Blood Stream Infections from MDR Bacteria
Abstract
:1. Introduction
2. Methodology
3. Epidemiology
4. Microbiology
4.1. Enterococcus spp.
4.2. Staphylococcus aureus
4.3. Klebsiella pneumoniae
4.4. Acinetobacter baumannii
4.5. Pseudomonas aeruginosae
4.6. Enterobacter spp.
5. Risk Factors
6. Early Microbiological Diagnosis in BSI
7. Rationale of Treatment
7.1. Single-Drug or Combination Therapy for Bloodstream Infection in ICU Patients
7.2. De-Escalation Strategy
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
Appendix A
Database | Search String | No. of Results |
---|---|---|
PUBMED | (“anti infective agents”[Pharmacological Action] OR “anti infective agents”[MeSH Terms] OR (“anti infective”[All Fields] AND “agents”[All Fields]) OR “anti infective agents”[All Fields] OR “antimicrobial”[All Fields] OR “antimicrobials”[All Fields] OR “antimicrobially”[All Fields]) AND (“resist”[All Fields] OR “resistance”[All Fields] OR “resistances”[All Fields] OR “resistant”[All Fields] OR “resistants”[All Fields] OR “resisted”[All Fields] OR “resistence”[All Fields] OR “resistences”[All Fields] OR “resistent”[All Fields] OR “resistibility”[All Fields] OR “resisting”[All Fields] OR “resistive”[All Fields] OR “resistively”[All Fields] OR “resistivities”[All Fields] OR “resistivity”[All Fields] OR “resists”[All Fields]) AND (“sepsis”[MeSH Terms] OR “sepsis”[All Fields] OR (“bloodstream”[All Fields] AND “infections”[All Fields]) OR “bloodstream infections”[All Fields]) | 13,466 |
EMBASE | (‘bloodstream infection’/exp OR ‘blood infection’ OR ‘blood infections’ OR ‘blood stream infection’ OR ‘blood stream infections’ OR ‘blood-borne infections’ OR ‘bloodstream infection’ OR ‘bloodstream infections’) AND (‘antibiotic resistance’/exp OR ‘antibacterial drug resistance’ OR ‘antibacterial resistance’ OR ‘antibiotic non-susceptibility’ OR ‘antibiotic nonsusceptibility’ OR ‘antibiotic resistance’ OR ‘antimicrobial drug resistance’ OR ‘antimicrobial resistance’ ODatabase Search String N. of result PUBMED (“anti infective agents”[Pharmacological Action] OR “anti infective agents”[MeSH Terms] OR (“anti infective”[All Fields] AND “agents”[All Fields]) OR “anti infective agents”[All Fields] OR “antimicrobial”[All Fields] OR “antimicrobials”[All Fields] OR “antimicrobially”[All Fields]) AND (“resist”[All Fields] OR “resistance”[All Fields] OR “resistances”[All Fields] OR “resistant”[All Fields] OR “resistants”[All Fields] OR “resisted”[All Fields] OR “resistence”[All Fields] OR “resistences”[All Fields] OR “resistent”[All Fields] OR “resistibility”[All Fields] OR “resisting”[All Fields] OR “resistive”[All Fields] OR “resistively”[All Fields] OR “resistivities”[All Fields] OR “resistivity”[All Fields] OR “resists”[All Fields]) AND (“sepsis”[MeSH Terms] OR “sepsis”[All Fields] OR (“bloodstream”[All Fields] AND “infections”[All Fields]) OR “bloodstream infections”[All Fields]) 13,466 EMBASE (‘bloodstream infection’/exp OR ‘blood infection’ OR ‘blood infections’ OR ‘blood stream infection’ OR ‘blood stream infections’ OR ‘blood-borne infections’ OR ‘bloodstream infection’ OR ‘bloodstream infections’) AND (‘antibiotic resistance’/exp OR ‘antibacterial drug resistance’ OR ‘antibacterial resistance’ OR ‘antibiotic non-susceptibility’ OR ‘antibiotic nonsusceptibility’ OR ‘antibiotic resistance’ OR ‘antimicrobial drug resistance’ OR ‘antimicrobial resistance’ OR ‘bacterial drug resistance’ OR ‘bacterial resistance’ OR ‘bacterium resistance’ OR ‘drug resistance, bacterial’ OR ‘drug resistance, microbial’ OR ‘microbial drug resistance’ OR ‘resistance, antibiotic’) 4558 Cochrane bloodstream infections and antimicrobial resistance 71R ‘bacterial drug resistance’ OR ‘bacterial resistance’ OR ‘bacterium resistance’ OR ‘drug resistance, bacterial’ OR ‘drug resistance, microbial’ OR ‘microbial drug resistance’ OR ‘resistance, antibiotic’) | 4558 |
Cochrane | bloodstream infections and antimicrobial resistance | 71 |
References
- Timsit, J.F.; Ruppe, E.; Barbier, F.; Tabah, A.; Bassetti, M. Bloodstream infections in critically ill patients: An expert statement. Intensive Care Med. 2020, 46, 266–284. [Google Scholar] [CrossRef] [PubMed]
- Adrie, C.; Garrouste-Orgeas, M.; Ibn Essaied, W.; Schwebel, C.; Darmon, M.; Mourvillier, B.; Ruckly, S.; Dumenil, A.S.; Kallel, H.; Argaud, L.; et al. Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative microorganism, resistance profile and antimicrobial therapy. J. Infect. 2017, 74, 131–141. [Google Scholar] [CrossRef] [PubMed]
- Bartoletti, M.; Giannella, M.; Caraceni, P.; Domenicali, M.; Ambretti, S.; Tedeschi, S.; Verucchi, G.; Badia, L.; Lewis, R.E.; Bernardi, M.; et al. Epidemiology and outcomes of bloodstream infection in patients with cirrhosis. J. Hepatol. 2014, 61, 51–58. [Google Scholar] [CrossRef]
