2022 Antibiogram

The 2022 PGH Antibiogram
Acknowledgement
Mary Anne Grace Garrido, RN
Hospital Infection Control Unit (HICU)
Ma. Corazon Guevarra

Section of Microbiology
Department of Laboratories
Julius Patrick Miranda, MD

ID Fellow-in-Training
Objectives
• To identify the most common isolated organisms from the service and pay
wards and intensive care units (ICUs)
• To determine the incidence of multidrug resistant organisms (MDROs) in

PGH
• To present the resistance rates of the most commonly isolated organisms
• To recommend the empiric antibiotic therapy based on the current

antibiogram, as applicable
Workflow
DATA DATA Sub

Cultures and Analysis grouped PGH 2022
AST results Using AREA ANTIBIOGRAM
WHONET SPECIMEN
One
Patient,
One isolate
Approach
CULTURE YIELD FROM ALL SPECIMENS
10%
N = 76,843
90%
With growth Without growth

DISTRIBUTION OF CULTURES WITH ISOLATES
3%
10% 2%
20%
30% N=8,302
10%
N=76,843
35%
90%
With isolate Blood CSF Exudates Fungal Respiratory Urine
Without isolate
TOP 10 MOST COMMON ISOLATES
2022 2021 2020 2019 2018
K. pneumoniae K. pneumoniae K. pneumoniae K. pneumoniae K. pneumoniae

Coagulase-negative staphylococci A. baumanii A. baumanii A. baumanii E. coli
A. baumanii E. coli E. coli E. coli P. aeruginosa
E. coli P. aeruginosa P. aeruginosa P. aeruginosa A. baumanii
P. aeruginosa S. hemolyticus S. hemolyticus S. aureus S. aureus
S. aureus E. faecium S. epidermidis S. epidermidis S. epidermidis
E. faecalis S. epidermidis E. cloacae E. faecium E. cloacae
S. maltophilia E. cloacae E. faecium S. haemolyticus S. hominis
E. cloacae S. hominis S. aureus B. cepacia S. hemolyticus
S. marcescens S. aureus S. hominis E. cloacae B. cepacia

TOP TEN MOST COMMON ISOLATES IN ALL AREAS
(N=8302, ADULT & PEDIA )
1400 1331
1200
1016
1000
870
NUMBER OF ISOLATES
780
800 746
600
400
311 301 275 263
200 144
81
0
K. CONS A. baumanii E. coli P. aeruginosa S. aureus E. faecalis S. E. cloacae S. P. mirabilis
pneumoniae maltophilia marcescens
ORGANISMS
MOST COMMON ISOLATES PER AREA
900
816 ICU
800
PAY
700
WARDS
600
NUMBER OF ISOLATES
516
500 479 465
400
333 346
300
234
210
200 165 180 178
142 155
130
82 83 96
100 66 75
51 49 53 45 63 61
30
56 47
11 24
0
K. pneumoniae A. baumanii E. coli P. aeruginosa S. aureus E. faecalis S. maltophilia E. cloacae S. marcescens P. mirabilis
NUMBER OF ISOLATES
ANNUAL INCIDENCE OF THE MOST COMMON ISOLATES
(2018-2022)
K. pneumoniae A. baumanii E. coli
20 19
18 18
18
16 15 15 15
14
14
12
INCIDENCE (%)
12 13
10
10 11 11
10 10
8 9
6
4
2
0
2018 2019 2020 2021 2022
YEAR
OVERALL RESISTANCE PATTERNS
OF THE MOST COMMON ISOLATES
PERCENT RESISTANCE
10
20
30
40
50
60
70
0
Ce
fo
xit
44
i n
24
Ce
fu
ro
xi
m
64
e 47
Ce
ftr
iax
on
61
e
45
Ce
fta
z id
im
61
e
42
Ce
fe
pi
m
46
e
30
Ci
p ro
f lo
xa
36
cin
48
Co
tri
m
ox
a zo
55
ANTIBIOTICS
le
Pi
46
p
(N=1,331)
/T
a zo
ba
ct
48
am
26
M
er
op
en
44
em
15
KLEBSIELLA PNEUMONIAE
Er
ta
p en
37
em
11
Am
ik
ac
16
in
6
Co
l ist
20
in
5
PGH
ARSP
PERCENT RESISTANCE
10
20
30
40
50
60
70
80
90
0
M
er
op
en
85
em
57
Im
ip
in
85
em
Am 56
p/
Su
l ba
ct
63
am
43
Ci
p ro
f lo
xa
82
cin
43
Ce
fta
z id
im
84
e
56
Ce
fe
pi
m
85
e
Pi
57
p /T
a zo
ba
ct
85
am
ANTIBIOTICS
(N=870)
59
Co
tri
m
ox
a zo
80
le
50
Am
ik
ac
50
in
29
Ge
ACINETOBACTER BAUMANII
nt
am
75
ici
n
42
Co
l
1
ist
in
7
M
in
oc
yc
lin
10
e
4
PGH
ARSP
PERCENT RESISTANCE
10
20
30
40
50
60
70
80
90
0
Am
Am pi
ci lli
ox
/C n
82 79
lav
ul
a ni
ca
cid
25 26
Ce
fa
zo 55
lin
46
Ce
fu
ro
xi
m
e
42 44
Ce
ftr
iax
on
e
41 39
Ce
fta
z id
im
36
e
31
Ce
fe
pi
m
e
24 26
Ci
p ro
f lo
xa
cin
ANTIBIOTICS
46 49
(N= 780)
Co
tri
m
ox
a zo
Pi le
p
53 55
/T
a zo
ESCHERICHIA COLI
ba
ct
am
17 14
M
er
op
en
15
em
8
Er
ta
p en
12
em
7
Am
ik
9
ac
in
4
Co
l ist
in
PGH
ARSP
2
PSEUDOMONAS AERUGINOSA
(N=746)
PGH
30
27 ARSP
25 24
PERCENT RESISTANCE
20
17 17 17
15 14
13
12 12
11
10 10 10
10 9
8 8 8
7
6
5
2
0
Ceftazidime Cefepime Pip/Tazobactam Amikacin Gentamicin Imipinem Meropenem Ciprofloxacin Aztreonam Colistin
ANTIBIOTICS
ENTEROCOCCUS FAECIUM
(N=360)
100 95 95 95 94
91 90 PGH
90 87
84
ARSP
80
72
PERCENT RESISTANCE
70
60 57
50 46 47
44
40
38
33
30
30 27
19
20
10 4 5
0
Ampicillin Penicillin G Vancomycin Linezolid Gentamicin Streptomycin Ciprofloxacn Levofloxacin Tetracycline Nitrofurantoin
ANTIBIOTICS
STAPHYLOCOCCUS AUREUS
(N=311)
100
91 PGH
90
88
ARSP
80
PERCENT RESISTANCE
70
60
50 45 47
40
38
30 25
20
10 12 11
10
8 7
3 2 1
0
Penicillin Oxacillin Cotrimoxazole Erythromycin Clindamycin Tetracycline Vancomycin Linezolid
ANTIBIOTICS
PGH RESISTANCE RATES OF MDRO
(2022 VS 2021)
90 85 83 2022
80
70 2021
64
61
PERCENT RESISTANCE
60
50 44 45 45 46
41 39 39
40
30 28
22 22
20 15 13
10
0
CR A baumanii CR P. aeruginosa CR E. coli CR K. pneumoniae E.coli ESBL+ K. pneumoniae VRE MRSA
ESBL+
ORGANISMS
ANNUAL INCIDENCE OF CARBAPENEM-RESISTANT ISOLATES
(2018-2022)
P. aeruginosa E. coli K. pneumoniae

50
45
40
35
INCIDENCE (%)
30
25
20
15
10
5
0
2018 2019 2020 2021 2022
YEAR
ANNUAL INCIDENCE OF ESBL+
KLEBSIELLA PNEUMONIAE & ESCHERICHIA COLI
(2018-2022)
70 E. coli K. pneumoniae
60
50
INCIDENCE (%)
40
30
20
10
0
2018 2019 2020 2021 2022
YEAR
ANNUAL INCIDENCE OF VR ENTEROCOCCUS (VRE) & MRSA
(2018-2022)
VRE MRSA
0.6
0.5
0.4
INCIDENCE (%)
0.3
0.2
0.1
0
2018 2019 2020 2021 2022
YEAR
DISTRIBUTION OF CARBAPENEM-RESISTANT
ACINETOBACTER BAUMANII FROM ALL SPECIMENS PER AREA
(N=718)
12
11
10
9
8 8
8
7 7
PERCENTAGE
6 6
6
5 5 5
4 4
4
3 3 3
2 2
2
1 1 1
4B
4A
U
Y
U
U
IT
an
CU
CI
D1
D2
D3
D4
D6
D8
6
b
PA
D1
D1
D1
D1
IC
SC
IC
IC
D5
UN
ha
ih
D1
KI
D1
M
N
NS
W
O
Re
W
n
CE
W
W
UR
RN
ya
Ba
BU
NE
AREA
OUTCOMES OF PATIENTS WITH
CARBAPENEM-RESISTANT ACINETOBACTER BAUMANII FROM ALL AREAS
(N=718)
6%
39%
55%
Discharged Mortality HPR

