SENTRY Antimicrobial Surveillance Program Report - Semantic Scholar

BJID 2004; 8 (February)

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SENTRY Antimicrobial Surveillance Program Report: Latin American and Brazilian Results for 1997 through 2001 Helio S. Sader1,2, Ronald N. Jones2, Ana C. Gales1, Juliana B. Silva1, Antonio C. Pignatari1 and the SENTRY Participants Group (Latin America)

Special Laboratory of Clinical Microbiology1, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, SP, Brazil; The JONES Group / JMI Laboratories2, North Liberty, Iowa, USA

The alarming emergence and spread of antimicrobial resistance among common bacteria threatens the effectiveness of therapy for many infections. Surveillance of antimicrobial resistance is essential to identify the major problems and guide adequate control measures. Several resistance surveillance programs have been implemented in North America and Europe in the last decade; however, very few programs have assessed antimicrobial resistance in Latin American countries. The SENTRY Antimicrobial Surveillance Program was initiated in 1997 and represents the most comprehensive surveillance program in place at the present time worldwide. The SENTRY Program collects consecutive isolates from clinically documented infections in more than 80 medical centers worldwide (10 in Latin America). The isolates are collected according to the type of infection (objectives) and susceptibility tested in a central microbiology laboratory by reference broth microdilution methods according to NCCLS guidelines. The Program also incorporated molecular typing (ribotyping and PFGE) and resistance mechanism analysis of selected isolates. In this report we present a very broad analysis of the data generated by testing almost 20,000 bacterial isolates against more than 30 antimicrobial agents. The susceptibility results (MIC50, MIC90 and % susceptible) are presented in 11 tables according to the organism and site of infection. The data from Brazil, as well as the data from isolates collected in 2001, are analyzed separately. This report allows the evaluation of the activities numerous antimicrobial agents against clinical isolates collected in Latin American countries. Key Words: SENTRY, antimicrobial resistance, nosocomial infection, surveillance, Latin America.

The importance of antimicrobial resistance among nosocomial and community-acquired pathogens is acknowledged worldwide. Well-designed antimicrobial surveillance programs are essential in the fight against these cases of resistance [1]. These programs provide important information on the trend in microbial occurrence in different geographical regions and antimicrobial resistance patterns in nosocomial and Received on 13 July 2003; revised 29 january 2004. Address for correspondence: Dr.Helio S. Sader, MD., PhD. The JONES Group / JMI Laboratories. 345 Beaver Kreek Centre, Suite A, North Liberty, Iowa 52317. Phone: 1 (319) 665-3370. Fax: 1 (319) 665-3371. E-mail: [email protected] The Brazilian Journal of Infectious Diseases 2004;8(1):25-79 © 2004 by The Brazilian Journal of Infectious Diseases and Contexto Publishing. All rights reserved.

community-acquired infections. Such information has the potential to guide therapeutic approaches for serious infections, pending directions from local susceptibility testing, and may have value in the prevention and control of infection. However, in order to be effective, surveillance data should be analyzed, tabulated and rapidly presented to the medical community and infection control workers. The SENTRY Antimicrobial Surveillance Program (SENTRY) was initiated in 1997 and was designed to monitor the spectrum of microbial pathogens and antimicrobial resistance trends for both nosocomial and community-acquired infections on a global scale, by using validated reference quality identification and susceptibility testing methods in designated central laboratories [1-4]. Rapid communication and dissemination of information

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Antimicrobial Surveillance Program Report: Latin American and Brazil

is a guiding principal of the SENTRY Program. This report is a summary of the data collected in the Latin American region during the first five years of the SENTRY Program (1997 through 2001).

Material and Methods Study design The SENTRY Program was established to monitor the important pathogens and antimicrobial resistance patterns of nosocomial and community-acquired infections via a broad network of sentinel hospitals distributed by geographic location and size. The collection of isolates was done according to the site of infection and/or type of patient. The types of infections that are monitored include bloodstream infections or true bacteremia (BSI, objective A), communityacquired respiratory tract infections (CARTI, objective B), lower respiratory tract infections in hospitalized patients (LRTI, objective C), skin and soft tissue infections in hospitalized patients (SSTI, objective D), urinary tract infections in hospitalized patients (UTI, objective E), gastroenteritis (objective G), β-haemolytic streptococci from community-acquired infections (objective H), and assessment of pathogens and resistance patterns among infected patients in the intensive care unit (ICU, objective I). Objectives G, H and I were introduced into the program in 2001. Each participating center contributed results (organism identification, date of isolation, antimicrobial susceptibility profile, etc.) for the first 20 consecutive episodes of BSI per month from January 1997 to December 2001, 100 consecutive episodes of LRTI and CARTI per year from 1997 to 2001, 50 consecutive isolates from SSTI per year from 1997 to 2000, and 50 consecutive isolates from UTI per year from 1997 to 1999 and in 2001, 25 consecutive isolates of organisms considered producers of diarrheal diseases (gastroenteritis) collected in 2001, 25 consecutive β-haemolytic streptococci isolated from community-acquired infections in 2001, and 50 consecutive and clinically


relevant bacterial isolates from patients hospitalized in the ICU in 2001. Just one isolate per patient was included in the study and all isolates were saved on transport swabs and sent to the monitoring center (Iowa, USA) for storage and further characterization by reference identification and susceptibility testing methods. We evaluated all the isolates that were recovered and the data collected from January 1997 to December 2001. Participating centers The laboratories were distributed in various cites of six countries: Sao Paulo, Rio de Janeiro, Florianopolis, Porto Alegre, and Brasilia, Brazil; Buenos Aires and San Isidro, Argentina; Santiago (two centers), Chile; Medellin, Colombia; Mexico City, Mexico; and Montevideo, Uruguay. In 1998, the center located in Montevideo was replaced by a center in Caracas, Venezuela; and in 1999 the Brazilian center located in Rio de Janeiro was replaced by another Brazilian center in Porto Alegre, which is also located in the South region of Brazil. In 2001, the center located in Mendellin, Colombia was replaced by a center located in Brasilia, Brazil. The selection of participant centers was based on the principle that they should be representative in their respective geographic region. Species identification All isolates were identified at the participating institution by the routine methodology in use at each laboratory. On receipt at the monitoring center, isolates were subcultured on blood agar to ensure viability and purity. Species identification was confirmed by standardized methods or performed by using the Vitek System (bioMérieux, Hazelwood, MO) or API (bioMérieux, Hazelwood, MO). Isolates were frozen at -70°C until they were processed. Susceptibility testing Antimicrobial susceptibility testing of isolates was performed by reference broth microdilution methods,

