scholarly journals Geographic and Temporal Patterns of Antimicrobial Resistance in Pseudomonas aeruginosa Over 20 Years From the SENTRY Antimicrobial Surveillance Program, 1997–2016

2019 ◽  
Vol 6 (Supplement_1) ◽  
pp. S63-S68 ◽  
Author(s):  
Dee Shortridge ◽  
Ana C Gales ◽  
Jennifer M Streit ◽  
Michael D Huband ◽  
Athanasios Tsakris ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Latin America ◽  
Susceptibility Testing ◽  
Temporal Trends ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
Asia Pacific ◽  
Surveillance Program ◽  
Medical Centers ◽  
Antimicrobial Surveillance

Abstract Background The SENTRY Antimicrobial Surveillance Program was established in 1997 and encompasses over 750 000 bacterial isolates from ≥400 medical centers worldwide. Among the pathogens tested, Pseudomonas aeruginosa remains a common cause of multidrug-resistant (MDR) bloodstream infections and pneumonia in hospitalized patients. In the present study, we reviewed geographic and temporal trends in resistant phenotypes of P. aeruginosa over 20 years of the SENTRY Program. Methods From 1997 to 2016, 52 022 clinically significant consecutive isolates were submitted from ≥200 medical centers representing the Asia-Pacific region, Europe, Latin America, and North America. Only 1 isolate per patient per infection episode was submitted. Isolates were identified by standard algorithms and/or matrix-assisted laser desorption ionization-time of flight mass spectrometry. Susceptibility testing was performed by Clinical and Laboratory Standards Institute (CLSI) methods and interpreted using CLSI and European Committee on Antimicrobial Susceptibility Testing 2018 criteria at JMI Laboratories. Results The most common infection from which P. aeruginosa was isolated was pneumonia in hospitalized patients (44.6%) followed by bloodstream infection (27.9%), with pneumonia having a slightly higher rate of MDR (27.7%) than bloodstream infections (23.7%). The region with the highest percentage of MDR phenotypes was Latin America (41.1%), followed by Europe (28.4%). The MDR rates were highest in 2005–2008 and have decreased in the most recent period. Colistin was the most active drug tested (99.4% susceptible), followed by amikacin (90.5% susceptible). Conclusions Over the 20 years of SENTRY Program surveillance, the rate of MDR P. aeruginosa infections has decreased, particularly in Latin America. Whether the trend of decreasing resistance in P. aeruginosa is maintained will be documented in future SENTRY Program and other surveillance reports.

scholarly journals Temporal and Geographic Variation in Antimicrobial Susceptibility and Resistance Patterns of Enterococci: Results From the SENTRY Antimicrobial Surveillance Program, 1997–2016

2019 ◽  
Vol 6 (Supplement_1) ◽  
pp. S54-S62 ◽  
Author(s):  
Michael A Pfaller ◽  
Martin Cormican ◽  
Robert K Flamm ◽  
Rodrigo E Mendes ◽  
Ronald N Jones
Keyword(s):  
Latin American ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Temporal Trends ◽  
Asia Pacific ◽  
Surveillance Program ◽  
Enterococcus Species ◽  
Medical Centers ◽  
Antimicrobial Surveillance ◽  
Tract Infections