- Islas-Munoz, B.; Volkow-Fernandez, P.; Ibanes-Gutierrez, C.; Villamar-Ramirez, A.; Vilar-Compte, D.; Cornejo-Juarez, P. Bloodstream infections in cancer patients. Risk factors associated with mortality. Int. J. Infect. Dis. 2018, 71, 59–64. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Silva, M., Jr.; Marra, A.R.; Pereira, C.A.; Medina-Pestana, J.O.; Camargo, L.F. Bloodstream infection after kidney transplantation: Epidemiology, microbiology, associated risk factors, and outcome. Transplantation 2010, 90, 581–587. [Google Scholar] [CrossRef] [PubMed]
- Bassetti, M.; Righi, E.; Carnelutti, A. Bloodstream infections in the Intensive Care Unit. Virulence 2016, 7, 267–279. [Google Scholar] [CrossRef] [PubMed]
- Santoro, A.; Franceschini, E.; Meschiari, M.; Menozzi, M.; Zona, S.; Venturelli, C.; Digaetano, M.; Rogati, C.; Guaraldi, G.; Paul, M.; et al. Epidemiology and Risk Factors Associated with Mortality in Consecutive Patients with Bacterial Bloodstream Infection: Impact of MDR and XDR Bacteria. Open Forum Infect. Dis. 2020, 7, ofaa461. [Google Scholar] [CrossRef]
- Singer, M.; Deutschman, C.S.; Seymour, C.W.; Shankar-Hari, M.; Annane, D.; Bauer, M.; Bellomo, R.; Bernard, G.R.; Chiche, J.D.; Coopersmith, C.M.; et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016, 315, 801–810. [Google Scholar] [CrossRef]
- Laupland, K.B.; Church, D.L. Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin. Microbiol. Rev. 2014, 27, 647–664. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tabah, A.; Koulenti, D.; Laupland, K.; Misset, B.; Valles, J.; Bruzzi de Carvalho, F.; Paiva, J.A.; Cakar, N.; Ma, X.; Eggimann, P.; et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: The EUROBACT International Cohort Study. Intensive Care Med. 2012, 38, 1930–1945. [Google Scholar] [CrossRef] [Green Version]
- Corona, A.; Bertolini, G.; Lipman, J.; Wilson, A.P.; Singer, M. Antibiotic use and impact on outcome from bacteraemic critical illness: The Bacteraemia Study in Intensive Care (BASIC). J. Antimicrob. Chemother. 2010, 65, 1276–1285. [Google Scholar] [CrossRef] [Green Version]
- Diekema, D.J.; Hsueh, P.R.; Mendes, R.E.; Pfaller, M.A.; Rolston, K.V.; Sader, H.S.; Jones, R.N. The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program. Antimicrob. Agents Chemother. 2019, 63. [Google Scholar] [CrossRef] [Green Version]
- Li, X.Z.; Nikaido, H. Efflux-mediated drug resistance in bacteria. Drugs 2004, 64, 159–204. [Google Scholar] [CrossRef] [PubMed]
- Wright, G.D. Bacterial resistance to antibiotics: Enzymatic degradation and modification. Adv. Drug Deliv. Rev. 2005, 57, 1451–1470. [Google Scholar] [CrossRef] [PubMed]
- Wilson, D.N. Ribosome-targeting antibiotics and mechanisms of bacterial resistance. Nat. Rev. Microbiol. 2014, 12, 35–48. [Google Scholar] [CrossRef] [PubMed]
- Elsner, H.A.; Sobottka, I.; Mack, D.; Claussen, M.; Laufs, R.; Wirth, R. Virulence factors of Enterococcus faecalis and Enterococcus faecium blood culture isolates. Eur. J. Clin. Microbiol. Infect. Dis. 2000, 19, 39–42. [Google Scholar] [CrossRef] [PubMed]
- Denyer, S.P.; Hodges, N.A.; Gorman, S.P. Hugo and Russell’s Pharmaceutical Microbiology; John Wiley & Sons: Hoboken, NJ, USA, 2008. [Google Scholar]
- Hope, R.; Livermore, D.M.; Brick, G.; Lillie, M.; Reynolds, R. On Behalf of BSAC Working Parties on Resistance Surveillance. Non-susceptibility trends among staphylococci from bacteraemias in the UK and Ireland, 2001. J. Antimicrob. Chemother. 2008, 62 (Suppl. 2), ii65–ii74. [Google Scholar] [CrossRef] [Green Version]
- Wu, D.; Wang, Q.; Yang, Y.; Geng, W.; Wang, Q.; Yu, S.; Yao, K.; Yuan, L.; Shen, X. Epidemiology and molecular characteristics of community-associated methicillin-resistant and methicillin-susceptible Staphylococcus aureus from skin/soft tissue infections in a children’s hospital in Beijing, China. Diagn. Microbiol. Infect. Dis. 2010, 67, 1–8. [Google Scholar] [CrossRef]
- Chambers, H.F.; Deleo, F.R. Waves of resistance: Staphylococcus aureus in the antibiotic era. Nat. Rev. Microbiol. 2009, 7, 629–641. [Google Scholar] [CrossRef]
- Appelbaum, P.C. Reduced glycopeptide susceptibility in methicillin-resistant Staphylococcus aureus (MRSA). Int. J. Antimicrob. Agents 2007, 30, 398–408. [Google Scholar] [CrossRef] [PubMed]
- Queenan, A.M.; Bush, K. Carbapenemases: The versatile beta-lactamases. Clin. Microbiol. Rev. 2007, 20, 440–458. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Yong, D.; Toleman, M.A.; Giske, C.G.; Cho, H.S.; Sundman, K.; Lee, K.; Walsh, T.R. Characterization of a new metallo-beta-lactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob. Agents Chemother. 2009, 53, 5046–5054. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Houang, E.T.; Sormunen, R.T.; Lai, L.; Chan, C.Y.; Leong, A.S. Effect of desiccation on the ultrastructural appearances of Acinetobacter baumannii and Acinetobacter lwoffii. J. Clin. Pathol. 1998, 51, 786–788. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Biendo, M.; Laurans, G.; Lefebvre, J.; Daoudi, F.; Eb, F. Epidemiological study of an Acinetobacter baumannii outbreak by using a combination of antibiotyping and ribotyping. J. Clin. Microbiol. 1999, 37, 2170–2175. [Google Scholar] [CrossRef] [Green Version]
