Journal List > Korean J Lab Med > v.27(4) > 1011405

Koh, Lee, Kim, Kim, Yong, Lee, Kim, Kim, and Chong: Microorganisms Isolated from Blood Cultures and Their Antimicrobial Susceptibility Patterns At a University Hospital During 1994–2003

Abstract

Background

Blood culture is important for the determination of the etiologic agent of bacteremia. Analysis of blood culture results and antimicrobial susceptibility trend can provide clinicians with relevant information for the empirical treatment of patients.

Methods

The species and antimicrobial susceptibility of the isolates from blood cultures at the Severance Hospital during 1994–2003 were analysed. Blood specimens were cultured for 7 days using tryptic soy broth and thioglycollate medium. Identification of organism was based on conventional methods or commercial kit systems. Antimicrobial susceptibility was tested by a disk diffusion method.

Results

Of 536,916 blood specimens cultured, 24,877 (4.6%) from 13,102 patients were positive. Among the isolates, 93.1% were aerobic or facultative anaerobic bacteria, 3.3% anaerobes, and 3.6% fungi. Escherichia coli was isolated most frequently, followed by Staphylococcus aureus, α-hemolytic Streptococcus, Enterococcus spp., and Klebsiella pneumoniae. The proportion of patients with Enterococcus faecium and K. pneumoniae gradually increased during this study. Enterococcus, S. aureus and α-hemolytic Streptococcus were frequently isolated from the age group of less than 2 yr. E. coli, Enterococcus spp., K. pneumoniae and S. aureus from the age group of over 50 yr. Oxacillin-resistant S. aureus decreased, whereas vancomycin-resistant E. faecium and imipenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii increased.

Conclusions

E. coli was the most common cause of bacteremia and S. aureus, α-hemolytic Streptococcus, and K. pneumoniae were frequently isolated pathogens. The bacteremia due to Enterococcus, K. pneumoniae, fungi, vancomycin-resistant E. faecium, and imipenem-resistant P. aeruginosa and A. baumannii gradually increased during this period.