Abstract Background The SENTRY Antimicrobial Surveillance Program was established in 1997 and presently encompasses more than 750 000 bacterial isolates from over 400 medical centers worldwide. Among these pathogens, enterococci represents a prominent cause of bloodstream (BSIs), intra-abdominal (IAIs), skin and skin structure, and urinary tract infections (UTIs). In the present study, we reviewed geographic and temporal trends in Enterococcus species and resistant phenotypes identified throughout the SENTRY Program. Methods From 1997 to 2016, a total of 49 491 clinically significant enterococci isolates (15 species) were submitted from 298 medical centers representing the Asia-Pacific (APAC), European, Latin American (LATAM), and North American (NA) regions. Bacteria were identified by standard algorithms and matrix-assisted laser desorption ionization–time of flight mass spectrometry. Susceptibility (S) testing was performed by reference broth microdilution methods and interpreted using Clinical and Laboratory Standards Institute/US Food and Drug Administration and European Committee on Antimicrobial Susceptibility Testing criteria. Results The most common Enterococcus species in all 4 regions were Enterococcus faecalis (64.7%) and E. faecium (EFM; 29.0%). Enterococci accounted for 10.7% of BSIs in NA and was most prominent as a cause of IAIs (24.0%) in APAC and of UTIs (19.8%) in LATAM. A steady decrease in the susceptibility to ampicillin and vancomycin was observed in all regions over the 20-year interval. Vancomycin-resistant enterococci (VRE) accounted for more than 8% of enterococcal isolates in all regions and was most common in NA (21.6%). Among the 7615 VRE isolates detected, 89.1% were the VanA phenotype (91.0% EFM) and 10.9% were VanB. Several newer antimicrobial agents demonstrated promising activity against VRE, including daptomycin (99.6–100.0% S), linezolid (98.0%–99.6% S), oritavancin (92.2%–98.3% S), tedizolid (99.5%–100.0% S), and tigecycline (99.4%–100.0% S). Conclusions Enterococci remained a prominent gram-positive pathogen in the SENTRY Program from 1997 through 2016. The overall frequency of VRE was 15.4% and increased over time in all monitored regions. Newly released agents with novel mechanisms of action show promising activity against VRE.

scholarly journals Bloodstream Infections Due to Candida Species: SENTRY Antimicrobial Surveillance Program in North America and Latin America, 1997-1998

2000 ◽  
Vol 44 (3) ◽  
pp. 747-751 ◽  
Author(s):  
M. A. Pfaller ◽  
R. N. Jones ◽  
G. V. Doern ◽  
H. S. Sader ◽  
S. A. Messer ◽  
...  
Keyword(s):  
United States ◽  
Latin America ◽  
Bloodstream Infections ◽  
The United States ◽  
Common Species ◽  
Surveillance Program ◽  
International Program ◽  
The Third ◽  
Medical Centers ◽  
Antimicrobial Surveillance

ABSTRACT An international program of surveillance of bloodstream infections (BSI) in the United States, Canada, and Latin America detected 306 episodes of candidemia in 34 medical centers (22 in the United States, 6 in Canada, and 6 in Latin America) in 1997 and 328 episodes in 34 medical centers (22 in the United States, 5 in Canada, and 7 in Latin America) in 1998. Of the 634 BSI, 54.3% were due to Candida albicans, 16.4% were due to C. glabrata, 14.9% were due to C. parapsilosis, 8.2% were due to C. tropicalis, 1.6% were due to C. krusei, and 4.6% were due to other Candida spp. The percentage of BSI due to C. albicans decreased very slightly in the United States between 1997 and 1998 (56.2 to 54.4%;P = 0.68) and increased in both Canada (52.6 to 70.1%; P = 0.05) and Latin America (40.5 to 44.6%;P = 0.67). C. glabrata was the second most common species observed overall, and the percentage of BSI due toC. glabrata increased in all three geographic areas between 1997 and 1998. C. parapsilosis was the third most prevalent BSI isolate in both Canada and Latin America, accounting for 7.0 and 18.5% of BSI, respectively. Resistance to fluconazole (MIC, ≥64 μg/ml) and itraconazole (MIC, ≥1.0 μg/ml) was observed infrequently in both 1997 (2.3 and 8.5%, respectively) and 1998 (1.5 and 7.6%, respectively). Among the different species ofCandida, resistance to fluconazole and itraconazole was observed in C. glabrata and C. krusei, whereas isolates of C. albicans, C. parapsilosis, and C. tropicalis were all highly susceptible to both fluconazole (98.9 to 100% susceptible) and itraconazole (96.4 to 100% susceptible). Isolates from Canada and Latin America were generally more susceptible to both triazoles than U.S. isolates were. Continued surveillance appears necessary to detect these important changes.

