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National Antimicrobial Resistance Monitoring System: Enteric BacteriaNational Antimicrobial Resistance Monitoring System: Enteric Bacteria

1999 Annual Report

NARMS

1999 Annual Report

NARMS

1999 National Antimicrobial Resistance Monitoring System (NARMS) For Enteric Bacteria Participants (Human Isolates)*

Centers for Disease Control and Prevention Frederick J. Angulo, Nina Marano, Shannon Rossiter, Jennifer McClellan, Thomas J. Van Gilder, Karen Stamey, Kevin Joyce, Richard Bishop, Tim Barrett, Joy Wells, Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases; National Center for Infectious Diseases US Food and Drug Administration Marcia Headrick, Kathy Hollinger, Linda Tollefson, Office of Surveillance and Compliance, Center for Veterinary Medicine Participating Local and State Health Departments California Department of Health Services Sharon Abbott, Paul Kimsey, Sue Shallow, Duc Vugia, Jim Ware Colorado Department of Public Health and Environment Mike Rau, David Butcher, Carol Hoff, Richard Hoffman Connecticut Department of Public Health Bob Howard, Don Mayo, Terry Fiorentino Florida Department of Health Jody Baldy, Rima Farah, Ronald Baker, Richard Hopkins Georgia Division of Public Health Marsha Ray, Mahin Park, Suzanne Segler, Elizabeth Franko, Paul Blake Kansas Department of Health and Environment Robert Flahart, June Sexton, Roger Carlson, Gianfranco Pezzino Los Angeles County Department of Health Services Liga Kilman, Elizabeth Cordero, Joan Sturgeon, Mary Dorado, Deborah Brown, Laurene Mascola Massachusetts Department of Public Health Joseph Peppie, Alfred DeMaria, John Fontana, Robert Goldbaum Maryland Department of Health and Mental Hygiene Yongyu Wang, Judy Johnson, Glenn Morris Minnesota Department of Health

Fe Leano, Julie Wicklund, John Besser, New Jersey Department of Health Keith Pilot, Sylvia Matiuck, John Brook New York City Department of Health Alice Agasan, Wydenia Perry, Mel Backer, Marci Layton New York State Department of Health Tim Root, Shelley Zansky, Amy Davignon, Dale Morse Oregon Department of Human Resources Steve Mauvais, Maureen Cassidy, Theresa McGivern, Beletsachew Shiferaw, Paul Cieslak Tennessee Department of Health Henrietta Hardin, Cynthia Graves Washington Public Health Laboratories Jay Lewis, Donna Green, Jon Counts, Craig Columbel West Virginia Department of Health and Human Resources Doug McElfresh, Loretta Haddy, Mary Connie Smith * Information on animal isolates is available at www.nps.ars.usda.gov/projects/projects.htm?accession=402399

Page Number Tables 10 Table 1. Population size and number of isolates received and tested, by site, 1999 11 Table 2. Antimicrobial agents used for susceptibility testing for Salmonella, Shigella, E. coli O157, and Campylobacter isolates 12 Table 3. Antimicrobial resistance of Salmonella, Shigella, and E. coli O157 isolates, 1999 13 Table 4. Submission of isolates by site and by month of collection, 1999 18 Table 5. Frequency of non-Typhi Salmonella serotypes, 1999 19 Table 6. Frequency of non-Typhi Salmonella serotypes / Frequency of pansusceptibility among serotypes, 1996-1999 21 Table 7. Frequency of non-Typhi Salmonella serotypes / Frequency of multiresistance among serotypes, 1999 22 Table 8. Percentage of S. Typhimurium isolates with ACSSuT, ACKSSuT, or AKSSuT resistance patterns, by site, 1999 23 Table 9. Additional antimicrobial resistance for S. Typhimurium isolates with ACSSuT or AKSSuT patterns, 1999 24 Table 10. Clinical source of non-Typhi Salmonella isolates, 1999 25 Table 11. Serotypes of non-Typhi Salmonella with reduced susceptibility or resistance to ciprofloxacin, 1999 26 Table 12. Serotypes of non-Typhi Salmonella with reduced susceptibility or resistance to ceftriaxone, 1999 27 Table 13. Frequency of Shigella species, 1999 28 Table 14. Antimicrobial susceptibility of Shigella isolates, 1999 29 Table 15. Frequency of Campylobacter species, 1999 30 Table 16. Antimicrobial susceptibility of Campylobacter isolates, 1999

Page Number Figures

31 Figure 1. Number of isolates submitted, by site, 1999 32 Figure 2. Resistance among non-Typhi Salmonella isolates, 1996-1999 33 Figure 3. Non-Typhi Salmonella MICs, by antimicrobial agent, 1996-1999 50 Figure 4. Resistance among non-Typhi Salmonella serotypes, 1996-1999 65 Figure 5. Percent of non-Typhi Salmonella isolates which are serotype Typhimurium, by site, 1996-1999 66 Figure 6. Percent of Salmonella Typhimurium isolates that are resistant to Ampicillin, Chloramphenicol, Streptomycin, Sulfamethoxazole, and Tetracycline (ACSSuT), by site, 1996-1999 67 Figure 7. Percentage of Salmonella Typhimurium isolates that are resistant to Ampicillin, Kanamycin, Streptomycin, Sulfamethoxazole, and Tetracycline (AKSSuT), by site, 1996-1999 68 Figure 8. Resistance among Salmonella Typhi isolates, 1999 69 Figure 9. Salmonella Typhi MICs, by antimicrobial agent, 1999 74 Figure 10. Resistance among Shigella isolates, 1999 75 Figure 11. Resistance among Shigella sonnei and Shigella flexneri isolates, 1999 76 Figure 12. Shigella sonnei MICs, by antimicrobial agent, 1999 81 Figure 13. Shigella flexneri MICs, by antimicrobial agent , 1999 86 Figure 14. Resistance among E. coli O157 isolates, 1996-1999 87 Figure 15. E. coli O157 MICs, by antimicrobial agent, 1996-1999 104 Figure 16. Resistance among Campylobacter isolates, 1997-1999 105 Figure 17. Resistance among Campylobacter jejuni and Campylobacter coli isolates, 1997-1999 107 Figure 18. Campylobacter jejuni MICs, by antimicrobial agent, 1997-1999 115 Figure 19. Campylobacter coli MICs, by antimicrobial agent ,

1997-1999

National Antimicrobial Resistance Monitoring System For Enteric Bacteria

1999 Annual Report

Summary

In 1999, 1499 non-Typhi Salmonella isolates, 166 Salmonella Typhi isolates, 375 Shigella,

292 E. coli O157 isolates, and 319 Campylobacter isolates from humans were tested by the

National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria. Twenty-six

percent of non-Typhi Salmonella isolates were resistant to one or more antimicrobial agents.

Among Salmonella serotype Typhimurium isolates, 49% were resistant to one or more

antimicrobial agents. Twenty-eight percent of Salmonella Typhimurium isolates had the multidrug-

resistant pattern characteristic of DT104; resistant to ampicillin, chloramphenicol, streptomycin,

sulfamethoxazole, and tetracycline (ACSSuT). One Salmonella isolate was resistant to

ciprofloxacin (S. Senftenberg). The percentage of non-Typhi Salmonella isolates with ciprofloxacin

minimum inhibitory concentrations (MICs) >0.25 µg/ml increased from 0.4% in 1996 to 1.0% in

1999. The percentage of non-Typhi Salmonella isolates with a ceftriaxone MIC > 16 µg/ml

increased from 0.1% in 1996 to 2% in 1999. Among S. Typhi isolates, 29% were resistant to one or

more antimicrobial agents. Among Shigella isolates, 91% were resistant to one or more

antimicrobial agents. Among E. coli O157 isolates, 10% were resistant to one or more

antimicrobial agents. Among all Campylobacter isolates, 53% were resistant to one or more

antimicrobial agents. Among Campylobacter jejuni isolates, 54% were resistant to one or more

antimicrobial agents; 18% were resistant to ciprofloxacin.

Methods

NARMS was launched in 1996, within the framework of CDC’s Emerging Infections

Program’s Epidemiology and Laboratory Capacity Program and the Foodborne Disease Active

Surveillance Network (FoodNet) as a collaboration among CDC, the U.S. Food and Drug

Administration (FDA)-Center for Veterinary Medicine, U. S. Department of Agriculture (USDA)-

Food Safety and Inspection Service and Agricultural Research Service, and state and local health

departments to monitor prospectively the antimicrobial resistance of human non-Typhi Salmonella

and Escherichia coli O157 isolates. Testing of Campylobacter isolates was added in 1997, and

testing of Salmonella Typhi and Shigella isolates was added in 1999. In 1999, there were 17

NARMS health department participants (CA, CO, CT, FL, GA, KS, Los Angeles County, MD, MN,

MA, NJ, New York City, NY, OR, TN, WA, and WV), representing approximately 103 million

persons (38% of the United States population), and 7 of the 9 U.S. regions [Table 1]. In 1999,

seven states (CA, CT, GA, MD, MN, NY, and OR) also monitored antimicrobial resistance among

human Campylobacter isolates.

In 1999, NARMS participating public health laboratories have selected every tenth non-

Typhi Salmonella, every Salmonella Typhi, every tenth Shigella, and every fifth E. coli O157 isolate

received at their laboratory, and forwarded the isolates to CDC for susceptibility testing. Although

we requested that participating laboratories send every S. Typhi isolate, analysis was restricted to

one isolate per patient. At CDC, a semiautomated system (Sensititre, Trek Diagnostics, Westlake,

OH) is used to determine the MICs for 17 antimicrobial agents: amikacin, ampicillin,

amoxicillin-clavulanic acid, apramycin, ceftiofur, ceftriaxone, cephalothin, chloramphenicol,

ciprofloxacin, florfenicol, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole,

tetracycline, and trimethoprim-sulfamethoxazole [Table 2].

Public health laboratories from eight states also select and forward the first Campylobacter

isolate received each week to CDC for susceptibility testing. For Campylobacter, the E-test system

(AB BIODISK, Solna, Sweden) is used to determine the MICs for 8 antimicrobial agents:

azithromycin, chloramphenicol, ciprofloxacin, clindamycin, erythromycin, gentamicin, nalidixic acid,

and tetracycline [Table 2]. After confirmation to genus level, identification of Campylobacter to

species level is performed using the hippurate test, and, for hippurate-negative Campylobacter

isolates, and polymerase chain reaction to identify the hippuricase gene, diagnostic of

Campylobacter jejuni.

For all pathogens in this report, MIC results are dichotomized: isolates with intermediate

susceptibility are categorized as sensitive. Breakpoints are determined using, when available,

National Committee for Clinical Laboratory Standards (NCCLS) [Table 2].

Results

Non-Typhi Salmonella

A total of 1514 non-Typhi Salmonella isolates were received at CDC in 1999; 1499/1514

(99%) were viable upon receipt and tested for antimicrobial susceptibility [Table 4a, Figure 1]. Non-

Typhi Salmonella refers to all Salmonella serotypes except serotype Typhi. The antimicrobial

agents to which Salmonella demonstrated the highest prevalence of resistance were tetracycline,

sulfamethoxazole, streptomycin, and ampicillin: 292/1499 (19%) were resistant to tetracycline,

272/1499 (18%) isolates were resistant to sulfamethoxazole, 254/1499 (17%) were resistant to

streptomycin, and 234/1499 (16%) were resistant to ampicillin [Figure 2]. Figure 3 provides MIC

results for each of the 17 antimicrobials tested. One (0.1%) isolate (S. serotype Senftenberg) was

resistant to ciprofloxacin; 16 (1%) isolates were resistant to nalidixic acid. Six (0.4%) isolates were

resistant to ceftriaxone.

Among non-Typhi Salmonella isolates, 388/1499 (26%) were resistant to one or more

agents, and 315/1499 (21%) were resistant to two or more agents. Among Salmonella isolates

tested, 269/1499 (18%) were serotype Enteritidis and 362/1499 (24%) were serotype Typhimurium

(includes serotype Typhimurium var. Copenhagen) [Table 5]. In 1999, the serotypes with the

highest proportion of isolates which were pansusceptible were Javiana (98%), Thompson (97%),

and Braenderup (96%) [Table 6]. Figure 4 provides the resistance among non-Typhi Salmonella

serotypes from 1996-1999. Among S. Enteritidis isolates, 44/269 (16%) were resistant to one or

more antimicrobial agents. Among S. Typhimurium isolates, 179/362 (49%) were resistant to one

or more antimicrobial agents [Table 7]. Figure 5 provides the percent of S. Typhimurium by site.

