NARMS 2012 Human Isolates Final Report—Tables

• Each graph presents point estimates and 95% confidence intervals for the percentage of resistant isolates by year. The 95% confidence interval estimates were calculated using the Paulson-Camp-Pratt approximation to the Clopper-Pearson exact method.
• Some antibiotics were not tested during all years.  For instance, NARMS stopped testing Salmonella, Shigella, and Escherichia coli O157 for susceptibility to cephalothin after 2003, and began testing for Salmonella, Shigella, and Escherichia coli O157 for susceptibility to azithromycin in 2011.
• View the Surveillance and Laboratory Testing Methods [PDF – 88 pages, 1.48 MB] for NARMS 2012 Human Isolates Annual Report [PDF – 88 pages].

More Information:

For a complete list of antibiotics used for susceptibility testing and criteria used to define resistance in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages] refer to:

• Table 2.  Antimicrobial agents used for susceptibility testing for Salmonella, Shigella, and Escherichia coliO157 isolates, NARMS, 1996–2012 [PDF – 88 pages]
• Table 3.  Antimicrobial agents used for susceptibility testing of Campylobacter isolates, NARMS, 1997–2012 [PDF – 88 pages]

Salmonella is a bacteria that typically causes two distinct disease syndromes, typhoid fever and routine gastrointestinal infections. Strains associated with routine gastrointestinal infections are referred to as “nontyphoidal Salmonella.”

Non-typhoidal Salmonella causes [PDF – 114 pages, 5.24 MB] approximately 1.2 million illnesses, 23,000 hospitalizations, and 450 deaths each year in the United States. Physicians rely on drugs for treating patients with complicated Salmonella infections.

Resistance to two of these clinically important drugs, ceftriaxone (a cephem) and ciprofloxacin (a quinolone), has climbed in non-typhoidal Salmonella since 1996. In 2011, about 5% of non-typhoidal Salmonella tested by CDC were resistant to five or more types of drugs.

Interactive Graph and Data

Use this graph to view all non-typhoidal Salmonella isolates or selected Salmonella serotypes that exhibit clinically important, antibiotic resistance patterns, including: Enteritidis, Typhimurium, Newport, Heidelberg, and I 4,[5],12:i:-.
Refer to these tables in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages, 1.48 MB] to view data on the graphs:

• Table 9.   Percentage and number of non-typhoidal Salmonella isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]
• Table 11. Broad-Spectrum β-lactam resistance among all ceftriaxone or ceftiofur resistant non-typhoidal Salmonella isolates, 2011–2012 [PDF – 88 pages]
• Table 16. Percentage and number of Salmonella ser. Typhimurium isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]
• Table 19. Percentage and number of Salmonella ser. Newport isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]
• Table 22. Percentage and number of Salmonella ser. Heidelberg isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]
• Table 25. Percentage and number of Salmonella ser. I 4,[5],12:i:- isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]

Salmonella is a bacteria that typically causes two distinct disease syndromes, typhoid fever and routine gastrointestinal infections. The strains of Salmonella associated with typhoid fever is referred to as “Salmonella serotype Typhi.”

Salmonella serotype Typhi [PDF – 114 pages, 5.24 MB]causes approximately 5,700 typhoid fever illnesses and 620 hospitalizations each year in the United States. Physicians rely on drugs such as ceftriaxone, azithromycin, and ciprofloxacin for treating patients with typhoid fever. CDC is seeing some level of resistance to ciprofloxacin in two-thirds of Salmonella serotype Typhi tested (the graph shows only the proportion with full resistance). CDC has not yet seen resistance to ceftriaxone or azithromycin in the United States, but this has been seen in other parts of the world.

CDC is seeing some level of resistance to ciprofloxacin in two-thirds of Salmonella serotype Typhi tested (the graph shows only the proportion with full resistance). CDC has not yet seen resistance to ceftriaxone or azithromycin in the United States, but this has been seen in other parts of the world.

Interactive Graph and Data
Refer to these tables in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages, 1.48 MB] to view data on the graphs:

• Table 28. Percentage and number of Salmonella ser. Typhi isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]

Some strains of Salmonella cause paratyphoid fever, a potentially life-threatening disease similar to typhoid fever. Salmonella serotype Paratyphi A is the most commonly reported cause of paratyphoid fever. Physicians rely on drugs such as ceftriaxone (a cephem) and ciprofloxacin (a fluoroquinolone) to treat patients with paratyphoid fever.

Although full resistance to ciprofloxacin is low (as reflected in the graph below), some level of resistance is common. Nalidixic acid belongs to the same antibiotic class as ciprofloxacin, and resistance to this drug is a marker for some level of resistance to ciprofloxacin. CDC has not yet seen resistance to ceftriaxone among Paratyphi A isolates in the United States, but this has been reported in other parts of the world.

Interactive Graph and Data

Refer to these tables in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages, 5.24 MB ]

• Table 32. Percentage and number of Salmonella ser. Paratyphi isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages, 1.48 MB]

Shigella [PDF – 114 pages, 5.24 MB] causes approximately 500,000 diarrheal illnesses, 5,500 hospitalizations, and 40 deaths each year in the United States. Drug-resistance in Shigella has been increasing steadily since 2006.

Resistance to traditional first-line drugs such as ampicillin (a penicillin) and trimethoprim-sulfamethoxazole (a folate pathway inhibitor) has become so high that physicians must now rely on alternative drugs like ciprofloxacin (a fluoroquinolone) and azithromycin (a macrolide) to treat infections.

Interactive Graph and Data

Use this graph to view all Shigella isolates or to select S. flexneri or S. sonnei isolates.

Refer to these tables in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages, 1.48 MB] to view data on the graphs:

• Table 34.  Frequency of Shigella species, 2012 [PDF – 88 pages]
• Table 39.  Percentage and number of Shigella sonnei isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]
• Table 42.  Percentage and number of Shigella flexneri isolates resistant to antimicrobial agents, 2003– 2012 [PDF -0 88 pages]

Most E. coli bacteria are harmless and live in the intestines of people and animals. However some E. coli can cause diarrheal illness or illness outside of the intestinal tract. Shiga toxin-producing E. coli (STEC), which includes E. coli O157, can cause severe disease. An estimated 265,000 STEC infections and 3600 hospitalizations occur each year in the United States.

Antibiotics are not recommended for treating STEC infections but resistant STEC bacteria can transfer their resistance to other types of bacteria. Among E. coli, only serogroup O157 is under surveillance by NARMS. In 2011, about 3% of E. coli O157 isolates were resistant to at least 5 classes of antibiotics.

Interactive Graph and Data

Refer to these tables in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages, 1.48 MB] to view data on the graphs:

• Table 45.  Percentage and number of Escherichia coli O157 isolates resistant to antimicrobial agents, 2003–2012 [PDF – 88 pages]

Campylobacter [PDF – 114 pages, 5.24 MB] is estimated to cause approximately 1.3 million infections, 13,000 hospitalizations, and 120 deaths each year in the United States. Physicians rely on drugs like ciprofloxacin (a quinolone) and azithromycin (a macrolide) for treating patients with severe disease.

Interactive Graph and Data

This graph includes the option to view C. jejuni or C. coli isolates.

Refer to these tables in the NARMS 2012 Human Isolates Annual Report [PDF – 88 pages, 1.48 MB] to view data on the graphs:

• Table 47.  Frequency of Campylobacter species, 2012 [PDF – 88 pages]
• Table 50.  Resistance patterns of Campylobacter jejuni isolates, 2003–2012 [PDF – 88 pages]