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טבלאות רגישויות מבית החולים שערי צדק - תרביות דם

מתוך ויקירפואה

שם הספר: שימוש מושכל באנטיביוטיקה ונהלים למניעת זיהומים
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שם המחבר פרופ' עמוס ינון, פרופ' יחיאל שלזינגר, דר' דוד רווה
שם הפרק טבלאות רגישויות מבית החולים שערי צדק - תרביות דם
מוציא לאור
שערי צדק1.png
מועד הוצאה תשע"א – 2010
מספר עמודים 196
הקדשה ספר זה מוקדש
לפרופ' חיים הרשקו
בהוקרה עמוקה

תוכן עניינים

טבלה 1. Number (%) of positive blood cultures/drawn cultures and rates of the most frequently isolated patient-specific isolated organisms/1000 admissions.

Variable/Year 1990-2000‏[1] 2001-2008‏[1]
Annual Mean ± SD 11year Total Annual Mean ± SD 8Year Total
Drawn blood cultures (BC) (n)‏[2] 15,779 ± 4787 173,571 15,070 ± 1047 120,565
No. of true positive BC (n) 1609 ± 524 17,703 1413 ± 125 11,308
Rate of true positive BC (%) 10.2 ± 1.5 10.2 9.4 ± 1.1 9.4
No. of false positive BC (n) NA‏[3] NA 1273 ± 132 10190
Rate of false positive BC (%) NA NA 8.4±1.3 8.4
Rate/1000 admissions‏[4]
Enterobacteriaceae 12.7±2 3394 13.2 4309
E. coli 5.5±1 1494 6.4 2102
S. aureus 4.7±0.9 1240 3.3 1238
K. pneumoniae 3±0.8 779 3.3 1063
Enterococcus spp. 2.3±0.7 631 2.9 939
P. aeruginosa 1.9±0.5 488 1.5 505
S. pneumoniae 1.7±0.4 447 2.1 681
Enterobacter spp. 1.3±0.5 338 1.1 347
Acinetobacter spp. 1±0.3 298 1.5 482
P. mirabilis 1±0.2 260 1.4 449

טבלה 2: Enterobacteriaceae, producing Extended-Spectrum β-lactamases (ESBL) (n,%)2002-2008‏[5]

טבלה 2א: Collected in the Emergency Department

Year All Enterobacteriaceae N=2330 (%) E.coli N=1336 (%)

K.pneumoniae N=341 (%)

P.mirabilis N=228 (%)
2002 42/286 (15) 16/151 (11) 13/54 (24) 5/21 (24)
2003 35/322 (11) 15/191 (8) 15/47 (32) 4/28 (14)
2004 41/307 (13) 17/165 (10) 8/40 (20) 9/33 (27)
2005 42/354 (11) 20/218 (9) 9/49 (18) 11/38 (29)
2006 61/319 (19) 28/198 (14) 17/37 (46) 7/32 (22)
2007 84/348 (24) 46/190 (24) 10/44 (23) 19/33 (58)
2008 79/357 (22) 40/208 (19) 18/59 (30) 10/37 (27)
Total 393/2330 (16) 185/1336 (14) 92/341 (27) 67/228 (29)

טבלה 2ב': Collected from hospitalized patients

Year All Enterobacteriaceae N=1562 (%) E.coli N=347 (%) K.pneumoniae N=495 (%) P.mirabilis N=143 (%)
2002 54/147 (37) 7/35 (20) 34/53 (64) 2/6 (33)
2003 62/213 (29) 10/46 (22) 22/55 (40) 13/26 (50)
2004 64/183 (35) 11/48 (23) 28/51 (55) 10/18 (56)
2005 93/234 (40) 22/58 (38) 35/68 (51) 17/30 (57)
2006 97/267 (36) 13/54 (24) 54/86 (63) 15/29 (52)
2007 58/244 (24) 12/44 (27) 35/99 (35) 7/14 (50)
2008 75/243 (31) 13/57 (23) 29/77 (37) 4/16 (25)
Total 512/1562 (33) 88/347 (25) 239/495 (48) 70/143 (49)