In recent years, a multidrug-resistant strain of S. Typhimurium has been identified. This

strain is characterized not only by the multidrug-resistant pattern, but also by the phage type –

DT104 [Table 8]. Although none of 362 S. Typhimurium isolates tested were phage typed, 102

(28%) were resistant to the five antimicrobial agents, ampicillin, chloramphenicol, streptomycin,

sulfamethoxazole, and tetracycline (ACSSuT), to which S. Typhimurium DT104 is commonly

resistant [Figure 6]. Of the 102 S. Typhimurium isolates with the ACSSuT resistance pattern, 12

(12%) were also resistant to kanamycin, 9 (9%) were also resistant to cephalothin, 7 (7%) were

also resistant to amoxicillin-clavulanic acid, 3 (3%) were also resistant to ceftiofur, and 1 (1%) was

also resistant to ceftriaxone [Table 9].

A second penta-resistant pattern, resistance to ampicillin, kanamycin, streptomycin,

sulfamethoxazole, and tetracycline (AKSSuT), also has emerged among Salmonella Typhimurium

[Table 8]. Strains with this resistance pattern are not DT104 by phage typing. Among 362

Salmonella Typhimurium isolates tested, 39/362 (11%) had the AKSSuT resistance pattern [Figure

7]. Of the 39 S. Typhimurium isolates with the AKSSuT resistance pattern, 12 (31%) were also

resistant to chloramphenicol, 8 (20%) were also resistant to cephalothin, and 2 (5%) were also

resistant to amoxicillin-clavulanic acid [Table 9]. Table 10 describes the clinical source of all non-

Typhi isolates tested in 1999.

One Salmonella isolate (0.1%) was resistant to ciprofloxacin [Figure 3i]. The percentage of

Salmonella isolates with ciprofloxacin MICs >0.25 increased from 0.4% (5/1326) in 1996 to 1%

(15/1499) in 1999 [Table 11]. The percentage of Salmonella isolates resistant to nalidixic acid (MIC

>32) increased from 0.4% (5/1326) in 1996 to 1% (16/1499) in 1999 [Figure 3m]. The percentage

of Salmonella isolates with decreased susceptibility to ceftriaxone (MIC >16) increased from 0.1%

(1/1326) in 1996 to 2% (28/1499) in 1999 [Table 12, Figure 3f]. Seventeen of the 97 (18%) S.

Newport isolates were highly multidrug-resistant, resistant to amoxicillin-clavulanic acid, ampicillin,

ceftiofur, cephalothin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline as well as

having decreased susceptibility to ceftriaxone [Figure 4j].

Salmonella Typhi

A total of 249 S. Typhi isolates were received at CDC in 1999; 207/249 (83%) were viable

upon receipt and tested for antimicrobial sensitivity [Table 4b, Figure 1]. Of these 207 isolates,

forty-one S. Typhi isolates were eliminated from analysis because they were duplicate

submissions. Among S. Typhi isolates, 49/166 (29%) were resistant to one or more antimicrobial

agents and 25/166 (15%) were resistant to two or more agents. The most common resistances

among S. Typhi isolates were to nalidixic acid 31/166 (19%), sulfamethoxazole 28/166 (17%), or

streptomycin 23/166 (14%) [Table 3, Figure 8]. Twenty-one (13%) isolates were resistant to

ampicillin; 20 (12%) isolates were resistant to chloramphenicol. Figure 9 provides data on

Salmonella Typhi MICs by antimicrobial agent. None of the S. Typhi isolates tested were resistant

to amikacin, apramycin, ciprofloxacin, florfenicol, gentamicin, or kanamycin.

Shigella

A total of 377 Shigella isolates were received at CDC in 1999; 375/377 (99%) were viable

upon receipt and tested for antimicrobial sensitivity [Table 4c, Figure 1]. Among Shigella isolates,

341/375 (91%) were resistant to one or more antimicrobial agents and 244/375 (65%) were

resistant to two or more agents. The most common resistances among all Shigella isolates were to

ampicillin 288/375 (77%), tetracycline 215/375 (57%), streptomycin 209/375 (56%), or

sulfamethoxazole 206/375 (55%) [Table 3, Figure 10]. One hundred ninety-three (51%) isolates

were resistant to trimethoprim-sulfamethoxazole. Shigella sonnei isolates were most frequently

resistant to ampicillin 219/275 (80%), sulfamethoxazole 150/275 (54%), or streptomycin 143/275

(52%) [Figure 11]. Figure 12 provides data on Shigella sonnei MICs by antimicrobial agent. The

most common resistances among Shigella flexneri isolates were to tetracycline 80/87 (92%),

ampicillin 67/87 (77%), or chloramphenicol 56/87 (64%) [Figure 11]. Figure 13 provides data on

Shigella flexneri MICs by antimicrobial agent. None of the Shigella isolates tested were resistant

to amikacin, apramycin, ceftiofur, ceftriaxone, ciprofloxacin, or florfenicol.

E. coli O157

A total of 296 E. coli O157 isolates were received at CDC in 1999; 292/296 (99%) were

viable upon receipt and tested for antimicrobial sensitivity [Table 4d, Figure 1]. Among E. coli O157

isolates, 30/292 (10%) were resistant to one or more antimicrobial agents and 12/292 (4%) were

resistant to two or more agents. The most common resistances among E. coli O157 isolates were

to sulfamethoxazole 24/292 (8%), tetracycline 10/292 (3%), and streptomycin 8/292 (3%) [Table 3,

Figure 14]. Figure 15 provides data on E. coli O157 MICs by antimicrobial agent. None of the E.

coli O157 isolates tested were resistant to amikacin, apramycin, ceftiofur, ceftriaxone,

chloramphenicol, ciprofloxacin, or florfenicol.

Campylobacter

A total of 393 Campylobacter isolates were collected in 1999 and forwarded to CDC;

319/398 (80%) were viable upon receipt and tested for antimicrobial susceptibility [Table 4e, Figure

1]. Of the isolates tested, 295/319 (92%) were C. jejuni, 20/319 (6%) were C. coli, 2 were C.

upsaliensis, and 2 were C. fetus [Table 15].

Among Campylobacter jejuni isolates, 158/295 (54%) were resistant to one or more

antimicrobial agents, and 60/295 (20%) were resistant to two or more agents. The most common

resistances among Campylobacter jejuni isolates was to tetracycline 135/295 (46%) followed by

nalidixic acid 59/295 (20%), and ciprofloxacin 52/295 (18%) [Table 16, Figure 17a]. Figure 18

provides data on C. jejuni MICs by antimicrobial agent.

Among Campylobacter coli isolates, 10/20 (50%) were resistant to one or more antimicrobial

agents, and 7/20 (35%) were resistant to two or more agents. The most common resistances

among C. coli isolates was to nalidixic acid 6/20 (30%), tetracycline 6/20 (30%), or ciprofloxacin

6/20 (30%) [Table 16, Figure 17b]. Figure 19 provides data on C. coli MICs by antimicrobial

agent.

The NARMS 1997-1999 Annual Reports are posted on the NARMS Website. The address is

www.cdc.gov./ncidod/dbmd/narms

National Antimicrobial Resistance Monitoring System: Enteric Bacteria

1999 Publications and Presentations

Publications 1. Zirnstein G, Li Y, Swaminathan B, Angulo F. Ciprofloxacin resistance in Campylobacter

jejuni isolates: Dectection of gyrA resistance mutations by MAMA PCR and DNA sequence analysis. Journal of Clinical Microbiology 1999; 37: 3276-3280.

Abstracts 1. Dunne E, Fey P, Shillam P, Kludt P, Keene W, Harvey E, Stamey K, Barrett T, Marano N,

Angulo F. Emergence of domestically acquired AmpC-mediated ceftriaxone-resistant Salmonella serotype Typhimurium (ST) infections. In Program and Abstracts of 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1999 September,

San Francisco, CA. 2. Fiorentino T, Howard R, Kinney A, Marcus R, Mshar P, Marano N, Westerman J, Reddy S,

Angulo F. Routine subtyping of Salmonella serotype Typhimurium by PFGE facilitates focused epidemiological investigations in Connecticut. In Program and Abstracts of 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1999 September, San Francisco, CA.

3. Fontana J, Bagshaw J, Angulo F, Marano N, Shea D, Goddard A, George H. Plasmid DNA

associated with specific bands in PFGE patterns of antibiotic-resistant Salmonella serotype Enteritidis. In Program and Abstracts of 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1999 September, San Francisco, CA.

4. Hollinger K, Bager F, Marano N, Angulo F, Aaerestrup F, Tollefson L, Gerner-Smidt,

Wegener H. Aminoglycoside (AG) resistance in the United States and Denmark: an association between resistance and AG use in food animals, particularly in US poultry sources. In Program and Abstracts of 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1999 September, San Francisco, CA.

5. Hollinger K, Silvers L, Marano N, Fedorka-Cray P, Angulo F, Tollefson L, Stamey K.

Antibiotic resistance in Salmonella enterica Serotypes Heidelberg, Kentucky, and Thompson isolated from human and broiler chicken sources. In Program and Abstracts of 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1999 September, San Francisco, CA.

6. Marano N, Benson J, Koehler J, MacKinson C, Wang Y, Madden J, Debess E, Hill B,

Archibald L, Boel J, Wegener H, Angulo F. Presence of high-level gentamicin-resistant (HLGR) enterococci in humans and retail chicken products in the US, but not Denmark. In Program and Abstracts of 39th Interscience Conference on Antimicrobial Agents and Chemotherapy, 1999 September, San Francisco, CA.

7. Marano N, Stamey K, Barrett T, Angulo F. High prevalence of gentamicin resistance among selected Salmonella serotypes in the US: associated with heavy use of gentamicin in poultry? In Program and Abstracts of Infectious Disease Society of America 37th Annual Meeting, 1999 November, Philadelphia, PA.

8. Marano N, Stamey K, Barrett TJ, Angulo FJ and NARMS: Enteric Bacteria Working Group.

The national antimicrobial resistance monitoring system (NARMS): trends in antimicrobial resistance. Emerging Antibiotic Resistance in Foodborne Enteric Pathogens Conference,1999 August, Athens, GA.

9. Marano N, Stamey K, Barrett TJ, Bopp C, Dabney P, Angulo FJ and the NARMS Working

Group. Emerging quinolone-and-extended spectrum cephalosporin-resistant Salmonella in the United States.. In Program and Abstracts of American Society for Microbiology, 99th General Meeting, 1999 May, Chicago, IL.

10. Marano N, Stamey K, Barrett TJ, Angulo FJ and NARMS: Enteric Bacteria Working Group.

Antibiotic resistance among human Campylobacter isolates in the United States, 1997-1998. Campylobacter, Helicobacter and Related Organisms Conference, 1999 September, Baltimore, MD.

10


Table 1. Population size and number of isolates received and tested, by site, 1999

Site Pop. Size*

No. (%)

Non-TyphiSalmonella

No. (%)

Salmonella Typhi

No. (%)

Shigella

No. (%)

E. coli

No. (%)

Campylobacter **

No. (%)California (1) 2,162,359 (2) 54 (4) 6 (4) 5 (1) 6

(2)48 (15)

Colorado 4,056,133 (4) 79 (5) 2 (1) 18 (5) 15 (5)

Connecticut 3,282,031 (3) 63 (4) 6 (4) 7 (2) 20 (7) 53 (16)

Florida 15,111,244 (15) 100 (7) 19 (11) 14 (4) 13 (4)

Georgia 7,788,240 (8) 126 (8) 2 (1) 19 (5) 14 (5) 52 (16)

Kansas 2,654,052 (3) 27 (2) 1 (1) 5 (1) 4(1)

Los Angeles (2) 9,329,989 (9) 134 (9) 25 (15) 19 (5) 3(1)

Maryland 5,171,634 (5) 48 (3) 3 (2) 2 (1) 5(2)

22 (7)

Massachusetts 6,175,169 (6) 123 (8) 17 (10) 80 (21) 40 (14)

Minnesota 4,775,508 (5) 62 (4) 4 (2) 19 (5) 32 (11) 42 (13)

New Jersey 8,143,412 (8) 133 (9) 22 (13) 34 (9) 22 (8)

New York City (3) 7,428,524 (7) 174 (12) 37 (22) 50 (13) 1(0)

New York State (4) 10,768,077 (10) 146 (10) 10 (6) 12 (3) 58 (20) 54 (17)

Oregon 3,316,154 (3) 44 (3) 4 (2) 9 (2) 12 (4) 34 (11)

Tennessee 5,483,535 (5) 70 (5) 1 (1) 65 (17) 12 (4) 14 (4)

Washington 5,756,361 (6) 96 (6) 7 (4) 13 (4) 31 (11)

West Virginia 1,806,928 (2) 20 (1) 0 (0) 4 (1) 4(1)

Totals 103,209,350 (100) 1499 (100) 166 (100) 375 (100) 292 (100) 319 (100)

* County population 1999, U.S. Census Bureau, post-census estimates** Campylobacter isolates are submitted only from FoodNet sites, population size of FoodNet sites is 25.6million persons (see http://www.cdc.gov/ncidod/dbmd/foodnet/default.htm)(1) San Francisco and Alameda Counties(2) Los Angeles County(3) Five boroughs of New York City (Bronx, Brooklyn, Manhattan, Queens, Staten Island)(4) Excluding New York City

