Changes in Antimicrobial Resistance and Etiology of Blood Culture Isolates: Results of a Decade (2010–2019) of Surveillance in a Northern Region of Colombia

Figures & data

Table 1 Trends in the Frequencies of Microorganisms in BSI from Health Institutions in Medellin Area, 2010–2019 GERMEN Antimicrobial Resistance Surveillance Network

Microorganisms	Years n (%)										p	Sen’s Slope Estimator	Total
	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	–	–	–
E. coli	900 (17.3)	1012 (17.6)	1017 (19.8)	1065 (18.0)	1282 (19.8)	1415 (20.7)	1456 (21.0)	1378 (21.3)	1441 (23.6)	1527 (23.6)	<0.01	0.70	12,493
S. aureus	664 (12.8)	714 (12.4)	683 (13.3)	868 (14.7)	869 (13.4)	1034 (15.1)	1101 (15.9)	1052 (17.1)	1045 (17.1)	1066 (16.5)	<0.01	0.60	9096
S. epidermidis	783 (15.0)	801 (14.0)	677 (13.2)	716 (12.1)	804 (12.4)	772 (11.3)	785 (11.3)	691 (9.6)	585 (9.6)	561 (8.7)	<0.01	−0.66	7175
K. pneumoniae	485 (9.3)	484 (8.4)	506 (9.9)	613 (10.4)	693 (10.7)	817 (11.9)	738 (10.7)	747 (11.6)	691 (11.3)	756 (11.7)	<0.01	0.30	6530
S. hominis	250 (4.8)	409 (7.1)	330 (6.4)	337 (5.7)	348 (5.4)	308 (4.5)	271 (3.9)	193 (3.0)	180 (3.0)	174 (2.7)	<0.01	−0.55	2800
P. aeruginosa	233 (4.5)	235 (4.0)	209 (4.1)	205 (3.5)	276 (4.3)	290 (4.2)	267 (3.9)	205 (3.2)	200 (3.2)	230 (3.6)	0.05	−0.10	2350
Candida spp	124 (2.4)	156 (2.7)	155 (3.0)	208 (3.5)	206 (3.2)	175 (2.6)	174 (2.6)	174 (2.7)	142 (2.3)	189 (2.4)	>0.05	−0.05	1703
E. faecalis	147 (2.8)	141 (2.5)	136 (2.7)	139 (2.4)	172 (2.3)	172 (2.6)	166 (2.4)	193 (3.0)	166 (2.7)	172 (2.7)	>0.05	0.01	1604
E. cloacae	109 (2.0)	125 (2.2)	104 (2.0)	162 (2.7)	173 (2.3)	150 (2.2)	169 (2.4)	184 (2.9)	135 (2.2)	147 (2.3)	>0.05	0.03	1458
S. marcescens	81 (1.6)	189 (3.3)	151 (2.9)	146 (2.5)	175 (2.3)	147 (2.2)	151 (2.2)	145 (2.2)	138 (2.3)	114 (1.8)	>0.05	−0.10	1437
S. pneumoniae	147 (2.8)	148 (2.6)	108 (2.1)	109 (1.8)	135 (2.1)	124 (1.8)	132 (1.9)	148 (2.3)	137 (2.3)	138 (2.1)	>0.05	−0.05	1326
Coagulase negative Staphylococcus	240 (4.6)	123 (2.1)	50 (1.0)	167 (2.8)	72 (1.1)	94 (1.4)	102 (1.5)	89 (1.4)	79 (1.3)	94 (1.5)	>0.05	−0.10	1110
S. haemolyticus	69 (1.3)	109 (1.9)	72 (1.4)	107 (1.8)	145 (2.2)	90 (1.3)	90 (1.3)	87 (1.4)	66 (1.0)	80 (1.3)	>0.05	−0.04	915
Salmonella sp.	65 (1.3)	46 (0.8)	76 (1.5)	69 (1.2)	67 (1.0)	109 (1.6)	127 (1.8)	104 (1.7)	81 (1.3)	75 (1.2)	>0.05	0.04	819
P. mirabilis	42 (0.8)	52 (0.9)	53 (1.0)	62 (1.1)	81 (1.3)	74 (1.1)	97 (1.4)	90 (1.4)	79 (1.3)	107 (1.7)	<0.01	0.10	737
K. oxytoca	47 (0.9)	81 (1.4)	40 (0.8)	56 (1.0)	76 (1.2)	88 (1.2)	79 (1.1)	72 (1.1)	48 (0.8)	81 (1.3)	>0.05	0.02	668
S. capitis	26 (0.5)	56 (1.0)	62 (1.2)	61 (1.0)	67 (1.0)	55 (0.8)	61 (0.9)	57 (0.9)	58 (1.0)	66 (1.0)	>0.05	0.01	569
A. baumanii	65 (1.3)	85 (1.5)	48 (1.0)	67 (1.1)	43 (0.7)	40 (0.6)	40 (0.6)	42 (0.7)	46 (0.8)	49 (0.8)	>0.05	−0.06	525
Group B Streptococcus	29 (0.6)	27 (0.5)	28 (0.6)	42 (0.7)	31 (0.5)	54 (0.8)	37 (0.5)	46 (0.7)	51 (0.8)	30 (0.5)	>0.05	0.01	375
Other	703 (13.6)	762 (13.2)	625 (12.2)	722 (12.2)	771 (12.9)	835 (12.2)	878 (12.7)	767 (11.9)	731 (12.0)	815 (12.6)	>0.05	−0.10	7609
Total	5209 (100)	5755 (100)	5130 (100)	5921 (100)	6486 (100)	6843 (100)	6921 (100)	6464 (100)	6099 (100)	6571 (100)	–	–	61,299

