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Antimicrobial Guide Spectrum Health Lakeland 2019-2020

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Antimicrobial Guide Spectrum Health Lakeland 2019-2020 Antimicrobial Guide Spectrum Health Lakeland 2019-2020 Table of Contents Antibiogram 2019 ................................................................................................................................................................................................................................................................................................................... 2 Spectrum Health Lakeland Outpatient Antibiotic Prescribing Guidelines 2020 .................................................................................................................................................................................................................... 3 Spectrum Health Lakeland Inpatient Antibiotic Prescribing Guidelines 2020 ....................................................................................................................................................................................................................... 4 Spectrum Health Lakeland Predictable Susceptibility Guidelines 2020 ................................................................................................................................................................................................................................. 5 Susceptibility Patterns of Common Bacteria Isolated from Clinical Specimens January 2019-December 2019 Microbiology Antibiogram 2019 Spectrum Health Lakeland – spectrumhealthlakeland.org 4 Bacterial Isolate Type: Gram-Negative Yeast # Isolate # Amikacin # Isolates # Cefepime Imipenem Cefazolin Cefazolin Aztreonam Ertapenem Gentamicin Ceftriaxone Tobramycin Ceftazidime Fluconazole Levofloxacin Caspofungin Meropenem Voriconazole Ciprofloxacin Nitrofurantoin Trimethoprim/ Trimethoprim/ sulfamethoxazole % ESBL Production ESBL % Ampicillin sulbactam / Ampicillin Amoxicillin / clavulanic Amoxicillin Piperacillin tazobactam / Piperacillin Acinetobacter baumannii complex 41 20% 61% 83% 98% 93% 85% 75% 100% 100% Candida albicans 291 99% 100% 100% Citrobacter braakii 35 83% 83% 100% 94% 100% 100% 100% 100% 90% 93% 100% 100% Candida glabrata 77 84% 100% 88% Citrobacter freundii 134 84% 84% 100% 98% 100% 97% 99% 97% 94% 86% 92% 99% Candida parapsilosis 31 100% 100% 100% Citrobacter koseri 110 98% 99% 100% 100% 100% 100% 100% 100% 100% 100% 90% 100% 98% 100% Enterobacter cloacae complex 356 80% 85% 97% 99% 99% 99% 94% 99% 38% 84% 92% 99% Escherichia coli 6370 57% 84% 64% 38% 92% 95% 97% 99% 84% 100% 93% 100% 100% 84% 96% 97% 82% 95% 95% Klebsiella aerogenes (formally Footnotes 114 85% 87% 100% 100% 100% 99% 79% 100% 22% 87% 98% 99% Enterobacter) General Klebsiella oxytoca 261 97% 65% 82% 97% 100% 100% 100% 100% 100% 100% 100% 92% 97% 97% 100% 98% 1 Organisms that are susceptible to tetracycline are also considered Klebsiella pneumoniae 1131 96% 87% 95% 97% 98% 99% 98% 100% 98% 100% 98% 43% 96% 93% 98% 96% susceptible to doxycycline and minocycline. Morganella morganii 159 8% 85% 82% 97% 82% 100% 94% 47% 82% 99% 79% 94% 2 Not routinely reported on organisms from the urinary tract. Proteus mirabilis 629 100% 88% 96% 98% 99% 99% 76% 100% 91% 17% 77% 100% 79% 91% 96% 3 Streptococcus milleri group consists of Streptococcus anginosus, Proteus vulgaris 47 100% 74% 83% 98% 98% 100% 100% 100% 24% 100% 100% 96% 100% Streptococcus constellatus, and Streptococcus intermedius . Pseudomonas aeruginosa 718 97% 66% 93% 91% 85% 93% 92% 97% 86% 100% 98% Enterobacteriaceae 4 Serratia marcescens 109 93% 98% 98% 99% 98% 100% 99% 100% 93% Cefotaxime or ceftriaxone should be tested and reported on Stenotrophomonas maltophilia 41 93% 88% isolates from CSF in place of cefazolin Staphylococcus spp. 5 Rifampin should not be used alone for antimicrobial therapy - 6 For agents with established clinical efficacy and considering site of 2 2 1 5 6 6 infection and appropriate dosing, oxacillin susceptible staphylococci (Oral) 7 Meningitis (MICMeningitis Meningitis (MICMeningitis - Bacterial Isolate Type: Gram-Positive - can be considered susceptible to: <=1) <=1) <=0.5) <=0.5) Non Linezolid # Isolates # Oxacillin Ampicillin Rifampin Rifampin meningitis Cefazolin Cefotaxime Gentamicin Ceftriaxone • Vancomycin B-lactam combination agents (amoxicillin-clavulanate, ampicillin- Levofloxacin Clindamycin Clindamycin Tetracycline Nitrofurantoin Erythromycin Penicillin Penicillin Gentamicin synergy Gentamicin sulbactam, piperacillin-tazobactam) Penicillin Parenteral Parenteral non Penicillin Cefotaxime Meningitis (MIC Meningitis Cefotaxime Ceftriaxone Meningitis (MICMeningitis Ceftriaxone • Oral cephems (cefaclor, cefdinir, cephalexin, cefpodoxime, Penicillin parenteralmeningitis Penicillin Cefotaxime Non Cefotaxime Ceftriaxone