Antimicrobial Resistance Nosocomial Strains of Enterobacter spp. in Ukrainian surgical Hospitals: results of multicenter study

2018 ◽  
Vol 2 (4) ◽  
pp. 39-45
Author(s):  
A.G. Salmanov ◽  
O.M. Verner
Keyword(s):  
Antimicrobial Resistance ◽  
Multicenter Study ◽  
Antimicrobial Susceptibility ◽  
National Level ◽  
Surgical Site Infections ◽  
Hospital Record ◽  
Antimicrobial Susceptibility Test ◽  
Local Data ◽  
Epidemiologic Surveillance ◽  
Medical Institutions

Objective. To determine activity of antimicrobials against Enterobacter spp. isolated from patients hospitalized to surgical departments in different Ukrainian hospitals. Materials and methods. A total of 3991 Enterobacter spp. isolated from patients with surgical site infections in 24 surgical hospitals in 17 Ukrainian regions. The identification and antimicrobial susceptibility of Enterobacter spp. were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results. The most potent antimicrobials were imipenem, meropenem, cefixime and amikacinum. The high rates of resistance were found to penicillin (46,2%), ampicillin/sulbactam (42,9%), gentamicin (40,4%), ceftazidime (39,4%), ampicillin (38,2%), and cefuroxime (36,3%). Conclusions. (1) Resistance of nosocomial strains of Enterobacter spp. at in patient medical institutions, that are subject to research, is a serious therapeutic and epidemiologic issue. Imipenem, meropenem, cefixime and amikacinum have been the most active to nosocomial strains of Enterobacter spp. (2) Taking into account resent changes and resistance levels of nosocomial strains of Enterobacter spp., which take place in various regions, constant monitoring over resistance to antimicrobials at every in patient medical institution is required. Also, hospital record sheets of antibiotics should be elaborated based upon the local data received. (3) Antibiotics utilization policy in each surgical in patient institution should be determined based in accordance with the local data on resistance to antimicrobials. (4) System of epidemiologic surveillance over antimicrobial resistance should be established on the local, regional, and national level.

scholarly journals ANTIMICROBIAL RESISTANCE OF STAPHYLOCOCCUS AUREUS CAUSING OF SURGICAL SITE INFECTIONS IN EAR, NOSE AND THROAT SURGERY

2019 ◽  
Vol 72 (2) ◽  
pp. 154-158 ◽  
Author(s):  
Aidyn G. Salmanov ◽  
Volodymyr O. Shkorbotun ◽  
Yaroslav V. Shkorbotun
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Susceptibility ◽  
Surgical Site Infections ◽  
The Other ◽  
Antimicrobial Susceptibility Test ◽  
Local Data ◽  
Ent Surgery ◽  
High Level ◽  
Major Pathogens ◽  
Nose And Throat

Introduction: Staphylococcus aureus is one of the major pathogens that causes of surgical site infection (SSI). Scant information is available on the occurrence and antimicrobial susceptibility of S. aureus in patients with SSI in Ear, Nose and Throat (ENT) surgery. The aim: To assess the activity of antimicrobials against S.aureus, isolated from patients with SSI by the ENT departments of Kyiv hospitals. Materials and methods: A total of 516 S. aureus isolates from of patients with SSI in ENT surgery. Antimicrobial susceptibility of S. aureus were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby – Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results: The most active antibiotics found in the study were linezolid and tigecycline, showing growth inhibition of 100% strains tested. Susceptibility to the other antimicrobials was also on a high level: 98,4% of strains were found susceptible to nitrofurantoin, 98.1% – to trimethoprim/sulphamethoxazole, 97.6% – to fusidic acid, 97.1% – to mupirocin, 95.9% – to teicoplanin, 94.7% – to vancomycin and fosfomicin, 90.6% – to moxifloxacin, 89.1% – to tobramycin, 87.3% – to gentamycin. Susceptibility to rifampicin (85.5%), cefoxitin (84.6%), levofloxacin (84.3%), erythromycin (82.6%), tetracycline (76.3%), and clindamycin (75.4%) was observed to be some lower. Resistance to oxacyllin S.aureus (MRSA) came up to 21.1%. Conclusions: S. aureus in ENT departments to be a serious therapeutic and epidemiologic problem. The constant monitoring of antimicrobials resistance in every hospital is required. Antibiotics application tactics should be determined in accordance with the local data of resistance to them.

