Surveillance and Control of Antibiotic Resistance in the Mediterranean Region
Identifieur interne : 000037 ( Pmc/Curation ); précédent : 000036; suivant : 000038Surveillance and Control of Antibiotic Resistance in the Mediterranean Region
Auteurs : Walter Ricciardi ; Gabriele Giubbini ; Patrizia LaurentiSource :
- Mediterranean Journal of Hematology and Infectious Diseases [ 2035-3006 ] ; 2016.
Abstract
Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant microorganisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients.
The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level.
The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance of antibiotic resistance in the countries bordering the Mediterranean Sea.
Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe. It is of particular concern the phenomenon of resistance carried out by some gram-negative, specifically
Is particularly high the incidence of resistance to carbapenems by strains of
Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes does support patient care, economic growth, agriculture, and economic and national security.
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DOI: 10.4084/MJHID.2016.036
PubMed: 27413528
PubMed Central: 4928537
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Surveillance and Control of Antibiotic Resistance in the Mediterranean Region</title><author><name sortKey="Ricciardi, Walter" sort="Ricciardi, Walter" uniqKey="Ricciardi W" first="Walter" last="Ricciardi">Walter Ricciardi</name></author><author><name sortKey="Giubbini, Gabriele" sort="Giubbini, Gabriele" uniqKey="Giubbini G" first="Gabriele" last="Giubbini">Gabriele Giubbini</name></author><author><name sortKey="Laurenti, Patrizia" sort="Laurenti, Patrizia" uniqKey="Laurenti P" first="Patrizia" last="Laurenti">Patrizia Laurenti</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27413528</idno><idno type="pmc">4928537</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928537</idno><idno type="RBID">PMC:4928537</idno><idno type="doi">10.4084/MJHID.2016.036</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000037</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000037</idno><idno type="wicri:Area/Pmc/Curation">000037</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000037</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Surveillance and Control of Antibiotic Resistance in the Mediterranean Region</title><author><name sortKey="Ricciardi, Walter" sort="Ricciardi, Walter" uniqKey="Ricciardi W" first="Walter" last="Ricciardi">Walter Ricciardi</name></author><author><name sortKey="Giubbini, Gabriele" sort="Giubbini, Gabriele" uniqKey="Giubbini G" first="Gabriele" last="Giubbini">Gabriele Giubbini</name></author><author><name sortKey="Laurenti, Patrizia" sort="Laurenti, Patrizia" uniqKey="Laurenti P" first="Patrizia" last="Laurenti">Patrizia Laurenti</name></author></analytic><series><title level="j">Mediterranean Journal of Hematology and Infectious Diseases</title><idno type="eISSN">2035-3006</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant microorganisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients.</p><p>The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level.</p><p>The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance of antibiotic resistance in the countries bordering the Mediterranean Sea.</p><p>Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe. It is of particular concern the phenomenon of resistance carried out by some gram-negative, specifically <italic>Klebsiella pneumoniae</italic> and <italic>Escherichia coli</italic> to third-generation cephalosporin, often combined in opposition to fluoroquinolones and aminoglycosides.</p><p>Is particularly high the incidence of resistance to carbapenems by strains of <italic>Enterobacteriaceae</italic> (<italic>Klebsiella</italic> included). The resistance exerted by MRSA (Methicillin-resistant <italic>Staphylococcus aureus</italic>) continues to be relevant, albeit showing some decline in recent years. The incidence of resistance carried on by <italic>Streptococcus pneumoniae</italic> is stable and is mainly relevant to macrolides. Finally, a significant increase in recording relatively exercised by <italic>Enterococcus faecium</italic> to Vancomycin.</p><p>Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes does support patient care, economic growth, agriculture, and economic and national security.