Ceftriaxone Trimethoprim/ sulfamethoxazole Trimethoprim/ cefprozil, cefuroxime) Enterococcus faecalis 958 11% 85% 87% 100% 99% 100% 100% 32% 98% • Parenteral cephems including cephalosporins I, II, III, and IV Enterococcus faecium 61 3% 90% 22% 100% 33% 100% 100% 67% 59% (cefamandole, cefazolin, cefepime, cefmetazole, cefonicid, Enterococcus avium 39 58% 100% 92% 96% 22% 100% 100% 33% 100% cefoperazone, cefotaxime, cefotetan, ceftizoxime, ceftriaxone, Staphylococcus aureus 1366 82% 45% 100% 63% 100% 100% 56% 0% 100% 91% 93% 56% 100% cefuroxime, ceftaroline, moxalactam) Staphylococcus epidermidis 610 80% 40% 97% 70% 100% 99% 47% 0% 99% 84% 66% 47% 100% • Carbapenems (doripenem, ertapenem, imipenem, meropenem) Other Coagulase-Negative 217 67% 51% 93% 80% 100% 100% 63% 0% 100% 85% 88% 63% 100% Enterococcus spp. Staphylococcus species 7 Streptococcus agalactiae (Group B) 192 100% 100% 37% 27% 96% 100% 100% 16% 100% Enterococci susceptible to penicillin are predictably susceptible to ampicillin, amoxicillin, ampicillin-sulbactam, amoxicillin-clavulanate, Streptococcus pyogenes (Group A) 39 100% 100% 84% 100% 95% 100% 100% 100% 89% 100% and piperacillin-tazobactam for non-B-lactamase producing Streptococcus milleri group 3 101 96% 88% 84% 80% 99% 100% 87% 87% 29% 100% enterococci. Streptococcus mitis/oralis 41 95% 88% 82% 34% 90% 100% 68% 87% 100% Streptococcus pneumoniae 52 93% 88% 95% 88% 64% 100% 100% 100% 76% 77% 81% 89% 100% Spectrum Health Lakeland Outpatient Antibiotic Prescribing Guidelines 2020 1st choice Alternatives Notes CAP without co- Asymptomatic Bacteriuria Amoxicillin 1000mg TID x5 days Doxycycline 100mg BID x5 days morbidities A condition in which larger than normal numbers of bacteria are Amoxicillin/clavulanic acid 875mg BID or 500mg TID x5-7 days Cefpodoxime 200mg BID x5-7 days present in the urine, but symptoms do PLUS PLUS Comorbidities include chronic heart, lung, liver, or renal disease; diabetes not result. CAP with co-morbidities Doxycycline 100mg PO q12hr x5-7 days OR Azithromycin Doxycycline 100mg PO q12hr x5-7 days OR Azithromycin mellitus; alcoholism; malignancy; or asplenia. • Fever and elevated WBC count 500mg QD x 3 days 500mg QD x 3 days are absent Doxycycline 100mg BID x5-7 days Macrolides are not recommended due to high resistance rates. • The patient is not experiencing Rhinosinusitis for ≥ 10 OR Viral versus bacterial: > 10 days without improvement, fever >102 with Amoxicillin/clavulanic acid 875mg BID or 500mg TID x5-7 days dysuria, urinary frequency, purulent nasal discharge for 3-4 days, or worsening symptoms after 5 days Levofloxacin 500mg QD x5-7 days urgency, or suprapubic days tenderness Azithromycin 500mg x1, then 250mg x4 days for patients with severe Often not a true infection and not Group A Strep (Strep penicillin allergies Amoxicillin 500mg TID x10 days Cephalexin 500mg BID x10 days routinely treated in Throat) immunocompetent, non-pregnant Alt: IM benzathine penicillin x1 dose adults Skin/soft tissue non- Cephalexin 500mg BID-QID x5 days Treatment is reserved for: OR Clindamycin 300mg TID x5 days May extend duration if not improved at 5 days • Pregnant females purulent Amoxicillin 500mg TID x5 days • Patients undergoing Skin/soft tissue – I&D with TMP/SMX DS BID 5-14 days I&D recommended for all purulent abscesses urologic procedure I&D only for mild infection OR Mild abscesses may be treated with I&D only purulent abscess I&D with Doxycycline 100mg PO BID 5-14 days Antibiotics recommended if signs of systemic infection Acute Bronchitis Add TMX/SMP or doxycycline if suspected MRSA • Inflammation of the lining of the Diabetic foot infection Amoxicillin/clavulanic acid 875mg BID or 500mg TID x7-14 days Clindamycin 150mg TID Severe infection may require up to 4 weeks bronchial tubes Wound care is needed in conjunction with antibiotics • Acute bronchitis is usually caused Cephalexin 500mg BID x5 days by viruses (90-99%) and antibiotics OR Amoxicillin is the drug of choice for enterococcus UTI are not indicated in patients Uncomplicated Urinary Fosfomycin 3GM x1 dose (may have high cost/availability Avoid nitrofurantoin in CrCl <30mL/min Nitrofurantoin 100mg BID x5 days without chronic lung disease Tract Infection issues) Empiric recommendations based on E. coli assumption, if other organisms • In the treatment of bronchitis, OR isolated consult antibiogram antibiotics have been shown to Trimethoprim-sulfamethoxazole DS BID x 3days provide minimal benefit especially Ceftriaxone 1GM IM x1 then Cephalexin 500mg BID-QID x7- Reserve fluoroquinolones due to higher resistance rates, C. difficile risk, compared to the possible adverse 14 days and other side effects. May be necessary for recurrent infections. effects Complicated urinary OR • Consider antibiotics if symptoms have not improved after 10 days tract infection or Ceftriaxone 1GM IM x1 then Cefdinir 300mg
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