Article Figures & Data
Tables
- TABLE 1.
Isolates characterized between 1993 and 2004
Organisms most frequently isolated Total no. isolated (n = 74,394) No. of isolates 1993-1995 1996-1998 1999-2001 2002-2004 Respiratory tract Urine Blood-stream infection Other sourcesc Respiratory tract Urine Blood-stream infection Other sources Respiratory tract Urine Blood-stream infection Other sources Respiratory tract Urine Blood-stream infection Other sources Pseudomonas aeruginosa 16,482 1,887 366 266 488 3,094 569 458 755 3,144 591 528 786 2,287 387 387 489 Escherichia coli 13,961 803 946 415 595 946 1,560 662 792 917 1,799 911 741 684 1,147 546 497 Klebsiella pneumoniae 10,571 996 354 300 350 1,571 506 490 486 1,527 612 642 481 1,121 442 407 286 Enterobacter cloacae 6,779 796 139 232 304 1,162 125 276 406 1,017 183 350 349 783 138 282 237 Acinetobacter spp.a 4,642 548 62 128 125 927 45 193 157 858 57 212 153 786 57 208 126 Serratia marcescens 4,112 453 60 74 88 910 41 169 132 844 68 192 164 621 54 133 109 Enterobacter aerogenes 3,307 523 77 86 111 726 85 82 141 614 85 102 112 360 58 62 83 Proteus mirabilis 3,011 272 138 68 134 354 269 102 190 326 248 173 176 216 149 91 105 Klebsiella oxytoca 2,018 240 72 44 89 316 70 78 90 294 82 106 87 234 55 88 73 Citrobacter freundii 1,483 153 59 48 100 212 97 47 116 163 97 59 98 83 75 32 44 All other speciesb 8,028 966 182 159 320 1,654 250 225 435 1,423 225 284 359 931 171 193 251 ↵a Includes Acinetobacter baumannii, Acinetobacter spp. nosocomial (NOS), Acinetobacter calcoaceticus, Acinetobacter anitratus, Acinetobacter lwoffii, and Acinetobacter junii.
↵b Other species (number of isolates) include Achromobacter group VD (1), Actinobacillus actinomycetemcomitans (1), Actinobacillus ureae (1), Aeromonas caviae (2), Aeromonas hydrophila (79), Aeromonas schubertii (1), Aeromonas sobria (6), nosocomial (NOS) Aeromonas spp. (13), Agrobacterium tumefaciens (5), Alcaligenes denitrificans (1), Alcaligenes faecalis (27), Alcaligenes odorans (3), NOS Alcaligenes spp. (29), Alcaligenes xylosoxidans (335), Bacteroides vulgatus (1), Bordetella bronchiseptica (10), Budvicia aquatica (1), Brevundimonas vesicularis (3), Burkholderia cepacia (195), Burkholderia gladioli (3), Burkholderia pickettii (1), NOS Burkholderia spp. (1), Campylobacter jejuni (1), NOS Capnocytophaga spp. (1), Cedecea davisae (5), NOS Cedecea spp. (3), Chromobacterium violaceum (3), Chryseobacterium gleum (4), Chryseobacterium indologenes (7), Chryseobacterium meningosepti (15), NOS Chryseobacterium spp. (5), Chryseomonas luteola (7), Citrobacter amalonaticus (96), Citrobacter braakii (34), Citrobacter farmeri (1), Citrobacter indologenes (2), Citrobacter koseri (734), NOS Citrobacter spp. (71), Citrobacter