PERCENTAGE
10
15
20
25
0
5
NS
SC
U
3
BU
RN
UN
IT
CE
N IC
U
1
KI
CU
1
M
IC
U
4
NE
UR
O
IC
U
2
Pa
y
21
CI
W
2
Ba
ya
n ih
an
2
Re
ha
b
1
W
D1
5
W
D2
6
AREA
W
D3
6
(N=253)
W
D4
8
W
D5
N
3
W
D6
W
D8
7
W
D1
0
4
W
FROM ALL SPECIMENS PER AREA
D1
2
4
W
D1
4A
5
W
D1
DISTRIBUTION OF ESCHERICHIA COLI ESBL+
4B
7
W
D1
5
4
W
D1
6
5
DISTRIBUTION OF CARBAPENEM-RESISTANT ESCHERICHIA COLI
(N=94)
12
11
10 10
10
9
8
7 7
PERCENTAGE
6
6
5 5
4 4
4
3 3 3 3
2 2
2
1 1 1 1
4B
4A
U
W
U
U
b
an
CU
RN
6
D1
D2
D3
D4
D6
D8
2
Pa
D1
D1
D1
ha
IC
SC
IC
IC
D5
D1
CI
ih
D1
KI
D1
BU
M
N
Re
W
NS
W
n
W
CE
W
W
UR
ya
Ba
NE
AREA
OUTCOMES OF PATIENTS WITH
CARBAPENEM-RESISTANT ESCHERICHIA COLI FROM ALL AREAS
(N=94)
3%
45% 52%

DISTRIBUTION OF KLEBSIELLA PNEUMONIAE ESBL+
(N=643)
12
10
10
8 8 8
8
7 7
PERCENTAGE
6
6
5 5 5
4
4
3 3 3 3 3 3
2 2 2
2
1 1
4B
4A
U
Y
U
W
U
IT
CU
D1
D2
D3
D4
D6
D8
6
an
PA
D1
D1
D1
D1
ha
IC
SC
IC
IC
D5
UN
CI
D1
KI
D1
ih
M
N
Re
NS
W
O
W
n
CE
W
W
UR
RN
ya
BU
Ba
NE
AREA
DISTRIBUTION OF CARBAPENEM-RESISTANT K. PNEUMONIAE
(N=455)
10
9 9 9
9
8 8
8
7
6 6
PERCENTAGE
6
5 5
5
4 4 4 4 4
4
3
3
2 2 2 2 2
2
1
1
0
W
4B
IT
4A
U
Y
U
U
U
CU
D1
D2
D3
D4
D6
D8
6
N
D1
D1
D1
D1
PA
HA
IC
HA
SC
IC
IC
D5
UN
CI
D1
W
W
KI
D1
M
N
W
NS
RE
W
NI
CE
W
W
RN
UR
YA
BU
NE
BA
AREA
OUTCOMES OF PATIENTS WITH CARBAPENEM-RESISTANT
KLEBSIELLA PNEUMONIAE FROM ALL AREAS
(N=455)
6%
45%
49%

DISTRIBUTION OF CARBAPENEM-RESISTANT
PSEUDOMONAS AERUGINOSA FROM ALL SPECIMENS PER AREA
(N=130)
9
8 8 8 8 8
8
7 7
7
6
6
PERCENTAGE
5 5 5 5 5
5
4
4
3
2 2 2 2
2
1
1
0
4A
U
W
U
4B
IT
CU
B
y
D1
D2
D3
D4
D6
D8
6
Pa
D1
D1
D1
D1
HA
IC
HA
SC
IC
IC
D5
UN
CI
D1
KI
D1
M
N
NS
W
O
RE
W
NI
CE
W
W
UR
RN
YA
BU
NE
BA
AREA
OUTCOMES OF PATIENTS WITH CARBAPENEM-RESISTANT
PSEUDOMONAS AERUGINOSA FROM ALL AREAS
(N=130)
8%
39% 53%

PERCENTAGE
10
12
14
0
2
4
6
8
NS
SC
U
1
BU
RN
UN
IT
5
CE
N IC
U
1
M
IC
U
2
NE
UR
O
IC
U
3
Pa
y
10
IC CI
W
U 1
Ba
ya
n ih
an
2
SO
JR
1
W
D1
10
W
AREA
D2
12
(N=201)
W
PER AREA
D3
7
W
D4
5
W
D5
N
3
W
D8
11
W
D1
2
4
W
D1
4A
6
W
D1
4B
2
W
D1
5
3
DISTRIBUTION OF MRSA FROM ALL SPECIMENS
W
D1
6
2
OUTCOMES OF PATIENTS WITH MRSA FROM ALL AREAS
(N=201)
1%
5%
23%
71%
Discharged Mortality HPR THOC

PERCENTAGE
10
12
0
2
4
6
8
NS
SC
U
6
BU
RN
UN
IT
4
CE
N CI
U
6
KI
CU
3
M
IC
U
NE
6
UR
O
IC
U
7
Pa
y
7
CI
W
1
Ba
ya
n ih
an
1
W
D
1
11
W
D2
11
W
AREA
D3
6
(N=158)
W
PER AREA
D4
7
W
D5
N
2
W
D6
1
W
D8
5
W
D1
0
1
W
D1
2
1
W
14
A
4
W
14
B
5
W
DISTRIBUTION OF VRE FROM ALL SPECIMENS
D1
5
1
W
D1
6
1
OUTCOMES OF PATIENTS WITH VRE FROM ALL AREAS
(N=158)
6%
46%
48%
Discharged Mortality HPR THOC

BLOOD ISOLATES
TOP TEN MOST COMMON BLOOD ISOLATES IN ALL AREAS
(N=1362)
600
500 483
NUMBER OF ISOLATES
400
300
200
133
114
100
59 58
44 39
28 23 20
0
CONS K. pneumoniae A. baumanii S. aureus E. coli, E. P. aeruginosa E. faecalis E. cloacae B. cepacia S. marcescens
faecium
ORGANISMS
MOST COMMON BLOOD ISOLATES PER AREA
350
ICU
300 288 PAY
WARDS
250
NUMBER OF ISOLATES
200
157
150
100
66
54 54 51
50 36 37 39 33
20 25 26 24 26
17 17 13 8 15
11
2 8 3 7 14 8 5
13 10 8 8 4
0
CONS K. A. baumanii S. aureus E. coli E. faecium P. aeruginosa E. faecalis E. cloacae B. cepacia S.
pneumoniae marcescens
ORGANISMS
KLEBSIELLA PNEUMONIAE ANTIBIOTIC RESISTANCE
PATTERN OF BLOOD ISOLATES IN ALL AREAS VS 2021
2022
2021
90 82 80 80 79
80
68 70 70
70 67 65 66 65
PERCENT RESISTANCE
60 62
60 57 55
51 51 52
49 47
50
38 39
40
30
18 18
20
9
10
1
0
in
in
e
cin
cin
em
e
em
n
e
e
am
m
m
l
on
im
i
ac
xit
zo
ist
xa
xa
en
pi
en
xi
ct
z id
iax
a
ik
l
fo
ro
Co
fe
ba
f lo
f lo
ox
p
op
Am
Ce
fta
ftr
ta
fu
Ce
zo
m
vo
ro
er
Er
Ce
Ce
Ce
tri
a
p
Le
M
/T
Ci
Co
p
Pi
ANTIBIOTICS
PATTERN OF BLOOD ISOLATES PER AREA
ICU
PAY
WARDS
100 92 92 89 89 89 86
90 83
80
80 71 71 72
PERCENT RESISTANCE
70 67 67
70
56 59
60 52 52 55
50
50 46
41 41 38
40 32
30
30 24 22 23 24 24 22
20
10 5
0
in
te
e
cin
e
em
n
e
e
am
m
m
l
on
im
i
ac
xit
zo
na
xa
pi
en
xi
ct
z id
iax
a
ik
fo
la
ro
fe
ba
f lo
ox
op
Am
vu
Ce
fta
ftr
fu
Ce
zo
m
ro
er
la
Ce
Ce
Ce
tri
a
p
M
/C
/T
Ci
Co
ox
p
Pi
Am
ANTIBIOTICS
ACINETOBACTER BAUMANII ANTIBIOTIC RESISTANCE
(N=114)
100 2022
89 88 89 88 89 90 89 90 88 89
90 86 88 87 86
81 79 2021
80
70 71
PERCENT RESISTANCE
70
60
50
40
30
20
10
10 4
1
0
in
em
n
e
em
am
e
cin
am
e
m
lin
l
im
ici
zo
ist
xa
pi
en
ct
ct
in
am
yc
z id
l
Co
ba
ip
fe
ba
f lo
ox
op
oc
fta
nt
Im
Ce
l
zo
m
ro
Su
in
er
Ge
Ce
tri
a
M
p
M
p/
/T
Ci
Co
Am
p
Pi
ANTIBIOTICS
ICU
120
PAY
100 96 96 94 96 96 94 94 WARDS
90
84 84 84 82 82
PERCENT RESISTANCE
80 78
80 76
72 72 72 72 72 72
68 68
63
60
45
40
27
20
11 9 8
2
0
in
m
em
n
e
am
cin
em
e
e
m
lin
l
ici
im
ta
zo
ist
xa
pi
ct
en
in
am
yc
z id
a
ac
l
Co
ba
ip
fe
f lo
ox
op
oc
ob
nt
fta
Im
Ce
l
m
ro
Su
in
er
Ge
az
Ce
tri
M
p
M
p/
/t
Ci
Co
p
Am
Pi
ANTIBIOTICS
STAPHYLOCOCCUS AUREUS ANTIBIOTIC RESISTANCE
(N=59)
2022
90 2021
80 78
80
70
PERCENT RESISTANCE
60
50
42
40 37
30 25
20 22
20 14 14
11 10 12
10 6 5 5 7
3 4
0
in
lid
cin
n
e
cin
cin
in
in
n
xin
l
ici
li
l
zo
yc
yc
cil
o
cil
xa
xa
ty
a
am
ez
om
a
m
ox
ni
om
f lo
f lo
ox
Ox
Lin
da
Pe
nt
if l
nc
m
vo
ro
hr
ox
in
Ge
Va
tri
p
yt
Le
Cl
M
Ci
Co
Er
ANTIBIOTICS
120
ICU
100
100 PAY
PERCENT RESISTANCE
80 79 WARDS
80
60
50 50
41
40 35
20 21
20 15 13
11 13 10 10
5 5 5 3 5 3
0
in
lid
n
e
cin
cin
cin
in
n
in
in
l
ici
li
l
zo
yc
yc
yc
cil
o
cil
xa
a
xa
am
ez
om
a
om
m
ox
a
ni
f lo
f lo
ox
Ox
Lin
da
if l
Pe
nt
hr
nc
m
vo
ro
ox
in
Ge
yt
Va
tri
p
Le
Cl
M
Ci
Er
Co
ANTIBIOTICS
SUMMARY OF THE MOST COMMON BLOOD ISOLATES
Gram Positive Organisms

