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Abstract
Background
Blood culture is an important method for identifying infectious microorganisms and confirming that a selected antimicrobial treatment is appropriate. In this study, we investigated the annual changes in the frequencies of blood isolates and antibiotic susceptibility test (AST) results.
Methods
We created a large database comprising data on all patient-unique blood cultures obtained from January 2007 through December 2016. Blood specimens were cultured using the BD BACTEC FX system, and species identification and AST were performed using the VITEK 2 system.
Results
During the 10-year study period, a total of 203,651 blood culture results were collected. Of these, gram-positive cocci, gram-negative rods, and fungi were isolated in 2.15%, 0.55%, and 0.12% of the blood cultures, respectively. Escherichia coli was the most commonly isolated species (22.8%), followed by Staphylococcus epidermidis (16.8%), Klebsiella pneumoniae (8.1%), and Staphylococcus aureus (8.0%). Fungal species were isolated in 3.0% of all positive blood cultures. Candida albicans was the most commonly isolated species (1.1%), followed by Candida parapsilosis (0.6%). Methicillin resistance was seen in 55.2% of S. aureus isolates. The frequencies of vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were 13.1% and 10.9%, respectively. The isolation rates of MRSA, VRE, and CRPA showed different patterns each year.
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References
1. Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical signifcance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis. 1997; 24:584–602.
2. Leibovici L, Shraga I, Drucker M, Konigsberger H, Samra Z, Pitlik SD. The beneft of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med. 1998; 244:379–86.
3. Decousser JW, Lamy B, Pina P, Allouch PY. Trends in antibiotic susceptibility of bloodstream pathogens in hospitalized patients in France, 1996 to 2007. Diagn Microbiol Infect Dis. 2010; 66:292–300.
4. Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002). Diagn Microbiol Infect Dis. 2004; 50:59–69.
5. Streit JM, Jones RN, Sader HS, Fritsche TR. Assessment of pathogen occurrences and resistance profles among infected patients in the intensive care unit: report from the SENTRY Antimicrobial Surveillance Program (North America, 2001). Int J Antimicrob Agents. 2004; 24:111–8.
6. Kang BK, Lee HJ, Suh JT. The trends of the species and antimicrobial susceptibility of bacteria and fungi isolated from blood cultures (1986–1996). Korean J Clin Pathol. 1998; 18:57–64.
7. Kim SY, Lim G, Kim MJ, Suh JT, Lee HJ. Trends in fve-year blood cultures of patients at a university hospital (2003∼2007). Korean J Clin Microbiol. 2009; 12:163–8.
8. Koh EM, Lee SG, Kim CK, Kim M, Yong D, Lee K, et al. Microorganisms isolated from blood cultures and their antimicrobial susceptibility patterns at a university hospital during 1994–2003. Korean J Lab Med. 2007; 27:265–75.
9. Clinical and Laboratory Standards Institute. Analysis and presentation of cumulative antimicrobial susceptibility test data; Approved guideline-Fourth edition. CLSI document M39-A4. Wayne PA:. Clinical and Laboratory Standards Institute;2014.
10. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 28th ed.CLSI supplement, M100. Wayne PA: Clinical and Laboratory Standards Institute;2018. p. 296.
11. Arpi M, Victor MA, M⊘ller JK, J⊘nsson V, Hansen MM, Peterslund NA, et al. Changing etiology of bacteremia in patients with hematological malignancies in Denmark. Scand J Infect Dis. 1994; 26:157–62.
12. Worth LJ and Slavin MA. Bloodstream infections in haematology: risks and new challenges for prevention. Blood Rev. 2009; 23:113–22.
13. Weinstein MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol. 2003; 41:2275–8.
14. Favre B, Hugonnet S, Correa L, Sax H, Rohner P, Pittet D. Nosocomial bacteremia: clinical signifcance of a single blood culture positive for coagulase-negative staphylococci. Infect Control Hosp Epidemiol. 2005; 26:697–702.
15. Murni IK, Duke T, Daley AJ, Kinney S, Soenarto Y. True pathogen or contamination: validation of blood cultures for the diagnosis of nosocomial infections in a developing country. J Trop Pediatr. 2018; 64:389–94.
16. Suh JT, Chong YS, Park JW, Kim KD, Son HC, Yang DW, et al. A study on Salmonella species isolated from several university hospitals in Korea. J Korean Med Assoc. 1989; 32:1230–8.
17. Lee HJ. Serovars and antimicrobial susceptibility of the recent clinical isolates of Salmonella. Korean J Clin Pathol. 1995; 15:422–9.
18. Shin KS. Species and antimicrobial susceptibilities of bacteria isolated from blood during recent 5 years at Chungbuk National University Hospital. Chungbuk Med J. 2004; 14:61–9.