youngae (7), Citrobacter werkmanii (1), Comamonas acidovorans (13), NOS Comamonas spp. (3), Comamonas testosteroni (1), Edwardsiella tarda (3), Enterobacter amnigenus (23), Enterobacter asburiae (45), Enterobacter cancerogenus (33), Enterobacter gergoviae (32), Enterobacter hormachei (4), Enterobacter intermedius (12), Enterobacter sakazakii (65), NOS Enterobacter spp. (200), Escherichia fergusonii (11), Escherichia hermanii (7), NOS Escherichia spp. (2), Escherichia vulneris (3), Flavimonas oryzihabitans (14), Flavobacterium breve (3), Flavobacterium indologenes (18), Flavobacterium meningosepticum (33), Flavobacterium odoratum (6), NOS Flavobacterium spp. (23), NOS Fusobacterium spp. (1), Haemophilus influenzae (6), Haemophilus parainfluenzae (1), NOS Haemophilus spp. (1), Hafnia alvei (102), Klebsiella ornithinolytica (27), NOS Klebsiella spp. (65), Klebsiella terrigena (2), Kluyvera ascorbate (8), NOS Kluyvera spp. (9), Leclercia adecarboxylata (6), NOS Leminorella spp. (1), Moraxella catarrhalis (14), Moraxella osloensis (1), Moraxella phenylpyruvica (1), NOS Moraxella spp. (5), Morganella morganii (744), Ochrobacterium anthropi (6), Pantoea agglomerans (133), NOS Pantoea spp. (2), Pasteurella multocida (12), NOS Pasteurella spp. (1), Plesiomonas shigelloides (4), Proteus penneri (30), NOS Proteus spp. (14), Proteus vulgaris (191), Providencia alcalifaciens (1), Providencia rettgeri (81), Providencia rustigianii (1), NOS Providencia spp. (3), Providencia stuartii (319), Pseudomonas alcaligenes (7), Pseudomonas fluorescens (181), Pseudomonas mendocina (8), Pseudomonas paucimobilis (4), Pseudomonas pseudoalcaligenes (1), Pseudomonas putida (48), NOS Pseudomonas spp. (81), Pseudomonas stutzeri (45), Rahnella aquatilis (3), Ralstonia pickettii (8), NOS Roseomonas spp. (1), Salmonella choleraesuis (3), Salmonella enteritidis (20), Salmonella hadar (1), Salmonella montevideo (1), NOS Salmonella spp. (46), Salmonella enterica serovar Typhimurium (6), Serratia ficaria (1), Serratia fonticola (23), Serratia liquefaciens (91), Serratia odorans (5), Serratia odorifera (20), Serratia plymuthica (14), Serratia rubidaea (18), NOS Serratia spp. (54), Shewanella putrefaciens (6), Shigella sonnei (4), NOS Shigella spp. (2), NOS Sphingobacterium spp. (1), Sphingomonas paucimobilis (4), Stenotrophomonas maltophilia (3,217), Vibrio fluvialis (1), Vibrio vulnificus (3), and Yersinia enterocolitica (4).
↵c Including abdomen, abscess, aorta, appendix, aspirate, bile, bone, bowel, biliary, colon, cerebral spinal fluid, drainage, eye, gastrointestinal, graft, gall bladder, kidney, liver, mandible, nasal cavities, mouth, pancreas, pelvis, perineum, peritoneum, pericardium, spleen, throat, unknown, and wound.
- TABLE 2.
