# Bug

Patient Group: HSC (adult patients)
Name: - Haemophilus influenzae [n = 142]
Notes:
  Only 112 isolates were tested for TMP-SMX.  Data from adult and pediatric patients, Jan to Dec 2022.


Patient Group: HSC (adult patients)
Name: - Klebsiella/Raoultella spp. [n = 119]
Notes:
  The current laboratory identification system is unable to differentiate Klebsiella oxytoca from Raoultella spp.


Patient Group: HSC (adult patients)
Name: + Streptococcus pyogenes (Group A Streptococcus) [number tested = not applicable]
Notes:
  Susceptibility testing of Streptococcus pyogenes is not routinely performed as 100% are susceptible to penicillin.  If treating infection in a penicillin allergic patient, contact the lab for testing of second line agents.


Patient Group: HSC (adult patients)
Name: + Streptococcus agalactiae (Group B Streptococcus) [n = 148]
Notes:
  Streptococcus agalactiae isolates were obtained from vaginal/rectal swabs submitted for Group B Streptococcus detection to the Health Sciences Centre, St. Boniface Hospital, and Westman Laboratory in 2022.


Patient Group: HSC (adult patients)
Name: + Streptococcus pneumoniae Systemic isolates (Blood + CSF): Meningitis [n = 160]
Notes:
  Data for systemic isolates (excluding meningitis).  Systemic isolates were obtained from the Health Sciences Centre (HSC) and St. Boniface Hospital (SBH) clinical microbiology laboratories between January and December, 2022.  CSF = cerebrospinal fluid.


Patient Group: HSC (adult patients)
Name: + Streptococcus pneumoniae Respiratory isolates [n = 40]
Notes:
  Data for respiratory isolates only.  Respiratory isolates were obtained from patients at the Health Sciences Centre (HSC) and St. Boniface Hospital (SBH) between January and December, 2018.


Patient Group: HSC (adult patients)
Name: ANAER: Bacteroides fragilis [n = 108]
Notes:
  Isolates were obtained from WRHA hospitals between Jan 2019 and Dec 2020; data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).


Patient Group: HSC (adult patients)
Name: YEAST: Candida albicans [n = 33]
Notes:
  Data obtained by testing a random sample of C. albicans isolates from Health Sciences Centre and St. Boniface Hospital, collected between Jan 2017 and Dec 2018.  Susceptibility interpretations are based on updated CLSI breakpoints (M27M44S, 3rd Edition).  Isolates tested and reported are from blood only.


Patient Group: HSC (adult patients)
Name: YEAST: Candida glabrata [n = 46]
Notes:
  Data obtained by testing C. glabrata isolates from the Health Sciences Centre and St. Boniface Hospital, collected between Jan 2021 and Dec 2022.  Susceptibility interpretations are based on updated CLSI breakpoints (M27M44S, 3rd Edition).  Isolates tested and reported are from blood only.


Patient Group: St. Boniface Hospital
Name: - Haemophilus influenzae [n = 142]
Notes:
  H. influenzae data obtained from isolates tested at Health Sciences Centre, Jan 1 to Dec 31, 2022.  Only 112 isolates were tested for Trimethoprim-Sulfamethoxazole.  Data from adult and pediatric patients.


Patient Group: Children's Hospital
Name: + Streptococcus pneumoniae Respiratory isolates [n = 40]
Notes:
  Data for respiratory isolates only.  Respiratory isolates were obtained from patients (adult and pediatric patients) at the Health Sciences Centre (HSC) and St. Boniface Hospital (SBH) between January and December, 2018.


# Drug

Patient Group: HSC (adult patients)
Name: Oxacillin
Notes:
  Oxacillin accurately predicts the activity of all semi-synthetic penicillins, including cloxacillin, beta-lactam/beta-lactamase inhibitor combinations, cephalosporins, and carbapenems for Staphylococcus aureus and coagulase-negative staphylococci.


Patient Group: HSC (adult patients)
Name: High-Level Gentamicin
Notes:
  Susceptibility to high-level gentamicin or high-level streptomycin indicates that these agents can be used in combination with a cell wall active agent (e.g. ampicillin or vancomycin) for synergy.  Gentamicin and streptomycin should never be used alone as treatment for Enterococcus faecalis or Enterococcus faecium.


Patient Group: HSC (adult patients)
Name: Erythromycin
Notes:
  Erythromycin activity predicts the activity of azithromycin and clarithromycin for staphylococci and streptococci.


Patient Group: HSC (adult patients)
Name: Penicillin (oral)
Notes:
  For Streptococcus pneumoniae, different susceptibility breakpoints for penicillin and ceftriaxone exist depending on whether meningitis or a non-meningitis infection is being treated [CLSI, M100, 32nd ed.].  For penicillin, when treating a non-meningitis infection different breakpoints exist for oral and intravenous dosing.  For non-meningitis infections, susceptibility to oral penicillin predicts susceptibility to amoxicillin.  Oral agents are not appropriate for the treatment of bacterial meningitis.


