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Antimicrobial Agents and Chemotherapy, July 1998, p. 1762-1770, Vol. 42, No. 7
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Bacterial Pathogens Isolated from Patients with Bloodstream
Infection: Frequencies of Occurrence and Antimicrobial
Susceptibility Patterns from the SENTRY Antimicrobial
Surveillance Program (United States and Canada, 1997)
Michael A.
Pfaller,*
Ronald N.
Jones,
Gary V.
Doern,
Kari
Kugler, and
The Sentry
Participants
Group
Medical Microbiology Division, Department of
Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Received 16 January 1998/Returned for modification 10 April
1998/Accepted 6 May 1998
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ABSTRACT |
The SENTRY Program was established in January 1997 to measure the
predominant pathogens and antimicrobial resistance patterns of
nosocomial and community-acquired infections over a broad network of sentinel hospitals in the United States (30 sites), Canada (8 sites), South America (10 sites), and Europe (24 sites).
During the first 6-month study period (January to June 1997), a
total of 5,058 bloodstream infections (BSI) were
reported by North American SENTRY participants (4,119 from the
United States and 939 from Canada). In both the United States and
Canada, Staphylococcus aureus and Escherichia
coli were the most common BSI isolates, followed by
coagulase-negative staphylococci and enterococci. Klebsiella spp., Enterobacter spp.,
Pseudomonas aeruginosa, Streptococcus pneumoniae, and 
-hemolytic streptococci were also among the 10 most frequently reported species in both the United States and Canada.
Although the rank orders of pathogens in the United States and Canada
were similar, distinct differences were noted in the antimicrobial
susceptibilities of several pathogens. Overall, U.S. isolates were
considerably more resistant than those from Canada. The differences in
the proportions of oxacillin-resistant S. aureus isolates
(26.2 versus 2.7% for U.S. and Canadian isolates, respectively), vancomycin-resistant enterococcal isolates (17.7 versus 0% for U.S. and Canadian isolates, respectively), and
ceftazidime-resistant Enterobacter sp. isolates (30.6 versus 6.2% for U.S. and Canadian isolates, respectively) dramatically
emphasize the relative lack of specific antimicrobial resistance genes
(mecA, vanA, and vanB) in the
Canadian microbial population. Among U.S. isolates, resistance to
oxacillin among staphylococci, to vancomycin among enterococci, to
penicillin among pneumococci, and to ceftazidime among
Enterobacter spp. was observed in both nosocomial and
community-acquired pathogens, although in almost every instance the
proportion of resistant strains was higher among nosocomial isolates.
Antimicrobial resistance continues to increase, and ongoing
surveillance of microbial pathogens and resistance profiles is
essential on national and international scales.
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INTRODUCTION |
Bloodstream infections (BSI)
due to bacterial and fungal pathogens affect over 200,000 individuals
annually in the United States alone and are a tremendously
important cause of morbidity and mortality worldwide (19, 20,
22). The attributable mortality of BSI is approximately 27%
(19), and a recently published national vital statistics
report has documented an increase in age-adjusted death rates due to
septicemia from 4.2 per 100,000 in 1980 to 13.2 per 100,000 in 1992 (18).
The impact of specific etiologic agents on the outcome of BSI has
been well documented and speaks to the need for a better understanding of the spectrum of pathogens causing both nosocomial and
community-acquired BSI (19, 22). Detection of microorganisms in blood cultures is considered an indicator of disseminated
infection and has been shown to be a valid marker for
surveillance of BSI (16). In a recent prospective
multicenter study of BSI, Weinstein et al. (22) noted
substantial changes in the microbiology, epidemiology, and
clinical and prognostic significance of positive blood cultures over a 20-year period. They found that Staphylococcus
aureus and Escherichia coli continued to be the most
common etiologic agents of BSI and noted important increases in BSI due
to coagulase-negative staphylococci (CoNS), fungi, and
Pseudomonas aeruginosa (community acquired).
