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

Hwang

et al. 2020

Korean J Intern Med

Background/Aims: This study was performed to evaluate trends in antibiotic usage at a tertiary care hospital in Korea. Methods: This study collated antibiotic prescription data and total patient days for inpatients at a tertiary care hospital in Korea between 2004 and 2013. The consumption of each class of antibiotic was converted to def ined daily dose (DDD)/1,000 patient-days. We defined 3rd generation cephalosporins, 4th generation cephalosporins, β-lactam/β-lactamase inhibitors, and fluoroquinolones as broad-spectrum antibiotics; carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin were defined as antibiotics against multidrug-resistant (MDR) pathogens. Other antibiotic classes were defined as nonbroad-spectrum antibiotics. Results: Mean antibiotic consumption was 920.69 DDD/1,000 patient-days. The proportions of broad-spectrum antibiotics, antibiotics against MDR pathogens, and nonbroad-spectrum antibiotics were 41.8% (384.48/920.69), 3.5% (32.24/920.69), and 54.7% (503.97/920.69), respectively. Consumption of broad-spectrum antibiotics (coefficient for time 0.141; p = 0.049) and antibiotics against MDR pathogens (coefficient for time 0.185; p < 0.001) showed a significant increasing trend over the study period. Nonbroad-spectrum antibiotic consumption showed a significant decreasing trend over the study period (coefficient for time-2.601; p < 0.001). Conclusions: Over the 10-year period, a stepwise increase in the consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens was observed at a tertiary care hospital in Korea. Conversely, during the same period, nonbroad-spectrum antibiotic consumption showed a significant decreasing trend.

Section: Discussionsupporting

confidence: 85%

“…35, No. 3, May 2020 rates to FQs were 30% in 2004, increasing to 42% and 34%, respectively, in 2013 [17]. Similarly, the E. coli and K. pneumoniae resistance rate to cefotaxime were 10% and 30%, respectively, in 2004, increasing to 29% and 40%, respectively, in 2013 [17].…”

Section: Discussionmentioning

confidence: 97%

Ten-year trends in antibiotic usage at a tertiary care hospital in Korea, 2004 to 2013

Hwang

et al. 2020

Korean J Intern Med

“…A limitation of this study was that we used ceftazidime in ASC, which could result in the low detection of CTX-M-14 type because the hydrolysis of ceftazidime is lower than that of cefotaxime with this CTX-M type. We could not detect carbapenem-resistant K. pneumoniae; although the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is still low in Korea [18], the recent sharp rise in CRE caused by carbapenemaseproducing Enterobacteriaceae (CPE) has created challenges for infection control in Korea [19]. K. pneumoniae is the most common bacterial type of CPE, carrying various types of carbapenemases, such as K. pneumoniae carbapenemase, New Delhi metalloβ-lactamase, and OXA-type carbapenemases [20].…”

mentioning

confidence: 79%

Prevalence and Risk Factors for Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Colonization in Intensive Care Units

et al. 2020

Self Cite

Active surveillance culture (ASC) can help detect hidden reservoirs, but the routine use of ASC for extended spectrum β-lactamase-producing Enterobacteriaceae is controversial in an endemic situation. We aimed to determine the prevalence and risk factors of extended spectrum β-lactamase-producing Klebsiella pneumoniae (EBSL-Kpn) colonization among intensive care unit (ICU)-admitted patients. Prospective screening of ESBL-Kpn colonization was performed for ICU-admitted patients within 48 hours for two months. A perirectal swab sample was inoculated on MacConkey agar supplemented with 2 μg/mL ceftazidime. ESBL genotype was determined by PCR-sequencing, and clonal relatedness was evaluated by pulsed-field gel electrophoresis (PFGE). The risk factors of ESBL-Kpn colonization were evaluated. The ESBL-Kpn colonization rate among the 281 patients at ICU admission was 6.4% (18/281), and blaCTX-M-15 was detected in all isolates. ESBL producers also showed resistance to fluoroquinolone (38.9%, 7/18). All isolates had the same ESBL genotype (blaCTX-M-15) and a highly clustered PFGE pattern, suggesting cross-transmission without a documented outbreak. In univariate analysis, the risk factor for ESBL-Kpn colonization over the control was the length of hospital stay (odds ratio = 1.062; P = 0.019). Routine use of ASC could help control endemic ESBL-Kpn for ICU patients.

“…of group 1 and CTX-M-14 of group 9 [17], triggers more usage of last options for the treatment resulting in vicious antimicrobial resistance. In South Korea, cefotaxime resistance reached at 38% for E. coli and at 35% for K. pneumoniae clinical isolates in 2015 [18] and it was associated with dominance of both CTX-M-15 and -14 since the mid-2010s [19]. The enterobacterial blood isolate collection of seven-month-period in 2017 presented cefotaxime resistance rates at 31.6% for E. coli and at 24.0% for K. pneumoniae, which were less than those in 2015, probably due to the differed specimens and surveillance systems.…”

Section: Continuing Increase In Ctx-m-type Esbl-producingmentioning

confidence: 99%

Differences in Antimicrobial Resistance Phenotypes by the Group of CTX-M Extended-Spectrum β-Lactamase

et al. 2019

Self Cite

Background: Escherichia coli and Klebsiella pneumoniae clinical isolates producing CTX-M extendedspectrum β-lactamases (ESBLs) were assessed for antimicrobial resistance phenotypes varied by group of enzymes. Methods: A total of 1,338 blood isolates, including 959 E. coli and 379 K. pneumoniae, were studied. All the strains were collected between January and July 2017 from eight general hospitals in South Korea. The species were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antimicrobial susceptibilities were determined by disk diffusion methods and ESBL phenotypes by double-disk synergy tests using disks containing cefotaxime, ceftazidime, cefepime, aztreonam, and clavulanic acid (CA). The genes for β-lactamases were identified by PCR and sequencing. Results: Of total microbes, 31.6% (303/959) E. coli and 24.0% (91/379) K. pneumoniae were resistant to cefotaxime and 28.1% (269/959) E. coli and 20.1% (76/379) K. pneumoniae were CTX-M-type ESBL producers. Among the detected CTX-M ESBLs, 58.0% (156/269) in E. coli and 86.8% (66/76) in K. pneumoniae belonged to group 1, 46.8% (126/269) in E. coli and 14.5% (11/76) in K. pneumoniae were group 9. Ten E. coli and one K. pneumoniae isolates co-produced both groups of CTX-M ESBL. The group 1 CTX-M producers had a higher level of resistance to cefotaxime, ceftazidime, cefepime, and aztreonam and exhibited stronger synergistic activities when combined with CA compared to group 9. Conclusion: ESBL phenotypes differ by CTX-M ESBL group and phenotype testing with drugs including 4 th generation cephalosporins and monobactams is critical for screening CTX-M-producers with better sensitivity. (Ann Clin Microbiol 2019;22:1-8)