טבלה 3: Enterobacteriaceae – antimicrobial susceptibilities (%) 2001-2008. Breakdown by source of patient

מקרא
  • Amp-Ampicillin;
  • Amk-Amikacin;
  • Aug-Amoxycillin-clavulanate,
  • Carbap-Carbapenems;
  • Caz-Ceftazidime;
  • Cef-Cefazolin;
  • Chl-Chloramphenicol;
  • Cip-Ciprofloxacin;
  • Col-colistin (polymyxin-B);
  • Cpm,-Cefepime,
  • Cro-Ceftriaxone;
  • Cxm-Cefuroxime;
  • Ert-Ertapenem (since 2005);
  • Gen-Gentamicin;
  • Imp-Imipenem;
  • Mez-Mezlocillin (up to mid-2006);
  • Meth-Methicillin; Sep-Cotrimoxazole;
  • Tob-Tobramycin;
  • Tzp-Piperacillin-Tazobactam;
  • Van-Vancomycin.


Group n Penicillins Carbap.‏[6] Cephalosporins Aminogly. Other
Aug Mez Tzp Ert Imp Cef Cxm Cro Caz Cpm Gen Amk Chl Sep Cip Col
≤48hr 3447 66 49 91 99 99 61 75 83 85 85 83 97 79 62 73 86
>48hr 1898 39 42 76 92 98 32 47 60 62 67 66 89 58 52 59 78

טבלה 4

Table 4a: Antimicrobial susceptibilities (%) of selected organisms (in lphabetical order), isolated from blood cultures, 2001-2008.

Organism n Amp Amk Aug Caz Cef Chl Cip Col Cpm Cro Cxm Ert Gen Imp Mez Sep Tzp
Acinetobacter baumanii 589 44 13 9 98 24 62 17 19
Citrobacter species 189 15 97 74 85 74 85 91 100 87 86 82 100 94 100 84 81 94
E. coli 2753 34 98 68 86 64 86 74 100 86 84 79 100 83 100 37 61 93
Enterobacter species 189 15 97 74 85 74 85 91 100 87 86 82 99 94 100 84 81 94
Enterococcus faecalis‏[7] 410 95
Klebsiella oxytoca 119 98 87 93 86 92 94 99 93 91 90 94 100 81 89 94
Klebsiella pneumoniae 1161 81 51 54 44 52 53 99 57 52 49 85 61 95 43 48 60
Morganella morganii 109 95 11 78 6 49 56 91 83 17 60 99 69 48 94
Proteus mirabilis 569 25 98 66 73 44 42 48 67 66 61 99 63 99 41 37 98
Pseudomonas aeruginosa 691 93 91 71 100 92 83 89 76 91
Salmonella‏[8] 108 97 100 98 73 100
Serratia marcescens 164 98 85 78 89 86 88 4 100 88 99 88 73 93
S. aureus ‏[9] 1646
Steno-trophomonas 156 79 89 82 86 78 88 90 90
Streptococcus pneumoniae‏[10]


Table 4b: Source of selected organisms isolated from blood cultures: community acquired versus nosocomial, 2001-2008.


Organism Total (n) Community (%) (≤48 hour in hospital) Hospital (%) (>48 hours in hospital) Other Health Care associated‏[11] (%)
Acinetobacter baumanii 589 11 78 11
Citrobacter spp. 189 47 42 11
E. coli 2762 72 19 9
Enterobacter cloacae 448 20 65 15
Enterococcus faecalis 392 35 53 12
Haemophilus influenzae 696 37 53 10
Klebsiella oxytoca 121 36 50 14
Klebsiella pneumoniae 1381 36 54 10
Morganella morganii 131 43 49 8
Proteus mirabilis 569 56 36 8
Pseudomonas aeruginosa 678 32 57 11
Salmonella non typhi 108 85 13 2
Serratia 196 25 57 17
S. aureus 1624 48 40 12
Stenotrophomonas 156 35 48 17
Streptococcus pneumoniae 902 93 2 5

טבלה 5

Table 5a: Change in antimicrobial susceptibility (%) of all isolates of E.coli (n=2102) isolated from blood cultures, 2000-2008

