Bacterial pathogens isolated from patients with skin and soft tissue infections: Frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program (United States and Canada, 1997)

As part of the SENTRY Antimicrobial Surveillance Program, 1562 bacterial isolates were recovered from hospitalized patients with skin and soft tissue infections (SSTIs) in 30 United States (U.S.) and 8 Canadian medical centres between October and December, 1997. The overall rank older of recovery of the six most common pathogens was Staphylococcus aureus (42.6%) > Pseudomonas aeruginosa (11.3%) > Enterococcus spp. (8.1%) > Escherichia coli (7.2%) > Enterobacter spp. (5.2%) > beta-hemolytic streptocci (5.1%). With one exception, essentially the same order was observed in both the U.S. and Canada. The single exception was the Enterococcus group, which were the third most common isolate in the U.S. (9.6%), but the seventh most common isolate in Canada (3.7). Of note, 24.0% of S. aureus isolates were oxacillin resistant; vancomycin uas uniformity active. Vancomycin resistance among Enterococcus spp. (16.5%) was observed only in the U.S. Several antimicrobial agents remained broadly active of SSTI isolates of P. aenuginosa, including meropenem, amikacin, tobramycin, and piperacillin with or without tazobactam. Imipenem resistance (MICs, greater than or equal to 8 mu g/mL) was observed in 11.9% of isolates of P. aeruginosa and ceftazidime, and cefepime had equivalent activity (85.2% and 85.8% susceptible, respectively). Numerous beta-lactams, aminoglycosides and fluoroquinolones were broadly active against E. coli SSTI isolates (i.e. < 5% resistance). Extended-spectrum beta-lactamase production was uncommon both with E. coli and Klebsiella spp. in both nations. Cefepime, imipenem, and meropenem; the amino-glycosides; and fluoroquinolones were conspicuously more active against Enterobacter spp. than other agents tested. High-level, stably derepressed Amp C beta-lactamase production was commonly observed in this group (26.8%), but cefepime generally retained activity against these ceftazidime-resistant organisms. The results of this study serve to define the most common bacterial causes of SSTIs in North America, elucidate patterns of antimicrobial resistance and carl be used as a basis for making initial empiric antimicrobial management decisions in hospitalized patients with such infections. (C) 1999 Elsevier Science Inc.