Importantly, they found that BSI due to fungi and
Enterobacteriaceae other than E. coli were
associated with a significantly increased risk of death. The rapid
detection of positive blood cultures and reporting of antimicrobial
susceptibility results were also useful in the care of patients
(22).
One of the more alarming recent trends in infectious diseases has
been the increasing frequency of antimicrobial resistance among
microbial pathogens causing nosocomial and
community-acquired infections (1, 9). Numerous classes
of antimicrobial agents have become less effective as a result of
the emergence of antimicrobial resistance, often as a result of
the selective pressure of antimicrobial usage (2, 9). Among
the more important emerging resistance problems are oxacillin
resistance in staphylococci, penicillin resistance in streptococci,
vancomycin resistance in enterococci (and eventually staphylococci),
resistance to extended-spectrum cephalosporins and fluoroquinolones in
the Enterobacteriaceae, and carbapenem resistance in
P. aeruginosa (1, 9, 17).
These resistance trends and the clinical significance and
changing spectrum of microbial pathogens argue strongly for a
national program of antimicrobial resistance surveillance. Such a
program will play a critical role in guiding physicians toward
appropriate parenteral agents for use in the treatment of both
community- and hospital-acquired BSI, as well as identifying changing
patterns of etiologic agents and drug susceptibility. In this study we describe the frequencies of occurrence and antimicrobial susceptibility profiles of BSI isolates from 38 North American medical centers (30 in
the United States and 8 in Canada) participating in the SENTRY
antimicrobial resistance surveillance program. The SENTRY program is a
longitudinal surveillance program designed to track antimicrobial
resistance trends nationally and internationally over a 5- to
10-year period. The present study includes all BSI isolates in the
United States and Canada from the initiation of the program (January
1997) through June 1997 (approximately 6 months).
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MATERIALS AND METHODS |
Study design.
The SENTRY program was established to monitor
the predominant pathogens and antimicrobial resistance patterns of
nosocomial and community-acquired infections via a broad network of
sentinel hospitals distributed equally by geographic location and size. The monitored infections include bacteremia and fungemia (objective A),
outpatient respiratory infections due to fastidious organisms (Streptococcus pneumoniae, Haemophilus
influenzae, and Moraxella catarrhalis; objective B),
pneumonia (objective C), wound infections (objective D), and urinary
tract infections (objective E) in hospitalized patients. Participating
institutions include 30 medical centers in the United States, 8 in
Canada, 10 in South America, and 24 in Europe. The present report will
focus on BSI isolates from North America (30 U.S. and 8 Canadian sites)
(Fig. 1). The U.S. sites were located in
23 different states and represented institutions ranging in size from
250 to 4,000 beds (mean, 760 beds). The Canadian sites were located in
seven provinces (Alberta, British Columbia, Manitoba, Nova Scotia,
Ontario, Quebec, and Saskatchewan) and represented institutions ranging
in size from 400 to 1,200 beds (mean, 726 beds).
Each participant hospital contributed results (organism identification,
date of isolation, and antimicrobial susceptibility
profile) on the
first 20 consecutive blood culture isolates judged
to be clinically
significant by local criteria (separate patients)
that were detected in
each calendar month during the initial 6-month
period, January 1997 through 30 June 1997. Each laboratory was
encouraged to critically
analyze CoNS in the context of their
clinical significance. All
isolates were saved on agar slants
and sent on a weekly basis to the
University of Iowa (Iowa City)
for storage and for further
characterization by reference identification
and susceptibility testing
methods.
Organism identification.
All blood culture isolates were
identified at the participating institution by the routine methodology
in use at each laboratory. Upon receipt at the University of Iowa,
isolates were subcultured onto blood agar to ensure viability and
purity. Confirmation of species identification was performed with Vitek
(bioMerieux Vitek, St. Louis, Mo.) and API (bioMerieux) products or
conventional methods as required (12). Isolates were frozen
at 
70°C until needed.