11


Table 2. Antimicrobial agents used for susceptibility testing for Salmonella, Shigella, E.coli O157, and Campylobacter isolates

Antimicrobial Agent Antimicrobial AgentConcentration Range (µg/ml)

Breakpoints[R] [I] [S]

Code

Amikacin 4 - 32 > 64 32 < 16 Ak

Amoxicillin – Clavulanic Acid 0.5/0.25 – 32/16 > 32 16 < 8 Cv

Ampicillin 2 – 64 > 32 16 < 8 A

Apramycin** 2 – 16 > 32 16 < 8 Ap

Azithromycin* 0.016 – 256 > 2 0.5-1 < 0.25 Az

Ceftiofur** 0.5 – 16 > 8 4 < 2 Cf

Ceftriaxone 0.25 – 64 > 64 32 < 8 Cx

Cephalothin 1 – 32 > 32 16 < 8 Ce

ChloramphenicolChloramphenicol*

4 – 320.125 – 256

> 32 16 < 8> 32 16 < 8

C

CiprofloxacinCiprofloxacin*

0.015 – 20.016 – 32

> 4 2 < 1> 4 2 < 1

Cp

Clindamycin* 0.032 – 256 > 4 1-2 < 0.5 Cl

Erythromycin* 0.047 – 256 > 8 1-4 < 0.5 E

Florfenicol** 2-16 > 16 F

GentamicinGentamicin*

0.25 – 160.025 – 16

> 16 8 < 4> 16 8 < 4

G

Kanamycin 16 – 64 > 64 32 < 16 K

Nalidixic AcidNalidixic Acid*

4 – 640.047 - 256

> 32 < 16> 32 < 16

Na

Streptomycin 32 – 356 > 64 < 32 S

Sulfamethoxazole 128 – 512 > 512 < 256 Su

TetracyclineTetracycline*

4 – 640.023 – 32

> 16 8 < 4> 16 8 < 4

T

Trimethoprim - Sulfamethoxazole 0.12/2.4 – 4/76 > 4/76 < 2/38 Tm

* Campylobacter antimicrobial agents and concentration ranges used

** No NCCLS interpretive standards for this antimicrobial agent (veterinary use only)

12


Table 3. Antimicrobial resistance of Salmonella, Shigella, and E. coli O157 isolates, 1999

Antimicrobial Agent Non-TyphiSalmonella(N=1499)

N %

SalmonellaTyphi(N=166)

N %

Shigella(N=375)

N %

E. coli O157(N=292)

N%

Amikacin 0 0 0 0 0 0 00

Amoxicillin – Clavulanic Acid 36 2 1 0.6 4 1 10.3

Ampicillin 234 16 21 13 291 77 41

Apramycin 5 0.3 0 0 0 0 00

Ceftiofur 31 2 2 1 0 0 00

Ceftriaxone 6 0.4 1 0.6 0 0 00

Cephalothin 55 4 4 2 12 3 21

Chloramphenicol 138 9 20 12 65 17 00

Ciprofloxacin 1 0.1 0 0 0 0 00

Florfenicol 128 8 0 0 0 0 00

Gentamicin 34 2 0 0 1 0.3 10.3

Kanamycin 66 4 0 0 2 0.5 21

Nalidixic Acid 16 1 31 19 6 2 21

Streptomycin 254 17 23 14 209 56 83

Sulfamethoxazole 272 18 28 17 210 55 248

Tetracycline 292 19 15 9 215 57 103

Trimethoprim - Sulfamethoxazole 31 2 21 13 193 51 41

13


Table 4a. Non-Typhi Salmonella submissions by site and by month of collection, 1999

Site Total Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

CA 54 2 4 3 4 3 5 7 5 7 4 5 5

CO 79 4 6 8 7 9 9 7 9 7 3 5 5

CT 64 3 3 4 3 5 7 9 7 7 7 3 6

FL 100 2 7 6 4 5 10 8 7 15 13 15 8

GA 130 9 7 10 7 8 12 17 11 16 14 10 9

KS 27 1 1 2 2 2 3 3 4 4 2 2 1

LX 134 8 5 8 8 8 11 21 18 13 14 11 9

MA 130 7 5 9 6 11 15 16 15 16 8 12 10

MD 48 3 0 2 1 3 1 11 7 7 5 4 4

MN 62 3 4 4 6 4 5 11 8 6 4 4 3

NJ 134 9 9 7 8 9 11 14 17 18 10 10 12

NYC 176 13 11 10 10 8 16 23 20 21 15 14 15

NYS 146 8 5 7 7 14 13 32 16 11 11 11 11

OR 44 3 4 2 2 3 8 6 4 3 2 3 4

TN 70 6 2 4 2 7 7 11 11 4 7 5 4

WA 96 5 7 7 4 5 16 14 10 6 6 6 10

WV 20 1 2 1 1 1 4 0 3 3 2 1 1

Total 1514 87 82 94 82 105 153 210 172 164 127 121 117

14


Table 4b. Salmonella Typhi submissions by site and by month of collection, 1999


CA 11 0 3 2 2 1 0 1 0 0 1 0 1

CO 2 0 0 0 0 0 2 0 0 0 0 0 0

CT 8 0 0 1 1 0 2 2 1 0 0 0 1

FL 20 7 8 0 3 1 0 0 0 1 0 0 0

GA 3 0 0 0 0 0 1 0 0 1 0 0 1

KS 1 0 0 0 0 0 0 0 1 0 0 0 0

LX 59 13 14 6 1 3 1 2 1 5 5 1 7

MA 18 0 3 3 1 0 0 7 0 0 0 3 1

MD 3 0 0 0 0 1 0 1 1 0 0 0 0

MN 4 0 0 0 2 0 0 1 1 0 0 0 0

NJ 36 0 4 4 1 7 1 2 3 9 3 1 1

NYC 52 2 6 2 3 1 4 4 12 1 5 6 6

NYS 14 2 4 0 0 3 0 0 1 3 1 0 0

OR 7 0 0 1 1 2 1 2 0 0 0 0 0

TN 1 0 0 1 0 0 0 0 0 0 0 0 0

WA 10 1 0 4 0 1 0 1 0 0 0 3 0

WV 0 0 0 0 0 0 0 0 0 0 0 0 0

Total 249 25 42 24 15 20 12 23 21 20 15 14 18

15


Table 4c. Shigella submissions by site and by month of collection, 1999


CA 5 0 0 0 0 0 0 0 3 0 1 1 0

CO 18 1 1 0 2 0 0 2 2 4 1 3 2

CT 7 0 0 0 1 1 1 0 1 1 0 1 1

FL 14 1 0 3 2 4 1 1 1 0 0 1 0

GA 19 1 1 1 2 1 1 3 2 1 3 2 1

KS 5 0 0 0 0 1 0 1 1 0 0 2 0

LX 19 3 1 2 1 1 1 1 2 2 2 1 2

MA 80 1 3 2 1 1 3 6 20 15 14 10 4

MD 2 0 1 0 0 0 0 1 0 0 0 0 0

MN 19 1 0 1 1 2 4 2 2 1 2 2 1

NJ 34 2 3 4 3 2 2 3 3 4 3 3 2

NYC 51 4 4 6 3 0 5 6 6 5 4 4 4

NYS 12 3 1 1 1 0 0 1 2 2 1 0 0

OR 9 1 0 1 0 0 1 0 2 1 1 1 1

TN 65 10 4 4 2 8 15 2 3 2 3 3 9

WA 14 1 1 1 1 1 1 1 1 2 1 1 2

WV 4 0 1 0 0 0 1 0 0 1 1 0 0

Total 377 29 21 26 20 22 36 30 51 41 37 35 29

16


Table 4d. E. coli O157 submissions by site and by month of collection, 1999


CA 6 1 0 0 0 0 1 1 0 1 1 1 0

CO 15 1 0 1 0 1 1 4 1 5 0 0 1

CT 20 2 0 1 1 1 0 6 4 2 2 1 0

FL 13 1 0 0 1 0 3 2 3 1 1 1 0

GA 14 1 0 0 2 0 1 2 1 1 1 2 3

KS 4 0 0 0 0 0 0 1 1 1 0 0 1

LX 3 0 0 0 1 0 0 1 0 0 1 0 0

MA 40 1 2 1 1 4 2 10 4 8 4 2 1

MD 5 0 0 0 0 1 0 1 0 2 1 0 0

MN 32 1 1 0 1 1 5 7 6 3 5 1 1

NJ 22 0 1 0 1 2 3 3 3 3 2 2 2

NYC 1 0 0 0 0 0 0 1 0 0 0 0 0

NYS 61 1 0 0 3 2 9 8 4 26 4 2 2

OR 12 1 1 0 0 1 1 2 2 3 1 0 0

TN 12 1 0 0 0 1 2 1 1 2 2 2 0

WA 31 0 0 1 2 0 2 4 8 6 5 2 1

WV 5 1 0 0 0 0 1 0 0 2 0 1 0

Total 296 12 5 4 13 14 31 54 38 66 30 17 12

17


Table 4e. Campylobacter submissions by site and by month of collection, 1999


CA 48 4 4 4 4 4 4 4 4 4 4 4 4

CT 53 4 6 4 5 5 3 4 4 4 5 3 6

GA 52 4 5 3 4 4 5 4 0 9 5 4 5

MD 22 4 0 2 1 2 5 0 0 0 0 6 2

MN 42 4 4 5 4 0 4 4 5 3 0 5 4

NYS 54 5 3 4 2 5 6 7 6 5 5 2 4

OR 34 3 1 0 3 7 6 4 3 0 1 3 3

TN 14 2 1 0 0 2 4 0 0 0 2 0 3

Total 319 30 24 22 23 29 37 27 22 25 22 27 31

18


Table 5. Frequency of non-Typhi Salmonella Serotypes, 1999

Serotype N %

Typhimurium 362 24.2

Enteritidis 269 17.9

Newport 97 6.5

Heidelberg 89 5.9

Montevideo 52 3.5

Muenchen 51 3.4

Javiana 42 2.8

St. Paul 35 2.3

Agona 33 2.2

Thompson 32 2.1

Braenderup 24 1.6

Oranienburg 24 1.6

Hadar 21 1.4

Infantis 17 1.1

Stanley 17 1.1

Not Serotyped 17 1.1

All Others 317 21.1

Total 1499 100

19National Antimicrobial Resistance Monitoring System For Enteric Bacteria

Table 6. Frequency of non-Typhi Salmonella Serotypes /

Frequency of Pansusceptibility* Among Serotypes, 1996-1999

Selected Salmonella Serotypes: NARMS 1996-1999 1999

Total Isolates Pansusceptible Isolates Serotype # % of Salmonella # % of Serotype

Javiana 42 3.6 41 97.6 Thompson 32 2.8 31 96.9 Braenderup 24 2.1 23 95.8 Oranienburg 24 2.1 23 95.8 Infantis 17 1.5 16 94.1 Muenchen 51 4.4 47 92.2 Montevideo 52 4.5 47 90.4 Enteritidis 269 23.1 225 83.6 St. Paul 35 3.0 29 82.9 Newport 97 8.3 74 76.3 Stanley 17 1.5 12 70.6 Heidelberg 89 7.6 61 68.5 Agona 33 2.8 21 63.6 Typhimurium 362 31.1 183 50.6 Hadar 21 1.8 0 0

1998

Total Isolates Pansusceptible Isolates Serotype # % of Salmonella # % of Serotype

Braenderup 23 1.6 23 100 Miami 10 0.7 10 100 Mississippi 16 1.1 16 100 Poona 12 0.8 12 100 Thompson 24 1.7 24 100 Oranienburg 33 2.3 32 96.7 Javiana 54 3.7 52 96.3 Newport 79 5.5 73 92.4 Montevideo 33 2.3 30 91.0 Infantis 22 1.5 20 90.9 Muenchen 30 2.1 27 90 Enteritidis 245 16.9 214 87.3 Brandenburg 10 0.7 8 80 St. Paul 31 2.1 24 77.4 Stanley 10 0.7 6 60 Agona 39 2.7 23 59.0 Heidelberg 103 7.1 58 56.3 Schwarzengrund 14 1.0 7 50 Typhimurium 378 26.0 176 46.6 Hadar 26 1.8 0 0

*Pansusceptible to antimicrobial agents tested all 4 years: amoxicillin-clavulanic acid, ampicillin, apramycin, ceftiofur, ceftriaxone, cephalothin, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole, tetracycline, trimethoprim-sulfamethoxazole


1999 Annual Report

Table 6. Frequency of non-Typhi Salmonella Serotypes / Frequency of Pansusceptibility* Among Serotypes, 1996-1999 (continued)

1997

Total Isolates Pansusceptible isolates Serotype # % of Salmonella # % of Serotype

