Yonsei Medical Journal

Yonsei Univ College Medicine (연세대학교의과대학)
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Further Increases in Carbapenem-, Amikacin-, and Fluoroquinolone-Resistant Isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR Study 2009

  • Lee, Kyung-Won (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Kim, Mi-Na (Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Jae-Seok (Department of Laboratory Medicine, Hallym University College of Medicine) ;
  • Hong, Hye-Lim (Department of Laboratory Medicine, Seoul Clinical Laboratories) ;
  • Kang, Jung-Oak (Department of Laboratory Medicine, Hanyang University College of Medicine) ;
  • Shin, Jong-Hee (Department of Laboratory Medicine, Chonnam National University Medical School) ;
  • Park, Yeon-Joon (Department of Laboratory Medicine, School of Medicine, The Catholic University of Korea) ;
  • Yong, Dong-Eun (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Jeong, Seok-Hoon (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • Chong, Yun-Sop (Department of Laboratory Medicine, Yonsei University College of Medicine) ;
  • The KONSAR Group, The KONSAR Group (The KONSAR Group)
  • Published : 2011.10.01
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Abstract

Purpose: The increasing prevalence of antimicrobial resistant bacteria has become a serious worldwide problem. The aim of this study was to analyze antimicrobial resistance data generated in 2009 by hospitals and commercial laboratories participating in the Korean Nationwide Surveillance of Antimicrobial Resistance program. Materials and Methods: Susceptibility data were collected from 24 hospitals and two commercial laboratories. In the analysis, resistance did not include intermediate susceptibility. Duplicate isolates were excluded from the analysis of hospital isolates, but not from the commercial laboratory isolates. Results: Among the hospital isolates, methicillin-resistant Staphylococcus aureus, penicillin G-nonsusceptible Streptococcus pneumoniae based on meningitis breakpoint, and ampicillin-resistant Enterococcus faecium remained highly prevalent. The proportion of vancomycin-resistant E. faecium gradually increased to 29%. Ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae increased to 17% and 33%, respectively, and fluoroquinolone-resistant K. pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa increased to 33%, 67% and 39%, respectively. Amikacin-resistant Acinetobacter spp. increased to 48%. Imipenem-resistant Acinetobacter spp. and P. aeruginosa increased to 51% and 26%, respectively. Higher resistance rates were observed in intensive care unit (ICU) isolates than in non-ICU isolates among the isolates from hospitals. Resistance rates were higher in hospital isolates than in clinic isolates among the isolates from commercial laboratories. Conclusion: Among the hospital isolates, ceftazidime-resistant K. pneumoniae and fluoroquinolone-resistant K. pneumoniae, Acinetobacter spp., and P. aeruginosa further increased. The increase in imipenem resistance was slight in P. aeruginosa, but drastic in Acinetobacter spp. The problematic antimicrobial-organism combinations were much more prevalent among ICU isolates.