Susceptibility testing.
Antimicrobial susceptibility testing
of isolates was performed by reference broth microdilution methods as
described by the National Committee for Clinical Laboratory Standards
(NCCLS) (13). Microdilution trays were purchased from
MicroScan (Sacramento, Calif.) and Prepared Media Laboratories
(Tualatin, Oreg.). Antimicrobial agents were obtained from the
respective manufacturers and included ampicillin, oxacillin,
penicillin, piperacillin, ticarcillin, amoxicillin-clavulanate,
ticarcillin-clavulanate, piperacillin-tazobactam, cefazolin,
cefuroxime, cefoxitin, ceftriaxone, ceftazidime, cefepime, aztreonam,
imipenem, meropenem, amikacin, gentamicin, tobramycin, streptomycin,
ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin, gatifloxacin,
trovafloxacin, erythromycin, clindamycin, quinupristin-dalfopristin, chloramphenicol, rifampin, tetracycline, teicoplanin, vancomycin, and
trimethoprim-sulfamethoxazole. Quality control was performed by testing
E. coli ATCC 25922, S. aureus ATCC 29213, P. aeruginosa ATCC 27853, S. pneumoniae ATCC
49619, and Enterococcus faecalis ATCC 29212. Interpretive
criteria for each antimicrobial tested were those published by NCCLS
(14).
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RESULTS |
Frequency of occurrence of bloodstream pathogens.
During the
6-month study period (January 1997 to June 1997) a total of 5,058 BSI
were reported by SENTRY participants (4,119 from the United States and
939 from Canada). Table 1 lists the 20 most frequently isolated bacterial pathogens causing BSI in these
hospitals. These 20 organisms and groups accounted for 97.8% of all
BSI during this time period. In both the United States and Canada,
S. aureus and E. coli were the most common BSI
isolates, followed by CoNS and enterococci. These four organism groups
accounted for approximately 64% of all BSI in the 38 North American
sites. Klebsiella spp., S. pneumoniae,
P. aeruginosa, Enterobacter spp., and
beta-hemolytic streptococci were also among the 10 most frequently reported species at both U.S. and Canadian study sites.
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TABLE 1.
Frequencies of occurrence of bacterial pathogens
associated with BSI in participating medical centers in the United
States and Canada (SENTRY antimicrobial surveillance
program, 1997)
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Antimicrobial susceptibilities of gram-positive pathogens.
Tables 2 to
5
list MICs of 27 antimicrobial agents tested against the four most
prevalent causes of gram-positive BSI (S. aureus, CoNS,
enterococci, and S. pneumoniae) in the United States (Tables
2 and 3) and Canada (Tables 4 and 5). In both countries these species
accounted for approximately 50% (51% in the United States and 49% in
Canada) of all bacteremic episodes. For the staphylococci, considerable
differences in the percentages of S. aureus isolates that
were susceptible to oxacillin between the United States and Canada were
observed. Only 73.8% of U.S. S. aureus BSI isolates were
susceptible to oxacillin versus 97.3% of Canadian isolates (Tables 2
and 4). This difference in oxacillin susceptibility corresponds to
similar differences in susceptibility to all -lactam agents (Tables
2 and 4) and also to non--lactam antimicrobials (Tables 3 and 5).
Canadian S. aureus BSI isolates were more susceptible to
gentamicin (97.7 versus 86.3%), fluoroquinolones (97.7 to 98.3%
versus 71.8 to 73.7%), macrolides (58.7 to 96.7% versus 35.9 to
76%), and trimethoprim-sulfamethoxazole (96.6 versus 89.2%).
Notably, quinupristin-dalfopristin, teicoplanin, and
vancomycin were uniformly active against all isolates of S. aureus in both the United States and Canada.
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TABLE 2.
