Recent Trends in Antimicrobial Resistance in Intensive Care Units in Korea

Lee Yangsoon; Ah Kim Young; Song Wonkeun; Lee Hyukmin; Soo Lee Hye; Jin Jang Sook; Hoon Jeong Seok; Geun Hong Seong; Yong Dongeun; Lee Kyungwon; Chong Yunsop

doi:10.14192/kjnic.2014.19.1.29

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Yangsoon, Young, Wonkeun, Hyukmin, Hye, Sook, Seok, Seong, Dongeun, Kyungwon, and Yunsop: Recent Trends in Antimicrobial Resistance in Intensive Care Units in Korea

Original Article

J Nosocomial Infect Control 2013;19(1):29-36.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2014.19.1.29

Recent Trends in Antimicrobial Resistance in Intensive Care Units in Korea

Lee Yangsoon, Ah Kim Young, Song Wonkeun, Lee Hyukmin, Soo Lee Hye, Jin Jang Sook, Hoon Jeong Seok, Geun Hong Seong, Yong Dongeun, Lee Kyungwon, Chong Yunsop

Department of Laboratory Medicine, Severance Hospital, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea

Department of Laboratory Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea

Department of Laboratory Medicine, Kwandong University College of Medicine, Gangneung, Korea

Department of Laboratory Medicine, Chonbuk National University Medical School, Jeonju, Korea

Department of Laboratory Medicine, Chosun University Hospital, Gwangju, Korea

Department of Laboratory Medicine, CHA Bundang Medical Center, CHA Univeristy, Seongnam, Korea

Address reprint requests to Kyungwon Lee, Department of Laboratory Medicine, Severance Hospital, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1, Yeonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: 02-2228-2446, Fax: 02-313-0908 E-mail: leekcp@yuhs.ac

Received 17 March 2014 Accepted 22 May 2014

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

Background

In general, higher resistance rates are observed among intensive care unit (ICU) isolates than non-ICU isolates. In this study, resistance rates of isolates from ICUs and non-ICUs were compared using the data generated from 20 hospitals in Korea.

Methods

Susceptibility data were collected from 20 hospitals participating in the Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) program. Duplicate isolates were excluded from the analysis. The resistance rates did not include intermediate susceptibility.

Results

The most prevalent bacteria in the ICUs were Staphylococcus aureus (21%) and Acinetobacter spp. (19%), and those in non-ICU were Escherichia coli (27%) and S. aureus (14%). The resistance rates were higher in ICUs than in non-ICUs at 84% and 58% for methicillin-resistant S. aureus, 86% and 70% for methicillin-resistant coagulase-negative Staphylcoccus (CNS), 34% and 19% for vancomycin-resistant Enterococcus faecium, 38% and 19% for cefotaxime-resistant E. coli, 45% and 25% for cefotaxime-resistant Klebsiella pneumoniae, 42% and 24% for ceftazidime-resistant Enterobacter cloacae, 29% and 11% for ceftazidime-resistant Serattia marcescens, 83% and 44% for imipenem-resistant Acinetobacter spp., and 32% and 17% for imipenem-resistant Pseudomonas aeruginosa, respectively.

Conclusion

The most prevalent bacteria in ICUs were S. aureus, CNS, and Acinetobacter spp., and high multi-drug resistance rates were observed in the Acinetobacter isolates. Therefore, infection control should be practiced in ICUs to prevent infections caused by multi-drug resistant bacteria.

Keywords: Acinetobacter spp., Antimicrobial resistance surveillance, Intensive care units (ICU), KONSAR, Staphylococcus aureus

References

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Table 1.

Number, proportion, and rank order of clinically important bacteria from ICU and non-ICU patients

Bacteria	ICU isolates		Non-ICU isolates
Bacteria	No. (%) of isolates tested	Rank order	No. (%) of isolates tested	Rank order
Staphylococcus aureus	5,393 (21)	1	14,330 (14)	2
Coagulase negative Staphylococcus	3,199 (13)	3	13,112 (13)	3
Enterococcus faecalis	1,195 (5)	8	8,283 (8)	6
E. faecium	1,767 (7)	6	5,413 (5)	7
Streptococcus pneumoniae	275 (1)	12	1,971 (2)	10
Escherichia coli	1,539 (6)	7	26,799 (27)	1
Klebsiella pneumoniae	2,550 (10)	5	10,104 (10)	4
Enterobacter cloacae	664 (3)	10	2,883 (3)	9
Serratia marcescens	522 (2)	11	1,498 (1)	12
Non-typhoidal Salmonella	12 (0)	14	433 (0)	14
Pseudomonas aeruginosa	2,673 (11)	4	8,662 (9)	5
Acinetobacter spp.	4,712 (19)	2	4,365 (4)	8
Stenotrophomonas maltophilia	796 (3)	9	1,765 (2)	11
Haemophilus influenzae	56 (0)	13	606 (1)	13
Total	25,353 (100)		100,224 (100)

Table 2.

