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Antimicrobial Susceptibility Patterns (%susceptibility) Epidemiology reference (MedMined): January 1, 2009 to December 31,

Antimicrobial Susceptibility Patterns (%susceptibility)

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

       

1st

2nd

3rd gen

4th

 

Aminoglycosides

                           

RESTRICTED

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

MET

FD

TE

CFZ

CRM

CAZ

CAX

CPE

AZI

AK

GM

TO

AZT

MER

C

LVX

CD

AUG

A/S

AM

P/T

PEN

OX

VA

T/S

 

RIF

SYN

LZD

$

$

$

$

$

$$$$

$

$$$

$

$$$$

$

$$

$$

$$$

$

$

$

$

$

$$

$$$$

$$

 

$

$$

$

$$$$$

$$$$

IV

Costs per Day:

                                                     

QUINUPRISTIN/DALFOPRIS

   

$ = < $15

 

Number of Isolates

$$

= $16-$30

NITROFURANTOIN

CHLORAMPHENICOL

$$$ = $31 to $50 $$$$ = $51-$100 $$$$$ = > $101

METRONIDAZOLE

TETRACYCLINE

CEFAZOLIN

CEFUROXIME

CEFTAZIDIME

CEFTRIAXONE

CEFEPIME

AZITHROMYCIN

AMIKACIN

GENTAMICIN

TOBRAMYCIN

AZTREONAM

MEROPENEM

LEVOFLOXACIN

CLINDAMYCIN

AMOXICILLIN/CA

AMP/SULBACTAM

AMPICILLIN

PIPERACILLIN/

TAZOBACTAM

PENICILLIN G

OXACILLIN

VANCOMYCIN

TRIMETHOPRIM/

SULFA (SXT)

RIFAMPIN

(SYNERGY ONLY)

TIN

LINEZOLID

 

Enterococcus faecalis

547

99

28

83

70

100

 

100

99

 

66

 

99

Enterococcus faecium

122

 

42

37

                     

100

23

     

32

 

31

 

50

   

69

95

(excluding

                                                         

casseliflavus/gallinarum)

28

33

25

100

6

5

79

96

Enterococcus species (all - faecalis, faecium, other)

300

 

89

29

                     

85

62

     

87

 

86

 

90

 

57

13

98

Finegoldia (Peptostreptococcus) magnus

17

   

75

                     

100

 

88

 

94

   

94

           

Peptoniphilus

                                                         

(Peptostreptococcus)

(Staphylococcus)

11

81

90

90

100

100

asaccharolyticus

POSITIVE ORGANISMS

Propionibacterium acnes

33

   

100

                     

100

 

90

 

96

   

96

           

Staphylococcus aureus

890

 

97

94

         

34

 

96

     

92

 

66

   

100

 

26

45

99

98

99

99

100

Staphylococcus aureus - MRSA

488

 

100

93

         

8

 

95

     

88

 

24

       

1

 

100

98

98

99

100

Staphylococcus aureus - MSSA

402

 

96

95

         

66

 

96

     

97

 

92

       

47

100

99

99

99

100

100

Staph epidermidis (coag negative)

186

 

100

86

             

69

                   

100

 

100

100

100

100

 

Staph epidemidis (MRSE)

144

 

100

85

         

20

 

62

     

98

31

             

99

59

96

99

99

Staph epidemidis (MSSE)

38

 

100

92

         

49

 

95

     

100

82

         

26

100

100

84

100

100

100

GRAM

Staph haemolyticus (coag negative)

21

 

100

61

         

28

 

57

     

98

 

39

       

12

 

98

64

97

98

100

Staph hominis (coag negative)

31

   

87

         

25

 

74

     

100

 

42

       

8

 

100

52

100

100

100

 

Strep agalactiae (Group B)

34

           

100

100

           

94

100

76

   

100

 

100

 

100

       

Strep anginosus (Group F)

173

   

87

     

99

99

85

       

100

96

87

90

   

93

 

92

 

100

       

Streptococcus bovis

18

           

94

94

           

90

 

60

   

84

 

89

 

100

     

100

Strep mitis/oralis (viridans)

98

   

64

     

96

94

52

       

80

97

90

84

   

76

 

76

 

100

       

Strep mutans (viridans grp)

16

           

100

100

           

100

 

100

   

93

 

93

 

100

       

Streptococcus parasanguinis

16

   

37

     

100

87

50

       

100

93

81

87

   

43

 

46

 

100

       

Streptococcus pneumoniae

82

   

82

 

81

 

95

97

         

85

100

96

81

33

     

70

 

100

75

     

Strep salivarius (viridans grp)

27

           

92

92

           

100

 

73

   

66

 

55

 

100

       

Streptococcus viridans group, NOS

46

           

100

100

           

96

 

90

   

86

 

86

 

100

       

Acinetobacter baumannii

24

75

79

45

66

87

79

79

78

 

79

 

58

     

75

Citrobacter freundii

47

 

100

85

       

100

 

100

93

89

 

96

90

91

               

82

     

GRAM NEGATIVE ORGANISMSEROBES

Citrobacter koseri (Citrobacter diversus)

19

 

77

100

100

89

100

100

100

 

