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
|
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#
|
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*
|
108
|
97
|
|
100
|
|
|
98
|
73
|
|
|
100
|
|
|
|
|
|
|
|
Serratia marcescens
|
164
|
|
98
|
|
85
|
|
78
|
89
|
|
86
|
88
|
4
|
100
|
88
|
99
|
88
|
73
|
93
|
S. aureus **
|
1646
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Steno-trophomonas
|
156
|
79
|
89
|
82
|
86
|
78
|
88
|
90
|
90
|
Streptococcus pneumoniae* **
|
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
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
ראו גם