Javiana 19 1.5 19 100 Thompson 32 2.5 31 96.9 Infantis 29 2.3 28 96.6 Montevideo 27 2.1 26 96.3 Braenderup 17 1.3 16 94.1 Oranienburg 27 2.1 25 92.6 Newport 48 2.7 42 87.5 Poona 13 1.0 11 84.6 St. Paul 19 1.5 16 84.2 Adelaide 10 0.8 8 80.0 Enteritidis 301 23.5 223 74.1 Muenchen 17 1.3 11 64.7 Heidelberg 75 5.9 48 64.0 Agona 25 2.0 13 52.0 Typhimurium 326 25.4 122 37.4 Hadar 30 2.3 1 3.3

1996

Total Isolates Pansusceptible isolates Serotype # % of Salmonella # % of Serotype

Braenderup 22 1.7 22 100 Montevideo 37 2.8 33 89.2 Javiana 27 2.0 24 88.9 Oranienburg 18 1.4 16 88.9 Java 12 0.9 10 83.3 Muenchen 17 1.3 14 82.4 Newport 51 3.8 42 82.4 Anatum 11 0.8 9 81.8 Thompson 24 1.8 19 79.2 Paratyphi-B 11 0.8 8 72.7 Infantis 18 1.4 13 72.2 Enteritidis 357 26.9 247 69.2 St. Paul 17 1.3 11 64.7 Heidelberg 74 5.6 38 51.4 Agona 12 0.9 5 41.7 Typhimurium 305 23.0 110 36.1 Hadar 38 2.9 1 2.6

*Pansusceptible to antimicrobial agents tested all 4 years: amoxicillin-clavulanic acid, ampicillin, apramycin, ceftiofur, ceftriaxone, cephalothin, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, nalidixic acid, streptomycin, sulfamethoxazole, tetracycline, trimethoprim-sulfamethoxazole


Table 7. Frequency of non-Typhi Salmonella Serotypes /

Frequency of Multiresistance Among Serotypes, 1999

Serotype Total

N %

Number resistant to > 1 antimicrobial

N %

Number resistant to > 2 antimicrobials N %

Typhimurium 362 24.4 179 49.5 166 45.9 Enteritidis 269 18.2 44 16.4 26 9.7 Newport 97 6.5 23 23.7 17 17.5 Heidelberg 89 6.0 28 31.5 25 28.1 Montevideo 52 3.5 5 9.6 5 9.6 Muenchen 51 3.4 4 7.8 4 7.8 Javiana 42 2.8 1 2.4 0 0 St. Paul 35 2.4 6 17.1 5 14.3 Agona 33 2.2 12 36.4 9 27.3 Thompson 32 2.2 1 3.1 1 3.1 Braenderup 24 1.6 1 4.2 0 0 Oranienburg 24 1.6 1 4.2 0 0 Hadar 21 1.4 21 100 18 93.3 Infantis 17 1.1 1 5.9 0 0 Stanley 17 1.1 5 29.4 5 29.4

22


Table 8. Percentage of S. Typhimurium isolates with ACSSuT, ACKSSuT, or AKSSuTresistance patterns, by site, 1999

Site Total #TyphimuriumN %

ACSSuTTyphimuriumN %

ACKSSuTTyphimuriumN %

AKSSuTTyphimuriumN %

California 6 1.7 3 50.0 1 16.7 1 16.7

Colorado 29 8.0 4 13.8 0 0 1 3.4

Connecticut 20 5.5 5 25.0 1 5.0 4 20.0

Florida 14 3.9 6 42.9 0 0 1 7.1

Georgia 24 6.6 6 25.0 0 0 2 8.3

Kansas 14 3.9 3 21.4 1 7.1 1 7.1

Los Angeles 18 5.0 8 44.4 0 0 2 11.1

Maryland 12 3.3 2 16.7 0 0 1 8.3

Massachusetts 40 11.1 6 15.0 1 2.5 4 10.0

Minnesota 19 5.3 8 42.1 1 5.2 1 5.2

New Jersey 29 8.0 11 37.9 1 3.4 2 6.9

New York City 13 3.6 4 30.8 0 0 1 7.7

New York State 49 13.5 13 26.5 1 2.0 5 10.2

Oregon 10 2.8 3 30.0 0 0 0 0

Tennessee 17 4.7 4 23.5 1 5.9 3 17.6

Washington 35 9.7 13 37.1 4 11.4 9 25.7

West Virginia 13 3.6 3 23.1 0 0 1 7.7

Totals 362 100 102 28.2 12 3.3 39 10.8

23


Table 9. Additional antimicrobial resistance for S. Typhimurium isolates with ACSSuT orAKSSuT patterns, 1999

AntimicrobialACSSuTN %

AKSSuTN %

*Amox-Clav 7 6.9 2 5.1

Ceftiofur 3 2.9 0 0

Ceftriaxone 1 1.0 0 0

Cephalothin 9 8.8 8 20.5

Chloramphenicol -- 12 30.8

Florfenicol 98 96.0 10 25.6

Gentamicin 2 2.0 2 5.1

Kanamycin 12 11.8 --

**Trimeth-Sulfa 7 6.9 5 12.8

*Amox-Clav=Amoxicillin-Clavulanic Acid**Trimeth-Sulfa=Trimethoprim-Sulfamethoxazole

24

National Antimicrobial Resistance Monitoring System for Enteric Bacteria

Table 10. Clinical source of non-Typhi Salmonella isolates, 1999

IsolateBlood

N %Stool

N %Other

N %Unknown

N %Total

N %S. Typhimurium -- ACSSuT 3

2.99189.2

65.9

22.0

1026.8

S. Typhimurium -- AKSSuT 25.1

3692.3

12.6

00

392.6

All other S. Typhimurium 94.1

19990.0

115.0

20.9

221 14.7

S. Enteritidis 217.8

23185.9

124.5

51.9

269 17.9

S. Heidelberg 910.1

7179.8

89.0

11.1

895.9

Other Salmonella 354.5

68087.3

506.4

141.8

779 52.0

Total 795.2

1308 87.3 885.9

241.6

1499 100

25


Table 11. Serotypes of non-Typhi Salmonella with reduced susceptibility to ciprofloxacin[MIC > 0.25 µµg/ml]

1999 (N=15)

Serotype # (%) Total received

Enteritidis 6 40 269

Berta 2 13 10

Typhimurium 1 7 362

Choleraesuis 1 7 1

Virchow 1 7 7

Montevideo 1 7 52

Heidelberg 1 7 89

Senftenberg* 1 7 3

Skansen 1 7 1

* S. Senftenberg was resistant to ciprofloxacin (MIC > 4.00 µg/ml)

26


Table 12. Serotypes of non-Typhi Salmonella with reduced susceptibility to ceftriaxone[MIC > 16 µµg/ml]

1999 (N=28)

Serotype # (%) Total received

Newport* 17 60 97

Typhimurium* 7 25 362

Agona 1 4 33

Enteritidis 1 4 269

Skansen 1 4 1

Worthington* 1 4 4

* Three S. Newport, 2 S. Typhimurium, and 1 S. Worthington isolates were resistant to ceftriaxone(MIC > 64.00 µg/ml)

27


Table 13. Frequency of Shigella Species, 1999

Species N %

sonnei 275 73.3

flexneri 87 23.2

boydii 7 1.9

dysenteriae 2 0.5

not identified 4 1.1

Total 375 100

28


Table 14. Antimicrobial Susceptibility of Shigella isolates, 1999

Antibiotic All Shigella(N=375)

Shigella sonnei(N=275)

Shigella flexneri(N=87)

Shigella boydii(N=7)

# Resist % Resist # Resist % Resist # Resist % Resist # Resist % Resist

Amikacin 0 0 0 0 0 0 0 0Amoxicillin – Clavulanic Acid 4 1 1 0.4 3 3 0 0Ampicillin 291 77 219 80 67 77 0 0Apramycin 0 0 0 0 0 0 0 0Ceftiofur 0 0 0 0 0 0 0 0Ceftriaxone 0 0 0 0 0 0 0 0Cephalothin 12 3 8 3 4 4 0 0Chloramphenicol 65 17 5 2 56 64 0 0Ciprofloxacin 0 0 0 0 0 0 0 0Florfenicol 0 0 0 0 0 0 0 0Gentamicin 1 0.3 1 0.4 0 0 0 0Kanamycin 2 0.5 2 1 0 0 0 0Nalidixic Acid 6 2 4 1 1 1 1 14Streptomycin 209 56 143 52 55 63 6 86Sulfamethoxazole 210 55 150 54 51 59 6 86Tetracycline 215 57 127 46 80 92 4 57Trimethoprim - Sulfamethoxazole 193 51 146 53 42 48 2 29

29


Table 15. Frequency of Campylobacter Species, 1999

Species N %

Jejuni 295 92.5

Coli 20 6.3

Fetus 2 0.6

Upsaliensis 2 0.6

Total 319 100

30


Table 16. Antimicrobial Susceptibility of Campylobacter isolates, 1999

AntibioticAll Campylobacter

(N=319)Campylobacter jejuni

(N=295)Campylobacter coli

(N=20)# Resist % Resist # Resist % Resist # Resist % Resist

Azithromycin 10 3 8 3 2 10

Chloramphenicol 1 0.3 1 0.3 0 0

Ciprofloxacin 58 18 52 18 6 30

Clindamycin 5 1 3 1 2 10

Erythromycin 8 2 6 2 2 10

Gentamicin 0 0 0 0 0 0

Nalidixic Acid 65 21 59 20 6 30

Tetracycline 141 44 135 46 6 30


Figure 1. Number of isolates submitted, by site, 1999

LX=Los Angeles County NYC=New York City

13

CA CO CT FL GA KS LX MA MD MN NJ NYC NY OR TN WA WV0

50

100

150

200

250

Site

Number of Isolates

Non-Typhi Salmonella S. Typhi Shigella E. coli O157 (N=1514) (N=249) (N=377) (N=296)


Figure 2. Resistance among non-Typhi Salmonella isolates, 1996-1999

Amikacin*Amox-Clav

AmpicillinApramycin

CeftiofurCeftriaxone

CephalothinChloramphenicol

CiprofloxacinFlorfenicol

GentamicinKanamycin

Nalidixic AcidStreptomycin

SulfamethoxazoleTetracycline

Ticarcillin**Trimeth-Sulfa

0 20 40 60 80 100

121

0.24

311

55

0.421

2324

4

Antimicrobial

Percent of Isolates Resistant

1996 (N=1326)Amikacin

*Amox-ClavAmpicillin

ApramycinCeftiofur

CeftriaxoneCephalothin

ChloramphenicolCiprofloxacin

FlorfenicolGentamicinKanamycin




0 20 40 60 80 100

219

30.4

310

35

122

2522

182

Antimicrobial


1997 (N=1301)

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin




0 20 40 60 80 100

216

0.1112

100.1

36

1191920

162

Antimicrobial


1998 (N=1466)

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin




0 20 40 60 80 100

216

0.32

0.44

90.1

82

41

171819

2

Antimicrobial


1999 (N=1499)

*Amox-Clav=Amoxicillin-Clavulanic Acid **Trimeth-Sulfa=Trimethoprim-Sulfamethoxazole

Not Tested

Not Tested

Not Tested

Not Tested

Not Tested

Not Tested

23


Figure 3a. MICs for Amikacin among non-Typhi Salmonella isolates, 1996 - 1999

1997 (N=1301)

1998 (N=1466)

Resistant:>640/1301=0%


>

>

<

1999 (N=1499)


<>

Not tested in 1996

4 8 16 32 640

20

40

60

80

100 99

0.8 0.2 0 0

Minimum Inhibitory Concentration

Percent of Isolates

4 8 16 32 640

20

40

60

80

100 99.9

0.1 0 0 0


Percent of Isolates

4 8 16 32 640

20

40

60

80

100 99.2

0.5 0.2 0.1 0


Percent of Isolates

<

33


Figure 3b. MICs for Amoxicillin-Clavulanic Acid among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>32/1620/1326=1%

Resistant:>32/1619/1301=1%

Resistant:>32/1624/1466=2%

>

>

><

<

<

Resistant:>32/1636/1499=2%

1999 (N=1499)

< >2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

78

1.56.6

12.3

1.4 0.1


Percent of Isolates

2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

81.2

0.45.7

11.3

1.2 0.2


Percent of Isolates

2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

83.1

0.94.5

9.8

0.9 0.7


Percent of Isolates

2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

83.7

0.84.3

8.8

0.5 1.9


Percent of Isolates

43


Figure 3c. MICs for Ampicillin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>32 279/1326=21%

Resistant:>32241/1301=18%

Resistant:>32241/1466=16%

>>

><

< <

1999 (N=1499)*

Resistant:>32234/1499=16%

><

2 4 8 16 32 64 1280

20

40

60

80

100

76.8

1.5 0.4 0.2 0 0.1

21


Percent of Isolates

2 4 8 16 32 64 1280

20

40

60

80

100

79.7

1.7 0.1 0 0.4 1.8

16.4


Percent of Isolates

2 4 8 16 32 64 1280

20

40

60

80

100

82.8

0.4 0.2 0.1 0.1 0.1

16.3


Percent of Isolates

2 4 8 16 32 64 1280

20

40

60

80

100

83.5

0.6 0.3 0 0

15.6

0


Percent of Isolates

* Maximum MIC dilution for 1999 was 32 ug/ml. All resistant isolates had a MIC >32 ug/ml.

