LPCH Data For Isolates
2014
Gram Negative Bacilli (a)
| Penicillins | Cephalosporins & Lactams | Carbapenems | Aminoglyc's | Others | Urines Only | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of Isolates9 (a) | Ampi- cillin ($) | Piper/ Tazo- bactam ($$$) | Cefur- oxime (IV) ($) | Ceftri- axone ($) | Ceft- azidime ($) | Cefe- pime ($) | Aztreo- nam ($$$) | Erta-penem ($$$) ??? | Mero-penem ($$$) | Ami- kacin ($$$) | Genta- micin ($$$) | Tobra- mycin ($$$) | Cipro- flox- acin ($) | Co-tri- moxa- zole ($) | Cefa- zolin ($) predicts 1st gen cephem | Nitro- furan- toin ($$$) | |
| Achromobacter xylosoxidans | 17 (b) | - | 94 | - | - | 71 | 18 | 0 | - | 88 | 0 | 0 | 0 | 24 | 100 | - | - |
| Acinetobacter baumannii | 5 (b,c) | - | - | - | - | 100 | 100 | - | - | 100 | 100 | 100 | 100 | 100 | 100 | - | - |
| Citrobacter freundii complex | 20 (b) | 0 | 68 | 0 | 65 | 65 | 100 | - | 94 | 100 | 92 | 84 | 84 | 95 | 60 | 0 | 86 |
| Enterobacter aerogenes | 22 (b,c) | 0 | 90 | 0 | 73 | 73 | 100 | 79 | 100 | 100 | 100 | 100 | 100 | 100 | 96 | - | 20 |
| Enterobacter cloacae complex | 62 | 0 | 79 | 0 | 65 | 74 | 100 | 77 | 70 | 100 | 100 | 97 | 97 | 98 | 83 | 0 | 25 |
| Escherichia coli | 300 | 44 | 97 | 91 | 93 | 96 | 96 | 96 | 99 | 100 | 100 | 90 | 90 | 87 | 65 | 78 | 93 |
| Klebsiella oxytoca | 37 | 0 | 88 | 86 | 92 | 100 | 100 | 80 | 100 | 100 | 100 | 94 | 94 | 91 | 89 | 75 | 68 |
| Klebsiella pneumoniae | 76 | 0 | 93 | 83 | 92 | 92 | 99 | 88 | 100 | 100 | 100 | 93 | 93 | 92 | 77 | 93 | 20 |
| Morganella morganii | 15 (b,c) | 0 | - | 0 | 93 | 100 | 100 | - | 100 | - | - | 93 | 100 | 80 | 80 | - | - |
| Proteus mirabilis | 27 (b) | 77 | 100 | 92 | 96 | 100 | 96 | 100 | 100 | 100 | 100 | 88 | 88 | 100 | 74 | 94 | 0 |
| Pseudomonas aeruginosa | 111 | - | 90 | - | - | 90 | 87 | 80 | - | 94 | 93 | 87 | 95 | 90 | - | - | - |
| Pseudomonas aeruginosa (CF-mucoid) (d) | 22 (b) | - | Pip 77 | - | - | 91 | 82 | 77 | Imp 73 | 77 | - | - | 95 | 59 | - | - | - |
| Pseudomonas aeruginosa (CF-non-mucoid) (d) | 53 | - | Pip 88 | - | - | 88 | 88 | 83 | Imp 75 | 77 | - | - | 88 | 83 | - | - | - |
| Salmonella spp. | 19 (b,c) | 83 | - | - | 84 | - | - | - | - | - | - | - | - | 53 | 95 | - | - |
| Serratia marcescens | 25 (b) | 0 | 95 | 0 | 88 | 96 | 100 | 95 | 100 | 100 | 100 | 100 | 96 | 96 | 100 | - | 0 |
| Stenotrophomonas maltophilia | 48 | - | - | - | - | - | - | - | - | - | - | - | Levo 81 | 94 | - | - | |
- Pip = Piperacillin; Imp = Imipenem; Levo = Levofloxacin
- (a) First isolate from each patient was included
- (b) Data from isolate totals <30 may be statistically unreliable
- (c) Includes isolates from 2013
- (d) Cystic fibrosis patient isolates tested by disk diffusion
Gram Positive Cocci
| Beta-Lactams | Others | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Number of Isolates | Oxa- cilli/ Naf- cillin ($$) | Penicillin or Ampicillin ($) | 1st Gener- ation cephem ($) | Cefur- oxime ($) | Ceftri- axone ($) | Mero- penem ($$$) | Genta- micin ($$$) | Cipro- floxacin ($) | Clinda- mycin (a) ($) | Erythro- mycin ($$) | Nitro- furantoin - urine ($$$) | Co-trimox- azole ($) |
Vanco- ($$) | Tetra- cycline ($) | Line- zolid ($$$$) | |||
| %S | %I | %R | ||||||||||||||||
| Staphylococcus aureus | 418 | 85 | (b) | - | - | 85 | - | - | - | 95 | - | 75 | 62 | - | 99 | 100 | - | - |
