מכאן שהרפואה המשולבת, זו המנסה לעשות שימוש בשני העולמות, הקונבנציונלי והאלטרנטיבי, מתמקדת באדם לא פחות מאשר במחלה. ...
מתוך הערך: המדריך לטיפול בסוכרת

טבלאות רגישויות מבית החולים שערי צדק - תרביות שתן

מתוך ויקירפואה

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

Table 12: Urine cultures

Table 12a: Urine cultures, main isolates, by source of patients (2001-2008)

Isolated organism ≤48 hours in hospital

N=21833

>48 hours in hospital

N=9823

p
Acinetobacter 237 (1) 585 (6) <0.001
Enterobacteriaceae (total) 15323 (70) 5397 (55) <0.001
Citrobacter koserii 499 (2) 174 (2)
Enterobacter cloacae 411 (2) 312 (3)
E.coli 8853 (40) 1927 (20) <0.001
Klebsiella pneumoniae 2132 (10) 1371 (14) <0.001
Morganella morganii 360 (2) 192 (2)
Proteus mirabilis 1640 (7) 762 (8) <0.01
Providencia stuartii 196 131
Serratia marcescens 77 52
Enterococcus sp. 2467 (11) 1833 (19) <0.001
Pseudomonas aeruginosa 1404 (6) 1263 (13) <0.001
Staphylococcus aureus 394 (1) 107 (1)
Staphylococcus epidermidis 686 (3) 309 (3)
Streptococcus 707 (3) 123 (1) <0.001
Group A 22 4
Group B 394 (2) 50 (0.5) <0.001
Group D 90 24
Group G 12 3
S.viridans 122 15


Table 12b: Antimicrobial susceptibilities (%) of Enterobacteriaceae isolated from urine cultures, 2000-2008

N

≤48 hrs in hospital‏[1]

15316

>48 hours in hospital[1]

5397

Penicillins
Augmentin 65 51
Tazocin 92 82
Cephalosporins
Cefazolin 63 43
Cefuroxime 76 56
Ceftriaxone 84 66
Ceftazidime 84 67
Cefepime 86 69
Carbapenems
Ertapenem 99 96
Imipenem 99 98
Aminoglycosides
Gentamicin 85 69
Amikacin 98 94
Other
Chloramph 78 62
Cotrimoxazole 62 52
Ciprofloxacin‏[2] 76 60
Colistin 84 77
Nitrofurantoin 70 52
ESBL-positive‏[3] 15 32


Table 12c: Antimicrobial susceptibilities (%) of Pseudomonas aeruginosa isolated from urine cultures, 2001-2008

≤48 hrs in hospital‏[4] >48 hours in hospital[4]
Penicillins
Mezlocillin‏[4] 77 73
Tazocin 92 88
Cephalosporins
Ceftazidime 92 89
Cefepime‏[5] 95 94
Carbapenems
Imipenem 94 91
Meropenem‏[6] 94 93
Aminoglycosides
Gentamicin 84 81
Amikacin 94 93
Other
Ciprofloxacin 73 69
Colistin 100 100


Table 12d: Ten most frequently isolated organisms from urine cultures and risk of isolation in presence and absence of urinary catheter (1st trimesters, 1990-2000)

No. Organism Isolates

(n=5272) n (%)

Catheter RR‏[7]

(95% CI)

P

value

Absent

(n=3421) n (%)

Present

(n=1851) n (%)

1 Escherichia coli 2540 (48) 1822 (53) 718 (39) 0.73 (0.69-0.78) <0.001
2 Klebsiella pneumoniae 574 (11) 340 (10) 234 (13) 1.28 (1.09-1.49) 0.002
3 Pseudomonas aeruginosa 469 (9) 259 (8) 210 (11) 1.50 (1.27-1.79) <0.001
4 Enterococcus spp. 418 (8) 198 (6) 220 (12) 2.06 (1.72-2.47) <0.001
5 Proteus mirabilis 333 (6) 207 (6) 126 (7) 1.13 (0.91-1.40) 0.265
6 Staphylococcus coag (-) 173 (3) 124 (4) 49 (3) 0.73 (0.53-1.01) 0.06
7 Enterobacter cloacae 129 (2) 75 (2) 54 (3) 1.34 (0.95-1.89) 0.099
8 Acinetobacter baumanii 88 (2) 48 (1) 40 (2) 1.55 (1.02-2.34) 0.04
9 Citrobacter freundii 72 (1) 46 (1) 26 (1) 1.05 (0.65-1.69) 0.846
10 Staphylococcus aureus 61 (1) 37 (1) 24 (1) 1.20 (0.72-2.00) 0.477
Total 4857 (92) 3156 (92) 1701 (92)


Table 12e: Frequencies of isolation of selected Enterobacteriaceae, Pseudomonas and Enterococcus, according to source of patient (2001-2008).

Organism Total

n (%)

Emergency Department

n (%)

Hospital Departments

n (%)

RR (95% CI)‏[8] P value
Enterobacteriaceae 3802 (72) 1586 (82) 2216 (66) 1.25 (1.21-1.29) <0.001
Other organisms 1470 (28) 337 (18) 1133 (34) 0.52 (0.47-0.58) <0.001
Escherichia coli 2508 (48) 1219 (63) 1289 (38) 1.65 (1.56-1.74) <0.001
Pseudomonas 469 (9) 109 (6) 360 (11) 0.53 (0.43-0.65) <0.001
Enterococcus spp. 418 (8) 63 (3) 355 (11) 0.31 (0.24-0.40) <0.001
All Isolates 5272 1923 3349

הערות שוליים

  1. 1.0 1.1 Differences in rates of susceptibility between community and hospital acquired strains were significant for all antimicrobials (p<0.001).
  2. No significant changes in susceptibility % were noted over the study period.
  3. ESBL: extended spectrum beta-lactamase
  4. 4.0 4.1 4.2 continues to be tested
  5. tested until 2006
  6. tested since 2006
  7. Relative risk of organism isolation in the presence versus absence of a catheter.
  8. Relative risk of organism isolation in emergency department versus inpatient departments.

ביבליוגרפיה

  1. Raveh D, Rudensky B, Huerta M, Aviv Y, Yinnon AM. Use of time-trend analysis in the design of empirical antimicrobial treatment of urinary tract infection. Eur J Clin Microbiol Infect Dis 2003; 22(3):158-64.
  2. Raveh D, Rosenzweig I, Rudensky B, Yinnon AM. Prospective, case control study to determine risk factors for community-acquired urinary tract infection due to Pseudomonas aeruginosa or Enterococcus. Eur J Clin Microbiol Infect Dis 2006; 25: 331-334.
  3. Raveh D, Rudensky B, Huerta M, Aviv Y, Yinnon AM. Use of time-trend analysis in the design of empirical antimicrobial treatment of urinary tract infection. Eur J Clin Microbiol Infect Dis 2003 Mar; 22(3):158-64.

ראו גם