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as described by the National Committee for Clinical Laboratory Standards (NCCLS) [5]. Microdilution trays were purchased from TREK Diagnostics (Cleveland, OH), MicroScan (West Sacramento, CA), and PML Microbiologicals (Wilsonville, OR). Antimicrobial agents were obtained from their respective manufactures as laboratory grade powder and included cephalosporins (cefepime, cefuroxime, cefotaxime, ceftriaxone, ceftazidime, cefazolin, cefoxitin, cefaclor, and cefixime), penicillins (ampicillin, penicillin, amoxicillin, and oxacillin), β-lactamase inhibitor combinations (amoxicillin-clavulanate, ticarcillin-clavulanate, and piperacillin-tazobactam), carbapenems (imipenem and meropenem), a monobactam (aztreonam), fluoroquinolones (ciprofloxacin, levofloxacin, gatifloxacin, and garenoxacin [formerly BMS 284756]), aminoglycosides (amikacin, gentamicin, and tobramycin), macrolides (erythromycin, azithromycin, and clarithromycin), glycopeptides (vancomycin and teicoplanin), the oxazolidinone linezolid, the streptogramin quinupristin-dalfopristin, and other drugs, such as clindamycin, chloramphenicol, tetracycline, rifampin, and trimethoprim-sulfamethoxazole. Quality control was performed by testing E. coli American Type Culture Collection (ATCC) 25922, Pseudomonas aeruginosa ATCC 27853, and other strains, as recommended by the NCCLS [5,6]. Interpretive criteria for each antimicrobial tested were those published by the NCCLS [5,6].

Results Almost 20,000 clinical isolates were analyzed during this period, and the frequencies of the different pathogens were investigated (Table 1). The antimicrobial susceptibility data for the year 2001 were analyzed separately (Tables 2-5), while the data for the entire 5-year period was also compiled (Tables 6-11). In addition, data collected in the participating Brazilian centers were analyzed separately from the data of the entire Latin American region (including

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Brazil). Minimum antimicrobial concentrations that inhibits 50% and 90% of the organism collection (MIC50 and MIC90, respectively) were presented only for the data of the entire region. Isolates collected from bloodstream infections and from lower respiratory tract infections (mainly pneumonia) in hospitalized patients were also analyzed separately (Tables 3, 5, 7 and 9). Two groups of pathogens, streptococci and extended-spectrum (ESBL)-producing strains, were analyzed separately due to their importance in community-acquired and nosocomial-acquired infections, respectively. Table 10 presents the antimicrobial susceptibility of streptococcal species, while Table 11 presents the antimicrobial susceptibility of ESBL-producing E. coli and Klebsiella pneumoniae.

Discussion We made a comprehensive analysis of the Latin American SENTRY Program data collected during the first five years of this global program. During this period, SENTRY has provided valuable information worldwide [2-4, 7-9]. The rapid publication of regional susceptibility data concerning a large number of antimicrobial agents, indexed by the site of infection, allowed the detection of considerable geographical variation of the in vitro activity of several antimicrobial agents and made evident the emergence of important resistance patterns. These data have been used to guide empirical therapy and the local implementation of control or intervention measures. In addition, SENTRY Program data has guided the implementation of more focused, local surveillance studies, which have been designed based on local resistance problems detected by SENTRY Program results [10,11]. The SENTRY Program has shown that resistance among Gram-negative bacteria seems to be much higher in Latin America when compared to other regions of the world, especially North America and Europe [1,2]. On the other hand, some resistance problems related to Gram-positive cocci, such as glycopeptideresistance among enterococci, and high-level penicillin-

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1,921 1,620 589 352 840 1,221 26 517 380 280 187 3 92 157 179 9 86 51 98 32

BSI (9,059) — — — 1,046 — — 1,006 — — — — 347 — — — — — — — —

CARTI (2,409) 760 128 862 158 328 41 143 165 299 58 18 29 42 89 2 — 60 24 19 10

LRTI (3,346) 584 233 210 — 103 99 — 100 73 137 31 — 72 30 6 — 7 21 5 15

SSTI (1,780)

203 20 — 77 35 79 8 — 112 28 5 — — 34 1 19

29 1,121 147

UTI (1,961)

Objectivea (no. of isolates)

102 55 85 4 43 16 1 38 39 29 1 — 10 16 — — 13 6 1 4

ICU (470)

3,396 3,164 1,893 1,560 1,517 1,397 1,176 897 826 583 443 379 328 320 308 209 166 136 124 80

Totalb (19,547) Antimicrobial Surveillance Program Report: Latin American and Brazil

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a. The collection of isolates was done according to the site of infection and/or type of patient. The monitored infections included bloodstream infections or true bacteremias (BSI, objective A), community-acquired respiratory tract infections (CARTI, objective B), lower respiratory tract infections in hospitalized patients (LRTI, objective C), skin and soft tissue infections in hospitalized patients (SSTI, objective D), urinary tract infections in hospitalized patients (UTI, objective E), gastroenteritis (objective G), β-haemolytic streptococci from community-acquired infections (objective H), and assessment of pathogens and resistance patterns among infected patients in the intensive care unit (ICU, objective I). Objectives G, H and I were introduced to the Program in 2001. b. Includes isolates from all objectives, including objectives G and H, which were not analyzed separately. c. CoNS: coagulase-negative staphylococci. d. The majority of β-haemolytic streptococci (198 isolates) were recovered from objective H in 2001 e. The majority of Shigella spp. (200 isolates) and a large number of Salmonella spp. (116 isolates) were collected from objective G (gastroenteritis) in 2001.

