The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program

• Published in: Antimicrobial agents and chemotherapy Vol. 63; no. 7
• Main Authors: Diekema, Daniel J., Hsueh, Po-Ren, Mendes, Rodrigo E., Pfaller, Michael A., Rolston, Kenneth V., Sader, Helio S., Jones, Ronald N.
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 01.07.2019
• Subjects: Acinetobacter baumannii - drug effects; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - epidemiology; Acinetobacter Infections - microbiology; Anti-Bacterial Agents - pharmacology; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Drug Resistance, Bacterial - drug effects; Enterococcus faecalis - drug effects; Enterococcus faecalis - isolation & purification; Epidemiology and Surveillance; Europe - epidemiology; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - microbiology; Humans; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - isolation & purification; Latin America - epidemiology; Microbial Sensitivity Tests; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - epidemiology; Pseudomonas Infections - microbiology; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Europe; Latin America; antimicrobial resistance; bloodstream infection; surveillance
• ISSN: 0066-4804; 1098-6596; 1098-6596
• DOI: 10.1128/AAC.00355-19

Bloodstream infection (BSI) organisms were consecutively collected from >200 medical centers in 45 nations between 1997 and 2016. Species identification and susceptibility testing followed Clinical and Laboratory Standards Institute broth microdilution methods at a central laboratory. Bloodstream infection (BSI) organisms were consecutively collected from >200 medical centers in 45 nations between 1997 and 2016. Species identification and susceptibility testing followed Clinical and Laboratory Standards Institute broth microdilution methods at a central laboratory. Clinical data and isolates from 264,901 BSI episodes were collected. The most common pathogen overall was Staphylococcus aureus (20.7%), followed by Escherichia coli (20.5%), Klebsiella pneumoniae (7.7%), Pseudomonas aeruginosa (5.3%), and Enterococcus faecalis (5.2%). S. aureus was the most frequently isolated pathogen overall in the 1997-to-2004 period, but E. coli was the most common after 2005. Pathogen frequency varied by geographic region, hospital-onset or community-onset status, and patient age. The prevalence of S. aureus isolates resistant to oxacillin (ORSA) increased until 2005 to 2008 and then declined among hospital-onset and community-acquired BSI in all regions. The prevalence of vancomycin-resistant enterococci (VRE) was stable after 2012 (16.4% overall). Daptomycin resistance among S. aureus and enterococci (DRE) remained rare (<0.1%). In contrast, the prevalence of multidrug-resistant (MDR) Enterobacteriaceae increased from 6.2% in 1997 to 2000 to 15.8% in 2013 to 2016. MDR rates were highest among nonfermentative Gram-negative bacilli (GNB), and colistin was the only agent with predictable activity against Acinetobacter baumannii-Acinetobacter calcoaceticus complex (97% susceptible). In conclusion, S. aureus and E. coli were the predominant causes of BSI worldwide during this 20-year surveillance period. Important resistant phenotypes among Gram-positive pathogens (MRSA, VRE, or DRE) were stable or declining, whereas the prevalence of MDR-GNB increased continuously during the monitored period. MDR-GNB represent the greatest therapeutic challenge among common bacterial BSI pathogens.