- Boucher, H.W.; Talbot, G.H.; Bradley, J.S.; Edwards, J.E.; Gilbert, D.; Rice, L.B.; Scheld, M.; Spellberg, B.; Bartlett, J. Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin. Infect. Dis. 2009, 48, 1–12. [Google Scholar] [CrossRef] [Green Version]
- Bush, K.; Jacoby, G.A.; Medeiros, A.A. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob. Agents Chemother. 1995, 39, 1211–1233. [Google Scholar] [CrossRef] [Green Version]
- Castanheira, M.; Deshpande, L.M.; Mathai, D.; Bell, J.M.; Jones, R.N.; Mendes, R.E. Early dissemination of NDM-1- and OXA-181-producing Enterobacteriaceae in Indian hospitals: Report from the SENTRY Antimicrobial Surveillance Program, 2006–2007. Antimicrob. Agents Chemother. 2011, 55, 1274–1278. [Google Scholar] [CrossRef] [Green Version]
- Prowle, J.R.; Echeverri, J.E.; Ligabo, E.V.; Sherry, N.; Taori, G.C.; Crozier, T.M.; Hart, G.K.; Korman, T.M.; Mayall, B.C.; Johnson, P.D.; et al. Acquired bloodstream infection in the intensive care unit: Incidence and attributable mortality. Crit. Care 2011, 15, R100. [Google Scholar] [CrossRef] [Green Version]
- Giacobbe, D.R.; Battaglini, D.; Ball, L.; Brunetti, I.; Bruzzone, B.; Codda, G.; Crea, F.; de Maria, A.; Dentone, C.; di Biagio, A.; et al. Bloodstream infections in critically ill patients with COVID-19. Eur. J. Clin. Investig. 2020, 50, e13319. [Google Scholar] [CrossRef]
- Di Franco, S.; Alfieri, A.; Petrou, S.; Damiani, G.; Passavanti, M.B.; Pace, M.C.; Leone, S.; Fiore, M. Current status of COVID-19 treatment: An opinion review. World J. Virol. 2020, 9, 27–37. [Google Scholar] [CrossRef]
- Rhodes, A.; Evans, L.E.; Alhazzani, W.; Levy, M.M.; Antonelli, M.; Ferrer, R.; Kumar, A.; Sevransky, J.E.; Sprung, C.L.; Nunnally, M.E. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017, 43, 304–377. [Google Scholar] [CrossRef] [PubMed]
- Cheng, M.P.; Stenstrom, R.; Paquette, K.; Stabler, S.N.; Akhter, M.; Davidson, A.C.; Gavric, M.; Lawandi, A.; Jinah, R.; Saeed, Z.; et al. Blood Culture Results Before and After Antimicrobial Administration in Patients with Severe Manifestations of Sepsis: A Diagnostic Study. Ann. Intern. Med. 2019, 171, 547–554. [Google Scholar] [CrossRef] [PubMed]
- Bassetti, M.; Righi, E.; Montravers, P.; Cornely, O.A. What has changed in the treatment of invasive candidiasis? A look at the past 10 years and ahead. J. Antimicrob. Chemother. 2018, 73, i14–i25. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Abbas, M.; Paul, M.; Huttner, A. New and improved? A review of novel antibiotics for Gram-positive bacteria. Clin. Microbiol. Infect. 2017, 23, 697–703. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Schnell, D.; Montlahuc, C.; Bruneel, F.; Resche-Rigon, M.; Kouatchet, A.; Zahar, J.-R.; Darmon, M.; Pene, F.; Lemiale, V.; Rabbat, A. De-escalation of antimicrobial therapy in critically ill hematology patients: A prospective cohort study. Intensive Care Med. 2019, 45, 743–745. [Google Scholar] [CrossRef]
- Nguyen, M.H.; Clancy, C.J.; Pasculle, A.W.; Pappas, P.G.; Alangaden, G.; Pankey, G.A.; Schmitt, B.H.; Rasool, A.; Weinstein, M.P.; Widen, R. Performance of the T2Bacteria panel for diagnosing bloodstream infections: A diagnostic accuracy study. Ann. Intern. Med. 2019, 170, 845–852. [Google Scholar] [CrossRef]
- Chiu, C.Y.; Miller, S.A. Clinical metagenomics. Nat. Rev. Genet. 2019, 20, 341–355. [Google Scholar] [CrossRef]
- Grumaz, S.; Stevens, P.; Grumaz, C.; Decker, S.O.; Weigand, M.A.; Hofer, S.; Brenner, T.; von Haeseler, A.; Sohn, K. Next-generation sequencing diagnostics of bacteremia in septic patients. Genome Med. 2016, 8, 1–13. [Google Scholar] [CrossRef] [PubMed]
- Blauwkamp, T.A.; Thair, S.; Rosen, M.J.; Blair, L.; Lindner, M.S.; Vilfan, I.D.; Kawli, T.; Christians, F.C.; Venkatasubrahmanyam, S.; Wall, G.D. Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious diseases. Nat. Microbiol. 2019, 4, 663–674. [Google Scholar] [CrossRef]
- Mangioni, D.; Viaggi, B.; Giani, T.; Arena, F.; D’Arienzo, S.; Forni, S.; Tulli, G.; Rossolini, G.M. Diagnostic stewardship for sepsis: The need for risk stratification to triage patients for fast microbiology workflows. Future Microbiol. 2019. [Google Scholar] [CrossRef]
- Tacconelli, E.; Gorska, A.; de Angelis, G.; Lammens, C.; Restuccia, G.; Schrenzel, J.; Huson, D.; Carević, B.; Preoţescu, L.; Carmeli, Y. Estimating the association between antibiotic exposure and colonization with extended-spectrum β-lactamase-producing Gram-negative bacteria using machine learning methods: A multicentre, prospective cohort study. Clin. Microbiol. Infect. 2020, 26, 87–94. [Google Scholar] [CrossRef] [Green Version]
- Giacobbe, D.R.; Mikulska, M.; Viscoli, C. Recent advances in the pharmacological management of infections due to multidrug-resistant Gram-negative bacteria. Expert Rev. Clin. Pharmacol. 2018, 11, 1219–1236. [Google Scholar] [CrossRef]
- Tamma, P.D.; Cosgrove, S.E.; Maragakis, L.L. Combination therapy for treatment of infections with gram-negative bacteria. Clin. Microbiol. Rev. 2012, 25, 450–470. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Paul, M.; Dickstein, Y.; Schlesinger, A.; Grozinsky-Glasberg, S.; Soares-Weiser, K.; Leibovici, L. Beta-lactam versus beta-lactam-aminoglycoside combination therapy in cancer patients with neutropenia. Cochrane Database Syst. Rev. 2013. [Google Scholar] [CrossRef]
- Ong, D.S.; Frencken, J.F.; Klein Klouwenberg, P.; Juffermans, N.; van der Poll, T.; Bonten, M.J.; Cremer, O.L. Short-course adjunctive gentamicin as empirical therapy in patients with severe sepsis and septic shock: A prospective observational cohort study. Clin. Infect. Dis. 2017, 64, 1731–1736. [Google Scholar] [CrossRef] [PubMed]
- Fiore, M.; Corrente, A.; Pace, M.C.; Alfieri, A.; Simeon, V.; Ippolito, M.; Giarratano, A.; Cortegiani, A. Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis. Antibiotics 2021, 10, 79. [Google Scholar] [CrossRef] [PubMed]
- De Waele, J.J.; Akova, M.; Antonelli, M.; Canton, R.; Carlet, J.; De Backer, D.; Dimopoulos, G.; Garnacho-Montero, J.; Kesecioglu, J.; Lipman, J.; et al. Antimicrobial resistance and antibiotic stewardship programs in the ICU: Insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018, 44, 189–196. [Google Scholar] [CrossRef]
- Tabah, A.; Bassetti, M.; Kollef, M.H.; Zahar, J.R.; Paiva, J.A.; Timsit, J.F.; Roberts, J.A.; Schouten, J.; Giamarellou, H.; Rello, J.; et al. Antimicrobial de-escalation in critically ill patients: A position statement from a task force of the European Society of Intensive Care Medicine (ESICM) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Critically Ill Patients Study Group (ESGCIP). Intensive Care Med. 2020, 46, 245–265. [Google Scholar] [CrossRef]
- Weiss, E.; Zahar, J.R.; Garrouste-Orgeas, M.; Ruckly, S.; Essaied, W.; Schwebel, C.; Timsit, J.F. De-escalation of pivotal beta-lactam in ventilator-associated pneumonia does not impact outcome and marginally affects MDR acquisition. Intensive Care Med. 2016, 42, 2098–2100. [Google Scholar] [CrossRef]
- Leone, M.; Bechis, C.; Baumstarck, K.; Lefrant, J.Y.; Albanèse, J.; Jaber, S.; Lepape, A.; Constantin, J.M.; Papazian, L.; Bruder, N.; et al. De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: A multicenter non-blinded randomized noninferiority trial. Intensive Care Med. 2014, 40, 1399–1408. [Google Scholar] [CrossRef]
- Montravers, P.; Tubach, F.; Lescot, T.; Veber, B.; Esposito-Farèse, M.; Seguin, P.; Paugam, C.; Lepape, A.; Meistelman, C.; Cousson, J.; et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: The DURAPOP randomised clinical trial. Intensive Care Med. 2018, 44, 300–310. [Google Scholar] [CrossRef] [PubMed]
- Armand-Lefèvre, L.; Angebault, C.; Barbier, F.; Hamelet, E.; Defrance, G.; Ruppé, E.; Bronchard, R.; Lepeule, R.; Lucet, J.-C.; El Mniai, A.; et al. Emergence of imipenem-resistant gram-negative bacilli in intestinal flora of intensive care patients. Antimicrob. Agents Chemother. 2013, 57, 1488–1495. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Woerther, P.L.; Lepeule, R.; Burdet, C.; Decousser, J.W.; Ruppé, É.; Barbier, F. Carbapenems and alternative β-lactams for the treatment of infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae: What impact on intestinal colonisation resistance? Int. J. Antimicrob. Agents 2018, 52, 762–770. [Google Scholar] [CrossRef] [PubMed]
- Carlier, M.; Roberts, J.A.; Stove, V.; Verstraete, A.G.; Lipman, J.; de Waele, J.J. A Simulation Study Reveals Lack of Pharmacokinetic/Pharmacodynamic Target Attainment in De-escalated Antibiotic Therapy in Critically Ill Patients. Antimicrob. Agents Chemother. 2015, 59, 4689–4694. [Google Scholar] [CrossRef] [Green Version]
- Beganovic, M.; Cusumano, J.A.; Lopes, V.; LaPlante, K.L.; Caffrey, A.R. Comparative Effectiveness of Exclusive Exposure to Nafcillin or Oxacillin, Cefazolin, Piperacillin/Tazobactam, and Fluoroquinolones Among a National Cohort of Veterans with Methicillin-Susceptible Staphylococcus aureus Bloodstream Infection. Open Forum Infect. Dis. 2019, 6, ofz270. [Google Scholar] [CrossRef]
Pathogens Causing BSIs | Reported Cases of BSIs for Country (n = Number of Cases) | |||||
---|---|---|---|---|---|---|