100

100

100

94

100

90

100

 

100

100

 

100

     

100

     

Enterobacter aerogenes

44

 

15

84

       

100

 

100

100

100

 

100

83

97

               

97

     

Enterobacter cloacae

116

 

35

88

       

99

 

100

100

100

 

97

89

99

               

95

     

Escherichia coli

974

 

96

62

84

90

97

97

97

 

99

83

82

96

99

85

60

 

76

44

39

94

     

56

     

Haemophilus influenzae

25

   

76

     

100

             

100

       

75

       

82

     

Haemophilus parainfluenza

5

           

100

             

40

       

80

       

80

     

Klebsiella oxytoca

60

 

95

73

35

70

86

75

88

 

100

100

100

76

100

86

78

 

71

60

1

75

     

76

     

Klebsiella pneumoniae

245

 

55

87

94

90

98

98

98

 

100

99

99

98

100

88

97

 

95

88

4

98

     

91

     

Morganella morganii

37

   

37

 

2

2

2

100

 

97

75

83

2

95

56

67

     

2

2

     

45

     

Proteus mirabilis

144

   

1

84

95

97

98

97

 

98

64

65

94

100

84

63

 

95

88

79

100

     

56

     

Pseudomonas aeruginosa

274

         

90

 

88

 

95

77

93

 

83

 

73

       

95

             

Serratia marcescens

47

   

31

       

100

 

100

100

95

 

100

60

93

               

95

     

Stenotrophomonas

                                                         

(Xanthomonas) maltophilia

33

42

75

78

96

Bacteroides fragilis

6

100

     

67

80

     

C.

perfringens

14

93

                             

64

 

100

                 

E.

lentum

24

62

                             

92

 

100

                 

ANA

P.

acnes

29

38

                             

90

 

97

                 

P.

magnus

14

86

                             

93

 

100

                 
Clinical Condition EMPIRIC ANTIBIOTIC USAGE GUIDELINES NOTE: If patient is severely septic or in ICU
Clinical Condition EMPIRIC ANTIBIOTIC USAGE GUIDELINES NOTE: If patient is severely septic or in ICU

Clinical Condition

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)

Preferred Regimen

Alternate Regimen

COMMUNITY ACQUIRED PNEUMONIA (CAP):

ICU patients ** Pseudomonas NOT an issue

Ceftriaxone + Azithromycin

Levofloxacin

Pseudomonas IS an issue

Piperacillin/Tazobactam + Levofloxacin

Aztrenam + Levofloxacin

Medical ward patients **

No recent antibiotic therapy

Ceftriaxone + Azithromycin

Levofloxacin

Recent antibiotic therapy

Ceftriaxone + Azithromycin

Levofloxacin

(choice depends on

recent antibiotic therapy)

Hospital nursing home resident **

Same as medical ward/ ICU patient recommendations

** If MRSA is a concern

Add Vancomycin to the appropriate above regimen (goal trough 15-20mcg/ml)

Add Vancomycin to the appropriate above regimen (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 multi- drug resistant (MDR) pathogens

Ceftriaxone

Levofloxacin

HAP, VAP or HCAP (HEALTHCARE ASSOCIATED PNEUMONIA) late onset or risk factors for MDR:

Late onset (>5 days) OR risk factors for multi- drug resistant (MDR) pathogens

Doripenem + Levofloxacin +/- Tobramycin + /-Vancomycin (goal trough 15-20mcg/ml)

Aztrenam + Levofloxacin +/-Tobramycin +/- Vancomycin (goal trough 15-20 mcg/ml)

if Legionella IS a concern

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

SKIN AND SOFT TISSUE INFECTIONS:

MSSA (methacillin sensitivity staph aureus)

Cefazolin

 

Vancomycin OR Trimethoprim/ Sulfamethoxazole

MRSA (methacillin resistant staph aureus)

Vancomycin

If unable to tolerate Vancomycin use Daptomycin

Oral alternatives: Trimethoprim/Sulfamethoxazole

SURGICAL SITE INFECTIONS:

Intestinal/ genital tract

Piperacillin/Tazobactam OR Ampicillin/Clavuiante

Levofloxacin +/- Metronidazole

Non-intestinal tract

Cefazolin

Vancomycin

AXILLARY OR PERINEUM:

Levofloxacin + Metronidazole

Levofloxacin + Metronidazole

DIABETIC FOOT INFECTION:

Mild to moderate

Cefazolin IV OR Augmentin PO

Levofloxacin +/- Metronidazole

Severe

Piperacillin/ Tazobactam

Levofloxacin +/- Metronidazole

Avoid quinolones if patient received as an outpatient

If MRSA is a concern

Above PLUS Vancomycin

Above PLUS Vancomycin

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

Nitrofurantoin

Nitrofurantoin

Acute uncomplicated pyelonephritis

Cefazolin + Tobramycin

Levofloxacin

Hospitalized complicated UTI/ catheter

Piperacillin/Tazobactam OR Doripenem

Levofloxacin +/- Aztrenam

C-DIFFICILE ENTEROCOLITIS:

1st episode/Mild/Moderate

Metronidazole

Metronidazole

Relapse/Severe/Ileus

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

www.idsociety.org

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).