Epidemiology and susceptibility to antimicrobials in community, hospital and long-term care facility bacteremia in northern Israel: A 6 year surveillance

Background: Identification of pathogens and their susceptibility to antimicrobials is mandatory for successful empiric antibiotic treatment. Objectives: 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 ∼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.