Inpatient & Outpatients       Jan‐ Dec 2015                

Susceptibilities shown in % susceptible

Class↓

Carbapen

em

Furane

s

Glycope

ptide

Macrolide

Streptogramin

Oxazolidiono

ne

Rifamycines

TMP/SM

X

Legend

Organisms alphabetically↓ Num

ber of 

Organisms

Amikacin

Gen

tamicin

Gen

tamycin 

syne

rgy

Streptom

ycin 

syne

rgy

Tobram

ycin

Ampicillin

Ampicillin/ 

Sulbactam

Benzylpe

nicillin 

(Pen

icillin G)

Oxacillin

Pip/Tazo

Cefazolin

 (1st)

Cefoxitin

 (2nd

)

Cefotaxime (3rd)

Ceftriaxon

e (3rd)

Ceftazidim

e (3rd)

Cefepime (4th)

Merop

enem

Nitrofurantoin

Vancom

ycin

Clindamycin

Clinda

mycin Resistance 

Indu

cible

Erythrom

ycin

Quinu

pristin

/ Dalfopristin

Line

zolid

Ciprofloxacin

Levoflo

xacin

Moxifloxacin

Rifampin†

Tetracycline

Tigeccline

SMX/TM

P

*: less than 30 isolates ‐ please exercise discretion when interpreting the susceptibility of these 

organisms because of the small sample size

Susceptability Breakpoints 16 4 4 8 8

S pneumo meningitis= 0.0625 

pneumonia= 2 Other= 

0.25ẋ staph=

2

16ẋ pseudo=64

8 8meningitis= 0.5 other= 

1

8 8 8 4 32

S. aureus = 2 

Strep=1 

Staph 0.5 Strep 0.25

0.5 1Staph 4 

Other 2

1 2 Strep 1 other 2 1 4

Staph= 0.5 

Enterococcus/Strep= 

40

Acinetobacter sp. 18* ~ 83 83 94 57 86 78 78 0 86 86 ~ ~ 72

Citrobacter sp. (All) 78 100 96 56 92 24 88 90 100 100 80 94 94 ~ ~ ~ 92

C. freundii 46 100 93 96 87 80 83 100 100 83 91 91 ~ ~ ~ 87

Enterobacter sp. (All) 95 100 95 96 82 86 87 98 98 20 93 93 ~ ~ ~ 93

E. aerogenes 27* 100 100 100 85 89 89 100 100 7 100 100 ~ ~ ~ 100

E. cloacae complex 57 100 95 96 82 86 86 98 98 25 91 91 ~ ~ ~ 89

Enterococcus sp. (All) 212 68 72 86 ~ 86 ~ ~ 93 92 15 8 100 58 59 ~ 20 100

E. faecalis 193 68 74 94 ~ 93 ~ ~ 99 97 17 0 100 62 64 ~ 21 100

E. faecium 18* 72 61 11 ~ 11 ~ 44 50 0 89 100 11 6 ~ 17 100

Escherichia coli 1365 100 93 95 57 65 97 90 87 96 96 97 100 94 80 80 ~ ~ ~ 77

ESBL + E. coli 57 100 81 72 0 46 95 9 37 18 21 23 100 81 14 14 ~ ~ ~ 47

Klebsiella sp. (All) 358 100 98 99 82 95 82 87 96 96 97 100 44 97 97 ~ ~ ~ 91ESBL + Klebsiella sp. 14* 100 79 93 14 43 0 86 29 21 21 100 29 79 79 ~ ~ ~ 71

Morganella morganii 16* 100 69 75 0 94 25 94 81 100 100 63 63 ~ 56

Proteus sp. (All) 193 100 84 89 65 80 100 78 82 88 89 90 99 48 48 ~ 59

P. mirabilis 186 100 84 88 67 80 100 80 81 89 88 89 99 46 46 ~ 58

Providencia sp. 18* 100 6 6 0 89 89 100 89 89 100 50 50 ~ 78

Pseudomonas aeruginosa 124 98 86 95 100 88 86 88 69 63 ~Serratia sp. 22* 100 86 82 18 32 86 95 95 95 73 73 ~ 95Staphylococcus sp. (All) 621 ~ 97 ~ ~ ~ 10 56 ~ ~ ~ ~ ~ ~ ~ 99 98 69 88 39 100 100 64 65 81 100 87 100 93 ~ : not tested

S. aureus (All) 469 ~ 98 ~ ~ ~ 10 55 ~ ~ ~ ~ ~ ~ ~ 99 98 71 89 40 100 100 61 62 81 100 88 100 97 $: less than $100MRSA 215 ~ 97 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 99 98 57 91 9 100 100 29 30 65 100 85 100 95 $$‐ $100‐$250MSSA 263 ~ 99 ~ ~ ~ 18 100 ~ ~ ~ ~ ~ ~ ~ 100 98 81 87 65 100 100 86 87 94 100 91 100 98 $$$‐ $250‐$500

