title: Epidemiology and susceptibility to antimicrobials in community, hospital and long-term care facility bacteremia in northern Israel: a 6 year surveillance.
abstract: BACKGROUND
  Identification of pathogens and their susceptibility to antimicrobials is mandatory for successful empiric antibiotic treatment.
  
  
  OBJECTIVE
  To compare the clinical characteristics of patients with bacteremia, as well as the bacterial distribution and antimicrobial susceptibility in community, hospital and long-term care facilities during two periods (2001-2002 and 2005-2006).
  
  
  METHODS
  The study was conducted at the HaEmek Medical Center, a community 500-bed teaching hospital in northern Israel serving a population of approximately 500,000 inhabitants. All episodes of bacteremia (n = 1546) during two 2 year periods (2001-2 and 2005-6) were prospectively recorded, evaluated and compared (755 in 2001-2 and 791 in 2005-6).
  
  
  RESULTS
  In both periods the urinary tract was the main port of entry in community and long-term care facility bacteremia, while the urinary tract--primary and catheter-related--were similar in frequency as sources of hospital bacteremia. Escherichia coli was the most frequent pathogen isolate. No significant changes in the frequency of methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing bacteria were seen between the two 2 year periods (2001-2 and 2005-6). The susceptibility of non-ESBL-producing E. coli decreased for some antibiotics while non-ESBL-producing Klebsiella pneumoniae susceptibility profile improved in the same period. A non-statistically significant trend of increased resistance in gram-negative isolates to quinolones, piperacillin and piperacillin-tazobactam was observed, but most isolates still remained highly susceptible to carbapenems. There was a small increase in mortality rate in hospital bacteremia during the second period.
  
  
  CONCLUSIONS
  Continuous surveillance is imperative for monitoring the local epidemiology and for developing local treatment guidelines.
authors.affiliation: Infectious Diseases Unit, HaEmek Medical Center, Afula, Israel. chazan_b@clalit.org.il
authors.forename: Bibiana
authors.initials: B
authors.lastname: Chazan
authors.forename: Raul
authors.initials: R
authors.lastname: Raz
authors.forename: Nava
authors.initials: N
authors.lastname: Teitler
authors.forename: Orna
authors.initials: O
authors.lastname: Nitzan
authors.forename: Hana
authors.initials: H
authors.lastname: Edelstein
authors.forename: Raul
authors.initials: R
authors.lastname: Colodner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology*; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents