הבדלים בין גרסאות בדף "טבלאות רגישויות מבית החולים שערי צדק - תרביות דם - Shaare zedek medical center antibiotic sensitivity table - blood cultures"

שם הספר: שימוש מושכל באנטיביוטיקה ונהלים למניעת זיהומים
שם המחבר	פרופ' עמוס ינון, פרופ' יחיאל שלזינגר, דר' דוד רווה
שם הפרק	טבלאות רגישויות מבית החולים שערי צדק - תרביות דם - Shaare zedek medical center antibiotic sensitivity table - blood cultures
מוציא לאור
מועד הוצאה	תשע"א – 2010
מספר עמודים	196
הקדשה	ספר זה מוקדש; לפרופ' חיים הרשקו; בהוקרה עמוקה

גרסה אחרונה מ־20:27, 9 בדצמבר 2022

שימוש מושכל באנטיביוטיקה ונהלים למניעת זיהומים
מאת המרכז הרפואי שערי צדק: פרופ' עמוס ינון, פרופ' יחיאל שלזינגר, ד"ר דוד רווה

פרק ראשי

תת הפרק הבא

תוכן עניינים > פרק #8.1: טבלאות רגישויות מבית החולים שערי צדק - תרביות דם - Shaare zedek medical center antibiotic sensitivity table - blood cultures

טבלה 1. Number (%) of positive blood cultures/drawn cultures and rates of the most frequently isolated patient-specific isolated organisms/1000 admissions.

Variable/Year	1990-2000‏^[1]		2001-2008‏^[1]
	Annual Mean ± SD	11year Total	Annual Mean ± SD	8Year Total
Drawn blood cultures (BC) (n)‏^[2]	15,779 ± 4787	173,571	15,070 ± 1047	120,565
No. of true positive BC (n)	1609 ± 524	17,703	1413 ± 125	11,308
Rate of true positive BC (%)	10.2 ± 1.5	10.2	9.4 ± 1.1	9.4
No. of false positive BC (n)	NA‏^[3]	NA	1273 ± 132	10190
Rate of false positive BC (%)	NA	NA	8.4±1.3	8.4
Rate/1000 admissions‏^[4]
Enterobacteriaceae	12.7±2	3394	13.2	4309
E. coli	5.5±1	1494	6.4	2102
S. aureus	4.7±0.9	1240	3.3	1238
K. pneumoniae	3±0.8	779	3.3	1063
Enterococcus spp.	2.3±0.7	631	2.9	939
P. aeruginosa	1.9±0.5	488	1.5	505
S. pneumoniae	1.7±0.4	447	2.1	681
Enterobacter spp.	1.3±0.5	338	1.1	347
Acinetobacter spp.	1±0.3	298	1.5	482
P. mirabilis	1±0.2	260	1.4	449

טבלה 2: Enterobacteriaceae, producing Extended-Spectrum β-Lactamases (ESBL) (n,%) 2002-2008‏^[5]

טבלה 2א': Collected in the Emergency Department

Year	All Enterobacteriaceae N=2330 (%)	E.coli N=1336 (%) K.pneumoniae N=341 (%)	P.mirabilis N=228 (%)
2002	42/286 (15)	16/151 (11)	13/54 (24)	5/21 (24)
2003	35/322 (11)	15/191 (8)	15/47 (32)	4/28 (14)
2004	41/307 (13)	17/165 (10)	8/40 (20)	9/33 (27)
2005	42/354 (11)	20/218 (9)	9/49 (18)	11/38 (29)
2006	61/319 (19)	28/198 (14)	17/37 (46)	7/32 (22)
2007	84/348 (24)	46/190 (24)	10/44 (23)	19/33 (58)
2008	79/357 (22)	40/208 (19)	18/59 (30)	10/37 (27)
Total	393/2330 (16)	185/1336 (14)	92/341 (27)	67/228 (29)

טבלה 2ב': Collected from hospitalized patients

Year	All Enterobacteriaceae N=1562 (%)	E.coli N=347 (%)	K.pneumoniae N=495 (%)	P.mirabilis N=143 (%)
2002	54/147 (37)	7/35 (20)	34/53 (64)	2/6 (33)
2003	62/213 (29)	10/46 (22)	22/55 (40)	13/26 (50)
2004	64/183 (35)	11/48 (23)	28/51 (55)	10/18 (56)
2005	93/234 (40)	22/58 (38)	35/68 (51)	17/30 (57)
2006	97/267 (36)	13/54 (24)	54/86 (63)	15/29 (52)
2007	58/244 (24)	12/44 (27)	35/99 (35)	7/14 (50)
2008	75/243 (31)	13/57 (23)	29/77 (37)	4/16 (25)
Total	512/1562 (33)	88/347 (25)	239/495 (48)	70/143 (49)

טבלה 3: Enterobacteriaceae – antimicrobial susceptibilities (%) 2001-2008. Breakdown by source of patient

מקרא

Amp - Ampicillin
Amk - Amikacin
Aug - Amoxycillin-clavulanate
Carbap - Carbapenems
Caz - Ceftazidime
Cef - Cefazolin
Chl - Chloramphenicol
Cip - Ciprofloxacin
Col - Colistin (polymyxin-B)
Cpm - Cefepime
Cro - Ceftriaxone
Cxm - Cefuroxime
Ert - Ertapenem (since 2005)
Gen - Gentamicin
Imp - Imipenem
Mez - Mezlocillin (up to mid-2006)
Meth - Methicillin; Sep - Cotrimoxazole
Tob - Tobramycin
Tzp - Piperacillin-Tazobactam
Van - Vancomycin