53


Figure 3d. MICs for Apramycin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>32 0/1326=0%


Resistant:>321/1466=0.1%

>>

><

< <

1999 (N=1499)

Resistant:>325/1499=0.3%

><

2 4 8 16 320

20

40

60

80

100

45.6 45.3

8.20.7 0.2


Percent of Isolates

2 4 8 16 320

20

40

60

80

100

51

40.8

7.80.5 0


Percent of Isolates

2 4 8 16 320

20

40

60

80

100

57.7

40.8

1.3 0.1 0.1


Percent of Isolates

2 4 8 16 320

20

40

60

80

100

60.8

34.9

3.80.2 0.3


Percent of Isolates

63


Figure 3e. MICs for Ceftiofur among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>8 53/1326=4%



>>

><

< <

1999 (N=1499)


><

.5 1 2 4 8 16 320

20

40

60

80

100

40.2

54

1.4 0.3 1.1 1.5 1.5


Percent of Isolates

.5 1 2 4 8 16 320

20

40

60

80

100

66.9

24.9

2.8 1.9 1.8 0.3 1.3


Percent of Isolates

.5 1 2 4 8 16 320

20

40

60

80

10087.7

10.7

0.5 0 0.2 0.1 0.7


Percent of Isolates

.5 1 2 4 8 16 320

20

40

60

80

100

86.3

11.5

0.1 0.1 0.1 0.1 1.9


Percent of Isolates

73


Figure 3f. MICs for Ceftriaxone among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

*MIC:>161/1326=0.1%

Resistant:>64 1/1326=0.1%

*MIC:>165/1301=0.4%

Resistant:>645/1301=0.4%

*MIC:>1610/1466=0.7%

Resistant:>6410/1466=0.7%

>>

><

< <

1999 (N=1499)

*MIC:>1628/1499=1.9%

Resistant:>646/1499=0.4%

><

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 94.8

1.2 1.2 1.1 1.1 0.5 0 0 0.1


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 96.2

2.1 0.7 0.5 0.2 0 0 0 0.4


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 98.9

0.1 0 0.1 0.1 0.1 0 0 0.7


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 97.8

0 0 0.1 0 0.3 0.7 0.8 0.4


Percent of Isolates

*MIC:>16 is decreased susceptibility.

83


Figure 3g. MICs for Cephalothin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>32 47/1326=3%

Resistant:>3243/1301=3%

Resistant:>3233/1466=2%

>>

><

< <

1999 (N=1499)

Resistant:>3255/1499=4%

><

1 2 4 8 16 32 640

20

40

60

80

100

2.5

50.2

29

11.4

3.4 2.3 1.3


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

2.8

57.3

23.1

10.72.8 1.6 1.7


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

1.9

68.1

20.2

4.6 2.5 0.9 1.7


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

0.7

48.9

37.7

7.41.6 0.7 2.9


Percent of Isolates

93


Figure 3h. MICs for Chloramphenicol among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>32 141/1326=11%

Resistant:>32131/1301=10%

Resistant:>32145/1466=10%

>>

><

< <

1999 (N=1499)

Resistant:>32138/1499=9%

><

4 8 16 32 640

20

40

60

80

100

75.6

13.6

0.3 0.1

10.5


Percent of Isolates

4 8 16 32 640

20

40

60

80

10088.2

1.6 0.1 0.8

9.2


Percent of Isolates

4 8 16 32 640

20

40

60

80

10088.7

1.1 0.2 0.1

9.8


Percent of Isolates

4 8 16 32 640

20

40

60

80

100

68.7

21.9

0.1 0

9.2


Percent of Isolates

04


Figure 3i. MICs for Ciprofloxacin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

MICs:>.25 5/1326=0.4%


MICs:>.2510/1466=0.7%

Resistant:>41/1466=0.1%

>>

><

< <

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.5

0.3 0.2 0.7 0.1 0.1 0 0.1

Mininum Inhibitory Concentration

Percent of Isolates 1999 (N=1499)

< >

MICs:>.25 8/1301=0.6%


MICs:>.25 15/1499=1%

Resistant:> 41/1499=0.1%

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.8

0.8 0.1 0.2 0.2 0 0 0


Percent of Isolates

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.2

0.6 0.6 0.4 0.2 0 0 0


Percent of Isolates

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.2

0.4 0.8 0.4 0.2 0 0 0.1


Percent of Isolates

14


Figure 3j. MICs for Florfenicol among non-Typhi Salmonella isolates, 1996 - 1999

2 4 8 160

20

40

60

80

100

28.8

60.2

2.58.5



< >

MICs:>16 128/1499=8%

Not tested in 1996 Not tested in 1997

Not tested in 1998

24


Figure 3k. MICs for Gentamicin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>16 64/1326=5%

Resistant:>1638/1301=3%

Resistant:>1642/1466=3%

>>

><

< <

.25 .5 1 2 4 8 16 320

20

40

60

80

100

46 45.2

5.50.7 0 0.3 0.9 1.3



Resistant:>1634/1499=2%

< >

.25 .5 1 2 4 8 16 320

20

40

60

80

100

11.2

55

23.5

50.2 0.2 1.5 3.3


Percent of Isolates

.25 .5 1 2 4 8 16 320

20

40

60

80

100

52

31.5

11.7

1.5 0.2 0.2 0.9 2


Percent of Isolates

.25 .5 1 2 4 8 16 320

20

40

60

80

100

25

62.5

9.2

0.1 0.1 0.3 1.1 1.8


Percent of Isolates

34


Figure 3l. MICs for Kanamycin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>64 65/1326=5%


Resistant:>6484/1466=6%

>>

><

< <

1999 (N=1499)

Resistant:>6466/1499=4%

><

16 32 64 1280

20

40

60

80

100 94.6

0.5 0.24.8


Percent of Isolates

16 32 64 1280

20

40

60

80

100 94.5

0.5 0.64.5


Percent of Isolates

16 32 64 1280

20

40

60

80

100 94

0.3 0.25.5


Percent of Isolates

16 32 64 1280

20

40

60

80

100 95.5

0.1 0.14.3


Percent of Isolates

44


Figure 3m. MICs for Nalidixic Acid among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>32 5/1326=0.4%

Resistant:>3211/1301=1%

Resistant:>3220/1466=1%

>>

><

< <

1999 (N=1499)

Resistant:>3216/1499=1%

><

2 4 8 16 32 640

20

40

60

80

100

1.8

85

12.6

0.2 0 0.4


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

0

88

9.9

1.2 0.2 0.7


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

0

93.7

4.50.4 0.1 1.2


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

0

90.7

7.90.3 0.1 1.1


Percent of Isolates

54


Figure 3n. MICs for Streptomycin among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>64 275/1326=21%

Resistant:>64282/1301=22%

Resistant:>64273/1466=19%

>>

><

< <

1999 (N=1499)

Resistant:>64254/1499=17%

><

32 64 128 256 5120

20

40

60

80

100

79.3

10.66.9

1.9 1.3


Percent of Isolates

32 64 128 256 5120

20

40

60

80

100

78.3

6.7 9.13.8 2


Percent of Isolates

32 64 128 256 5120

20

40

60

80

100

81.4

8.1 7.32 1.2


Percent of Isolates

32 64 128 256 5120

20

40

60

80

100

83.1

6.6 5.1 3.1 2.1


Percent of Isolates

64

National Antimicrobial Resistance Monitoring SystemFor Enteric Bacteria

Figure 3o. MICs for Sulfamethoxazole among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>512 305/1326=23%

Resistant:>512328/1301=25%

Resistant:>512283/1466=19%

>>

><

< <

1999 (N=1499)

Resistant:>512272/1499=18%

><

128 256 512 10240

20

40

60

80

100

75.4

1.6 1.1

21.9


Percent of Isolates

128 256 512 10240

20

40

60

80

100

71.5

3.2 3

22.2


Percent of Isolates

128 256 512 10240

20

40

60

80

100

80.4

0.3 0.1

19.2


Percent of Isolates

128 256 512 10240

20

40

60

80

100

81.8

0.1 0.1

18.1


Percent of Isolates

74


Figure 3p. MICs for Tetracycline among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>16321/1326=24%

Resistant:>16283/1301=22%

Resistant:>16295/1466=20%

>>

><

< <

1999 (N=1499)*

Resistant:>16292/1499=20%

><

4 8 16 32 64 1280

20

40

60

80

100

75.2

0.66.4 6.3

10.9

0.6


Percent of Isolates

4 8 16 32 64 1280

20

40

60

80

100

77.8

0.5 2.46.1 6.8 6.4


Percent of Isolates

4 8 16 32 64 1280

20

40

60

80

100

79.7

0.2 1.26.1 3.9

8.9


Percent of Isolates

4 8 16 32 64 1280

20

40

60

80

100

80.5

0.1 0.24.1

15.2

0


Percent of Isolates


84


Figure 3q. MICs for Trimethoprim-Sulfamethoxazole among non-Typhi Salmonella isolates, 1996 - 1999

1996 (N=1326) 1997 (N=1301)

1998 (N=1466)

Resistant:>4/76 51/1326=4%

Resistant:>4/7624/1301=2%

Resistant:>4/7634/1466=2%

>>

><

< <

1999 (N=1499)

Resistant:>4/7631/1499=2%

><

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100

86.3

9

0.5 0.2 0.2 03.8


Percent of Isolates

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100 95.8

1.9 0.3 0.2 0 0.2 1.6


Percent of Isolates

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100 96.5

0.8 0.2 0.1 0.1 0 2.3


Percent of Isolates

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

10087.8

9.6

0.5 0 0.1 0 2.1


Percent of Isolates

94


Figure 4a. Resistance among Salmonella serotype Agona isolates, 1996-1999

1997 (N=25)

Amikacin*Amox-Clav

AmpicillinApramycin

CeftiofurCeftriaxoneCephalothin






0 20 40 60 80 100

4

4

4

2040

364

8

Antimicrobial


1998 (N=39)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

3

3

53

1036

313

Antimicrobial


1999 (N=33)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

33

3

33

3

327

36

3

Antimicrobial


1996 (N=12)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

8

8

255050

Antimicrobial



Not TestedNot Tested

Not Tested

Not Tested

Not Tested

Not Tested

05


Figure 4b. Resistance among Salmonella serotype Braenderup isolates, 1996-1999

1996 (N=22)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

Antimicrobial


1997 (N=17)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

1

6

6

Antimicrobial


1998 (N=23)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

Antimicrobial


1999 (N=24)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

4

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

15


Figure 4c. Resistance among Salmonella serotype Enteritidis isolates, 1996-1999 1996 (N=357)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

121

4

61

5

12

1317

7

Antimicrobial


1997 (N=301)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

112

5

30.3

0.31

414

10

1

Antimicrobial


1998 (N=245)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

6

0.40.4222

76

1

Antimicrobial


1999 (N=269)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

0.410

0.4

21

0.4

0.4333

9

1

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

25


Figure 4d. Resistance among Salmonella serotype Hadar isolates, 1996-1999

1996 (N=38)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

26

16

5

845

95

Antimicrobial


1997 (N=30)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

23

7

13

33

9320

973

Antimicrobial


1998 (N=26)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

442

194

4

431

8100

42

Antimicrobial


1999 (N=21)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

24

14

145

8119

91

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

35


Figure 4e. Resistance among Salmonella serotype Heidelberg isolates, 1996-1999

1996 (N=74)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

415

7

71

2313

421820

Antimicrobial


1997 (N=75)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

112

1

4

178

2324

12

Antimicrobial


1998 (N=103)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

116

1

51

1614

130

2120

172

Antimicrobial


1999 (N=89)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

18

1

32

215

9

251919

1

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

45


Figure 4f. Resistance among Salmonella serotype Infantis isolates, 1996-1999

1996 (N=18)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

6

6

6

628

6

Antimicrobial


1997 (N=29)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

3

Antimicrobial


1998 (N=22)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

4

44

Antimicrobial


1999 (N=17)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

6

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

55


Figure 4g. Resistance among Salmonella serotype Javiana isolates, 1996-1999

1996 (N=27)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

4

4

47

Antimicrobial


1997 (N=19)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

Antimicrobial


1998 (N=54)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

2

222

Antimicrobial


1999 (N=42)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

2

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

65


Figure 4h. Resistance among Salmonella serotype Montevideo isolates, 1996-1999 1996 (N=37)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