World n. BSIs/n. Tot (66,729/319,581) | Asia n. BSIs/n. Tot (6914/29,359) | West Europe n. BSIs/n. Tot (20,897/77,554) | East Europe n. BSIs/n. Tot (6689/29,313) | South America n. BSIs/n. Tot (5188/19,462) | North America n. BSIs/n. Tot (27,041/163,893) | |
K. pneumoniae | 1882 | 150 | 551 | 561 | 335 | 285 |
Escherichia coli | 1747 | 266 | 612 | 285 | 164 | 420 |
Acinetobacter baumannii-calcoaceticus species complex | 855 | 98 | 188 | 345 | 155 | 69 |
Pseudomonas aeruginosae | 612 | 41 | 172 | 175 | 75 | 149 |
Proteus mirabilis | 351 | 13 | 142 | 50 | 14 | 132 |
E. cloacae species complex | 180 | 22 | 22 | 18 | 48 | 70 |
S. marcescens | 124 | 2 | 33 | 34 | 32 | 23 |
E. cloacae | 114 | 12 | 44 | 23 | 14 | 21 |
Morganella morganii | 87 | 3 | 23 | 10 | 6 | 45 |
K. oxytoca | 59 | 1 | 21 | 8 | 8 | 21 |
P. stuartii | 54 | 12 | 9 | 4 | 29 | |
Klebsiella aerogenes | 41 | 5 | 15 | 5 | 3 | 13 |
C. freundii species complex | 25 | 3 | 8 | 1 | 1 | 12 |
Citrobacter freundii | 14 | 7 | 7 | |||
Hafnia alvei | 14 | 9 | 1 | 4 | ||
A. lwoffii | 7 | 2 | 2 | 3 | ||
A. pittii | 7 | 1 | 2 | 2 | 2 | |
Providencia rettgeri | 5 | 1 | 4 | |||
Unspeciated acinetobacter | 5 | 1 | 2 | 2 | ||
A. berezinae | 4 | 3 | 1 | |||
A. nosocomialis | 3 | 1 | 1 | 1 | ||
A. ursingii | 3 | 3 | ||||
Enterobacter asburiae | 3 | 1 | 1 | 1 | ||
A. johnsonii | 2 | 1 | 1 | |||
C. koseri | 2 | 1 | 1 | |||
P. vulgaris group | 2 | 2 | ||||
Acinetobacter baumannii | 1 | 1 | ||||
A. radioresistens | 1 | 1 | ||||
E. hormaechei | 1 | 1 | ||||
K. variicola | 1 | 1 | ||||
Pluralibacter gergoviae | 1 | 1 | ||||
P. vulgaris | 1 | 1 | ||||
Raoultella ornithinolytica | 1 | 1 | ||||
Serratia liquefaciens | 1 | 1 | ||||
S. rubidaea | 1 | 1 | ||||
Providencia (unspeciated) | 1 | 1 | ||||
Raoultella (unspeciated) | 1 | 1 | ||||
Salmonella (unspeciated) | 1 | 1 | ||||
Serratia (unspeciated) | 1 | 1 |
MDR Bacteria Causing BSIs Form SENTRY Database | ||||||
---|---|---|---|---|---|---|
Pathogen | World | Asia | West Europe | East Europe | North America | South America |
K. pneumoniae | 1882 | 150 | 551 | 561 | 285 | 335 |
Escherichia coli | 1747 | 266 | 612 | 285 | 420 | 164 |
A. baumannii-calcoaceticus species complex | 855 | 98 | 188 | 345 | 69 | 155 |
Pseudomonas aeruginosae | 612 | 41 | 172 | 175 | 149 | 75 |
Proteus mirabilis | 351 | 13 | 142 | 50 | 132 | 14 |
E. cloacae species complex | 180 | 22 | 22 | 18 | 70 | 48 |
Serratia marcescens | 124 | 2 | 33 | 34 | 23 | 32 |
E. cloacae | 114 | 12 | 44 | 23 | 21 | 14 |
Morganella morganii | 87 | 3 | 23 | 10 | 45 | 6 |
K. oxytoca | 59 | 1 | 21 | 8 | 21 | 8 |
Providencia stuartii | 54 | 12 | 9 | 29 | 4 | |
Klebsiella aerogenes | 41 | 5 | 15 | 5 | 13 | 3 |
C. freundii species complex | 25 | 3 | 8 | 1 | 12 | 1 |
Citrobacter freundii | 14 | 7 | 7 | |||
Hafnia alvei | 14 | 9 | 1 | 4 | ||
A. lwoffii | 7 | 2 | 3 | 2 | ||
A. pittii | 7 | 1 | 2 | 2 | 2 | |
Providencia rettgeri | 5 | 4 | 1 | |||
unspeciated Acinetobacter | 5 | 1 | 2 | 2 | ||
A. berezinae | 4 | 3 | 1 | |||
A. nosocomialis | 3 | 1 | 1 | 1 | ||
A. ursingii | 3 | 3 | ||||
Enterobacter asburiae | 3 | 1 | 1 | 1 | ||
A. johnsonii | 2 | 1 | 1 | |||
C. koseri | 2 | 1 | 1 | |||
P. vulgaris group | 2 | 2 | ||||
Acinetobacter baumannii | 1 | 1 | ||||
A. radioresistens | 1 | 1 | ||||
E. hormaechei | 1 | 1 | ||||
K. variicola | 1 | 1 | ||||
Pluralibacter gergoviae | 1 | 1 | ||||
P. vulgaris | 1 | 1 | ||||
Raoultella ornithinolytica | 1 | 1 | ||||
Serratia liquefaciens | 1 | 1 | ||||
S. rubidaea | 1 | 1 | ||||
Providencia (unspeciated) | 1 | 1 | ||||
Raoultella (unspeciated) | 1 | 1 | ||||
Salmonella (unspeciated) | 1 | 1 | ||||
Serratia (unspeciated) | 1 | 1 |
Pathogen | n. Cases of Infections (n = Number) | n. BSIs Reported (n = Number) | Frequent Resistance Profiles in BSIs |
---|---|---|---|
Enterococcus spp. | 15,022 | 5154 | Van-A |
S. aureus | 69,918 | 13,608 | MRSA (less frequent VRSA) |
K. pneumoniae | 26,701 | 6901 | NMD-1 |
Acinetobacter spp. | 7151 | 1372 | IMP and OXA |
P. aeruginosae | 28,096 | 3264 | ESBLs, KPC, VIM and IMP |
Enterobacter spp. | 11,597 | 2241 | ESBLs |
Agent | MIC50 | MIC90 | Range | Count | CLSI a | EUCAST a | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
%S | %I | %R | Count | %S | %I | %R | Count | |||||
Amoxicillin-clavulanic acid | ≤1 | >8 | ≤1 to >8 | 1451 | ||||||||
Piperacillin-tazobactam | 8 | >16 | ≤2 to >16 | 3042 | 64.9 | 0.3 | 34.8 | 3040 | ||||
Imipenem | 1 | >8 | ≤0.12 to >8 | 1458 | ||||||||
Meropenem | 8 | >8 | 0.25 to >8 | 1458 | ||||||||
Cefepime | >16 | >16 | ≤0.5 to >16 | 1458 | ||||||||
Ceftaroline | 4 | >8 | ≤0.25 to >8 | 5045 | ||||||||
Ceftriaxone | >8 | >8 | ≤0.06 to >8 | 1458 | ||||||||
Trimethoprim-sulfamethoxazole | ≤0.5 | >4 | ≤0.5 to >4 | 1458 | ||||||||
Teicoplanin | ≤2 | >16 | ≤2 to >16 | 5145 | 85.3 | 2.1 | 12.7 | 5145 | 84.7 | 15.3 | 5145 | |
