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Epidemiology and Surveillance

The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program

Daniel J. Diekema, Po-Ren Hsueh, Rodrigo E. Mendes, Michael A. Pfaller, Kenneth V. Rolston, Helio S. Sader, Ronald N. Jones
Daniel J. Diekema
aUniversity of Iowa, Iowa City, Iowa, USA
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Po-Ren Hsueh
bNational Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Rodrigo E. Mendes
cJMI Laboratories, North Liberty, Iowa, USA
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Michael A. Pfaller
aUniversity of Iowa, Iowa City, Iowa, USA
cJMI Laboratories, North Liberty, Iowa, USA
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Kenneth V. Rolston
dThe University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Helio S. Sader
cJMI Laboratories, North Liberty, Iowa, USA
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Ronald N. Jones
cJMI Laboratories, North Liberty, Iowa, USA
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DOI: 10.1128/AAC.00355-19
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ABSTRACT

Bloodstream infection (BSI) organisms were consecutively collected from >200 medical centers in 45 nations between 1997 and 2016. Species identification and susceptibility testing followed Clinical and Laboratory Standards Institute broth microdilution methods at a central laboratory. Clinical data and isolates from 264,901 BSI episodes were collected. The most common pathogen overall was Staphylococcus aureus (20.7%), followed by Escherichia coli (20.5%), Klebsiella pneumoniae (7.7%), Pseudomonas aeruginosa (5.3%), and Enterococcus faecalis (5.2%). S. aureus was the most frequently isolated pathogen overall in the 1997-to-2004 period, but E. coli was the most common after 2005. Pathogen frequency varied by geographic region, hospital-onset or community-onset status, and patient age. The prevalence of S. aureus isolates resistant to oxacillin (ORSA) increased until 2005 to 2008 and then declined among hospital-onset and community-acquired BSI in all regions. The prevalence of vancomycin-resistant enterococci (VRE) was stable after 2012 (16.4% overall). Daptomycin resistance among S. aureus and enterococci (DRE) remained rare (<0.1%). In contrast, the prevalence of multidrug-resistant (MDR) Enterobacteriaceae increased from 6.2% in 1997 to 2000 to 15.8% in 2013 to 2016. MDR rates were highest among nonfermentative Gram-negative bacilli (GNB), and colistin was the only agent with predictable activity against Acinetobacter baumannii-Acinetobacter calcoaceticus complex (97% susceptible). In conclusion, S. aureus and E. coli were the predominant causes of BSI worldwide during this 20-year surveillance period. Important resistant phenotypes among Gram-positive pathogens (MRSA, VRE, or DRE) were stable or declining, whereas the prevalence of MDR-GNB increased continuously during the monitored period. MDR-GNB represent the greatest therapeutic challenge among common bacterial BSI pathogens.

  • Copyright © 2019 Diekema et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

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The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program
Daniel J. Diekema, Po-Ren Hsueh, Rodrigo E. Mendes, Michael A. Pfaller, Kenneth V. Rolston, Helio S. Sader, Ronald N. Jones
Antimicrobial Agents and Chemotherapy Jun 2019, 63 (7) e00355-19; DOI: 10.1128/AAC.00355-19

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The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program
Daniel J. Diekema, Po-Ren Hsueh, Rodrigo E. Mendes, Michael A. Pfaller, Kenneth V. Rolston, Helio S. Sader, Ronald N. Jones
Antimicrobial Agents and Chemotherapy Jun 2019, 63 (7) e00355-19; DOI: 10.1128/AAC.00355-19
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KEYWORDS

antimicrobial resistance
bloodstream infection
surveillance

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