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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
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