19. Vidal F, Mensa J, Almela M, Olona M, Martinez JA, Marco F, et al. Bacteraemia in adults due to glucose non-fermentative Gram-negative bacilli other than P. aeruginosa. QJM. 2003; 96:227–34.
20. Lai CH, Chi CY, Chen HP, Chen TL, Lai CJ, Fung CP, et al. Clinical characteristics and prognostic factors of patients with Stenotrophomonas maltophilia bacteremia. J Microbiol Immunol Infect. 2004; 37:350–8.
21. Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin infect Dis. 1999; 29:239–44.
22. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med. 1988; 148:2642–5.
23. Kao AS, Brandt ME, Pruitt WR, Conn LA, Perkins BA, Stephens DS, et al. The epidemiology of candidemia in two United States cities: results of a population-based active surveillance. Clin Infect Dis. 1999; 29:1164–70.
24. Ji M, Choi YM, Bae E, Kim CK. Trends in microorganisms isolated from blood cultures at a veterans hospital from 2012 to 2015. J Lab Med Qual Assur. 2017; 39:141–6.
25. Yong D, Shin HB, Kim YK, Cho J, Lee WG, Ha GY, et al. Increase in the prevalence of carbapenem-resistant Acinetobacter isolates and ampicillin-resistant non-typhoidal Salmonella species in Korea: a KONSAR study conducted in 2011. Infect Chemother. 2014; 46:84–93.
26. 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 KON-SAR study data from 2005 and 2007. Yonsei Med J. 2010; 51:901–11.
27. Kim SH, Lee KJ, Park C, Lee H. Results of Korean antimicrobial resistance monitoring system (KARMS) in general hospitals, 2008–2015. http://www.cdc.go.kr/CDC/info/CdcKrInfo0301.jsp?menuIds=. HOME006-MNU3003-MNU2950-MNU2951&cid=76882 (Updated on Nov 2017).
28. Gouby A, Neuwirth C, Bourg G, Bouziges N, Carles-Nurit MJ, Des-paux E, et al. Epidemiological study by pulsed-feld gel electrophoresis of an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a geriatric hospital. J Clin Microbiol. 1994; 32:301–5.
29. Murray PR, Baron EJ, et al. eds. Manual of clinical microbiology. 7th ed.Washington: ASM Press;1999.
30. Farber BF, Eliopoulos GM, Ward JI, Ruoff K, Moellering RC Jr. Resistance to penicillin-streptomycin synergy among clinical isolates of viridans streptococci. Antimicrob Agents Chemother. 1983; 24:871–5.
31. Seo YH, Jeong JH, Lee HT, Kwoun WJ, Park PW, Ahn JY, et al. Analysis of blood culture data at a tertiary university hospital, 2006–2015. Ann Clin Microbiol. 2017; 20:35–41.
32. Rahkonen M, Luttinen S, Koskela M, Hautala T. True bacteremias caused by coagulase negative Staphylococcus are diffcult to distinguish from blood culture contaminants. Eur J Clin Microbiol Infect Dis. 2012; 31:2639–44.
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 | Fig. 2.Proportion of isolated organisms from blood cultures according to department of medicine between 2007 and 2016. Abbreviations: ER, Emergency Room; MG, Medicine of Gastroenterology; MO, Medicine of Oncology; MN, Medicine of Nephrology; MC, Medicine of Cardiovascular; GS, General Surgery; NS, Neurological Surgery; MF, Medicine of Infectious Diseases; MR, Medicine of Respiratory. |
 | Fig. 3.Ten-year trend of percent resistance to ciprofloxacin, oxacillin, rifampin, cotrimoxazole, and vancomycin for S. aureus. Abbreviations: CIP, ciprofloxacin; OXA, oxacillin; RIF, rifampin; SXT, cotrimoxazole; VAN, vancomycin; %R, % resistance. |
 | Fig. 4.Ten-year trend of percent resistance to ampicillin and vancomycin for E. faecium and E. faecalis. Abbreviations: EFM, E. faecium; EFA, E. faecalis; AMP, ampicillin; VAN, vancomycin; %R, % resistance. |
 | Fig. 5.Ten-year trend of percent resistance to third-generation cephalosporins and fluoroquinolone for E. coli and K. pneumoniae. Abbreviations: ECO, E. coli; KPN, K. pneumoniae; 3rd cepha, third-generation cephalosporins; FQ, fluoroquinolone; %R, % resistance. |
 | Fig. 6.Ten-year trend of percent resistance to imipenem and fluoroquinolone for P. aeruginosa and A. baumannii. Abbreviations: PAE, P. aeruginosa; ABA, A. baumannii; IPM, imipenem; FQ, fluoroquinolone; %R, % resistance. |
Table 1.
Relatively common species of isolated bacteria by age group
Table 2.
Frequency of bacterial isolates from blood cultures
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