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Borg, Ma" uniqKey="Borg M">Ma Borg</name></author><author><name sortKey="Scicluna, E" uniqKey="Scicluna E">E Scicluna</name></author><author><name sortKey="De Kraker, M" uniqKey="De Kraker M">M De Kraker</name></author><author><name sortKey="Van De Sande Bruinsma, N" uniqKey="Van De Sande Bruinsma N">N Van De Sande-Bruinsma</name></author><author><name sortKey="Tiemersma, E" uniqKey="Tiemersma E">E Tiemersma</name></author><author><name sortKey="Gur, D" uniqKey="Gur D">D Gür</name></author><author><name sortKey="Ben Redjeb, S" uniqKey="Ben Redjeb S">S Ben Redjeb</name></author><author><name 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Borg</name></author><author><name sortKey="Cookson, Bd" uniqKey="Cookson B">Bd Cookson</name></author><author><name sortKey="Zarb, P" uniqKey="Zarb P">P Zarb</name></author><author><name sortKey="Scicluna, Ea" uniqKey="Scicluna E">Ea Scicluna</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Borg, Ma" uniqKey="Borg M">Ma Borg</name></author><author><name sortKey="Zarb, P" uniqKey="Zarb P">P Zarb</name></author><author><name sortKey="Scicluna, Ea" uniqKey="Scicluna E">Ea Scicluna</name></author><author><name sortKey="Rasslan, O" uniqKey="Rasslan O">O Rasslan</name></author><author><name sortKey="Gur, D" uniqKey="Gur D">D Gür</name></author><author><name sortKey="Ben Redjeb, S" uniqKey="Ben Redjeb S">S Ben Redjeb</name></author><author><name sortKey="Elnasser, Z" uniqKey="Elnasser Z">Z Elnasser</name></author><author><name sortKey="Daoud, Z" uniqKey="Daoud Z">Z Daoud</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Albiger, B" uniqKey="Albiger B">B Albiger</name></author><author><name sortKey="Glasner, C" uniqKey="Glasner C">C Glasner</name></author><author><name sortKey="Struelens, Mj" uniqKey="Struelens M">Mj Struelens</name></author><author><name sortKey="Grundmann, H" uniqKey="Grundmann H">H Grundmann</name></author><author><name sortKey="Monnet, Dl" uniqKey="Monnet D">Dl Monnet</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Carlet, J" uniqKey="Carlet J">J CARLET</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Enani, Ma" uniqKey="Enani M">MA Enani</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Borg, Ma" uniqKey="Borg M">Ma Borg</name></author><author><name sortKey="Cookson, Bd" uniqKey="Cookson B">Bd Cookson</name></author><author><name sortKey="Scicluna, Ea" uniqKey="Scicluna E">Ea 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Mediterr J Hematol Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Mediterr J Hematol Infect Dis</journal-id><journal-id journal-id-type="publisher-id">Mediterranean Journal of Hematology and Infectious Diseases</journal-id><journal-title-group><journal-title>Mediterranean Journal of Hematology and Infectious Diseases</journal-title></journal-title-group><issn pub-type="epub">2035-3006</issn><publisher><publisher-name>Università Cattolica del Sacro Cuore</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27413528</article-id><article-id pub-id-type="pmc">4928537</article-id><article-id pub-id-type="doi">10.4084/MJHID.2016.036</article-id><article-id pub-id-type="publisher-id">mjhid-8-1-e2016036</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Surveillance and Control of Antibiotic Resistance in the Mediterranean Region</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ricciardi</surname><given-names>Walter</given-names></name></contrib><contrib contrib-type="author"><name><surname>Giubbini</surname><given-names>Gabriele</given-names></name></contrib><contrib contrib-type="author"><name><surname>Laurenti</surname><given-names>Patrizia</given-names></name><xref ref-type="corresp" rid="c1-mjhid-8-1-e2016036"></xref></contrib><aff id="af1-mjhid-8-1-e2016036">Institute of Public Health - Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1-00168, Rome, Italy</aff></contrib-group><author-notes><corresp id="c1-mjhid-8-1-e2016036">Correspondence to: Prof. Patrizia Laurenti. E-mail: <email>Patrizia.Laurenti@unicatt.it</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>01</day><month>7</month><year>2016</year></pub-date><volume>8</volume><issue>1</issue><elocation-id>e2016036</elocation-id><history><date date-type="received"><day>26</day><month>5</month><year>2016</year></date><date date-type="accepted"><day>01</day><month>6</month><year>2016</year></date></history><permissions><copyright-year>2016</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant microorganisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients.</p><p>The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level.</p><p>The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance of antibiotic resistance in the countries bordering the Mediterranean Sea.</p><p>Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe. It is of particular concern the phenomenon of resistance carried out by some gram-negative, specifically <italic>Klebsiella pneumoniae</italic> and <italic>Escherichia coli</italic> to third-generation cephalosporin, often combined in opposition to fluoroquinolones and aminoglycosides.</p><p>Is particularly high the incidence of resistance to carbapenems by strains of <italic>Enterobacteriaceae</italic> (<italic>Klebsiella</italic> included). The resistance exerted by MRSA (Methicillin-resistant <italic>Staphylococcus aureus</italic>) continues to be relevant, albeit showing some decline in recent years. The incidence of resistance carried on by <italic>Streptococcus pneumoniae</italic> is stable and is mainly relevant to macrolides. Finally, a significant increase in recording relatively exercised by <italic>Enterococcus faecium</italic> to Vancomycin.</p><p>Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes does support patient care, economic growth, agriculture, and economic and national security.