Distribution and Antimicrobial Resistance of Streptococcus pneumoniae at Four University Hospitals in Busan and Gyeongnam

Si Hyun Kim; Sae Am Song; Jongyoun Yi; Duyeal Song; Chulhun Ludgerus Chang; Dong-Chul Park; Sang-Hwa Urm; Hye Ran Kim; Jeong Hwan Shin

doi:10.5145/ACM.2021.19.1.48

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Kim, Song, Yi, Song, Chang, Park, Urm, Kim, and Shin: Distribution and Antimicrobial Resistance of Streptococcus pneumoniae at Four University Hospitals in Busan and Gyeongnam

Original Article

Ann Clin Microbiol 2016;19(2):48-53.

Published online: 12 June 2016

DOI: https://doi.org/10.5145/ACM.2021.19.1.48

Distribution and Antimicrobial Resistance of Streptococcus pneumoniae at Four University Hospitals in Busan and Gyeongnam

Si Hyun Kim, Sae Am Song, Jongyoun Yi³, Duyeal Song³, Chulhun Ludgerus Chang³, Dong-Chul Park¹, Sang-Hwa Urm⁴, Hye Ran Kim¹, Jeong Hwan Shin^1,²

^¹Department of Laboratory Medicine, Inje University College of Medicine, Busan

^²Paik Institute for Clinical Research, Inje University College of Medicine, Busan

^³Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan

^⁴Department of Preventive Medicine, Inje University College of Medicine, Busan, Korea

Correspondence: Jeong Hwan Shin, Department of Laboratory Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. (Tel) 82-51-890-6475, (Fax) 82-51-893-1562, (E-mail) jhsmile@inje.ac.kr

* These authors contributed equally to this work.

Received 23 March 2016 Revised 23 May 2016 Accepted 7 June 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Streptococcus pneumoniae is the most common human pathogen causing community-acquired pneumonia. There is little information on the recent antimicrobial susceptibility patterns of S. pneumoniae in Busan and Gyeongnam of Korea. The aim of this study was to investigate the distribution and antimicrobial resistance of S. pneumoniae at 4 university hospitals in Busan and Gyeongnam.

Methods

We collected and analyzed the antimicrobial susceptibility results of 850 S. pneumoniae strains isolated from regional 4 university hospitals during the last 2 years from July 2013 through June 2015.

Results

Among 850 S. pneumoniae strains, 635 strains were isolated from respiratory specimens, followed by blood (N=121), CSF (N=13), and others (N=81). Antimicrobial susceptibility rates to penicillin, cefotaxime and ceftriaxone were 79.4%, 76.6% and 83.6%, respectively. The resistant rates to erythromycin and clindamycin were 80.9% and 68.2%, respectively. The resistant rates to levofloxacin were 9.2%. There were some differences in resistant rates by age groups, years, and specimen types.

Conclusion

We found the changes of antimicrobial resistance of S. pneumoniae during the last 2 years. It is necessary to monitor the antimicrobial susceptibility of S. pneumoniae regularly for empirical therapy and for early detection of the changes of resistance.

Keywords: Drug resistance, Multiple, Streptococcus pneumoniae

References

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Fig. 1.

Antimicrobial resistance of 850 Streptococcus pneumoniae isolates by age group. Abbreviations: PEN, penicillin; CTX, cefotaxime; CRO, ceftriaxone; CLI, clindamycin; ERY, erythromycin; LVX, levofloxacin; LZD, linezolid; TET, tetracycline; SXT, trimet-hoprim-sulfamethoxazole; VAN, vancomycin; CHL, chloramphenicol; AMC, amoxicillin-clavulanic acid; MEM, meropenem; CXM, cefuroxime, FEP, cefepime; CEC, cefaclor.

Fig. 2.

Distribution of antimicrobial resistance in Streptococcus pneumoniae by period (2013–2015). Abbreviations: PEN, penicillin; CTX, cefotaxime; CRO, ceftriaxone; CLI, clindamycin; ERY, erythromycin; LVX, levofloxacin; LZD, linezolid; TET, tetracycline; SXT, trimethoprim-sulfamethoxazole; VAN, vancomycin; CHL, chloramphenicol; AMC, amoxicillin-clavulanic acid; MEM, meropenem; CXM, cefuroxime, FEP, cefepime; CEC, cefaclor.

Table 1.

Antimicrobial susceptibility of 850 Streptococcus pneumoniae strains isolated from four university hospitals