Keywords

References

  1. Hsueh PR, Badal RE, Hawser SP, Hoban DJ, Bouchillon SK, Ni Y, 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. https://doi.org/10.1016/j.ijantimicag.2010.07.002
  2. Samuelsen O, Toleman MA, Sundsfjord A, Rydberg J, Leegaard TM, Walder M, et al. Molecular epidemiology of metallo-$\beta$-lactamase-producing Pseudomonas aeruginosa isolates from Norway and Sweden shows import of international clones and local clonal expansion. Antimicrob Agents Chemother 2010;54:346-52. https://doi.org/10.1128/AAC.00824-09
  3. Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988;319:157-61. https://doi.org/10.1056/NEJM198807213190307
  4. Uttley AH, Collins CH, Naidoo J, George RC. Vancomycin-resistant enterococci. Lancet 1988;1:57-8.
  5. Perichon B, Courvalin P. VanA-type vancomycin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2009;53:4580-7. https://doi.org/10.1128/AAC.00346-09
  6. Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Bidisolates dle JW, Steward CD, et al. Novel carbapenem-hydrolyzing $\beta$-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001;45:1151-61. https://doi.org/10.1128/AAC.45.4.1151-1161.2001
  7. Walsh TR, Toleman MA, Poirel L, Nordmann P. Metallo-$\beta$-lactamases: the quiet before the storm? Clin Microbiol Rev 2005; 18:306-25. https://doi.org/10.1128/CMR.18.2.306-325.2005
  8. Yong D, Toleman MA, Giske CG, Cho HS, Sundman K, Lee K, et al. Characterization of a new metallo-$\beta$-lactamase gene, blaNDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother 2009;53:5046-54. https://doi.org/10.1128/AAC.00774-09
  9. Morris AK, Masterton RG. Antibiotic resistance surveillance: action for international studies. J Antimicrob Chemother 2002;49:7-10.
  10. 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;39:569-77. https://doi.org/10.3349/ymj.1998.39.6.569
  11. Lee K, Lee MA, Lee CH, Lee J, Roh KH, Kim S, et al. Increase of ceftazidime- and fluoroquinolone-resistant Klebsiella pneumoniae and imipenem-resistant Acinetobacter spp. in Korea: analysis of KONSAR study data from 2005 and 2007. Yonsei Med J 2010;51:901-11. https://doi.org/10.3349/ymj.2010.51.6.901
  12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; nineteenth informational supplement, M100-S19. Wayne, PA: CLSI; 2009.
  13. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement, M100-S21. Wayne, PA: CLSI; 2011.
  14. O'Brien TF, Stelling JM. WHONET: removing obstacles to the full use of information about antimicrobial resistance. Diagn Microbiol Infect Dis 1996;25:162-8.
  15. Fridkin SK, Hill HA, Volkova NV, Edwards JR, Lawton RM, Gaynes RP, et al. Temporal changes in prevalence of antimicrobial resistance in 23 US hospitals. Emerg Infect Dis 2002;8:697-701. https://doi.org/10.3201/eid0807.010427
  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. https://doi.org/10.3201/eid0909.020620
  17. Sahm DF, Marsilio MK, Piazza G. Antimicrobial resistance in key bloodstream bacterial isolates: electronic surveillance with the Surveillance Network Database-USA. Clin Infect Dis 1999;29:259-63. https://doi.org/10.1086/520195
  18. Felmingham D, Gruneberg RN. The Alexander Project 1996-1997: latest susceptibility data from this international study of bacterial pathogens from community-acquired lower respiratory tract infections. J Antimicrob Chemother 2000;45:191-203. https://doi.org/10.1093/jac/45.2.191
  19. Giske CG, Cornaglia G, ESCMID Study Group on Antimicrobial Resistance Surveillance (ESGARS). Supranational surveillance of antimicrobial resistance: the legacy of the last decade and proposals for the future. Drug Resist Updat 2010;13:93-8. https://doi.org/10.1016/j.drup.2010.08.002
  20. Clinical and Laboratory Standards Institute. Analysis and presentation of cumulative antimicrobial susceptibility test data; Approved guideline-Third Edition. M39-A3. Wayne, PA: CLSI; 2008.
  21. Halstead DC, Gomez N, McCarter YS. Reality of developing a community-wide antibiogram. J Clin Microbiol 2004;42:1-6. https://doi.org/10.1128/JCM.42.1.1-6.2004
