Antimicrobial Susceptibility Patterns (%susceptibility)

Epidemiology reference (MedMined): January 1, 2009 to December 31, 2009

1st

2nd

3rd gen

4th

Aminoglycosides

RESTRICTED

CRM

MER

AUG

MET

CAX

PEN

SYN

CPE

CAZ

$$$$

$$$

$$$$

$$

$$

$$$

$$

$$$$

$$

$$

$$$$$ QUINUPRISTIN/DALFOPRIS TIN

$$$$

Number of Isolates

CHLORAMPHENICOL

NITROFURANTOIN

AMP/SULBACTAM

METRONIDAZOLE

RIFAMPIN (SYNERGY ONLY)

AMOXICILLIN/CA

TRIMETHOPRIM/ SULFA (SXT)

LEVOFLOXACIN

TETRACYCLINE

AZITHROMYCIN

PIPERACILLIN/ TAZOBACTAM

CEFTRIAXONE

CLINDAMYCIN

VANCOMYCIN

TOBRAMYCIN

CEFTAZIDIME

CEFUROXIME

PENICILLIN G

MEROPENEM

AZTREONAM

GENTAMICIN

CEFAZOLIN

AMPICILLIN

OXACILLIN

Enterococcus faecalis Enterococcus faecium (excluding casseliflavus/gallinarum) Enterococcus species (all - faecalis, faecium, other) Finegoldia (Peptostreptococcus) magnus Peptoniphilus (Peptostreptococcus) (Staphylococcus) asaccharolyticus

547 122 28 300 17

99 42 33

28 37 25

83 100 100

70 23

100 32 6

100 31 5

99 50

66 69 79

99 95 96

89

29

85

62

87

86

90

57

13

98

75

100

88

94

94

11

81

90

90

100

100

GRAM POSITIVE ORGANISMS M

Propionibacterium acnes Staphylococcus aureus Staphylococcus aureus - MRSA Staphylococcus aureus - MSSA Staph epidermidis (coag negative) Staph epidemidis (MRSE) Staph epidemidis (MSSE) Staph haemolyticus ( p y (coag g negative) Staph hominis (coag negative) Strep agalactiae (Group B) Strep anginosus (Group F) Streptococcus bovis Strep mitis/oralis (viridans) Strep mutans (viridans grp) Streptococcus parasanguinis Streptococcus pneumoniae Strep salivarius (viridans grp) Streptococcus viridans group, NOS Acinetobacter baumannii Citrobacter freundii

33 890 488 402 186 144 38 21 31 34 173 18 98 16 16 82 27

97 100 96 100 100 100 100

100 94 93 95 86 85 92 61 87 100 87 99 94 64 96 100 37 82 81 100 95 92 100 99 94 94 100 87 97 92 50 100 85 52 80 85 100 20 49 28 25 34 8 66 96 95 96 69 62 95 57 74

100 92 88 97

90 66 24 92

96 100

96 26 1 47 100 100 45 99 100 99 100 99 26 100 100 98 100 100 100 100 100 100 100 100 100 75 100 98 98 99 100 59 84 64 52 99 98 99 100 96 100 97 100 99 99 100 100 99 100 98 100 99 100 100 100 100 100 100

98 100 98 100 94 96 90 97 100 93 100 100

31 82 39 42 100 87 76 90 60 90 84 100 81 96 87 81 73 33 66 100 93 84 76 93 43

12 8 100 92 89 76 93 46 70 55

46 24 47 19 44 116 974 25 5 60 245 37 144 274 47 33 6 14 24 29 14

100 93 62 38 86 31 42 95 55 73 87 37 1 84 35 94 70 90 2 95 86 98 2 97 90 100 77 15 35 96 75 85 100 84 88 62 76 84 90 97 100 89 100 79

100 45

100 66 100 87 100 100 100 100 99 79 93 79 89 94 78 96 100 100 97 96 99

96 79 90 90 83 89 85 100 40 91 100 97 99 60

90 58

86

86

100 75 82

GRAM NEGATIVE ORGANISMS

Citrobacter koseri (Citrobacter diversus) Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzae Haemophilus parainfluenza Klebsiella oxytoca Klebsiella pneumoniae Morganella morganii Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens Stenotrophomonas (Xanthomonas) maltophilia

100

100 100 99

100 100 100 100 100 100 83 82

100

100

100

100 97 95

97 100 100 75 98 2 98

97

76

44

39 75 80

94

56 82 80

88 98 100 97 88 100

100 100 97 98 95 100

100 100 99 75 64 77 100 99 83 65 93 95

76 98 2 94

100 100 95 100 83 100

86 88 56 84

78 97 67 63 73

71 95

60 88

1 4 2

75 98 2 100 95

76 91 45 56

95

88

79

60 75

93 78

95 96

ANAE AEROBES

Bacteroides fragilis C. perfringens E. lentum P. acnes P. magnus

67 64 92 90 93

80 100 100 97 100

LINEZOLID

CEFEPIME

AMIKACIN

IV Costs per Day: $ = < $15 $$ = $16-$30 $$$ = $31 to $50 $$$$ = $51-$100 $$$$$ = > $101

