Duke University Medical Center Clinical Microbiology Laboratory Durham, North Carolina

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1 Duke University Medil Center Clinil Miroiology Lortory Durhm, North Crolin SUMMARY OF ANTIMICROBIAL SUSCEPTIBILITY TEST RESULTS 2017 HOURS OF OPERATION: 24 hours per dy 365 dys per yer. TELEPHONE: A ertified medil tehnologist is on duty t ll times. CONSULTATIONS: Pge 970-GERM An Adult Infetious Diseses Fellow or Pge A Peditri Infetious Diseses Fellow A Miroiology Attending is on ll t ll times. 5/2018

2 TABLE 1. Grm-positive Coi, Perent Suseptile Bet-ltms Other Antimiroils (MIC rekpoint, µg per ml) (MIC rekpoint, µg per ml) Miroorgnism (No. tested) AMP NAF CFZ CLI ERY VAN F/M* T-S TET (8) (2) (8) (0.5) (0.5) (2) (32) (2/38) (4) Enterooi (1147) 82 N R R N R N E. felis (900) 99 N R R N R N E. feium (216) 11 N R R N R N Enteroous spp (31) 81 N R R N R N Stphyloous ureus (2352) e MSSA (1415) N e MRSA (937) R R R e Stphyloous spp., ogulse- N N N 100 d negtive (279) MSSA = methiillin-suseptile S. ureus MRSA = methiillin-resistnt S. ureus Suseptile MIC rekpoint is 0.25 µg/ml for ogulse-negtive stphylooi (CoNS). d Suseptile MIC rekpoint is 4 µg/ml for CoNS. e Isoltes suseptile to tetryline re lso onsidered suseptile to doxyyline nd minoyline for treting unomplited skin infetions. * Applies only to urine isoltes Dt were otined y roth mirodilution, lterntive MIC methods, or disk diffusion testing ording to Clinil nd Lortory Stndrds Institute (CLSI [formerly NCCLS]) guidelines. Miroorgnisms from oth inptients nd outptients re inluded nd no ttempt ws mde to differentite nosoomil isoltes. Repeted isoltes from the sme ptient were exluded. Suseptile implies tht n infetion due to the miroorgnism my e ppropritely treted with the dosge of ntimiroil gent reommended for the infeting speies nd the site of infetion. MIC (minimum inhiitory onentrtion) is the lowest onentrtion of drug tht will inhiit growth of miroorgnism in vitro. N indites n gent not tested. R indites n gent to whih n orgnism is known to e intrinsilly resistnt or linilly ineffetive. For up to dte ost informtion for seleted ntimiroils see: AMK (mikin) CIP (iprofloxin) ERY (erythromyin) MXF (moxifloxin) T-S (trimethoprim-sulfmethoxzole) AMP (mpiillin) CLI (lindmyin) F/M (nitrofurntoin) NAF (nfillin) VAN (vnomyin) AMP-SUL (mpiillin-sultm) CPIM (efepime) GEN (gentmiin) PEN (peniillin) CAZ (eftzidime) CRO (eftrixone) IMP (imipenem) PIP-TAZ (piperillin-tzotm) CFX (efoxitin) CTX (efotxime) MER (meropenem) TET (tetryline) CFZ (efzolin) CXM (efuroxime) MET (metronidzole) TOB (tormyin)

3 TABLE 2. Grm-negtive Billi (ll soures exept urine ), Perent Suseptile Bet-ltms Aminoglyosides Other Antimiroils (MIC rekpoint, µg/ml) (MIC rekpoint, µg/ml) Miroorgnism (No. tested) AMP- CAZ CRO AMP CFZ PIP- CPIM MER GEN AMK TOB CIP T-S TAZ SUL Enteroteriee rekpoints (8) (8/4) (2) (4) (1) (2) (1) (16/4) (4) (16) (4) (1) (2/38) Non-fermenter rekpoints* Non-fermenter exeption rekpoint** (8) (8) (8) (2) (4)** (16/4) (4) (16) (4) (1) (2/38) Ainetoter spp. (48)* R 96 R N Ahromoter xylosoxidns/denitrifins (59) ** R N R Burkholderi epi omplex (44)** R R R 57 R N 85 R R R R R 56 Citroter freundii omplex (25) R R R Citroter koseri (18) R Enteroter erogenes (49) R R R Enteroter loe/surie (153) R R R Esherihi oli (423) Klesiell oxyto (53) R Klesiell pneumonie (240) R Morgnell morgnii (19) R 5 R Proteus mirilis (101) Pseudomons eruginos (690)* R R R 83 R R Serrti mresens (105) R R R Stenotrophomons mltophili (123)* R R R 42 R N R R R R R R 99 Non-urine soures inlude lood, respirtory, tissue, wound, nd sf. For Enteroteriee, eftrixone (CRO) usully predits suseptiility to efotxime. Clulted from fewer thn the stndrd reommendtion of 30 isoltes.

4 TABLE 3. Grm-negtive Billi (urine soure), Perent Suseptile Bet-ltms Aminoglyosides Other Antimiroils (MIC rekpoint, µg/ml) (MIC rekpoint, µg/ml) Miroorgnism (No. tested) AMP AMP- CFZ CAZ CXM CRO SUL PIP- CPIM MER TAZ GEN AMK TOB CIP F/M T-S Enteroteriee rekpoints (8) (8/4) (2) (4) (4) (1) (2) (1) (16/4) (4) (16) (4) (1) (32) (2/38) Non-fermenter rekpoints* (8) (8) (8) (2) (16/4) (4) (16) (4) (1) (2/38) C. freundii omplex (160) R R R 78 R C. koseri (141) R E. erogenes (212) R R R 81 R E.loe/surie (207) R R R 68 R E. oli (7145) ,d K. oxyto (134) R K. pneumonie (1463) R 83 93,d M. morgnii (51) R 12 R 69 R R 78 P. mirilis (662) ,d R 89 P. eruginos (314) * R R R 91 N N N N S. mresens (82) R R R 64 R R 98 Brekpoint for efuroxime p.o. For Enteroteriee, eftrixone (CRO) usully predits suseptiility to efotxime. Brekpoint of 16 µg/ml for these orgnisms is sed on unomplited urinry trt infetion. d Cefzolin predits suseptiility to orl ephlosporins, inluding ephlexin, efuroxime, nd efdinir when used for therpy of unomplited UTIs.

5 TABLE 4. Aneroes, Perent Suseptile AMP- SUL CLI (2*) IMP (4*) MER (4*) Miroorgnism (No. tested)** (8/4*) MET (8*) MXF (2*) PIP- TAZ (32/4*) Aneroi grm-positive oi (1692) Bteroides frgilis group (30) Cutiterium (formerly Propioniterium) nes (18) Fusoterium spp (55) Prevotell spp (63) **Isoltes olleted from seleted US hospitls: 1 Jnury Deemer 2016 * CLSI Interpretive Ctegory Brekpoint for Suseptile (ug/ml) Pigmented grm-negtive illi (Prevotell nd Porphyromons spp.), Fusoterium spp., nd neroi grm-positive oi (Peptoous, Peptostreptoous, Finegoldi, Peptoniphilus, nd Aneroous spp.) nd illi re usully suseptile to -ltm ntiiotis, lindmyin, nd metronidzole. Inludes Bteroides frgilis, B. thetiotomiron, B. ovtus,, B. vulgtus, B. uniformis, B. eggerthii, Prteroides distsonis. TABLE 5. Fstidious Miroorgnisms, Perent Suseptile 1. Streptoous pneumonie. (No. tested = 96). Brekpoints sed on Meningitis riteri for Streptoous pneumonie (MIC Brekpoint, µg per ml) % Suseptile % Intermedite % Resistnt Peniillin 64 ( 0.06) 36 ( 0.12) Ceftrixone or efotxime Vnomyin 85 ( 0.5) 100 ( 1) 13 (1) 2 ( 2) One Streptoous pneumonie ws isolted from CSF in Brekpoints sed on Non-meningitis riteri for Streptoous pneumonie (MIC Brekpoint, µg per ml) Peniillin Ceftrixone or efotxime Erythromyin 97 ( 2) 98 ( 1) 63 ( 0.25) 2 (4) 2 (2) 2 (0.5) 1 ( 8) 0 ( 4) 35 ( 1) Levofloxin 100 ( 2) 0 (4) 0 ( 8) Moxifloxin 100 ( 1) 0 (2) 0 ( 4) Erythromyin predits suseptiility nd resistne to zithromyin nd lrithromyin. 2. Hemophilus influenze. (No. tested = 142) All isoltes were non-type : 70% (99) were ß-ltmse negtive nd proly suseptile to mpiillin (moxiillin); 30% (43) were -ltmse positive nd therefore, resistnt to mpiillin (moxiillin). H. influenze is preditly suseptile to efotxime, eftrixone, nd usully to moxiillin-lvulnte nd efuroxime.

6 TABLE 6. Yests ( ) Cndid speies - % Suseptile (No. tested) MIC Drug Brekpoint C. lins C. tropilis C. glrt C. prpsilosis C. krusei (µg per ml) Mifungin % (287) % (269) 97% (67) 100% (31) 2 97% (78) Fluonzole 2 97% (364) 89% (100) 92% (112) 32 75% (388) d R Vorionzole % (355) 87% (97) --- e 97% (112) % (40) First isolte from eh episode of lood or normlly sterile site infetion ; Mifungin sine 2014 only. CLSI speies-speifi rekpoints. C. krusei usully is suseptile to mphoteriin B, ut inherently resistnt to fluonzole. d Suseptile-dose dependent (SDD); for C. glrt isoltes with MIC 32 µg/ml, ptients should reeive mximum dosge regimen of fluonzole. e CLSI interpretive rekpoints hve not een estlished for C. glrt nd vorionzole. Fluonzole resistnt isoltes typilly hve high MICs to vorionzole (Pfller et l. JCM, 2011). An epidemiologil utoff vlue ( 0.25 µg/ml) my e helpful in differentiting strins with resistnt muttions (CLSI M59 Doument). Among 382 Duke isoltes tested, 42% hd MICs 0.25 µg/ml. Additionl Informtion Cndid lusitnie is often resistnt to mphoteriin B, ut usully suseptile to fluonzole. Clinil nd Lortory Stndrds Institute (CLSI) interpretive rekpoints hve not een estlished for mphoteriin B. Bsed on niml model dt, isoltes with MIC vlues > 1 µg/ml re likely to e resistnt to mphoteriin B. Cryptoous neoformns is resistnt to ehinondins ut typilly suseptile to mphoteriin B nd fluonzole in the sene of prior exposure.