Activities and spectra of activity of the 10 -lactam
antimicrobial agents tested against the four most prevalent causes
of gram-positive bacteremia in the United States (51% of all
bacteremic episodes)
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TABLE 3.
Activities and spectra of activity of 16 representatives
of non--lactam drug classes tested against the four most
prevalent causes of gram-positive bacteremia in the United States
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TABLE 4.
Activities and spectra of activity of 10 -lactam
antimicrobial agents tested against the four most prevalent causes
of gram-positive bacteremia in Canada (49% of all
bacteremic episodes)
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TABLE 5.
Activities and spectra of activity of 16 representatives
of non--lactam drug classes tested against the four most
prevalent causes of gram-positive bacteremia in Canada
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Oxacillin resistance rates were high among CoNS BSI isolates from both
U.S. (56.9%) and Canadian (52.2%) sites (Tables
2 and
4).
Although the fluoroquinolones were slightly more active
against
Canadian isolates (68.2 to 68.9% versus 57.5 to 58.5%
susceptible) there were no major differences in activity among
the
other non-
-lactam agents tested. Neither gatifloxacin nor
trovafloxacin demonstrated increased activity against CoNS compared
with ciprofloxacin or sparfloxacin. As with
S. aureus,
quinupristin-dalfopristin,
teicoplanin, and vancomycin were all active
against these CoNS.
Striking differences in the proportion of enterococcal BSI isolates
that were resistant to vancomycin between the United States
and Canada
were observed. Approximately 18% of U.S. isolates (3.5%
of
E. faecalis isolates and 53% of
Enterococcus faecium
isolates)
were resistant to vancomycin versus 0% of Canadian isolates.
Conversely,
high-level resistance (HLR) to aminoglycosides was more
common
among Canadian isolates (52% had HLR to gentamicin and 49.3%
had
HLR to streptomycin) than among U.S. isolates (corresponding values
are 33.3 and 43.3%, respectively). All
E. faecium isolates
were
inhibited by
4 µg of quinupristin-dalfopristin per ml.
Decreased susceptibility to penicillin was noted among both U.S. (41%
resistant) and Canadian (30.5% resistant) isolates of
S. pneumoniae (Tables
2 and
4). HLR (MIC,
2 µg/ml) to
penicillin
was greater among U.S. isolates (14 versus
6.8%). U.S. isolates
were also considerably less susceptible
than Canadian isolates
to ampicillin-amoxicillin (84.4 versus 94.9%),
to extended-spectrum
cephalosporins such as cefotaxime-ceftriaxone
(86.8 versus 94.9%),
and cefepime (83.4 versus 93.2%). Both U.S. and
Canadian
S. pneumoniae BSI isolates remained highly
susceptible to fluoroquinolones (96
to 100%) and vancomycin (100%).
Quinupristin-dalfopristin was
also quite active, with 99% of all
S. pneumoniae BSI isolates
inhibited by
4 µg/ml.
Antimicrobial susceptibilities of gram-negative pathogens.
Tables 6 to
9
list the results for 26 antimicrobial agents tested against the four
most prevalent causes of gram-negative BSI (E. coli,
Klebsiella spp., P. aeruginosa, and
Enterobacter spp.) in the United States (Tables 6 and 7) and
Canada (Tables 8 and 9). These species accounted for 33 to 34% of all
bacteremic episodes in the two countries. For E. coli, there
were no major differences in the antimicrobial susceptibility profiles
between the U.S. and Canadian isolates. Piperacillin-tazobactam
was the most active of the penicillins (95.5% susceptible),
and cefepime was the most active cephalosporin (99.3 to 100%
susceptible). Only 1.1 (Canada) to 2% (United States) of E. coli BSI isolates were resistant to ceftazidime, suggesting a low
prevalence of extended-spectrum -lactamase (ESBL)-producing strains,
although these isolates were not tested further to confirm ESBL
production (14). Virtually all isolates remained
susceptible to the carbapenems (imipenem and meropenem; >99%
susceptible) and aztreonam (96.1 to 98.3% susceptible).