Vancomycin | 1 | >16 | ≤0.5 to >16 | 5145 | 83.1 | 0.6 | 16.3 | 5145 | 83.1 | 16.9 | 5145 | |
Tigecycline | ≤0.06 | 0.12 | ≤0.06 to >0.5 | 5142 | 99.6 | 0.4 | 4971 | |||||
Clindamycin | >2 | >2 | ≤0.25 to >2 | 2246 | ||||||||
Daptomycin | 1 | 2 | ≤0.25 to >8 | 5144 | ||||||||
Erythromycin | >16 | >16 | ≤0.12 to >16 | 2245 | 8.2 | 27.5 | 64.2 | 2245 | ||||
Linezolid | 1 | 2 | ≤0.25 to >8 | 5145 | 99.6 | 0.2 | 0.2 | 5145 | 99.8 | 0.2 | 5145 | |
Ampicillin | 1 | >8 | ≤0.5 to >8 | 5150 | 66.0 | 34.0 | 5150 | 65.7 | 0.4 | 34.0 | 5150 | |
Penicillin | 4 | >8 | ≤0.06 to >8 | 1448 | 61.8 | 38.2 | 1448 | |||||
Ciprofloxacin | >4 | >4 | ≤0.03 to >4 | 1457 | 36.8 | 8.6 | 54.6 | 1457 | 47.4 | 52.6 b | 1457 | |
Levofloxacin | 4 | >4 | ≤0.5 to >4 | 5151 | 48.4 | 2.0 | 49.6 | 5151 | 50.4 | 49.6 b | 5151 | |
Moxifloxacin | 2 | >4 | ≤0.25 to >4 | 4262 | ||||||||
Doxycycline | 8 | >8 | ≤0.06 to >8 | 1353 | 46.0 | 34.5 | 19.5 | 1353 | ||||
Minocycline | 8 | >8 | ≤1 to >8 | 3691 | 48.1 | 19.9 | 32.1 | 3691 | ||||
Tetracycline | >8 | >8 | ≤1 to >8 | 5141 | 32.9 | 1.0 | 66.1 | 5141 |
Agent | MIC50 | MIC90 | Range | Count | CLSI a | EUCAST a | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
%S | %I | %R | Count | %S | %I | %R | Count | |||||
Amoxicillin-clavulanic acid | ≤1 | >8 | ≤1 to >8 | 4055 | 65.7 | 34.3 | 4055 | |||||
Piperacillin-tazobactam | 1 | >16 | ≤0.5 to >16 | 8387 | 66.0 | 34.0 | 8387 | 66.0 | 34.0 | 8387 | ||
Imipenem | ≤0.12 | >8 | ≤0.12 to >8 | 4021 | 65.8 | 34.2 | 4021 | |||||
Meropenem | 0.12 | >8 | ≤0.06 to >8 | 4023 | 65.8 | 34.2 | 4023 | |||||
Cefepime | 4 | >16 | ≤0.5 to >16 | 4026 | 65.8 | 34.2 | 4026 | |||||
Ceftaroline | 0.25 | 1 | ≤0.06 to 8 | 13,099 | 95.8 | 4.2 | 0.1 b | 13,099 | 95.8 | 4.1 | 0.1 c | 13,099 |
95.8 | 4.2 d | 13,099 | ||||||||||
Ceftriaxone | 4 | >8 | ≤0.25 to >8 | 13,608 | 66.3 | 33.7 | 13,608 | |||||
Trimethoprim-sulfamethoxazole | ≤0.5 | ≤0.5 | ≤0.5 to >4 | 13,608 | 98.3 | 1.7 | 13,608 | 98.3 | 0.2 | 1.4 | 13,608 | |
Teicoplanin | ≤2 | ≤2 | ≤2 to 16 | 13,606 | >99.9 | <0.1 | 0.0 | 13,606 | 99.6 | 0.4 | 13,606 | |
Vancomycin | 1 | 1 | ≤0.12 to 2 | 13,607 | 100.0 | 0.0 | 0.0 | 13,607 | 100.0 | 0.0 | 13,607 | |
Tigecycline | 0.06 | 0.12 | ≤0.015 to 1 | 13,602 | >99.9 | 13,602 | >99.9 | <0.1 | 13,602 | |||
Clindamycin | ≤0.25 | >2 | ≤0.25 to >2 | 13,608 | 87.6 | 0.1 | 12.3 | 13,608 | 87.4 | 0.2 | 12.4 | 13,608 |
Daptomycin | 0.25 | 0.5 | ≤0.12 to 4 | 13,607 | 99.9 | 13,607 | 99.9 | 0.1 | 13,607 | |||
Azithromycin | 0.5 | >4 | ≤0.03 to >4 | 5034 | 59.2 | 1.2 | 39.6 | 5034 | 58.4 | 0.8 | 40.8 | 5034 |
Erythromycin | 0.25 | >8 | ≤0.12 to >8 | 13,603 | 59.1 | 4.4 | 36.5 | 13,603 | 59.5 | 1.6 | 38.9 | 13,603 |
Linezolid | 1 | 2 | ≤0.12 to 4 | 13,607 | 100.0 | 0.0 | 13,607 | 100.0 | 0.0 | 13,607 | ||
Oxacillin | 0.5 | >2 | ≤0.25 to >2 | 13,608 | 66.3 | 33.7 | 13,608 | 66.3 | 33.7 | 13,608 | ||
Penicillin | >2 | >2 | ≤0.06 to >2 | 8377 | 17.5 | 82.5 e | 8377 | 17.5 | 82.5 | 8377 | ||
Ciprofloxacin | 0.5 | >4 | 0.06 to >4 | 4021 | 68.4 | 1.8 | 29.7 | 4021 | ||||
Levofloxacin | 0.25 | >4 | ≤0.12 to >4 | 13,604 | 71.4 | 0.5 | 28.1 | 13,604 | ||||
Moxifloxacin | ≤0.12 | 4 | ≤0.12 to >4 | 11,069 | 72.0 | 5.6 | 22.4 | 11,069 | 71.6 | 28.4 | 11,069 | |
Doxycycline | ≤0.06 | 0.25 | ≤0.06 to >8 | 13,102 | 98.1 | 1.6 | 0.3 | 13,102 | 95.2 | 1.8 | 3.1 | 13,102 |
Minocycline | ≤0.06 | 0.12 | ≤0.06 to >8 | 9581 | 98.9 | 0.6 | 0.5 | 9581 | 97.7 | 2.3 | 9581 | |
Tetracycline | ≤0.5 | 1 | ≤0.5 to >8 | 13,602 | 92.6 | 0.8 | 6.6 | 13,602 | 91.3 | 0.6 | 8.1 | 13,602 |
Agent | MIC50 | MIC90 | Range | Count | CLSI a | EUCAST a | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
%S | %I | %R | Count | %S | %I | %R | Count | |||||
Amikacin | 1 | 8 | ≤0.25 to >32 | 6897 | 93.5 | 3.0 | 3.5 | 6897 | 91.3 | 8.7 b | 6897 | |
Gentamicin | ≤1 | >8 | ≤1 to >8 | 6899 | 81.6 | 0.9 | 17.5 | 6899 | 81.0 | 19.0 b | 6899 | |
Tobramycin | 0.5 | >8 | ≤0.12 to >8 | 6897 | 74.1 | 4.8 | 21.1 | 6897 | 72.5 | 27.5 b | 6897 | |
Amoxicillin-clavulanic acid | 4 | >8 | ≤1 to >8 | 4662 | 67.6 | 8.6 | 12.1 | 4662 | ||||
Ampicillin-sulbactam | 8 | >32 | ≤0.5 to >32 | 6901 | 56.4 | 7.0 | 36.7 | 6901 | 56.4 | 43.6 c | 6901 | |
Cefoperazone-sulbactam | ≤0.25 | >32 | ≤0.25 to >32 | 5723 | 78.1 | 21.9 d | 5723 | |||||
Ceftazidime-avibactam | 0.12 | 1 | ≤0.015 to >32 | 1074 | 98.5 | 1.5 | 1074 | 98.5 | 1.5 | 1074 | ||
Ceftolozane-tazobactam | 0.25 | >16 | ≤0.12 to >16 | 1073 | 84.5 | 1.4 | 14.1 | 1073 | 84.5 | 15.5 | 1073 | |
Piperacillin-tazobactam | 4 | >64 | ≤0.5 to >64 | 6891 | 78.1 | 5.1 | 16.8 | 6891 | 71.9 | 28.1 | 6891 | |
Doripenem | ≤0.12 | 2 | ≤0.12 to >4 | 5827 | 89.5 | 0.8 | 9.7 | 5827 | 89.5 | 0.8 | 9.7 | 5827 |
Ertapenem | 0.015 | >2 | ≤0.008 to >2 | 2888 | 85.2 | 1.0 | 13.8 | 2888 | 85.2 | 14.8 | 2888 | |
Imipenem | ≤0.12 | 2 | ≤0.12 to >8 | 6899 | 89.4 | 1.0 | 9.6 | 6899 | 90.4 | 1.2 | 8.4 | 6899 |