Staphylococcus aureus Escherichia coli Pseudomonas aeruginosa Streptococcus pneumoniae Klebsiella pneumoniae CoNSc Haemophilus influenzae Enterobacter spp. Acinetobacter spp. Enterococcus spp. β-haemolytic streptococcid Moraxella catarrhalis Proteus spp. Serratia spp. Salmonella spp.e Shigella spp.e Stenotrophomonas maltophilia Citrobacter spp. Viridans group streptococci Morganella morganii

Pathogen

Table 1. Occurrence of the major pathogens isolated in Latin America during the period of January 1997 to December 2001 according to SENTRY objectivesa

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Table 2. Antimicrobial activity and spectrum of drugs tested against the most prevalent Gram-negative pathogens isolated in the year 2001 througout Latin America and in Brazil alone Pathogen (no total/Brazil)/ Antimicrobial agent Acinetobacter spp. (166/90) Cephalosporins Ceftazidime Cefepime Other β-lactams Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Polymyxin B Enterobacter spp. (186/94) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam

Latin America

Brazil % Susceptiblea

% Susceptiblea

MIC50

MIC90

>16 >16

>16 >16

30.1 34.3

28.9 36.7

>16 128 >64 1 2

>16 >128 >64 >8 >8

7.2 39.8 27.7 83.7 81.9

5.6 30 31.1 97.8 96.7

>32 >8 16

>32 >/8 >16

38 30.7 45.8

35.6 38.9 50

>2 >4 >4 >4

>2 >4 >4 >4

28.3 28.9 30.1 29.5

33.3 33.3 34.4 34.4

8

>8

33.7

36.7

>2 2 2

31.3 98.2

36.7 —

>16 >16 >32 1 16 >32 >32 >16 >16

4.3 38.7 2.2 61.3 61.8 84.9

4.3 48.9 2.1 73.4 73.4 95.7

>16 0.5 16 4

>16 >16 >128 >64

2.7 60.2 51.1 65.6

3.2 72.3 64.9 76.6

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Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Polymyxin B E. coli (457/158) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/


0.5 8 >16

84.9 67.7 62.4

91.5 81.9 78.7

0.03 0.03 0.03 0.12

>2 >4 >4 >4

78 78.5 79.6 76.9

89.4 91.5 92.6 90.4

8

71.5

81.9

8

68.8 79.9

77.7 —

32 >8 >16

65.4 49.6 54.5

54.7 42.5 45.7

1 4

>2 >4

49.9 49.6

46.2 46.6

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d d d d

d d d d d

d d

d d d

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Antimicrobial Surveillance Program Report: Latin American and Brazil BJID 2004; 8 (February)

Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Polymyxin B Salmonella spp. (151/57) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Serratia spp. (66/39) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime

4 >4

>4 >4

46.4 42.8

43.3 40.9

>8

>8

1

0.4

>2 2

>2 2

5.4 97

5.3

16 >128 64 2 0.25

1.5 74.2 50 71.2 98.5 100

0 74.4 43.6 61.5 100 100

4 32 >8 >16

68.2 59.1 51.5

64.1 53.8 43.6

0.12 0.25 0.25 2

>2 >4 >4 >4

72.7 77.3 77.3 60.6

59 64.1 64.1 53.8

>8

>8

0

8

>2 >8

66.7 0

64.1

8

2.9 45.7 21.7 0 2.9

0 63 29.6 0 7.4

>32 >8 >16

10 5.7 7.1

11.1 11.1 11.1

>2 1 1 4

55.7 98.6 98.6 88.6

48.1 100 100 81.5

>8

11.4

11.1

16 Ticarcillin/clavulanate 32 Piperacillin/tazobactam 64 Imipenem >8 Meropenem >8 Aminoglycosides Amikacin >32 Gentamicin >8 Tobramycin >16 Fluoroquinolones Ciprofloxacin 1 Levofloxacin 0.5 Gatifloxacin 0.5 Garenoxacin 1 Others Tetracycline >8 Trimethoprim/ sulfamethoxazole 4 for resistant); b. Percentage of strain with MIC > 2 µg/mL, indicating possible ESBL production; c. Percentage of non-β-lactamase producing strains. This value also represents the susceptibility rate to amoxicillin. d. Breakpoints for Haemophilus influenzae were used; e. The results were not analyzed because the number of isolates was low (32 >16

56.2 b 56.2 b

56.8b 56.8b

0.5 16 8 >32 >16 >64 >8

56.2 7.5 56.2 b 56.2 b 56.2 b

56.8 8.8 56.8b 56.8b 56.8b

0.12 0.5

>8 >8

60.5 50.7

59.9 48.9

0.5 0.25 0.12 0.03

>2 4 4 1

58.4 62.9 89.7 97.8

59.9 65 86.9 97.9

2 1 2 0.5 2

55.3 75.7 72.2 74.1 82.4 73.4 100 99.9 100 100

56.2 63.8 67.8 59.6 70.8 56.2 100 99.7 100 100

16 4

>32 >16

20.7b 20.7b

17.7b 17.7b

>8 8 8 >32 >16 >64 >8

20.7 11 20.7b 20.7b 20.7b

17.7 10.2 17.7b 17.7b 17.7b

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Clindamycin Erythromycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Gentamicin Rifampin Chloramphenicol Tetracycline Doxycycline Trimethoprim/sulfamethoxale Vancomycin Teicoplanin Quinupristin/dalfopristin Linezolid


0.12 >8

>8 >8

53.7 28.5

46.9 27.9

0.5 0.5 0.25 0.06

>2 >4 2 2

52.4 63 93.1 95.1

44.9 57.1 92.5 94.6

8 0.25 8 2 >16 >8 >4 >2 2 8 0.5 2

44.9 74.8 68.3 77.6 88.6 48.8 100 92.3 99.2 100

39.7 70.7 59.2 74.1 87.8 35.4 100 91.2 100 100

90.2 70.6 90.2c 90.2c

96.2 61.5 96.2c 96.2c

6.9

9.6

46.1 54.9 54.9 92.2

38.5 46.2 46.2 59.6

55.9 62.7 22.5 57.8 29.4 37.3 73.5 93.1 94.1 6.9 100

42.3 82.7 15.4 42.3 30.8 36.5 61.5 92.3 92.3 3.8 100

Enterococcus spp. (102 / 52) β-lactams 8 >8 Fluoroquinolones Ciprofloxacin 2 >2 Levofloxacin 2 >4 Gatifloxacin 1 >4 Garenoxacin 1 4 Others Gentamicin (HL) 1,000 Streptomycin (HL) 2,000 Rifampin >2 >2 Chloramphenicol 8 >16 Tetracycline >8 >8 Doxycycline >4 >4 Trimethoprim/sulfamethoxale 2 Vancomycin 1 2 Teicoplanin 0.12 0.5 Quinupristin/dalfopristin 8 >8 Linezolid 2 2

a. Interpreted by NCCLS 2003 criteria, when available [6]; b. Susceptibility is predicted by the oxacillin result [6]; c. Susceptibility is predicted by the ampicillin result [6]; CoNS: coagulase-negative staphylococci; HL: High level aminoglycoside resistance screen. www.bjid.com.br