Group	n	Penicillins			Carbap.‏^[6]		Cephalosporins					Aminoglycoside		Other
		Aug	Mez	Tzp	Ert	Imp	Cef	Cxm	Cro	Caz	Cpm	Gen	Amk	Chl	Sep	Cip	Col
≤48hr	3447	66	49	91	99	99	61	75	83	85	85	83	97	79	62	73	86
>48hr	1898	39	42	76	92	98	32	47	60	62	67	66	89	58	52	59	78

טבלה 4

Table 4a: Antimicrobial susceptibilities (%) of selected organisms (in Alphabetical order), isolated from blood cultures, 2001-2008

Organism	n	Amp	Amk	Aug	Caz	Cef	Chl	Cip	Col	Cpm	Cro	Cxm	Ert	Gen	Imp	Mez	Sep	Tzp
Acinetobacter baumanii	589		44		13			9	98					24	62		17	19
Citrobacter species	189	15	97	74	85	74	85	91	100	87	86	82	100	94	100	84	81	94
E. coli	2753	34	98	68	86	64	86	74	100	86	84	79	100	83	100	37	61	93
Enterobacter species	189	15	97	74	85	74	85	91	100	87	86	82	99	94	100	84	81	94
Enterococcus faecalis‏^[7]	410	95
Klebsiella oxytoca	119		98	87	93	86	92	94	99	93	91	90		94	100	81	89	94
Klebsiella pneumoniae	1161		81	51	54	44	52	53	99	57	52	49	85	61	95	43	48	60
Morganella morganii	109		95	11	78	6	49	56		91	83	17		60	99	69	48	94
Proteus mirabilis	569	25	98	66	73	44	42	48		67	66	61	99	63	99	41	37	98
Pseudomonas aeruginosa	691		93		91			71	100	92				83	89	76		91
Salmonella‏^[8]	108	97		100			98	73			100
Serratia marcescens	164		98		85		78	89		86	88	4	100	88	99	88	73	93
S. aureus ‏^[9]	1646
Steno-trophomonas	156		79		89			82		86				78		88	90	90
Streptococcus pneumoniae‏[10][./index.php%3Ftitle=טבלאות_רגישויות_מבית_החולים_שערי_צדק_-_תרביות_דם#cite_note-10 [10]]

Table 4b: Source of selected organisms isolated from blood cultures: community acquired versus nosocomial, 2001-2008

Organism	Total (n)	Community (%) (≤48 hour in hospital)	Hospital (%) (>48 hours in hospital)	Other Health Care associated‏^[11] (%)
Acinetobacter baumanii	589	11	78	11
Citrobacter spp.	189	47	42	11
E. coli	2762	72	19	9
Enterobacter cloacae	448	20	65	15
Enterococcus faecalis	392	35	53	12
Haemophilus influenzae	696	37	53	10
Klebsiella oxytoca	121	36	50	14
Klebsiella pneumoniae	1381	36	54	10
Morganella morganii	131	43	49	8
Proteus mirabilis	569	56	36	8
Pseudomonas aeruginosa	678	32	57	11
Salmonella non typhi	108	85	13	2
Serratia	196	25	57	17
S. aureus	1624	48	40	12
Stenotrophomonas	156	35	48	17
Streptococcus pneumoniae	902	93	2	5

טבלה 5

Table 5a: Change in antimicrobial susceptibility (%) of all isolates of E.coli (n=2102) isolated from blood cultures, 2000-2008

Year	01	02	03	04	05	06	07	08	mean	Trend analysis
N	240	232	255	227	282	286	305	275		P %
Penicillins
Augmentin	69	69	69	64	65	75	64	67	68	NS
Mezlocillin	36	37	38	36	35	49	NA	NA	37	<0.05
Tazocin	89	93	89	92	87	96	95	94	93	<0.01
Cephalosporins
Cefazolin	47	56	64	70	78	75	69	76	63	<0.001
Cefuroxime	78	81	83	81	79	81	74	76	79	NS
Ceftriaxone	83	90	89	84	83	83	76	79	84	NS
Ceftazidime	87	89	89	85	83	84	76	79	86	NS
Cefepime	93	89	88	87	85	86	78	81	85	NS
Carbapenems
Ertapenem	NA	NA	NA	NA	100	100	100	100	100	NS
Imipenem	98	100	100	100	100	100	100	100	100	NS
Aminoglycosides
Gentamicin	81	87	86	83	76	86	83	82	83	0.01
Amikacin	99	99	97	99	99	99	99	97	98	NS
Other
Chloramph	83	87	87	90	88	88	86	88	86	<0.01
Cotrimoxazole	60	61	60	53	60	61	65	68	61	NS
Ciprofloxacin	73	79	72	73	69	72	68	74	74	NS
Colistin	99	99	100	100	100	100	100	99	100	NS

Table 5b: Change in antimicrobial susceptibility (%) of all isolates of K.pneumoniae (n=1058) isolated from blood cultures, 2000-2008

Year	1	2	3	4	5	6	7	8	mean	Trend analysis
N	114	139	113	103	126	128	192	143		P %
Penicillins
Augmentin	39	55	64	57	57	41	44	59	51	<0.001
Mezlocillin	30	50	59	51	46	NA	NA	NA	43	<0.001
Tazocin	39	60	70	72	63	56	47	73	60	<0.001
Cephalosporins
Cefazolin	36	50	61	54	50	34	40	41	44	<0.001
Cefuroxime	46	54	62	55	54	38	43	50	53	<0.01
Ceftriaxone	46	55	64	61	60	38	45	53	52	<0.001
Ceftazidime	46	55	66	61	60	39	45	53	53	<0.001
Cefepime	74	63	66	61	60	37	45	56	58	<0.001
Carbapenems
Ertapenem	NA	NA	NA	NA	89	94	74	86	85
Imi/Mero‏^[12]	99	97	96	100	100	95	86	87	95	<0.001
Aminoglycosides
Gentamicin	42	57	75	61	62	44	75	81	61	<0.001
Amikacin	89	94	95	96	82	69	63	73	81	<0.001
Other
Chloramph	41	52	69	61	58	38	40	65	52	<0.001
Cotrimoxazole	37	52	64	56	53	34	35	59	48	<0.001
Ciprofloxacin	41	54	68	64	57	41	40	56	53	<0.001
Colistin	100	99	100	100	100	96	98	99	99	NS