Meropenem | ≤0.06 | 2 | ≤0.06 to >8 | 6899 | 89.4 | 0.8 | 9.8 | 6899 | 90.2 | 9.8 e | 6899 | |
90.2 | 1.7 | 8.0 f | 6899 | |||||||||
Cefepime | ≤0.5 | >16 | ≤0.5 to >16 | 6899 | 70.9 | 2.5 | 26.6 g | 6899 | 69.9 | 2.0 | 28.1 | 6899 |
Cefoperazone | 0.5 | >32 | ≤0.25 to >32 | 1450 | 68.1 | 0.9 | 31.0 d | 1450 | ||||
Cefoxitin | 4 | >16 | 1 to >16 | 883 | 77.5 | 4.6 | 17.9 | 883 | ||||
Ceftaroline | 0.12 | >16 | ≤0.03 to >16 | 6738 | 65.0 | 2.0 | 33.0 | 6738 | 65.0 | 35.0 | 6738 | |
Ceftazidime | 0.25 | >16 | ≤0.12 to >16 | 6901 | 70.3 | 2.3 | 27.4 | 6901 | 68.4 | 1.9 | 29.7 | 6901 |
Ceftriaxone | ≤0.06 | >8 | ≤0.06 to >8 | 6899 | 68.8 | 0.6 | 30.6 | 6899 | 68.8 | 31.2 e | 6899 | |
68.8 | 0.6 | 30.6 f | 6899 | |||||||||
Cefuroxime | 4 | >64 | ≤0.5 to >64 | 2458 | 53.5 | 8.5 | 37.9 h | 2458 | 58.8 | 41.2 j | 2458 | |
58.8 | 3.3 | 37.9 i | 2458 | |||||||||
Trimethoprim-sulfamethoxazole | ≤0.5 | >4 | ≤0.5 to >4 | 6893 | 67.0 | 33.0 | 6893 | 67.0 | 1.1 | 31.9 | 6893 | |
Tigecycline | 0.5 | 1 | ≤0.06 to 8 | 6893 | 98.0 | 1.7 | 0.2 k | 6893 | ||||
Colistin | ≤0.5 | ≤0.5 | ≤0.5 to >8 | 6848 | 95.8 | 4.2 | 6848 | |||||
Polymyxin B | 1 | 1 | ≤0.25 to >8 | 1757 | ||||||||
Aztreonam | ≤0.12 | >16 | ≤0.12 to >16 | 6899 | 70.5 | 0.8 | 28.7 | 6899 | 69.2 | 1.3 | 29.5 | 6899 |
Ciprofloxacin | ≤0.03 | >4 | ≤0.03 to >4 | 6884 | 65.2 | 4.1 | 30.7 | 6884 | 65.2 | 4.1 | 30.7 | 6884 |
Levofloxacin | ≤0.12 | >4 | ≤0.12 to >4 | 6884 | 70.9 | 5.0 | 24.1 | 6884 | 70.9 | 5.0 | 24.1 | 6884 |
Moxifloxacin | ≤0.25 | >4 | ≤0.25 to >4 | 5465 | 60.3 | 39.7 | 5465 | |||||
Doxycycline | 2 | >8 | 0.12 to >8 | 6372 | 69.5 | 6.6 | 23.9 | 6372 | ||||
Minocycline | 2 | >8 | ≤0.06 to >8 | 6521 | 78.8 | 7.7 | 13.4 | 6521 | ||||
Tetracycline | 2 | >8 | ≤0.5 to >8 | 6526 | 68.6 | 3.8 | 27.6 | 6526 |
Agent | MIC50 | MIC90 | Range | Count | CLSI a | EUCAST a | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
%S | %I | %R | Count | %S | %I | %R | Count | |||||
Amikacin | >32 | >32 | ≤0.25 to >32 | 1370 | 46.4 | 2.6 | 50.9 | 1370 | 44.7 | 55.3 b | 1370 | |
Gentamicin | >8 | >8 | ≤1 to >8 | 1370 | 44.7 | 3.9 | 51.4 | 1370 | 44.7 | 55.3 b | 1370 | |
Tobramycin | 2 | >8 | ≤0.12 to >8 | 1370 | 56.2 | 1.2 | 42.6 | 1370 | 56.2 | 43.8 b | 1370 | |
Amoxicillin-clavulanic acid | >8 | >8 | ≤1 to >8 | 666 | ||||||||
Ampicillin-sulbactam | 32 | >32 | ≤0.5 to >32 | 1372 | 39.2 | 8.1 | 52.7 | 1372 | ||||
Cefoperazone-sulbactam | 16 | >32 | ≤1 to >32 | 1184 | ||||||||
Piperacillin-tazobactam | >64 | >64 | ≤0.5 to >64 | 1359 | 33.3 | 3.4 | 63.3 | 1359 | ||||
Doripenem | >4 | >4 | ≤0.12 to >4 | 1201 | 39.6 | 0.6 | 59.8 | 1201 | ||||
Imipenem | >8 | >8 | ≤0.12 to >8 | 1370 | 41.9 | 0.6 | 57.5 | 1370 | 41.9 | 0.6 | 57.5 | 1370 |
Meropenem | >8 | >8 | ≤0.06 to >8 | 1370 | 40.4 | 1.1 | 58.5 | 1370 | 40.4 | 59.6 c | 1370 | |
40.4 | 2.0 | 57.6 d | 1370 | |||||||||
Cefepime | >16 | >16 | ≤0.5 to >16 | 1370 | 35.5 | 4.4 | 60.1 | 1370 | ||||
Cefoperazone | >32 | >32 | 8 to >32 | 378 | ||||||||
Ceftazidime | >16 | >16 | ≤0.25 to >16 | 1372 | 34.4 | 3.9 | 61.7 | 1372 | ||||
Ceftriaxone | >8 | >8 | 0.25 to >8 | 1026 | 17.1 | 0.0 | 0.0 | 1026 | ||||
Trimethoprim-sulfamethoxazole | 4 | >4 | ≤0.5 to >4 | 1371 | 48.1 | 51.9 | 1371 | 48.1 | 2.5 | 49.5 | 1371 | |
Tigecycline | 1 | 4 | ≤0.12 to >8 | 1370 | ||||||||
Colistin | ≤0.5 | 2 | ≤0.5 to >8 | 1368 | 92.1 | 7.9 | 1368 | |||||
Polymyxin B | 1 | 2 | ≤0.25 to >8 | 443 | ||||||||
Aztreonam | >16 | >16 | 0.25 to >16 | 1372 | ||||||||
Ciprofloxacin | >4 | >4 | ≤0.03 to >4 | 1370 | 37.3 | 0.4 | 62.3 | 1370 | ||||
Levofloxacin | >4 | >4 | ≤0.12 to >4 | 1372 | 38.6 | 3.7 | 57.7 | 1372 | 37.6 | 0.4 | 62.0 | 1372 |
Moxifloxacin | >4 | >4 | ≤0.25 to >4 | 1122 | ||||||||
Doxycycline | 1 | >8 | ≤0.06 to >8 | 1124 | 65.4 | 1.3 | 33.3 | 1124 | ||||
Minocycline | 0.5 | >8 | ≤0.06 to >8 | 1348 | 75.8 | 6.7 | 17.5 | 1348 | ||||
Tetracycline | >8 | >8 | ≤0.5 to >8 | 1165 | 39.5 | 9.8 | 50.7 | 1165 |
Agent | MIC50 | MIC90 | Range | Count | CLSI a | EUCAST a | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
%S | %I | %R | Count | %S | %I | %R | Count | |||||
Amikacin | 4 | 16 | ≤0.25 to >32 | 3264 | 92.6 | 1.5 | 5.9 | 3264 | 92.6 | 7.4 b | 3264 | |
Gentamicin | 2 | >8 | ≤1 to >8 | 3264 | 86.0 | 3.5 | 10.5 | 3264 | ||||
Tobramycin | 0.5 | >8 | ≤0.12 to >8 | 3264 | 88.8 | 0.6 | 10.6 | 3264 | 88.4 | 11.6 b | 3264 | |
Ampicillin-sulbactam | >32 | >32 | 4 to >32 | 3264 | ||||||||
Cefoperazone-sulbactam | 4 | >32 | ≤1 to >32 | 2743 | ||||||||
Ceftazidime-avibactam | 2 | 8 | 0.25 to >32 | 428 | 93.9 | 6.1 | 428 | 93.9 | 6.1 | 428 | ||
Ceftolozane-tazobactam | 0.5 | 2 | ≤0.12 to >16 | 435 | 93.8 | 0.9 | 5.3 | 435 | 93.8 | 6.2 | 435 | |
Piperacillin-tazobactam | 4 | >64 | ≤0.5 to >64 | 3259 | 79.3 | 10.0 | 10.7 | 3259 | ||||