Figure 1 Trends in more frequent microorganisms isolated from BSI in health institutions of Medellin area, 2010–2019 GERMEN antimicrobial resistance surveillance network. P values show the significance of the trend and Sen’s slope estimator shows upward or downward trends.

Table 2 Distribution of Microorganisms by Age Group in BSI from Health Institutions in Medellín Area, 2010–2019 GERMEN Antimicrobial Resistance Surveillance Network

Microorganisms	n (%) Neonates	n (%) Pediatrics	n (%) Adults	n (%) Older Adults
S. epidermidis	1299 (32.4)	1498 (20.0)	1918 (8.1)	1819 (8.3)
E. coli	356 (8.9)	524 (7.0)	4956 (21.0)	5896 (26.9)
S. aureus	301 (7.5)	1103 (14.7)	3983 (16.9)	3057 (14.0)
S. hominis	293 (7.3)	760 (10.1)	639 (2.7)	825 (3.8)
K. pneumoniae	217 (5.4)	448 (6.0)	2887 (12.3)	2603 (11.9)
coagulase negative Staphylococcus	183 (4.6)	198 (2.6)	312 (1.3)	314 (1.4)
E. faecalis	172 (4.3)	214 (2.9)	524 (2.2)	584 (2.7)
grupo B Streptococcus	170 (4.2)	23 (0.3)	122 (0.5)	115 (0.5)
S. marcescens	127 (3.2)	188 (2.5)	575 (2.4)	454 (2.1)
E. cloacae	90 (2.2)	159 (2.1)	623 (2.6)	492 (2.2)
S. haemolyticus	86 (2.1)	73 (1.0)	353 (1.5)	312 (1.4)
Candida spp	83 (2.1)	289 (3.9)	673 (2.9)	518 (2.4)
K. oxytoca	51 (1.3)	73 (1.0)	229 (0.1)	268 (1.2)
P. aeruginosa	52 (1.3)	154 (2.0)	982 (4.2)	1001 (4.6)
S. capitis	42 (1.0)	108 (1.4)	161 (0.7)	216 (1.0)
A. baumannii	40 (1.0)	88 (1.2)	211 (0.9)	129 (0.6)
S. pneumoniae	21 (0.5)	266 (3.5)	546 (2.3)	409 (1.9)
Salmonella sp.	12 (0.3)	118 (1.6)	416 (1.8)	230 (1.0)
P. mirabilis	6 (0.1)	21 (0.3)	309 (1.3)	360 (1.6)
Other	492 (12.3)	1194 (15.9)	3137 (13.3)	2309 (10.5)
Total	4010 (100.0)	7499 (100.0)	23.556 (100.0)	21,911 (100.0)

Table 3 Distribution of Microorganisms Obtained from BSI According to Hospital Wards in Medellín Area, 2010–2019 GERMEN Antimicrobial Resistance Surveillance Network