Table 6: Carbapenem Resistant Klebsiella Pneumoniae (CRKP)

	Blood Isolates		Urine isolates		Sputum isolates
Year	All isolates of K. pneumoniae	CRKP N (%)	All isolates of K. pneumoniae	CRKP N (%)	All isolates of K. pneumoniae	CRKP N (%)
2001	103	1 (1)	393	1 (0.2)	60
2002	128	4 (3)	474	1 (0.2)	2
2003	105	4 (4)	403	3 (0.7)	22
2004	105	0	406	2 (0.5)	99
2005	110	0	379	3 (0.8)	98	1 (1)
2006	116	5 (4)	353	26 (7.4)	97	4 (4.1)
2007	129	22 (17)	314	46 (14.6)	89	26 (29.2)
2008	136	17 (12)	487	31 (6.4)	104	18 (17.3)
Total	932	53 (5.7)	3209	113 (3.5)	571	49 (8.6)

Table 7: Antimicrobial susceptibility (%) of all isolates of Pseudomonas aeruginosa (n=691) isolated from blood cultures, 2001-2008

	≤48 hrs in hospital	>48 hours in hospital
	214	394
Penicillins
Mezlocillin‏^[13]	83	69
Tazocin	94	87
Cephalosporins
Ceftazidime	95	88
Cefepime‏^[14]	92	91
Carbapenems
Imipenem	97	82
Meropenem‏^[15]	91	93
Aminoglycosides
Gentamicin	80	78
Amikacin	95	90
Other
Ciprofloxacin	76	65
Colistin	100	99

Table 8: Methicillin susceptibility (%) of Staphylococcus aureus, bacteremia, 2001-2008

Table 8a: S. aureus, % methicillin susceptible bacteremia, by department‏^[16]

Department	S. aureus Total (n)	MSSA/Total n (%)
Pediatrics	243	213 (88)
Emergency Department	526	322 (61)
Surgery Total	203	127 (63)
Chest surgery	87	56 (64)
Orthopedics	22	14 (64)
General surgery	56	27 (48)
Medicine Total	583	282 (48)
Oncology	66	52 (79)
Geriatrics	125	40 (32)
Medicine A + B	232	88 (38)
ICU	65	21 (32)
<48 hours in hospital	795	542 (68)
>48 hours in hospital	666	321 (48)
Overall	1646	977 (59)

Table 8b: Susceptibility (%) of S.aureus to other anti-staphylococcal agents‏^[17] , ^[18]

Group	n	Oxa	Rif	Cip	Clin	Chlor	Sept	Vanc	Fus
MSSA	959	100	100	94	96	92	97	100	95
MRSA	646	0	85	9	33	52	88	100	93

Table 9: Blood isolates of Streptococcus pneumoniae

Table 9a: age distribution

Year	All isolates n	Age 0-20	Age >20
2001	34	19	15
2002	47	28	19
2003	67	46	21
2004	53	33	20
2005	87	40	47
2006	70	39	31
2007	39	25	14
2008	93	42	51
Grand Total	490	273 (56)	218 (44)

Table 9b: Penicillin susceptibility, age 0-20‏^[19]

Year	N	Susceptible	Intermediate
2001	19	12 (63)	7 (37)
2002	28	26 (93)	2 (7)
2003	46	40 (87)	6 (13)
2004	33	18 (54)	15 (45)
2005	40	29 (72)	11 (28)
2006	39	30 (77)	9 (23)
2007	25	14 (56)	11 (44)
2008	42	34 (81)	8 (19)
Grand Total	273	203 (74)	69 (26)

Table 9c: Penicillin susceptibility, age >20‏^[20]

Year	N	Susceptible	Intermediate
2001	15	12 (80)	3 (20)
2002	19	17 (89)	2 (10)
2003	21	19 (90)	2 (10)
2004	20	13 (65)	7 (35)
2005	47	43 (91)	4 (8)
2006	31	28 (90)	3 (10)
2007	14	11 (79)	3 (21)
2008	51	42 (82)	9 (18)
Grand Total	218	185 (85)	33 (15)

Table 9d: S. pneumoniae, macrolide susceptibility (%), blood culture specimens

Year	Age 0-20 N (%)	Age >20 N (%)
2001	32 (81)	25 (80)
2002	43 (88)	29 (97)
2003	64 (81)	26 (92)
2004	33 (76)	22 (95)
2005	40 (90)	51 (96)
2006	59 (89)	46 (96)
2007	53 (77)	42 (95)
2008	56 (82)	59 (85)
Total‏^[21]	379 (84)	300 (92)

Table 10: Number of patient-specific positive blood cultures with β-hemolytic streptococci, by Lancefield grouping (2001-2008)

Total	Lancefield Group						Year
	G	F	D	C	B	A
149 (29)	1 (1)	0	16 (20)	0	69 (42)	63 (27)	≤20
363 (71)	81 (99)	1 (100)	66 (80)	13 (100)	94 (58)	108 (63)	>20
512	82	1	82	13	163	171	‏^[22] Total

הערות שוליים

↑ ^1.0 ^1.1 Data for 1990-2000 were manually computerized by volunteers from microbiology records; data for 2001-2008 were obtained with the cubes computer program.

