viral or of Selected Pathogens Amebiasis (Entamoeba histolytica) other bacterial agents) 1999 Anthrax (Bacillus anthracis) a Meningococcemia (Neisseria meningitidis) b,g Babesiosis (Babesia spp.) Streptococcal disease (all invasive disease caused by Botulism (Clostridium botulinum) a Groups A and B streptococci and S. pneumoniae) b,c (Brucella spp.) g Toxic shock syndrome b (Campylobacter spp.) b Vaccine Preventable Disease and Tuberculosis Cat scratch disease (infection caused by spp.) Diphtheria (Corynebacterium diphtheriae) b () a,b Hepatitis (all primary viral types including A,B,C,D, and E) Cryptosporidiosis (Cryptosporidium parvum) Influenza (unusual case incidence or lab confirmed cases) d Dengue virus infection Measles (Rubeola) a Diphyllobothrium latum infection Mumps a (Ehrlichia spp.) Pertussis (Bordetella pertussis) a,b Encephalitis (caused by viral agents) g Poliomyelitis a,d Enteric E. coli infection (E. coli O157:H7 and other Rubella and congenital rubella syndrome Minnesota Department of Health pathogenic E.coli from gastrointestinal infections) b Tetanus (Clostridium tetani) 717 Delaware Street SE Giardiasis (Giardia lamblia) Tuberculosis (Mycobacterium tuberculosis and M. bovis) b Minneapolis, MN 55414 Hantavirus infection g Sexually Transmitted Diseases and Retroviral Infections www.health.state.mn.us Hemolytic uremic syndrome (Haemophilus ducreyi) a,e Leptospirosis (Leptospira interrogans) trachomatis infections e Listeriosis (Listeria monocytogenes) b (Neisseria gonorrhoeae) e Lyme disease (Borrelia burgdorferi) Human immunodeficiency virus (HIV) infection, Malaria (Plasmodium spp.) including Acquired Immunodeficiency Syndrome (AIDS) f () g Retrovirus infection (other than HIV) Psittacosis (Chlamydia psittaci) (Treponema pallidum) a,e () g Other Conditions To Report a Case: Rabies (animal and human cases and suspects) a Agents of bioterrorism g Fill out a Minnesota Department of Health case Rocky Mountain (Rickettsia spp., R. canada) Blastomycosis (Blastomyces dermatitidis) report form and mail to the above address. For Salmonellosis, including typhoid (Salmonella spp.) b Histoplasmosis (Histoplasma capsulatum) diseases that require immediate reporting, or for (Shigella spp.) b Increased incidence of any illness beyond expectations questions about reporting, call the Acute Disease Toxoplasmosis Kawasaki disease Epidemiology Section at: 612-676-5414 or Trichinosis (Trichinella spiralis) Legionellosis (Legionella spp.) d 877-676-5414 or fax form to 612-676-5743. () g Leprosy (Mycobacterium leprae) (Rickettsia spp.) Reye syndrome To Send an Isolate to MDH: Yellow fever Rheumatic fever (cases meeting the Jones Criteria only) Send isolates by U.S. mail using approved (Yersinia spp.) b Staphlococcus aureus (only death or serious illness due to methicillin- containers to the above address. If using a courier, resistant S. aureus) b isolates should be sent to 717 Delaware Street SE, Vancomycin Intermediate/Resistant Staphylococcus aureus d Minneapolis, MN 55414. To order pre-paid etiologic a Report immediately by telephone 612-676-5414 or 877-676-5414 Unexplained deaths b and serious illness d (possibly due to agent mailers, or for other assistance, call the b Submit isolates to the MDH. If a rapid, non-culture assay is used for infectious cause) Public Health Laboratory Specimen Handling Unit at: diagnosis, we request that positives be cultured, and isolates submitted. d Submission of isolates to MDH is requested, but not required by rule 612-676-5396. If not possible, please send specimens, enrichment broth, or other e Report on separate Sexually Transmitted Disease Report Card appropriate material f Report on separate HIV Report Card c Isolates are considered to be from invasive disease if they are isolated g Requested to repor t immediately by telephone; reporting rule change from normally sterile sites, i.e. blood, CSF, joint fluid,..etc. expected in 2000