Year 01 02 03 04 05 06 07 08 mean Trend analysis
N 240 232 255 227 282 286 305 275 P %
Penicillins
Augmentin 69 69 69 64 65 75 64 67 68 NS
Mezlocillin 36 37 38 36 35 49 NA NA 37 <0.05
Tazocin 89 93 89 92 87 96 95 94 93 <0.01
Cephalosporins
Cefazolin 47 56 64 70 78 75 69 76 63 <0.001
Cefuroxime 78 81 83 81 79 81 74 76 79 NS
Ceftriaxone 83 90 89 84 83 83 76 79 84 NS
Ceftazidime 87 89 89 85 83 84 76 79 86 NS
Cefepime 93 89 88 87 85 86 78 81 85 NS
Carbapenems
Ertapenem NA NA NA NA 100 100 100 100 100 NS
Imipenem 98 100 100 100 100 100 100 100 100 NS
Aminoglycosides
Gentamicin 81 87 86 83 76 86 83 82 83 0.01
Amikacin 99 99 97 99 99 99 99 97 98 NS
Other
Chloramph 83 87 87 90 88 88 86 88 86 <0.01
Cotrimoxazole 60 61 60 53 60 61 65 68 61 NS
Ciprofloxacin 73 79 72 73 69 72 68 74 74 NS
Colistin 99 99 100 100 100 100 100 99 100 NS


Table 5b: Change in antimicrobial susceptibility (%) of all isolates of K.pneumoniae (n=1058) isolated from blood cultures, 2000-2008

Year 1 2 3 4 5 6 7 8 mean Trend analysis
N 114 139 113 103 126 128 192 143 P %
Penicillins
Augmentin 39 55 64 57 57 41 44 59 51 <0.001
Mezlocillin 30 50 59 51 46 NA NA NA 43 <0.001
Tazocin 39 60 70 72 63 56 47 73 60 <0.001
Cephalosporins
Cefazolin 36 50 61 54 50 34 40 41 44 <0.001
Cefuroxime 46 54 62 55 54 38 43 50 53 <0.01
Ceftriaxone 46 55 64 61 60 38 45 53 52 <0.001
Ceftazidime 46 55 66 61 60 39 45 53 53 <0.001
Cefepime 74 63 66 61 60 37 45 56 58 <0.001
Carbapenems
Ertapenem NA NA NA NA 89 94 74 86 85
Imi/Mero‏[12] 99 97 96 100 100 95 86 87 95 <0.001
Aminoglycosides
Gentamicin 42 57 75 61 62 44 75 81 61 <0.001
Amikacin 89 94 95 96 82 69 63 73 81 <0.001
Other
Chloramph 41 52 69 61 58 38 40 65 52 <0.001
Cotrimoxazole 37 52 64 56 53 34 35 59 48 <0.001
Ciprofloxacin 41 54 68 64 57 41 40 56 53 <0.001
Colistin 100 99 100 100 100 96 98 99 99 NS


Table 6: Carbapenem Resistant Klebsiella pneumoniae (CRKP)

Blood Isolates Urine isolates Sputum isolates
Year All isolates of K. pneumoniae CRKP N (%) All isolates of K. pneumoniae CRKP N (%) All isolates of K. pneumoniae CRKP N (%)
2001 103 1 (1) 393 1 (0.2) 60
2002 128 4 (3) 474 1 (0.2) 2
2003 105 4 (4) 403 3 (0.7) 22
2004 105 0 406 2 (0.5) 99
2005 110 0 379 3 (0.8) 98 1 (1)
2006 116 5 (4) 353 26 (7.4) 97 4 (4.1)
2007 129 22 (17) 314 46 (14.6) 89 26 (29.2)
2008 136 17 (12) 487 31 (6.4) 104 18 (17.3)
Total 932 53 (5.7) 3209 113 (3.5) 571 49 (8.6)


Table 7: Antimicrobial susceptibility (%) of all isolates of Pseudomonas aeruginosa (n=691) isolated from blood cultures, 2001-2008


≤48 hrs in hospital >48 hours in hospital
214 394
Penicillins
Mezlocillin‏[13] 83 69
Tazocin 94 87
Cephalosporins
Ceftazidime 95 88
Cefepime‏[14] 92 91
Carbapenems
Imipenem 97 82
Meropenem‏[15] 91 93
Aminoglycosides
Gentamicin 80 78
Amikacin 95 90
Other
Ciprofloxacin 76 65
Colistin 100 99


Table 8: Methicillin susceptibility (%) of Staphylococcus aureus, bacteremia, 2001-2008.