| MRSA only | 63 | 0 | 0 | - | - | 0 | - | - | - | 90 | - | 59 | 23 | - | 100 | 100 | 95 | - |
| Staphylococcus lugdunensis | 12 (c,d) | 100 | (b) | - | - | 100 | - | - | - | 100 | - | 100 | 100 | - | 100 | 100 | - | - |
| Staphylococcus sp., Coagulase-negative | 83 | 37 | (b) | - | - | 37 | - | - | - | 64 | - | 60 | 30 | - | 72 | 100 | - | - |
| Enterococcus faecium | 12 (c,d) | - | 25 | 0 | 75 | - | - | - | - | - | - | - | - | - | - | 42 | - | 75 |
| Enterococcus faecalis | 23 (c) | - | 100 | 0 | 0 | - | - | - | - | - | - | - | - | - | - | 100 | - | - |
| Enterococcus sp. (not identified to species) | 148 | - | 95 | 0 | 5 | - | - | - | - | - | 85 | - | - | 98 | - | 97 | - | - |
| Streptococcus group B (vag/anal screen) | 236 | - | 100 | 0 | 0 | - | - | - | - | - | - | 66 | - | - | - | - | - | - |
| viridans group streptococci | 38 | - | 76 | 21 | 3 | - | - | 97 | - | - | - | 89 | 56 | - | - | 100 | - | - |
| Streptococcus pneumoniae | 33 | - | 73(e) | - | 27 | - | 88 | 91(f) | 90 | - | - | 90 | 82 | - | 73 | 100 | - | - |
- (a) Testing for inducible clindamycin resistance performed on all staphylococci and group B strep isolates
- (b) Sensitivity confirmed by PCR per request
- (c) Data from isolate totals <30 may be statistically unreliable
- (d) Includes isolates from 2013
- (e) Based on meningitis interpretive criteria (more
conservative). Nonmeningitis
interpretation is 100% - (f) Ceftriaxone uses the meningitis interpretive criteria (more conservative)
Candida
| Percent Susceptible By Broth Microdilution (YeastOne, Trek Diagnostics) | No. Tested | Amphotericin B ($$$$) | Fluconazole (b) ($) | Itraconazole (b) ($) | Voriconazol (b) ($$$$) | Caspofungin (c) ($$$) |
|---|---|---|---|---|---|---|
| Candida albicans | 22 (d,e) | 100 | 95 | 95 | 95 | 100 |
| Candida glabrata | 10 (d,e) | 100 | 70 | 40 | 89 | 100 |
| Candida parapsilosis | 8 (d,e) | 100 | 100 | 100 | 100 | 100 |
| Other Candida species | 19 (d,e) | 100 | (f) | 100 | 100 | 90 |
- (a) Suggested Ampho Resistant breakpoint MIC > or = 2 mcg/ml.
- (b) Susceptibe dose-dependend breakpoint MIC was used
- (c) Consult Peds ID if Caspofungin being considered for treatment
- (d) Data from isolate totals <30 may be statistically unreliable
- (e) Includes isolates from 2013
- (f) Species other than C. krusei are 100% susceptible; C. krusei is intrinsically resistant to fluconazole
Haemophilus influenzae
- For infections with beta-lactamase producing H. influenzae: cefuroxime, cefotaxime, trimethoprim/sulfamethoxazole, amoxicillin/clavulanate, or azithromycin is recommended. Cefotaxime or ceftriaxone is drug of choice for CNS infections.
- At LPCH, 79% (61/77) of H. influenzae are ampicillin susceptible.
Drug cost:
- Please chose the appropriate antibiotic based on best spectrum of coverage and lowest cost.
- Costs are reflective of 1 day of therapy based on
adult dosing and include drug levels and reformulations.
$ = $0-20
$$ = $20-50
$$$ = $50-100
$$$$ => $100
Clinical Microbiology
- Niaz Banaei, MD, Director
- Nancy Watz CLS, Laboratory Reference Technologist, Antibiotics
- Diane Getsinger, CLS, Laboratory Reference Technologist, AFB/Mycology
- Kathleen Gutierrez, MD, Integrated Pediatric Infectious Diseases Program Committee Committee Chair