BJID 2004; 8 (February) Antimicrobial Surveillance Program Report: Latin American and Brazil

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Table 4. Antimicrobial activity and spectrum of drugs tested against the most prevalent Gram-negative pathogens isolated in the year 2001 throughout Latin America and in Brazil alone, from patients with bacteremia and pneumonia. Pathogen/ Antimicrobial agents

Acinetobacter spp. Cephalosporins Ceftazidime Cefepime Other β-lactams Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Enterobacter spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate

% Susceptible strains (number of isolates tested) Latin America

Brazil

Bacteremia (67)

Pneumonia (60)

Bacteremia (40)

44.8 49.3

21.7 23.3

47.5 55

13.8 17.2

11.9 38.8 44.8 88.1 85.1

6.7 11.7 15 86.7 85

10 47.5 50 97.5 97.5

3.4 10.3 6.9 100 96.6

50.7 46.3 58.2

33.3 21.7 38.3

55 57.5 70

17.2 24.1 34.5

44.8 46.3 46.3 46.3

18.3 18.3 20 20

52.5 52.5 52.5 52.5

13.8 13.8 17.2 17.2

47.8

21.7

52.5

17.2

46.3

23.3

52.5

24.1

Bacteremia (117)

Pneumonia (31)

Bacteremia (59)

Pneumonia (14)

3.4 37.6 0.9 63.2 61.5 86.3

6.5 41.9 6.5 51.6 61.3 77.4

3.4 50.8 0 78 72.9 96.6

7.1 42.9 7.1 57.1 57.1 92.9

3.4 62.4 51.3

3.2 51.6 51.6

3.4 72.9 67.8

7.1 57.1 57.1

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Pneumonia (29)

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Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

67.5 100 99.1

61.3 96.8 96.8

83.1 100 98.3

57.1 92.9 92.9

84.6 69.2 63.2

87.1 67.7 67.7

93.2 83.1 79.7

85.7 85.7 85.7

76.9 78.6 79.5 77.8

71 71 71 71

86.4 89.8 91.5 88.1

92.9 92.9 92.9 92.9

67.5

83.9

79.7

85.7

65

80.6

74.6

85.7

E. coli (381) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline

Bacteremia (14)

Pneumonia (122)

Bacteremia (a)

Pneumonia

a

87.4 91.6 93.4 96.3 (4.7)b 96.3 (5.8)b 97.6

64.3 85.7 85.7 92.9 (7.1)b 100 (7.1)b 100

93.4 95.1 93.4 98.4 (2.5)b 96.7 (3.3)b 98.4

41.7 96.6 (4.7)b 71.4 95.8 100 100

28.6 92.3 (7.7)b 64.3 85.7 92.9 100

45.1 98.4 (1.6)b 82 96.7 100 100

a

a a a a a

a a a a a

96.9 90.3 90.3

92.9 85.7 92.9

100 95.9 95.9

a

85.8 87.4 87.1 85.8

85.7 85.7 92.9 92.9

91.8 94.3 93.4 91.8

a

61.5

a

58.8

42.9

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a a

a a a



Trimethoprim/ sulfamethoxazole K. pneumoniae Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole P. aeruginosa Cephalosporins Ceftazidime Cefepime Other β-lactams Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem

52.8

57.1

Bacteremia (176)

Pneumonia (73)

56.3 58.5 84.7 66.5 (37.5)b 69.9 (36.4)b 79

57.5 58.9 84.9 69.9 (39.7)b 82.2 (28.8)b 82.2

5.7 1.4 b 64.8(36.9) 74(32.9)b 56.3 57.5 73.9 84.9 100 100 99.4 100

45.1

41

a

Bacteremia Pneumonia (90) (28) 56.7 60 86.7 64.4 (37.8)b 70 (37.8)b 75.6

53.6 53.6 82.1 57.1 (42.9)b 67.9 (39.3)b 71.4

4.4 0 b 62.2(35.6) 57.1(42.9)b 55.6 50 74.4 78.6 100 100 98.9 100

84.1 63.6 59.7

89 71.2 63

90 65.6 62.2

85.7 67.9 50

84.7 86.9 86.9 84.1

90.4 91.8 91.8 90.4

86.7 86.7 86.7 86.7

85.7 85.7 85.7 85.7

64.2

78.1

62.2

67.9

65.3

78.1

58.9

71.4

Bacteremia (119)

Pneumonia (203)

Bacteremia (58)

68.1 66.4

50.7 49.8

69 65.5

40.8 38.7

47.9 59.7 79.8 79 80.7

39.4 47.8 56.2 53.7 57.3

51.7 58.6 75.9 75.9 77.6

31 38.7 46.5 41.5 45.1

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Pneumonia (142)

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Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Salmonella spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

73.9 63 67.2

61.1 43.3 50.7

70.7 69 69

51.4 35.9 41.5

60.5 60.5 56.3 51.3

43.3 42.9 39.9 37.4

70 70.7 5.2 62.1

40.1 40.8 38 35.9

3.4

0

1.7

0

2.5

3.9

3.4

7.7

Bacteremia (35)

Pneumonia (a)

Bacteremia Pneumonia (a) (a)

100 91.4 97.1 100 100 100

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

91.4 100 91.4 97.1 100 100

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

100 97.1 97.1

a

a

a

a

a

a

a

a

a

100 100 100 100

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

a

85.7 100

www.bjid.com.br


Serratia spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Stenotrophomonas maltophilia Cephalosporins Ceftazidime Cefepime Other β-lactams Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin

Bacteremia (32)

Pneumonia (18)

43

Bacteremia Pneumonia (22) (a)

0 0 0 62.5 78.1 68.8

5.6 0 5.6 83.3 94.4 94.4

0 0 0 68.2 77.3 77.3

a

0 68.8 34.4 56.3 100 100

0 88.9 72.2 94.4 94.4 100

0 77.3 31.8 45.5 100 100

a

62.5 43.8 37.5

83.3 88.9 72.2

59.1 40.9 31.8

a

56.3 62.5 62.5 46.9

100 100 100 83.3

45.5 50 50 40.9

a

0

0

0

a

46.9

83.3

45.5

a

Bacteremia (38)

Pneumonia (19)

a a a a a

a a a a a

a a

a a a

Bacteremia Pneumonia (16) (a)

65.8 39.5

52.6 26.3

93.8 62.5

a

5.3 52.6 29.7 0 2.6

0 47.4 15.8 0 5.3

0 81.3 43.8 0 6.3

a

13.2 10.5

10.5 0

18.8 18.8

a

www.bjid.com.br

a

a a a a

a

44


Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

10.5

5.3

18.8

a

68.4 100 100 94.7

42.1 100 100 84.2

62.5 100 100 87.5

a

15.8

5.3

18.8

a

97.4

100

100

a

a a a

a. The results were not analyzed because the number of isolates was low ( 2 µg/mL, indicating possible ESBL production [6].