Doripenem | 0.5 | >4 | ≤0.12 to >4 | 2827 | 80.3 | 6.0 | 13.7 | 2827 | ||||
Imipenem | 1 | >8 | ≤0.12 to >8 | 3264 | 75.6 | 3.8 | 20.6 | 3264 | ||||
Meropenem | 0.5 | >8 | ≤0.06 to >8 | 3254 | 78.4 | 5.3 | 16.3 | 3254 | 78.4 | 21.6 c | 3254 | |
78.4 | 10.1 | 11.4 d | 3254 | |||||||||
Cefepime | 2 | 16 | ≤0.5 to >16 | 3256 | 83.5 | 8.9 | 7.6 | 3256 | ||||
Cefoperazone | 8 | >32 | 0.25 to >32 | 768 | ||||||||
Ceftazidime | 2 | >16 | ≤0.25 to >16 | 3257 | 81.1 | 4.4 | 14.5 | 3257 | ||||
Trimethoprim-sulfamethoxazole | 4 | >4 | ≤0.5 to >4 | 3257 | ||||||||
Colistin | 1 | 2 | ≤0.5 to >8 | 3264 | 99.3 | 0.7 | 3264 | |||||
Polymyxin B | 2 | 2 | ≤0.25 to 4 | 937 | ||||||||
Aztreonam | 8 | >16 | 0.25 to >16 | 3257 | 70.3 | 11.8 | 17.8 | 3257 | ||||
Ciprofloxacin | 0.12 | >4 | ≤0.03 to >4 | 3259 | 76.5 | 3.5 | 20.0 | 3259 | ||||
Levofloxacin | 0.5 | >4 | ≤0.12 to >4 | 3253 | 69.9 | 7.3 | 22.8 | 3253 | ||||
Moxifloxacin | 1 | >4 | ≤0.25 to >4 | 2626 | ||||||||
Minocycline | >8 | >8 | 0.25 to >8 | 3164 |
Agent | MIC50 | MIC90 | Range | Count | CLSI a | EUCAST a | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
%S | %I | %R | Count | %S | %I | %R | Count | |||||
Amikacin | 1 | 2 | ≤0.25 to >32 | 2239 | 98.6 | 0.3 | 1.1 | 2239 | 97.9 | 2.1 b | 2239 | |
Gentamicin | ≤1 | ≤1 | ≤1 to >8 | 2241 | 92.5 | 0.8 | 6.7 | 2241 | 91.7 | 8.3 b | 2241 | |
Tobramycin | 0.5 | 4 | ≤0.12 to >8 | 2238 | 90.9 | 1.9 | 7.2 | 2238 | 89.6 | 10.4 b | 2238 | |
Amoxicillin-clavulanic acid | >8 | >8 | ≤1 to >8 | 1451 | 3.3 | 1.4 | 57.5 | 1451 | ||||
Ampicillin-sulbactam | 32 | >32 | 0.5 to >32 | 2233 | 17.2 | 20.1 | 62.7 | 2233 | 17.2 | 82.8 c | 2233 | |
Cefoperazone-sulbactam | 0.5 | 16 | ≤0.25 to >32 | 1853 | 82.6 | 17.4 d | 1853 | |||||
Ceftazidime-avibactam | 0.25 | 0.5 | 0.03 to 32 | 337 | 99.7 | 0.3 | 337 | 99.7 | 0.3 | 337 | ||
Ceftolozane-tazobactam | 0.25 | 8 | ≤0.12 to >16 | 337 | 84.3 | 3.0 | 12.8 | 337 | 84.3 | 15.7 | 337 | |
Piperacillin-tazobactam | 2 | 64 | ≤0.5 to >64 | 2237 | 81.1 | 9.8 | 9.1 | 2237 | 77.2 | 22.8 | 2237 | |
Doripenem | ≤0.12 | ≤0.12 | ≤0.12 to >4 | 1903 | 98.1 | 0.5 | 1.4 | 1903 | 98.1 | 0.5 | 1.4 | 1903 |
Ertapenem | 0.06 | 0.5 | ≤0.008 to >2 | 883 | 90.8 | 4.5 | 4.6 | 883 | 90.8 | 9.2 | 883 | |
Imipenem | 0.25 | 1 | ≤0.12 to >8 | 2240 | 97.8 | 0.8 | 1.4 | 2240 | 98.6 | 0.4 | 1.0 | 2240 |
Meropenem | ≤0.06 | 0.12 | ≤0.06 to >8 | 2240 | 98.3 | 0.3 | 1.4 | 2240 | 98.6 | 1.4 e | 2240 | |
98.6 | 0.7 | 0.7 f | 2240 | |||||||||
Cefepime | ≤0.5 | 4 | ≤0.5 to >16 | 2238 | 88.8 | 4.3 | 6.9 g | 2238 | 83.1 | 8.5 | 8.4 | 2238 |
Cefoperazone | 0.5 | >32 | ≤0.25 to >32 | 471 | 76.2 | 1.9 | 21.9 d | 471 | ||||
Cefoxitin | >16 | >16 | 2 to >16 | 286 | 3.1 | 1.7 | 95.1 | 286 | ||||
Ceftaroline | 0.25 | >16 | ≤0.03 to >16 | 2200 | 66.4 | 3.7 | 29.9 | 2200 | 66.4 | 33.6 | 2200 | |
Ceftazidime | 0.5 | >16 | ≤0.12 to >16 | 2241 | 73.6 | 1.1 | 25.3 | 2241 | 69.8 | 3.7 | 26.4 | 2241 |
Ceftriaxone | 0.25 | >8 | ≤0.06 to >8 | 2219 | 68.4 | 1.5 | 30.1 | 2219 | 68.4 | 31.6 e | 2219 | |
68.4 | 1.5 | 30.1 f | 2219 | |||||||||
Cefuroxime | 16 | >64 | 0.5 to >64 | 646 | 12.7 | 44.4 | 42.9 h | 646 | ||||
43.5 | 13.6 | 42.9 i | 646 | |||||||||
Trimethoprim-sulfamethoxazole | ≤0.5 | >4 | ≤0.5 to >4 | 2237 | 84.4 | 15.6 | 2237 | 84.4 | 0.2 | 15.4 | 2237 | |
Tigecycline | 0.5 | 1 | ≤0.06 to >8 | 2240 | 98.6 | 1.4 | 0.1 j | 2240 | ||||
Colistin | ≤0.5 | >8 | ≤0.5 to >8 | 2166 | 78.8 | 21.2 | 2166 | |||||
Polymyxin B | 1 | >8 | ≤0.25 to >8 | 539 | ||||||||
Aztreonam | ≤0.12 | >16 | ≤0.12 to >16 | 2235 | 74.0 | 1.7 | 24.3 | 2235 | 71.5 | 2.5 | 26.0 | 2235 |
Ciprofloxacin | ≤0.03 | 1 | ≤0.03 to >4 | 2235 | 85.7 | 3.1 | 11.2 | 2235 | 85.7 | 3.1 | 11.2 | 2235 |
Levofloxacin | ≤0.12 | 1 | ≤0.12 to >4 | 2237 | 89.4 | 2.5 | 8.2 | 2237 | 89.4 | 2.5 | 8.2 | 2237 |
Moxifloxacin | ≤0.25 | 2 | ≤0.25 to >4 | 1732 | 79.3 | 20.7 | 1732 | |||||
Doxycycline | 2 | 8 | ≤0.06 to >8 | 2039 | 87.7 | 5.2 | 7.0 | 2039 | ||||
Minocycline | 2 | 8 | 0.25 to >8 | 2057 | 88.9 | 4.8 | 6.3 | 2057 | ||||
Tetracycline | 2 | >8 | ≤0.5 to >8 | 2069 | 85.1 | 3.2 | 11.7 | 2069 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Di Franco, S.; Alfieri, A.; Pace, M.C.; Sansone, P.; Pota, V.; Fittipaldi, C.; Fiore, M.; Passavanti, M.B. Blood Stream Infections from MDR Bacteria. Life 2021, 11, 575. https://doi.org/10.3390/life11060575
Di Franco S, Alfieri A, Pace MC, Sansone P, Pota V, Fittipaldi C, Fiore M, Passavanti MB. Blood Stream Infections from MDR Bacteria. Life. 2021; 11(6):575. https://doi.org/10.3390/life11060575
Chicago/Turabian StyleDi Franco, Sveva, Aniello Alfieri, Maria Caterina Pace, Pasquale Sansone, Vincenzo Pota, Ciro Fittipaldi, Marco Fiore, and Maria Beatrice Passavanti. 2021. "Blood Stream Infections from MDR Bacteria" Life 11, no. 6: 575. https://doi.org/10.3390/life11060575