LZD

LVX

CFZ

AZT

A/S

GM

AZI

RIF

T/S

P/T

AM

OX

AK

CD

TO

VA

FD

TE

GREEN (100%-90%) Best choice YELLOW (89%-75%) Second choice RED (>75%) AVOID

EMPIRIC ANTIBIOTIC USAGE GUIDELINES

NOTE: If patient is severely septic or in ICU use the 'Severe Sepsis Guidelines' (Based on 2009 Antibiogram information, Sanford Guide, and IDSA Guidelines)

Clinical Condition
COMMUNITY ACQUIRED PNEUMONIA (CAP): ICU patients ** Pseudomonas NOT an issue Pseudomonas IS an issue Medical ward patients ** No recent antibiotic therapy Recent antibiotic therapy (choice depends on recent antibiotic therapy) Hospital nursing home resident ** ** If MRSA is a concern

Preferred Regimen

Alternate Regimen

Ceftriaxone + Azithromycin Piperacillin/Tazobactam + Levofloxacin Ceftriaxone + Azithromycin Ceftriaxone + Azithromycin

Levofloxacin Aztrenam + Levofloxacin Levofloxacin Levofloxacin

Same as medical ward/ ICU patient recommendations Add Vancomycin to the appropriate above regimen Add Vancomycin to the appropriate above regimen (goal trough 15-20mcg/ml) (goal trough 15-20mcg/ml)

HOSPITAL ACQUIRED PNEUMONIA (HAP) and VENTILATOR ASSOCIATED PNEUMONIA (VAP) early onset and no risk factors for MDR: Early onset (< 5 days) and no risk factors for multiCeftriaxone drug resistant (MDR) pathogens HAP, VAP or HCAP (HEALTHCARE ASSOCIATED PNEUMONIA) late onset or risk factors for MDR: Late onset (>5 days) OR risk factors for multidrug resistant (MDR) pathogens if Legionella IS a concern SKIN AND SOFT TISSUE INFECTIONS: MSSA (methacillin sensitivity staph aureus) MRSA (methacillin resistant staph aureus) Cefazolin Vancomycin OR Trimethoprim/ Sulfamethoxazole Vancomycin Oral alternatives: Trimethoprim/Sulfamethoxazole SURGICAL SITE INFECTIONS: Intestinal/ genital tract Non-intestinal tract AXILLARY OR PERINEUM: Levofloxacin + Metronidazole DIABETIC FOOT INFECTION: Mild to moderate Severe If MRSA is a concern COMPLICATED INTRA-ABDOMINAL INFECTION: (Diverticulitis/Severe Peritonitis) Doripenem Levofloxacin +/- Metronidazole Combined treatment of a quinolone + Piperacillin/Tazobactam is NOT indicated URINARY TRACT INFECTION: Acute uncomplicated UTI in female Acute uncomplicated pyelonephritis Hospitalized complicated UTI/ catheter C-DIFFICILE ENTEROCOLITIS: 1st episode/Mild/Moderate Relapse/Severe/Ileus Metronidazole Metronidazole Nitrofurantoin Cefazolin + Tobramycin Piperacillin/Tazobactam OR Doripenem Nitrofurantoin Levofloxacin Levofloxacin +/- Aztrenam Cefazolin IV OR Augmentin PO Piperacillin/ Tazobactam Avoid quinolones if patient received as an outpatient Above PLUS Vancomycin Above PLUS Vancomycin Levofloxacin +/- Metronidazole Levofloxacin +/- Metronidazole Levofloxacin + Metronidazole Piperacillin/Tazobactam OR Ampicillin/Clavuiante Cefazolin Levofloxacin +/- Metronidazole Vancomycin If unable to tolerate Vancomycin use Daptomycin Doripenem + Levofloxacin +/- Tobramycin + /-Vancomycin (goal trough 15-20mcg/ml) Aztrenam + Levofloxacin +/-Tobramycin +/- Vancomycin (goal trough 15-20 mcg/ml) Levofloxacin

Use Azithromycin or Levofloxacin instead of an aminoglycoside in the above regimen

Vancomycin 125 mg PO 4 times daily x 10-14 days. If ileus : vancomycin 500mg PO 4 times daily AND 500mg IVPB every 8 hours AND vancomycin 500gm/100ml NS retention enema every 6 hrs ANTIBIOTIC THERAPY SHOULD BE ADJUSTED ONCE CULTURE AND SENSITIVITY DATA IS KNOWN

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Patients should be switched from intravenous to oral therapy when they are hemodynamically stable and improving clinically, are able to ingest medications, and have a normally functioning gastrointestinal tract (Strong recommendation: Level II evidence) evidence).