↑ BC, blood cultures

↑ NA, not available

↑ Trend statistical analysis demonstrated an absence of significant changes in annual incidence of any of these organisms for 1990-2000.

↑ * Routine testing for ESBL was initiated in 2002

↑ Susceptibilities of Imipenem (Imp) and Meropenem (Mer) are not identical, but similar. Since 2006, the microbiology laboratory determines susceptibility to both Imipenem and meropenem

↑ All isolates of Enterococcus faecalis were susceptible to vancomycin. Of 91 isolates of Enterococcus faecium 47% were Vancomycin susceptible.

↑ Salmonella: includes Salmonella arizonae, group B, group C, group D, group E, and Salmonella species. Not included are S. typhi (n=3 ) and S. paratyphi (n=1).

↑ S. aureus: 59% methicillin susceptible (=MSSA). Rate varies from Pediatric isolates (90%); through ED isolates (61%) and Medical Departments' isolates (48%) to ICU isolates (32%). 100% of isolates were Vancomycin-susceptible. See separate tables for results of S. aureus.

↑ S. pneumoniae (n=490): Below, respectively, age 20 years (n=273) and above 20 years (n=218): Penicillin susceptible (defined as MIC < 0.1 μgm/ml) respectively 74% and 85%; Intermediate resistance (MIC = 0.1-2) 26% and 15 respectively; Resistant (MIC > 2) 0% and 0% respectively. See separate tables for detailed results of S. pneumoniae.

↑ Includes: adult and pediatric dialysis units, hematological and pediatric day care centers, personnel, other

↑ Imipenem until 2006, Meropenem since 2006

↑ continues to be tested

↑ tested until 2006

↑ tested since 2006

↑ significant change in % methicillin susceptibility was noted over the study period

↑ Oxa-Oxacillin (=similar to methicillin), Rif-Rifampicin, Cip-Ciprofloxacin, Clin-Clindamycin, Chlor-Chloramphenicol, Sept-Cotrimoxazole (=trimethorpim-sulfamethoxazole), Vanc-Vancomycin, Fus-Fusidic acid

↑ Linezolid and daptomycin are available in SZMC; however, systematic susceptibility testing of all strains is not yet performed.

↑ 83% of isolates were erythromycin susceptible

↑ 92% of isolates were erythromycin susceptible, a significantly higher rate than in children (p<0.01).

↑ 92% of isolates from adults were erythromycin susceptible, a significantly higher rate than in children (p<0.01).

↑ No significant changes in annual incidence of various streptococci were observed.

ביבליוגרפיה

לטבלה 1

Yinnon AM, Schlesinger Y, Gabbay D, Rudensky B. Analysis of 5 years of bacteraemias: importance of stratification of microbial susceptibilities by source of patients. J Infect 1007 Jul; 35(1):17-23.

Raveh D, Rudensky B, Schlesinger Y, Benenson S, Yinnon AM. Susceptibility trends in bacteraemias: Analysis of 7544 patient-unique bacteraemic episodes spanning 11 years (1990-2000). J Hosp Infect 2003.

לטבלה 2

Friedmann R, Raveh D, Zartzer E, Rudensky B, Broide E, Attias D, Yinnon AM. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534-42.

Raveh D, Yinnon AM, Broide E, Rudensky B. Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, Meropenem and piperacillin-tazobactam with and without clavulanic acid. Chemotherapy. 2007;53(3):185-9.

Cohen MJ, Anshelevich O, Raveh D, Broide E, Rudensky B, Yinnon AM. Acquisition of multidrug-resistant organisms among hospital patients hospitalized in beds adjacent to critically ill patients. Infect Control Hosp Epidemiol. 2006;27(7):675-81.

Henshke-Bar-Meir R, Yinnon AM, Rudensky B, Attias D, Schlesinger Y, Raveh D. Assessment of the clinical significance of production of extended-spectrum beta-lactamases (ESBL) by Enterobacteriaceae. Infection. 2006;34(2):66-74.

Tallis E, Rudensky B, Attias D, Raveh D, Schlesinger Y, Yinnon AM. In-vitro activity of cefepime and other broad-spectrum antimicrobials against several groups of gram-negative bacilli and Staphylococcus aureus. Diagn Microbiol Infect Dis. 1999;35(2):121-6

[.D7.94.D7.A2.D7.A8.D7.941-1] 1.0 ^1.1 Data for 1990-2000 were manually computerized by volunteers from microbiology records; data for 2001-2008 were obtained with the cubes computer program.

[.D7.94.D7.A2.D7.A8.D7.943-2] BC, blood cultures

[.D7.94.D7.A2.D7.A8.D7.944-3] NA, not available

[.D7.94.D7.A2.D7.A8.D7.942-4] Trend statistical analysis demonstrated an absence of significant changes in annual incidence of any of these organisms for 1990-2000.

[.D7.94.D7.A2.D7.A8.D7.945-5] * Routine testing for ESBL was initiated in 2002

[.D7.94.D7.A2.D7.A8.D7.946-6] Susceptibilities of Imipenem (Imp) and Meropenem (Mer) are not identical, but similar. Since 2006, the microbiology laboratory determines susceptibility to both Imipenem and meropenem

[.D7.94.D7.A2.D7.A8.D7.9410-7] All isolates of Enterococcus faecalis were susceptible to vancomycin. Of 91 isolates of Enterococcus faecium 47% were Vancomycin susceptible.

[8] Salmonella: includes Salmonella arizonae, group B, group C, group D, group E, and Salmonella species. Not included are S. typhi (n=3 ) and S. paratyphi (n=1).

[9] S. aureus: 59% methicillin susceptible (=MSSA). Rate varies from Pediatric isolates (90%); through ED isolates (61%) and Medical Departments' isolates (48%) to ICU isolates (32%). 100% of isolates were Vancomycin-susceptible. See separate tables for results of S. aureus.

