Antibiogram July 2022 to June 2023 Juravinski Hospital

Before using this antibiogram you should know:

1. The antibiogram is used to direct initial empiric therapy only. Antibiotics need to be reassessed based on susceptibility testing and patient clinical status.
2. Data presented in the antibiogram should be considered in combination with an individual patient’s risk factors for resistant organisms, clinical syndrome and hospital epidemiology.
3. The antibiogram provides the percentage of isolates which are susceptible to an antibiotic. For life-threatening infections, it is reasonable to choose an antibiotic regimen with the lowest resistance rate.
4. Fewer than 30 isolates may not be reliable for guiding empiric treatment and cannot be used to statistically compare results to other years.
5. A shaded box indicates that the particular antibiotic/microorganism combinations are not recommended.
6. Calculation of results was based on the first isolate per patient for the year 2021. Duplicate isolates and surveillance isolates were removed.

For further information, contact the Microbiology Laboratory, Hamilton Regional Laboratory Medicine Program

All Specimens Excluding Surveillance for July 2022 – June 2023

% Susceptible

Gram Negative Organisms	Number of Isolates	Ampicillin	Ceftriaxone	Ceftazidime	Piperacillin-Tazobactam	Ertapenem	Meropenem	Gentamicin	Tobramycin	TMP/SMX	Ciprofloxacin
E. coli	1151	56	85	–	95	99	99	91	92	79	71
Klebsiella pneumoniae	454	0	85	–	89	98	99	96	96	90	85
Enterobacter spp.	120	–	–	–	–	84	97	96	93	90	84
Proteus mirabilis	147	83	97	–	100	99	97	95	97	89	89
Pseudomonas aeruginosa	288	–	–	87	90	–	86	97	99	–	82

* Cefazolin is not included in this table as automated susceptibility results are not reliable. Refer to the table on blood cultures where alternative methods (Kirby-Bauer) are used for testing.

Gram Positive Organisms	Number of Isolates	Ampicillin	Cloxacillin	Cefazolin	Clindamycin	Erythromycin	TMP/SMX	Ciprofloxacin*	Tetracycline	Rifampin (not to be used as monotherapy)	Vancomycin
Staphylococcus aureus (includes MSSA and MRSA)	389	–	77	77	See MSSA & MRSA	See MSSA & MRSA	See MSSA & MRSA	See MSSA & MRSA	See MSSA & MRSA	See MSSA & MRSA	See MSSA & MRSA
Methicillin Sensitive S. aureus (MSSA)	302	–	100	100	76	69	98	84	96	100	100
Methicillin Resistant S. aureus (MRSA)	93	–	0	0	60	29	95	25	92	100	100
Enterococcus spp	589	69	–	–	–	–	–	–	–	–	93

* Ciprofloxacin monotherapy is NOT recommended for serious infections caused by Staphylococcus spp.

Blood Culture Specimens: % Susceptible

Organism	Number of Isolates	Ampicillin	Cloxacillin	Cefazolin	High-Level Gentamicin *	Vancomycin
Staphylococcus aureus	141	–	83	83	–	100
Coagulase negative Staphylococcus	50	–	50	50	–	100
Enterococcus faecalis	73	100	–	–	72	100
Enterococcus faecium	50	0	–	–	69	100

* For use in combination with Ampicillin or Vancomycin for synergy

Organism	Number of Isolates	Ampicillin	Cefazolin	Ceftriaxone	Ceftazidime	Piperacillin-Tazobactam	Ertapenem	Meropenem	Gentamicin	Tobramycin	TMP/SMX	Ciprofloxacin
E. coli	213	54	64	81	–	95	99	99	92	93	79	70
Klebsiella pneumoniae	110	0	68	86	–	90	98	98	96	95	92	89
Enterobacter spp	38	–	–	–	–	–	81	94	100	97	97	84
Pseudomonas aeruginosa	51	–	–	–	86	90	–	86	100	100	—	86

Urine Culture Specimens:
% Susceptible

Organism	Number of Isolates	Ampicillin	Cefazolin (Urinary) *	Ceftriaxone	Ceftazidime	Piperacillin-Tazobactam	Ertapenem	Meropenem	Gentamicin	Tobramycin	Nitrofurantoin (for urine only)	TMP/SMX	Ciprofloxacin
E. coli	975	56	83	86	–	95	99	99	91	92	96	79	70
Klebsiella pneumoniae	345	0	76	85	–	89	99	100	96	96	43	90	84
Enterobacter spp	72	–	–	–	–	–	88	100	94	88	54	86	84
Proteus mirabilis	127	83	96	98	–	100	99	97	95	96	0	88	89
Pseudomonas aeruginosa	184	–	–	–	90	94	–	89	97	99	–	–	79

* Cefazolin (urinary) predicts for cephalexin and cefprozil when used for treatment of uncomplicated UTIs due to E. coli, K. pneumoniae, and P. mirabilis but not for therapy of infections other than uncomplicated UTIs.

Organism	Number of Isolates	Ampicillin	Cefazolin/Cloxacillin	TMX/SMP	Ciprofloxacin	Nitrofurantoin (for urine only)	Tetracycline	Rifampin (not to be used as monotherapy)	Vancomycin
Staphylococcus aureus (includes MSSA and MRSA)	52	–	76	98	61	98	96	100	100
Enterococcus spp	440	75	–	–	52	75	21	–	94

Intrinsic Resistance for Selected Organisms

Organism	Antibiotics that are INEFFECTIVE ***DO NOT USE***
Enterococcus	Cephalosporins, Cloxacillin, Clindamycin, TMP/SMX Ciprofloxacin and Tetracycline should be used only for urinary source
SPICE organisms High risk for inducible resistance: Citrobacter freundii complex, Enterobacter cloacae, Klebsiella aerogenes Lower risk for inducible resistance: Serratia, Providencia, Morganella	Penicillins, cephalosporins, broad spectrum penicillins and β-lactam/ β-lactamase inhibitor combinations (eg. piperacillin-tazobactam) are not recommended as SPICE organisms contain an inducible chromosomal AmpC β-lactamase. For lower risk SPICE organisms: 3rd generation cephalosporins that test in vitro suseptible, can be used for uncomplicated urinary tract infection
Salmonella spp	Aminoglycosides, 1st and 2nd generation cephalosporins
Methicillin resistant S. aureus (MRSA)	Penicillins, cephalosporins, broad spectrum penicillins and β-lactam/ β-lactamase inhibitor combinations, carbapenems (e.g. meropenem)

Helpful Web Sites

Centers for Disease Control and Prevention
http://www.cdc.gov/drugresistance
http://www.cdc.gov/getsmart

Infectious Diseases Society of America
http://www.idsociety.org

Choosing Wisely Canada
http://www.choosingwiselycanada.org

Association of Medical Microbiologists and Infectious Diseases Canada (AMMI)
http://www.ammi.ca

Johns Hopkins Infectious Diseases
http://www.hopkinsguides.com

AidsInfo (US Dept of Health and Human Services)
http://www.aidsinfo.nih.gov/