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

Abstract

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

Keywords: antimicrobial resistance; bloodstream infection; surveillance.

FIG 1

Twenty-year trend in percent methicillin-resistant S. aureus (MRSA) among all S. aureus bloodstream infections, SENTRY, 1997 to 2016.

FIG 2

Twenty-year trend in percent vancomycin-resistant enterococci (VRE) among Enterococcus sp. bloodstream infections, SENTRY, 1997 to 2016.

FIG 3

Twenty-year trend in percent multidrug resistance (MDR) among Enterobacteriaceae bloodstream infection, by community-onset versus hospital-onset infection, SENTRY, 1997 to 2016.

FIG 4

Twenty-year trend in percent extended-spectrum-β-lactamase (ESBL)-resistant and carbapenem-resistant Enterobacteriaceae (CRE) among selected Enterobacteriaceae, SENTRY, 1997 to 2016.