Organism 2022 2021
Staphylococcus aureus 4.33% 3.23%
E faecium 4.25% 5.21%
E faecalis 2.86% 1.80%
Gram Negative Organisms

Organism 2022 2021
Klebsiella pneumoniae 9.76% 9.43%
Acinetobacter baumanii 8.37% 12.03%
Escherichia coli 4.26% 3.86%
MDRO RATES FOR BLOOD ISOLATES
Acinetobacter baumanii
Area Carbapenem-Resistant
Wards 84%
ICU 96.29%
Pay 72.73%
Klebsiella pneumoniae
Area ESBL+ Carbapenem-Resistant
Wards 71.21% 54.55%
ICU 88.89% 86.11%
Pay 37.84% 22.22%
RESPIRATORY ISOLATES
NUMBER OF ISOLATES
100
200
300
400
500
600
700
800
0
K.
pn
eu
m
on
ia
e
A. 677
b au
m
an
ii
578
P.
a er
ug
in
os
a
328
S.
m
al
to
ph
i lia
185
E.
co
li
87
S.
m
ar
ce
sc
ORGANISMS
en
s
60
IN ALL AREAS
S.
au
re
us
60
E.
clo
ac
ae
52
K.
ae
ro
ge
ne
s
22
H.
pa
ra
i nf
lu
en
z ae
21
TOP TEN MOST COMMON RESPIRATORY ISOLATES
MOST COMMON RESPIRATORY ISOLATES PER AREA
500
ICU
443 PAY
450
WARDS
400
350 328
NUMBER OF ISOLATES
300
245
250
207
200 190
150
100 90
100 85
68
43 53
50 36 33 28 30 37
19 20 26 16
6 16 15 11 1 5 1 7 15
0
K. pneumoniae A. baumanii P. aeruginosa S. maltophilia E. coli S. marcescens S. aureus E. cloacae K. aerogenes H.
parainfluenzae
ORGANISMS
PATTERN OF RESPIRATORY ISOLATES IN ALL AREAS VS 2021
(N=677)
2022
70 66 66
2021
63 62 62 64 61 62
60 57
50 52
PERCENT RESISTANCE
50 48 48
45 46
42 43
39 39
40
29
30
20 15
10 4 6
3
0
in
in
e
e
cin
em
em
n
e
e
am
m
m
l
on
im
i
ac
zo
xit
ist
xa
en
pi
en
xi
ct
z id
iax
a
ik
l
fo
ro
Co
fe
ba
f lo
ox
p
op
Am
Ce
fta
ftr
ta
fu
Ce
zo
m
ro
er
Er
Ce
Ce
Ce
tri
a
p
M
/T
Ci
Co
p
Pi
ANTIBIOTICS
PATTERN OF RESPIRATORY ISOLATES PER AREA
ICU
PAY
80 76 76 75
68 70 WARDS
70 67
64 64
62 61 60
57 56
PERCENT RESISTANCE
60 54
52
50 45 45 45 46
41
38 39
40 34 35 35 35
33 31 28
30 25
23
20 13
8
10
in
e
e
cin
em
em
n
am
e
e
m
m
l
on
im
i
ac
zo
xit
xa
en
pi
en
xi
ct
z id
iax
a
ik
fo
ro
ba
fe
f lo
ox
p
op
Am
Ce
fta
ftr
ta
fu
Ce
zo
m
ro
er
Er
Ce
Ce
Ce
tri
a
p
M
/T
Ci
Co
p
Pi
ANTIBIOTICS
(N=578)
2022
2021
100
90 87 86 87 86 85 84 86 87 84 86 85
80 83
79 79
80
PERCENT RESISTANCE
69 71
70 65
60
50
40
30
20 12
10 5
1 1
0
in
n
cin
m
em
em
am
e
e
m
ol
lin
ici
im
ta
ist
xa
pi
en
az
ct
in
am
yc
z id
ac
l
Co
ip
fe
ba
f lo
ox
op
oc
lb
nt
fta
Im
Ce
zo
im
ro
su
in
er
Ge
Ce
a
p
M
-t r
M
/T
Ci
lli
Co
p
ci
Pi
pi
Am
ANTIBIOTICS
100 93 93 93 93 93
92 92 90 ICU
90 84 84 84 84 83
82
79 PAY
80 78 78
74 75 75 75 74
69 69 WARDS
PERCENT RESISTANCE
70 64
61
60
50
50
40
30
19
20
12 10
10
1 1
0
in
em
n
e
am
cin
em
am
e
e
m
lin
l
ici
im
zo
ist
xa
pi
ct
en
ct
in
am
yc
z id
l
Co
ba
ip
ba
fe
f lo
ox
op
oc
nt
fta
Im
Ce
l
zo
m
ro
Su
in
er
Ge
Ce
tri
a
M
p
M
p/
/T
Ci
Co
Am
p
Pi
ANTIBIOTICS
PSEUDOMONAS AERUGINOSA ANTIBIOTIC RESISTANCE
(N=328)
40
36
2022
35
2021
30 29
PERCENT RESISTANCE
25
25 22 22
22
20 17 17 16
15 14
12
11 11 11 11
9
10 7
7 6 6
5 3 2
0
in
em
in
n
cin
cin
em
e
am
am
ici
im
ac
ist
xa
xa
pi
en
on
in
ct
am
z id
ik
l
Co
ip
fe
ba
f lo
f lo
op
tre
Am
nt
fta
Im
Ce
zo
vo
ro
er
Ge
Az
Ce
a
Le
M
/T
Ci
p
Pi
ANTIBIOTICS
ICU
60
PAY
49 WARDS
50
PERCENTAGE RESISTANCE
40 40
40 37
33
29
30
24 25 24
23
21 20 21
19
20 16 17
15 16 15
12 12 14 12
10 10 9
10 10 8
5 3
1 3
0
in
cin
in
em
n
e
cin
am
am
em
e
m
im
ici
ac
ist
xa
xa
on
pi
en
ct
in
am
z id
ik
l
Co
ip
ba
fe
f lo
f lo
op
tre
Am
fta
nt
Im
Ce
zo
vo
ro
er
Az
Ge
Ce
a
Le
M
/T
Ci
p
Pi
ANTIBIOTICS
STENOTROPHOMONAS MALTOPHILIA ANTIBIOTIC RESISTANCE
(N=185)
ICU
PAY
25 WARDS
22 21
PERCENTAGE RESISTANCE
20
15
15
10 8
6 6 6
5 4
0
Levofloxacin Cotrimoxazole Minocycline
ANTIBIOTICS
ESCHERICHIA COLI ANTIBIOTIC RESISTANCE PATTERN OF
RESPIRATORY ISOLATES PER AREA
ICU
PAY
80 74 73 WARDS
68 65 67 64
70 63 60
PERCENT RESISTANCE
60 58 56 58 58 60 58 58
60 53 51 53 53
50 47 47
50 45 42 44 44 44
40 38
40 35 32 31
30 25 25 25
21 23 20
20 15
10 10
10
0
e
in
cid
le
e
cin
cin
em
em
n
am
m
m
im
on
zo
ac
xit
ta
xa
xa
cA
en
pi
en
xi
ct
z id
iax
ac
a
ik
fo
ro
fe
ba
f lo
f lo
ox
p
op
ni
Am
b
Ce
fta
ftr
ta
fu
Ce
zo
ul
m
vo
ro
er
Er
ul
Ce
Ce
Ce
S
tri
a
p
Le
M
/T
lav
p/
Ci
Co
Am
/C
Pi
ox
Am
ANTIBIOTICS
SUMMARY OF THE MOST COMMON RESPIRATORY ISOLATES
Organism 2022 2021