Resistance rates for the 10 most frequently isolated GNB from 2002 to 2004a
GNB and source % of isolates (%I/%R) Ampicillin-sulbactam Ceftriaxone Ceftazidime Cefepime Piperacillin Piperacillin-tazobactam Imipenem Ertapenem Aztreonam Tobramycin Amikacin Ciprofloxacin P. aeruginosa Respiratory tract 34.9/48.6 6.5/4.6 14.6/13.0 NA/15.9 NA/13.7 3.5/14.9 15.7/18.5 1.8/13.5 6.9/3.5 5.7/27.4 Urine 35.4/48.1 4.1/3.1 16.0/12.9 NA/11.8 NA/14.0 3.1/13.4 17.1/17.3 2.1/17.8 7.8/4.7 2.1/41.9 Bloodstream infection 42.9/41.3 5.9/5.4 15.3/8.8 NA/18.9 NA/10.9 5.9/14.7 12.4/15.0 1.3/15.8 6.0/3.9 3.1/28.4 All 35.9/48.0 6.3/4.5 14.5/12.5 NA/16.0 NA/13.2 3.8/14.5 15.1/17.8 1.8/13.7 6.9/3.5 4.8/28.9 E. coli Respiratory tract 13.9/32.3 1.9/5.0 1.3/1.9 0.9/3.5 5.0/35.0 2.9/6.6 0/0 0.3/0.9 0.9/6.0 3.4/8.9 1.5/1.2 0.4/18.6 Urine 12.7/25.9 1.7/3.1 0.9/1.1 0.5/1.8 3.8/33.8 2.3/3.8 0.2/0.3 0.2/1.0 1.0/4.1 2.9/6.0 0.4/0.4 0.2/16.3 Bloodstream infection 14.1/35.4 2.8/2.9 0.9/1.8 0.4/1.8 5.6/41.9 4.0/3.9 0/0 0.6/0.6 1.8/3.5 3.5/7.1 0.7/1.3 0.2/16.3 All 13.5/30.0 2.1/4.6 1.2/1.6 0.5/2.5 4.3/36.3 2.8/4.8 0.1/0.2 0.4/0.9 1.2/4.6 3.3/7.1 0.7/0.9 0.2/17.3 K. pneumoniae Respiratory tract 8.2/22.9 4.8/11.7 0.7/4.1 2.1/8.1 19.9/24.9 4.3/11.8 0.7/0.7 0.2/3.5 1.1/15.7 2.2/15.2 5.4/3.4 1.6/16.8 Urine 8.6/21.3 4.3/10.4 1.4/2.9 1.6/6.6 16.2/31.8 5.0/7.5 0.5/0.2 0/2.0 1.1/13.1 2.3/13.6 3.4/2.3 1.1/16.1 Bloodstream infection 7.6/26.8 4.7/13.8 1.0/4.7 1.5/9.3 13.7/36.7 3.7/13.0 1.5/1.5 0.3/5.2 0.7/16.7 3.9/17.0 5.7/3.7 1.5/18.2 All 8.2/23.6 4.7/11.8 0.8/3.8 1.8/8.1 17.0/28.7 4.0/11.8 1.0/0.7 0.2/3.7 0.9/15.6 2.5/15.1 5.1/3.1 1.4/16.8 E. cloacae Respiratory tract 19.0/61.6 8.6/26.1 2.6/11.0 4.0/9.3 5.2/31.7 11.6/14.6 0.6/0.4 2.0/2.7 4.7/27.5 2.9/10.6 1.7/1.4 2.2/12.0 Urine 20.3/50.7 8.7/36.2 2.2/12.3 5.8/11.6 10.9/34.8 13.1/20.3 0/0 1.5/2.9 13.0/23.2 2.9/13.8 2.2/2.2 2.9/14.5 Bloodstream infection 16.7/62.4 10.3/30.1 3.6/13.5 2.8/16.0 6.9/46.0 13.1/17.7 0/0 3.6/0.7 5.0/33.7 2.5/13.1 1.8/2.1 1.4/12.1 All 18.5/62.5 8.9/28.7 2.7/11.7 4.0/10.8 6.1/35.1 12.6/16.2 0.4/0.3 2.3/2.3 5.0/30.1 3.1/11.1 1.6/1.5 1.7/12.4 Acinetobacter spp. Respiratory tract 7.6/31.6 16.4/53.2 