5

5

311

3

3

Antimicrobial


1997 (N=27)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

4

Antimicrobial


1998 (N=33)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

6

33

66

36

3

Antimicrobial


1999 (N=52)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

22

6

2

6

2222

4

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

75


Figure 4i. Resistance among Salmonella serotype Muenchen isolates, 1996-1999

1996 (N=17)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

66

12

Antimicrobial


1997 (N=17)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

66

6

6

122323

Antimicrobial


1998 (N=30)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

33

77

Antimicrobial


1999 (N=51)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

2

2

68

6

2

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

85


Figure 4j. Resistance among Salmonella serotype Newport isolates, 1996-1999

1996 (N=51)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

26

4

46

62

812

8

4

Antimicrobial


1997 (N=48)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

26

4

44

4

68

4

4

Antimicrobial


1998 (N=78)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

13

1

33

11

343

11

Antimicrobial


1999 (N=97)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

1818

183

1818

18

1

1922

19

2

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

95


Figure 4k. Resistance among Salmonella serotype Oranienburg isolates, 1996-1999

1996 (N=18)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

116

Antimicrobial


1997 (N=27)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

4

47

Antimicrobial


1998 (N=33)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

33

Antimicrobial


1999 (N=24)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

4

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

06


Figure 4l. Resistance among Salmonella serotype Saint Paul isolates, 1996-1999

1998 (N=31)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

313

37

37

131919

137

Antimicrobial


1999 (N=35)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

3

33

543

6

614

6

9

Antimicrobial



Not Tested

Not Tested

1996 (N=17)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

6

12

66

1835

18

12

Antimicrobial


16

Not Tested

Not Tested

Not Tested

Not Tested

1997 (N=19)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

5

5

5

55

5

Antimicrobial



Figure 4m. Resistance among Salmonella serotype Stanley isolates, 1996-1999

1996 (N=4)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

25

507575

25

Antimicrobial


1997 (N=6)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

17

3350

33

17

Antimicrobial


1998 (N=10)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

1010

10

10

3030

401010

Antimicrobial


1999 (N=17)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

6

6

24

1266

123030

24

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

26


Figure 4n. Resistance among Salmonella serotype Thompson isolates, 1996-1999

1996 (N=24)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

44

8

4

12

1212

4

Antimicrobial


1997 (N=32)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

3

Antimicrobial


1998 (N=24)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

Antimicrobial


1999 (N=32)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

333

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

36


Figure 4o. Resistance among Salmonella serotype Typhimurium isolates, 1996-1999

1996 (N=306)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

450

4

240

414

0.35254

49

4

Antimicrobial


1997 (N=326)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

551

51

636

516

15557

53

3

Antimicrobial


1998 (N=380)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

445

2

434

416

0.547

5046

444

Antimicrobial


1999 (N=362)

Amikacin*Amox-Clav

AmpicillinApramycin







0 20 40 60 80 100

341

21

529

282

13

4345

42

3

Antimicrobial




Not Tested

Not Tested

Not Tested

Not Tested

46

National Antimicrobial Resistance Monitoring SystemFor Enteric Bacteria

Figure 5. Percent of non-Typhi Salmonella isolates that are serotype Typhimurium, by site, 1996 - 1999


56

Percent Typhimurium for all sites:1996 - 306/1326 = 23% 1997 - 326/1301 = 25%1998 - 380/1466 = 26% 1999 - 362/1499 = 24%

CACO

CTFL

GAKS

LXMA

MDMN

NJNYC

NYOR

TNWA

WVTOTAL

0

20

40

60

80

100

Site

Percent of Isolates

1996 1997 1998 1999


Figure 6. Percent of Salmonella Typhimurium isolates that are resistant to Ampicillin, Chloramphenicol, Streptomycin, Sulfamethoxazole, and Tetracycline

(ACSSuT), by site, 1996-1999


66

Percent Typhimurium with ACSSuT pattern for all sites:1996 - 103/306 = 34% 1997 - 115/326 = 35%1998 - 120/380 = 32% 1999 - 102/362 = 28%

CACO

CTFL

GAKS

LXMA

MDMN

NJNYC

NYOR

TNWA

WVTOTAL

0

20

40

60

80

100

Site

Percent of Isolates

1996 1997 1998 1999


Figure 7. Percent of Salmonella Typhimurium isolates that are resistant to Ampicillin, Kanamycin, Streptomycin, Sulfamethoxazole, and Tetracycline

(AKSSuT), by site, 1996-1999


76

Percent Typhimurium with AKSSuT pattern for all sites:1996 - 27/306 = 9% 1997 - 41/326 = 13%1998 - 46/374 = 12% 1999 - 39/362 = 11%

CACO

CTFL

GAKS

LXMA

MDMN

NJNYC

NYOR

TNWA

WVTOTAL

0

20

40

60

80

100

Site

Percent of Isolates

1996 1997 1998 1999


Figure 8. Resistance among Salmonella Typhi isolates, 1999

N=166

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin



**Trimeth-Sulfa

0 20 40 60 80 100

0.613

10.62

12

1914

179

13

Antimicrobial



86


Figure 9a. MICs among Salmonella Typhi isolates, by antimicrobial agent, 1999

Amikacin Amoxicillin-Clavulanic Acid

Ampicillin Apramycin

4 8 16 32 640

20

40

60

80

100 100

0 0 0 0


Percent of Isolates


>< 2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

87.4

1.27.8

30 0.6


Percent of Isolates

Resistant:>321/166=0.6%

><

2 4 8 16 32 64 1280

20

40

60

80

100

86.7

0.6 0 0 0.6

12

0


Percent of Isolates

Resistant:>3221/166=13%

>< 2 4 8 16 320

20

40

60

80

100

64.1

22.9

30 0


Percent of Isolates


><

96


Figure 9b. MICs among Salmonella Typhi isolates, by antimicrobial agent, 1999

Ceftiofur Ceftriaxone

Cephalothin Chloramphenicol

.5 1 2 4 8 16 320

20

40

60

80

100 97

1.2 0.6 0 0 0 1.2


Percent of Isolates


>< .25 .5 1 2 4 8 16 32 640

20

40

60

80

100 98.8

1 0.6 0 0 0 0 0 0.6


Percent of Isolates

Resistant:>641/166=0.6%

><

1 2 4 8 16 32 640

20

40

60

80

100

24.7

33.1

22.9

124.8

1.2 1.2


Percent of Isolates


>< 4 8 16 32 640

20

40

60

80

100

80.7

7.20 0

12


Percent of Isolates

Resistant:>32 20/166=12%

><

07


Figure 9c. MICs among Salmonella Typhi isolates, by antimicrobial agent, 1999

2 4 8 160

20

40

60

80

100

78.9

19.9

1.2 0


Percent of IsolatesCiprofloxacin Florfenicol

Gentamicin

><

Kanamycin

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100

75.3

1.87.8

13.9

1.2 0 0 0


Percent of Isolates

MICs:>.25 25/166=15%

><

MICs:>160/166=0%

.25 .5 1 2 4 8 16 320

20

40

60

80

100

70.5

27.1

2.4 0 0 0 0 0


Percent of Isolates

Resistant:>16 0/166=0%

>< 16 32 64 1280

20

40

60

80

100 100

0 0 0


Percent of Isolates


><

17


Figure 9d. MICs among Salmonella Typhi isolates, by antimicrobial agent, 1999

Nalidixic Acid Streptomycin

Sulfamethoxazole Tetracycline

2 4 8 16 32 64 128 2560

20

40

60

80

100

0

73.5

6.61.2 0 1.2 1.8

15.6


Percent of Isolates

Resistant:>3231/166=19%

>< 32 64 128 256 5120

20

40

60

80

100

86.1

1.8 0 0

12


Percent of Isolates

Resistant:>6423/166=14%

><

128 256 512 10240

20

40

60

80

100

83.1

0 0

16.9


Percent of Isolates

Resistant:>51228/166=17%

>< 4 8 16 32 64 1280

20

40

60

80

10091.9

0 0 0

9

0


Percent of Isolates


><

27


Figure 9e. MICs among Salmonella Typhi isolates, by antimicrobial agent, 1999

Trimethoprim-Sulfamethoxazole

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100

86.7

0.6 0 0 0 0

12.7


Percent of Isolates

Resistant:>4/76 21/166=13%

><

37


Figure 10. Resistance among Shigella isolates, 1999

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin



**Trimeth-Sulfa

0 20 40 60 80 100

177

317

0.30.52

565557

51

Antimicrobial



N=375

47


Figure 11. Resistance among Shigella sonnei and Shigella flexneri isolates, 1999


Shigella sonnei (N=275) Shigella flexneri (N=87)

Amikacin*Amox-Clav

AmpicillinApramycin






**Trimeth-Sulfa

0 20 40 60 80 100

377

564

163

5992

48

Antimicrobial


Amikacin*Amox-Clav

AmpicillinApramycin






**Trimeth-Sulfa

0 20 40 60 80 100

0.480

32

0.411

5254

4653

Antimicrobial


57


Figure 12a. MICs among Shigella sonnei isolates, by antimicrobial agent, 1999

4 8 16 32 640

20

40

60

80

100 100

0 0 0 0


Percent of Isolates

2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

15.312

63.6

8.7

0.4 0


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

16

2.2 0 2.2 1.1

78.5


Percent of Isolates


Ampicillin


Resistant:>321/275=0.4%

Resistant:>32219/275=80%

>>

><

< <

2 4 8 16 320

20

40

60

80

100

4

59.3

36.4

0.4 0


Percent of IsolatesApramycin


><

67

.5 1 2 4 8 16 320

20

40

60

80

100 99.6

0.4 0 0 0 0 0


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 100

0 0 0 0 0 0 0 0


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

0.4 1.59.1

55.6

30.5

1.8 1.1


Percent of Isolates


Cephalothin



Resistant:>328/275 =3%

>>

><

< <

4 8 16 32 640

20

40

60

80

100 97.5

0.7 0 1.8 0


Percent of IsolatesChloramphenicol


><


Figure 12b. MICs among Shigella sonnei isolates, by antimicrobial agent, 1999

77


Figure 12c. MICs among Shigella sonnei isolates, by antimicrobial agent, 1999

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.6

0.4 0.4 0.7 0 0 0 0


Percent of IsolatesCiprofloxacin

Resistant:>0.250/275=0%

><

.25 .5 1 2 4 8 16 320

20

40

60

80

100

6.9

56.7

35.3

0.7 0 0 0 0.4


Percent of IsolatesGentamicin

Resistant:>161/275=0.4%

>< 16 32 64 1280

20

40

60

80

100 99.3

0 0.4 0.4


Percent of Isolates Kanamycin


><

2 4 8 160

20

40

60

80

100

48.451.3

0.4 0


Percent of Isolates Florfenicol


><

87


Figure 12d. MICs among Shigella sonnei isolates, by antimicrobial agent, 1999

2 4 8 16 32 640

20

40

60

80

100

0

97.8

0.7 0 0.4 1.1


Percent of IsolatesNalidixic Acid


>< 32 64 128 256 5120

20

40

60

80

100

48

4.712 10.5

24.7


Percent of Isolates Streptomycin

Resistant:>64 143/275=52%

><

128 256 512 10240

20

40

60

80

100

45.5

0 0.7

53.8


Percent of Isolates Sulfamethoxazole

Resistant:>512150/275=54%

>< 4 8 16 32 64 1280

20

40

60

80

100

53.5

0.4 0.4

22.2 23.6

0


Percent of IsolatesTetracycline

Resistant:>16127/275=46%

><

97

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100

45.8

0.4 0.4 0.4 0 0

53.1


Percent of IsolatesTrimethoprim-Sufamethoxazole

Resistant:>4/76146/275=53%

><


Figure 12e. MICs among Shigella sonnei isolates, by antimicrobial agent, 1999

08

4 8 16 32 640

20

40

60

80

100 97.7

2.3 0 0 0


Percent of Isolates

2/1 4/2 8/4 16/8 32/16 64/320

20

40

60

80

100

20.6

4.69.2

62.1

3.40


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

21.8

1.1 0 0 1.1

75.9


Percent of Isolates


Ampicillin




>>

><

< <

2 4 8 16 320

20

40

60

80

100

8

43.7 46

2.3 0


Percent of IsolatesApramycin


><


Figure 13a. MICs among Shigella flexneri isolates, by antimicrobial agent, 1999

18

.5 1 2 4 8 16 320

20

40

60

80

100 100

0 0 0 0 0 0


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 100

0 0 0 0 0 0 0 0


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

06.9

29.9

42.5

16.1

3.4 1.1


Percent of Isolates


Cephalothin

Resistant:>80/87=0%



>>

><

< <

4 8 16 32 640

20

40

60

80

100

31

2.3 2.3

28.735.6


Percent of IsolatesChloramphenicol


><


Figure 13b. MICs among Shigella flexneri isolates, by antimicrobial agent, 1999

28


Figure 13c. MICs among Shigella flexneri isolates, by antimicrobial agent, 1999

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.9

0 0 0 0 1.1 0 0


Percent of IsolatesCiprofloxacin

><

.25 .5 1 2 4 8 16 320

20

40

60

80

100

9.2

44.8 46

0 0 0 0 0


Percent of IsolatesGentamicin

>< 16 32 64 1280

20

40

60

80

100 100

0 0 0


Percent of Isolates Kanamycin

><

2 4 8 160

20

40

60

80

10093.1

6.90 0


Percent of Isolates Florfenicol

><

Resistant:>0.250/87=0%




38


Figure 13d. MICs among Shigella flexneri isolates, by antimicrobial agent, 1999

2 4 8 16 32 640

20

40

60

80

100

0

97.7

1.1 0 0 1.1


Percent of IsolatesNalidixic Acid


>< 32 64 128 256 5120

20

40

60

80

100

36.8

20.7

9.214.9

18.4


Percent of Isolates Streptomycin

Resistant:>64 55/87=63%

><

128 256 512 10240

20

40

60

80

100

41.4

0 0

58.6


Percent of Isolates Sulfamethoxazole

Resistant:>51251/87=59%

>< 4 8 16 32 64 1280

20

40

60

80

100

8

0 0

11.5

80.5

0


Percent of IsolatesTetracycline


><

48

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100

50.6

1.1 0 0 0 0

48.3


Percent of IsolatesTrimethoprim-Sufamethoxazole

Resistant:>4/7642/87=48%

><


Figure 13e. MICs among Shigella flexneri isolates, by antimicrobial agent, 1999

58


Figure 14. Resistance among E. coli O157 isolates, 1996-1999

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin




0 20 40 60 80 100

1

5

30.5

214

5

Antimicrobial


1996 (N=201)Amikacin

*Amox-ClavAmpicillin

ApramycinCeftiofur

CeftriaxoneCephalothin






0 20 40 60 80 100

4

211

3

Antimicrobial


1997 (N=161)