Microorganisms	n (%) ICU	n (%) no ICU	n (%) Emergency Room
E. coli	1445 (10.7)	4217 (17.5)	6611 (29.5)
S. aureus	1488 (11.0)	4156 (17.3)	3603 (16.0)
K. pneumoniae	1694 (12.5)	2800 (11.6)	2034 (9.0)
S. epidermidis	2293 (17.0)	2716 (11.3)	1849 (8.2)
P. aeruginosa	691 (5.1)	1024 (4.2)	600 (2.6)
S. hominis	607 (4.5)	992 (4.14)	1071 (4.7)
E. faecalis	509 (3.7)	652 (2.72)	412 (1.8)
S. marcescens	586 (4.3)	572 (2.3)	246 (1.1)
S. pneumoniae	128 (0.9)	270 (1.1)	845 (3.7)
P. mirabilis	114 (0.8)	282 (1.1)	333 (1.4)
Coagulase negative Staphylococcus	207 (1.5)	507 (2.1)	270 (1.21)
Salmonella sp.	81 (0.6)	285 (1.1)	(1.9)
A. baumanii	156 (1.1)	259 (1.0)	85 (0.3)
E. cloacae	423 (3.1)	663 (2.7)	310 (1.3)
Candida spp	362 (2.6)	669 (2.7)	144 (0.6)
S. haemolyticus	885 (1.7)	408 (1.7)	231 (1.0)
K. oxytoca	172 (1.2)	265 (1.1)	211 (0.9)
S. capitis	125 (0.9)	175 (0.7)	236 (1.0)
Group B Streptococcus	90 (0.6)	115 (0.4)	165 (0.7)
Other	3161 (23.4)	4964 (20.6)	3903 (17.4)
Total	13,491 (100.0)	23,990 (100.0)	22,390 (100.0)

Table 4 Trends of Susceptibility to Marker Antibiotics in More Frequent Microorganisms in BSI from Hospital Institutions in the Medellín Area, 2010–2019 GERMEN Antimicrobial Resistance Surveillance Network