K. pneumoniae 26.08% 30.94%
A. baumanii 22.27% 29.23%
P. aeruginosa 12.63% 13.63%
MDRO RATES FOR RESPIRATORY ISOLATES
ESBL+
Organism WARDS ICU PAY
K. pneumoniae 58.91% 75.79% 43.52%
Carbapenem Resistance
Organism WARDS ICU PAY
K. pneumoniae 58.91% 75.79% 43.52%
A. baumanii 83.84% 93.44% 77.78%
P. aeruginosa 23.78% 40.40 33.33%
RECOMMENDATIONS FOR EMPIRIC THERAPY FOR
HOSPITAL-ACQUIRED PNEUMONIA
Charity and Pay Wards
• Meropenem 1-2 gm IV q 8 prolonged infusion (over 3 hours) PLUS
Amikacin 15 mg/kg IV every 24 hours
Intensive Care Units

• Meropenem 1-2 gm IV q 8 prolonged infusion (over 3 hours) PLUS
Polymyxin B 2.5 mg/kg IV as LD then 1.5 mg /kg IV as MD every 12
hours via 4-hour infusion
URINE ISOLATES
TOP TEN MOST COMMON URINE ISOLATES
IN ALL AREAS
350
300
300
NUMBER OF ISOLATES
250
200 186
173
150
101
100 70 59
50 40
21 13 13
0
E. coli E. faecium K. E. faecalis P. aeruginosa A. baumanii E. cloacae P. mirabilis M. morganii S. aureus
pneumoniae
ORGANISMS
MOST COMMON URINE ISOLATES PER AREA
ICU
PAY
WARDS
30
26
25
NUMBER OF ISOLATES
21
20
17
15 12 12 11 12
10
10 7
5 6 6 5 6
5 3 3 4 4 3
2 3
1 1 2 1 1
0
Escherichia coli Enterococcus Klebsiella Enterococcus Pseudomonas Acinetobacter Enterobacter Proteus Morganella Staphylococcus
faecium pneumoniae faecalis aeruginosa baumanii cloacae mirabilis morganii aureus
ORGANISMS
PERCENT RESISTANCE
10
20
30
40
50
60
0
Ce
fu
ro
xi
m
e
42 41
Ce
ftr
iax
on
e
39 40
Ce
fo
xit
i n
20 21
Ce
fta
z id
im
33
e
37
Ce
fe
pi
m
23
e
34
Am
ik
ac
8
Co in
11
tri
m
ox
a zo
48
Ci le
p
54
ro
f lo
xa
49
cin
Le
43
vo
f lo
xa
Pi
47
p/ cin
Ta
39
zo
ba
ANTIBIOTICS
Am ct
(N=300)
ox am
/C
16 14
lav
ul
an
Am at
p/ e
23 22
Su
lb
ac
ta
m
30
M
27
er
op
en
em
14
9
Er
ta
pe
ne
m
12
Fo
sf
om
URINE ISOLATES IN ALL AREAS VS 2021
yc
10
Ni in
14
tro
fu
ra
nt
1
oi
n
3
Co
l ist
in
2021
2022
ESCHERICHIA COLI ANTIBIOTIC RESISTANCE PATTERN OF
ESCHERICHIA COLI ANTIBIOTIC RESISTANCE PATTERN
OF URINE ISOLATES PER AREA
100
91 ICU
90
82 PAY
80
73 73 71 WARDS
70 64
PERCENT RESISTANCE
60 60 60
60 55 54
50 47 45 45 45 45
43
40
40 37 3638 36 36
32 32
30 25 27
24 25
22
17 19
20 14 15 16 16
12 13
9
10 6 8 6 4
2 3
0
e
in
te
e
cin
cin
in
em
le
am
em
n
in
am
m
m
on
im
i
zo
ac
to
xit
yc
na
xa
xa
en
pi
en
xi
ct
ct
z id
iax
an
om
a
ik
fo
a
ro
ba
fe
ba
f lo
f lo
ox
p
op
ul
Am
ur
Ce
fta
ftr
ta
fu
Ce
sf
zo
l
lav
m
vo
ro
Su
er
f
Fo
Er
Ce
Ce
tro
Ce
tri
a
p
Le
M
/C
p/
/T
Ci
Co
Ni
Am
ox
p
Pi
Am
ANTIBIOTICS
ENTEROCOCCUS FAECIUM ANTIBIOTIC RESISTANCE
PATTERN OF URINE ISOLATES IN ALL AREAS VS 2021
(N=186)
120 2022
98 98
2021
100 95 95 95 95
PERCENT RESISTANCE
80
71
61
60 53
50 51
41
40
20
3
0
Penicillin Ampicillin Gentamicin-High Streptomycin- High Levofloxacin Linezolid Vancomycin
ANTIBIOTICS
ENTEROCOCCUS FAECIUM ANTIBIOTIC RESISTANCE
PATTERN OF URINE ISOLATES PER AREA
120
ICU
97 100 99 97 100 98 100
96
100
89 PAY
PERCENT RESISTANCE
79 WARDS
80 74
66
60 53 51 53
47
40 37 37
20
6 2
0
Penicilin Ampicillin Gentamicin High Steptomycin High Levofloxacin Linezolid Vancomycin
ANTIBIOTICS
PATTERN OF URINE ISOLATES IN ALL AREAS VS 2021
2022
2021
80
70 68 66 65
63 62 62 63
59 59
PERCENT RESISTANCE
60
50 49
50 42 45 43 44
39 39 37
40 33 34
30
30 26
20 18 20 18
9
10 2
0
in
e
in
le
e
cin
cin
in
em
am
em
n
e
m
m
im
on
zo
ac
to
xit
ist
xa
xa
en
pi
en
xi
ct
z id
iax
an
ik
l
fo
ro
Co
ba
fe
f lo
f lo
ox
p
op
Am
ur
Ce
fta
ftr
ta
fu
Ce
zo
m
vo
ro
er
f
Er
Ce
Ce
Ce
tro
tri
a
p
Le
M
/T
Ci
Co
Ni
p
Pi
ANTIBIOTICS
ICU
90 86 86 86 PAY
81
80 76 76 76 WARDS
71 71 74
70 69 69 69
70 66
PERCENT RESISTANCE
60 54
51
50 45 45 45
42 43 42
39 38 37
40 35
30 27
24
19 21 19
20 16 17
14 13 13
10
10
a…
e
in
le
e
cin
cin
in
em
em
n
e
m
m
im
ct
on
zo
ac
to
xit
xa
xa
en
pi
en
ba
xi
z id
iax
an
ik
fo
ro
fe
f lo
f lo
ox
zo
p
op
Am
ur
Ce
fta
ftr
ta
fu
Ce
a
vo
ro
er
f
/T
Er
Ce
Ce
Ce
tro
tri
Le
M
p
Ci
Co
Ni
ANTIBIOTICS
Pi
ENTEROCOCCUS FAECALIS ANTIBIOTIC RESISTANCE
ICU
PAY
WARDS
100
90 86
83
80
PERCENT RESISTANCE
70
60
50
50 43 42
40 36
32 33
29 29 30
30 25 26
21
20 14 14 15 14 14
10 10 8
10 5 4 3
0
Penicillin Ampicillin Gentamicin Streptomycin Ciprofloxacin Levofloxacin Fosfomycin Nitrofurantoin Linezolid Tetracycline
High High
ANTIBIOTICS
PERCENT RESISTANCE
Pi
p
10
20
30
40
50
60
70
0
/T
a zo
ba
ct
am
Ce
fta
z id
im
e
Ce
fe
pi
m
e
Az
tre
on
am
M
er
op
en
em
Am
ik
ac
in
ANTIBIOTICS
Ge
nt
am
ici
n
To
br
am
yc
in
Ci
p ro
f lo
xa
cin
Le
vo
f lo
xa
cin
Co
l ist
in
PAY
WARDS
SUMMARY OF THE MOST COMMON URINE ISOLATES
Organism 2022 2021

Escherichia coli 19.48% 26.9%
Enterococcus faecium 14.74% 16.7%
Klebsiella pneumoniae 12.08% 15.2%
MDRO RATES FOR URINE ISOLATES
ESBL+
Organism ICU PAY WARDS
Escherichia coli 72% 31.34% 34.91%
Klebsiella pneumoniae 12.08% 35.4% 65.57%
Carbapenem Resistance
Organism ICU PAY WARDS
Escherichia coli 45% 4.5% 15.61%
Klebsiella pneumoniae 76.19% 12.90% 45.45%
HOSPITAL-ACQUIRED UTI
With no ESBL risk
• Amikacin 15mg/kg IV q 24 hours
With ESBL risk