Patient Group: HSC (adult patients)
Name: Fluconazole*
Notes:
  For fluconazole, there is only a susceptible-dose dependent (SDD) breakpoint for C. glabrata. The percentage of C. glabrata isolates that tested SDD to fluconazole was 93%.  Susceptibility of SDD isolates to fluconazole is dependent on achieving the maximum blood level possible (i.e., should use the maximum dosage regimen).  Consultation with infectious diseases is recommended for further guidance.


Patient Group: St. Boniface Hospital
Name: High-Level Gentamicin
Notes:
  Susceptibility to high-level gentamicin or high-level streptomycin indicates that these agents can be used in combination with a cell wall active agent (e.g., ampicillin or vancomycin) for synergy.  Gentamicin and streptomycin should never be used alone as treatment for Enterococcus faecalis, Enterococcus faecium, or Enterococcus spp.


Patient Group: Children's Hospital
Name: High-Level Gentamicin
Notes:
  Susceptibility to high-level gentamicin or high-level streptomycin indicates that these agents can be used in combination with a cell wall active agent (e.g., ampicillin or vancomycin) for synergy.  Gentamicin and streptomycin should never be used alone as treatment for Enterococcus spp.


# Info

Finalized: 2023-03-20
Contact Name: Dr. Andrew Walkty
Contact Email: AWalkty@sharedhealthmb.ca
BugTitle: Bacteria
TestGroupTitle: Group
Disclaimer:
  General Disclaimer: This guide is provided as an educational resource for physicians and other healthcare professionals caring for patients at the Health Sciences Centre, St. Boniface Hospital, Grace Hospital, and the Children's Hospital.  The authors of the guide have made every effort to ensure that the information contained in it was accurate at the time of publication.  Users of the guide are encouraged to consult other references to confirm the information presented in it.  The authors are not responsible for errors, omissions, inaccuracies, or the continued completeness of the information contained in the guide.  The information in the guide should not be used or relied upon to replace the skill and professional judgment required to determine appropriate patient care and treatment.  Also, the guide is not intended to replace or to be used as a substitute for the complete prescribing information prepared by each pharmaceutical manufacturer for their anti-infective agents.  Because of possible changes in anti-infective indications, changes in dosage information, differences in patients responses to therapy, newly described toxicities, drug-drug interactions, and other items of importance, reference to complete prescribing information is recommended before any of the anti-infective agents described in the guide are used.

  Gram-negative Susceptibility Data (Health Sciences Centre): Isolates tested and reported are from all sources combined, Jan 1 to Dec 31, 2022 with the exception of Escherichia coli (subdivided into systemic isolates and urine isolates); data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).  

  Gram-negative Susceptibility Data (Children's Hospital): Isolates tested and reported are from all sources combined, with the exception of Escherichia coli (subdivided into systemic isolates and urine isolates); isolates were collected from Jan 1 to Dec 31, 2022 with the exception of Proteus mirabilis and Klebsiella/Raoultella spp.(collected from Jan 2021 to Dec 2022); data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).  

  Gram-negative Susceptibility Data (St. Boniface Hospital): Isolates tested and reported are from all sources combined, with the exception of Escherichia coli (subdivided into systemic isolates and urine isolates); isolates were collected from Jan 1 to Dec 31, 2022 with the exception of Klebsiella aerogenes (collected from Jan 2021 to Dec 2022); data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).   

  Gram-negative Susceptibility Data (Grace Hospital): Isolates tested and reported are from all sources combined, with the exception of Escherichia coli (subdivided into systemic isolates and urine isolates); isolates were collected from Jan 1 to Dec 31, 2022 with the exception of Citrobacter spp. and Morganella morganii (collected from Jan 2021 to Dec 2022); data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).     

  Gram-positive Susceptibility Data (Health Sciences Centre): Isolates tested and reported are from all sources (surveillance isolates excluded) with the exception of Enterococcus faecalis and Enterococcus faecium (systemic isolates only), Jan to Dec, 2022; data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).   

  Gram-positive Susceptibility Data (Children's Hospital): Isolates tested and reported are from all sources (surveillance isolates excluded), Jan to Dec, 2022 with the exception of Enterococcus faecalis (systemic isolates only, data obtained from adult patients); data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).    

  Gram-positive Susceptibility Data (St. Boniface Hospital):  Isolates tested and reported are from all sources (surveillance isolates excluded) with the exception of Enterococcus faecalis and Enterococcus faecium (systemic isolates only), Jan to Dec, 2022; data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).  

  Gram-positive Susceptibility Data (Grace Hospital): Isolates tested and reported are from all sources (surveillance isolates excluded), Jan to Dec, 2022 with the exception of Staphylococcus lugdunensis (collected from Jan 2021 to Dec 2022); data compiled according to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) in their document M39, 5th ed. (2022).