scholarly journals Antimicrobial Susceptibility of Streptococcus pneumoniae from North America, Europe, Latin America, and the Asia-Pacific Region: Results From 20 Years of the SENTRY Antimicrobial Surveillance Program (1997–2016)

2019 ◽  
Vol 6 (Supplement_1) ◽  
pp. S14-S23 ◽  
Author(s):  
Helio S Sader ◽  
Rodrigo E Mendes ◽  
Jennifer Le ◽  
Gerald Denys ◽  
Robert K Flamm ◽  
...  
Keyword(s):  
Latin America ◽  
Streptococcus Pneumoniae ◽  
North America ◽  
Antimicrobial Susceptibility ◽  
Asia Pacific ◽  
Surveillance Program ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Antimicrobial Surveillance ◽  
Tract Infections

Abstract Background The SENTRY Antimicrobial Surveillance Program monitors the frequency of occurrence and antimicrobial susceptibility of organisms from various infection types worldwide. In this investigation, we evaluated the antimicrobial susceptibility of Streptococcus pneumoniae isolates collected worldwide over 20 years (1997–2016). Methods A total of 65 993 isolates were consecutively collected (1 per infection episode) from North America (NA; n = 34 626; 2 nations), Europe (EUR; n = 19 123; 23 nations), the Asia-Pacific region (APAC; n = 7111; 10 nations), and Latin America (LATAM; n = 5133; 7 nations) and tested for susceptibility using reference broth microdilution methods. Resistant subgroups included multidrug-resistant (MDR; nonsusceptible to ≥3 classes of agents) and extensively drug-resistant (XDR; nonsusceptible to ≥5 classes). Results The isolates were collected primarily from respiratory tract infections (77.3%), and 25.4% were from pediatric patients. Penicillin susceptibility (≤0.06 mg/L) rates varied from 70.7% in EUR to 52.4% in APAC for all years combined. In NA, there was a slight improvement in susceptibility for the first few years of the program, from 66.5% in 1997–1998 to 69.4% in 1999–2000, followed by a decline until 2011–2012 (57.0%). Similar declines in penicillin susceptibility rates were observed in all regions, with the lowest rates of 67.3% in EUR (2011–2012), 41.6% in the APAC region (2007–2008), and 48.2% in LATAM (2013–2014). These declines were followed by improved susceptibility rates in all regions in later program years, with susceptibility rates of 55.6% to 71.8% in 2015–2016 (65.8% overall). Susceptibility rates to ceftriaxone, erythromycin, clindamycin, tetracycline, and trimethoprim-sulfamethoxazole followed a similar pattern, with a decrease in the first 12–14 years and a continued increase in the last 6–8 years of the program. MDR and XDR frequencies were highest in APAC (49.8% and 17.3% overall, respectively) and lowest in LATAM (10.8% and 1.9% overall, respectively). The most active agents for MDR/XDR isolates were ceftaroline (99.7%/99.1% susceptible), tigecycline (96.8%/95.9% susceptible), linezolid (100.0%/100.0% susceptible), and vancomycin (100.0%/100.0% susceptible). Conclusions S. pneumoniae susceptibility to many antibiotics increased in all regions in the last few years, and these increases may be related to PCV13 immunization, which was introduced in 2010.

scholarly journals Twenty Years of the SENTRY Antifungal Surveillance Program: Results for Candida Species From 1997–2016

2019 ◽  
Vol 6 (Supplement_1) ◽  
pp. S79-S94 ◽  
Author(s):  
Michael A Pfaller ◽  
Daniel J Diekema ◽  
John D Turnidge ◽  
Mariana Castanheira ◽  
Ronald N Jones
Keyword(s):  
Candida Glabrata ◽  
Hot Spot ◽  
Bloodstream Infections ◽  
The United States ◽  
Asia Pacific ◽  
Steady Increase ◽  
Surveillance Program ◽  
Candida Auris ◽  
Medical Centers ◽  
Clinical Breakpoints