scholarly journals SURGICAL SITE INFECTIONS AND ANTIMICROBIAL RESISTANCE IN KYIV CITY HOSPITALS, UKRAINE

2019 ◽  
Vol 72 (5) ◽  
pp. 760-764
Author(s):  
Aidyn G. Salmanov ◽  
Olena A. Dyndar ◽  
Yuriy P. Vdovychenko ◽  
Tetiana R. Nykoniuk ◽  
Igor V. Maidannyk ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Surgical Site Infections ◽  
Orthopedic Procedures ◽  
Lower Segment ◽  
Antimicrobial Susceptibility Test ◽  
Gram Positive Bacteria ◽  
Essential Step

Introduction: Surgical site infections (SSIs) are associated with increased morbidity and mortality. Scant information is available on the SSI in Ukrainian hospitals. The aim: to determine the incidence of SSIs and estimates antimicrobial resistance of the major responsible pathogens in Kyiv city hospitals. Materials and methods: This study was conducted from January 2011 to December 2013 in 3 hospitals. Definitions of SSIs were adapted from the CDC/NHSN. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby - Bauer antibiotic testing. Results: Among 9,162 patients, 1,912 (20.9%) SSIs were observed. The high SSI case in appendectomy (29.8 %), gastric, small and large bowel surgeries (28.4 %), cholelithiasis (25.7%), and orthopedic procedures (22.9 %). Low infection rate in excision of dermoid cysts, lipoma (5.3%) and lower segment caesarean structure (6.5%). Staphylococcus aureus were most commonly reported, accounting for 27,8% of all organisms, followed by Escherichia coli (18.4 %), Pseudomonas aeruginosa (11.9 %) and Enterococcus faecalis (11.6 %). The antimicrobial resistance in the isolates associated with SSIs showed, among the Gram-positive bacteria, that 43.8% and 4.7% of CoNS isolates were β-lactam (oxacillin) - and glycopeptide (teicoplanin) - resistant, respectively. Meticillin resistance was reported in 35.7 % of S. aureus isolates Conclusions: SSIs and antimicrobial resistance of the responsible pathogens is an actually problem. One essential step in the prevention of SSIs is to implement a national system for their surveillance.

Antimicrobial resistance of nosocomial strains Staphylococcus aureus isolates from surgical patients in Kyiv regional clinical hospital, ukraine

2018 ◽  
Vol 2 (1) ◽  
pp. 49-63
Author(s):  
A.G. Salmanov ◽  
V.V. Potochilovа ◽  
K.L. Rudneva
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Surgical Patients ◽  
Local Data ◽  
Clinical Hospital ◽  
Epidemiologic Surveillance ◽  
Microbiological Laboratory ◽  
Amoxicillin Clavulanic Acid