Similarly, the vast majority of E. coli isolates remained
susceptible to the aminoglycosides (94.3 to 98.9%) and
fluoroquinolones (96.6 to 97.6%). Notably, only 74.3 and 80.7%
of U.S. and Canadian E. coli BSI isolates,
respectively, were susceptible to trimethoprim-sulfamethoxazole.
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TABLE 6.
Activities and spectra of activity of 15 -lactam
antimicrobial agents tested against the four most prevalent causes
of gram-negative bacteremia in the United States (34% of all
bacteremic episodes)
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TABLE 7.
Activities and spectra of activity of 11 representatives
of non--lactam drug classes tested against the four most
prevalent causes of gram-negative bacteremia in the United States
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TABLE 8.
Activities and spectra of activity of 15 -latam
antimicrobial agents tested against the four most prevalent causes
of gram-negative bacteremia in Canada (33% of all
bacteremic episodes)
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TABLE 9.
Activities and spectra of activity of 11 representatives
of non--lactam drug classes tested against the four most
prevalent causes of gram-negative bacteremia in Canada
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As for
E. coli, there were no important differences in the
susceptibility profiles of
Klebsiella sp. BSI isolates
from the
United States and Canada. Piperacillin-tazobactam (90.2 to 94%
susceptible) and cefepime (98 to 98.7% susceptible) were
the most
active agents among the penicillins and cephalosporins,
respectively.
Approximately 2 to 4% of
Klebsiella sp. BSI
isolates exhibited
an ESBL phenotype (resistant to ceftazidime)
(
14). All of the
Klebsiella spp. were susceptible
to meropenem and imipenem. As
with
E. coli, the
aminoglycosides and fluoroquinolones retained
activity against
Klebsiella spp.
Comparable susceptibilities to piperacillin (93 versus 95.5%),
piperacillin-tazobactam (92.4 versus 95.5%), ceftazidime (87.1
versus 86.4%), and cefepime (87 versus 84.1%) were observed for
P. aeruginosa BSI isolates from the United States
and Canada,
respectively. The Canadian
P. aeruginosa isolates were less susceptible
than the U.S. isolates
to the carbapenems (72.7 to 88.6% versus
88 to 95.2%), aztreonam
(70.5 versus 77.4%), and the fluoroquinolones
(63.6 to 79.5% versus
80.6 to 89.1%). Against these isolates,
meropenem was the most active
of the carbapenems (88.6 to 95.2%
susceptible) and ciprofloxacin was
the most active of the fluoroquinolones
(79.5 to 89.1% susceptible).
Not surprisingly, tobramycin (95.5
to 95.7% susceptible) and amikacin
(95.5 to 98.4% susceptible)
were more active than gentamicin (84.1 to
89.7% susceptible).
The
Enterobacter sp. BSI isolates from Canada were
substantially more susceptible than those from the United States
to virtually
every class of antimicrobial agent tested in this
study. Canadian
Enterobacter sp. isolates were more
susceptible than U.S. isolates
to piperacillin (84.4 versus 63.9%),
piperacillin-tazobactam (93.8
versus 68.8%), ticarcillin (71.9 versus
59.2%), and ticarcillin-clavulanate
(71.9 versus 58.5%). Among the
cephalosporins, carbapenems, and
monobactams, cefepime (99.3 and 100%
susceptible), meropenem (99.3
and 100% susceptible), and imipenem
(98.6 and 100% susceptible)
were highly active against both U.S. and
Canadian isolates, but
ceftazidime (69.4 versus 93.8% susceptible),
cefotaxime-ceftriaxone
(69.5 versus 93.8% susceptible), and aztreonam
(70.7 versus 93.8%
susceptible) were more active against Canadian
isolates. The aminoglycosides
and fluoroquinolones inhibited the
majority of
Enterobacter sp.
isolates; however, 6.8 to 8.8%
of U.S. isolates were resistant
to fluoroquinolones, whereas none of
the Canadian isolates were
resistant to these agents. Canadian isolates
were also more susceptible
to tetracycline (93.8 versus 83%) and
trimethoprim-sulfamethoxazole
(96.9 versus 84.4%) than U.S. isolates.