7.4/13.4 13.7/46.6 11.4/50.4 16.9/35.8 6.4/4.8 22.8/60.6 4.6/28.5 5.2/21.9 1.4/61.5 Urine 10.5/29.8 17.5/68.4 10.5/22.8 17.5/54.4 11.1/66.7 26.3/33.3 1.8/8.8 14.0/75.4 3.5/36.8 5.3/31.6 0/74.5 Bloodstream infection 7.7/39.4 15.4/56.7 10.6/15.9 15.4/51.4 6.1/54.6 17.3/38.9 9.1/4.3 16.4/67.3 3.9/33.3 2.9/26.9 0.5/63.5 All 8.1/33.2 16.2/56.2 8.2/14.6 14.2/49.0 10.9/52.4 17.9/36.9 6.9/5.2 20.7/63.9 5.2/30.3 5.0/23.9 1.0/63.8 S. marcescens Respiratory tract 12.7/81.0 5.6/4.7 2.1/2.3 1.5/4.4 7.1/9.0 5.3/6.8 0.2/0.5 1.0/1.3 2.1/7.6 4.7/6.4 0.6/0.3 3.7/6.6 Urine 14.8/72.2 7.4/7.4 3.7/3.7 1.9/5.6 9.5/23.8 3.7/5.6 0/1.9 0/3.7 1.9/13.0 9.3/16.7 5.6/3.7 3.7/11.1 Bloodstream infection 18.8/76.7 6.0/2.3 2.3/0 2.3/2.3 2.5/15.0 6.0/9.0 0/1.5 0.8/0 3.0/7.5 6.8/9.8 1.5/2.3 3.8/1.5 All 14.0/79.6 5.7/4.5 2.2/1.9 1.4/4.0 6.6/10.9 5.5/7.2 0.1/0.7 0.8/1.3 2.5/17.8 5.8/7.1 1.1/0.8 3.7/6.1 E. aerogenes Respiratory tract 25.6/34.4 13.6/2.8 4.2/3.6 1.1/0.8 9.4/6.8 9.2/2.2 0.6/0 0.6/2.5 7.2/4.7 0.6/0.8 0.6/0.3 0.6/1.9 Urine 20.7/42.0 10.3/6.9 8.6/5.2 0/3.5 11.8/17.7 12.1/5.2 1.7/0 0/1.7 6.9/10.4 0/5.2 0/3.5 3.5/8.6 Bloodstream infection 19.4/48.4 25.8/1.6 11.3/4.8 0/0 21.1/15.8 17.7/3.2 0/0 0/0 12.9/8.1 1.6/0 0/0 1.6/4.8 All 22.9/38.9 15.6/4.3 5.9/4.6 1.2/1.5 11.3/10.8 11.4/3.4 1.1/0 0.4/2.8 8.4/7.1 0.7/1.8 1.2/0.5 1.1/3.5 P. mirabilis Respiratory tract 6.0/2.8 6.0/2.8 0.5/0.5 1.4/0.9 1.4/8.1 0.9/0.5 0.5/0 0/0.9 0/2.3 3.2/2.3 0.9/0.5 0.9/13.4 Urine 7.4/8.7 0/0.7 8.6/5.2 1.3/1.3 5.0/15.0 0/1.5 0/0 0/0.7 0/2.7 4.0/3.4 0.7/0 3.4/19.5 Bloodstream infection 6.7/7.7 1.1/0 0/1.1 0/2.2 0/14.7 1.1/1.1 1.1/0 0/1.1 0/1.1 3.3/4.4 0/0 3.3/12.1 All 7.5/5.3 1.2/0.4 0.5/0.5 0.9/1.4 2.1/10.5 0.7/0.7 0.7/0 0/0.7 0/2.1 3.0/3.6 0.5/0.2 2.1/15.0 K. oxytoca Respiratory tract 22.2/12.4 3.9/4.3 1.3/0.4 1.3/2.1 41.2/24.7 3.4/6.4 0/0 0/1.3 0.4/7.7 1.3/4.7 0/0.4 0.4/3.9 Urine 21.8/29.1 5.5/14.6 1.8/3.6 1.8/5.5 20.0/40.0 0/18.2 0/0 0/0 1.8/23.6 5.5/12.7 0/0 1.8/10.9 Bloodstream infection 19.3/25.0 6.8/8.0 0/1.1 1.1/0 10.0/40.0 4.6/10.2 0/0 0/1.1 2.3/13.6 5.7/6.8 2.3/0 2.3/4.6 All 19.8/17.6 4.9/6.0 0.9/1.1 1.1/2.0 32.9/27.0 3.3/8.7 0/0 0/1.1 0.9/11.3 2.9/6.0 0.4/0.4 0.9/6.0 