Objective — to determine antimicrobial resistance of nosocomial strains Staphylococcus aureus isolates from surgery patients. Materials and methods. The clinical strains of S. aureus (574) isolated from surgical patients from January 2015 to December 2017 in Kyiv Regional Clinical Hospital of the Ukraine have been studied. Clinical isolates were allocated and identified in Central microbiological laboratory in Kyiv Regional Clinical Hospital. The identification and antimicrobial susceptibility of the cultures were determined, using automated microbiology analyzer VITEK 2 Compact (bioMerieux, France). Susceptibility to antibiotics was determined using AST card (bioMerieux, France). Some antimicrobial susceptibility test used K-B (Kirby – Bauer antibiotic testing). Sensitivity of S. aureus strains has been studied up to 51 antibiotics: penicillum, ampicillin, amoxicillin, azlocillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, oxacillin, cefoperazone/sulbactam, piperacillin/tazobactam, piperacillin, cefazolin, cefuroxime, cefamandolum, cefotaximum, cefoxitin, ceftriaxone, cefixime, cefpodoxime, ceftazidime, cefepim, imipenem, meropenem, ertapenem, kanamycin, gentamicin, tobramyinum, netilmicin, amikacinum, eritromicin, azithromycin, clindamycin, tetracyclin, doxycyclinum, vancomycin, teicoplaninum, ofloxacinum, levofloxacin, ciprofloxacin, moxifloxacin, gatifloxacin, norfloxacin, chloramphenicol, nitrofurantoinum, rifampicin, linezolidum, tigecycline, fosfomicin, acidum fusidicum, mupirocinum, trimethoprimum, and trimethoprim/sulfamethoxazole. Interpretative criteria were those suggested by the European Committee on Antimicrobial Testing (EUCAST). Results and discussion. To S.aureus the drug sensitive rates of piperacillin/tazobactam and ertapenem were both 100 %, but most of the drug resistant rates were over 65—70 %. The highest activity to S. aureus had nitrofurantoinum, cefoxitin, linezolid, trimethoprimum, tigecycline, and trimethoprim/sulfamethoxazole. The high rates of resistance were registered for cefpodoxime (91.7 %), ampicillin (85.0 %), ceftazidime (80.0 %), penicillin (75.0 %), cefixime (73.0 %), cefoperazone/sulbactam (71.5 %), and to azithromycin (69.5 %). The vancomycin — resistant S. aureus (VRSA) accounted for 21.1 % [95 % CI 19.4—22.8 %]. The frequency of isolation of MRSA among tested strains was 37.8 % [95 % CI 35.2—39.2 %] varying from 28.7 % to 44.8 % in different surgical departments in Kyiv Regional Clinical Hospital. Conclusions. Antibiotic resistance to S. aureus in surgical hospitals, being a subject of the research is considered to be a serious therapeutic and epidemiologic problem. Taking into account the constant changes and significant differences of the S. aureus resistance levels observed in various regions, the constant monitoring of antibiotic resistance to antimicrobials in every in-patient medical institution is required and on the base of the local obtained results to elaborate the hospital record sheets. Antibiotics application tactics should be determined in accordance with the local data of resistance to them in each surgical in-patient institution. The system of epidemiologic surveillance over microbial resistance should be established on the local, regional, and national levels.

scholarly journals Antimicrobial susceptibility and diarrheagenic diagnosis of Escherichia coli and Salmonella enterica isolated from feral pigeons (Columba livia) captured in Fortaleza, Brazil

2018 ◽  
Vol 38 (11) ◽  
pp. 2150-2154 ◽  
Author(s):  
Ruben V. Horn ◽  
Windleyanne G.A. Bezerra ◽  
Elisângela S. Lopes ◽  
Régis S.C. Teixeira ◽  
Isaac N.G. Silva ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Clavulanic Acid ◽  
Antimicrobial Susceptibility ◽  
Salmonella Enterica ◽  
Columba Livia ◽  
Susceptibility Test ◽  
Antimicrobial Susceptibility Test ◽  
E Coli ◽  
Feral Pigeons