Antimicrobial susceptibilities of selected nosocomial and
community-acquired pathogens.
Among the 4,119 BSI isolates from
U.S. centers, 819 (20%) were determined to be of nosocomial origin
(obtained after 72 h in hospital), 1,481 (36%) were nonnosocomial or
community acquired, and for 1,819 (44%) the status (nosocomial
versus community acquired) could not be ascertained. Although
differences in the rank orders of the various pathogens between
nosocomial and community-acquired BSI were observed, S. aureus, CoNS, enterococci, and E. coli accounted for
>50% of infections in both groups (data not shown). In order to
evaluate and compare antimicrobial resistance in nosocomial and
community settings, the eight sentinel antimicrobial-organism combinations designated by Archibald et al. (1) were
selected (Table 10). These combinations
included oxacillin-S. aureus, oxacillin-CoNS, ceftazidime-Enterobacter cloacae,
ceftazidime-P. aeruginosa, imipenem-P. aeruginosa, ceftazidime-E. coli, ciprofloxacin-E.
coli, and vancomycin-Enterococcus spp. The
extent of antimicrobial resistance in nosocomial BSI isolates was
higher than that in isolates from community-acquired BSI for all of the
antimicrobial-organism combinations except ciprofloxacin-E.
coli (Table 10).
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TABLE 10.
Antimicrobial resistance in bloodstream isolates from
nosocomial versus community-acquired infections for selected
antimicrobial pathogen combinations
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DISCUSSION |
It is abundantly clear that surveillance programs are necessary to
identify changes in the spectrum of microbial pathogens causing serious
infection and to monitor trends in antimicrobial resistance
patterns in nosocomial and community-acquired infections (1, 8, 9,
15, 16). The information gleaned from surveillance efforts
is integral to the design of empirical approaches to the therapy
of serious infection and also to defining appropriate control
measures for antimicrobial-resistant pathogens (1, 8, 9).
Such information has been provided in recent years by programs
such as the National Nosocomial Infection Surveillance (NNIS) system
(4, 6), the Surveillance and Control of Pathogens of
Epidemiologic Importance (SCOPE) program (10, 11, 17, 21),
and the Intensive Care Antimicrobial Resistance Epidemiology (ICARE) project (1). These programs have been limited
by their focus on nosocomial infections (NNIS and SCOPE) and by the
lack of validated identification and antimicrobial susceptibility
testing performed in a central laboratory (NNIS and ICARE). The
SENTRY program was initiated in January 1997 and was designed to
monitor the spectrum of microbial pathogens and antimicrobial
resistance trends for both nosocomial and community-acquired infections
on a broad geographic scale by using validated reference quality identification and susceptibility testing methods performed in a
central laboratory. Because rapid communication and dissemination of
information is an important component of any surveillance program, we
are summarizing the first 6 months of data for BSI in the present report.
The early findings of the SENTRY Program for BSI (objective A)
underscore the prominence of gram-positive cocci and E. coli as etiologic agents of both community-acquired and nosocomial BSI
(Table 1). These findings are consistent with the recent observations
of Weinstein et al. (22) and also confirm those of the NNIS
(3, 5, 7) and SCOPE (10, 11) programs regarding
the importance of staphylococci and enterococci.
