1997 - 1998 ANTIMICROBIAL SUSCEPTIBILITY

                                      GRAM NEGATIVE ISOLATES          GRAM POSITIVE ISOLATES

Percent  Susceptible	E. coli	Entero bacter	K. pneu	P. mirab	P. aerug	H flu	E.Coccus (blood)	S. aureus	S. epi	Strep pneumo	E.Coccus Urine
Number of isolates	1278	114	147	132	149	67	73	429	223	36	188
Amikacin	0	0	0	0	100	0	0	0	0	0	0
Amoxicillin/Clavulanate	93	22	98	95	0	0	0	0	0	0	0
Ampicillin	62	7	0	95	0	46	69	0	0	0	91
Ampicillin/Sulbactam	0	0	0	0	0	0	0	93	18	0	0
Aztreonam	0	0	0	0	77	0	0	0	0	0	0
Cefotaxime	100	93	100	100	0	0	0	0	0	0	0
Cefotetan	0	0	0	0	0	0	0	0	0	0	0
Cefpodoxime	0	0	0	0	0	100	0	0	0	0	0
Ceftazidime	0	0	0	0	97	0	0	0	0	0	0
Ceftriaxone	100	99	100	100	0	0	0	0	0	0	0
Chloramphenicol	0	0	0	0	0	0	0	0	0	0	0
Ciprofloxacin	100	100	99	100	70	0	0	92	53	0	0
Clindamycin	0	0	0	0	0	0	0	94	40	0	0
Erythromycin	0	0	0	0	0	0	0	77	23	0	0
Gentamicin	99	100	97	92	90	0	0	0	0	0	0
Imipenem	0	0	0	0	88	0	0	0	0	0	0
Mezlocillin	0	0	0	0	83	0	0	0	0	0	0
Nitrofurantoin	100	86	79	12	0	0	0	0	0	0	56
Penicillin	0	0	0	0	0	0	0	6	7	83	0
Spectinomycin	0	0	0	0	0	0	0	0	0	0	0
Tetracycline	76	94	96	3	0	86	0	94	85	0	24
Trimethoprim/ sulfamethoxazole	82	98	96	91	0	68	0	96	49	0	0
Vancomycin	0	0	0	0	0	0	0	100	100	0	0

Blood and Urine isolates (except as indicated)

AMINOGLYCOSIDE ONCE DAILY DOSING GUIDELINES:

CrCl < 60 ml/min : Standard dosing Load 2mg/kg (contact the pharmacy for dosing assistance)

Adult: 5mg/kg/day; Elderly 4mg/kg/day

Obtain trough 18 hours after first dose: trough concentration must be less than 1 mcg/ml to continue once daily dosing

EMPIRIC THERAPY RECOMMENDATIONS:

· Nosocomial Pneumonia : Cefotaxime 2gm IV q 12h +/- gentamicin.

                If special concern for Pseudomonas: Piperocillin/tazobactam+ gentamicin

· Urinary Tract Infection (Complicated) Based on gram stain: Gram negative: Ceftriaxone

                Gram Positive :Ampicillin + gentamicin (if elevated Scr consider alternative)

· Surgical Prophylaxis:

Clean and soft tissue: Cefazolin: Adult 1 gm preop; pediatric 20mg/kg pre op

Head and Neck (through oral cavity): Cefazolin: adult 1 gm preop; pediatric 20mg/kg pre op; Cefazolin 1gm + metronidazole 500mg or clindamycin or ampicillin/sulbactam (adult)

Vascular: Cefazolin: Adult 1gm preop, post op as indicated; Pediatric see SBE prophylaxis

Thoracic: Cefazolin: Adult 1gm pre op; Pediatric 20mg/kg pre op, 10mg/kg IV q 6 hr post op

Colorectal: Adult: cefotetan 1gm pre op;

Pediatric: cefotetan 40mg/kg preop, postop 40mg/kg q 12 hr x 48 hrs (or) ampicillin 50mg/kg q 6 h + gentamicin 2.5mg/kg q 8 h + clindamycin 10mg/kg preop/postop q 8 h x 48 hrs

SBE:  See standard recommendations

(Prepared by Clinical Pharmacy Services, David Grant Medical Center. Direct any comments to Clinical Pharmacist at extension 7180

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Last updated/reviewed: 8/20/1998

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Last updated 7/8/1997