ABSTRACT: This study aimed to isolate Escherichia coli and Salmonella enterica from captured feral pigeons in Fortaleza, Brazil, and, in addition to evaluate the antimicrobial susceptibility profiles and diagnose diarrheagenic E. coli strains. Pigeons were captured in four public locations in Fortaleza with three techniques. Individual cloacal swab samples were collected and submitted to bacterial isolation, biochemical identification and antimicrobial susceptibility test. Disk diffusion technique was used with twelve antibiotics. E. coli strains were submitted to DNA extraction followed by PCR to diagnose five diarrheagenic pathotypes. A total of 124 birds were captured. One bird was positive for Salmonella enterica (0.81%) and 121 (97.58%) were positive for E. coli. Among these, 110 isolates were submitted to antimicrobial susceptibility test and 28.18% (31/110) presented resistance to at least one antibiotic. Resistance to azithromycin was the most frequent (21.82%), followed by tetracycline (10.91%) and sulfamethoxazole with trimethoprim (8.9%). Multidrug resistance, calculated as a resistance to at least 3 antimicrobial classes, was identified in 3.64% (4/110) of strains. The maximum number of antimicrobial classes to which one strain was resistant was seven. Results demonstrated nine different resistance profiles and the most frequent was tetracycline and sulfamethoxazole with trimethoprim (4 strains), followed by chloramphenicol, azithromycin, tetracycline and sulfamethoxazole with trimethoprim (3 strains). Amoxicillin with clavulanic acid and tobramycin presented lowest levels of antimicrobial resistance, to which none of the tested strains were resistant. A single strain was positive for the eltB gene, which is a diagnostic tool to identify the Enterotoxigenic E. coli (ETEC) pathotype. None of the other investigated genes (stx1, stx2, estA, eaeA, ipaH, aatA and aaiC) were identified. The single isolate of S. enterica was a rough strain of Salmonella enterica subsp. enterica, but serotype identification was not possible. However, this isolate presented resistance to amoxicillin, amoxicillin with clavulanic acid, tetracycline and sulfamethoxazole with trimethoprim. Therefore, captured feral pigeons of Fortaleza presented a low prevalence of S. enterica and diarrheagenic E. coli. Considering the investigated pathogens, our results suggest a good health status and a low public health risk. However, important antimicrobial resistance profiles were identified.

Incidence of Surgical Site Infections (SSIs) and Antimicrobial Resistance their Pathogens in Ukraine

2018 ◽  
Vol 2 (1) ◽  
pp. 18-29 ◽  
Author(s):  
A.G. Salmanov ◽  
Yu.P. Vdovychenko ◽  
M.Yu. Nychytailo ◽  
D.V. Andriuschenko ◽  
O.M. Verner
Keyword(s):  
Antimicrobial Resistance ◽  
Infection Rate ◽  
Antimicrobial Susceptibility ◽  
Bacterial Resistance ◽  
Clinical Symptoms ◽  
Enterobacter Aerogenes ◽  
Surgical Site Infections ◽  
Incidence Rates ◽  
Orthopedic Procedures ◽  
Vancomycin Resistant