[10] S. pneumoniae (n=490): Below, respectively, age 20 years (n=273) and above 20 years (n=218): Penicillin susceptible (defined as MIC < 0.1 μgm/ml) respectively 74% and 85%; Intermediate resistance (MIC = 0.1-2) 26% and 15 respectively; Resistant (MIC > 2) 0% and 0% respectively. See separate tables for detailed results of S. pneumoniae.

[.D7.94.D7.A2.D7.A8.D7.9411-11] Includes: adult and pediatric dialysis units, hematological and pediatric day care centers, personnel, other

[.D7.94.D7.A2.D7.A8.D7.9412-12] Imipenem until 2006, Meropenem since 2006

[13] tinues to be tested

[14] tested until 2006

[15] tested since 2006

[16] significant change in % methicillin susceptibility was noted over the study period

[17] Oxa-Oxacillin (=similar to methicillin), Rif-Rifampicin, Cip-Ciprofloxacin, Clin-Clindamycin, Chlor-Chloramphenicol, Sept-Cotrimoxazole (=trimethorpim-sulfamethoxazole), Vanc-Vancomycin, Fus-Fusidic acid

[18] Linezolid and daptomycin are available in SZMC; however, systematic susceptibility testing of all strains is not yet performed.

[19] 83% of isolates were erythromycin susceptible

[20] 92% of isolates were erythromycin susceptible, a significantly higher rate than in children (p<0.01).

[21] 92% of isolates from adults were erythromycin susceptible, a significantly higher rate than in children (p<0.01).

[22] No significant changes in annual incidence of various streptococci were observed.

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[4]

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[9]

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[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

שם הספר: שימוש מושכל באנטיביוטיקה ונהלים למניעת זיהומים

שם המחבר	פרופ' עמוס ינון, פרופ' יחיאל שלזינגר, דר' דוד רווה
שם הפרק	טבלאות רגישויות מבית החולים שערי צדק - תרביות דם - Shaare zedek medical center antibiotic sensitivity table - blood cultures
מוציא לאור
מועד הוצאה	תשע"א – 2010
מספר עמודים	196