S. epidermidis 38 ~ 95 ~ ~ ~ 3 50 ~ ~ ~ ~ ~ ~ ~ 100 97 61 87 21 100 100 58 58 84 100 89 100 66 $$$$‐ >= $1000S. haemolyticus 28* ~ 82 ~ ~ ~ 11 43 ~ ~ ~ ~ ~ ~ ~ 96 96 57 82 18 96 100 61 64 75 96 61 100 82

Stenotrophamonas maltophi 12* ~ ~ ~ 92 ~ ~ ~ 92Streptococcus agalactiae 134 100 ~ 100 ~ ~ ~ ~ 67 100 ~ ~ ~ ~ 100 3 67 98 100 ~ 98 ~ 18 100 100

Streptococcus pneumoniae

10* ~ ~

meningitis= 50 pneumonia=100

~ ~ ~ ~

meningitis=90 other

meningitis=80 other=1

00

~ ~ ~ ~ 100 50 50 100 ~ 90 ~ 80 ~ 80

Approx. drug charge/day ‡ $$ $$ $$ $$$ $$$ $$$ $$$ $$$ $$ $$$ $$ $$$ $$$ $$$$ $ $$ $$$ $$$$ $$$$ $ $$ $$$$ $$ $$$$ $

Tetracyclines

Aminoglycosides (AMG) Cephalosporins (generation)Penicillins

Fluo

roqu

inolon

es (FQs)

Lincosam

ide

†: Do not use as monotherapy

Black fields: bacteria is intrinsicly resistant to antibiotic or should not be used clinically

Blue highlight: gram negative organism

‡: severe disease in 70kg patient without renal impairment or 

monitoring

TMP/SMX: Trimethoprim/Sulfamethoxazole

PIP/TAZO: Piperacillin/Tazobactam

Shaded fields: test does not apply to organism

Green highlight: non‐formulary medications

Red highlight: gram positive organism

Carbopenem resistant organisms

# of

 isol

ates

Am

ikac

inGen

tam

icin

Tobr

amyc

inCe

fepi

me

Ceftaz

idim

eCe

ftria

xone

Cipr

oflo

xacin

Levo

floxa

cin

TMP /

SMX

E. gergoviae 1 S S SS. marcescens 1 S S S S S S S S S

Bacterial Endocarditis ProphylaxisRecent guidelines from the American Heart Association and American College of Cardiology are suggesting antimicrobial prophylaxis only for patients having underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis:

• Prosthetic heart valve• History of endocarditis

Congenital Heart Disease:• Un-repaired cyanotic CHD, Including palliative

shunts or conduits• Completely repaired congenital heart defect with

prosthetic material or device during the first six months after the procedure

• Repaired CHD with residual effects at the site or adjacent to the site of a prosthetic patch or device

• Cardiac transplant recipients with cardiac valvular disease.

Treatment: 30-60 minutes pre-procedure (pediatric doses in parentheses) Dental, Oral, Respiratory Tract or Esophageal procedures**

• Amoxicillin 2 g PO (50mg/kg)• Ampicillin 2 g 111/11.1 (50mg/kg)• Clindamycin 600mg PO/III (20mg/kg)• Cephalexin 2 g PO (50mg/kg)• Cettriaxone 1 g IV/N (50mg/kg)• C,efazotin 1 g 111/IM (50mg/kg)• Azithromycin SOOmg PO (15mg/kg)

**Involving incision, biopsy, of respiratory tract or manipulation of gingival tissue, periapical region of teeth or perforation of oral mucosa (Viridans streptococci (alpha-hemolytic streptococci) most prevalent bacteria)

Infected skin, skin structure or musculoskeletal tissue• Treat with agents active against staphylococci and

beta-hemolytic streptococci: antistaphytococcal PCN (oxacilin) or cephalosporin (see above doses).

• If MRSA suspected i1 wound/skin structure: (or intolerant of beta-lactam) Vancomycin 15.20mg/kg for adults up to 2g or (15mg/kg to 1g for children)

GL or Genitourinary Tract (prophylaxis solely to prevent endocarditis NOT Recommended)

IF: An enterococcal UTI present, treat before an elective GU procedure or include enterococcal coverage perioperatively for non-elective procedures.

IF: Existing GL or GU infection or receiving perioperative antibiotics to prevent surgical site infection or sepsis, it is reasonable to include an agent with activity against enterococci.

Antibiogram 2015

SM

Antibiogram 2015

Prepared by Microbiology & Pharmacy Departments

740.393.9655 | 740.393.9669

References:

1. Bratzler DW, Dellinger EP, Olsen KM, Perl T, Auwaerter, PG, Balon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. Am J Health System Pharm. 2013 Feb 1:70(3):195-283.

2. Performance Standards for Antimicrobial Susceptibility Testing: Twenty-second informational Supplement. Clinical and Laboratory Standards Institute. 2012 Jan:32(3):29.