OBJECTIVE — to analyses the results of patients’ surgery, to determine the incidence rate of surgical site infections (SSIs) and to identify prevailing pathogens and their resistance to antibiotics in Ukrainian hospitals. MATERIALS AND METHODS. The investigation included 9,408 patients who underwent surgeries during 2015 in 12 surgical hospitals in different Ukrainian regions. In order to determine the incidence rates of SSIs were used the standard definition that were developed by the CDС (USA). The investigation included the analysis of 1,248 strains from patients with clinical symptoms SSIs. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer Vitek 2 Compact (BioMerieux, France). Susceptibility to antibiotics was determined using AST cards (BioMerieux, France). Some antimicrobial susceptibility test used Kirby — Bauer antibiotic testing. Interpretative criteria were those suggested by the CLSI (USA). RESULTS AND DISCUSSION. Data analysis demonstrated that 13.3 % (CI 95 %: 12.3—14.2 %) patients developed postoperative SSIs. Infection rates after various surgical procedures at surgical sites were observed. Shows the high infection rate in appendectomy (17.47 %), gastric, small and large bowel surgeries (18.23 %). The infection rate in orthopedic procedures (13.27 %), cholelithiasis (hepatobiliary) (14.93 %), uterus and adnexal structures (11.10 %), urinary tract and genitalia (9.37 %) and hernia (14.1 %) are comparatively lower. The infection rate in lower segment caesarean structure is 4.24 % and excision of dermoid cysts, lipomas 3.22 %. Staphylococcus aureus was identified as the most common causative agent of SSIs (27.6 %), followed by Escherichia coli (14.1 %), Enterococcus faecalis (13.5 %), and Pseudomonas aeruginosa (10.1 %). Frequency of Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter aerogenes, Enterococcus faecium, Streptococcus spp., Staphylococcus epidermidis and Proteus vulgaris was 7.1 %, 6.9 %, 6.1 %, 4.7 %, 4.6 %, 3.6 %, and 1.6 %, respectively. Antibiotic susceptibility testing showed that all strains of S. aureus resistant to penicillin. The most active antibiotics found were linezolid, tigecycline, and mupirocin, showing growth inhibition of 100 % strains tested, followed by nitrofurantoin, trimethoprim/ sulphamethoxazole, to fusidic acid, teicoplanin, fosfomycin, gentamycin, vancomycin. Susceptibility to tetracycline, rifampicin, erythromycin, and clindamycin was observed to be some lower. Methicillin-resistant S. aureus comprised 1 %, while Vancomycin-resistant S. aureus comprised 9.3 %. Resistance E. faecalis to ceftibuten, chloramphenicol, moxifloxacin, and teicoplanin was 100 % and to cefepime 96 %. The proportion of vancomycin-resistant enterococci was 6.9 %. 26.5 % of E. coli strains showed resistance to all tested antibiotics. The most potent antimicrobials were imipenem, tobramycin, meropenem, levofloxacin and amikacinum. The high rates of resistance were found to penicillum, lincomycin, clindamycin, ampicillin, clarithromycin, amoxicillin, and to cefuroxime. K. pneumoniae showed the lowest resistance to amikacin and imipenem, and was moderately sensitive to cefepime, gentamicin, ceftriaxone, tobramycin, piperacillin/ tazobactam, ciprofloxacin, tetracycline, ceftazidime, and aztreonam. 39.6 % of P. aeruginosa were resistant to all tested antibiotics. The most potent antimicrobials were meropenem, tobramycin, imipenem and levofloxacin. The high rates of resistance were found to penicillin, erythromycin, rifampicin, tetracycline, azithromycin, amoxicillin, cefalexin, ampicillin/sulbactam, clarithromycin, and to pefloxacin. P. aeruginosa were 100 % resistant to oxacillin, ceftibuten, tetracycline, and erythromycin. CONCLUSIONS. SSIs remain an important cause of postoperative morbidity. Antimicrobial resistance among these and other clinically important pathogens is an increasing problem. The clinical should choose antimicrobial drug in accordance with the local bacterial resistance characteristics for reduce the production of drug resistance and improve the effect of anti-infection treatment possibly.

scholarly journals Surgical Site Infections with Predominance of Multidrug Resistant in Benin: A Multicenter Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s526-s526
Author(s):  
Carine Laurence YEHOUENOU ◽  
Hector RODRIGUEZ-VILLALOBOS ◽  
Olivia DALLEUR ◽  
Anne SIMON
Keyword(s):  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Antimicrobial Susceptibility ◽  
Surgical Site Infections ◽  
Public Hospitals ◽  
Secondary Outcome ◽  
Gram Negative ◽  
E Coli ◽  
Maldi Tof ◽  
Esbl Producers

