J Korean Med Sci.  2023 Mar;38(10):e73. 10.3346/jkms.2023.38.e73.

Changing Epidemiology of Pathogenic Bacteria Over the Past 20 Years in Korea

• Bae MH
• Kim MS
• Kim TS
• Kim S
• Yong D
• Ha GY
• Ryoo NH
• Uh Y
• Shin JH
• Lee HS
• Sohn YH
• Shin S
• Kim MN

• KMID: 2540431
• DOI: http://doi.org/10.3346/jkms.2023.38.e73

Abstract

Background
The epidemiology of pathogenic bacteria varies according to the socioeconomic status and antimicrobial resistance status. However, longitudinal epidemiological studies to evaluate the changes in species distribution and antimicrobial susceptibility of pathogenic bacteria nationwide are lacking. We retrospectively investigated the nationwide trends in species distribution and antimicrobial susceptibility of pathogenic bacteria over the last 20 years in Korea.
Methods
From 1997 to 2016, annual cumulative antimicrobial susceptibility and species distribution data were collected from 12 university hospitals in five provinces and four metropolitan cities in South Korea.
Results
The prevalence of Staphylococcus aureus was the highest (13.1%) until 2012 but decreased to 10.3% in 2016, consistent with the decrease in oxacillin resistance from 76.1% in 2008 to 62.5% in 2016. While the cefotaxime resistance of Escherichia coli increased from 9.0% in 1997 to 34.2% in 2016, E. coli became the most common species since 2013, accounting for 14.5% of all isolates in 2016. Pseudomonas aeruginosa and Acinetobacter baumannii rose to third and fifth places in 2008 and 2010, respectively, while imipenem resistance increased from 13.9% to 30.8% and 0.7% to 73.5% during the study period, respectively. Streptococcus agalactiae became the most common pathogenic streptococcal species in 2016, as the prevalence of Streptococcus pneumoniae decreased since 2010. During the same period, pneumococcal penicillin susceptibility decreased to 79.0%, and levofloxacin susceptibility of S. agalactiae decreased to 77.1% in 2016.
Conclusion
The epidemiology of pathogenic bacteria has changed significantly over the past 20 years according to trends in antimicrobial resistance in Korea. Efforts to confine antimicrobial resistance would change the epidemiology of pathogenic bacteria and, consequently, the diagnosis and treatment of infectious diseases.

Keyword

Epidemiology; Bacteria; Korea; Antimicrobial Resistance; MRSA; Streptococcus agalactiae

Figure

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  Fig. 1 Trend of species distribution of major pathogenic bacteria in (A) total isolates and (B) blood isolates for 20 years from 1997 to 2016.

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  Fig. 2 Correlation between species distribution and antimicrobial resistance of four most prevalent species. (A) Correlation analysis of the E/S ratio and the CREC/MRSA ratio showed strong correlation in total isolates (ρ = 0.947) and moderate correlation with blood isolates (ρ = 0.740). (B) The A/P ratio and the IRAB/IRPA ratio showed moderate correlations in both total (ρ = 0.698) and blood isolates (ρ = 0.777).E/S ratio = ratio of the number of isolates of Escherichia coli to those of Staphylococcus aureus, CREC/MRSA ratio = ratio of % cefotaxime-resistant E. coli to % oxacillin-resistant S. aureus, A/P ratio = ratio of the number of isolates of Acinetobacter baumannii to those of Pseudomonas aeruginosa, IRAB/IRPA ratio = ratio of % imipenem-resistant A. baumannii to % imipenem-resistant P. aeruginosa.

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