Table 8a: S. aureus, % methicillin susceptible bacteremia, by department‏[16]


Department S. aureus Total (n) MSSA/Total n (%)
Pediatrics 243 213 (88)
Emergency Department 526 322 (61)
Surgery Total 203 127 (63)
Chest surgery 87 56 (64)
Orthopedics 22 14 (64)
General surgery 56 27 (48)
Medicine Total 583 282 (48)
Oncology 66 52 (79)
Geriatrics 125 40 (32)
Medicine A + B 232 88 (38)
ICU 65 21 (32)
<48 hours in hospital 795 542 (68)
>48 hours in hospital 666 321 (48)
Overall 1646 977 (59)


Table 8b: Susceptibility (%) of S.aureus to other anti-staphylococcal agents‏[17] , [18]


Group n Oxa Rif Cip Clin Chlor Sept Vanc Fus
MSSA 959 100 100 94 96 92 97 100 95
MRSA 646 0 85 9 33 52 88 100 93


Table 9: Blood isolates of Streptococcus pneumoniae

Table 9a: age distribution


Year All isolates n Age 0-20 Age >20
2001 34 19 15
2002 47 28 19
2003 67 46 21
2004 53 33 20
2005 87 40 47
2006 70 39 31
2007 39 25 14
2008 93 42 51
Grand Total 490 273 (56) 218 (44)


Table 9b: Penicillin susceptibility, age 0-20‏[19]


Year N Susceptible Intermediate Resistant
2001 19 12 (63) 7 (37) 0
2002 28 26 (93) 2 (7) 0
2003 46 40 (87) 6 (13) 0
2004 33 18 (54) 15 (45) 0
2005 40 29 (72) 11 (28) 0
2006 39 30 (77) 9 (23) 0
2007 25 14 (56) 11 (44) 0
2008 42 34 (81) 8 (19) 0
Grand Total 273 203 (74) 69 (26) 0


Table 9c: Penicillin susceptibility, age >20‏[20]


Year N Susceptible Intermediate Resistant
2001 15 12 (80) 3 (20) 0
2002 19 17 (89) 2 (10) 0
2003 21 19 (90) 2 (10) 0
2004 20 13 (65) 7 (35) 0
2005 47 43 (91) 4 (8) 0
2006 31 28 (90) 3 (10) 0
2007 14 11 (79) 3 (21) 0
2008 51 42 (82) 9 (18) 0
Grand Total 218 185 (85) 33 (15) 0


Table 9d: S. pneumoniae, macrolide susceptibility (%), blood culture specimens


Year Age 0-20 N (%) Age >20 N (%)
2001 32 (81) 25 (80)
2002 43 (88) 29 (97)
2003 64 (81) 26 (92)
2004 33 (76) 22 (95)
2005 40 (90) 51 (96)
2006 59 (89) 46 (96)
2007 53 (77) 42 (95)
2008 56 (82) 59 (85)
Total‏[21] 379 (84) 300 (92)


Table 10: Number of patient-specific positive blood cultures with β-hemolytic streptococci, by Lancefield grouping (2001-2008)


Total Lancefield Group Year
G F D C B A
149 (29) 1 (1) 0 16 (20) 0 69 (42) 63 (27) ≤20
363 (71) 81 (99) 1 (100) 66 (80) 13 (100) 94 (58) 108 (63) >20
512 82 1 82 13 163 171 [22] Total

