Journal List > Lab Med Online > v.9(2) > 1128323

Lim, Yeom, Joo, Cheong, Lee, Woo, Park, and Kwon: Trends in Bloodstream Infections and Antimicrobial Susceptibilities at a University Hospital in Korea Between 2007 and 2016

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.

Conclusions

Among the isolates, E. coli was the most common, followed by S. epidermidis and K. pneumoniae. This study represents a longterm analysis of bloodstream infections, and the results can be used to identify trends in the microorganisms isolated and their drug resistance.

References

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Fig. 1.
Proportions of isolated organisms from blood cultures between 2007 and 2016.
lmo-9-63f1.tif
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.
lmo-9-63f2.tif
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.
lmo-9-63f3.tif
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.
lmo-9-63f4.tif
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.
lmo-9-63f5.tif
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.
lmo-9-63f6.tif
Table 1.
Relatively common species of isolated bacteria by age group
Organisms Patients by age group (yr)
  <10 10–19 20–29 30–39 40–49 50–59 60–69 70–79 80–89 ≥90 Total
S. aureus N 15 12 7 15 25 99 103 169 165 48 658
  % 5.7 12.5 6.1 6.6 5.6 10.6 7.7 7.2 8.6 9.3  
E. faecium N 3 0 1 3 6 25 27 71 70 21 227
  % 1.1 0.0 0.9 1.3 1.3 2.7 2.0 3.0 3.7 4.1  
E. faecalis N 1 1 0 2 12 12 40 72 64 19 223
  % 0.4 1.0 0.0 0.9 2.7 1.3 3.0 3.1 3.4 3.7  
S. pneumoniae e N 2 1 1 2 4 8 15 15 16 5 69
  % 0.8 1.0 0.9 0.9 0.9 0.9 1.1 0.6 0.8 1.0  
E. coli N 12 5 21 37 96 206 310 593 471 116 1,867
  % 4.6 5.2 18.3 16.4 21.4 22.1 23.3 25.2 24.7 22.4  
K. pneumoniae e N 1 2 4 14 23 84 136 230 138 32 664
  % 0.4 2.1 3.5 6.2 5.1 9.0 10.2 9.8 7.2 6.2  
P. aeruginosa N 0 0 0 5 10 24 39 48 42 10 178
  % 0.0 0.0 0.0 2.2 2.2 2.6 2.9 2.0 2.2 1.9  
A. baumannii N 1 1 2 3 12 22 29 54 43 10 177
  % 0.4 1.0 1.7 1.3 2.7 2.4 2.2 2.3 2.3 1.9  
E. cloacae N 3 0 0 2 4 11 22 26 19 3 90
  % 1.1 0.0 0.0 0.9 0.9 1.2 1.7 1.1 1.0 0.6  
Candida specie es N 2 1 3 5 8 26 38 86 51 17 237
  % 0.8 1.0 2.6 2.2 1.8 2.8 2.9 3.7 2.7 3.3  
Table 2.
Frequency of bacterial isolates from blood cultures
Organisms No. of isolates N=8,196 % of isolates
Gram-positive organisms
Staphylococcus, coagulase-negative 2,645 32.3
Staphylococcus aureus 658 8.0
Enterococcus faecium 227 2.8
Enterococcus faecalis 223 2.7
Streptococcus pneumoniae 69 0.8
Gram-negative organisms
Escherichia coli 1,867 22.8
Klebsiella pneumoniae 664 8.1
Pseudomonas aeruginosa 178 2.2
Acinetobacter baumannii 177 2.2
Enterobacter cloacae 90 1.1
Fungal organisms
Candida albicans 94 1.1
Candida parapsilosis 51 0.6
Candida tropicalis 35 0.4
Candida glabrata 35 0.4
Candida famata 10 0.1
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