Table 12.
Percentage of Pathogens Reported from Pediatric Surgical Site Infections (SSIs) that Tested Nonsusceptiblea (NS) to Selected Antimicrobial Agents, by Surgical Categoryb, 2015–2017
| Pathogen, Antimicrobial | All Surgery Typesc | Abdominald | Orthopedice | Neurosurgicalf | Cardiacg | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. Reported | % Tested | % NSa | No. Reported | % Tested | % NSa | No. Reported | % Tested | % NSa | No. Reported | % Tested | % NSa | No. Reported | % Tested | % NSa | |
| Staphylococcus aureus | 622 | 175 | 157 | 117 | 152 | ||||||||||
| OX/CEFOX/METH (MRSA) | 93.1 | 27.3 | 97.7 | 33.9 | 90.4 | 19.0* | 91.5 | 28.0 | 91.4 | 25.2 | |||||
| Enterococcus faecium | 42 | 39 | 1 | 1 | 1 | ||||||||||
| Vancomycin (VRE) | 97.6 | 24.4 | 97.4 | 26.3 | 100.0 | . . . | 100.0 | . . . | 100.0 | . . . | |||||
| Enterococcus faecalis | 199 | 168 | 10 | 5 | 9 | ||||||||||
| Vancomycin (VRE) | 94.0 | 1.1 | 94.0 | 1.3 | 100.0 | . . . | 100.0 | . . . | 77.8 | . . . | |||||
| Selected Klebsiella spp | 138 | 92 | 17 | 17 | 8 | ||||||||||
| ESCs | 85.5 | 16.1 | 82.6 | 17.1 | 82.4 | . . . | 100.0 | . . . | 87.5 | . . . | |||||
| Carbapenems (CRE) | 78.3 | 0.9 | 80.4 | 1.4 | 70.6 | . . . | 82.4 | . . . | 62.5 | . . . | |||||
| MDR | 92.8 | 6.3 | 94.6 | 6.9 | 94.1 | . . . | 88.2 | . . . | 75.0 | . . . | |||||
| Escherichia coli | 616 | 536 | 53 | 15 | 5 | ||||||||||
| ESCs | 80.0 | 15.6 | 78.9 | 12.8 | 94.3 | 34.0* | 73.3 | . . . | 100.0 | . . . | |||||
| Carbapenems (CRE) | 70.9 | 0.2 | 70.9 | 0.3 | 81.1 | 0.0 | 66.7 | . . . | 40.0 | . . . | |||||
| FQs | 85.9 | 15.3 | 87.7 | 14.5 | 86.8 | 28.3* | 26.7 | . . . | 80.0 | . . . | |||||
| MDR | 91.6 | 4.3 | 92.0 | 4.3 | 94.3 | 6.0 | 66.7 | . . . | 100.0 | . . . | |||||
| Enterobacter spp | 236 | 150 | 39 | 33 | 9 | ||||||||||
| Cefepime | 72.9 | 4.1 | 78.7 | 5.9 | 59.0h | 0.0 | 66.7h | 0.0 | 55.6 | . . . | |||||
| Carbapenems (CRE) | 74.2 | 3.4 | 80.0 | 4.2 | 59.0h | 0.0 | 72.7 | 4.2 | 55.6 | . . . | |||||
| MDR-2 | 89.4 | 0.5 | 94.7 | 0.7 | 79.5 | 0.0 | 81.8 | 0.0 | 77.8 | . . . | |||||
| Pseudomonas aeruginosa | 292 | 181 | 58 | 33 | 14 | ||||||||||
| AMINOs | 97.9 | 6.3 | 98.9 | 6.7 | 98.3 | 5.3 | 93.9 | 9.7 | 100.0 | . . . | |||||
| ESCs-2 | 97.9 | 16.8 | 97.8 | 15.3 | 98.3 | 19.3 | 97.0 | 18.8 | 100.0 | . . . | |||||
| FQs-2 | 87.3 | 3.5 | 91.7 | 1.2 | 91.4 | 9.4* | 54.5 | . . . | 92.9 | . . . | |||||
| Carbapenems-2 | 78.8 | 5.7 | 80.1 | 5.5 | 75.9 | 4.5 | 75.8 | 8.0 | 85.7 | . . . | |||||
| PIP/PIPTAZ | 82.9 | 6.6 | 86.7 | 5.7 | 79.3 | 4.3 | 66.7h | 9.1 | 85.7 | . . . | |||||
| MDR-3 | 97.9 | 2.1 | 98.3 | 1.7 | 98.3 | 3.5 | 93.9 | 0.0 | 100.0 | . . . | |||||