• Ertapenem 1gm IV every 24 hours
With risk for Pseudomonas or for seriously ill patients

• Meropenem 1gm IV every 8 hours
TISSUE ISOLATES
TISSUE ISOLATES WITH TRUE PATHOGENS
4%
6%
Extremities
Others*
N=781 32% N = 516 Trunk
58% Perineal
True
34% pathogens
Contaminants
66% /colonizers
* Neck | Peritoneum | Back | Chest | Breast | Scalp | Oral cavity | Perianal | Abdominal wall | Mastoid | Nose | Perirectal | CNS | Kidney | Genital | Vascular | Biliary tree |
Chest wall | Colon | Face | Gallbladder | Lung | Ovary | Spine | Ear | Esophagus | Eye | Frontal sinus | Heart | Ileum | Larynx
TYPE OF INFECTION IN PATIENTS WITH TRUE PATHOGENS IN
TISSUE ISOLATES
(N=516)
Community-
acquired
Healthcare-
40%
associated
60%
*Healthcare-associated infection:
• Associated with health care delivery in any setting
• Considered if it appears ≥48 hours after admission
Unahalekhaka, Akeau. "Epidemiology of health care-associated infections." IFIC Basic Concepts of Infection Control 27 (2011)
SOURCE OF TISSUE ISOLATES IN PATIENTS WITH
COMMUNITY-ACQUIRED INFECTION
5%
6%
Extremities
N=208 49%
Others*
Breast
40% Perineal
*Scalp | Neck | Peritoneum | Oral cavity | Mastoid | Perianal | Perirectal | Chest | Chest wall | Kidney | Back | Biliary tree | Colon | Face | Gallbladder | Nose | Ovary |
Abdominal wall | CNS | Ear | Esophagus | Eye | Frontal sinus | Ileum | Larynx | Lung | Trunk | Vascular
SOURCE OF TISSUE ISOLATES IN PATIENTS WITH
HEALTHCARE-ASSOCIATED INFECTION
4% 3%
4%
10% Extremities
Others*
Trunk
N=308 Back
16% Perineal
63%
Chest
* Chest wall | Neck | Peritoneum | Abdominal wall | CNS | Genital | Nose | Oral cavity | Scalp | Spine | Vascular | Heart | Lung | Perianal
MOST COMMON UNDERLYING CONDITIONS IN PATIENTS WITH
TISSUE ISOLATES FROM COMMUNITY-ACQUIRED INFECTION
(N=208)
Trauma 53
Burn 16
Breast CA 15
UNDERLYING CONDITION
Abscess 15
Fournier's gangrene 12
Necrotizing fasciitis 7
CSOM 6
Septic arthritis 5
Scalp mass 5
Cellulitis 5
0 10 20 30 40 50 60
NUMBER OF ISOLATES
MOST COMMON UNDERLYING CONDITIONS IN PATIENTS WITH
TISSUE ISOLATES FROM HEALTHCARE-ASSOCIATED INFECTION
(N=308)
Burn 124
Trauma 65
Implant-associated infection 29
UNDERLYING CONDITION
Fournier's gangrene 12
Decubitus ulcer 9
Breast CA 9
Cellulitis 5
Septic arthritis 4
Necrotizing fasciitis 4
Gingival SCCA 4
Abscess 4
0 20 40 60 80 100 120 140
NUMBER OF ISOLATES
MOST COMMON TISSUE ISOLATES IN ALL AREAS
(N=516)
90 85
80
70 66
60
NU,BER OF ISOLATES
50
43
39 38
40
34 33
30
20 17
14 13
10
0
Pseudomonas Klebsiella Staphylococcus Acinetobacter Escherichia coli Enterobacter Enterococcus Enterococcus Proteus Staphylococcus
aeruginosa pneumoniae aureus baumanii cloacae faecalis faecium mirabilis epidermidis
ORGANISMS
MOST COMMON TISSUE ISOLATES IN PATIENTS WITH
COMMUNITY-ACQUIRED INFECTION
(N=208)
30
25 25
25 24
20
NUMBER OF ISOLATES
20
15
13
11
10
8
7 7 7
0
Escherichia coli Klebsiella Pseudomonas Staphylococcus Enterococcus Enterobacter Enterococcus Staphylococcus Aeromonas Morganela
pneumoniae aeruginosa aureus faecalis cloacae faecium epidermidis hydrophila morganii
ORGANISMS
COMMUNITY-ACQUIRED INFECTION PER AREA
(N=208)
25
21 21 21 WARD (N=174)
20
ICU (N=17)
16
NUBER OF ISOLATES
15 PAY (N=17)
11
10
7 7
6 6
5
5
3 3 3 3
2 2
1 1 1 1 1 1 1 1 1 1
0
Escherichia coli Klebsiella Pseudomonas Staphylococcus Enterococcus Enterobacter Enterococcus Staphylococcus Aeromonas Morganella
pneumoniae aeruginosa aureus faecalis cloacae faecium epidermidis hydrophila morganii
ORGANISMS
HEALTHCARE-ASSOCIATED INFECTION
(N=308)
70
61
60
50
NUMBER OF ISOLATES
41
40
35
30
23 23
20
20
13
9 8
10 6
0
Pseudomonas Klebsiella Acinetobacter Enterobacter Staphylococcus Enterococcus Escherichia coli Enterococcus Proteus Staphylococcus
aeruginosa pneumoniae baumanii cloacae aureus faecalis faecium mirabilis epidermidis
ORGANISMS
HEALTHCARE-ASSOCIATED INFECTION PER AREA
(N=308)
45
40
40 WARD (N=193)
35 ICU (N=87)
NUMBER OF ISOLATES
30
27 PAY (N=28)
25
20
17 18 17
15 14
15
12 12
10 9
10
5 6 5
5 4 4 3 3 3 2 3 3
2 2 1 1 2 1 2 1 1
0
Pseudomonas Klebsiella Acinetobacter Enterobacter Staphylococcus Enterococcus Escherichia coli Enterococcus Proteus Staphylococcus Enterobacter
aeruginosa pneumoniae baumanii cloacae aureus faecalis faecium mirabilis epidermidis hormaechei
ORGANISMS
ESCHERICHIA COLI ANTIBIOTIC RESISTANCE PATTERN IN TISSUE ISOLATES IN
PATIENTS WITH COMMUNITY-ACQUIRED VS HEALTHCARE-ASSOCIATED INFECTION
(N=37)
70 Community-Acquired
60
58 58 Healthcare-Associated
55
50 50 50 48
PERCENT RESISTANCE
50 44 44
40 42 40
40 36
33 32 30
30
20
20 17 17 17
12
10 8 8 8 8 9
0
e
in
e
le
am
em
e
cin
e
cid
am
em
am
m
m
on
im
zo
ac
xa
ca
pi
en
xi
en
on
ct
ct
z id
iax
a
ik
ro
ba
fe
ba
f lo
ox
ni
op
tre
Am
fta
ftr
fu
ta
Ce
zo
l
a
m
ro
Su
er
Az
ul
Er
Ce
Ce
Ce
tri
a
p
M
p/
lav
/T
Ci
Co
Am
p
/C
Pi
ox
Am
ANTIBIOTICS
KLEBSIELLA PNEUMONIAE ANTIBIOTIC RESISTANCE PATTERN IN TISSUE ISOLATES IN
PATIENTS WITH COMMUNITY-ACQUIRED VS HEALTHCARE-ASSOCIATED INFECTION
(N=69)
Community-Acquired
Healthcare-Associated
90
79 79 79 79 79
80 73
69 69
70 62 62
PERCENT RESISTANCE
60 56
50
48
37 37 40
40 33 33
30 28
30 26 26 23 23
19
20 15
10
0
e
in
le
e
am
e
cin
am
em
am
em
e
cid
m
m
im
on
zo
ac
xa
ca
en
on
pi
ct
en
xi
ct
z id
iax
a
ik
ro
ba
ba
fe
f lo
ox
ni
p
op
tre
Am
fta
ftr
ta
fu
Ce
zo
l
a
m
ro
Su
er
Az
ul
Er
Ce
Ce
Ce
tri
a
p
M
p/
lav
/T
Ci
Co
Am
p
/C
Pi
ox
Am
ANTIBIOTICS
PSEUDOMONAS AERUGINOSA ANTIBIOTIC RESISTANCE PATTERN IN TISSUE
ISOLATES IN PATIENTS WITH COMMUNITY-ACQUIRED VS HEALTHCARE-
ASSOCIATED INFECTION
(N=87)
25 Community-Acquired
23
20
PERCENT RESISTANCE
16
15
15
12 12
10 9
8 8
6 6 7
5 4 4
5
2
0
in
cin
in
em
n
e
cin
am
am
em
e
m
im
ici
ac
ist
xa
xa
on
pi
en
ct
en
am
z id
ik
l
Co
ba
fe
f lo
f lo
ip
op
tre
Am
fta
nt
Ce
zo
Im
vo
ro
er
Az
Ge
Ce
a
Le
M
/T
Ci
p
Pi
ANTIBIOTICS
STAPHYLOCOCCUS AUREUS ANTIBIOTIC RESISTANCE PATTERN IN TISSUE ISOLATES
IN PATIENTS WITH COMMUNITY-ACQUIRED VS HEALTHCARE-ASSOCIATED
INFECTION
(N=43)
100
90 85 87 Community-Acquired
80
70
PERCENT RESISTANCE
61
60
50 45 45
40
30 26
22
20 17 17 17
13
10 5 5 5 5
0
in
G
cin
id
le
in
cin
in
in
n
ne
ici
li
zo
yc
ol
ac
yc
yc
in
cil
cli
xa
xa
am
ez
l
ox
om
a
om
cil
cy
f lo
f lo
ox
Ox
Lin
da
if l
nt
ni
tra
hr
nc
m
vo
ro
ox
in
Pe
Ge
yt
Va
tri
Te
p
Le
Cl
M
Ci
Er
Co
ANTIBIOTICS
ACINETOBACTER BAUMANII ANTIBIOTIC RESISTANCE PATTERN IN TISSUE ISOLATES
IN PATIENTS WITH HEALTHCARE-ASSOCIATED INFECTION
(N=35)
100
91 91 89 90 89 91 91 89
90 83
80 74
PERCENT RESISTANCE
70
60
50
40
30
20 14
10
0
in
n
cin
em
le
em
am
e
cin
am
e
m
lin
ici
im
zo
ist
xa
xa
pi
en
ct
ct
en
am
yc
z id
l
Co
ba
fe
ba
f lo
f lo
ox
ip
op
oc
nt
fta
Ce
zo
l
Im
m
vo
ro
Su
er
in
Ge
Ce
tri
a
M
p
Le
M
p/
/T
Ci
Co
Am
p
Pi
ANTIBIOTICS
PSEUDOMONAS AERUGINOSA ANTIBIOTIC RESISTANCE PATTERN IN TISSUE
ISOLATES IN PATIENTS WITH HEALTHCARE-ASSOCIATED INFECTION PER AREA
(N=62)
WARD (N=40)
40
ICU (N=18)
PAY (N=4)
35 33
30
PERCENT RESISTANCE
25 25 25 25 25 25 25
25 22
20 18
15
15
12 12 13
11 11 11 11
10 8 9
6 7
5 5 5
5 3 3 3
in
cin
in
em
n
e
cin
am
am
em
e
m
im
ici
ac
ist
xa
xa
on
pi
en
ct
en
am
z id
ik
l
Co
ba
fe
f lo
f lo
ip
op
tre
Am
fta
nt
Ce
zo
Im
vo
ro
er
Az
Ge
Ce
a
Le
M
/T
Ci
p
Pi
ANTIBIOTICS
KLEBSIELLA PNEUMONIAE ANTIBIOTIC RESISTANCE PATTERN IN TISSUE ISOLATES IN
PATIENTS WITH HEALTHCARE-ASSOCIATED INFECTION PER AREA
(N=42)
WARD (N=28)
ICU (N=12)
PAY (N=4)
120
100 100 100 100 100 100 100 100 100 100 100 100 100 100
100 92 92 92 92
PERCENT RESISTANCE
83 83 83 83
78
80 71 71 71 68 67
61 61 62
60 50 50 50
43 46
40 29
20
0
e
in
le
e
am
e
cin
am
em
am
em
e
cid
m
m
im
on
zo
ac
xa
ca
en
on
pi
ct
en
xi
ct
z id
iax
a
ik
ro
ba
ba
fe
f lo
ox
ni
p
op
tre
Am
fta
ftr
ta
fu
Ce
zo
l
a
m
ro
Su
er
Az
ul
Er
Ce
Ce
Ce
tri
a
p
M
p/
lav
/T
Ci
Co
Am
p
/C
Pi
ox
Am
ANTIBIOTICS
ACINETOBACTER BAUMANII ANTIBIOTIC RESISTANCE PATTERN IN TISSUE ISOLATES
IN PATIENTS WITH HEALTHCARE-ASSOCIATED INFECTION PER AREA
(N=35)
120 WARD (N=15)
100 100 100 100 100 100 100 100 ICU (N=18)
100 100 100
100 94 94 94 93 94 94 94
89 89
PAY (N=2)
87 87 87 87
83
80 80
PERCENT RESISTANCE
80 73 73
60 53
40
20 17
13
in
em
le
n
am
cin
e
cin
em
am
e
e
m
lin
im
ici
zo
ist
xa
xa
pi
ct
en
ct
en
am
yc
z id
l
Co
ba
ba
fe
f lo
f lo
ox
ip
op
oc
fta
nt
Ce
zo
l
Im
m
vo
ro
Su
er
in
Ge
Ce
tri
a
M
p
Le
M
p/
/T
Ci
Co
Am
p
Pi
ANTIBIOTICS
SURGICAL SITE INFECTION
Post-Trauma
If with sepsis:
• Vancomycin 15-20 mg/kg/day IV q12h PLUS Meropenem 1g IV q8h
Burn Wound Sepsis