AbstractBackgroundThe emergence of antifungal resistance threatens effective treatment of invasive fungal infection (IFI). Invasive candidiasis is the most common health care–associated IFI. We evaluated the activity of fluconazole (FLU) against 20 788 invasive isolates of Candida (37 species) collected from 135 medical centers in 39 countries (1997–2016). The activity of anidulafungin, caspofungin, and micafungin (MCF) was evaluated against 15 308 isolates worldwide (2006–2016).MethodsSpecies identification was accomplished using phenotypic (1997–2001), genotypic, and proteomic methods (2006–2016). All isolates were tested using reference methods and clinical breakpoints published in the Clinical and Laboratory Standards Institute documents.ResultsA decrease in the isolation of Candida albicans and an increase in the isolation of Candida glabrata and Candida parapsilosis were observed over time. Candida glabrata was the most common non–C. albicans species detected in all geographic regions except for Latin America, where C. parapsilosis and Candida tropicalis were more common. Six Candida auris isolates were detected: 1 each in 2009, 2013, 2014, and 2015 and 2 in 2016; all were from nosocomial bloodstream infections and were FLU-resistant (R). The highest rates of FLU-R isolates were seen in C. glabrata from North America (NA; 10.6%) and in C. tropicalis from the Asia-Pacific region (9.2%). A steady increase in isolation of C. glabrata and resistance to FLU was detected over 20 years in the United States. Echinocandin-R (EC-R) ranged from 3.5% for C. glabrata to 0.1% for C. albicans and C. parapsilosis. Resistance to MCF was highest among C. glabrata (2.8%) and C. tropicalis (1.3%) from NA. Mutations on FKS hot spot (HS) regions were detected among 70 EC-R isolates (51/70 were C. glabrata). Most isolates harboring FKS HS mutations were resistant to 2 or more ECs.ConclusionsEC-R and FLU-R remain uncommon among contemporary Candida isolates; however, a slow and steady emergence of resistance to both antifungal classes was observed in C. glabrata and C. tropicalis isolates.

scholarly journals High Prevalence of Oxacillin-Resistant Staphylococcus aureus Isolates from Hospitalized Patients in Asia-Pacific and South Africa: Results from SENTRY Antimicrobial Surveillance Program, 1998-1999

2002 ◽  
Vol 46 (3) ◽  
pp. 879-881 ◽  
Author(s):  
Jan M. Bell ◽  
John D. Turnidge
Keyword(s):  
South Africa ◽  
Staphylococcus Aureus ◽  
Respiratory Tract ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Asia Pacific ◽  
Surveillance Program ◽  
Antimicrobial Surveillance ◽  
Resistance Patterns ◽  
Tract Infections

ABSTRACT As part of the SENTRY antimicrobial surveillance program, we examined the prevalence rates, types, and antibiograms of oxacillin-resistant Staphylococcus aureus from hospitalized patients from 17 institutions in eight countries in Asia-Pacific and South Africa (APAC). From April 1998 to December 1999, a total of 1,711 isolates of S. aureus (814 from blood, 392 from the respiratory tract, 467 from skin and skin structures, and 38 from urine) were collected from hospitalized patients within the APAC region. Multidrug-resistant oxacillin-resistant S. aureus (MORSA) isolates, defined as strains with three or more resistances to drug classes other than β-lactams, were the most common type of oxacillin-resistant S. aureus (ORSA). They were the most frequently identified pathogen in wound infections and were common in bloodstream and lower respiratory tract infections. In all contributing institutions combined, more than 45% (range, 4 to 74%) of S. aureus isolates were oxacillin resistant, and in six institutions, this rate exceeded 60%. MORSA accounted for 91.2% of all oxacillin-resistant isolates. Distinct resistance patterns predominated at various sites within the APAC region, suggesting the local evolution of resistant clones. Non-multidrug-resistant strains were frequent in one part of Australia. No vancomycin-intermediate strains were detected, and no strains were resistant to linezolid or quinupristin-dalfopristin. MORSA strains are a very common cause of infection in hospitalized patients in the APAC region.

