Why standardise susceptibility testing?
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Why standardise susceptibility testing?
Transcript of Why standardise susceptibility testing?
Why standardisesusceptibility testing?
• LIMS– Single setup
• Clinical consistency– Results look the same & mean the same
• Business management consistency– Merging of trusts
– Cost comparisons
• Surveillance consistency– Levels (methods) of ID
– Antimicrobials tested
– “expert” rules
Issues revealed by surveillance
• What we test
Collation of results forcomparative AR report
• Quinolones – ciprofloxacin &/orlevofloxacin, norfloxacin
• Third generation cephalosporins (3GC) –ceftazidime &/or cefotaxime, ceftriaxone,cefpodoxime.
• Carbapenems – imipenem &/ormeropenem
ABER SWAN RHYL CARDPenicillin 1 1 1Erythromycin 1 1 1 1Clindamycin 1 2Ciprofloxacin 1 2 2Levofloxacin 2Gentamicin 1 1 1 1Chloramphenicol 1Fusidic acid 1 1 1 1Tetracycline 2 2 1Trimethoprim 2 2 1 1Rifampicin 2 2 2 2Mupirocin (5) 2 2 2Mupirocin (20) 2Teicoplanin 2 2Vancomycin 2 1 2 1Linezolid 2 2Neomycin 2Synercid 2Cefoxitin 1Oxacillin 1 1 1
Issues revealed by surveillance
• What we test
• What we ID & how
Community urine isolates
0
10
20
30
40
50
60
70
80
90
100
Antimicrobial
Re
sis
tan
ce
(%)
Coli 50.8 7.2 6.1 5.8 29.0
E. coli 99.0 72.4 61.5 91.4 72.4
AMO AUG FQ CEF1 TRI
AllWales
Swansea
Community urine isolates
0
10
20
30
40
50
60
70
80
90
100
Antimicrobial
Re
sis
tan
ce
(%)
Coli 50.8 7.2 6.1 5.8 29.0
E. coli 99.0 72.4 61.5 91.4 72.4
AMO AUG FQ CEF1 TRI
AllWales
Swansea
Organism Total
Citrobacter freundii 8
Citrobacter sp 5
Coliform 10105
Enterobacter aerogenes 1
Enterobacter cloacae 26
Enterobacter sakazakii 1
Enterobacter sp 2
Escherichia coli 435
Klebsiella aerogenes 40
Klebsiella oxytoca 2
Klebsiella pneumoniae 36
Klebsiella sp 42
Morganella morganii 5
Pantoea sp 1
Proteus mirabilis 3
Proteus sp 142
Serratia liquefaciens 12
Serratia marcescens 55
Serratia odorifera 1
Serratia rubidaea 1
Serratia sp 14
Grand Total 10937
Organism Total
Citrobacter freundii 46
Citrobacter koseri 1
Citrobacter sp 3
Coliform 3168
Enterobacter aerogenes 16
Enterobacter cloacae 91
Escherichia coli 12166
Hafnia alvei 3
Klebsiella oxytoca 22
Klebsiella ozaenae 2
Klebsiella pneumoniae 144
Morganella morganii 25
Morganella sp 1
Pantoea agglomerans 1
Proteus mirabilis 3
Proteus sp 692
Serratia marcescens 71
Serratia odorifera 1
Serratia plymuthica 7
Serratia proteamaculas 3
Serratia sp 1
Grand Total 16467
Swansea UHW
Issues revealed by surveillance
• What we test
• What we ID & how
• Sensitivity testing method
• How we record results
Matching resistancewith usage
Co-amoxiclav resistance 2007
05
10
15202530
354045
In-patient data
Re
sis
tan
ce
(%).
AUG - 2007 40.4 36.5 32.0 29.4 18.8 16.5 15.6 11.4 10.4 9.0
C N F G A H D J M B
Co-amoxiclav resistance 2007
0
5
10
15
20
25
30
35
Community data
Re
sis
tan
ce
(%).
