Fairview Lakes Medical Center

2015 Antibiotic Susceptibility Report

GRAM-NEGATIVE ORGANISMS

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2015 Gram-Negative

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

susceptible strains.

Enterobacter a Enterobacter cloacae Enterobacter coli Escherichia influenzenza Haemophilus oxytoca Klebsiella pneumoniae Klebsiella mirabilis Proteus aeruginosa Pseudomonas marcescens Serratia Stenotrophomonas freundii Citrobacter No. Isolates 32 19 96 75 21 44 73 45 52 27 63 Amikacin 100 100 100 100 100 100 100 98 100 Amoxicillin/Clav (Augmentin) IR IR IR 95 IR IR Ampicillin IR IR IR 65 57 IR IR 82 IR IR Ampicillin/Sulbactam (Unasyn) IR IR IR 68 59 83 82 IR IR Aztreonam * Cefazolin IR IR IR 93 50 96 80 IR IR Cefepime 100 100 100 100 100 98 100 98 96 Cefoxitin IR IR IR NT NT NT NT IR IR Ceftazidime - 3rd Generation 72 95 97 99 100 96 91 100 96 27 Ceftriaxone - 3rd Generation 72 95 98 99 100 100 96 91 IR 96 Ciprofloxacin 90 100 100 93 100 98 89 94 100 Gentamicin 96 100 100 99 100 100 100 96 100 Levofloxacin 90 100 100 93 100 100 98 89 94 100 78 Meropenem (Merrem) 100 100 100 100 100 100 100 92 100 Piperacillin/Tazo (Zosyn) 85 95 98 100 98 94 100 96 96 Ticarcillin/Clav (Timentin) * 25 Tobramycin 100 100 98 99 100 100 100 100 100 Trimethoprim/Sulfa (Bactrim) 97 100 94 89 96 93 89 IR NT 97  : 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 v2

GRAM-NEGATIVE ORGANISMS

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2015 Gram-Negative

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

susceptible strains.

Enterobacteraerogenes Enterobactercloacae Escherichiacoli Klebsiellaoxytoca Klebsiellapneumoniae morganiiMorganella Proteusmirabilis Pseudomonasaeruginosa Serratiamarcescens Stenotrophomonas Citrobacterfreundii No. Isolates 49 88 195 1817 55 240 54 83 91 80 37 Amikacin * * * * * * * * * * *NT Ampicillin IR IR IR 65 IR IR IR 90 IR IR Ampicillin/Sulbactam (Unasyn) IR IR IR 72 78 93 NT 94 IR IR Cefazolin IR IR IR 97 80 99 IR 95 IR IR Cefepime 100 100 99 100 100 100 93 96 95 100 *NT Cefoxitin IR IR IR 94 100 97 46 94 NT IR Ceftazidime - 3rd Generation 98 78 90 99 100 100 72 96 99 98 *NT Ceftriaxone - 3rd Generation 98 78 90 99 100 100 85 98 IR 96 Ciprofloxacin 96 100 98 88 100 98 69 66 82 93 Gentamicin 92 100 99 95 100 100 65 96 98 100 Levofloxacin 96 *NT *NT 88 100 98 72 68 82 93 *NT Meropenem (Merrem) * * * * * * * * 100 * Nitrofurantoin (Macrobid) 90 17 32 96 86 41 IR IR NT IR Piperacillin/Tazo (Zosyn) * 98 88 94 98 100 98 88 99 100 Tobramycin 98 100 100 97 100 100 88 96 100 95 Trimethoprim/Sulfa (Bactrim) NT 99 90 85 100 95 53 70 IR *NT 84

: 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

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2015 Gram- Positive 

Non-Urine

Group B Group

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– Organisms  The number of isolates is listed along

with the percent of susceptible strains.

Agalactiae

Pneumonia Pneumonia

hemolytic Strep (Groups A, C, F, G) C, F, A, (Groups Strep hemolytic

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Strep Enterococcus Species Species Enterococcus D. Enterococcus) (Group MSSA Aureus, Staph. MRSA Aureus, Staph. Staph Negative Coag. lugdunensis Staph. Strep. Beta No. Isolates 74 245 110 96 122 94 638 84 Ampicillin 100 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) 88 Ceftriaxone (nonmen) 96 Ciprofloxacin 64 91 35 67 98 NT NT NT Meropenem (Merrom) 94 Clindamycin IR 85 61 67 85 90 67 87 Erythromycin IR 78 5 43 84 NT 59 86 Gentamicin 65 100 100 99 100 NT NT NT Levofloxacin 64 91 39 68 98 100 NT Linezolid 100 100 100 100 100 NT NT NT Oxacillin NT 100 0 56 98 NT NT NT Penicillin 100 0 0 9 0 100 100 Penicillin (mening) 68 Penicillin (nonmen) 93 Quinupristin / Dalfoprisin (Synercid) ‡ 100 100 100 100 NT NT NT Tetracycline 16 96 94 86 100 NT NT NT Trimethoprim/Sulfa (Bactrim) IR 97 100 60 95 NT NT NT Vancomycin 100 100 100 100 100 100 100 100

: 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-POSITIVE ORGANISMS

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Group B Group 

– 2015 Gram-Positive Urine

Organisms Agalactiae

The number of isolates is listed along

with the percent of susceptible strains.

Enterococcusfaecium Staph. MSSA Aureus, Staph. MRSA Aureus, Coag. Staph Negative Strep AerococcusUrinae Enterococcusfaecalis No. Isolates 220 57 42 15 206 267 43 Ampicillin 98 23 NT NT NT 100 95 Ciprofloxacin 69 5 76 7 60 NT Clindamycin IR IR NT NT NT * Erythromycin IR IR NT NT NT * Rifampicin * NT NT * * * NT Quinupristin / Dalfoprisin (Synercid) * IR ‡ NT NT NT NT Moxifloxacin * * * * * NT NT Gentamicin 65 71 100 80 98 NT Levofloxacin 71 7 79 0 60 99 Linezolid * * 100 * * * * Nitrofurantoin (Macrobid) 100 42 100 100 98 NT Oxacillin NT NT 100 0 54 NT Penicillin 97 15 17 0 9 100 100 Tetracycline 21 43 97 93 82 NT Trimethoprim/Sulfa (Bactrim) IR IR 95 73 NT NT IR Vancomycin 100 37 100 100 100 100 100

 : 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

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)

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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.

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.

Reviewed: Helen Brenny, Director of Laboratory Operations 5/2016

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