The most striking finding of the SENTRY program was the degree of
antimicrobial resistance among key pathogens in the United States
(Table 10). Resistance to oxacillin among staphylococci, to vancomycin
among enterococci, and to ceftazidime among
Enterobacter spp. was observed for nosocomial and
community-acquired pathogens alike. It is notable that in
almost every instance the percentage of resistant strains was
higher among nosocomial isolates than among those from the
community (Table 10). Unfortunately, this analysis is compromised by
the fact that for 44% of the BSI the status of nosocomial or community
acquired could not be confirmed. Thus, although the apparent increased
resistance among nosocomial BSI isolates compared to those from the
community is consistent with that reported by Archibald et al.
(1) for the ICARE program, these findings must be tempered
by the fact that a large number of isolates were excluded from the
analysis.
Of note, in the current survey, among 209 bloodstream isolates of
S. pneumoniae in the United States, 59.0% were susceptible to penicillin; in Canada, 69.5% of 59 isolates were susceptible. In
objective B of the SENTRY study (data not shown), the percentage of
penicillin-susceptible strains among 845 outpatient respiratory tract
isolates of S. pneumoniae collected during roughly the same period in the United States was 56.2%; among 202 such isolates in
Canada, 69.2% were susceptible. In other words currently there exist
only minor differences in rates of penicillin resistance among
bloodstream versus respiratory tract isolates of S. pneumoniae in North America. Comparisons of resistance rates
with other antimicrobial agents revealed the same degree of concordance
between bloodstream and respiratory tract isolates of the pneumococci.
Although the rank orders of pathogens in the United States and Canada
were very similar (Table 1), distinct differences were observed in the
antimicrobial susceptibilities of several pathogens. Overall, U.S.
isolates were considerably more resistant than those from Canada. This
was most apparent with S. aureus, Enterococcus spp., and Enterobacter spp. For oxacillin-resistant S. aureus, vancomycin-resistant enterococci, and
ceftazidime-resistant Enterobacter spp., the percentages of
resistant U.S. isolates were 26, 17.7, and 30.6%, respectively; the
corresponding values for resistant Canadian isolates were 2.7, 0, and
6.2%, respectively. This comparison dramatically emphasizes the
differences and points to the relative lack of specific antimicrobial
resistance genes (mecA, vanA, and vanB) in the Canadian microbial population. The in vitro
susceptibilities of U.S. and Canadian E. coli,
Klebsiella spp., and P. aeruginosa were
generally comparable, although the Canadian P. aeruginosa isolates were somewhat less susceptible than U.S.
isolates to carbapenems and fluoroquinolones. The reasons for these
differences in antimicrobial susceptibility are unclear but may be due
to differences in antimicrobial utilization practices.
Although high rates of antimicrobial resistance were observed in this
survey, there were several encouraging observations regarding
specific antimicrobial agents. First, we did not observe any
vancomycin-resistant or -intermediate strains among 1,829 U.S.
and Canadian isolates of staphylococci. Second, the investigational agent quinupristin-dalfopristin appeared to be quite active against oxacillin-resistant staphylococci, vancomycin-resistant E. faecium, and penicillin-resistant S. pneumoniae. Third,
the extended-spectrum cephalosporin cefepime and the carbapenems
imipenem and meropenem were highly active against the major
gram-negative BSI pathogens, including those strains of
Enterobacteriaceae that were resistant to ceftazidime and
other extended-spectrum -lactam and monobactam agents.
In conclusion, ongoing surveillance of microbial pathogens and their
resistance profiles is essential on national and international scales.
The SENTRY program will continue to monitor these trends in both
nosocomial and community-acquired BSI. Comparisons of the results
both internally within the SENTRY program and with other ongoing
programs such as NNIS and ICARE will enhance our knowledge base
regarding the problem of antimicrobial resistance and will serve as a
basis for policies and practices that might serve to limit the scope
and magnitude of this problem.