  22. Jones RN. Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 2010;51 Suppl 1:S81-7. https://doi.org/10.1086/653053
  23. Llata E, Gaynes RP, Fridkin S. Measuring the scope and magnitude of hospital-associated infection in the United States: the value of prevalence surveys. Clin Infect Dis 2009;48:1434-40. https://doi.org/10.1086/598328
  24. Peleg AY, Hooper DC. Hospital-acquired infections due to gramnegative bacteria. N Engl J Med 2010;362:1804-13. https://doi.org/10.1056/NEJMra0904124
  25. Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38:95-104.e2. https://doi.org/10.1016/j.ajic.2009.12.004
  26. Zhao WH, Hu ZQ. $\beta$-lactamases identified in clinical isolates of Pseudomonas aeruginosa. Crit Rev Microbiol 2010;36:245-58. https://doi.org/10.3109/1040841X.2010.481763
  27. Lee K, Kim MN, Choi TY, Cho SE, Lee S, Whang DH, et al. Wide dissemination of OXA-type carbapenemases in clinical Acinetobacter spp. isolates from South Korea. Int J Antimicrob Agents 2009;33:520-4. https://doi.org/10.1016/j.ijantimicag.2008.10.009
  28. Falagas ME, Koletsi PK, Bliziotis IA. The diversity of definitions of multidrug-resistant (MDR) and pandrug-resistant (PDR) Acinetobacter baumannii and Pseudomonas aeruginosa. J Med Microbiol 2006;55:1619-29. https://doi.org/10.1099/jmm.0.46747-0
  29. Kallen AJ, Srinivasan A. Current epidemiology of multidrug resistant gram negative bacilli in the United States. Infect Control Hosp Epidemiol 2010;31 Suppl 1:S51-4. https://doi.org/10.1086/655996
  30. Ko KS, Suh JY, Kwon KT, Jung SI, Park KH, Kang CI, et al. High rates of resistance to colistin and polymyxin B in subgroups of Acinetobacter baumannii isolates from Korea. J Antimicrob Chemother 2007;60:1163-7. https://doi.org/10.1093/jac/dkm305
  31. Bae S, Lee J, Lee J, Kim E, Lee S, Yu J, et al. Antimicrobial resistance in Haemophilus influenzae respiratory tract isolates in Korea: results of a nationwide acute respiratory infections surveillance. Antimicrob Agents Chemother 2010;54:65-71. https://doi.org/10.1128/AAC.00966-09
  32. Ramsey AM, Zilberberg MD. Secular trends of hospitalization with vancomycin-resistant Enterococcus infection in the United States, 2000-2006. Infect Control Hosp Epidemiol 2009;30:184-6. https://doi.org/10.1086/593956
  33. Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996-1011. https://doi.org/10.1086/591861
  34. Jones RN, Sader HS, Moet GJ, Farrell DJ. Declining antimicrobial susceptibility of Streptococcus pneumoniae in the United States: report from the SENTRY Antimicrobial Surveillance Program (1998-2009). Diagn Microbiol Infect Dis 2010;68:334-6. https://doi.org/10.1016/j.diagmicrobio.2010.08.024
  35. Watanabe M, Iyobe S, Inoue M, Mitsuhashi S. Transferable imipenem resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother 1991;35:147-51. https://doi.org/10.1128/AAC.35.1.147
  36. Salabi AE, Toleman MA, Weeks J, Bruderer T, Frei R, Walsh TR. First report of the metallo-$\beta$-lactamase SPM-1 in Europe. Antimicrob Agents Chemother 2010;54:582. https://doi.org/10.1128/AAC.00719-09
  37. Rhee JY, Park YK, Shin JY, Choi JY, Lee MY, Peck KR, et al. KPC-producing extreme drug-resistant Klebsiella pneumoniae isolate from a patient with diabetes mellitus and chronic renal failure on hemodialysis in South Korea. Antimicrob Agents Chemother 2010;54:2278-9. https://doi.org/10.1128/AAC.00011-10
  38. Dumartin C, L'Heriteau F, Pefau M, Bertrand X, Jarno P, Boussat S, et al. Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007. J Antimicrob Chemother 2010;65:2028-36. https://doi.org/10.1093/jac/dkq228
  39. Sykes R. The 2009 Garrod lecture: the evolution of antimicrobial resistance: a Darwinian perspective. J Antimicrob Chemother 2010;65:1842-52. https://doi.org/10.1093/jac/dkq217
  40. Woodford N, Livermore DM. Infections caused by Gram-positive bacteria: a review of the global challenge. J Infect 2009;59 Suppl 1:S4-16. https://doi.org/10.1016/S0163-4453(09)60003-7

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