| Acinetobacter spp | 20 | 6 | 3 | 7 | 1 | ||||||||||
| Carbapenems-2 | 70.0 | . . . | 83.3 | . . . | 0.0 | . . . | 85.7 | . . . | 100.0 | . . . | |||||
| MDR-4 | 95.0 | . . . | 100.0 | . . . | 100.0 | . . . | 100.0 | . . . | 100.0 | . . . | |||||
Note. Selected Klebsiella spp, K. oxytoca and K. pneumoniae; OX/CEFOX/METH, oxacillin, cefoxitin, or methicillin; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus; ESCs, extended-spectrum cephalosporins (cefepime, cefotaxime, ceftazidime, or ceftriaxone); CRE, carbapenem-resistant Enterobacteriaceae (imipenem, meropenem, doripenem, or ertapenem); MDR, multidrug-resistant (NS to 1 drug in at least 3 of the following classes: ESCs, FQs, AMINOs, carbapenems (R only), PIPTAZ); MDR-2, multidrug-resistant (NS to 1 drug in at least 3 of the following classes: cefepime, FQs, AMINOs, carbapenems (R only), PIPTAZ); FQs, fluoroquinolones (ciprofloxacin, levofloxacin, or moxifloxacin); AMINOs, aminoglycosides (amikacin, gentamicin, or tobramycin); ESCs-2, extended-spectrum cephalosporins (cefepime or ceftazidime); FQs-2, fluoroquinolones (ciprofloxacin or levofloxacin); PIP, piperacillin; PIPTAZ, piperacillin/tazobactam; Carbapenems-2, imipenem, meropenem, or doripenem; MDR-3, multidrug-resistant (NS to 1 drug in at least 3 of the following classes: ESCs-2, FQs-2, AMINOs, carbapenems-2, PIP/PIPTAZ); MDR-4, multidrug-resistant (NS to 1 drug in at least 3 of the following classes: ESCs-2, FQs-2, AMINOs, carbapenems-2, PIP/PIPTAZ, ampicillin/sulbactam).
Statistically significantly different than %NS among abdominal SSIs; P < .05.
MRSA, VRE, and CRE data are presented as %R (ie, includes only those pathogens that tested resistant). All other phenotypes are shown as %NS (ie, includes pathogens that tested intermediate or resistant). This metric is only calculated when at least 20 isolates have been tested.
The 4 most commonly reported surgical categories by pathogen volume are shown.
Consists of all NHSN pediatric operative procedure codes and is not limited to the 4 surgical categories shown in the table.
Appendix surgery, bile duct, liver, or pancreatic surgery, liver transplant, gallbladder surgery, colon surgery, gastric surgery, herniorrhaphy, small bowel surgery, spleen surgery, exploratory laparotomy, and rectal surgery.
Open reduction of fracture, hip prosthesis, knee prosthesis, limb amputation, spinal fusion/refusion, and laminectomy.
Craniotomy and ventricular shunt.
Cardiac surgery, heart transplant, coronary artery bypass graft with chest incision with or without donor incision, pacemaker surgery, and thoracic surgery.
If the percentage tested is <70%, caution should be used when interpreting the %NS.