Antimicrobial resistance of clinically important Gram-positive cocci

Antimicrobial agents	Resistance rate (%)
Antimicrobial agents	SAU	CNS	EFA	EFM	SPN
	19,723*	16,311	9,478	7,180	2,246
Penicillin/ampicillin^†	96	93	3	93	70
Gentamicin	47	41	-	-	-
Fluoroquinolone	51	41	29	92	7
Clindamycin	58	38	-	-	59
Erythromycin	60	56	68	89	74
Oxacillin/cefoxitin	67	73	-	-	-
Cotrimoxazole	2	28	-	-	55
Tetracycline	51	29	85	32	71
Teicoplanin	0	0	1	19	-
Vancomycin	0	0	1	23	-

*No. of isolates tested; ^†Penicillin for Staphylococcus spp., SPN, and ampicillin for Enterococcus spp.

Abbreviations: SAU, Staphlyococcus aureus; CNS, coagulase negative Staphylococcus; EFA, Enterococcus faecalis; EFM, E. faecium; SPN, Streptococcus pneumoniae.

Table 3.

Antimicrobial resistance of clinically important Gram-negative bacilli

Antimicrobial agents	Resistance rate (%)
Antimicrobial agents	ECO 28,338*	KPN 12,654	ECL 3,547	SMA 2,020	ACI 9,077	PAE 11,335	SMP 2,561
Ampicillin	68	-	-	-	-	-	-
Ampicillin-Sulbactam	34	36	-	-	55	-	-
Cephalothin	32	37	-	-	-	-	-
Cefotaxime	21	29	33	24	70	-	-
Ceftazidime	18	29	31	15	66	18	40
Cefepime	18	26	8	8	66	19	-
Aztreonam	19	30	29	17	80	20	-
Cefoxitin	7	14	-	-	-	-	-
Piperacillin	65	77	38	26	66	28	-
Piperacillin-Tazobactam	6	14	24	12	63	24	-
Imipenem	0.1	0.3	0.2	1	63	21	-
Meropenem	0.0	0.3	0.2	1	63	18	-
Amikacin	1	7	3	9	49	15	-
Gentamicin	27	17	12	16	66	25	-
Tobramycin	12	21	16	23	57	22	-
Fluoroquinolone	36	27	8	13	70	32	8
Cotrimoxazole	37	20	20	10	62	-	8
Tetracycline	42	16	12	60	40	-	-
Minocycline	-	-	-	-	3	-	3
Colistin	-	-	-	-	2	2	-

*No. of isolates tested.

Abbreviations: ECO, Escherichia coli; KPN, Klebsiella pneumoniae; ECL, Enterobacter cloacae; SMA, Serratia marcescens; ACI, Acinetobacter spp.; PAE, Pseudomonas aeruginosa; SMP, Stenotrophomonas maltophilia.

Table 4.

Comparison of resistance rates of clinically important species isolated from ICU and non-ICU patients

Bacteria	Antimicrobial agents	ICU isolate		Non ICU isolate		P-value*
Bacteria	Antimicrobial agents	No. of isolates tested	Resistance rate (%)	No. of isolates tested	Resistance rate (%)	P-value*
Staphylococcus aureus	Oxacillin	5,393	84	14,330	58	ä0.001
Staphylococcus, coagulase-negative	Oxacillin	3,199	86	13,112	70	ä0.001
Enterococcus faecalis	Vancomycin	1,195	2	8,283	1	0.005
Enterococcus faecium	Vancomycin	1,767	34	5,413	19	ä0.001
Streptococcus pneumoniae	Penicillin	275	70	1,971	62	0.011
Escherichia coli	Ampicillin	1,539	77	26,799	68	ä0.001
	Cefotaxime		38		19	ä0.001
	Cefoxitin		13		7	ä0.001
	Fluoroquinolone		52		35	ä0.001
	Gentamicin		37		26	ä0.001
Klebsiella pneumoniae	Cefotaxime	2,550	45	10,104	25	ä0.001
	Cefoxitin		20		11	ä0.001
	Fluoroquinolone		39		22	ä0.001
	Gentamicin		24		15	ä0.001
Enterobacter cloacae	Ceftazidime	664	42	2,883	29	ä0.001
	Cefepime		10		8	0.120
	Fluoroquinolone		12		8	0.001
Serratia marcescens	Ceftazidime	522	24	1,498	11	ä0.001
	Cefepime		13		6	ä0.001
	Fluoroquinolone		17		10	ä0.001
Acinetobacter spp.	Ampicillin-sulbactam	4,712	71	4,365	42	ä0.001
	Ceftazidime		86		47	ä0.001
	Imipenem		83		44	ä0.001
	Fluoroquinolone		87		54	ä0.001
	Gentamicin		84		49	ä0.001
Pseudomonas aeruginosa	Piperacillin	2,673	37	8,662	25	ä0.001
	Ceftazidime		26		15	ä0.001
	Imipenem		32		17	ä0.001
	Fluoroquinolone		38		29	ä0.001
	Gentamicin		27		24	0.002
Stenotrophomonas maltophilia	Cotrimoxazole	796	8	1,765	9	0.449
	Fluoroquinolone		11		8	0.013

*Statistical significance was declared for P-values less than 0.05 by the χ² test (Fisher’s exact test).

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