הקדשה	ספר זה מוקדש לפרופ' חיים הרשקו בהוקרה עמוקה

@@ שורה 1: / שורה 1: @@
+{{Sub Chapter
+|Book=
+שימוש מושכל באנטיביוטיקה ונהלים למניעת זיהומים
+|Chapter number=8
+|Sub Chapter number=1
+}}
 {{פנקס|
 |שם המחבר=פרופ' עמוס ינון, פרופ' יחיאל שלזינגר, דר' דוד רווה
@@ שורה 113: / שורה 119: @@
 |}
-==טבלה 2: Enterobacteriaceae, producing Extended-Spectrum β-lactamases (ESBL) (n,%)2002-2008{{כ}}{{הערה|שם=הערה5|* Routine testing for ESBL was initiated in 2002}}==
+==טבלה 2: Enterobacteriaceae, producing Extended-Spectrum β-Lactamases (ESBL) (n,%) 2002-2008{{כ}}{{הערה|שם=הערה5|* Routine testing for ESBL was initiated in 2002}}==
-===טבלה 2א: Collected in the Emergency Department===
+===טבלה 2א': Collected in the Emergency Department===
+{{רווח קשיח}}
 {|dir="ltr" border="1" cellpadding="4"
 |Year
@@ שורה 172: / שורה 178: @@
 |67/228 (29)
 |}
+{{רווח קשיח}}
 ===טבלה 2ב': Collected from hospitalized patients===
+{{רווח קשיח}}
 {|dir="ltr" border="1" cellpadding="4"
 |Year
@@ שורה 234: / שורה 240: @@
 ==טבלה 3: Enterobacteriaceae – antimicrobial susceptibilities (%) 2001-2008. Breakdown by source of patient==
-;מקרא:
+;מקרא
-<div class="mw-content-ltr">
+*Amp - [[Ampicillin]]
-*Amp-Ampicillin;
+* Amk - [[Amikacin]]
-* Amk-Amikacin;
+* Aug - [[Augmentin|Amoxycillin-clavulanate]]
-* Aug-Amoxycillin-clavulanate,
+* Carbap - [[Carbapenem|Carbapenems]]
-*Carbap-Carbapenems;
+* Caz - [[Ceftazidime]]
-* Caz-Ceftazidime;
+*Cef - [[Cefazolin]]
-*Cef-Cefazolin;
+* Chl - [[Chloramphenicol]]
-* Chl-Chloramphenicol;
+* Cip - [[Ciprofloxacin]]
-* Cip-Ciprofloxacin;
+* Col - [[Colistin]] (polymyxin-B)
-* Col-colistin (polymyxin-B);
+* Cpm - [[Cefepime]]
-* Cpm,-Cefepime,
+* Cro - [[Ceftriaxone]]
-* Cro-Ceftriaxone;
+* Cxm - [[Cefuroxime]]
-* Cxm-Cefuroxime;
+* Ert - [[Ertapenem]] (since 2005)
-* Ert-Ertapenem (since 2005);
+* Gen - [[Gentamicin]]
-* Gen-Gentamicin;
+* Imp - [[Imipenem]]
-* Imp-Imipenem;
+* Mez - [[Mezlocillin]] (up to mid-2006)
-* Mez-Mezlocillin (up to mid-2006);
+* Meth - [[Methicillin]]; Sep - [[Cotrimoxazole]]
-* Meth-Methicillin; Sep-Cotrimoxazole;
+* Tob - [[Tobramycin]]
-* Tob-Tobramycin;
+* Tzp - [[Tazocin|Piperacillin-Tazobactam]]
-* Tzp-Piperacillin-Tazobactam;
+* Van - [[Vancomycin]]
-* Van-Vancomycin.
-</div>
+{{רווח קשיח}}
-{|dir="ltr" border="1" cellpadding="4"
+{| dir="ltr" border="1" cellpadding="4"
 |Group
 |n
-|colspan="3"|Penicillins
+| colspan="3" |[[פניצילין|Penicillins]]
-|colspan="2"|Carbap.{{כ}}{{הערה|שם=הערה6|Susceptibilities of Imipenem (Imp) and Meropenem (Mer) are not identical, but similar. Since 2006, the microbiology laboratory determines susceptibility to both imipenem and meropenem}}
+| colspan="2" |Carbap.{{כ}}{{הערה|שם=הערה6|Susceptibilities of [[t:Imipenem|Imipenem]] (Imp) and [[t:Meropenem|Meropenem]] (Mer) are not identical, but similar. Since 2006, the microbiology laboratory determines susceptibility to both [[t:Imipenem|Imipenem]] and meropenem}}
-|colspan="5"|Cephalosporins
+| colspan="5" |[[Cephalosporins]]
-|colspan="2"|Aminogly.
+| colspan="2" |[[Aminoglycoside]]
-|colspan="4"|Other
+| colspan="4" |Other
 |-
 |
@@ שורה 287: / שורה 291: @@
 |Col
 |-
 |≤48hr
 |3447
 |66
 |49
 |91
@@ שורה 298: / שורה 302: @@
 |83
 |85
 |85
 |83
 |97
 |79
 |62
@@ שורה 306: / שורה 310: @@
 |86
 |-
 |>48hr
 |1898
 |39
@@ שורה 312: / שורה 316: @@
 |76
 |92
 |98
 |32
 |47
 |60
 |62
 |67
 |66
 |89
 |58
 |52
 |59
@@ שורה 329: / שורה 333: @@
 <div class="mw-content-ltr">
-===Table 4a: Antimicrobial susceptibilities (%) of selected organisms (in lphabetical order), isolated from blood cultures, 2001-2008.===
+===Table 4a: Antimicrobial susceptibilities (%) of selected organisms (in Alphabetical order), isolated from blood cultures, 2001-2008===
 </div>
@@ שורה 433: / שורה 437: @@
 |94
 |-
-|Enterococcus faecalis{{כ}}{{הערה|שם=הערה10|All isolates of Enterococcus faecalis were susceptible to vancomycin. Of 91 isolates of Enterococcus faecium 47% were vancomycin susceptible.}}
+|Enterococcus faecalis{{כ}}{{הערה|שם=הערה10|All isolates of Enterococcus faecalis were susceptible to vancomycin. Of 91 isolates of Enterococcus faecium 47% were [[t:Vancomycin|Vancomycin]] susceptible.}}
 |410
 |95
@@ שורה 633: / שורה 637: @@
 |90
 |-
-|Streptococcus pneumoniae{{כ}}{{הערה|1=S. pneumoniae (n=490): Below, respectively, age 20 years (n=273) and above 20 years (n=218): Penicillin susceptible (defined as MIC < 0.1 μgm/ml) respectively 74% and 85%; Intermediate resistance (MIC = 0.1-2) 26% and 15 respectively; Resistant (MIC > 2) 0% and 0% respectively. See separate tables for detailed results of  S. pneumoniae.}}
