Yonsei Med J.  2006 Oct;47(5):634-645. 10.3349/ymj.2006.47.5.634.

High Prevalence of Ceftazidime-Resistant Klebsiella pneumoniae and Increase of Imipenem-Resistant Pseudomonas aeruginosa and Acinetobacter spp. in Korea: a KONSAR Program in 2004

• Lee K
• Lim CH
• Cho JH
• Lee WG
• Uh Y
• Kim HJ
• Yong D
• Chong Y

• KMID: 1381244
• DOI: http://doi.org/10.3349/ymj.2006.47.5.634

Abstract

A nationwide antimicrobial resistance surveillance has been conducted since 1997 in Korea. In this study, susceptibility test data generated in 2004 by KONSAR group hospitals were analyzed and compared to those at a commercial laboratory. In hospitals, the rank orders of organisms in 2004 were identical to those in 2003. The most prevalent species was Staphylococcus aureus (20.2%) in hospitals, but Escherichia coli (29.7%) in the commercial laboratory. The proportions of Enterococcus faecium to all isolates of Enterococcus faecalis plus E. faecium were 47.2% in hospitals and 24.9% in the commercial laboratory. The mean resistance rates of significant antimicrobial-organism combinations in hospitals were: oxacillin-resistant S. aureus (68%), oxacillin-resistant (penicillin- nonsusceptible) Streptococcus pneumoniae (68%), vancomycin-resistant E. faecium (25%), cefotaxime-resistant E. coli (14%), ceftazidime- and cefoxitin-resistant Klebsiella pneumoniae (34% and 32%, respectively), and imipenem-resistant Acinetobacter spp. and Pseudomonas aeruginosa (17% and 24%, respectively). In conclusion, oxacillin-resistant staphylococci, expanded-spectrum cephalosporin-resistant K. pneumoniae, and imipenem-resistant Acinetobacter spp. and P. aeruginosa were prevalent in 2004. Increasing trends were observed for vancomycin-resistant E. faecium, cefoxitin- resistant E. coli and K. pneumoniae, and imipenem-resistant Acinetobacter spp. and P. aeruginosa. Certain antimicrobial- organism combinations were also prevalent among the commercial laboratory-tested strains.

Keyword

Antimicrobial resistance surveillance; Korea; ceftazidime resistance; imipenem resistance

MeSH Terms

Pseudomonas aeruginosa/drug effects/isolation & purification
Microbial Sensitivity Tests
Laboratories
Korea
Klebsiella pneumoniae/drug effects/isolation & purification
Imipenem/*pharmacology
Hospitals
Gammaproteobacteria/*drug effects/isolation & purification
Drug Resistance, Multiple, Bacterial
Ceftazidime/*pharmacology
Anti-Bacterial Agents/*pharmacology
Acinetobacter/drug effects/isolation & purification

Figure

• 

  Fig. 1 Temporal changes of oxacillin-resistant S. aureus, ampicillin- and vancomycin-resistant E. faecium and penicillin-nonsusceptible S. pneumoniae. A continued increase of vancomycin-resistant E. faecium was observed. OXA, oxacillin; AMP, ampicillin; PEN, penicillin G; VAN, vancomycin; SAU, Staphylococcus aureus; EFM, Enterococcus faecium; SPN, Streptococcus pneumoniae; NS, nonsusceptible;. R, resistant.

• 

  Fig. 2 Temporal changes of ceftazidime, cefoxitin, fluoroquinolone and amikacin resistance in K. pneumoniae. All of these resistances increased in 2004. CAZ, ceftazidime; FOX, cefoxitin; FQN, fluoroquinolone; AMK, amikacin; R, resistant.

• 

  Fig. 3 Temporal changes of fluoroquinolone, amikacin, ceftazidime and imipenem resistance in Acinetobacter spp. A continued increase of imipenem resistance was observed. FQN, fluoroquinolone; AMK, amikacin; CAZ, ceftazidime; IPM, imipenem; R, resistant.

• 

  Fig. 4 Comparison of antimicrobial resistance rates of Acinetobacter spp. isolated in 2003 and in 2004. Resistance rates to carbapenem and cefoperazone-sulbactam remained relatively low, but those to other antimicrobial agents were very high. IPM, imipenem; MER, meropenem; C/S, cefoperazone-sulbactam; P/T, piperacillin-sulbactam; A/S, ampicillin-sulbactam; FEP, cefepime; PIP, piperacillin; CAZ, ceftazidime; CTX, cefotaxime; AZT, aztreonam; AMK, amikacin; GEN, gentamicin; TOB, tobramycin; CIP, ciprofloxacin; COT, cotrimoxazole; TET, tetracycline.

• 

  Fig. 5 Prevalence of problem antimicrobial-organism combinations in different hospital groups and at the commercial laboratory. Vancomycin-resistant E. faecium, and imipenem-resistant P. aeruginosa and Acinetobacter spp. were more prevalent among strain isolated from large hospitals than those tested at a commercial laboratory. S-Med, Seoul-medium; N-Med, non-Seoul-medium; Comm Lab, commercial laboratory; VAN, vancomycin; FQN, fluoroquinolone; FOX, cefoxitin; IMP, imipenem; EFM, Enterococcus faecium; ECO, Escherichia coli; KPN, Klebsiella pneumoniae; PAE, Pseudomonas aeruginosa; ABA, Acinetobacter baumannii; R, resistant.

• 

  Fig. 6 Comparison of resistance rates by including duplicate isolates and by including only the first isolate from a patient per year. The difference was relatively greater in piperacillin- and imipenem-resistant P. aeruginosa, and oxacillin-resistant S. aureus. OXA, oxacillin; VAN, vancomycin; FQN, fluoroquinolone; CAZ, ceftazidime; CTX, cefotaxime; PIP, piperacillin; IPM, imipenem; SAU, Staphylococcus aureus; EFM, Enterococcus faecium; ECO, Escherichia coli; KPN, Klebsiella pneumoniae; SMA, Serratia marcescens, PAE, Pseudomonas aeruginosa; R., resistant.

• 

  Fig. 7 The time (day) between the first isolation of an imipenem-susceptible strain and the subsequent isolation of an imipenem-resistant strain of P. aeruginosa. The first resistant strain was detected within 4 weeks in 58 of 78 (74%) patients.

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