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin




0 20 40 60 80 100

3

0.3

0.3

26

43

1

Antimicrobial


1998 (N=313)

Amikacin*Amox-Clav

AmpicillinApramycin




GentamicinKanamycin




0 20 40 60 80 100

0.31

1

0.311

38

3

1

Antimicrobial


1999 (N=292)


Not Tested

Not Tested

Not Tested

Not Tested

Not Tested

Not Tested

68


Figure 15a. MICs for Amikacin among E. coli O157 isolates, 1996 - 1999

4 8 16 32 640

20

40

60

80

100 99.4

0.6 0 0 0


Percent of Isolates

4 8 16 32 640

20

40

60

80

100 99.7

0.3 0 0 0


Percent of Isolates

1997 (N=161)

1998 (N=313)



>

><

<

4 8 16 32 640

20

40

60

80

100 98.6

1.4 0 0 0




<>

Not tested in 1996

78


Figure 15b. MICs for Amoxicillin-Clavulanic Acid among E. coli O157 isolates, 1996 - 1999

1 2 4 8 16 320

20

40

60

80

100

0 3

92

4.50.5 0


Percent of Isolates

1 2 4 8 16 320

20

40

60

80

100

2.5

14.9

82

0.6 0 0


Percent of Isolates

1 2 4 8 16 320

20

40

60

80

100

1.3

19.2

76.7

2.6 0.3 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>

>

><

<

< 1 2 4 8 16 320

20

40

60

80

100

0.35.8

92.1

1 0.3 0.3


Percent of Isolates

Resistant:>321/292=0.3%

1999 (N=292)

< >

88


Figure 15c. MICs for Ampicillin among E. coli O157 isolates, 1996 - 1999

2 4 8 16 32 64 1280

20

40

60

80

100

28.4

70.1

0 0 0 0 1.5


Percent of Isolates

2 4 8 16 32 64 1280

20

40

60

80

100

19.3

80.7

0 0 0 0 0


Percent of Isolates

2 4 8 16 32 64 1280

20

40

60

80

100

37.7

59.4

0.3 0 0 0 2.6


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

2 4 8 16 32 64 1280

20

40

60

80

100

26.7

71.9

0 0 0 1.4 0


Percent of Isolates 1999 (N=292)*


><


98


Figure 15d. MICs for Apramycin among E. coli O157 isolates, 1996 - 1999

2 4 8 16 320

20

40

60

80

100

27.4

47.3

24.9

0.5 0


Percent of Isolates

2 4 8 16 320

20

40

60

80

100

69.6

23.6

5.61.2 0


Percent of Isolates

2 4 8 16 320

20

40

60

80

100

57.2

39

3.80 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

2 4 8 16 320

20

40

60

80

100

59.9

33.9

5.11 0




><

09


Figure 15e. MICs for Ceftiofur among E. coli O157 isolates, 1996 - 1999

.5 1 2 4 8 16 320

20

40

60

80

100

87.6

70.5 0 2 2 1


Percent of Isolates

.5 1 2 4 8 16 320

20

40

60

80

100 97.7

0.7 0 1.4 0 0 0


Percent of Isolates

.5 1 2 4 8 16 320

20

40

60

80

100 99.4

0.6 0 0 0 0 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

.5 1 2 4 8 16 320

20

40

60

80

100 100

0 0 0 0 0 0




><

19


Figure 15f. MICs for Ceftriaxone among E. coli O157 isolates, 1996 - 1999

.25 .5 1 2 4 8 16 32 640

20

40

60

80

10093

2 2.5 2.5 0 0 0 0 0


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 98.1

1.2 0 0 0.6 0 0 0 0


Percent of Isolates

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 100

0 0 0 0 0 0 0 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

.25 .5 1 2 4 8 16 32 640

20

40

60

80

100 100

0 0 0 0 0 0 0 0




><

29


Figure 15g. MICs for Cephalothin among E. coli O157 isolates, 1996 - 1999

1 2 4 8 16 32 640

20

40

60

80

100

0 06

61.7

29.4

3 0


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

1.2 1.9

25.5

61.5

6.2 3.70


Percent of Isolates

1 2 4 8 16 32 640

20

40

60

80

100

0.3 0.6

22

72.2

4.80 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

1 2 4 8 16 32 640

20

40

60

80

100

0 0.37.5

85.6

5.80.3 0.3




><

39


Figure 15h. MICs for Chloramphenicol among E. coli O157 isolates, 1996 - 1999

4 8 16 32 640

20

40

60

80

100

22.4

77.1

0 0.5 0


Percent of Isolates

4 8 16 32 640

20

40

60

80

100 94.4

5.60 0 0


Percent of Isolates

4 8 16 32 640

20

40

60

80

100

84.3

15

0.3 0 0.3


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)

Resistant:>32 1/201=0.5%


Resistant:>321/313=0.3%

>>

><

< <

4 8 16 32 640

20

40

60

80

100

58.9

41.1

0 0 0




><

49


Figure 15i. MICs for Ciprofloxacin among E. coli O157 isolates, 1996 - 1999

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 99

1 0 0 0 0 0 0


Percent of Isolates

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 98.7

0 0 1.2 0 0 0 0


Percent of Isolates

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 100

0 0 0 0 0 0 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)


Resistant;>40/313=0%

>>

><

< <

.03 .06 .12 .25 .5 1 2 40

20

40

60

80

100 99.3

0 0 0.3 0.3 0 0 0



< >



59

2 4 8 160

20

40

60

80

100

5.8

67.5

26.7

0


Percent of Isolates

< >

Not tested in 1996 Not tested in 1997

Not tested in 1998


Figure 15j. MICs for Florfenicol among E. coli O157 isolates, 1996 - 1999

1999 (N=292)

MICs:>16 0/292=0%

69


Figure 15k. MICs for Gentamicin among E. coli O157 isolates, 1996 - 1999

.25 .5 1 2 4 8 16 320

20

40

60

80

100

10.4

46.3

33.8

9.5

0 0 0 0


Percent of Isolates

.25 .5 1 2 4 8 16 320

20

40

60

80

100

59

26.1

13

1.2 0.6 0 0 0


Percent of Isolates

.25 .5 1 2 4 8 16 320

20

40

60

80

100

31.9

49.2

17.6

1.3 0 0 0 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

.25 .5 1 2 4 8 16 320

20

40

60

80

100

40.4

50.7

6.52.1 0 0 0 0.3



Resistant:>161/292=0.3%

< >

79


Figure 15l. MICs for Kanamycin among E. coli O157 isolates, 1996 - 1999

16 32 64 1280

20

40

60

80

100 100

0 0 0


Percent of Isolates

16 32 64 1280

20

40

60

80

100 100

0 0 0


Percent of Isolates

16 32 64 1280

20

40

60

80

100 99.4

0.3 0 0.3


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)



Resistant:>641/313=0.3%

>>

><

< <

16 32 64 1280

20

40

60

80

100 99.3

0 0 0.7




><

89


Figure 15m. MICs for Nalidixic Acid among E. coli O157 isolates, 1996 - 1999

2 4 8 16 32 640

20

40

60

80

100

6

90.1

40 0 0


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

0

98.8

0.6 0.6 0 0


Percent of Isolates

2 4 8 16 32 640

20

40

60

80

100

0

97.8

1.9 0.3 0 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

2 4 8 16 32 640

20

40

60

80

100

0

99

0 0.3 0 0.7




><

99


Figure 15n. MICs for Streptomycin among E. coli O157 isolates, 1996 - 1999

32 64 128 256 5120

20

40

60

80

100 98

1.5 0.5 0 0


Percent of Isolates

32 64 128 256 5120

20

40

60

80

100 97.5

0.6 1.2 0.6 0


Percent of Isolates

32 64 128 256 5120

20

40

60

80

100 98.1

0.3 1.3 0.3 0


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

32 64 128 256 5120

20

40

60

80

100 97.3

2.4 0 0.3 0




><

001


Figure 15o. MICs for Sulfamethoxazole among E. coli O157 isolates, 1996 - 1999

128 256 512 10240

20

40

60

80

100

79.6

6.51

12.9


Percent of Isolates

128 256 512 10240

20

40

60

80

100

87

2.5 3.17.5


Percent of Isolates

128 256 512 10240

20

40

60

80

100 94.2

0 05.8


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)

Resistant:>512 28/201=14%

Resistant:>51217/161=11%

Resistant:>51218/313=6%

>>

><

< <

128 256 512 10240

20

40

60

80

10091.8

0 0

8.2


Percent of Isolates1999 (N=292)

Resistant:>51224/292=8%

><

101


Figure 15p. MICs for Tetracycline among E. coli O157 isolates, 1996 - 1999

4 8 16 32 64 1280

20

40

60

80

100 94

1 0 04.5

0.5


Percent of Isolates

4 8 16 32 64 1280

20

40

60

80

100 96.9

0 0 0.6 0.6 1.9


Percent of Isolates

4 8 16 32 64 1280

20

40

60

80

100 95.5

0 0 0.6 1.6 2.2


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)




>>

><

< <

4 8 16 32 64 1280

20

40

60

80

100 96.6

0 0 03.4

0


Percent of Isolates 1999 (N=292)*


><


201


Figure 15q. MICs for Trimethoprim-Sulfamethoxazole among E. coli O157 isolates, 1996 - 1999

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100 99.5

0.5 0 0 0 0 0


Percent of Isolates

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100 100

0 0 0 0 0 0


Percent of Isolates

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100 99.4

0 0 0 0 0 0.6


Percent of Isolates

1996 (N=201) 1997 (N=161)

1998 (N=313)

Resistant:>4/76 0/201=0%

Resistant:>4/760/161=0%

Resistant:>4/762/313=1%

>>

><

< <

.12/2.38 .25/4.75 .50/9.5 1/19 2/38 4/76 8/1520

20

40

60

80

100 98.3

0.3 0 0 0 0 1.4



Resistant:>4/764/292=1%

><

301

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

6

13

7

8

24

48

Antimicrobial


1997 (N=217)

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

2

2

13

1

3

17

46

Antimicrobial


1998 (N=345)

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

3

0.3

18

1

2

21

44

Antimicrobial


1999 (N=319)

Not Tested

Not Tested

Not Tested


Figure 16. Resistance among Campylobacter isolates, 1997- 1999

401

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

6

13

6

8

24

48

Antimicrobial


1997 (N=209)

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

2

1

13

1

3

15

46

Antimicrobial


1998 (N=330)

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

3

0.3

18

1

2

20

46

Antimicrobial


1999 (N=295)

Not Tested

Not Tested

Not Tested


Figure 17a. Resistance among Campylobacter jejuni isolates, 1997- 1999

501

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

25

25

75

Antimicrobial


1997 (N=4)

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

11

22

11

11

11

55

44

Antimicrobial


1998 (N=9)

Azithromycin

Chloramphenicol

Ciprofloxacin

Clindamycin

Erythromycin

Gentamicin

Nalidixic Acid

Tetracycline

0 20 40 60 80 100

10

30

10

10

30

30

Antimicrobial


1999 (N=20)

Not Tested

Not Tested

Not Tested


Figure 17b. Resistance among Campylobacter coli isolates, 1997- 1999

601


Figure 18a. MICs for Azithromycin among Campylobacter jejuni isolates, 1997 - 1999

