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Yun, Gwon, Hong, Lim, Lee, Jang, Yoon, and Jeong: Antimicrobial Resistance in Bacterial Isolates Recovered from Nursing Hospitals between 2014 and 2017
Original Article

Annals of Clinical Microbiology 2019; 22(4): 96-104.

Published online: 20 December 2019

DOI: https://doi.org/10.5145/ACM.2019.22.4.96

Antimicrobial Resistance in Bacterial Isolates Recovered from Nursing Hospitals between 2014 and 2017

Seon Han Yun1, 2, *, Bareum Gwon2, 3, *, Hea Lim Hong1, Hwan Seop Lim1, Kyung Ryul Lee1, Inho Jang2, Eun-Jeong Yoon3, Seok Hoon Jeong3

1Seoul Clinical Laboratory, Seoul, Korea.

2Department of Clnical Pathology, Sangji University College of Science, Wonju, Korea.

3Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.

Correspondence: Eun-Jeong Yoon, Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea. (Tel) 82-2-2019-3783, (Fax) 82-2-2019-3784, ejyoon@yuhs.ac

Equal contributor:

*Both contributed equally as a first author.

Received 7 May 2019       Revised 7 June 2019       Accepted 7 June 2019

© 2019 The Korean Society of Clinical Microbiology

The Korean Society of Clinical Microbiology

(open-access):

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

Antimicrobial resistance (AMR) is an issue not only with regard to public health, but also in terms of economic impact. AMR surveillance has mainly been carried out in general hospitals, and not in nursing hospitals. This study was conducted to investigate the AMR rate for bacterial strains isolated from nursing hospital samples.

Methods

Antimicrobial susceptibility testing (AST) results from a total of 23,518 bacterial isolates recovered from clinical specimens taken in 61 nursing hosals were analyzed. AST was conducted using Vitek 2 with AST cards specific for the bacterial strains.

Results

A total of 19,357 Gram-negative and 4,161 Gram-positive bacterial strains were isolated. Pseudomonas aeruginosa (n=6,384) and Escherichia coli (n=5,468) were the most prevalent bacterial species and, among Gram-positive bacteria, Staphylococcus aureus (n=1,565) was common. The AMR rate was high for the following strains: cefotaxime-resistant Klebsiella pneumoniae, 77.4%; cefotaxime-resistant E. coli, 70.6%; imipenem-resistant Acinetobacter baumannii, 90.3%; imipenem-resistant P. aeruginosa, 49.3%; oxacillin-resistant S. aureus, 81.1%, penicillin-resistant Enterococcus faecalis, 44.8%, and vancomycin-resistant Enterococcus faecium, 53.5%. AMR rate change varied by bacterial species and antimicrobial drug.

Conclusion

AMR rates of major pathogens from nursing hospitals were higher than those from general hospitals with the exception of imipenem-resistant A. baumannii. Continuous monitoring and infection control strategies are needed.

Keywords: Antimicrobial resistance, Nursing hospital, Surveillance study

Figures and Tables

Fig. 1

Participating nursing hospitals in this study. Numbers of nursing hospitals are indicated in parentheses after the name of each district.

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Fig. 2

Resistance rates of K. pneumoniae, E. coli, A. baumannii, and P. aeruginosa in each year. Each bar indicates resistance rate of the year: black bar for 2014, dark gray for 2015, light gray for 2016, and white for 2017. Numbers of isolates analyzed are presented in parentheses following the year in the plot legend.

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Fig. 3

Heatmap for the proportion of major drug-resistant bacteria isolated from each district in each year. The darker shading indicates higher rate of resistance and the lighter shading indicates lower rate of resistance. The shading indicator is located in the left-bottom. The district having recovered bacteria less than 2 isolates are removed from the analysis and indicated as NA, not applicable. The resistance rate of each year is indicated in front of the map. Abbreviations: CTX, cefotaxime; IMP, imipenem; OXA, oxacillin.

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Fig. 4

Resistance rates of S. aureus, E. faecalis, and E. faecium in each year. Each bar indicates resistance rate of the year: black bar for 2014, dark gray for 2015, light gray for 2016, and white for 2017. Numbers of isolates analyzed are presented in parentheses following the year in the plot legend.

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Table 1

Patients included in the study

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*Other Gram-negatives include S. marcescense (n=641), Enterobacter spp. (n=319), and Citrobacter spp. (n=314); †Other Gram-positive include coagulase-negative staphylocci (n=972), S. agalatiae (n=160), and S. pneumoniae (n=124).

Table 2

Specimens included in the study

acm-22-96-i002

*Other Gram-negatives include S. marcescense (n=641), Enterobacter spp. (n=319), and Citrobacter spp. (n=314); †Other Gram-positives include coagulase-negative staphylocci (n=972), S. agalatiae (n=160), and S. pneumoniae (n=124).

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