scholarly journals Activities of BMS 284756 (T-3811) against Haemophilus influenzae, Moraxella catarrhalis, andStreptococcus pneumoniae Isolates from SENTRY Antimicrobial Surveillance Program Medical Centers in Latin America (1999)

2001 ◽  
Vol 45 (5) ◽  
pp. 1463-1466 ◽  
Author(s):  
Ana Gales ◽  
Helio Sader ◽  
Ronald N. Jones
Keyword(s):  
Latin America ◽  
Haemophilus Influenzae ◽  
Moraxella Catarrhalis ◽  
Respiratory Tract Infections ◽  
Rank Order ◽  
Therapeutic Option ◽  
Surveillance Program ◽  
Medical Centers ◽  
Antimicrobial Surveillance ◽  
Tract Infections

ABSTRACT The antimicrobial activity of BMS 284756, a novel des-F(6)-quinolone, was comparatively evaluated against 257Streptococcus pneumoniae, 198 Haemophilus influenzae, and 88 Moraxella catarrhalis strains isolated in Latin America between July and September of 1999 as part of the SENTRY Antimicrobial Surveillance Program. Nearly 28.0% ofS. pneumoniae strains were nonsusceptible to penicillin. The rank order of quinolone potency versus S. pneumoniaewas BMS 284756 (MIC at which 90% of isolates were inhibited [MIC90], 0.12 μg/ml) > trovafloxacin (MIC90, 0.25 μg/ml) > gatifloxacin (MIC90, 0.5 μg/ml) > levofloxacin and ciprofloxacin (MIC90, 1 to 2 μg/ml). All S. pneumoniaestrains that were not susceptible to other quinolones were inhibited by BMS 284756 at ≤2 μg/ml. The overall prevalence of β-lactamase production was 15.2% in H. influenzae and 98.9% inM. catarrhalis. BMS 284756 showed excellent potency and spectrum against this group of pathogens, inhibiting all isolates at ≤0.12 μg/ml. BMS 284756 exhibited activity similar to those displayed by the new fluoroquinolones, such as levofloxacin, trovafloxacin, or gatifloxacin, and could be a therapeutic option for empirical treatment of community-acquired respiratory tract infections.

scholarly journals 1226. In Vitro Activity of Tebipenem and Comparators Against Enterobacterales Collected from Patients with Bloodstream Infections as Part of the 2019 Global STEWARD Surveillance Program

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S702-S702
Author(s):  
Ian A Critchley ◽  
Nicole Cotroneo ◽  
Rodrigo E Mendes ◽  
Michael J Pucci
Keyword(s):  
Bloodstream Infections ◽  
Clinical Development ◽  
Asia Pacific ◽  
Surveillance Program ◽  
In Vitro Activity ◽  
Medical Centers ◽  
Oral Agents ◽  
The Us ◽  
Research Grant

