Pediatr Infect Vaccine.  2015 Dec;22(3):178-185. 10.14776/piv.2015.22.3.178.

The Impact of the Antibiotic Burden on the Selection of its Resistance among Gram Negative Bacteria Isolated from Children

• Kim S
• Yoo R
• Lee J

• KMID: 2315683
• DOI: http://doi.org/10.14776/piv.2015.22.3.178

Abstract

PURPOSE
We investigated trends in antibiotic pressure and the antibiotic susceptibility of gram negative bacteria isolated from Korean children over 10 consecutive years.
METHODS
From January 2004 to December 2013, the antibiotic susceptibility of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii blood isolates obtained from children <18 years of age was determined according to the 2009 Clinical and Laboratory Standards Institute guidelines. Antibiotic consumption data were also analyzed.
RESULTS
The prevalence of K. pneumoniae, E. coli, P. aeruginosa, and A. baumannii bacteremia was 4.6, 3.5, 3.4, and 2.2 cases/1,000 blood cultures/year, respectively. In K. pneumoniae, resistance to the third and fourth cephalosporin did not increase significantly. However, carbapenem-resistant K. pneumoniae first appeared in 2010, and the resistance rate increased to 9% between 2012 and 2013. Resistance to 3rd and 4th cephalosporin increased from 10% to 50% in E. coli, and resistance to carbapenem rose abruptly from 11% to 71% in A. baumannii (P for trend <0.01). However, such an increase of resistance was not observed in P. aeruginosa. There is a positive correlation between the resistance rate of cefepime in E. coli and the consumption of cefepime (r=0.900, P=0.037).
CONCLUSION
The significant burden of antibiotic consumption and the high prevalence of antibiotic resistance to gram negative pathogen isolated from bacteremic children were observed. Empirical antibiotics should be wisely selected, and continued efforts to decrease the overall antibiotic pressure are mandatory, especially in highly resistant situations.

Keyword

Gram negative bacteria; Antibiotic resistance; Antibiotic consumption

MeSH Terms

Acinetobacter baumannii
Anti-Bacterial Agents
Bacteremia
Child*
Drug Resistance, Microbial
Escherichia coli
Gram-Negative Bacteria*
Humans
Klebsiella pneumoniae
Pneumonia
Prevalence
Pseudomonas aeruginosa
Anti-Bacterial Agents

Figure

• 

  Fig. 1. The prevalence of A. baumannii, E. coli, K. pneumoniae, and P. aeruginosa blood isolates obtained from hospitalized children during the study period, 2004-2013. P for trends evaluated by linear-by-linear association was as follows; 1.000 for A. baumannii, 0.826 for E. coli, 0.949 for K. pneumoniae, and 0.941 for R aeruginosa, respectively.

• 

  Fig. 2. Changes in antibiotic use and antibiotic-resistance over 10 consecutive years (2004-2013). (A) K. pneumoniae, (B) E. coli, (C) P! aeruginosa, and (D) A. baumannii. The line graphs show the changes in the percentage of antibiotic resistances and bar graph represents antibiotic usage, presented as days on antibiotics per 1000 patient-days each year. Abbreviations: B/Bl, B-lactamlB-lactamase inhibitor; 3C5, 3rd generation cephalosporin; 4C5, 4th generation cephalosporin; AMP/SB, ampicillin/sulbactam; PlP/TZ piperacillin/tazobactam; ∗In P. aeruginosa, 3rd generation cephalosporin resistance rates were determined by the resistance to ceftazidime.

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