C. freundii Respiratory tract 10.8/57.8 20.5/30.1 1.2/14.5 2.4/6.0 6.7/36.7 21.7/16.9 0/0 1.2/3.6 9.6/36.1 1.2/27.7 4.8/9.6 7.2/24.21 Urine 13.3/48.0 14.7/28.0 6.7/6.7 4.0/12.0 4.6/22.7 14.7/13.3 0/0 0/4.0 5.3/32.0 1.3/21.3 4.0/4.0 1.3/20.0 Bloodstream infection 12.5/43.8 12.5/15.6 3.1/15.6 0/0 7.7/46.2 9.4/9.4 0/0 0/3.1 9.4/28.1 6.3/28.1 3.1/0 3.1/18.8 All 12.8/53.4 18.8/25.2 3.9/15.0 2.6/6.8 10.5/37.2 15.4/13.7 0/0 0.4/3.9 9.0/31.6 3.9/23.1 4.7/5.1 4.7/21.4 a I, intermediate; R, resistant. NA, not available.
- TABLE 3.
Trends in antimicrobial resistance among various GNB between 1993 and 2004a
Organism Antimicrobial % of isolates (%I/%R) Trendb 1993-1995 1996-1998 1999-2001 2002-2004 Pseudomonas aeruginosa Ceftazidime 5.6/9.9 5.6/12 5.2/14.2 6.3/4.5 ↓ Imipenem 4.5/10.6 3.5/11.1 3.6/13.7 3.8/14.5 ↑ Tobramycin 0.9/7.8 1.5/9.6 0.4/13.3 1.8/13.7 ↑ Ciprofloxacin 5.6/11.2 5.7/17.6 5.4/25.1 4.8/28.9 ↑ Escherichia coli Ampicillin-sulbactam 10/22.9 10.8/26.4 10.3/28.6 13.5/30 ↑ Ceftriaxone 0.8/1 1.3/2.3 1.6/2.7 2.1/4.6 ↑ Tobramycin 0.9/1.5 0.1/2.9 1/4.6 3.3/7.1 ↑ Ciprofloxacin 0.2/0.9 0.4/3.9 0.4/8.3 0.2/17.3 ↑ Klebsiella pneumoniae Ceftazidime 0.6/12.7 1.4/13.5 1/10.8 0.8/3.8 ↓ Piperacillin 27.4/38.3 22.3/36.9 22.1/37.4 17/28.7 ↓ Ciprofloxacin 3.1/7.9 3.4/9.7 1.8/10.5 1.4/16.8 ↑ Enterobacter cloacae Ceftazidime 3.9/36 4.2/33.8 3.6/30.4 2.7/11.7 ↓ Ciprofloxacin 2.5/5 2.9/7.6 2.1/10.9 1.7/12.4 ↑ Acinetobacter spp.a Ampicillin-sulbactam 6/18.2 9.3/22 7.5/25.5 8.1/33.2 ↑ Ceftriaxone 25/30.1 21.3/43 16.3/51.7 16.2/56.2 ↑ Ceftazidime 10.1/23.9 8.7/36.8 8/45.2 8.2/14.6 ↓ Cefepime 13.7/31.6 15.5/37.7 14.2/49 ↑ Piperacillin 18.9/31.4 16.4/40.3 14.8/49.1 10.9/52.4 ↑ Piperacillin-tazobactam 22.4/18.4 20.1/26.7 17.9/36.9 ↑ Imipenem 2.1/2 4.4/2.1 6.6/5.6 6.9/5.2 ↑ Tobramycin 7.8/13 7/24.5 5.8/30.4 5.2/30.3 ↑ Amikacin 3.7/5.7 3.9/13.4 4.1/19.2 5/23.9 ↑ Ciprofloxacin 2.6/35.9 3/49.4 1.9/57.1 1/63.8 ↑ Serratia marcescens Ceftazidime 1.8/8.4 3.5/11.6 2.5/10.7 2.2/1.9 ↓ Imipenem 2.8/3.6 1.5/1.8 0.7/1.3 0.1/0.7 ↓ Enterobacter aerogenes Ceftazidime 6.3/23.8 3/24.7 3.5/22.7 5.9/4.6 ↓ Piperacillin 12.5/22 15.8/17.1 11.5/19.5 11.3/10.8 ↓ Proteus mirabilis