Table 5. Antimicrobial activity and spectrum of drugs tested against the most prevalent Gram-positive pathogens isolated in the year 2001 from patients with bacteremia and pneumonia Pathogen/ Antimicrobial agents S. aureus Cephalosporins Cefazolin Ceftriaxone Cefepime Other β-lactams Oxacillin Penicillin Amoxicillin/clavulanate Piperacillin/tazobactam Imipenem MLS Clindamycin Erythromycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Gentamicin Rifampin Chloramphenicol

% Susceptible strains (number of isolates tested) Latin America Bacteremia (389

Pneumonia (178)

Brazil Bacteremia Pneumonia (182) (105)

65b 65b 65b

43.3b 43.3b 43.3b

64.8b 64.8b 64.8b

47.6b 47.6b 47.6b

65 10 65b 65b 65b

43.3 2.8 43.3b 43.3b 43.3b

64.8 12.6 64.8b 64.8b 64.8b

47.6 3.8 47.6b 47.6b 47.6b

69.9 57.6

46.1 39.9

68.7 54.9

47.6 40

66.6 71.2 91.3 98.7

47.2 51.1 87.1 95.5

68.1 73.1 88.5 98.9

49.5 54.3 84.8 96.2

63.2 81.7 78.7

44.9 64 65.7

63.7 72.5 74.7

47.6 51.4 62.9

www.bjid.com.br



Tetracycline Doxycycline Trimethoprim/sulfamethoxale Vancomycin Teicoplanin Quinupristin/dalfopristin Linezolid CoNS Cephalosporins Cefazolin Ceftriaxone Cefepime Other β-lactams Oxacillin Penicillin Amoxicillin/clavulanate Piperacillin/tazobactam Imipenem MLS Clindamycin Erythromycin Fluoroquinolones Ciprofloxacin Gatifloxacin Levofloxacin Garenoxacin Others Gentamicin Rifampin Chloramphenicol Tetracycline Doxycycline Trimethoprim/sulfamethoxale Vancomycin Teicoplanin Quinupristin/dalfopristin Linezolid Enterococcus spp. β-lactams Ampicillin

81.2 87.4 79.7 100 99.7 100 100 Bacteremia (219)

62.9 75.3 64 100 100 100 100

67 76.4 62.1 100 99.5 100 100

Pneumonia Bacteremia (11) (123)

45

51.4 64.8 52.4 100 100 100 100 Pneumonia (11)

19.6b 19.6b 19.6b

54.5b 54.5b 54.5b

15.4b 15.4b 15.4b

54.5b 54.5b 54.5b

19.6 10.5 19.6b 19.6b 19.6b

54.5 36.4 54.5b 54.5b 54.5b

15.4 8.9 15.4b 15.4b 15.4b

54.5 36.4 54.5b 54.5b 54.5b

55.7 30.1

63.6 27.3

49.6 30.9

63.6 27.3

54.3 93.2 65.3 95.4

54.5 81.8 54.5 90.9

47.2 92.7 61 95.1

54.5 81.8 54.5 90.9

45.9 77.2 69.4 78.1 89 51.1 100 93.2 99.5 100

54.5 72.7 81.8 63.6 81.8 27.3 100 81.8 100 100

40.2 74 60.2 74 87.8 39.8 100 92.7 100 100

54.5 72.7 81.8 63.6 81.8 27.3 100 81.8 100 100

Bacteremia (64) 90.6

Pneumonia Bacteremia (d) (28) d

www.bjid.com.br

96.4

Pneumonia (d) d

46


Penicillin Amoxicillin/Clavulanate Piperacillin/Tazobactam MLS Erythromycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Gentamicin (HL) Streptomycin (HL) Rifampin Chloramphenicol Tetracycline Doxycycline Vancomycin Teicoplanin Quinupristin/dalfopristin Linezolid

d

76.6 90.6c 90.6c

d

7.8

d

d

50 62.5 60.9 90.6

d

60.9 62.5 28.1 62.5 32.8 42.2 96.9 96.9 7.8 100

d

d d d

d d d d d d d d d

64.3 96.4c 96.4c

d

10.7

d

d d

39.3 53.6 53.6 89.3

d

46.4 75 21.4 46.4 35.7 39.3 100 100 7.1 100

d

d d d

d d d d d d d d d

a. Interpreted by NCCLS 2003 criteria, when available [6]; b. Susceptibility is predicted by the oxacillin result [6]; c. Susceptibility is predicted by the ampicillin result [6]; d. The results were not analyzed because the number of isolates was low (16 16

>16 >16

28.6 35.4

27.3 33.8

>16 >128 >64 1 1

>16 >128 >64 >8 >8

7.6 24.8 26.8 86.9 86.8

6.5 28.3 28.8 90.8 90.8

www.bjid.com.br

% Susceptible

% Susceptible


Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

>32 >8 16

>32 >16 >16

34 32.9 41.7

32.3 37.8 51.8

>2 >4 4 >4

>2 >4 >4 >4

30.5 32.3 34.4 34.9

35.3 36.3 38.5 35.8

8

51

56.1

>1

>2

32.4

31

16 >16

82.4 51.5

85.3 47.1

>16 >128 64 >8 >8

19.1 17.6 67.6 52.9 76.5

20.6 14.7 64.7 52.9 85.3

>32 >16 >16

17.6 13.2 13.2

8.8 8.8 8.8

>2 4 >4 >4

60.3 80.9 77.9 66.7

70.6 82.4 79.4 76.9

>8

13.2

8.8

>1

79.4

97.1

>16 >16 >32 >32

19.1 56.6 20.6 70.6

18.6 55.8 20.9 65.1

Burkholderia cepacia (68/ 34) Cephalosporins Ceftazidime 4 Cefepime 8 Other β-lactams Aztreonam >16 Ticarcillin/clavulanate >128 Piperacillin/tazobactam 8 Imipenem 4 Meropenem 2 Aminoglycosides Amikacin >32 Gentamicin 16 Tobramycin >16 Fluoroquinolones Ciprofloxacin 1 Levofloxacin 1 Gatifloxacin 1 Garenoxacin 2 Others Tetracycline >8 Trimethoprim/ sulfamethoxazole < 0.5 Citrobacter spp. (136/ 43) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone

47

>16 8 >32 0.25

www.bjid.com.br

48


Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Enterobacter spp. (897/ 441) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin


1 0.12

>16 4

67.6 93.4

62.8 95.3

>16 0.25 4 4 0.5 0.06

>16 >16 >128 >64 1 0.12

12.5 66.2 59.6 68.4 100 100

11.6 60.5 55.8 67.4 100 100

2 16

81.6 79.4 73.5

74.4 74.4 71.8

0.25 2 4 4 >4

81.6 84.6 83.1 85.3

76.7 81.4 76.7 81

8

67.6

67.4

2

68.4

62.8

>16 >16 >32 0.5 16 >32 >32 >16 8

5.1 35.9 2.2 64.2 64 90.5

3.9 40.4 5.9 69.4 69.2 92.3

>16 0.25 16 4 0.5 16 >16 >128 >64 1 0.25

5.6 63.4 52.1 64.9 99.8 99.7

5.2 69.4 55.8 68.3 99.5 99.5

2 32 >8 >16

83.4 74.1 63

82.3 74.6 66.8

0.25

>2

80.2

82.8

www.bjid.com.br



Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole E. coli (3164/ 835) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

49

4 >4 >4

81.7 82.5 75

84.8 86.4 85.6

8

66.6

67.8

2

70.9

71.4

64 0.5 0.12

0 62.2 (41.7)b 50.4 66.8 99.8 99.4

0 57.7 (46.3)b 49 68.5 100 99.5

2 16 >16

80.7 65.1 53.9

81.6 63.1 51.3

0.25 2 4

86.5 88.7

88.9 89.6

www.bjid.com.br

100 100 100 100

100 100 100 100


Gatifloxacin Garenoxacin Others Tetracycline Choranphenicol Trimethoprim/ sulfamethoxazole

0.06 0.12

2 >4

89.8 87.1

90.3 85.6

16 >16

62.4 62.7

56 53.9

16 64 16 2 1

>16 >128 >64 >8 >8

44.5 55.6 72.1 71.9 74.8

38.2 47.8 64.6 62.5 65.8

4 4 1

>32 >16 >16

70 58.2 58.2

58.4 49.7 47.9

0.5 1 2 4

>2 >4 >4 >4

58.1 56.8 54.4 46.3

52.8 52.4 50.2 42

>8

>8

1.5

0.9

>2

>2

3.4

3.8

4 2 4 0.25 0.12 0.12

>16 >16 8 >32 2 >16

62.2 69.8 93.9 81.4 96.3 83.2

74.2 78.8 95.5 92.4 98.5 92.4

4

>16

52.4

56.1

www.bjid.com.br



Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Salmonella spp (308/ 97) Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others

53

0.12 4 >4 >4

76.2 79.6 76.8 75.1

92.4 95.5 93.9 87.8

>8

>8

5.5

9.1

2

61.6

71.2

16 >16 >128 >64 2 0.25

4.1 82.8 57.8 73.1 99.7 100

3 84 47.9 64.5 100 100

4 1 4

>32 >16 >16

73.4 66.6 54.4

66.9 56.2 45

0.25 2 4 >4 >4

74.1 82.2 80 62.5

59.8 69.8 67.5 51.7

>8

>8

7.5

4.7

2

66.9

58.6

2

25.8

14.9

>16 >16

57.8 31.3

66.1 35.5

>16 128 >64 >8 >8

5.4 56 33.3 1.2 4.8

4.8 69.4 40.3 0 6.5

>32 >16 >16

16.3 15.1 13.1

12.9 11.3 8.1

>2 4 2 4

43.4 88 91 82.4

33.9 90.3 93.5 78.4

>8

14.5

12.9

16 Ticarcillin/clavulanate 16 Piperacillin/tazobactam 64 Imipenem >8 Meropenem >8 Aminoglycosides Amikacin >32 Gentamicin >8 Tobramycin >16 Fluoroquinolones Ciprofloxacin 2 Levofloxacin 0.5 Gatifloxacin 0.5 Garenoxacin 1 Others Tetracycline >8 Trimethoprim/ sulfamethoxazole 32 >16

63.2b 63.2b 63.2b

62.7b 62.7b 62.7b

0.5 16 2 2 8 >32 >16 >64 >8

63.2 7.2 63.2 b 63.2 b 63.2b

62.7 9 62.7b 62.7b 62.7b

0.25 0.5

>8 >8

66 50.5

64.1 47.9

0.5 0.25 0.12 0.03

>2 4 4 2

64.5 66.3 89.6 97.6

63.4 64.8 87.8 96.9

1 1 2 0.5 4

62.7 76.6 64.4 71.1 83.7 75.8 100 99.6 99.7 100

61.9 67.8 63.2 60.9 75.2 63.5 100 99.6 99.9 100

16 >32 >16

22.8b 22.8b 22.8b

19.5b 19.5b 19.5b

8

>8

22.8

19.5

www.bjid.com.br



Penicillin Amoxicillin/clavulanate Piperacillin/tazobactam Imipenem MLS Clindamycin Erythromycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Gentamicin Rifampin Chloramphenicol Tetracycline Doxycycline Trimetoprim/sulfametoxale Vancomycin Teicoplanin Quinupristin/dalfopristin Linezolid Enterococcus spp. (583/ 243) β-lactams Ampicillin Penicillin Amoxicillin/Clavulanate Piperacillin/Tazobactam MLS Erythromycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Gentamicin (HL) Streptomycin (HL) Rifampin Chloramphenicol Tetracycline Doxycycline

8 32 >16 >64 >8

0.25 >8

>8 >8

55.3 35.3

46.3 34.6

0.5 0.25 0.12 0.03

>2 >4 2 2

56.9 65.7 93.8 91.5

47.9 58.1 92.8 92.4

8 0.25 8 16 >2 >16 >8 >4 >2 2 8 0.5 2

45.1 72 62.7 76.5 87.1 50.6 100 90.3 98.7 100

40.5 68.1 55.6 74.9 85.8 38.4 100 90.3 98.2 100

1 2 64

94.7 90.2 94.7c 94.7c

97.5 81.5 97.5c 97.5c

>8

>8

9.4

9.1

1 1 0.5 0.25

>2 >4 >4 4

52.7 65.7 73.9 93.6

46.9 56.3 66.7 94.9

8 >4

>1,000 2 >16 >8 >4

76.2 90.1 23.3 67.2 33.4 44.4

65 94.7 18.1 55.6 32.1 49.4

www.bjid.com.br

9.3 22.8b 22.8b 22.8b

57

8.2 19.5b 19.5b 19.5b

58


Vancomycin Teicoplanin Linezolid

1 0.25 2

2 0.5 2


97.5 98.1 96.4

97.5 97.5 97

a. Interpreted by NCCLS 2003 criteria, when available [6]; b. Susceptibility is predicted by the oxacillin result [6]; c. Susceptibility is predicted by the ampicillin result [6]; Abbreviations: HL - High level aminoglycoside resistance screen.