• Meropenem 1-2g IV q8h PLUS Polymyxin B 2.5 mg/kg IV as loading dose then 1.5
mg/kg IV q12h as maintenance dose
CSF ISOLATES
MOST COMMON CSF ISOLATES IN ALL AREAS
(N=35)
8
7
7
6
NUMBER OF ISOLATES
5
5
4
4
3 3
3
0
Klebsiella pneumoniae Staphylococcus Acinetobacter complex Sphingomonas Staphylococcus
epidermidis paucimobilis haemolyticus
ORGANISMS
MOST COMMON CSF ISOLATES PER AREA
(N=35)
6
Ward (N=24)
5 Pay (N=8)
5
ICU (N = 4)
4
NUMBER OF ISOLATES
3 3
3
2 2
2
1 1 1 1
1
0
Klebsiella pneumoniae ss. Staphylococcus Acinetobacter complex Staphylococcus Sphingomonas
pneumoniae epidermidis haemolyticus paucimobilis
ORGANISMS
PERCENT RESISTANCE
100
10
20
30
40
50
60
70
80
90
0
Ce
fu
ro
xi
m
e
86
Ce
fta
z id
im
e
86
Ce
ftr
iax
on
e
71
Ce
fo
xit
i n
57
Ce
fe
pi
m
e
57
Pi
p /T
a zo
ba
ct
am
71
Am
p/
Su
l ba
ct
Am am
86
ox
/C
ANTIBIOTICS
lav
ul
a ni
ca
cid
86
Ci
p ro
f lo
xa
cin
43
Co
tri
m
ox
a zo
le
71
Am
ik
ac
in
M
er
op
PATTERN IN CSF ISOLATES IN ALL AREAS (N=7)
en
em
57
Er
ta
p en
em
57
PATTERN IN CSF ISOLATES PER AREA (N=7)
Ward (N=4)
Pay (N=2)
ICU (N=1)
120
100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
PERCENT RESISTANCE
100
80 75 75 75 75
60 50 50 50 50 50 50 50
40
20
0
le
e
in
e
cin
em
am
em
e
cid
am
m
m
on
im
ac
o
xit
xa
ca
en
pi
en
xi
az
ct
ct
z id
iax
ik
fo
ro
ba
fe
ba
f lo
ox
ni
p
op
Am
Ce
fta
ftr
ta
fu
Ce
zo
im
a
ro
Su
er
ul
Er
Ce
Ce
Ce
-t r
M
p/
lav
/T
Ci
Co
Am
p
/C
Pi
ox
Am
ANTIBIOTICS
CNS INFECTIONS
Community-Acquired*
• 18 to 50 years: Ceftriaxone 2g IV q12h
• > 50 years: Ampicillin 2g IV q4h PLUS Ceftriaxone 2g IV q12h
Healthcare-Associated**
• Vancomycin 30-60 mg/kg divided into 2-3 doses PLUS
• Ceftazidime 2g IV q8h OR Cefepime 2g IV q8h OR Meropenem 2g IV q8h
*Based on the DOH National Antibiotic Guidelines, 2018