הערות שוליים

  1. 1.0 1.1 Data for 1990-2000 were manually computerized by volunteers from microbiology records; data for 2001-2008 were obtained with the cubes computer program.
  2. BC, blood cultures
  3. NA, not available
  4. Trend statistical analysis demonstrated an absence of significant changes in annual incidence of any of these organisms for 1990-2000.
  5. * Routine testing for ESBL was initiated in 2002
  6. Susceptibilities of Imipenem (Imp) and Meropenem (Mer) are not identical, but similar. Since 2006, the microbiology laboratory determines susceptibility to both Imipenem and meropenem
  7. All isolates of Enterococcus faecalis were susceptible to vancomycin. Of 91 isolates of Enterococcus faecium 47% were Vancomycin susceptible.
  8. Salmonella: includes Salmonella arizonae, group B, group C, group D, group E, and Salmonella species. Not included are S. typhi (n=3 ) and S. paratyphi (n=1).
  9. S. aureus: 59% methicillin susceptible (=MSSA). Rate varies from Pediatric isolates (90%); through ED isolates (61%) and Medical Departments' isolates (48%) to ICU isolates (32%). 100% of isolates were Vancomycin-susceptible. See separate tables for results of S. aureus.
  10. S. pneumoniae (n=490): Below, respectively, age 20 years (n=273) and above 20 years (n=218): Penicillin susceptible (defined as MIC < 0.1 μgm/ml) respectively 74% and 85%; Intermediate resistance (MIC = 0.1-2) 26% and 15 respectively; Resistant (MIC > 2) 0% and 0% respectively. See separate tables for detailed results of S. pneumoniae.
  11. Includes: adult and pediatric dialysis units, hematological and pediatric day care centers, personnel, other
  12. Imipenem until 2006, Meropenem since 2006
  13. continues to be tested
  14. tested until 2006
  15. tested since 2006
  16. significant change in % methicillin susceptibility was noted over the study period
  17. Oxa-Oxacillin (=similar to methicillin), Rif-Rifampicin, Cip-Ciprofloxacin, Clin-Clindamycin, Chlor-Chloramphenicol, Sept-Cotrimoxazole (=trimethorpim-sulfamethoxazole), Vanc-Vancomycin, Fus-Fusidic acid
  18. Linezolid and daptomycin are available in SZMC; however, systematic susceptibility testing of all strains is not yet performed.
  19. 83% of isolates were erythromycin susceptible
  20. 92% of isolates were erythromycin susceptible, a significantly higher rate than in children (p<0.01).
  21. 92% of isolates from adults were erythromycin susceptible, a significantly higher rate than in children (p<0.01).
  22. No significant changes in annual incidence of various streptococci were observed.

ביבליוגרפיה

לטבלה 1
  1. Yinnon AM, Schlesinger Y, Gabbay D, Rudensky B. Analysis of 5 years of bacteraemias: importance of stratification of microbial susceptibilities by source of patients. J Infect 1007 Jul; 35(1):17-23.
  2. Raveh D, Rudensky B, Schlesinger Y, Benenson S, Yinnon AM. Susceptibility trends in bacteraemias: Analysis of 7544 patient-unique bacteraemic episodes spanning 11 years (1990-2000). J Hosp Infect 2003.
לטבלה 2
  1. Friedmann R, Raveh D, Zartzer E, Rudensky B, Broide E, Attias D, Yinnon AM. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534-42.
  2. Raveh D, Yinnon AM, Broide E, Rudensky B. Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, Meropenem and piperacillin-tazobactam with and without clavulanic acid. Chemotherapy. 2007;53(3):185-9.
  3. Cohen MJ, Anshelevich O, Raveh D, Broide E, Rudensky B, Yinnon AM. Acquisition of multidrug-resistant organisms among hospital patients hospitalized in beds adjacent to critically ill patients. Infect Control Hosp Epidemiol. 2006;27(7):675-81.
  4. Henshke-Bar-Meir R, Yinnon AM, Rudensky B, Attias D, Schlesinger Y, Raveh D. Assessment of the clinical significance of production of extended-spectrum beta-lactamases (ESBL) by Enterobacteriaceae. Infection. 2006;34(2):66-74.
  5. Tallis E, Rudensky B, Attias D, Raveh D, Schlesinger Y, Yinnon AM. In-vitro activity of cefepime and other broad-spectrum antimicrobials against several groups of gram-negative bacilli and Staphylococcus aureus. Diagn Microbiol Infect Dis. 1999;35(2):121-6

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