Global view of antimicrobial resistance. Findings of the SENTRY Antimicrobial Surveillance Program, 1997-1999

The SENTRY Antimicrobial Surveillance Program, originated in 1997, currently encompasses 74 sentinel sites in 22 nations. SENTRY was designed to track antimicrobial resistance globally over a 5- to 10-year period. Isolates from bloodstream infections (BSIs), community-acquired lower respiratory tract infections, pneumonia in hospitalized patients, skin and soft tissue infections, and urinary tract infections are collected by each participating center and sent to the central monitoring laboratory for identification and antimicrobial susceptibility testing. Since 1997 more than 93,000 isolates have been processed by the SENTRY monitoring laboratories. Over the past 3 years (1997-1999), considerable data about BSI pathogens have been generated by the SENTRY program. Antimicrobial resistance among gram-positive cocci, especially Staphylococcus aureus, enterococci, and Streptococcus pneumoniae, constitutes a pressing concern worldwide. Among the S aureus organisms, methicillin resistance exceeds 30% of BSI isolates in most regions. Resistant gram-negative bacilli pose considerable problems, especially in Latin America and the Asia-Pacific region. Both enteric and nonenteric gram-negative pathogens resistant to ss-lactams, fluoroquinolones, and even carbapenems appear to be especially prevalent in those regions. In contrast, Canadian isolates of S aureus, enterococci, and gram-negative bacilli were considerably more susceptible to the agents tested when compared with isolates from the United States, Europe, Latin America, and the Asia-Pacific region. Given the regional differences in BSI pathogens and antimicrobial susceptibility observed thus far, further investigation directed at determining the reasons for such differences is warranted.