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Fig. 1.
Trend of resistance of S. aureus and E. faecium to antimicrobial agents by year.
kjlm-27-265f1.tif
Fig. 2.
Trend of resistance of E.coli and K. pneumoniae to antimicrobial agents by year.
kjlm-27-265f2.tif
Fig. 3.
Trend of resistance of A. baumannii and P. aeruginosa to antimicrobial agents by year.
kjlm-27-265f3.tif
Table 1.
Microorganisms isolated at a tertiary care hospital during 1994–2003
Organisms   N (%) positive by year
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Total
Aerobic and facultative                        
Gram-positive cocci Isolates 1,307 1,375 1,321 1,403 1,320 1,472 1,345 1,487 1,552 1,735 14,317
  Patients 630 682 648 684 647 672 662 721 768 821 6,935 (56.8)
Gram-negative cocci Isolates 2 3 2 3 1 1 3 1 2 1 19
  Patients 2 3 2 3 1 1 3 1 2 1 19 (0.2)
Gram-positive bacilli Isolates 65 76 61 82 79 68 81 92 98 100 802
  Patients 59 61 48 67 62 52 63 71 75 77 635 (5.2)
Enterobacteriaceae Isolates 532 601 564 561 582 592 567 612 726 814 6,151
  Patients 325 341 331 328 341 351 332 362 392 423 3,526 (28.9)
Glucose-nonfermenting gram-negative bacilli Isolates 157 172 162 154 157 174 167 178 198 227 1,746
  Patients 81 91 87 83 82 91 89 94 102 120 920 (7.5)
Other gram-negative bacilli Isolates 17 18 19 22 24 28 27 32 31 34 252
  Patients 12 14 13 15 16 19 18 22 19 23 171 (1.4)
Subtotal Isolates 2,080 2,245 2,129 2,225 2,163 2,335 2,190 2,402 2,607 2,911 23,287
  Patients 1,109 1,192 1,129 1,180 1,149 1,186 1,167 1,271 1,358 1,465 12,206 (100.0)
Anaerobic                        
Gram-positive cocci Isolates 2 4 2 2 2 2 3 4 0 0 21
  Patients 2 3 2 1 2 2 2 2 0 0 16 (3.7)
Gram-positive bacilli Isolates 30 31 38 29 41 30 35 34 32 31 331
  Patients 24 25 31 24 34 25 28 24 21 22 258 (60.4)
Gram-negative bacilli Isolates 24 24 28 20 29 26 16 23 21 19 230
  Patients 15 16 18 15 18 17 12 15 14 13 153 (35.8)
Subtotal Isolates 56 59 68 51 72 58 54 61 53 50 582
  Patients 41 44 51 40 54 44 42 41 35 35 427 (100.0)
Fungi Isolates 91 79 89 92 87 94 110 121 117 128 1,008
  Patients 41 38 43 47 42 45 51 52 53 57 469
Total Isolates 2,227 2,383 2,286 2,368 2,322 2,487 2,354 2,584 2,777 3,089 24,877
  Patients 1,191 1,274 1,223 1,267 1,245 1,275 1,260 1,364 1,446 1,557 13,102
Table 2.
Species of aerobic gram-positive cocci, gram-negative cocci and gram-positive bacilli isolated
Organisms N (%) positive
Isolates Patients
Gram-posotive cocci    
Staphylococcus aureus 2,895 1,165 (20.0)
Staphylococcus, coagulase negative 7,608 3,759 (52.7)
Streptococcus pneumoniae 352 185 (2.4)
α-hemolytic Streptococcus 1,642 829 (11.4)
β-hemolytic Streptococcus    
group A 91 53 (0.6)
β-hemolytic Streptococcus    
group B 7 6 (0.0)
not group A, B 137 89 (0.9)
γ-hemolytic Streptococcus 32 24 (0.2)
Enterococcus faecalis 656 323 (4.5)
E. faecium 804 422 (5.6)
Other Enterococcus spp. 72 63 (0.5)
Other gram-positive cocci 145 103 (1.0)
Subtotal 14,441 7,021 (100.0)
Gram-negative cocci    
Neisseria spp. 21 19 (100.0)
Subtotal 21 19 (100.0)
Gram-positive bacilli    
Listeria monocytogenes 21 15 (3.1)
Bacillus spp. 512 426 (75.5)
Corynebacterium spp. 124 91 (18.3)
Other gram-positive bacilli 21 17 (3.1)
Subtotal 678 549 (100.0)
Total 15,140 7,589
Table 3.
Species of aerobic and facultative anaerobic gramnegative bacilli isolated
Organisms N (%) positive
Isolates Patients
Enterobacteriaceae    
Escherichia coli 3,461 1,832 (52.0)
Edwardsiella spp. 3 3 (0.1)
Salmonella Typhi 71 48 (1.4)
S. Paratyphi-A 9 6 (0.2)
Other Salmonella spp. 141 105 (3.0)
Citrobacter spp. 101 78 (2.2)
Klebsiella pneumoniae 1,346 734 (20.8)
K. oxytoca 202 114 (3.2)
K. ozaenae 1 1 (0.0)
Enterobacter cloacae 427 371 (10.5)
Other Enterobacter spp. 121 75 (2.1)
Serratia marcescens 128 73 (2.1)
