Transcript Document

Overview resistance microorganisms isolated 2005-2006
Martha van der Beek, MD
Eveline Roelofsen, MD
Analytic Diagnostic Center
Curaçao, Netherlands Antilles
Isolates
• 5358 isolates
– St. Elisabeth Hospital
– general practitioners
icu
11%
– first isolate
per patient
per body site
– 2005 and 2006
(except MRSA)
gp
11%
outpatient
21%
inpatient
52%
other
5%
Staphylococcus aureus
MRSA
50
45
number of patients
40
35
30
25
20
15
10
5
0
St.Mrtn
2001
Bonaire
2002
2003
2004
Curacao
2005
2006
SEHOS
2007
2008
Enterococci
Enterococcus species distribution
faecium
2%
other
12%
faecalis
86%
265 isolates
Streptococci
Streptococcus pneumoniae
100,0
96
91
91
I
80,0
% of isolates
S
R
60,0
40,0
20,0
0,0
Penicillin G
Erythromycin
Tetracyclin
56 isolates
Streptococci
Streptococcus pyogenes
100,0
95
94
98
I
80,0
% of isolates
S
R
60,0
40,0
20,0
0,0
Penicillin G
Erythromycin
Clindamycin
42 isolates
Conclusions
• MRSA prevalence now < 5%
• <3% ampicillin resistant Enterococci
• 9% penicillin reduced-susceptible
Pneumococci
• 9% erythromycin-resistant Pneumococci
Neisseria gonorrhoeae
Neisseria gonorrhoeae
100,0
94
88
% of isolates
80,0
S
I
R
60,0
40,0
20,0
19
0,0
Penicillin G
Ciprofloxacin
Ceftriaxone
16 isolates
Gram-negative rods
Gram-negative rods
Ampicillin
100
90
% susceptible
80
70
60
50
40
30
20
10
0
gp
hospital
Escherichia coli
all
gp
hospital
all
Klebsiella pneumoniae
gp
hospital
Proteus mirabilis
all
Gram-negative rods
Amoxicillin-clavulanic acid
100
90
% susceptible
80
70
60
50
40
30
20
10
0
gp
hospital
Escherichia coli
all
gp
hospital
all
Klebsiella pneumoniae
gp
hospital
Proteus mirabilis
all
Gram-negative rods
Cefuroxime
100
90
% susceptible
80
70
60
50
40
30
20
10
0
gp
hospital
Escherichia coli
all
gp
hospital
all
Klebsiella pneumoniae
gp
hospital
Proteus mirabilis
all
Gram-negative rods
ESBL positive
100
90
80
% of isolates
70
60
50
40
38
30
20
38
26
25
18
10
15
15
8
5
specialist
other
0
icu
hospital
GP
Escherichia coli
icu
hospital
GP
specialist
Klebsiella pneumoniae
11
other
Gram-negative rods
Gentamicin
100
90
% susceptible isolates
80
95
97
Klebsiella pneumoniae
Proteus mirabilis
81
70
60
50
40
30
20
10
0
Escherichia coli
Gram-negative rods
Gram-negative rods
100
90
% susceptible isolates
80
70
60
50
40
30
20
10
0
Cotrimoxazole
Escherichia coli
Ciprofloxacin
Klebsiella pneumoniae
Nitrofurantoin
Proteus mirabilis
Conclusions
• 31% E. coli decreased susceptiblity to
amoxicillin-clavulanic acid
• 2% E. coli resistant to empiric sepsis
therapy
Enteric pathogens
Campylobacter jejuni
Salmonella spp.
100
100
100
94
99
Ciprofloxacin
Co-trimoxazole
94
80
% susceptible isolates
80
% susceptible isolates
100
60
40
20
60
40
20
0
0
Ciprofloxacin
Erythromycin
Ampicillin
Haemophilus influenzae
Haemophilus influenzae
100
90
% susceptible isolates
80
70
gp
60
hospital
50
specialist
40
other
30
20
10
0
Ampicillin
Amoxicillin-clavulanic
acid
Cotrimoxazole
Pseudomonas aeruginosa
Other gram-negative rods
Conclusions
• low prevalence of resistance of enteric
pathogens
• low prevalence of resistance of
Haemophilus influenzae
Take Home Message
• Pneumococci decreased susceptibility to
penicillin and erythromycin
• E. coli and Klebsiella pneumoniae
frequently resistant to (oral) antimicrobial
agents