Microorganisms	Antibiotic	2010	2011	2012	2013	2014	2015	2016	2017	2018	2019	p	Sen’s Slope Estimator
E. faecalis	Vancomycin
	% susceptibility	96	99	98	99	99	100	100	100	99	98	>0.05	0.17
	Total	130	126	132	137	168	169	163	188	150	171	–	–
E. faecium	% susceptibility	60	52	73	73	84	76	95	85	67	68	>0.05	2.0
	Total	20	19	15	19	39	21	23	21	28	25	–	–
S. aureus	Oxacillin
	% susceptibility	69	73	69	72	75	74	76	73	72	71	>0.05	2.0
	Total	633	714	680	865	855	1006	1069	1030	1015	1055	–	–
E. coli	Ceftazidime
	% susceptibility	87.8	87.9	84	80.9	82	83.4	80.5	80.0	78.0	76.0	<0.01	−1.22
	Total	769	860	972	1019	1270	1391	1446	1368	1395	1439	–	–
	Cefepime
	% susceptibility	87.7	89	84.1	81	82.3	83.2	80.7	80.0	78.0	76.0	<0.01	−1.26
	Total	859	985	1006	1047	1269	1394	1440	1367	1393	1516	–	–
	Imipenem
	% susceptibility	97.7	99.3	99.6	99.6	99.3	99.6	99.7	99.0	99.0	99.0	>0.05	0.01
	Total	848	991	1004	939	1126	1222	1288	1150	1187	1319	–	–
	Meropenem
	% susceptibility	97.6	99.7	99.5	99.4	99.3	99.6	99.5	99.0	99.0	99.0	>0.05	−0.07
	Total	760	889	1008	1050	1272	1400	1448	1372	1394	1520	–	–
	Gentamicin
	% susceptibility	86.8	82.8	79.3	77.3	77	78.7	79.2	79.0	79.0	82.0	>0.05	−0.10
	Total	863	992	1007	1049	1273	1347	1448	1370	1399	1521	–	–
	Ciprofloxacin
	% susceptibility	70.6	68.9	68.2	64.3	63	66.1	69.8	67.0	65.0	65.0	>0.05	−0.51
	Total	865	994	1009	1050	1271	1401	1449	1372	1401	1522	–	–
K. pneumoniae	Ceftazidime
	% susceptibility	75.5	77.3	79.1	75.9	74.4	70.1	74.7	72.0	72.0	75.0	>0.05	−0.52
	Total	409	415	479	588	684	807	723	736	663	715	–	–
	Cefepime
	% susceptibility	75.8	79.4	80.2	77	75.1	69.8	75.1	73.0	72.0	74.0	<0.05	−0.78
	Total	471	474	500	596	683	807	719	734	662	751	–	–
	Imipenem
	% susceptibility	93.8	93.2	93.2	91.4	93.6	93.1	93.6	93.0	93.0	92.0	>0.05	−0.05
	Total	468	472	499	548	595	694	658	623	560	651	–	–
	Meropenem
	% susceptibility	93.9	95	94	92.1	92.8	93.3	94.1	93.0	94.0	93.0	>0.05	−0.07
	Total	410	435	501	598	683	808	726	735	664	753	–	–
	Gentamicin
	% susceptibility	90.3	89.7	88.6	87.2	87.3	81.5	84.4	82.0	87.0	83.0	<0.05	−0.85
	Total	473	474	502	600	685	767	726	737	664	754	–	–
	Ciprofloxacin
	% susceptibility	88.2	89.1	86.4	86.2	81.3	81.7	82	77.0	79.0	81.0	<0.01	−1.23
	Total	473	470	500	601	685	807	728	735	664	753	–	–
P. aeruginosa	Ceftazidime
	% susceptibility	81	83	75	77	82	88	88	84	93	91	<0.01	1.50
	Total	202	208	202	201	272	284	261	200	192	216	–	–
	Cefepime
	% susceptibility	76	81	78	82	85	89	89	87	94	89	<0.01	1.80
	Total	224	226	207	202	273	287	261	200	190	226	–	–
	Imipenem
	% susceptibility	73	76	77	78	79	85	88	85	85	91	<0.01	1.71
	Total	224	225	206	186	242	256	235	184	176	215	–	–
	Meropenem
	% susceptibility	77	77	82	80	78	86	87	86	88	91	<0.01	1.50
	Total	225	227	207	199	274	285	265	203	194	224	–	–
	Gentamicin
	% susceptibility	75	77	80	87	88	92	91	88	90	90	<0.01	1.67
	Total	225	226	207	202	274	268	262	202	192	225	–	–
	Ciprofloxacin
	% susceptibility	75	78	76	83	88	89	89	88	90	90	<0.01	1.71
	Total	228	226	207	201	276	286	263	204	194	226	–	–
	Piperacilline/tazobactam
	% susceptibility	70	73	70	73	75	83	85	81	83	84	<0.01	2.0
	Total	226	223	196	200	264	280	258	200	192	225	–	–
E. cloacae	Ceftazidime
	% susceptibility	58.5	83.7	68.8	72.5	77.9	82.9	82.2	83.6	81.5	78	>0.05	1.80
	Total	94	98	96	153	172	146	169	183	135	141	–	–
	Cefepime
	% susceptibility	75.5	88.1	85.6	87.4	92.5	91.3	88.8	89.1	91.1	82.9	>0.05	0.47
	Total	102	118	104	159	173	148	169	184	135	146	–	–
	Imipenem
	% susceptibility	88.7	92.6	86.4	84.8	89	88.5	92.9	87.9	88.3	89.2	>0.05	0.06
	Total	100	122	103	138	146	122	155	165	120	130	–	–
	Meropenem
	% susceptibility	92.7	95.6	92.3	89.3	92.4	91.9	94	90.8	94.1	90.4	>0.05	−0.20
	Total	96	113	104	159	172	148	168	184	135	146	–	–
S. marcescens	Ceftazidime
	% susceptibility	72.9	58.9	83.6	79.3	90.8	88.8	91.9	93.7	91.1	84.7	<0.05	2.13
	Total	70	158	146	140	174	143	148	143	135	111	–	–
	Cefepime
	% susceptibility	87.4	75.7	90	80.2	87.9	86.8	87.8	88.3	86.8	82.5	>0.05	0.01
	Total	79	185	149	142	174	144	148	145	136	114	–	–
	Imipenem
	% susceptibility	90	77,4	83,3	81	91,3	81.2	93.2	78	69.6	62.5	>0.05	−1.86
	Total	80	182	150	126	149	48	44	59	46	40	–	–
	Meropenem
	% susceptibility	96	90.2	94	89.4	94.2	93.8	95.3	94.4	91.1	87.7	>0.05	−0.31
	Total	75	174	150	142	173	145	148	144	135	114	–	–

Figure 2 Trends of susceptibility to marker antibiotics in more frequent microorganisms causing BSI from hospital institutions in the Medellín area, 2010–2019 GERMEN antimicrobial resistance surveillance network. P values show the significance of the trend and Sen’s slope estimator shows upward or downward trends.