+|[[Streptococcus pneumoniae|Streptococcus pneumoniae{{כ}}{{הערה|1=S. pneumoniae (n=490): Below, respectively, age 20 years (n=273) and above 20 years (n=218): Penicillin susceptible (defined as MIC < 0.1 μgm/ml) respectively 74% and 85%; Intermediate resistance (MIC = 0.1-2) 26% and 15 respectively; Resistant (MIC > 2) 0% and 0% respectively. See separate tables for detailed results of  S. pneumoniae.}}]][./index.php%3Ftitle=טבלאות_רגישויות_מבית_החולים_שערי_צדק_-_תרביות_דם#cite_note-10 <span class="mw-reflink-text"><nowiki>[10]</nowiki></span>]
 |
 |
@@ שורה 654: / שורה 658: @@
 |}
+{{רווח קשיח}}
 <div class="mw-content-ltr">
-===Table 4b: Source of selected organisms isolated from blood cultures: community acquired versus nosocomial, 2001-2008.===
+===Table 4b: Source of selected organisms isolated from blood cultures: community acquired versus nosocomial, 2001-2008===
 </div>
+{{רווח קשיח}}
 {|dir="ltr" border="1" cellpadding="4"
 |Organism
@@ שורה 998: / שורה 1,002: @@
 |}
+{{רווח קשיח}}
 <div class="mw-content-ltr">
@@ שורה 1,143: / שורה 1,147: @@
 |
 |-
-|Imi/Mero{{כ}}{{הערה|שם=הערה12|Imipenem until 2006, Meropenem since 2006}}
+|Imi/Mero{{כ}}{{הערה|שם=הערה12|Imipenem until 2006, [[t:Meropenem|Meropenem]] since 2006}}
 |99
 |97
@@ שורה 1,232: / שורה 1,236: @@
 |}
+{{רווח קשיח}}
 <div class="mw-content-ltr">
+==Table 6: Carbapenem Resistant Klebsiella Pneumoniae (CRKP)==
-==Table 6: Carbapenem Resistant Klebsiella pneumoniae (CRKP)==
 </div>
@@ שורה 1,325: / שורה 1,328: @@
 |}
+{{רווח קשיח}}
 <div class="mw-content-ltr">
 ==Table 7: Antimicrobial susceptibility (%) of all isolates of Pseudomonas aeruginosa (n=691) isolated from blood cultures, 2001-2008==
 </div>
 {|dir="ltr" border="1" cellpadding="4"
 |
@@ שורה 1,392: / שורה 1,393: @@
 |}
+{{רווח קשיח}}
 <div class="mw-content-ltr">
-==Table 8: Methicillin susceptibility (%) of Staphylococcus aureus, bacteremia, 2001-2008.==
+==Table 8: Methicillin susceptibility (%) of Staphylococcus aureus, bacteremia, 2001-2008==
 </div>
@@ שורה 1,400: / שורה 1,401: @@
 ===Table 8a: S. aureus, % methicillin susceptible bacteremia, by department{{כ}}{{הערה|1=significant change in % methicillin susceptibility was noted over the study period}}===
 </div>
 {|dir="ltr" border="1" cellpadding="4"
 !Department
@@ שורה 1,436: / שורה 1,435: @@
 |}
+{{רווח קשיח}}
 <div class="mw-content-ltr">
 ===Table 8b: Susceptibility (%) of S.aureus to other anti-staphylococcal agents{{כ}}{{הערה|1=Oxa-Oxacillin (=similar to methicillin), Rif-Rifampicin, Cip-Ciprofloxacin, Clin-Clindamycin, Chlor-Chloramphenicol, Sept-Cotrimoxazole (=trimethorpim-sulfamethoxazole), Vanc-Vancomycin, Fus-Fusidic acid}} , {{הערה|1=Linezolid and daptomycin are available in SZMC; however, systematic susceptibility testing of all strains is not yet performed.}}===
 </div>
-== הערות שוליים ==
+{{רווח קשיח}}
+{|dir="ltr" border="1" cellpadding="4"
+!	Group||n||Oxa||Rif||Cip||Clin||Chlor||Sept||Vanc||Fus
+|-
+||MSSA||959||100||100||94||96||92||97||100||95
+|-
+||MRSA||646||0||85||9||33||52||88||100||93
+|}
-{{הערות שוליים}}
+==Table 9: Blood isolates of Streptococcus pneumoniae==
-==ביבליוגרפיה==
+<div class="mw-content-ltr">
+===Table 9a: age distribution===
-;לטבלה 1
-<blockquote>
-<div style="text-align: left; direction: ltr">
-#Yinnon AM, Schlesinger Y, Gabbay D, Rudensky B.  Analysis of 5 years of bacteraemias: importance of stratification of microbial susceptibilities by source of patients.  J Infect 1007 Jul; 35(1):17-23.
-#Raveh D, Rudensky B, Schlesinger Y, Benenson S, Yinnon AM.  Susceptibility trends in bacteraemias: Analysis of 7544 patient-unique bacteraemic episodes spanning 11 years (1990-2000). J Hosp Infect 2003.
 </div>
-</blockquote>
+{|dir="ltr" border="1" cellpadding="4"
+!Year	||	All isolates n	||	Age 0-20	||	Age >20
+|-
+||	2001	||	34	||	19	||	15
+|-
+||	2002	||	47||	28	||	19
+|-
+||	2003	||	67	||	46	||	21
+|-
+||	2004	||	53	||	33||	20
+|-
+||	2005	||87	||	40	||	47
+|-
+||	2006	||	70	||	39	||	31
+|-
+||	2007	||	39	||	25	||	14
+|-
+||	2008	||	93	||	42	||	51
+|-
+||	Grand Total	||490	||	273 (56)||	218 (44)
+|}
-;לטבלה 2
+{{רווח קשיח}}
-<blockquote>
+<div class="mw-content-ltr">
-<div style="text-align: left; direction: ltr">
+===Table 9b: Penicillin susceptibility, age 0-20{{כ}}{{הערה|1=83% of isolates were erythromycin susceptible}}===
-#Friedmann R, Raveh D, Zartzer E, Rudensky B, Broide E, Attias D, Yinnon AM. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534-42.
-#Raveh D, Yinnon AM, Broide E, Rudensky B. Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, meropenem and piperacillin-tazobactam with and without clavulanic acid. Chemotherapy. 2007;53(3):185-9.
-#Cohen MJ, Anshelevich O, Raveh D, Broide E, Rudensky B, Yinnon AM. Acquisition of multidrug-resistant organisms among hospital patients hospitalized in beds adjacent to critically ill patients.  Infect Control Hosp Epidemiol. 2006;27(7):675-81.
-#Henshke-Bar-Meir R, Yinnon AM, Rudensky B, Attias D, Schlesinger Y, Raveh D. Assessment of the clinical significance of production of extended-spectrum beta-lactamases (ESBL) by Enterobacteriaceae. Infection. 2006;34(2):66-74.