Other Serratia spp. 14 11 (0.3)
Proteus mirabilis 49 27 (0.8)
P. vulgaris 11 9 (0.3)
Morganella morganii 59 34 (1.0)
Providencia rettgeri 7 5 (1.0)
Subtotal 6,151 3,526 (100.0)
Other gram-negative bacilli    
Haemophilus influenzae 19 15 (8.8)
Other Haemophilus spp. 7 4 (2.3)
Campylobacter fetus subsp. fetus 3 2 (1.2)
Aeromonas spp. 162 104 (60.8)
Vibrio vulnificus 16 12 (7.0)
Other Vibrio spp. 2 1 (0.6)
Pasteurella multocida 2 1 (0.6)
Plesiomonas shigelloides 2 1 (0.6)
Others 37 31 (18.1)
Subtotal 252 171 (100.0)
Total 6,403 3,697
Table 4.
Species of glucose-nonfermentative gram-negative bacilli isolated
Organisms N (%) positive
Isolates Patients
Pseudomonas aeruginosa 721 353 (38.4)
P. fluorescens/putida 51 35 (3.8)
P. stutzeri 4 3 (0.3)
Other Pseudomonas spp. 29 18 (2.0)
Burkholderia cepacia 83 44 (4.8)
B. picketti 32 20 (2.2)
Sphingomonas paucimobilis 3 2 (0.2)
Acinetobacter baumannii 465 196 (21.3)
A. lowffii 19 11 (1.2)
Other Acinetobacter spp. 61 44 (4.8)
Achromobacter xylosoxidans 41 34 (3.7)
Alcaligenes spp. 7 4 (0.4)
Stenotrophomonas maltophilia 125 73 (7.9)
Flavobacterium spp. 39 30 (3.3)
Moraxella spp. 12 9 (1.0)
Others 54 44 (4.8)
Total 1,746 920 (100.0)
Table 6.
Species of fungi isolated
Organisms N (%) positive
Isolates Patients
Candida albicans 418 198 (42.2)
C. tropicalis 171 71 (15.1)
C. glabrata 142 66 (14.1)
C. parapsilosis 134 59 (12.6)
C. guilliermondii 11 9 (1.9)
C. krusei 6 5 (1.1)
Other Candida spp. 68 25 (5.3)
Other yeast 44 27 (5.8)
Other mold 11 7 (1.5)
Cryptococcus neoformans 3 2 (0.4)
Total 1,008 469 (100.0)
Table 5.
Species of anaerobic bacteria isolated
Organisms N (%) positive
Isolates Patients
Gram-positive cocci    
Peptostreptococcus anaerobius 5 4 (25.0)
P. micros 6 5 (31.3)
Other Peptostreptococcus spp. 8 6 (37.4)
Others 2 1 (6.3)
Subtotal 21 16 (100.0)
Gram-positive bacilli    
Propionibacterium spp. 108 85 (32.9)
Lactobacillus spp. 29 23 (8.9)
Clostridium perfringens 98 72 (27.9)
C. clostridiforme 2 2 (0.8)
C. difficile 3 3 (1.2)
C. ramosum 3 2 (0.8)
Other Clostridium spp. 62 53 (20.5)
Others 26 18 (7.0)
Subtotal 331 258 (100.0)
Gram-negative bacilli    
Bacteroides fragilis 137 88 (57.5)
B. thetaiotaomicron 28 22 (14.4)
B. vulgatus 4 3 (2.0)
B. distasonis 3 2 (1.3)
B. ovatus 2 1 (0.7)
B. uniformis 1 1 (0.7)
Other Bacteroides spp. 11 6 (3.9)
Prevotella bivia 4 3 (2.0)
Other Prevotella spp. 23 17 (11.1)
Fusobacterium mortiferum 2 1 (0.7)
F. necrophorum 2 1 (0.7)
Other Fusobacterium spp. 8 5 (3.3)
Others 5 3 (2.0)
Subtotal 230 153 (100.0)
Total 582 427
Table 7.
Relation between number of admission and blood culture-positive patients
Year N of admission (A) N of blood culture (B) Blood culture rate (B/A×100) N positive
Isolates Patients per 1,000 admission
1994 531,794 36,211 6.8 2,227 791 1.5
1995 519,063 39,420 7.6 2,383 874 1.7
1996 541,291 40,350 7.5 2,286 823 1.5
1997 531,466 43,120 8.1 2,368 867 1.6
1998 531,250 52,665 9.9 2,322 845 1.6
1999 540,709 59,132 10.9 2,487 875 1.6
2000 536,910 53,817 10.0 2,354 860 1.6
2001 523,154 71,028 13.6 2,584 954 1.8
2002 525,674 79,734 15.2 2,777 946 1.8
2003 530,913 60,439 11.4 3,089 957 1.8
Total 5,312,224 535,916 10.1 24,877 8,792 1.7
Table 8.
Annual isolation of relatively common species of bacteria during 1994–2003
Organisms   Positive patients
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Total
S. aureus N 106 93 120 116 137 107 124 118 127 117 1,165
  % 18.4 15.1 17.5 16.8 19.4 16.7 18.6 15.7 16.1 13.6 16.7
S. pneumoniae N 17 10 12 17 25 22 12 23 28 19 185
  % 2.9 1.6 1.8 2.5 3.5 3.4 1.8 3.1 3.6 2.2 2.6
α-hemolytic Streptococcus N 66 69 61 82 88 83 85 96 101 98 829
  % 11.4 11.2 8.9 11.8 12.4 12.9 12.7 12.8 12.8 11.4 11.9
β-hemolytic Streptococcus group A N 7 4 11 4 7 3 2 8 4 9 59
  % 1.2 0.7 1.6 0.6 1.0 0.5 0.3 1.1 0.5 1.0 0.8