**Based on the IDSA CPG for Healthcare-Associated Ventriculitis and Meningitis
BILE ISOLATES
MOST COMMON BILE ISOLATES IN ALL AREAS
(N=122)
30
25
25 22
NUMBER OF ISOLATES
20
15
11 10
10 8 7
5 4 4
5
0
Escherichia coli Klebsiella Enterococcus Pseudomonas Enterococcus Acinetobacter Enterobacter Candida tropicalis Stenotrophomonas
pneumoniae faecium aeruginosa faecalis baumannii cloacae maltophilia
ORGANISMS
MOST COMMON BILE ISOLATES PER AREA
(N=122)
18
16 16
16 Ward (N=91)
14
Pay (N=23)
12
NUMBER OF ISOLATES
ICU (N=13)
10 9
8
8 7
6
6
4 4 4
4 3 3 3 3
2 2 2 2
2 1 1
0
0
Escherichia coli Klebsiella Enterococcus Pseudomonas Acinetobacter Enterococcus Enterobacter Candida tropicalis Stenotrophomonas
pneumoniae faecium aeruginosa baumannii faecalis cloacae maltophilia
ORGANISMS
PERCENT RESISTANCE
10
20
30
40
50
60
70
80
0
Ce
fu
ro
xi
m
e
60
Ce
fta
z id
im
e
56
Ce
ftr
iax
on
e
52
Ce
fo
xit
i n
32
Ce
fe
pi
m
e
13
Pi
p /T
a zo
ba
ct
am
17
Am
p/
Su
l ba
Am ct
am
40
ox
/C
lav
ANTIBIOTICS
ul
a ni
ca
cid
36
Ci
p ro
f lo
xa
cin
68
Co
tri
m
ox
a zo
le
64
Am
ik
BILE ISOLATES IN ALL AREAS (N=25)
ac
in
4
M
er
op
en
em
8
Er
ta
p en
em
4
ESCHERICHIA COLI ANTIBIOTIC RESISTANCE PATTERN IN
PERCENT RESISTANCE
10
20
30
40
50
60
70
80
0
Ce
fu
ro
xi
m
e
Ce
fta 68
z id
im
e
64
Ce
ftr
iax
on
e
64
Ce
fo
xit
i n
59
Ce
Pi fe
p er pi
m
ac e
38
ill
in
/T
a zo
ba
Am ct
am
pi
75
ci lli
n/
Am Su
ox l ba
i cil ct
am
l in
68
/C
l av
ANTIBIOTICS
ul
an
ic
ac
id
64
Tr
im Ci
et pr
ho of
pr lo
im xa
/S cin
64
ul
fa
m
et
ho
xa
zo
le
55
Am
ik
ac
in
14
M
er
op
en
em
59
Er
ta
p
PATTERN IN BILE ISOLATES IN ALL AREAS (N=22)
en
em
52
RECOMMENDATIONS FOR EMPIRIC THERAPY* FOR
BILIARY TRACT INFECTIONS
Community-Acquired*
Mild to Moderate:
• Cefazolin 1-2 g IV q8h OR
• Cefuroxime 1.5 g IV q8h OR
• Ceftriaxone 1-2 g IV q12-24h
Severe:
• Piperacillin-Tazobactam 4.5 gm IV q6h
Healthcare-Associated*
With MDRO risk:
• Meropenem 1 gm IV q8h
*Based on DOH National Antibiotic Guidelines, 2018
BONE ISOLATES
MOST COMMON BONE ISOLATES IN ALL AREAS
(N=29)
8
7
7
6
NUMBER OF ISOLATES
5
5
4
3 3 3
3
0
Staphyolococcus aureus Pseudomonas aeruginosa Staphyolococcus Acinetobacter baumanii Proteus mirabilis
epidermidis
ORGANISMS
MOST COMMON TISSUE ISOLATES PER AREA
(N=29)
7
WARD (N=23)
6
6 PAY (N=5)
ICU (N=1)
NUMBER OF ISOLATES
5
4
4
3
3
2 2
2
1 1 1 1
1
0
Staphylococcus aureus Pseudomonas aeruginosa Staphylococcus Acinetobacter baumanii Proteus mirabilis
epidermidis
ORGANISMS
PERCENT RESISTANCE
100
10
20
30
40
50
60
70
80
90
0
Pe
ni
cil
l in
Ox
a
86
cil
li n
71
Co
tri
m
ox
a zo
le
29
Er
yt
hr
om
yc
in
14
Ge
nt
am
ici
n
Ci
p ro
f lo
xa
cin
Le
vo
f lo
xa
ANTIBIOTICS
cin
M
ox
if l
ox
ac
in
Cl
in
da
m
yc
in
Lin
ez
ol
id
Va
nc
om
yc
in
Te
PATTERN IN BONE ISOLATES IN ALL AREAS (N=7)
tra
cy
cli
ne
RECOMMENDATIONS FOR EMPIRIC THERAPY*
FOR BONE INFECTIONS
If MRSA likely:
• Vancomycin 15 mg/kg IV q12
If Gram negative bacilli seen on Gram stain:

ADD
• Ceftazidime 2g IV q8h OR
• Ceftriaxone 2g IV q24h OR
• Levofloxacin 750g IV q24h
*Based on the DOH National Antibiotic Guidelines, 2018

CENTRAL VENOUS CATHETER ISOLATES
TYPES OF CENTRAL VENOUS CATHETERS WITH ISOLATES
(N=144)
Femoral
19%
Long-term Short-term IJ
7% 93% 74%
TYPE OF INFECTION IN PATIENTS WITH TRUE PATHOGENS IN
(N=516)
True Contaminants/
pathogens colonizers
49% 51%
MOST COMMON CENTRAL VENOUS CATHETER ISOLATES
CONSIDERED AS TRUE PATHOGENS IN ALL AREAS
(N=71)
14
12
12
11
10
NUMBER OF ISOLATES
8
7
6
5
4 4 4 4
4
3 3
0
Acinetobacter Klebsiella Staphylococcus Staphylococcus Staphylococcus Enterococcus Enterococcus Pseudomonas Enterobacter Serratia
baumanii pneumoniae aureus haemolyticus epidermidis faecalis faecium aeruginosa cloacae marcescens
ORGANISMS
MOST COMMON CENTRAL VENOUS CATHETER ISOLATES
CONSIDERED AS TRUE PATHOGENS PER AREA
(N=71)
10
9 Ward (N) = 32
9
8
ICU (N) = 30
7 Pay (N) = 9
NUMBER OF ISOLATES
6 6
6
5
4 4 4
4
3 3
3
2 2 2 2
2
1 1 1 1 1 1 1 1 1 1
1
0
Acinetobacter Klebsiella Staphylococcus Staphylococcus Staphylococcus Enterococcus Enterococcus Pseudomonas Enterobacter Serratia
baumanii pneumoniae aureus haemolyticus epidermidis faecalis faecium aeruginosa cloacae marcescens
ORGANISMS
MOST COMMON SHORT-TERM CENTRAL VENOUS
CATHETER ISOLATES
(N=63)
14
12
12
10
10
NUMBER OF ISOLATES
6
5 5 5
4 4
4
3 3 3
0
Acinetobacter Klebsiella Staphylococcus Staphylococcus Candida Staphylococcus Enterococcus Enterobacter Enterococcus Pseudomonas
baumanii pneumoniae aureus haemolyticus epidermidis faecium cloacae faecalis aeruginosa
ORGANISMS
MOST COMMON INTERNAL JUGULAR CATHETER ISOLATES
(N=47)
12
11
10
8
NUMBER OF ISOLATES
6
5 5 5
4 4
4
2 2 2 2
2
0
Acinetobacter Klebsiella Staphylococcus Staphylococcus Staphylococcus Enterococcus Burkholderia Enterococcus Serratia Candida*
baumanii pneumoniae aureus haemolyticus epidermidis faecium cenocepacia faecalis marcescens
ORGANISMS
*Candida albicans (n=1), Candida tropicalis (n=1)

FEMORAL CATHETER ISOLATES
(N=16)
6
5
5
4
NUMBER OF ISOLATES
3
3
2 2
2
1 1 1 1
1
0
Klebsiella Candida* Enterobacter cloacae Pseudomonas Acinetobacter Enterococcus Stenotrophomonas Proteus mirabilis
pneumoniae aeruginosa baumanii faecalis maltophilia
ORGANISMS
*Candida albicans (n=1), Candida parapsilosis (n=1), Candida tropicalis (n=1)

ACINETOBACTER BAUMANII ANTIBIOTIC RESISTANCE PATTERN IN
(N=12)
100
91 91 91 91 90 90
90 82 82
80 75
PERCENT RESISTANCE
70
60
50
40
30
20
10
0
in
n
cin
em
le
am
em
e
e
am
e
m
lin
ici
im
zo
ist
xa
pi
en
ct
ct
en
am
yc
z id
l
Co
ba
fe
ba
f lo
ox
ip
op
oc
nt
fta
Ce
zo
l
Im
m
vo
Su
er
in
Ge
Ce
tri
a
M
Le
M
p/
/T
Co
Am
p
Pi
ANTIBIOTICS
PERCENT RESISTANCE
100
120
20
40
60
80
0
Ce
fu
ro
xi
m
e
100
Ce
fta
z id
im
e
Ce 100
ftr
iax
on
e
100
Ce
fo
xit
i n
100
Ce
fe
pi
m
e
91
Pi
p /T
a zo
ba
ct
am
100
Am
p/
Su
l ba
Am ct
am
ox
100
/C
(N=11)
lav
ANTIBIOTICS
ul
a ni
ca
cid
91
Ci
p ro
f lo
xa
cin
73
Co
tri
m
ox
a zo
le
100
Am
ik
IN CENTRAL VENOUS CATHETER ISOLATES
ac
in
36
M
er
op
en
em
100
Er
ta
p
KLEBSIELLA PNEUMONIAE ANTIBIOTIC RESISTANCE PATTERN
en
em
100
STAPHYLOCOCCUS AUREUS ANTIBIOTIC RESISTANCE PATTERN IN
(N=7)
120
100
100
PERCENT RESISTANCE
80
60
40
29
20 14 14
0
Penicillin G Oxacillin Co-trimoxazole Erythromycin Clindamycin Tetracycline Vancomycin Linezolid
ANTIBIOTICS
RECOMMENDATIONS FOR EMPIRIC THERAPY* FOR
CENTRAL VENOUS CATHETER-RELATED INFECTIONS
Ward, patient is not in shock
• Vancomycin 15 mg/kg IV q12 PLUS Meropenem 1g IV q8h
ICU/Ward, patient in septic shock

