Infect Chemother.  2014 Jun;46(2):84-93. 10.3947/ic.2014.46.2.84.

Increase in the Prevalence of Carbapenem-Resistant Acinetobacter Isolates and Ampicillin-Resistant Non-Typhoidal Salmonella Species in Korea: A KONSAR Study Conducted in 2011

• Yong D
• Shin HB
• Kim YK
• Cho J
• Lee WG
• Ha GY
• Choi TY
• Jeong SH
• Lee K
• Chong Y
• The KONSAR group

• KMID: 2284984
• DOI: http://doi.org/10.3947/ic.2014.46.2.84

Abstract

BACKGROUND
Antimicrobial surveillance is important for providing an up-to-date understanding of the epidemiology of antimicrobial resistance and for creating a forum for rational drug development. In this study, we analyzed antimicrobial test data generated in 2011 by hospitals and commercial laboratories participating in the Korean Nationwide Surveillance of Antimicrobial Resistance program (KONSAR).
MATERIALS AND METHODS
Data on the results of susceptibility tests conducted in 32 hospitals and two commercial laboratories were analyzed. Data on isolates from patients admitted to an intensive care unit (ICU) and those admitted to other wards were compared. Intermediate susceptibility was not analyzed and duplicate isolates were excluded.
RESULTS
Escherichia coli was the most prevalent organism identified in both the hospital and commercial laboratories. Among the hospital isolates, methicillin-resistant Staphylococcus aureus (MRSA), penicillin G-non-susceptible Streptococcus pneumoniae, and ampicillin-resistant Enterococcus faecium remained as prevalent as they were in 2009. The proportion of vancomycin-resistant E. faecium (VR-EFM) slightly decreased from 29% in 2009 to 23% in 2011. Resistance rates of Klebsiella pneumoniae to ceftazidime, cefoxitin, fluoroquinolone, and amikacin were 24%, 14%, 27%, and 8%, respectively. Resistance rates of Pseudomonas aeruginosa to fluoroquinolone, ceftazidime, imipenem, and amikacin were 33%, 20%, 22%, and 16%, respectively, whereas those of Acinetobacter spp. resistance were 71%, 66%, 64, and 51%, respectively. The prevalence of oxyimino-cephalosporin-resistant E. coli and K. pneumoniae, carbapenem-resistant Acinetobacter spp. and P. aeruginosa, MRSA, and VR-EFM among ICU isolates was higher than those among non-ICU isolates. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae, imipenem-resistant P. aeruginosa, and VR-EFM were more prevalent among isolates from commercial laboratories than those from hospitals. Resistance rates of K. pneumoniae to ceftazidime and amikacin decreased from 32% and 24% in 2005 to 24% and 8% in 2011, respectively. The resistance rate of P. aeruginosa to amikacin decreased from 22% in 2005 to 16% in 2011. The proportion of imipenem-resistant Acinetobacter spp. increased from 16% in 2005 to 64% in 2011.
CONCLUSIONS
The prevalence of MRSA, penicillin G-non-susceptible S. pneumoniae, and ampicillin-resistant E. faecium among clinical isolates tested in laboratories remained high. Multidrug resistance was more prevalent among isolates from ICUs. The prevalence of ceftazidime-resistant and amikacin-resistant K. pneumoniae and amikacin-resistant P. aeruginosa decreased after 2005, while the prevalence of imipenem-resistant Acinetobacter spp. increased.

Keyword

Antimicrobial resistance surveillance; KONSAR; Staphylococcus; Acinetobacter; Pseudomonas aeruginosa

MeSH Terms

Acinetobacter*
Amikacin
Cefoxitin
Ceftazidime
Drug Resistance, Multiple
Enterococcus faecium
Epidemiology
Escherichia coli
Humans
Imipenem
Intensive Care Units
Klebsiella pneumoniae
Korea
Methicillin-Resistant Staphylococcus aureus
Penicillins
Pneumonia
Prevalence*
Pseudomonas aeruginosa
Salmonella*
Staphylococcus
Streptococcus pneumoniae
Amikacin
Cefoxitin
Ceftazidime
Imipenem
Penicillins

Figure

• 

  Figure 1 Prevalence of antimicrobial-microorganism combinations detected in isolates from ICU and non-ICU patients in 20 hospitals. CTX-R ECO, cefotaxime-resistant E. coli; CAZ-R KPN, ceftazidime-resistant K. pneumoniae; IPM-R ACI, imipenem-resistant Acinetobacter spp.; IPM-R PAE, imipenem-resistant P. aeruginosa; OXA-R SAU, oxacillin/cefoxitin-resistant S. aureus; VAN-R EFM, vancomycin-resistant E. faecium.

• 

  Figure 2 Resistance rates of isolates tested by hospitals and commercial laboratories. ESBL (+) ECO, ESBL-producing E. coli; ESBL (+) KPN, ESBL-producing K. pneumoniae; IPM-R ACI, imipenem-resistant Acinetobacter spp.; IMP-R PAE, imipenem-resistant P. aeruginosa; OXA-R SAU, oxacillin-resistant S. aureus; VAN-R EFM, vancomycin-resistant E. faecium.

• 

  Figure 3 Trends in resistance of clinically significant Gram-positive cocci isolated from 1997 to 2011 from KONSAR-participating hospitals. OXA-R SAU, oxacillin/cefoxitin-resistant S. aureus; PEN-NS SPN, penicillin G-non-susceptible S. pneumoniae; AMP-R EFM, ampicillin-resistant E. faecium; VAN-R EFM, vancomycin-resistant E. faecium.

• 

  Figure 4 Trends in resistance of K. pneumoniae samples isolated from 1997 to 2011 from KONSAR-participating hospitals. CAZ-R, ceftazidime resistance; FOX-R, cefoxitin resistance; FQN-R, fluoroquinolone resistance; AMK-R, amikacin resistance.

• 

  Figure 5 Trends in resistance of Acinetobacter spp. isolated from 1997 to 2011 from KONSAR-participating hospitals. FQN-R, fluoroquinolone resistance; AMK-R, amikacin resistance; CAZ-R, ceftazidime resistance; IPM-R, imipenem resistance.

• 

  Figure 6 Trends in resistance of P. aeruginosa samples isolated from 1997 to 2011 from KONSAR-participating hospitals. FQN-R, fluoroquinolone resistance; AMK-R, amikacin resistance; CAZ-R, ceftazidime resistance; IPM-R, imipenem resistance.

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