Abstract Background Bloodstream infections (BSI) are a significant cause of morbidity and mortality. Enterobacterales (ENT) are frequently implicated in BSI with an increase in organisms producing extended-spectrum β-lactamase (ESBL). This challenges a possible transition to current oral agents due to co-resistance. Carbapenems are active against ESBL-ENT and tebipenem (TBP) is a new oral carbapenem in clinical development. The aim of the study was to assess resistance (R) among BSI isolates and activity of TBP and comparators against ENT collected in a 2019 surveillance study. Methods 2612 ENT from BSI were centrally tested by reference broth microdilution. Isolates were from medical centers in the US, Europe (EU), Latin America (LA) and Asia Pacific (AP). MIC results were interpreted according to CLSI, including ESBL assignment. CRE were sequenced to identify carbapenemase genes. Results Among the ENT, non-susceptibility (NS) rates to ceftazidime, levofloxacin were 20.4 and 27.0%, respectively, and R to trimethoprim-sulfamethoxazole was 31.1%. NS rates for ertapenem (ETP) and MER were 4.9 and 2.7%, respectively. MIC90s for TBP, ETP and MER were 0.12, 0.12 and 0.06 µg/mL, respectively. The MIC90 for TBP was 0.06 µg/mL for ENT from the US and 0.12 µg/mL for isolates from EU, LA and AP. Escherichia coli (EC) was the most prevalent (52% of ENT isolates) and the MIC90 for TBP ranged from 0.015 µg/mL for isolates in the US/EU to 0.03 µg/mL for isolates in LA/AP. ESBL-EC ranged from 15.7% in US to 34.3% in LA. TBP was active against ESBL-EC with an MIC90 of 0.03 µg/mL. Klebsiella pneumoniae (KP) accounted for 22.7% of BSI caused by ENT and TBP MIC90 ranged from 0.06 µg/mL for KP in US to >8 µg/mL in EU, LA and AP. MER-R KP ranged from 2.4% in US to 14.9% in LA. KPC-2, -3 and NDM were the most prevalent carbapenemases. TBP MIC90 values for MER-S ESBL KP in EU, LA and AP were ≤0.12 µg/mL. Conclusion TBP activity was similar to ETP and MER against ENT responsible for BSI. R to oral agents was compromised by ESBL co-resistance. TBP was among the most active agents against EC isolates and ESBL phenotypes. Among KP, TBP was more active against isolates from US where prevalence of CRE was lower than EU, LA and AP. TBP may be considered as an alternative oral option for BSI caused by non-CRE ESBL-producing ENT. Disclosures Ian A. Critchley, Ph.D., Spero Therapeutics (Employee, Shareholder) Nicole Cotroneo, Spero Therapeutics (Employee, Shareholder) Rodrigo E. Mendes, PhD, AbbVie (Research Grant or Support)AbbVie (formerly Allergan) (Research Grant or Support)Cipla Therapeutics (Research Grant or Support)Cipla USA Inc. (Research Grant or Support)ContraFect Corporation (Research Grant or Support)GlaxoSmithKline, LLC (Research Grant or Support)Melinta Therapeutics, Inc. (Research Grant or Support)Melinta Therapeutics, LLC (Research Grant or Support)Nabriva Therapeutics (Research Grant or Support)Pfizer, Inc. (Research Grant or Support)Shionogi (Research Grant or Support)Spero Therapeutics (Research Grant or Support)

scholarly journals 693. In Vitro Activity of Ceftazidime–Avibactam and Comparator Agents Against Enterobacteriaceae and Pseudomonas aeruginosa Collected From Patients with Bloodstream Infections as Part of the ATLAS Global Surveillance Program, 2014–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S314-S314
Author(s):  
Krystyna Kazmierczak ◽  
Gregory Stone ◽  
Daniel F Sahm
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Therapeutic Option ◽  
Bloodstream Infections ◽  
The United States ◽  
Vitro Activity ◽  
Asia Pacific ◽  
Surveillance Program ◽  
In Vitro Activity ◽  
Susceptibility Data

Abstract Background Avibactam (AVI) is a β-lactamase inhibitor with potent inhibitory activity against Class A, Class C, and some Class D serine β-lactamases. The combination of ceftazidime (CAZ) with AVI has been approved in Europe and in the United States for several indications. This study evaluated the in vitro activity of CAZ-AVI and comparators against Enterobacteriaceae (Eba) and Pseudomonas aeruginosa (Pae) isolates collected from patients with bloodstream infections as part of the ATLAS surveillance program in 2014–2017. Methods A total of 53416 Eba and 15050 Pae nonduplicate clinically significant isolates, including 5155 Eba and 845 Pae isolated from bloodstream infections, were collected by 167 hospital laboratories in 36 countries in Europe, Latin America, Asia/Pacific (excluding China), and the Middle East/Africa region. Susceptibility testing was performed by CLSI broth microdilution. CAZ-AVI was tested at a fixed concentration of 4 µg/mL AVI. Meropenem-nonsusceptible (MEM-NS) Eba and Pae isolates were screened for the presence of β-lactamase genes. Results Susceptibility data are shown in the Table. Percentages of susceptibility (% S) to the tested agents were 0.2–2.8% lower among Eba and Pae from bloodstream infections compared with isolates from combined sources in most cases. CAZ-AVI showed potent in vitro activity against all Eba bloodstream isolates and subsets of CAZ-NS and colistin-resistant (CST-R) isolates (MIC90, 0.5–2 µg/mL, 96.0–100% S). Reduced activity against MEM-NS Eba was attributable to carriage of class B metallo-β-lactamases (MBLs) because all MEM-NS MBL-negative isolates were susceptible to CAZ-AVI. CAZ-AVI also showed good in vitro activity against the majority of Pae bloodstream isolates (MIC90, 16 µg/mL, 89.5% S). Activity was reduced against CAZ-NS, MEM-NS and CST-R subsets (53.7–85.0% S), which included isolates carrying MBLs, but exceeded the activity of CAZ and MEM against these subsets by 15–65%. CST and amikacin were the only tested comparators that demonstrated comparable or greater activity against Pae bloodstream isolates. Conclusion CAZ-AVI provides a valuable therapeutic option for treating bloodstream infections caused by MBL-negative Eba and Pae isolates. Disclosures All authors: No reported disclosures.

