Ann Lab Med.  2017 May;37(3):231-239. 10.3343/alm.2017.37.3.231.

Increasing Resistance to Extended-Spectrum Cephalosporins, Fluoroquinolone, and Carbapenem in Gram-Negative Bacilli and the Emergence of Carbapenem Non-Susceptibility in Klebsiella pneumoniae: Analysis of Korean Antimicrobial Resistance Monitoring System (KARMS) Data From 2013 to 2015

• Kim D
• Ahn JY
• Lee CH
• Jang SJ
• Lee H
• Yong D
• Jeong SH
• Lee K

• KMID: 2369748
• DOI: http://doi.org/10.3343/alm.2017.37.3.231

Abstract

BACKGROUND
National surveillance of antimicrobial resistance becomes more important for the control of antimicrobial resistance and determination of treatment guidelines. We analyzed Korean Antimicrobial Resistance Monitoring System (KARMS) data collected from 2013 to 2015.
METHODS
Of the KARMS participants, 16 secondary or tertiary hospitals consecutively reported antimicrobial resistance rates from 2013 to 2015. Data from duplicate isolates and institutions with fewer than 20 isolates were excluded. To determine the long-term trends, previous KARMS data from 2004 to 2012 were also considered.
RESULTS
The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium from 2013 to 2015 was 66-72% and 29-31%, respectively. The resistance rates of Escherichia coli to cefotaxime and cefepime gradually increased to 35% and 31%, respectively, and fluoroquinolone resistance reached 48% in 2015. The resistance rates of Klebsiella pneumoniae to cefotaxime, cefepime, and carbapenem were 38-41%, 33-41%, and <0.1-2%, respectively, from 2013 to 2015. The carbapenem susceptibility rates of E. coli and K. pneumoniae decreased from 100% and 99.3% in 2011 to 99.0% and 97.0% in 2015, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenem increased to 35% and the prevalence of carbapenem-resistant Acinetobacter baumannii increased from 77% in 2013 to 85% in 2015.
CONCLUSIONS
Between 2013 and 2015, the resistance rates of E. coli to third- and fourth-generation cephalosporins increased continuously, while carbapenem-susceptibility gradually decreased, particularly in K. pneumoniae. The prevalence of carbapenem-resistant P. aeruginosa and A. baumannii increased significantly; therefore, few treatment options remain for these resistant strains.

Keyword

Antimicrobial drug resistance; Surveillance; Acinetobacter baumannii; KARMS

MeSH Terms

Acinetobacter baumannii
Cefotaxime
Cephalosporins*
Drug Resistance, Microbial
Enterococcus faecium
Escherichia coli
Klebsiella pneumoniae*
Klebsiella*
Methicillin-Resistant Staphylococcus aureus
Pneumonia
Prevalence
Pseudomonas aeruginosa
Tertiary Care Centers
Cefotaxime
Cephalosporins

Figure

• 

  Fig. 1 Antimicrobial resistance rates (%) of Escherichia coli and Klebsiella pneumoniae from 2004 to 2015. The resistance rates from 2004 to 2012 were from the previous publication of the KARMS [8910]. The resistance rates of E. coli to fluoroquinolone, third- and fourth-generation cephalosporins (CAZ, CTX, FEP) gradually increased since 2004. However, the resistance rates of E. coli and K. pneumonia to cephamycin decreased. The vertical dotted lines indicate the application of the lowered cefotaxime and ceftazidime breakpoints according to changes in the CLSI guideline in 2010.Abbreviations: CAZ, ceftazidime; CTX, cefotaxime; FEP, cefepime; FOX, cefoxitin; FQ, fluoroquinolone.

• 

  Fig. 2 Carbapenem susceptibility rates of Escherichia coli and Klebsiella pneumoniae from 2011 to 2015. The resistance rates from 2011 to 2012 were from the previous publication of the KARMS [10].Abbreviations: ECO, E. coli; KPN, K. pneumoniae; S, susceptible.

• 

  Fig. 3 Antimicrobial resistance rates (%) of Acinetobacter baumannii and Pseudomonas aeruginosa from 2004 to 2015. The resistance rates from 2004 to 2012 were from the previous publication of the KARMS [8910].Abbreviations: CAZ, ceftazidime; FEP, cefepime; FQ, fluoroquinolone; IMP, imipenem; MEM, meropenem; Amp-Sul, ampicillin-sulbactam.

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