Journal List > Ewha Med J > v.36(2) > 1058559

TOOLS
Kim, Cho, Lee, Woo, Seong, and Noh: Differences in Bacterial Species and Their Resistance Rates based on Sputum Cultures between Tertiary Hospitals and Smaller Medical Institutions
Original Article

The Ewha Medical Journal 2013; 36(2): 126-131.

Published online: 26 September 2013

DOI: https://doi.org/10.12771/emj.2013.36.2.126

Differences in Bacterial Species and Their Resistance Rates based on Sputum Cultures between Tertiary Hospitals and Smaller Medical Institutions

Tae Hyung Kim, Kyung Pyo Cho, Jae Sung Lee, Yong Moon Woo, Ji Seok Seong, Chang Suk Noh1

Department of Internal Medicine, Seoul Red Cross Hospital, Seoul, Korea.

1Department of Internal Medicine, Seoul Seonam Hospital, Seoul, Korea.

Corresponding author: Chang Suk Noh. Department of Internal Medicine, Seoul Seonam Hospital, Sinjeongyipen1-ro, Yangcheon-gu, Seoul 158-070, Korea. Tel: 82-2-6300-7777, Fax: 82-2-6300-9009, 00021@eussh.org

Received 1 May 2013       Accepted 27 June 2013

Copyright © 2013. Ewha Womans University School of Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Since the 1990s, drug-resistant bacteria have become common pathogens of hospital-acquired infections. In recent years, healthcare-associated infections have come to the fore, and it is reported that distribution rates of these bacteria are comparable to those of hospital-acquired infections. However, there have been few studies on differences in resistant bacteria depending on the size of hospitals. Thus, the authors studied differences in drug-resistant bacteria between a tertiary hospital and smaller medical institutions.

Methods

We retrospectively analyzed the clinical findings and sputum culture results of patients transferred from tertiary hospitals (group A, n=74) and those transferred from smaller medical institutions (group B, n=65).

Results

The number of patients with malignancy was higher in group A than in group B. The length of intensive care unit stay was longer in group A than in group B. Antibiotic therapy and mechanical ventilation were more frequently used in group A than in group B. There were no significant differences between the 2 groups in bacterial species (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and their resistance rates to carbapenem, while there were significant differences between the 2 groups in the bacterial species (Acinetobacter baumannii) and its resistance rate to carbapenem.

Conclusion

In this study, there were significant differences between the 2 groups in the bacterial species and resistance rates to carbapenem for A. baumannii infection unlike other bacterial infections. Further studies on risk factors and patient classification are needed to confirm our results.

Keywords: Acinetobacter baumannii, Carbapenem resistance, Healthcare-associated infection

Figures and Tables

Table 1
Characteristics and clinical features of the subjects: tertiary hospitals versus smaller medical institutions
emj-36-126-i001

Values are presented as mean±SD or number (%). ECOG, Eastern Cooperative Oncology Group; ICU, intensive care unit.

Table 2
Differences in bacterial species and their resistance rates based on sputum cultures between tertiary hospitals and smaller medical institutions
emj-36-126-i002

*Multi-drug resistant pathogen include MRSA, ESBL E. coli, ESBL K. pneumoniae, CRPA, and CRAB. MRSA, methicillin resistant Staphylococcus aures; ESBL, extended-spectrum beta-lactamase; CRPA, carbapenem resistant Pseudomonas aeruginosae; CRAB, carbapenem resistant Acinetobacter baumannii.

References

1. Kwak YG, Cho YK, Kim JY, Lee MS, Kim HY, Kim YK, et al. Korean Nosocomial Infections Surveillance System, intensive care unit module report: data summary from July 2009 through June 2010. Korean J Nosocomial Infect Control. 2011; 16:1–12.
2. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005; 128:3854–3862.
3. Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother. 2007; 51:3568–3573.
4. Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, et al. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest. 2009; 135:633–640.
5. American Thoracic Society. Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005; 171:388–416.
6. Poch DS, Ost DE. What are the important risk factors for healthcare-associated pneumonia? Semin Respir Crit Care Med. 2009; 30:26–35.
7. Lujan M, Gallego M, Rello J. Healthcare-associated infections: a useful concept? Curr Opin Crit Care. 2009; 15:419–424.
8. Lee K, Lee MA, Lee CH, Lee J, Roh KH, Kim S, et al. Increase of ceftazidime- and fluoroquinolone-resistant Klebsiella pneumoniae and imipenem-resistant Acinetobacter spp. in Korea: analysis of KONSAR study data from 2005 and 2007. Yonsei Med J. 2010; 51:901–911.
9. Lee K, Kim MN, Kim JS, Hong HL, Kang JO, Shin JH, et al. Further increases in carbapenem-, amikacin-, and fluoroquinolone-resistant isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR study 2009. Yonsei Med J. 2011; 52:793–802.
10. Kanerva M, Ollgren J, Hakanen AJ, Lyytikainen O. Estimating the burden of healthcare-associated infections caused by selected multidrug-resistant bacteria Finland, 2010. Antimicrob Resist Infect Control. 2012; 1:33.
11. Son JS, Song JH, Ko KS, Yeom JS, Ki HK, Kim SW, et al. Bloodstream infections and clinical significance of healthcare-associated bacteremia: a multicenter surveillance study in Korean hospitals. J Korean Med Sci. 2010; 25:992–998.
12. Yoon WK, Kim M, Kim YY, Lee YJ, Hwangbo Y, Choi KJ, et al. The clinical and microbial characteristics of healthcare-associated pneumonia. Korean J Med. 2010; 78:709–716.
13. Kim JM, Park ES, Jeong JS, Kim KM, Kim JM, Oh HS, et al. Multicenter surveillance study for nosocomial infections in major hospitals in Korea. Nosocomial Infection Surveillance Committee of the Korean Society for Nosocomial Infection Control. Am J Infect Control. 2000; 28:454–458.
14. Lee H, Kim CK, Lee J, Lee SH, Ahn JY, Hong SG, et al. Antimicrobial resistance of clinically important bacteria isolated from 12 hospitals in Korea in 2005 and 2006. Korean J Clin Microbiol. 2007; 10:59–69.
15. Kollef MH, Morrow LE, Baughman RP, Craven DE, McGowan JE Jr, Micek ST, et al. Health care-associated pneumonia (HCAP): a critical appraisal to improve identification, management, and outcomes--proceedings of the HCAP Summit. Clin Infect Dis. 2008; 46:Suppl 4. S296–S334.
16. Song JH, Joo EJ. The crisis of antimicrobial resistance: current status and future strategies. J Korean Med Assoc. 2010; 53:999–1005.
17. Falagas ME, Kopterides P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect. 2006; 64:7–15.
18. Kwon KT, Oh WS, Song JH, Chang HH, Jung SI, Kim SW, et al. Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia. J Antimicrob Chemother. 2007; 59:525–530.
19. Huang J, Tang YQ, Sun JY. Intravenous colistin sulfate: a rarely used form of polymyxin E for the treatment of severe multidrug-resistant Gram-negative bacterial infections. Scand J Infect Dis. 2010; 42:260–265.
TOOLS
Similar articles