scholarly journals CandidaBloodstream Infections: Comparison of Species Distributions and Antifungal Resistance Patterns in Community-Onset and Nosocomial Isolates in the SENTRY Antimicrobial Surveillance Program, 2008-2009

2010 ◽  
Vol 55 (2) ◽  
pp. 561-566 ◽  
Author(s):  
Michael A. Pfaller ◽  
Gary J. Moet ◽  
Shawn A. Messer ◽  
Ronald N. Jones ◽  
Mariana Castanheira
Keyword(s):  
Species Distributions ◽  
Bloodstream Infections ◽  
Antifungal Resistance ◽  
Surveillance Program ◽  
Medical Centers ◽  
Health Care Practices ◽  
Antimicrobial Surveillance ◽  
Resistance Patterns ◽  
Community Onset ◽  
Substantial Morbidity

ABSTRACTCommunity-onset (CO) candidemia, defined as a positive blood culture taken at or within 2 days of hospital admission, represents a distinct clinical entity associated with substantial morbidity and mortality. Reference MIC results from the SENTRY Antimicrobial Surveillance Program (2008-2009) were analyzed to compare the antifungal resistance patterns and species distributions from patients with CO and nosocomial bloodstream infections (BSI) in 79 medical centers. Among 1,354 episodes of BSI, 494 (36.5%) were classified as CO and 860 (63.5%) as nosocomial in origin. More than 95% of the isolates from both BSI types were contributed byCandida albicans(48.4%),C. glabrata(18.2%),C. parapsilosis(17.1%),C. tropicalis(10.6%), andC. krusei(2.0%).C. albicanswas more common in CO BSI (51.0%) than nosocomial BSI (46.9%), whereasC. parapsilosisandC. kruseiwere more common in nosocomial BSIs (18.1 and 2.7%, respectively) than in CO BSIs (15.4 and 0.8%, respectively).C. glabrataandC. tropicaliswere comparable in both CO (18.4 and 10.5%, respectively) and nosocomial (18.1 and 10.6%, respectively) episodes. Resistance to azoles (fluconazole, posaconazole, and voriconazole) and echinocandins (anidulafungin, caspofungin, and micafungin) was uncommon (<5%) in CO BSI using recently established Clinical and Laboratory Standards Institute breakpoint criteria. Resistance to echinocandins (anidulafungin [3.8%], caspofungin [5.1%], and micafungin [3.2%]) and azoles (fluconazole [7.7%], posaconazole [5.1%], and voriconazole [6.4%]) was most prevalent among nosocomial BSI isolates ofC. glabrata. CO candidemia is not uncommon and appears to be increasing worldwide due to changing health care practices. Although resistance to the azoles and echinocandins remains uncommon among CO isolates, we demonstrate the emergence of nosocomial occurrences ofC. glabrataexpressing resistance to both monitored classes of antifungal agents.

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