Korean J Nosocomial Infect Control.  2014 Jun;19(1):29-36. 10.14192/kjnic.2014.19.1.29.

Recent Trends in Antimicrobial Resistance in Intensive Care Units in Korea

• Lee Y
• Kim YA
• Song W
• Lee H
• Lee HS
• Jang SJ
• Jeong SH
• Hong SG
• Yong D
• Lee K
• Chong Y
• KONSAR Group

• KMID: 1802351
• DOI: http://doi.org/10.14192/kjnic.2014.19.1.29

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.

Keyword

Acinetobacter spp.; Antimicrobial resistance surveillance; Intensive care units (ICU); KONSAR; Staphylococcus aureus

MeSH Terms

Acinetobacter
Bacteria
Drug Resistance, Multiple
Enterobacter cloacae
Enterococcus faecium
Escherichia coli
Infection Control
Intensive Care Units*
Klebsiella pneumoniae
Korea
Methicillin Resistance
Pseudomonas aeruginosa
Staphylococcus aureus

Reference

References

1. Lee K, Kim MN, Kim JS, Hong HL, Kang JO, Shin JH, KONSAR Group, et al. Further increases in carbapenem-, amikacin-, and fluoroquinolone-resistant isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR study 2009. Yonsei Med J. 2011; 52:793–802.

2. van Duijn PJ, Dautzenberg MJ, Oostdijk EA. Recent trends in antibiotic resistance in European ICUs. Curr Opin Crit Care. 2011; 17:658–65.

3. Lee Y, Lee J, Jeong SH, Lee J, Bae IK, Lee K. Carbapenem-non-susceptible Acinetobacter baumannii of sequence type 92 or its single-locus variants with a G428T substitution in zone 2 of the rpoB gene. J Antimicrob Chemother. 2011; 66:66–72.

4. Mugnier PD, Poirel L, Naas T, Nordmann P. Worldwide dissemination of the blaOXA-23 carbapenemase gene of Acinetobacter baumannii. Emerg Infect Dis. 2010; 16:35–40.

5. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010; 10:597–602.

6. Giakkoupi P, Tryfinopoulou K, Kontopidou F, Tsonou P, Golegou T, Souki H, et al. Emergence of NDM-producing Klebsiella pneumoniae in Greece. Diagn Microbiol Infect Dis. 2013; 77:382–4.

7. Mezzatesta ML, Gona F, Caio C, Adembri C, Dell’utri P, Santagati M, et al. Emergence of an extensively drug-resistant ArmA- and KPC-2-producing ST101 Klebsiella pneumoniae clone in Italy. J Antimicrob Chemother. 2013; 68:1932–4.

8. Poirel L, Potron A, Nordmann P. OXA-48-like carbapenemases: the phantom menace. J Antimicrob Chemother. 2012; 67:1597–606.

9. Korean Centers for Disease control and Prevention.Public health weekly report. 2013; 6:617–9.

10. Lee K, Chong Y, Jeong SH, Yong D, Kim HJ, Lee Y. Increasing prevalence of multidrug- resistant Acinetobacter spp., Pseudomonas spp., and Stenotrophomonas maltophilia. 1st ed.Seoul. Seohung Publisher;2014; 19–37.

11. Hsueh PR, Badal RE, Hawser SP, Hoban DJ, Bouchillon SK, Ni Y, 2008 Asia-Pacific SMART Group, et al. Epidemiology and antimicrobial susceptibility profiles of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region: 2008 results from SMART (Study for Monitoring Antimicrobial Resistance Trends). Int J Antimicrob Agents. 2010; 36:408–14.

12. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, National Healthcare Safety Network (NHSN) Team and Participating NHSN Facilities, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013; 34:1–14.

13. Chong Y, Lee K, Park YJ, Jeon DS, Lee MH, Kim MY, et al. Korean Nationwide Surveillance of Antimicrobial Resistance of bacteria in 1997. Yonsei Med J. 1998; 39904:569–77.

14. Clinical and Laboratory Standard Institute.Performance standards for antimicrobial susceptibility testing: nineteenth informational supplement M100-S19. Wayne, PA; CLSI;2009.

15. Fridkin SK, Hill HA, Volkova NV, Edwards JR, Lawton RM, Gaynes RP, Intensive Care Antimicrobial Resistance Epidemiology Project Hospitals, et al. Temporal changes in prevalence of antimicrobial resistance in 23 US hospitals. Emerg Infect Dis. 2002; 8:697–701.

16. Van Beneden CA, Lexau C, Baughman W, Barnes B, Bennett N, Cassidy PM, et al. Aggregated antibiograms and monitoring of drug-resistant Streptococcus pneumoniae. Emerg Infect Dis. 2003; 9:1089–95.

17. Health Insurance Review and Assessment Service.HIRA web sites on News and Information. http://www.hira.or.kr./rdc_hospsearch.hospsearch.do?method=hospital&pgmid=HIRAA030002000000. (Updated on March 7,. 2014.

18. Jeon MH, Park WB, Kim SR, Chun HK, Han SH, Bang JH, et al. Korean nosocomial infections surveillance system, intensive care unit module report: data summary from July 2010 through June 2011. Korean J Nosocomial Infect Control. 2012; 17:28–39.

19. Rosenthal VD, Bijie H, Maki DG, Mehta Y, Apisarnthanarak A, Medeiros EA, INICC members, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004-2009. Am J Infect Control. 2012; 40:396–407.

20. Jung JY, Park MS, Kim SE, Park BH, Son JY, Kim EY, et al. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis. 2010; 10:228.

21. Kim YJ, Kim SI, Hong KW, Kim YR, Park YJ, Kang MW. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: impact of appropriate antimicrobial therapy. J Korean Med Sci. 2012; 27:471–5.

22. Kim SY, Jung JY, Kang YA, Lim JE, Kim EY, Lee SK, et al. Risk factors for occurrence and 30-day mortality for carbapenem-resistant Acinetobacter baumannii bacteremia in an intensive care unit. J Korean Med Sci. 2012; 27:939–47.