</p></abstract></article-meta></front><floats-group><fig id="f1-mjhid-8-1-e2016036" position="float"><label>Figure 1</label><caption><p>(Antimicrobial resistance surveillnace in Europe, Surveillance report, ECDC, 2014). <italic>Escherchia coli.</italic> Percentage (%) of invasive isolate with combined resistance to third generation cephalosporin, fluorochinolones and aminoglycosides, by country, EU/EEA countries, 2014</p></caption><graphic xlink:href="mjhid-8-1-e2016036f1"></graphic></fig><fig id="f2-mjhid-8-1-e2016036" position="float"><label>Figure 2</label><caption><p>(Antimicrobial resistance surveillnace in Europe, Surveillance report, ECDC, 2014). <italic>Klebsiella pneumoniae</italic> Percentage (%) of invasive isolates with combined resistance to fluoroquinolones, third generation cephalosporins and aminoglycosides, by countries, 2014.</p></caption><graphic xlink:href="mjhid-8-1-e2016036f2"></graphic></fig><fig id="f3-mjhid-8-1-e2016036" position="float"><label>Figure 3</label><caption><p>(Antimicrobial resistance surveillnace in Europe, Surveillance report, ECDC, 2014). <italic>Pseudomonas aeruginosa</italic>. Percentage (%) of invasive isolates with combined resistance (resistance to three or more antimicrobial groups among piperacillin + tazobactan, ceftazidime, fluoroquinolones, amynoglycosides and carbapenems), by country, EU/EEA countries, 2014.</p></caption><graphic xlink:href="mjhid-8-1-e2016036f3"></graphic></fig><fig id="f4-mjhid-8-1-e2016036" position="float"><label>Figure 4</label><caption><p>(Antimicrobial resistance surveillnace in Europe, Surveillance report, ECDC, 2014). <italic>Acinetobacter spp</italic>. Percentage (%) of invasive isolates with combined resistance to fluoroquinolones, aminoglycosides and carbapenens, by country, EU/EEA countries, 2014.</p></caption><graphic xlink:href="mjhid-8-1-e2016036f4"></graphic></fig><table-wrap id="t1-mjhid-8-1-e2016036" position="float"><label>Table 1</label><caption><p>Pathogen–antimicrobial combinations on which GLASS will gather data (Adapted by the Manual for Early Implementation, GLASS).</p></caption><table frame="hsides" rules="cols"><thead><tr><th valign="top" align="left" rowspan="1" colspan="1">Pathogen</th><th valign="top" align="left" rowspan="1" colspan="1">Antibacterial class</th><th valign="top" align="left" rowspan="1" colspan="1">Antibacterial agents that may be used for AST<xref ref-type="table-fn" rid="tfn1-mjhid-8-1-e2016036">a</xref>,<xref ref-type="table-fn" rid="tfn2-mjhid-8-1-e2016036">b</xref></th></tr><tr><th colspan="3" valign="top" align="left" rowspan="1"><hr></hr></th></tr></thead><tbody><tr><td rowspan="7" valign="top" align="left" colspan="1"><italic>Escherichia coli</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Sulfonamides and trimethoprim</td><td valign="top" align="left" rowspan="1" colspan="1">Co-trimoxazole</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fluoroquinolones</td><td valign="top" align="left" rowspan="1" colspan="1">Ciprofloxacin or levofloxacin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Third-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Ceftriaxone or cefotaxime and ceftazidime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fourth-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Cefepime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Carbapenems<xref ref-type="table-fn" rid="tfn3-mjhid-8-1-e2016036">c</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Imipenem, meropenem, ertapenem or doripenem</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Polymyxins</td><td valign="top" align="left" rowspan="1" colspan="1">Colistin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Penicillins</td><td valign="top" align="left" rowspan="1" colspan="1">Ampicillin</td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td rowspan="6" valign="top" align="left" colspan="1"><italic>Klebsiella pneumoniae</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Sulfonamides and trimethoprim</td><td valign="top" align="left" rowspan="1" colspan="1">Co-trimoxazole</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fluoroquinolones</td><td valign="top" align="left" rowspan="1" colspan="1">Ciprofloxacin or levofloxacin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Third-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Ceftriaxone or cefotaxime and ceftazidime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fourth-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Cefepime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Carbapenems<xref ref-type="table-fn" rid="tfn3-mjhid-8-1-e2016036">c</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Imipenem, meropenem, ertapenem or doripenem</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Polymyxins</td><td valign="top" align="left" rowspan="1" colspan="1">Colistin</td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td rowspan="4" valign="top" align="left" colspan="1"><italic>Acinetobacter baumannii</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Tetracyclines</td><td