Nato il 12 novembre 1959 a San Paolo del Brasile Cittadinanza e Nazionalità Italiana Coniugato Immatricolazione alla Facoltà di Medicina e Chirurgia dell’Università degli Studi di Padova Durante il corso di laurea è allievo interno prima presso la Clinica Medica I (dir prof C. Dal Palù) e poi presso la cattedra di Tossicologia Medica (dir prof L. Cima) Laurea in Medicina e Chirurgia (vot
Accp poster4/2/02.42 x 84"Similarities and differences of Escherichia coli and Klebsiella pneumoniae susceptibility to
cephalosporins and fluoroquinolones from 1987-2001: results of the Antimicrobial Resistance
University of Florida, Gainesville, FL, 32601 USATel: +1.352-392-4541 Management (ARM) program
Gums JG. University of Florida, Gainesville, FL, USA What is the Antimicrobial Resistance Management
• Nationally, E coli susceptibility was 99.4% to third-generation ceftriaxone • In Southwest, differences were seen between ciprofloxacin and ceftriaxone and 95.4% for levofloxacin, a difference seen largely in Northeast for E coli and between levofloxacin and ceftriaxone for K pneumoniae (ARM) Program?
PURPOSE: Using data from the ARM program, this study examined national • Antibiograms and sensitivity reports of E coli and K pneumoniae isolates and regional susceptibility rates of E coli and K pneumoniae to cephalosporin Figure 3. E coli susceptibility to ceftriaxone and levofloxacin
Figure 6. Differences between fluoroquinolone and ceftriaxone
susceptibility in the Southwest
• The Antimicrobial Resistance Management (ARM) Program is an ongoing study to METHODS: Since 1987, more than 10 million US inpatient and outpatient document trends in antimicrobial susceptibility patterns in inpatient and isolates have been collected from 101 hospitals in 5 regions (Northeast, outpatient isolates and to identify relationships between antibiotic use and North Central, Southeast, South Central, Southwest). Antibiograms and sensitivity reports of isolates for E coli and K pneumoniae were reviewed for susceptibility to cephalosporins (cefazolin, cephalothin, cefuroxime, • Hospitals can delineate if and when antimicrobial resistance occurs cefoxitin, cefotetan, cefotaxime, ceftazidime, ceftriaxone, cefepime) and fluoroquinolones (ciprofloxacin, levofloxacin, ofloxacin, trovafloxacin).
• Provides data for local, regional, national benchmarks RESULTS: Nationally, E coli susceptibility to first-generation cephalosporins Fluoroquinolones
• Has potential to reduce costs of antibiotics associated with inappropriate use (n=402,596) ranged from 70.2% to 92.2%; second generation (n=368,877), 95.3% to 99.6%; third generation (n=568,828), 97.3% to 99.4%; cefepime • A total of 115 hospitals have enrolled to date (n=33,184) was 99.1%. Fluoroquinolone susceptibility ranged from 95.4% to 97.8%; n=562,693. E coli susceptibility was 99.4% to third-generation RESULTS
ceftriaxone and 95.4% for levofloxacin, a difference seen largely in Northeast • For the purposes of comparison, US hospitals are grouped in 6 geographic regions (99.1%, ceftriaxone; 92.7%, levofloxacin). Nationally, K pneumoniae • Nationally, E coli susceptibility to first-generation cephalosporins ranged • Nationally, K pneumoniae susceptibility to third-generation cephalosporins susceptibility to third-generation cephalosporins ranged from 94.1% for from 70.2% to 92.2%; second generation, 95.3% to 99.6%; third generation ranged from 94.1% for ceftazidime to 98.2% for ceftriaxone, a range seen ceftazidime (n=46,899) to 98.2% for ceftriaxone (n=99,345); a range seen 97.3% to 99.4%; fourth-generation cefepime was 99.1% (Figure 1) in every region except Northeast. K pneumoniae susceptibility to first- CONCLUSION
generation cefazolin (n=116,035) and second-generation cefuroxime Figure 1. E coli susceptibility to cephalosporins (n=1,373,485)
Figure 4. K pneumoniae susceptibility to third-generation
• National and regional differences in E coli and K pneumoniae susceptibility (n=58,081) was equal (92.5%), an anomaly attributed to North Central cephalosporins
were detected to cephalosporin and fluoroquinolone antibiotics and were differences (90.7%, cefazolin; 88.9%, cefuroxime). In Southwest, differences associated with an anticipated class/subclass effect were seen between ciprofloxacin (91.1%) and ceftriaxone (98.7%) for E coli • E coli and K pneumoniae susceptibility to third-generation and between levofloxacin (91.6%) and ceftriaxone (98.0%) for K Cephalothin 70.2%
cephalosporins remains high, suggesting no evidence of ESBL activity Cefazolin 92.2%
• In the North Central region, K pneumoniae susceptibility to first- CONCLUSION: National and regional differences in E coli and K generation cefazolin was greater than to second-generation cefuroxime Cefuroxime 95.3%
pneumoniae susceptibility were detected to cephalosporin and fluoroquinolone antibiotics; these differences were associated with an • An association between fluoroquinolone resistance and ESBL Cefoxitin 96.5%
• These data suggest cephalosporin susceptibility has remained stable over PURPOSE
time, whereas a role for fluoroquinolones in the treatment of gram- • The number of hospitals included from each region is as follows: Cefotaxime 99.2%
negative infections may increasingly be limited • North Central: 18 (16%) • Southeast: 56 (49%) • Extended-spectrum beta-lactamase (ESBL)-producing organisms can Ceftriaxone 99.4%
mediate resistance to broad-spectrum beta-lactams, causing infectious Cefepime 99.1%
1. Paterson DL. Recommendation for treatment of severe infections caused by Enterobacteriaceae • The two species in which ESBLs are most common are E coli and K producing extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect. 2000;6:460-463.
• K pneumoniae susceptibility to first-generation cefazolin and second- Data Collection
generation cefuroxime was equal, an anomaly attributed to North Central • Recent evidence suggests increasing frequency of an association between • Each hospital provides a minimum of 3 years of antibiogram or sensitivity report • Fluoroquinolone susceptibility ranged from 95.4% to 97.8% (Figure 2) fluoroquinolone resistance and ESBL production, greatly limiting the role The author would like to thank the participating institutions in the R-BUG Database-USA who make of this class of antibiotic against ESBL producers1 data collection possible, and Roche Laboratories, Inc., which financially supported the study.
Figure 2. E coli susceptibility to fluoroquinolones (n=562,693)
Figure 5. K pneumoniae susceptibility to first-, second-, and
• Individual antibiotics and organisms are captured in the database • Using data from the ARM program, national and regional susceptibility third-generation cephalosporins
rates of E coli and K pneumoniae to cephalosporin and fluoroquinolone • A Web-based analysis tool allows comparisons between antibiotic use and resistance rates for any number of parameters • Groups of years to other groups of years
Why don’t you walk? David Lindelöw Lund University Dep. of Technology and Society P.O. Box 118 221 00 Lund Sweden Abstract The purpose of this paper is to review the literature and have a critical look at studies analyzing factors that influence walking. How does the propensity to walk change when a condition changes and which of the factors have a proven effect? A literature research