Table 8. Antimicrobial activity and spectrum of drugs tested against the most prevalent Gram-negative pathogens isolated from January 1997 to December 2001 throughout Latin America and in Brazil alone, from patients with bacteremia and pneumonia Pathogen/ Antimicrobial agent Acinetobacter spp. Cephalosporins Ceftazidime Cefepime Other β-lactams Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Burkholderia cepacia Cephalosporins Ceftazidime Cefepime

% Susceptible strainsa (number of isolates tested) Latin America

Brazil

Bacteremia (380)

Pneumonia (299)

Bacteremia (212)

40 46.1

17.7 25.8

40.6 45.8

12.2 19.4

11.8 35.8 37.6 88.9 89.5

4.3 13.4 16.4 85.3 84.3

10.8 40.1 39.6 91.5 92.5

2.2 12.9 15.1 89.2 88.5

43.2 44.2 52.4

23.1 23.4 32.7

43.9 49.5 64.7

17.3 23.7 36.2

42.9 45 45.5 48.9

18.7 21.1 24.1 24.5

46.7 48.6 48.6 48.7

20.1 20.1 25.2 19.7

59.9

46.2

65.9

46

42.4

23.4

40.6

19.4

Bacteremia (43)

Pneumonia (19)

Bacteremia (21)

Pneumonia (b)

79.1 48.8

84.2 57.9

85.7 33.3

b

www.bjid.com.br

Pneumonia (139)

b



Other β-lactams Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Gatifloxacin Levofloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Citrobacter spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin

59

16.3 14 62.8 48.8 79.1

15.8 26.3 84.2 57.9 68.4

19 9.5 52.4 38.1 85.7

b

16.3 7 9.3

21.1 26.3 21.1

4.8 4.8 4.8

b

65.1 76.7 81.4 62.5

47.4 78.9 84.2 75

71.4 76.2 81 66.7

b

9.3

26.3

4.8

b

74.4

89.5

95.2

b

Bacteremia (51)

Pneumonia (24)

Bacteremia (16)

Pneumonia (b)

15.7 51 15.7 62.7 60.8 92.2

33.3 54.2 33.3 66.7 66.7 91.7

12.5 50 12.5 56.3 56.3 87.5

b

17.6 56.9 52.9 66.7 100 100

12.5 66.7 62.5 75 100 100

12.5 50 37.5 62.5 100 100

b

84.3 78.4 72.3

79.2 83.3 73.7

75 62.5 62.5

b

82.4 82.4 80.4

83.3 95.8 95.8

75 75 75

b

www.bjid.com.br

b b b b

b b

b b b

b b b b b

b b b b b

b b

b b

60


Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Enterobacter spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole E. coli Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime


83.3

100

87.5

b

74.5

70.8

75

b

64.7

70.8

56.3

b

Bacteremia (517)

Pneumonia (165)

5.2 37.7 5.2 67.1 66.9 90.3

6.1 40.6 5.5 61.2 63 90.3

4.1 44.7 6 74.4 73.3 92.1

6.6 43.4 9.2 61.8 63.2 90.8

5.4 67.1 55.3 67.9 99.8 99.8

6.7 62.4 52.7 64.8 99.4 98.8

5.3 74.8 61.7 72.9 99.6 99.6

7.9 64.5 51.3 65.8 98.7 98.7

82.6 74.5 63.8

86.7 79.4 68.3

83.1 76.7 69.6

86.8 78.9 69

83.2 84.5 85.3 77.8

81.2 83 83.6 78.5

85.7 87.6 89.5 84.4

86.8 89.5 89.5 93.8

68.3

73.3

71.1

71.1

70.7

77.9

72.5

76

Bacteremia (1620)

Pneumonia (128)

83.8 88.5 92.4 94.7 (6.1)a 95.7 (6.4)a

56.3 68 84.4 78.9 (21.1)a 89.1 (21.9)a

www.bjid.com.br

Bacteremia (266)

Bacteremia (419) 86.4 89.5 93.8 94.5( 6)a 95 (6.4)a

Pneumonia (76)

Pneumonia (46) 63 69.6 95.7 76.1 (19.6)a 89.1 (19.6)a



Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Gatifloxacin Levofloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole K. pneumoniae Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin

97.2

85.9

39.8 94.9 (6.2)a 66.7 92.5 100 100

28.9 78.7 (21.3)a 48.4 77.3 99.2 100

97.1 42.2 94.7 (5.7)a 72.8 93.6 100 100

61

87 26.1 80 (20)a 58.7 82.6 100 100

97 90.4 88.7

92.2 77.3 72

97.6 93.3 91.5

97.8 82.6 73.3

85.5 86.2 86.1 85.9

78.1 78.9 78.1 73.2

92.4 93.3 93.3 92.4

91.3 91.3 91.3 89.3

53.7

54.7

60.9

65.2

50.9

58.3

47.5

63

Bacteremia (328)

Pneumonia (124)

Bacteremia (840)

Pneumonia (328)

47.5 52.7 84.6 60.7 (45)b 65.2 (45)b 75.7

55.2 82 63.1 (41.2)b 67.4 (39.3)b 77.4

54.6 53.7 86.6 59.8 (45.4)b 70.1 (43.9)b 73.8

0 60.2 (44)b 48.9 65.4 99.9 99.8

0 63.4 (40.2)b 56.7 72.3 99.7 99.4

0 60.4 (43.6)b 50.9 69.8 100 99.7

78.6 62.5 50.6

85.7 71.6 60.6

80.8 63.1 52.3

85.5 66.9 52.7

88.1

87.5

91.8

88.7

www.bjid.com.br

47.3 45.2 46 83.9 50.8 (51.6)a 57.3 (60)b 72.6 0 51.6 (60)b 46.8 66.9 100 99.2

62



Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

90.1 91.2 89.1

88.4 89.9 88.5

91.8 93 89.6

88.7 88.7 86.7

65.3

71.6

72.9

66.1

66.1

76.1

59.3

66.1

Morganella morgannii

Bacteremia (32)

Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole P. aeruginosa Cephalosporins Ceftazidime Cefepime Other β-lactams

Pneumonia (b)

0 6.3 31.3 87.5 84.4 90.6

b

0 84.4 71.9 90.6 100 100

b

96.9 81.3 85.7

b

68.8 68.8 68.8 66.7

b

Bacteremia (12)

Pneumonia (b)

0 8.3 33.3 75 91.7 83.3

b

0 83.3 83.3 100 100 100

b

91.7 91.7 81.8

b

66.7 66.7 66.7

b

b

b

b

40.6

b

25

b

56.3

b

50

b

Bacteremia (247)

Pneumonia (473)

b b b b b

b b b b b

b b

b b

Bacteremia (589) 69.1 71

Pneumonia (862) 58.7 58.5

www.bjid.com.br

66.8 65.2

b b b b b

b b b b b

b b

b b

51.8 51.2



Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Proteus spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin

63

51.3 62.8 78.9 83.4 84.6

42.1 52.8 67.1 65.5 68.3

49.8 18.2 59.1 79.8 80.6

35.1 13.1 44 56.4 59.6

75.4 65.5 64.8

68.7 56.3 57.7

69.2 63.2 59

57.3 47.8 47.9

66.2 65.7 63.7 57.7

55.7 54.4 50.9 40.7

66.4 66.8 64.8 58.9

50.7 50.5 47.4 39

1.5

1.5

1.6

0.8

2.2

5.2

3.6

5.1

Bacteremia (92)

Pneumonia (42)

Bacteremia (15)

Pneumonia (b)

54.3 65.2 95.7 72.8 93.5 75

54.8 59.5 90.5 66.7 97.6 66.7

80 86.7 100 100 100 100

b

43.5 92.4 90.2 91.3 97.8 100

57.1 83.3 97.6 92.9 100 100

60 100 100 100 93.3 100

b

91.3 63 65.4

88.1 69 69.4

100 100 100

b

68.5 70.7 67.4 70.2

71.4 76.2 71.4 72

100 100 100

b

b

b

www.bjid.com.br

b b b b b

b b b b b

b b

b b

64


Others Tetracycline Trimethoprim/ sulfamethoxazole Salmonella spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole Serratia spp. Cephalosporins Cefazolin Cefuroxime Cefoxitin Ceftriaxone Ceftazidime Cefepime Other β-lactams


4.3

7.1

13.3

b

53.3

64.3

86.7

b

Bacteremia (179)

Pneumonia (b)

97.8 95.5 98.3 98.9 98.9 98.9

b

92.2 98.3 93.3 98.9 100 100

b

99.4 96.1 94.7

b

b b b b b

b b b b b

b b

b

100 100 100 100

b b b

87.2

b

93.3

b

Bacteremia (157) 0 1.3 8.3 72.6 85.4 86

Bacteremia (44) 100 95.5 97.7 100 100 100

b

100 100 100 100 100 100

b

100 95.5 91.7

b

100 100 100 100

b

97.7

Pneumonia (89) 2.2 3.4 3.4 80.9 85.4 93.3

www.bjid.com.br

Pneumonia (b)

b b b b b

b b b b b

b b

b b b

b

100

b

Bacteremia (86)

Pneumonia (40)

0 0 5.8 69.8 81.4 90.7

0 0 2.5 72.5 77.5 97.5



Ampicillin Aztreonam Ticarcillin/clavulanate Piperacillin/tazobactam Imipenem Meropenem Aminoglycosides Amikacin Gentamicin Tobramycin Fluoroquinolones Ciprofloxacin Levofloxacin Gatifloxacin Garenoxacin Others Tetracycline Trimethoprim/ sulfamethoxazole

65

4.5 79.6 57.3 72 100 100

1.1 88.8 60.7 77.5 98.9 100

2.3 82.6 48.8 62.8 100 100

0 87.5 45 70 100 100

70.7 63.7 51.8

80.9 75.3 57.9

64 53.5 42.9

75 62.5 45.9

75.2 82.2 79.6 59.2

78.7 87.6 84.3 75

60.5 69.8 65.1 46.5

67.5 77.5 75 63.2

9.6

7.9

4.7

5

63.1

70.8

54.7

Pneumonia (60)

Bacteremia (35)

46.7 23.3

85.7 42.9

47.8 30.4

1.7 51.7 26.7 0 3.3

8.6 77.1 51.4 0 5.7

0 69.6 30.4 0 8.7

15 11.7 8.9

17.1 14.3 8.6

8.7 8.7 8.7

38.3 90 96.7 81.8

45.7 94.3 94.3 79.2

17.4 87 95.7 80

13.3

17.1

8.7

Stenotrophomonas maltophilia Bacteremia (86) Cephalosporins Ceftazidime 73.3 Cefepime 40.7 Other β-lactams Aztreonam 8.1 Ticarcillin/clavulanate 64 Piperacillin/tazobactam 43.5 Imipenem 2.3 Meropenem 7 Aminoglycosides Amikacin 20.9 Gentamicin 20.9 Tobramycin 19 Fluoroquinolones Ciprofloxacin 50 Levofloxacin 88.4 Gatifloxacin 88.4 Garenoxacin 83.3 Others Tetracycline 17.4 Trimethoprim/ sulfamethoxazole 95.3

100

100

60 Pneumonia (23)

100

a. Percentage of strains with MIC > 2 µg/mL, indicating possible ESBL production [6]; b. The results were not analyzed because the number of isolates was low (8 >2 0.5 0.12 4 >8 >1 2 4 0.5

100 100d 100d 100d 100 96.6 62.1 66.7 75 72.4 100 100 — 100 48.3 NA 100 86.2 100

94.4 94.4d 94.4d 94.4d 100 94.4 61.1 60 62.5 72.2 100 100 — 100 33.3 NA 100 83.3 100

S. pneumoniae (1561/497) Amoxicillin Penicillin Cefuroximeb Cefprozil Cefpodoxime Cefotaximec Cefepime Erythromycin Azithromycin Clarithromycin Clindamycin Levofloxacin Gatifloxacin Garenoxacin Chloramphenicol Tetracyclinee Trimethoprim/sulfamethoxale Linezolid Quinupristin/ dalfopristin Vancomycin

0.06 0.03 0.06 0.25