-#Tallis E, Rudensky B, Attias D, Raveh D, Schlesinger Y, Yinnon AM. In-vitro activity of cefepime and other broad-spectrum antimicrobials against several groups of gram-negative bacilli and Staphylococcus aureus. Diagn Microbiol Infect Dis. 1999;35(2):121-6
 </div>
-</blockquote>
+{|dir="ltr" border="1" cellpadding="4"
-==ראו גם==
+!Year||N||Susceptible||Intermediate||Resistant
+|-
-* לנושא הקודם: [[תקופות הדגירה וההדבקה של מחלות זיהומיות - Incubation and contagious periods of infections]]
+||	2001||	19	||	12 (63)	||	7 (37)	||	0
-* לנושא הבא: [[טבלאות רגישויות מבית החולים שערי צדק - תרביות ליחה]]
+|-
+||	2002	||	28	||26 (93)	||	2 (7)	||	0
+|-
+||	2003	||	46	||	40 (87)	||	6 (13)	||	0
+|-
+||	2004	||	33	||	18 (54)	||	15 (45)	||	0
+|-
+||	2005	||	40	||	29 (72)	||	11 (28)	||	0
+|-
+||	2006	||	39	||	30 (77)	||	9 (23)||	0
+|-
+||	2007	||	25	||14 (56)	||	11 (44)	||	0
+|-
+||	2008||	42	||	34 (81)	||	8 (19)	||	0
+|-
+||Grand Total||273||203 (74)||69 (26)||0
+|}
+{{רווח קשיח}}
+<div class="mw-content-ltr">
+===Table 9c: Penicillin susceptibility, age >20{{כ}}{{הערה|1=92% of isolates were erythromycin susceptible, a significantly higher rate than in children (p<0.01).}}===
+</div>
+{|dir="ltr" border="1" cellpadding="4"
+!Year||N||Susceptible||Intermediate||Resistant
+|-
+||2001	||15	||12 (80)	||	3 (20)	||	0
+|-
+||	2002||	19	||17 (89)	||	2 (10)||	0
+|-
+||	2003||	21	||19 (90)	||	2 (10)	||	0
+|-
+||2004	||20	||13 (65)	||	7 (35)	||	0
+|-
+||	2005||	47	||	43 (91)	||	4 (8)	||	0
+|-
+||2006	||31||28 (90)	||3 (10)	||	0
+|-
+||2007	||14	||	11 (79)	||	3 (21)	||	0
+|-
+||2008	||51	||42 (82)	||	9 (18)||	0
+|-
+||Grand Total||218||185 (85)||33 (15)||0
+|}
-* [[שימוש מושכל באנטיביוטיקה|לתוכן העניינים של פנקס שימוש מושכל באנטיביוטיקה]]
+{{רווח קשיח}}
+<div class="mw-content-ltr">
+===Table 9d: S. pneumoniae, macrolide susceptibility (%), blood culture specimens ===
+</div>
+{|dir="ltr" border="1" cellpadding="4"
+!	Year	||	Age 0-20 N (%)	||	Age >20 N (%)
+|-
+||	2001	||	32 (81)	||	25 (80)
+|-
+||	2002	||	43 (88)	||	29 (97)
+|-
+||	2003	||	64 (81)||	26 (92)
+|-
+||	2004	||	33 (76)	||	22 (95)
+|-
+||	2005	||40 (90)	||	51 (96)
+|-
+||	2006	||	59 (89)	||46 (96)
+|-
+||	2007	||	53 (77)||	42 (95)
+|-
+||	2008	||56 (82)	||	59 (85)
+|-
+||	Total{{כ}}{{הערה|1=92% of isolates from adults were erythromycin susceptible, a significantly higher rate than in children (p<0.01).}}	||	379 (84)	||	300 (92)
+|}
+<div class="mw-content-ltr">
+==Table 10: Number of patient-specific positive blood cultures with β-hemolytic streptococci, by Lancefield grouping (2001-2008)==
+</div>
+{|border="1" cellpadding="4" dir="ltr"
+!Total
+!colspan="6"|Lancefield Group
+|Year
+|-
+||		||G	||	F	||D||	C||	B||A||
+|-
+||149 (29)||1 (1)||0||16 (20)||0||69 (42)||63 (27)||≤20
+|-
+||363 (71)||81 (99)||1 (100)||66 (80)||13 (100)	||94 (58)||108 (63)||>20
+|-
+||512||82||1||	82	||13	||163	||171	||{{כ}}{{הערה|1=No significant changes in annual incidence of various streptococci were observed.}} Total
+|}
+== הערות שוליים ==
+<blockquote>
+<div style="text-align: left; direction: ltr">
+{{הערות שוליים}}
+</div>
+</blockquote>
+==ביבליוגרפיה==
+;לטבלה 1
+<blockquote>
+<div style="text-align: left; direction: ltr">
+#Yinnon AM, Schlesinger Y, Gabbay D, Rudensky B.  Analysis of 5 years of bacteraemias: importance of stratification of microbial susceptibilities by source of patients.  J Infect 1007 Jul; 35(1):17-23.
+#Raveh D, Rudensky B, Schlesinger Y, Benenson S, Yinnon AM.  Susceptibility trends in bacteraemias: Analysis of 7544 patient-unique bacteraemic episodes spanning 11 years (1990-2000). J Hosp Infect 2003.
+</div>
+</blockquote>
+;לטבלה 2
+<blockquote>
+<div style="text-align: left; direction: ltr">
+#Friedmann R, Raveh D, Zartzer E, Rudensky B, Broide E, Attias D, Yinnon AM. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534-42.
+#Raveh D, Yinnon AM, Broide E, Rudensky B. Susceptibilities of ESBL-producing Enterobacteriaceae to ertapenem, [[t:Meropenem|Meropenem]] and piperacillin-tazobactam with and without clavulanic acid. Chemotherapy. 2007;53(3):185-9.
+#Cohen MJ, Anshelevich O, Raveh D, Broide E, Rudensky B, Yinnon AM. Acquisition of multidrug-resistant organisms among hospital patients hospitalized in beds adjacent to critically ill patients.  Infect Control Hosp Epidemiol. 2006;27(7):675-81.
+#Henshke-Bar-Meir R, Yinnon AM, Rudensky B, Attias D, Schlesinger Y, Raveh D. Assessment of the clinical significance of production of extended-spectrum beta-lactamases (ESBL) by Enterobacteriaceae. Infection. 2006;34(2):66-74.
+#Tallis E, Rudensky B, Attias D, Raveh D, Schlesinger Y, Yinnon AM. In-vitro activity of cefepime and other broad-spectrum antimicrobials against several groups of gram-negative bacilli and Staphylococcus aureus. Diagn Microbiol Infect Dis. 1999;35(2):121-6
+</div>
+</blockquote>