הבדלים בין גרסאות בדף "טבלאות רגישויות מבית החולים שערי צדק - תרביות דם - Shaare zedek medical center antibiotic sensitivity table - blood cultures"
מתוך ויקירפואה
(←טבלה 5) |
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גרסה מ־06:40, 25 בספטמבר 2013
שם הספר: שימוש מושכל באנטיביוטיקה ונהלים למניעת זיהומים | |
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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 |
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 | Aminogly. | 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 lphabetical 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] |
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 | ||||||||||
Cefuroxime | ||||||||||
Ceftriaxone | ||||||||||
Ceftazidime | ||||||||||
Cefepime
50 53 53 56 44 53 52 53 58 <0.001 <0.01 <0.001 <0.001 <0.001 Carbapenems Ertapenem Imi/Mero* NA 99 NA 97 NA 96 NA 100 89 100 94 95 74 86 86 87 85 95 <0.001 Aminoglycosides Gentamicin Amikacin 42 89 57 94 75 95 61 96 62 82 44 69 75 63 81 73 61 81 <0.001 <0.001 Other Chloramph Cotrimoxazole Ciprofloxacin Colistin 41 37 41 100 52 52 54 99 69 64 68 100 61 56 64 100 58 53 57 100 38 34 41 96 40 35 40 98 65 59 56 99 52 48 53 99 <0.001 <0.001 <0.001 |
NS |
Table 5b: Change in antimicrobial susceptibility (%) of all isolates of K.pneumoniae (n=1058) isolated from blood cultures, 2000-2008
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
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