• Vancomycin 15 mg/kg IV q12 PLUS Meropenem 2g IV q8h PLUS Polymyxin B 2.5
mg/kg IV as LD then 1.5 mg/kg IV q12h
*IDSA CPG on Intravascular Catheter-Related Infection, 2009

FUNGAL ISOLATES
SPECIMENS WITH FUNGAL ISOLATES
Blood
16% CSF
Catheter tip
2%
N=120
82%
TOP FUNGAL ISOLATES IN ALL AREAS
45
40 39
35
NUMBER OF ISOLATES
30
25
25
20
15
15
11
10
5 4 4 4
2
0
Candida tropicalis Candida albicans Candida Candida glabrata Pichia kudriavzevii Candida spp Candida Crypotococcus
parapsilosis orhtopsilosis neoformans
ORGANISMS
FUNGAL INFECTIONS
Critically Ill/Immunocompromised
• Caspofungin 70 mg IV LD, then 50 mg OD OR
• Micafungin 100 mg IV OD OR
• Anidulafungin 200 mg IV LD then 100 mg IV OD
Non-Critically Ill/Non-Neutropenic
If with fungemia:
• Fluconazole 12 mg/kg (or 800 mg) IV LD then 6mg/kg (or 400 mg) IV q24
hours*
*Pappas, Peter G., et al. "Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of
America." Clinical Infectious Diseases 62.4 (2016): e1-e50.
Summary Table of the Resistance Patterns
of the Most Common Isolates in 2022
Aminoglycoside Carbapenem Cephalosporin Penicillin Quinolones Miscellaneous
Ampicillin sulbactam
Streptomycin High
Co-trimoxazole
Erythromycin
Ciprofloxacin
Meropenem
Levofloxacin
Clindamycin
Vancomycin
Tetracycline
Gentamycin
Minocycline
Ceftazidime
Tobramycin
Ceftriaxone
Cefuroxime
Ertapenem
Aztreonam
Penicillin G
Amox/clav
Ampicillin
Cefepime
Cefazolin
Amikacin
Cefoxitin
Linezolid
Pip/Tazo
Oxacillin
Colistin
Organisms (No of isolates)
Percentage Resistance of Commonly encountered organisms
Gram Negative (%)
K. pneumoniae n=1331 16 27 40 37 43 66 46 43 60 60 63 53 99 59 55 47 35 30 55 60
A. baumannii n=870 74 85 84 85 84 62 85 81 78 10 1
E. coli n=780 9 23 22 11 14 55 24 23 40 35 42 25 81 31 0.3 17 45 42 53
P. aeruginosa n=746 6 9 21 11 14 11 19 8 12 2
Gram Positive (%)
E. faecium n=360 71* 94 95 94 0.94 3 43 45 46
S. aureus n=331 0.01 44 88 4 4 8 9 0.3 25 2 3
*. High level aminoglycoside

10% or more increase in resistant rate compared to 2021
10% or more decrease in resistant rate compared to 2021
SUMMARY OF RECOMMENDATIONS
CLINICAL SYNDROME RECOMMENDATION
HAP Charity and Pay Wards

Meropenem 1-2 gm IV q 8 prolonged infusion (over 3 hours) PLUS
Amikacin 15 mg/kg IV every 24 hours
Intensive Care Units

Meropenem 1-2 gm IV q 8 prolonged infusion (over 3 hours) PLUS
Polymyxin B 2.5 mg/kg IV as LD then 1.5 mg /kg IV as MD every 12 hours
via 4-hour infusion
Hospital-Acquired UTI With no ESBL risk
Amikacin 15mg/kg IV q 24 hours
With ESBL risk

Ertapenem 1gm IV every 24 hours
With risk for Pseudomonas or for seriously ill patients

Meropenem 1gm IV every 8 hours
Surgical Site Infection Post-Trauma

If with sepsis:
Vancomycin 15-20 mg/kg/day IV q12h PLUS Meropenem 1g IV q8h
Burn Wound Sepsis

Meropenem 1-2g IV q8h PLUS Polymyxin B 2.5 mg/kg IV as loading dose
then 1.5 mg/kg IV q12h as maintenance dose
CNS Infection Community-Acquired
18 to 50 years: Ceftriaxone 2g IV q12h
> 50 years: Ampicillin 2g IV q4h PLUS Ceftriaxone 2g IV q12h
Vancomycin 30-60 mg/kg divided into 2-3 doses PLUS
Ceftazidime 2g IV q8h OR Cefepime 2g IV q8h OR Meropenem 2g IV q8h
Biliary Tract Infection Community-Acquired

Mild to Moderate:
Cefazolin 1-2 g IV q8h OR
Cefuroxime 1.5 g IV q8h OR
Ceftriaxone 1-2 g IV q12-24h
Severe:
Piperacillin-Tazobactam 4.5 gm IV q6h
With MDRO risk:
Meropenem 1 gm IV q8h
Bone Infection If MRSA likely:

Vancomycin 15 mg/kg IV q12
If Gram negative bacilli seen on Gram stain:

ADD
Ceftazidime 2g IV q8h OR
Ceftriaxone 2g IV q24h OR
Levofloxacin 750g IV q24h
Central Venous Catheter-Related Ward, patient is not in shock
Infection Vancomycin 15 mg/kg IV q12 PLUS Meropenem 1g IV q8h
ICU/Ward, patient in septic shock

Vancomycin 15 mg/kg IV q12 PLUS Meropenem 2g IV q8h PLUS
Polymyxin B 2.5 mg/kg IV as LD then 1.5 mg/kg IV q12h
Fungal Infection Critically Ill/Immunocompromised

Caspofungin 70 mg IV LD, then 50 mg OD OR
Micafungin 100 mg IV OD OR
Anidulafungin 200 mg IV LD then 100 mg IV OD
Non-Critically Ill/Non-Neutropenic
If with fungemia:
Fluconazole 12 mg/kg (or 800 mg) IV LD then 6mg/kg (or 400 mg) IV q24
hours

2022 Antibiogram

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2022 Antibiogram

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The 2022 PGH Antibiogram

Ma. Corazon Guevarra

Julius Patrick Miranda, MD

• To determine the incidence of multidrug resistant organisms (MDROs) in

• To present the resistance rates of the most commonly isolated organisms

• To recommend the empiric antibiotic therapy based on the current

DATA DATA Sub

With growth Without growth

K. pneumoniae K. pneumoniae K. pneumoniae K. pneumoniae K. pneumoniae

A. baumanii E. coli E. coli E. coli P. aeruginosa

E. coli P. aeruginosa P. aeruginosa P. aeruginosa A. baumanii

P. aeruginosa S. hemolyticus S. hemolyticus S. aureus S. aureus

S. aureus E. faecium S. epidermidis S. epidermidis S. epidermidis

E. faecalis S. epidermidis E. cloacae E. faecium E. cloacae

S. maltophilia E. cloacae E. faecium S. haemolyticus S. hominis

E. cloacae S. hominis S. aureus B. cepacia S. hemolyticus

S. marcescens S. aureus S. hominis E. cloacae B. cepacia

P. aeruginosa E. coli K. pneumoniae

Discharged Mortality HPR

Discharged Mortality HPR

Discharged Mortality HPR

Discharged Mortality HPR

Discharged Mortality HPR THOC

Discharged Mortality HPR THOC

Gram Positive Organisms

Gram Negative Organisms

Organism 2022 2021

Intensive Care Units

Organism 2022 2021

With ESBL risk

With risk for Pseudomonas or for seriously ill patients

Burn Wound Sepsis

*Based on the DOH National Antibiotic Guidelines, 2018

If Gram negative bacilli seen on Gram stain:

*Based on the DOH National Antibiotic Guidelines, 2018

*Candida albicans (n=1), Candida tropicalis (n=1)

*Candida albicans (n=1), Candida parapsilosis (n=1), Candida tropicalis (n=1)

ICU/Ward, patient in septic shock

*IDSA CPG on Intravascular Catheter-Related Infection, 2009

*. High level aminoglycoside

HAP Charity and Pay Wards

Intensive Care Units

With ESBL risk

With risk for Pseudomonas or for seriously ill patients

Surgical Site Infection Post-Trauma

Burn Wound Sepsis

Biliary Tract Infection Community-Acquired

Bone Infection If MRSA likely:

If Gram negative bacilli seen on Gram stain:

ICU/Ward, patient in septic shock

Fungal Infection Critically Ill/Immunocompromised

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