The Impact of the Antibiotic Burden on the Selection of its Resistance among Gram Negative Bacteria Isolated from Children

Seohee Kim; Reenar Yoo; Jina Lee

doi:10.14776/piv.2015.22.3.178

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Kim, Yoo, and Lee: The Impact of the Antibiotic Burden on the Selection of its Resistance among Gram Negative Bacteria Isolated from Children

Original Article

Pediatr Infect Vaccine 2015;22(3):178-185.

Published online: 21 January 2015

DOI: https://doi.org/10.14776/piv.2015.22.3.178

The Impact of the Antibiotic Burden on the Selection of its Resistance among Gram Negative Bacteria Isolated from Children

Seohee Kim, Reenar Yoo, Jina Lee

Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Received 12 July 20159 September 2015 Accepted 9 September 2015

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

Purpose

We investigated trends in antibiotic pressure and the antibiotic susceptibility of gram negative bacteria isolated from Korean children over 10 consecutive years.

Methods

From January 2004 to December 2013, the antibiotic susceptibility of Kiebsiella pneumonlae, Escherichia cobi, Pseudomonas aeruginosa, and Acinetobacter baumanni blood isolates obtained from children <18 years of age was determined according to the 2009 Clinical and Laboratory Standards Institute guidelines. Antibiotic consumption data were also analyzed.

Results

The prevalence 01K. pneumonae, E. coli', P aerugihosa, and A. baumannii bacteremia was 4.6, 3.5, 3.4, and 2.2 cases/1,000 blood culturesiyear, respectively. In K. pneumoniae, resistance to the third and fourth cephalosporin did not increase significantly. However, carbapenem-resistant K. pneumoniae first appeared in 2010, and the resistance rate increased to 9% between 2012 and 2013. Resistance to 3rd and 4th cephalosporin increased from 10% to 50% in E. co//, and resistance to carbapenem rose abruptly from 11% to 71% in A, baumanniI' (P for trend <0.01). However, such an increase of resistance was not observed in P. aeruginosa. There is a positive correlation between the resistance rate of cefepime in E. coli and the consumption of cefepime (r=0.900, P=0.037).

Conclusion

The significant burden of antibiotic consumption and the high prevalence of antibiotic resistance to gram negative pathogen isolated from bacteremic children were observed. Empirical antibiotics should be wisely selected, and continued efforts to decrease the overall antibiotic pressure are mandatory, especially in highly resistant situations.

Keywords: Gram negative bacteria, Antibiotic resistance, Antibiotic consumption

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Fig. 1.

The prevalence of A. baumannii, E. coli, K. pneumoniae, and P. aeruginosa blood isolates obtained from hospitalized children during the study period, 2004-2013. P for trends evaluated by linear-by-linear association was as follows; 1.000 for A. baumannii, 0.826 for E. coli, 0.949 for K. pneumoniae, and 0.941 for R aeruginosa, respectively.

Fig. 2.

Changes in antibiotic use and antibiotic-resistance over 10 consecutive years (2004-2013). (A) K. pneumoniae, (B) E. coli, (C) P! aeruginosa, and (D) A. baumannii. The line graphs show the changes in the percentage of antibiotic resistances and bar graph represents antibiotic usage, presented as days on antibiotics per 1000 patient-days each year. Abbreviations: B/Bl, B-lactamlB-lactamase inhibitor; 3C5, 3rd generation cephalosporin; 4C5, 4th generation cephalosporin; AMP/SB, ampicillin/sulbactam; PlP/TZ piperacillin/tazobactam; ∗In P. aeruginosa, 3rd generation cephalosporin resistance rates were determined by the resistance to ceftazidime.

Table 1.

Changes in Parenteral Antibiotic Use∗ from 2004 to 2013

	2004-2005	2006-2007	2008-2009	2010-2011	2012-2013	P for trend
B/BI	63.6	61.9	49.4	45.6	61.3	0.34
AMP/SB	53.3	50.2	41.6	38.8	37.0	0.039
PIP/TZ	10.2	11.6	7.8	6.8	24.3	0.04
3CS	178.9	173.6	141.4	161.9	151.1	0.067
CTX	81.4	83.0	83.4	111.0	103.4	0.013
CRO	70.6	60.1	40.4	34.9	32.0	<0.001
CAZ	26.9	30.5	17.6	16.0	15.7	0.014
4CS	33.2	37.4	41.8	38.3	46.8	0.143
FEP	33.2	37.4	41.8	38.3	46.8	0.143
Carbapenem	73.5	80.7	68.0	67.1	72.9	0.603
MER	56.5	60.3	49.1	59.3	65.2	0.48
IM	16.9	20.4	18.9	7.7	7.7	0.013
Total	349.1	353.6	300.6	312.8	332.1	0.073

^∗ Antibiotic consumption was presented as days an antibiotic per 1,000 patien admission days per year. Abbreviations: AMP/SB, ampicillin/sulbactam; PIP/TZ piperacillin/tazobactam;) cefotaxime; CRO, ceftriaxone; CAZ, ceftazidime; FEP, cefepime; MER, meropn IM, imipenem; B/BI, B-Iactam/B-Iactamase inhibitor; 3CS, 3rd generation cephalo sporin- 4cs 4th generation cephalosporin.

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