Antimicrobial agent	A hospital (N=139, %)			B hospital (N=300, %)			C hospital (N=234, %)			D hospital (N=177, %)			Total (N=850, %)
Antimicrobial agent	S	I	R	S	I	R	S	I	R	S	I	R	S	I	R
Penicillin	74.8	18.7	6.5	74.0	13.3	12.7	84.4	9.3	6.2	86.0	9.3	4.7	79.4	12.3	8.3
Cefotaxime	86.3	7.2	6.5	80.7	10.3	9.0	69.1	19.3	11.6	71.7	24.9	3.5	76.6	15.3	8.2
Ceftriaxone	87.1	5.8	7.2	83.3	8.3	8.3	79.9	9.0	11.1	86.2	10.9	2.9	83.6	8.6	7.8
Clindamycin	39.6	0.0	60.4	31.0	0.3	68.7	30.9	0.0	69.1	27.7	0.0	72.3	31.7	0.1	68.2
Erythromycin	19.4	0.7	79.9	19.7	0.7	79.7	16.9	0.0	83.1	18.6	0.6	80.8	18.7	0.5	80.9
Levofloxacin	92.8	0.0	7.2	88.3	1.0	10.7	86.3	0.9	12.8	96.6	0.0	3.4	90.2	0.6	9.2
Linezolid							100	0.0	0.0	100	0.0	0.0	100	0.0	0.0
Tetracycline	23.7	0.0	76.3	18.7	2.0	79.3	20.1	0.4	79.5	19.5	0.6	79.9	20.1	0.9	79.0
Trimethoprim-Sulfamethoxazole	54.0	8.6	37.4	53.3	8.7	38.0	42.3	8.5	49.1	55.7	9.8	34.5	50.9	8.9	40.3
Vancomycin	100	0.0	0.0	100	0.0	0.0	100	0.0	0.0	100	0.0	0.0	100	0.0	0.0
Chloramphenicol	70.5	0.7	28.8	74.3	0.0	25.7							73.1	0.2	26.7
Amoxicillin-clavulanic acid	75.5	3.6	20.9	74.3	8.0	17.7							74.7	6.6	18.7
Meropenem	34.5	29.5	36.0	29.7	22.0	48.3							31.2	24.4	44.4
Cefuroxime	23.0	1.4	75.5	24.3	5.7	70.0							23.9	4.3	71.8
Cefepime	74.8	15.1	10.1	63.3	23.3	13.3							67.0	20.7	12.3
Cefaclor	21.6	2.2	76.3	15.7	6.3	78.0							17.5	5.0	77.4

Abbreviations: S, susceptible; I, intermediate resistant; R, resistant.

Table 2.

Antimicrobial susceptibility of 850 Streptococcus pneumoniae strains by specimen type

Antimicrobial agent	Respiratory (N=635, %)			Blood (N=121, %)			CSF (N=13, %)			Other (N=81, %)			Total (N=850, %)
	S	I	R	S	I	R	S	I	R	S	I	R	S	I	R
Penicillin	80.9	12.6	6.5	81.2	10.3	8.5	15.4	0.0	84.6	75.9	15.2	8.9	79.4	12.3	8.3
Cefotaxime	74.8	16.2	9.0	89.7	4.3	6.0	46.2	46.2	7.7	76.5	18.5	4.9	76.6	15.3	8.2
Ceftriaxone	82.5	9.0	8.5	93.2	0.8	5.9	46.2	46.2	7.7	84.0	11.1	4.9	83.6	8.6	7.8
Clindamycin	31.7	0.2	68.1	36.4	0.0	63.6	30.8	0.0	69.2	24.7	0.0	75.3	31.7	0.1	68.2
Erythromycin	18.8	0.5	80.7	22.3	0.0	77.7	15.4	7.7	76.9	12.3	0.0	87.7	18.7	0.5	80.9
Levofloxacin	90.1	0.5	9.4	90.7	1.7	7.6	100.0	0.0	0.0	88.9	0.0	11.1	90.2	0.6	9.2
Linezolid 1	100.0	0.0	0.0	100.0	0.0	0.0	100.0	0.0	0.0	100.0	0.0	0.0	100	0.0	0.0
Tetracycline	20.8	1.1	78.1	20.3	0.0	79.7	15.4	0.0	84.6	14.8	1.2	84.0	20.1	0.9	79.0
Trimethoprim-Sulfamethoxazole	50.2	8.3	41.4	62.7	5.9	31.4	76.9	7.7	15.4	34.6	17.3	48.1	50.9	8.9	40.3
Vancomycin 1	100.0	0.0	0.0	100.0	0.0	0.0	100.0	0.0	0.0	100.0	0.0	0.0	100	0.0	0.0
Chloramphenicol	72.4	0.3	27.3	78.0	0.0	22.0	75.0	0.0	25.0	73.9	0.0	26.1	73.1	0.2	26.7
Amoxicillin-clavulanic acid	76.5	6.6	16.9	74.0	4.0	22.0	50.0	0.0	50.0	52.2	13.0	34.8	74.7	6.6	18.7
Meropenem	30.4	25.7	43.9	40.0	16.0	44.0	50.0	0.0	50.0	21.7	26.1	52.2	31.2	24.4	44.4
Cefuroxime	22.4	5.2	72.4	36.0	0.0	64.0	25.0	0.0	75.0	21.7	0.0	78.3	23.9	4.3	71.8
Cefepime	67.1	21.5	11.3	70.0	14.0	16.0	50.0	25.0	25.0	60.9	21.7	17.4	67.0	20.7	12.3
Cefaclor	16.3	4.4	79.3	30.0	6.0	64.0	0.0	25.0	75.0	13.0	8.7	78.3	17.5	5.0	77.4

Abbreviations: S, susceptible; I, intermediate resistant; R, resistant.

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