.016 .032 .064 .125 .25 .5 1 2 4 8 16 32 64 1280

20

40

60

80

100

0.9 0.3 0.6 1.54.6

13.7

24.121

15.8

8.54.6

0.9 0.9 0.6 0.6 0.3 0 0 0 0 0 0 0 0 0 0 0 0.9



1999 (N=295)



> 256

> 256

<

<

Not tested in 1997

.016 .032 .064 .125 .25 .5 1 2 4 8 16 32 64 1280

20

40

60

80

100

0 0 0.7 2

8.5

13.6

26.8

19.7

12.57.5

2.4 1.7 1.4 0.7 0.3 0.3 0.7 0 0 0 0 0 0 0 0 0 0 1.3


Percent of Isolates

701


Figure 18b. MICs for Chloramphenicol among Campylobacter jejuni isolates, 1997 - 1999

1997 (N=209)


.125 .38 .75 1 2 4 8 16 32 64 128 2560

20

40

60

80

100

0.5 1 14.3 3.3

0.5

1114.4 14.8

12 12.4

5.7 4.82.9 2.4 3.3

1 0 0.5 0 0 04.3


Percent of Isolates

.125 .38 .75 1 2 4 8 16 32 64 128 2560

20

40

60

80

100

0 0.3 0 0.3 2.10

6.1

13.6

19.724.5

10.97.9 7.3

4.51.2 0.9 0.3 0 0.3 0 0 0 0



1999 (N=295)


Resistant:>321/295=0.3%

<

<

>

>

><

.125 .38 .75 1 2 4 8 16 32 64 128 2560

20

40

60

80

100

0.3 0.3 0.3 02

0

12.2

27.8

20.316.9

9.8

4.4 3.1 1.4 0.3 0.3 0 0.3 0 0 0 0 0


Percent of Isolates

801


Figure 18c. MICs for Ciprofloxacin among Campylobacter jejuni isolates, 1997 - 1999

.016 .047 .094 .19 .38 .75 1.5 3 6 12 240

20

40

60

80

100

0.5 1.43.8

9.6

17.714.4 14.8

11.5

3.8 5.31 1 1 1 0.5 0 0 0 0 0 0

12.9




> 32< .016 .047 .094 .19 .38 .75 1.5 3 6 12 240

20

40

60

80

100

0.64.8

7.9

19.717.3 18.5

8.5

3.3 3 1.5 0 0.9 0.3 0 0 0 0 0 0 0.3 0

13.1




> 32<

.016 .047 .094 .19 .38 .75 1.5 3 6 12 240

20

40

60

80

100

1

16.9 15.918.6

12.59.8

3.40.6 1 1 0.3 0.7 0.3 0 0 0 0 0.7 0.3 0 0

16.6




< > 32

901


Figure 18d. MICs for Clindamycin among Campylobacter jejuni isolates, 1997 - 1999

.032 .064 .125 .25 .5 1 2 4 8 16 32 96 1920

20

40

60

80

100

1.4 2.9 1.94.8

10 10.5

19.614.412.4

3.8 5.72.9 2.4 1.4 1 0 0.5 0 0 0 0.5 0.5 0 0 0 0

3.3




> 256< .032 .064 .125 .25 .5 1 2 4 8 16 32 96 1920

20

40

60

80

100

1.5 2.47

3.9

19.118.515.515.8

6.1 4.9 2.7 0.9 0.3 0.3 0 0 0.6 0 0 0 0.3 0 0 0 0 0 0




> 256<

.032 .064 .125 .25 .5 1 2 4 8 16 32 96 1920

20

40

60

80

100

0.6 0.7 2.46.8

13.6

22 21.4

14.99.5

3.7 1.7 1.4 0.3 0 0.3 0 0.3 0 0 0 0 0 0 0 0 0 0.3




> 256<

01

1


Figure 18e. MICs for Erythromycin among Campylobacter jejuni isolates, 1997 - 1999

.047 .094 .19 .38 .75 1.5 3 6 12 24 48 1280

20

40

60

80

100

1.4 0.5 1 1.9 1 2.97.2 8.1

17.219.6

13.4

7.24.8 5.3

1 1.4 1 0.5 0 0 0 0 04.8




> 256< .047 .094 .19 .38 .75 1.5 3 6 12 24 48 1280

20

40

60

80

100

0 0.6 0.3 0.6 1.5 2.1

9.4

18.5 18.5

25.1

11.56.7

1.2 0.9 0.3 0.3 0.6 0.6 0 0 0 0 0 1.2




> 256<

1999 (N=295)


> 256< .047 .094 .19 .38 .75 1.5 3 6 12 24 48 1280

20

40

60

80

100

0 0 0 0 0.33.1

8.5

18.3

24.4 23.4

13.6

4.71 0.3 0.3 0.3 0 0.3 0 0 0 0 0 1.4


Percent of Isolates

11

1


Figure 18f. MICs for Gentamicin among Campylobacter jejuni isolates, 1997 - 1999

.025 .064 .125 .25 .5 1 2 4 8 160

20

40

60

80

100

0.6 0.3 0.3 0.9

6.7

13.7

20.4 21.3 21

7.94

1.5 0.9 0 0 0 0.3 0 0




><

.025 .064 .125 .25 .5 1 2 4 8 160

20

40

60

80

100

02 3.1

9.2

21.719.7 18.3

16.2

4.71.7 1.7 0 1 0.3 0.3 0 0 0 0




><

Not tested in 1997

21

1


Figure 18g. MICs for Nalidixic Acid among Campylobacter jejuni isolates, 1997 - 1999

.047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0.5 0 0 0 0 0 0 0 0 0.5 04.3

6.710.5

14.812

14.8

6.7 5.71 0.5 1 1.4 0 0

19.6



Resistant:>3249/209=23%

< > 256 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0 0 0 0 0.3 0 0.65.5

10.6

19.518.815.2

9.1

2.4 2.1 0.6 0.3 0 0 0 0 0

14.9



Resistant:>3250/330=15%

< > 256

.047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0 0.3 0.3 0.74.4 5.1

12.58.1

12.5

18.3

11.5

3.1 1.4 1 0.7 0 0 0.7 0 0 0 0

19.3



Resistant:>3259/295=20%

< > 256

31

1


Figure 18h. MICs for Tetracycline among Campylobacter jejuni isolates, 1997 - 1999

.023 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0.5 1.9 1.4 1.44.8 6.7 8.1 8.2

4.81.4

3.3 3.31.4 1 1 0 1.4 0.5 1 0 0 0.5 0

2.4 1 1 0

43.1



Resistant:>16102/209=49%

> 256< .023 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0.9 2.1 36.4

9.4 8.8 7 5.5 4.2 2.7 1.5 0.6 0.3 0.3 0.3 0.3 0.3 0 0.3 0 0.9 0 0.9 0.9 1.2 0

42.1



Resistant:>16153/330=46%

> 256<

.023 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0.35.4 5.4

15.310.1

6.13.7 3.7

1 0.7 1.4 1 0 0 0 0 0 0 0.7 0.3 1.7 1 0 0 0

42



Resistant:>16135/295=46%

> 256<

41

1


Figure 19a. MICs for Azithromycin among Campylobacter coli isolates, 1997 - 1999

.016 .032 .064 .125 .25 .5 1 2 4 8 16 32 64 1280

20

40

60

80

100

0 0 0

11.1

0 0

22.2

0

22.2

11.1

0 0 0

22.2

0 0 0 0 0 0 0 0 0 0 0 0 0

11.1



1999 (N=20)


> 256

> 256

<

<

Not tested in 1997

.016 .032 .064 .125 .25 .5 1 2 4 8 16 32 64 1280

20

40

60

80

100

0 0 0 0 0

1520

1520

510

50 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10


Percent of Isolates

Resistant:>21/9=11%

51

1


Figure 19b. MICs for Chloramphenicol among Campylobacter coli isolates, 1997 - 1999

1997 (N=4)

.125 .38 .75 1 2 4 8 16 32 64 1280

20

40

60

80

100

0 0 0 0 0 0 0 0

25

0 0

25

0 0 0

25

0 0 0 0 0 0

25


Percent of Isolates

.125 .38 .75 1 2 4 8 16 32 64 1280

20

40

60

80

100

0 0 0 0 0 0 0

11.1 11.1

0

33.3

0 0 0

11.1 11.1 11.1 11.1

0 0 0 0 0



1999 (N=20)

<

<

>256

>256

>256<

.125 .38 .75 1 2 4 8 16 32 64 1280

20

40

60

80

100

0 0 0 0 0 0 05

1015

45

10 105

0 0 0 0 0 0 0 0 0


Percent of Isolates




61

1


Figure 19c. MICs for Ciprofloxacin among Campylobacter coli isolates, 1997 - 1999

.016 .047 .094 .19 .38 .75 1.5 3 6 12 240

20

40

60

80

100

0 0

25

0 0

25

0 0 0 0 0

50

0 0 0 0 0 0 0 0 0 0



> 32 < .016 .047 .094 .19 .38 .75 1.5 3 6 12 240

20

40

60

80

100

11.1

0 0

11.1 11.1 11.1 11.1

33.3

0 0 0 0 0 0 0 0 0 0 0 0 0

11.1



> 32<

.016 .047 .094 .19 .38 .75 1.5 3 6 12 240

20

40

60

80

100

0 05

30

1510

50 0 0 0

50 0 0 0 0 0 0 0 0

30



< > 32

Resistant:>40/4=0%

Resistant:>41/9=11%


71

1


Figure 19d. MICs for Clindamycin among Campylobacter coli isolates, 1997 - 1999

.032 .064 .125 .25 .5 1 2 4 8 16 32 96 1920

20

40

60

80

100

0 0 0 0

25

0

25

0

25

0 0

25

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



>256< .032 .064 .125 .25 .5 1 2 4 8 16 32 96 1920

20

40

60

80

100

11.1

0 0 0 0

22.2

11.1

0 0 0

22.222.2

0 0 0 0 0 0 0 0 0 0 0 0 0 0

11.1



>256<

.032 .064 .125 .25 .5 1 2 4 8 16 32 96 1920

20

40

60

80

100

0 0 0 0 05

10

30 30

105

0 0 0 0 0 0 0 0 0 05

0 0 0 05



>256<

Resistant:>40/4=0%

Resistant:>41/9=11%


81

1


Figure 19e. MICs for Erythromycin among Campylobacter coli isolates, 1997 - 1999

.047 .094 .19 .38 .75 1.5 3 6 12 24 48 1280

20

40

60

80

100

0 0 0 0 0

25

0 0 0

50

0 0 0

25

0 0 0 0 0 0 0 0 0 0



> 256< .047 .094 .19 .38 .75 1.5 3 6 12 24 48 1280

20

40

60

80

100

0 0.6 0.3 0.6 1.5 2.1

9.4

18.5 18.5

25.1

11.56.7

1.2 0.9 0.3 0.3 0.6 0.6 0 0 0 0 0 1.2



> 256<

1999 (N=20)

> 256 <.047 .094 .19 .38 .75 1.5 3 6 12 24 48 1280

20

40

60

80

100

0 0 0 0 0 0

15 15 1520

10 10

50 0 0 0 0 0 0 0 0 0

10


Percent of Isolates

Resistant:>80/4=0%

Resistant:>81/9=11%


91

1


Figure 19f. MICs for Gentamicin among Campylobacter coli isolates, 1997 - 1999

.025 .064 .125 .25 .5 1 2 4 8 160

20

40

60

80

100

0 0 0 0 0

11.1

0

33.3

11.1 11.1 11.1

22.2

0 0 0 0 0 0 0



><

.025 .064 .125 .25 .5 1 2 4 8 160

20

40

60

80

100

0 0 0 0 0

15

25

30

15

510

0 0 0 0 0 0 0 0



><

Not tested in 1997

Resistant:>160/9=0%


021


Figure 19g. MICs for Nalidixic Acid among Campylobacter coli isolates, 1997 - 1999

.047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50

0

25

0 0

25

0 0 0 0



< > 256 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0 0 0 0 0 0 0 0 0 0

22.2

11.1

0 0

11.1

0 0

11.1

0 0 0 0

44.4



< > 256

.047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0 0 0 0 0 0 05

15

5

2015

50

50 0 0 0 0 0 0

30



< > 256




121


Figure 19h. MICs for Tetracycline among Campylobacter coli isolates, 1997 - 1999

.023 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0 0 0 0 0 0 0 0

25

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

75



> 256< .023 .047 .094 .19 .38 .75 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0

11.1

0 0 0

11.1

22.2

11.1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

44.4



> 256<

.023 .047 .094 .190 .380 .750 1.5 3 6 12 24 48 96 1920

20

40

60

80

100

0 0 0 0

5

20

10 10 10 10

0

5

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

30



> 256<




221

NARMS final report 1999 INTRO · isolates, 1999 13 Table 4. Submission of isolates by site a nd by...

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