Antibiotic Profile. January - December 2015 ANTIBIOGRAM Q&A. Ciprofloxacin. Levofloxacin Colistin. Cephalothin** Ceftazidime. Ceftriaxone.

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1 Total Patients Isolets Tested Achromobacter xylosoxidans Citrobacter freundii Citrobacter species Enterobacter cloacae Enterobacter species Escherichia coli 1, Klebsiella pneumoniae Klebsiella species not pneumoniae Proteus mirabilis Pseudomonas aeruginosa Salmonella species not typhi Serratia species Shigella species Stenotrophomonas maltophilia Achromobacter xylosoxidans (CF) Pseudomonas aeruginosa (CF) Stenotrophomonas maltophilia (CF) Isolets Tested High Colistin Minocycline Streptomycin High Alpha streptococcus not Streptococcus pneumoniae Coagulase negative staphylococcus Enterococcus faecalis Enterococcus species Staphylococcus aureus 1, Streptococcus agalactiae (Group B Streptococcus) TOC* Streptococcus anginosus group Streptococcus pneumoniae Streptococcus pyogenes (Group A Streptococcus) TOC* Staphylococcus aureus (CF) Staphylococcus aureus, Resistant (CF) Staphylococcus aureus, Sensitive (CF) purposes, is the therapy of

2 High Streptomycin High Coagulase negative staphylococcus Enterococcus faecalis Enterococcus species Staphylococcus aureus Streptococcus pneumoniae Streptococcus pyogenes (Group A Streptococcus) TOC* Enterobacter cloacae Escherichia coli 1, Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Shigella species The antibiogram includes both the main campus and west campus emergency centers. The antibiogram accounts for 47% of total patient antibiogram isolates. The main campus emergency center accounts for 69% of total isolates, and the west campus accounts for 31% of total isolates. purposes, is the therapy of

3 Inpatients High Streptomycin High Alpha streptococcus not Streptococcus pneumoniae Coagulase negative staphylococcus Enterococcus faecalis Enterococcus species Staphylococcus aureus Streptococcus anginosus group Streptococcus pneumoniae Streptococcus pyogenes (Group A Streptococcus) TOC* Enterobacter cloacae Escherichia coli Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Stenotrophomonas maltophilia Pseudomonas aeruginosa (CF) The inpatient antibiogram includes both main campus and west campus isolates, but does not include isolates from the pavilion for women. The inpatient antibiogram accounts for 29% of the total antibiogram isolates. The four inpatient areas that comprise the top 48% of inpatient isolates are: WT-OR (23%), WT-PICU (11%), Pulmonary-14 th floor (8%), and 11 th floor WT-surgery care (6%). Colistin Imipenem Minocycline purposes, is the therapy of

4 Outpatients Staphylococcus aureus Staphylococcus aureus (CF) Staphylococcus aureus, Resistant (CF) Staphylococcus aureus, Sensitive (CF) Escherichia coli Klebsiella pneumoniae Pseudomonas aeruginosa Pseudomonas aeruginosa (CF) Achromobacter xylosoxidans (CF) Stenotrophomonas maltophilia (CF) The outpatient antibiogram includes all of the outpatient clinics, and accounts for 17% of the total patient isolates. The three clinics that account for 55% of the outpatient isolates are: Pulmonary medicineincluding CF (38%), urology clinic (11%), and special needs primary care clinic (6%). Colistin Minocycline purposes, is the therapy of

5 Neonatology Coagulase negative staphylococcus Staphylococcus aureus ORGANISM # % SUSCEPTIBILITY Escherichia coli The NICU antibiogram is comprised of isolates from the level 2 and level 3 newborn centers as well as the newborn center at the pavilion for women. The NICU antibiogram accounts for 3% of total patient isolates. 64% of NICU isolates come from level 3, 19% of NICU isolates come from level 2, and 17% of NICU isolates come from the pavilion NICU. purposes, is the therapy of

6 Pavilion ObGyn Rifampin Staphylococcus aureus Streptococcus agalactiae (Group B Streptococcus) TOC* ORGANISM # % SUSCEPTIBILITY Escherichia coli The pavilion OBGYN antibiogram does not include the Pavilion NICU patients; isolates from the non-nicu pavilion patients account for only 4% of the total patient isolates. 50% of pavilion patient isolates come from the woman s assessment center, 15% come from women s specialty, and 14% of isolates come from labor and delivery. purposes, is the therapy of

7 Q&A Antibiogram Q&A Q: What is an antibiogram? A: An antibiogram is a summary of microbial susceptibility data for a given patient population summarized in a manner that can readily aid physicians in selecting initial empiric antimicrobial therapy. Q: Why is the Antibiogram only available for the prior year? A: Typically 12 months of accumulated data are required to achieve an appropriate level of statistical significance. Hence the presentation of the prior year is common practice. Q: Why are some organisms not represented in the data? A: Not all drug/bug combinations are presented in an antibiogram because a minimum of thirty patient isolates are required to provide reliable indication of susceptibility. Q: If a patient has multiple isolates throughout a year, are all of them included in the antibiogram data? VIEW ANTIBIOTIC PROFILES A: No, only the first isolate of a species from an individual patient is included to ensure that the antibiogram most closely represents the likelihood of an organism being susceptible to a given drug on first presentation. For questions or additional information, please contact: James Dunn, Ph.D., D(ABMM) Director of Medical Microbiology and Virology Phone: jjdunn@texaschildrens.org Paula Revell, Ph.D., D(ABMM) Medical Microbiology and Virology Phone: parevell@texaschildrens.org