valign="top" align="left" rowspan="1" colspan="1">Tigecycline or minocycline</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Aminoglycosides</td><td valign="top" align="left" rowspan="1" colspan="1">Gentamicin and amikacin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Carbapenems<xref ref-type="table-fn" rid="tfn3-mjhid-8-1-e2016036">c</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Imipenem, meropenem, ertapenem or doripenem</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Polymyxins</td><td valign="top" align="left" rowspan="1" colspan="1">Colistin</td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"><italic>Staphylococcus aureus</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Penicillinase-stable beta-lactams</td><td valign="top" align="left" rowspan="1" colspan="1">Cefoxitin<xref ref-type="table-fn" rid="tfn4-mjhid-8-1-e2016036">d</xref></td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td rowspan="4" valign="top" align="left" colspan="1"><italic>Streptococcus pneumoniae</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Penicillins</td><td valign="top" align="left" rowspan="1" colspan="1">Oxacillin<xref ref-type="table-fn" rid="tfn5-mjhid-8-1-e2016036">e</xref></td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Penicillin G</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Sulfonamides and trimethoprim</td><td valign="top" align="left" rowspan="1" colspan="1">Co-trimoxazole</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Third-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Ceftriaxone or cefotaxime</td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td rowspan="3" valign="top" align="left" colspan="1"><italic>Salmonella</italic> spp.</td><td valign="top" align="left" rowspan="1" colspan="1">Fluoroquinolones</td><td valign="top" align="left" rowspan="1" colspan="1">Ciprofloxacin or levofloxacin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Third-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Ceftriaxone or cefotaxime and ceftazidime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Carbapenems<xref ref-type="table-fn" rid="tfn3-mjhid-8-1-e2016036">c</xref></td><td valign="top" align="left" rowspan="1" colspan="1">Imipenem, meropenem, ertapenem or doripenem</td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td rowspan="3" valign="top" align="left" colspan="1"><italic>Shigella</italic> spp.</td><td valign="top" align="left" rowspan="1" colspan="1">Fluoroquinolones</td><td valign="top" align="left" rowspan="1" colspan="1">Ciprofloxacin or levofloxacin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Third-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Ceftriaxone or cefotaxime and ceftazidime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Macrolides</td><td valign="top" align="left" rowspan="1" colspan="1">Azithromycin</td></tr><tr><td colspan="3" valign="top" align="left" rowspan="1"><hr></hr></td></tr><tr><td rowspan="6" valign="top" align="left" colspan="1"><italic>Neisseria gonorrhoeae</italic></td><td valign="top" align="left" rowspan="1" colspan="1">Third-generation cephalosporins</td><td valign="top" align="left" rowspan="1" colspan="1">Cefixime</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1"></td><td valign="top" align="left" rowspan="1" colspan="1">Ceftriaxone</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Macrolides</td><td valign="top" align="left" rowspan="1" colspan="1">Azithromycin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Aminocyclitols</td><td valign="top" align="left" rowspan="1" colspan="1">Spectinomycin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Fluoroquinolones</td><td valign="top" align="left" rowspan="1" colspan="1">Ciprofloxacin</td></tr><tr><td valign="top" align="left" rowspan="1" colspan="1">Aminoglycosides</td><td valign="top" align="left" rowspan="1" colspan="1">Gentamicin</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-mjhid-8-1-e2016036"><label>a</label><p>The listed substances are priorities for surveillance of resistance in each pathogen, although they may not be first-line options for treatment. One or more of the drugs listed may be tested.</p></fn><fn id="tfn2-mjhid-8-1-e2016036"><label>b</label><p>One or more of the drugs listed may be tested in countries. S, I, R and nominator and denominator data for each shall be reported separately.</p></fn><fn id="tfn3-mjhid-8-1-e2016036"><label>c</label><p>Imipenem or meropenem is preferred to represent the group when available.</p></fn><fn id="tfn4-mjhid-8-1-e2016036"><label>d</label><p>Cefoxitin is a surrogate for testing susceptibility to oxacillin (methicillin, nafcillin); the AST report to clinicians should state susceptibility or resistance to oxacillin.</p></fn><fn id="tfn5-mjhid-8-1-e2016036"><label>e</label><p>Oxacillin is a surrogate for testing reduced susceptibility or resistance to penicillin; the AST report to clinicians should state reduced susceptibility or resistance to penicillin.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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