E. faecalis N 33 32 34 30 46 33 31 28 28 28 323
  % 5.7 5.2 5.0 4.3 6.5 5.1 4.6 3.7 3.6 3.2 4.6
E. faecium N 21 22 20 37 35 34 43 55 68 87 422
  % 3.6 3.6 2.9 5.3 5.0 5.3 6.4 7.3 8.6 10.1 6.0
E. coli N 139 152 194 179 160 169 192 195 236 216 1,832
  % 24.1 24.7 28.4 25.9 22.6 26.3 28.8 26.0 30.0 25.1 26.2
K. pneumoniae N 43 60 59 52 72 80 76 100 80 112 734
  % 7.5 9.8 8.6 7.5 10.2 12.5 12.4 13.3 10.2 13.0 10.5
Enterobacter spp. N 38 45 59 53 56 40 30 46 32 47 446
  % 6.6 7.3 8.6 7.7 7.9 6.2 4.5 6.1 4.1 5.5 6.4
Serratia spp. N 9 8 7 8 9 7 6 9 8 13 84
  % 1.6 1.3 1.0 1.2 1.3 1.1 0.9 1.2 1.0 1.5 1.2
Proteus spp. N 1 2 3 3 2 5 6 4 5 5 36
  % 0.2 0.3 0.4 0.4 0.3 0.8 0.9 0.5 0.6 0.6 0.5
Salmonella spp. N 18 22 17 17 15 11 21 14 9 15 159
  % 3.2 3.6 2.5 2.5 2.1 1.7 3.1 1.9 1.1 1.7 2.3
A. baumanii N 24 20 21 21 28 12 7 9 25 29 196
  % 4.2 3.3 3.1 3.0 4.0 1.9 1.0 1.2 3.2 3.4 2.8
P. aeruginosa N 34 51 53 57 19 20 21 28 20 50 353
  % 5.9 8.3 7.7 8.2 2.7 3.1 3.1 3.7 2.5 5.8 5.1
S. maltophilia N 13 16 4 7 6 4 1 7 6 9 73
  % 2.3 2.6 0.6 1.0 0.8 0.6 0.1 0.9 0.8 1.0 1.0
B. fragilis N 8 9 9 9 2 12 10 11 10 8 88
  % 1.4 1.5 1.3 1.3 0.3 1.9 1.5 1.5 1.3 0.9 1.3
Total N 577 615 684 692 707 642 667 751 787 862 6,984
  % 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Table 9.
Relatively common species of bacteria isolated by age group of patient
Organisms   Patients by age group (yr)
<1/12 1/12–1 2–5 6–9 10–19 20–29 30–39 40–49 50–59 60–69 ≥70 Total
S. aureus N 78 81 42 31 68 87 187 194 146 139 112 964
  % 16.9 24.0 16.9 23.5 27.5 17.1 23.3 19.7 11.4 11.0 15.7 13.8
Enterococcus spp. N 120 48 18 7 10 32 68 81 134 166 124 622
  % 26.0 14.2 7.3 5.3 4.0 6.3 8.5 8.2 10.4 13.1 17.4 8.9
S. pneumoniae N 3 6 16 9 11 22 64 24 19 7 4 160
  % 0.6 1.8 6.5 6.8 4.5 4.3 8.0 2.4 1.5 0.6 0.6 2.3
α-hemolytic Streptococcus N 88 61 70 27 73 98 56 72 105 139 40 610
  % 19.0 18.1 28.2 20.5 29.6 19.3 7.0 7.3 8.2 11.0 5.6 8.7
E. coli N 64 32 27 24 21 129 187 287 382 441 238 1,709
  % 13.9 9.5 10.9 18.2 8.5 25.4 23.3 29.1 29.8 34.8 33.4 24.5
K. pneumoniae N 48 42 19 6 16 42 67 94 194 121 85 625
  % 10.4 12.5 7.7 4.5 6.5 8.3 8.3 9.5 15.1 9.5 11.9 8.9
Enterobacter spp. N 34 36 21 6 14 28 34 67 88 91 27 355
  % 7.4 10.7 8.5 4.5 5.7 5.5 4.2 6.8 6.9 7.2 3.8 5.1
Serratia spp. N 2 4 3 5 6 7 28 12 13 3 1 75
  % 0.4 1.2 1.2 3.8 2.4 1.4 3.5 1.2 1.0 0.2 0.1 1.1
Proteus spp. N 0 0 0 0 0 3 2 5 8 12 6 36
  % 0.0 0.0 0.0 0.0 0.0 0.6 0.2 0.5 0.6 0.9 0.8 0.5
Salmonella spp. N 4 1 1 4 1 11 28 49 40 17 3 153
  % 0.9 0.3 0.4 3.0 0.4 2.2 3.5 5.0 3.1 1.3 0.4 2.2
A. baumannii N 7 8 5 4 9 21 28 31 26 34 23 176
  % 1.5 2.4 2.0 3.0 3.6 4.1 3.5 3.1 2.0 2.7 3.2 2.5
P. aeruginosa N 9 11 24 6 15 16 38 41 94 67 32 309
  % 1.9 3.3 9.7 4.5 6.1 3.1 4.7 4.2 7.3 5.3 4.5 4.4
S. maltophilia N 2 3 1 3 0 4 5 13 16 17 9 67
  % 0.4 0.9 0.4 2.3 0.0 0.8 0.6 1.3 1.2 1.3 1.3 1.0
B. fragilis N 3 4 1 0 3 8 12 15 19 14 9 80
  % 0.6 1.2 0.4 0.0 1.2 1.6 1.5 1.5 1.5 1.1 1.3 1.1
Total N 462 337 248 132 247 508 804 985 1,284 1,268 713 6,988
  % 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Table 10.
Number of patients from whom two species of bacteria were isolated
Organisms N of patients
KPN KOX ENT ABA PAE PCE GNF SAU ENC AST BST GST ANB Total
ECO 27 4 13 6 4 0 0 11 29 12 0 0 0 106
KPN 0 0 16 1 4 0 0 8 11 1 0 0 0 41
KOX   0 2 0 0 0 0 0 6 0 0 0 0 8
ENT     11 1 2 0 0 4 15 2 0 0 0 35
SER       0 3 0 0 2 1 3 0 0 0 9
ABA       0 2 0 0 8 7 0 0 0 0 17
PAE         0 2 3 8 5 2 0 0 2 22
PCE           0 0 2 1 0 0 0 0 3
GNF             1 0 0 0 0 0 0 1
SAU               0 32 4 2 1 0 39
ENC                 7 4 0 0 0 11
AST                   5 3 0 0 8
BST                     2 0 0 2
ANB                       0 0 0
ANC                         0 0
Total                           302