Background: Surgical site infections remain common and widespread; they contribute to increasing antimicrobial resistance among the etiological agents. Antimicrobial resistance is the ability of a microorganism like bacteria to stop an antimicrobial from working against it. This study was conducted to determine the spectrum of bacterial isolates from surgical site infections and their susceptibility patterns. A secondary outcome was to compare bacterial identification by a local lab and a European one. Methods: This descriptive cross-sectional study was conducted between January and August 2019 in 6 public hospitals in Benin. Pus specimens were processed using standard microbiological procedures, and identification was performed using the analytical profile index (API). Antimicrobial susceptibility testing was performed in Benin following the modified Kirby-Bauer disk-diffusion technique and was confirmed in Belgium by MALDI-TOF mass spectrometry. A second antimicrobial susceptibility test was performed using BD Phoenix automated microbiology system (Becton Dickinson). Clinical data of enrolled patients were obtained from hospital records. Results: The mean age of patients was 32 ± 11 years (range, 18–76). The median time for surgical site infections was 9 postoperative days. Of the 229 patients from whom wound swabs were collected, 195 (85.15%) showed positive aerobic bacterial growth. In total, 164 pathogenic bacteria were isolated, including 41 gram-positive organisms (25%), 78 gram-negative fermentative bacteria (47.5%), and 45 gram-negative nonfermentative bacteria (27.5%). We observed 3 discrepancies between API technique and MALDI-TOF. Two Klebsiella pneumoniae and 1 Pseudomonas spp (API) versus, respectively, Klebsiella varicola and Pseudomonas mendocina (MALDI-TOF). The most prevalent bacterial species were E. coli (31%), followed by S. aureus (25%), Pseudomonas aeruginosa (18%), and Klebsiella pneumoniae (11%). Of the 41 S. aureus, 26 (63,41%) were methicillin-resistant Staphylococcus aureus (MRSA), and 3 of these were carrying both MRSA and induced clindamycin resistance (ICR). Extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae were observed in 60 of 78 isolates tested (77%). All of 2 Morganella morgannii and 89% of K. pneumoniae were ESBL producers. Conclusions: Among S. aureus, 2 of 3 were MRSA, whereas almost K. pneumoniae and E. coli were ESBL producers. Three strains are pan–drug resistant in nonfermentative bacteria, and no isolate was susceptible to all antibiotics. These findings are of high interest for better management of patients and control of antimicrobial resistance in Benin.Funding: This study was supported by Académie de Recherche pour l’Enseignement Supérieur (ARES).Disclosures: None

scholarly journals Trends in antimicrobial resistance in Europe: update of EARSS results

2007 ◽  
Vol 12 (11) ◽  
Author(s):  
M De Kraker ◽  
N Van de Sande-Bruinsma
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Surveillance System ◽  
Bacterial Species ◽  
Susceptibility Test ◽  
Test Results ◽  
Antimicrobial Susceptibility Test ◽  
The Past ◽  
Antimicrobial Resistance Surveillance

For the past seven years (1999 to 2006), the European Antimicrobial Resistance Surveillance System (EARSS) has collected antimicrobial susceptibility test results of invasive isolates in humans of seven bacterial species that serve as indicators for the development of antimicrobial resistance in Europe.

The Path of More Resistance: A Comparison of NHSN and CLSI Criteria in Developing Cumulative Antimicrobial Susceptibility Test Reports and Institutional Antibiograms

2021 ◽  
Author(s):  
Alexander Winnett ◽  
Vinay Srinivasan ◽  
Matthew Davis ◽  
Tara Vijayan ◽  
Daniel Z. Uslan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Empiric Therapy ◽  
Annual Data ◽  
Antimicrobial Susceptibility Test ◽  
Susceptibility Data ◽  
National Healthcare Safety Network

Background In the absence of antimicrobial susceptibility data, the institutional antibiogram is a valuable tool to guide clinicians in the empiric treatment of infections. However, there is a misunderstanding on how best to prepare cumulative antimicrobial susceptibility testing reports (CASTRs) to guide empiric therapy (e.g., routine antibiogram) versus monitoring antimicrobial resistance, with the former following guidance from the Clinical Laboratory Standards Institute (CLSI), and the latter from Center for Disease Control and Preventions National Healthcare Safety Network (NHSN). These criteria vary markedly in their exclusion or inclusion of isolates cultured repeatedly from the same patient. Methods We compared rates of non-susceptibility (NS)using annual data from a large teaching healthcare system subset to isolates eligible by either NHSN criteria or CLSI criteria. Results For a panel of the three most prevalent gram-negative pathogens in combination with clinically relevant antimicrobial agents (or priority pathogen-agent combinations, PPACs), we found that the inclusion of duplicate isolates by NHSN criteria yielded higher NS rates than when CLSI criteria (for which duplicate isolates are not included) were applied. Conclusions Patients with duplicate isolates may not be representative of antimicrobial resistance within a population. For this reason, users of CASTR data should carefully consider that the criteria used to generate these reports can impact resulting NS rates, and therefore maintain the distinction between CASTRs created for different purposes.

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