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APPENDIX |
SENTRY participants contributing data and/or isolates to the
study include Lynn Steele-Moore, The Medical Center of Delaware, Wilmington; Gerald Denys, Methodist Hospital of Indiana, Indianapolis; Carol Staley, Henry Ford Hospital, Detroit, Mich.; Joseph R. Dipersio, Summa Health Systems, Akron, Ohio; Michael Saubolle, Good Samaritan Regional Medical Center, Phoenix, Ariz.; Michael L. Wilson, Denver General Hospital, Denver, Colo.; Gary D. Overturf, University of New
Mexico Hospital, Albuquerque; Lance R. Peterson, Northwestern Memorial
Hospital, Chicago, Ill.; Paul C. Schreckenberger, University of
Illinois at Chicago, Chicago; Ronald N. Jones, University of Iowa
Hospitals and Clinics, Iowa City; Stephen Cavalieri, Creighton University, Omaha, Neb.; Sue Kehl, Froedtert Memorial Lutheran Hospital-East, Milwaukee, Wis.; Stephen Brecher, Boston VAMC, Boston,
Mass.; Phyllis Della-Latta, Columbia Presbyterian Medical Center, New
York, N.Y.; Henry Isenberg, Long Island Jewish Medical Center, New Hyde
Park, N.Y.; Dwight Hardy, Strong Memorial Hospital, Rochester, N.Y.;
Dennis Koga, St. Jude Medical Center, Fullerton, Calif.; Judy Fusco,
Kaiser Laboratory, Berkeley, Calif.; Marcy Hoffmann, Sacred Heart
Medical Center, Spokane, Wash.; Thomas Fritsche, University of
Washington, Seattle; Patrick R. Murray, Barnes-Jewish
Hospital, St. Louis, Mo.; Paul Southern, Parkland Health and Hospital
System, Dallas, Tex.; Audrey Wanger, The University of Texas Medical
School, Houston; Gail L. Woods, University of Texas Medical Branch at
Galveston, Galveston; Joseph Chiao, University Medical Center,
Jacksonville, Fla.; James Snyder, University of Louisville Hospital,
Louisville, Ky.; Joe Humphrey, University of Mississippi Medical
Center, Jackson; Steve Jenkins, Carolinas Medical Center, Charlotte,
N.C.; Kevin Hazen, University of Virginia Health Sciences Center,
Charlottesville; Robert Rennie, University of Alberta Hospital,
Edmonton, Alberta, Canada; Michael Noble, The Vancouver Hospital and
Health Science Center, Vancouver, British Columbia, Canada; Daryl
Hoban, Health Sciences Centre, Winnipeg, Manitoba, Canada; Kevin
Forward, Queen Elizabeth II Health Sciences Centre, Halifax, Nova
Scotia, Canada; Don Low, Mount Sinai Hospital, Toronto,
Ontario, Canada; Baldwin Toye, Ottawa General Hospital, Ottawa,
Ontario, Canada; Andrew Simor, Sunnybrook Health Science Centre,
Toronto, Ontario, Canada; Susan Richardson, The Hospital for Sick
Children, Toronto, Ontario, Canada; Hugh Robson, Royal Victoria
Hospital, Montreal, Quebec, Canada; Joseph Blondeau, Royal
University Hospital, Saskatoon, Saskatchewan, Canada.
| |
ACKNOWLEDGMENTS |
Kay Meyer provided excellent support in the preparation of this
paper. We express our appreciation to all SENTRY participants.
The SENTRY program was sponsored by a research grant from Bristol-Myers
Squibb.
| |
FOOTNOTES |
*
Corresponding author. Mailing address: Medical
Microbiology Division, Department of Pathology, C606 GH, University of
Iowa College of Medicine, Iowa City, IA 52242. Phone: (319) 384-9566 or
(319) 335-8170. Fax: (319) 356-4916. E-mail:
mpfaller{at}blue.weeg.uiowa.edu.
| |
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Antimicrobial Agents and Chemotherapy, July 1998, p. 1762-1770, Vol. 42, No. 7
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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Abstract
Introduction