AUG - 2007 28.8 23.1 18.9 13.2 10.8 8.0 7.1 6.9 6.9 4.9
C N G F A D M J H B
Beta-lactam/beta-lactamase inhibitor combinations (J01CR)
Usage by Hospital 2007 (DDD/1000 BD)
0
50
100
150
200
250
300
350
400
450
500
Hospital Code
DD
D/1
000
BD
J01CR 406 311 256 252 217 207 184 166 131 111
C N B F A M D H J G
Matching resistancewith usage
Co-amoxiclav resistance 2007
05
10
15202530
354045
In-patient data
Re
sis
tan
ce
(%).
AUG - 2007 40.4 36.5 32.0 29.4 18.8 16.5 15.6 11.4 10.4 9.0
C N F G A H D J M B
Co-amoxiclav resistance 2007
0
5
10
15
20
25
30
35
Community data
Re
sis
tan
ce
(%).
AUG - 2007 28.8 23.1 18.9 13.2 10.8 8.0 7.1 6.9 6.9 4.9
C N G F A D M J H B
Beta-lactam/beta-lactamase inhibitor combinations (J01CR)
Usage by Hospital 2007 (DDD/1000 BD)
0
50
100
150
200
250
300
350
400
450
500
Hospital Code
DD
D/1
000
BD
J01CR 406 311 256 252 217 207 184 166 131 111
C N B F A M D H J G
?
Changes inco-amoxiclav
resistancein coliforms
over time0
5
10
15
20
25
30
35
40
0 5 10 15 20 25 30
0
5
10
15
20
25
30
35
40
0 5 10 15 20 25 30
Quarters
%re
sist
ance
Quarters
%re
sist
ance
Co-amoxiclav resistance in urinarycoliforms from practices that submit
>100 urines per year
0
5
10
15
20
25
30
35
40
45
0 2 4 6 8
Year
Perc
en
tag
ere
sis
tan
ce
W95011
W95014
W95024
W95025
W95027
W95036
W95044
W95062
W95071
ABER SWAN RHYL CARDPenicillin 1 1 1Erythromycin 1 1 1 1Clindamycin 1 2Ciprofloxacin 1 2 2Levofloxacin 2Gentamicin 1 1 1 1Chloramphenicol 1Fusidic acid 1 1 1 1Tetracycline 2 2 1Trimethoprim 2 2 1 1Rifampicin 2 2 2 2Mupirocin (5) 2 2 2Mupirocin (20) 2Teicoplanin 2 2Vancomycin 2 1 2 1Linezolid 2 2Neomycin 2Synercid 2Cefoxitin 1Oxacillin 1 1 1
Mupirocin resistance in S. aureus
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
%is
ola
tes
R 1.4 1.4 2.5 8.5
I 1.0 1.4 0.0 0.0
UHW RHYL ABER SWAN
Mupirocin Resistance in Hospital In-Patients 2007/2008
( Data up to 01/12/2008)
0
5
10
15
20
25
30
35
40
45
50
Q1 2007 Q2 2007 Q3 2007 Q4 2007 Q1 2008 Q2 2008 Q3 2008 Q4 2008
Quarter (Q4 2008 incomplete)
Re
sis
tan
ce
(%)
RGL IP PCH IP UHW IP LLAN IP VEL POW IP
MORR IP SING IP NPT IP BRH IP WBH IP WWGH IP
PPH IP RGW IP NNH IP YGC IP WMH IP All-Wales
Issues revealed by surveillance
• What we test
• What we ID & how
• Sensitivity testing method
• How we record results
• Use of expert rules
Susceptibility of Enterobacter spp.COMM I/P
LAB % AMO S % 1GC S % 1GC S
A 0 0 0
B 0 0 0
C 0 0 0
D 0 0 0
E 0 0 0
F 0 0 0
G 0 0 0
H 0 0 0
I 0 3.2 0
J 0 0 0
K 8.9 11.1 3.0
Grand Total 1.4 2.2 1.2
What could we standardise?
• Organism ID
• Antimicrobials tested
• Standard Testing method
• Additional testing criteria & method
• Expert rules
• Antimicrobials reported
