Antimicrobial susceptibility profile of selected bacteraemic pathogens from private institutions in South Africa.
OBJECTIVE
The National Antimicrobial Surveillance Forum is a continuous surveillance organisation comprising all academic/public and private sector laboratories in South Africa.


METHODS
The antibiotic susceptibility of blood culture isolates of Escherichia coli, Klebsiella pneumoniae, Enterobacter species, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus from patients in private hospitals in five major centres were investigated. Antimicrobial susceptibility tests were performed by 12 participating laboratories according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended-spectrum b-lactamase (ESBL) production was determined in selected species of Enterobacteriaceae irrespective of source.


RESULTS
The overall prevalence of ampicillin resistance in blood culture isolates of E. coli (N = 471) was 84%, and 20% were resistant to the fluoroquinolones. Considerable geographical differences were noted between the centres with regard to the K. pneumoniae (N = 636) resistance rates for ceftriaxone and/or cefotaxime (39 - 87%). The most active agents in the Enterobacter spp. (N = 244) were imipenem/meropenem, ertapenem, ciprofloxacin, levofloxacin and cefepime, with 100%, 94%, 88%, 87% and 80% susceptibility, respectively. Carbapenem resistance in P. aeruginosa (N = 382) varied between 42% and 45%, and in the case of A. baumannii (N = 190) resistance varied between 32% and 33% for meropenem and imipenem respectively. The nationwide incidence of oxacillin resistance in S. aureus (N = 629) was 36%. Overall, the prevalence of ESBL production among all isolates of K. pneumoniae was 26% (N = 7 514), while in Enterobacter spp. it was 12% (N = 4 031) and in E. coli 5% (N = 28 412).


CONCLUSIONS
The data highlight the widespread problem of antibiotic resistance among important bacteraemic pathogens in private institutions in South Africa. Continued surveillance is vital to guide appropriate empirical therapy for invasive infections.
Brink
Adrian
A
Department of Clinical Microbiology, Ampath Laboratories, Johannesburg, South Africa. brinka@ampath.co.za
Moolman
Johan
J
da Silva
Mark Cruz
MC
Botha
Maria
M
D040981:Acinetobacter baumannii / Q000187:drug effects*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology; D016304:Hospitals, Private; D006801:Humans; D008826:Microbial Sensitivity Tests; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D013019:South Africa; D013211:Staphylococcus aureus / Q000187:drug effects*; D001618:beta-Lactamases / Q000378:metabolism
D000900:Anti-Bacterial Agents; D001618:beta-Lactamases