Abbreviations: ECO, E. coli; KPN, K. pneumoniae; KOX, K. oxytoca; ENT, Enterobacter; SER, Serratia; ABA, A baumannii; PAE, P. aeruginosa; PCE, Other Pseudomonas sp.; GNF, glucose-nonfermenting gram-negative bacilli; SAU, S. aureus; ENC, Enterococcus; AST, α-hemolytic Streptococcus; BST, β-hemolytic Streptococcus; GST, γ-hemolytic Streptococcus; ANB, anaerobic bacilli; ANC, anaerobic cocci.

Abbreviations: Met R SAU, methicillin-resistant S. aureus; SXT R SAU, cotrimoxazole-resistant S. aureus; Amp R EFM, ampicillin-resistant E. faecium; Van R EFM, vancomycin-resistant E. faecium.

Abbreviations: CTX R ECO, cefotaxime-resistant E. coli; FOX R ECO, cefoxitin-resistant E. coli; CTX R KPN, cefotaxime-resistant K. pneumoniae; FOX R KPN, cefoxitin-resistant K. pneumoniae.

Abbreviations: AMS R ABA, ampicillin-sulbactam-resistant A. baumannii; IMP R ABA, imipenem-resistant A. baumannii; PIP R PAE, piperacillin-resistant P. aeruginosa; CAZ R PAE, ceftazidime-resistant P. aeruginosa; IMP R PAE, imipenem-resistant P. aeruginosa; CIP R PAE, ciprofloxacin-resistant P. aeruginosa.

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