Imipenem 7.7/3.4 2.8/1.2 1.1/1.2 0.7/0 ↓ Ciprofloxacin 0.3/3.3 2.1/7.8 0.1/13.1 2.1/15 ↑ Klebsiella oxytoca Cefepime 0.9/3.4 1.9/5.1 1.1/2 ↓ Citrobacter freundii Ceftazidime 1.9/43.6 1.5/47 3.1/38.9 3.9/15 ↓ Ertapenem 1.4/1.7 0.4/3.9 ↑ Tobramycin 2.2/10.8 5.3/12.7 3.4/12.7 3.9/23.1 ↑ Ciprofloxacin 2.8/9.2 4.7/14.4 3.4/14.9 4.7/21.4 ↑ - TABLE 4.
Longitudinal increase in multidrug resistance
Organism 1993 2004 No. of MDR isolates/total no. of isolatesa % of MDR isolates No. of MDR isolates/total no. of isolates % of MDR isolates Pseudomonas aeruginosa 13/769 1.7 93/1,004 9.3 Escherichia coli 0/724 0 16/808 2.0 Klebsiella pneumoniae 26/513 5.1 84/633 13.3 Enterobacter cloacae 13/397 3.3 24/406 5.9 Acinetobacter spp. 19/285 6.7 101/338 29.9 Enterobacter aerogenes 6/213 2.8 0/154 0 Proteus mirabilis 1/174 0.6 1/142 0.7 Citrobacter freundii 5/95 5.3 7/63 11.1 ↵a Multidrug resistances is defined here as being resistant to one or more extended-generation cephalosporins (ceftazidime, ceftriaxone, or cefotaxime), one or more aminoglycosides (amikacin or tobramycin), and the fluoroquinolone ciprofloxacin. MDR, multidrug resistant.
- TABLE 5.
Fluoroquinolones usage levels between 1999 and 2004 and antimicrobial resistance among GNB between 1999 and 2004a
Organism R2 values for fluoroquinolone resistance compared to that of antimicrobials shown J01M Levofloxacin Ciprofloxacin Gatifloxacin Moxifloxacin P. aeruginosa 0.7352 0.6624 0.1806 0.6473 0.1588 E. coli 0.7552 0.7262 0.5846 0.5099 0.6468 K. pneumoniae 0.5544 0.6193 0.6135 0.1816 0.07451 E. cloacae 0.5048 0.5852 0.0968 0.2224 0.0173 Acinetobacter spp. 0.5844 0.6724 0.6602 0.1976 0.6711 S. marcescens 0.1758 0.1212 0.4336 0.2023 0.566 E. aerogenes 0.0914 −0.0338 −0.1401 0.3243 −0.1359 P. mirabilis 0.0556 0.1484 0.0879 −0.1876 0.2782 K. oxytoca −0.0721 −0.1682 −0.0307 0.0415 0.2849 C. freundii 0.4462 0.2455 0.1463 0.6528 0.3016 ↵a Adjusted linear regression values comparing antimicrobial usage levels of fluoroquinolones in the United States between 1999 and 2004 and rates of antimicrobial resistance among GNB between 1999 and 2004. J01M, antimicrobial class of fluoroquinolones.
