J Korean Med Sci.  2023 Mar;38(10):e75. 10.3346/jkms.2023.38.e75.

Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study

• Kim HJ
• Oh DK
• Lim SY
• Cho YJ
• Park S
• Suh GY
• Lim CM
• Lee YJ

• KMID: 2540433
• DOI: http://doi.org/10.3346/jkms.2023.38.e75

Abstract

Background
Administration of adequate antibiotics is crucial for better outcomes in sepsis. Because no uniform tool can accurately assess the risk of multidrug-resistant (MDR) pathogens, a local antibiogram is necessary. We aimed to describe the antibiogram of MDR bacteria based on locations of sepsis onset in South Korea.
Methods
We performed a prospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 from 19 institutions (13 tertiary referral and 6 universityaffiliated general hospitals) in South Korea. Patients were divided into four groups based on the respective location of sepsis onset: community, nursing home, long-term-care hospital, and hospital. Along with the antibiogram, risk factors of MDR bacteria and drug-bug match of empirical antibiotics were analyzed.
Results
MDR bacteria were detected in 1,596 (22.7%) of 7,024 patients with gram-negative predominance. MDR gram-negative bacteria were more commonly detected in long-termcare hospital- (30.4%) and nursing home-acquired (26.3%) sepsis, whereas MDR grampositive bacteria were more prevalent in hospital-acquired (10.9%) sepsis. Such findings were consistent regardless of the location and tier of hospitals throughout South Korea. Patients with long-term-care hospital-acquired sepsis had the highest risk of MDR pathogen, which was even higher than those with hospital-acquired sepsis (adjusted odds ratio, 1.42; 95% confidence interval, 1.15–1.75) after adjustment of risk factors. The drug-bug match was lowest in patients with long-term-care hospital-acquired sepsis (66.8%).
Conclusion
Gram-negative MDR bacteria were more common in nursing home- and long-term-care hospital-acquired sepsis, whereas gram-positive MDR bacteria were more common in hospital-acquired settings in South Korea. Patients with long-term-care hospitalacquired sepsis had the highest the risk of MDR bacteria but lowest drug-bug match of initial antibiotics. We suggest that initial antibiotics be carefully selected according to the onset location in each patient.

Keyword

Sepsis; Drug Resistance; Multiple; Bacterial; Nursing homes; Epidemiologic Studies

Figure

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  Fig. 1 Detected multidrug-resistant pathogens according to the onset of sepsis. The prevalence of multidrug-resistant pathogens differed according to the location of sepsis onset: (A) community-acquired, (B) nursing home-acquired, (C) long-term-care hospital-acquired, and (D) hospital-acquired sepsis. Long-term-care hospital- (C) and nursing home-acquired (B) sepsis revealed the highest prevalence, predominantly gram-negative bacteria.MDR = multidrug-resistant.

• 

  Fig. 2 Prevalence of multidrug-resistant pathogen among sepsis patients according to the region and tier of hospitals. Multidrug-resistant pathogens were most predominant in patients with long-term-care hospital-acquired sepsis regardless of the (A) region and (B) tier of each center. The central region of South Korea refers to Seoul, Gyeonggi-do, Gangwon-do, and Chungcheong-do. The southern region of South Korea refers to Jeolla-do and Gyeongsang-do. Numbers indicate the proportion of patients with MDR bacteria. Higher ratios are shown with a darker color.MDR = multidrug-resistant.

• 

  Fig. 3 Prevalence of multidrug-resistant pathogen among sepsis patients according to the primary site of infection. Multidrug-resistant pathogens were most predominant in patients with long-term-care hospital-acquired sepsis regardless of the primary site of infection. Patients with urinary tract infection had the highest rate of MDR gram-negative infection, whereas those with skin or soft tissue infection had the highest rate of MDR gram-positive bacteria. Higher ratios are shown with a darker color.MDR = multidrug-resistant.

• 

  Fig. 4 Drug-bug match according to the onset location of sepsis. Community- (86.4%) and hospital-acquired (83.1%) sepsis had higher rates of drug-bug match, whereas nursing home- (73.9%) and long-term-care hospital-acquired (66.8%) sepsis had much lower results.

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