Increasing prevalence of vancomycin-resistant Enterococcus faecium, expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae, and imipenem-resistant Pseudomonas aeruginosa in Korea: KONSAR study in 2001

Abstract

The 5th year KONSAR surveillance in 2001 was based on routine test data at 30 participating hospitals. It was of particular interest to find a trend in the resistances of enterococci to vancomycin, of Enterobacteriaceae to the 3rd generation cephalosporin and fluoroquinolone, and of Pseudomonas aeruginosa and acinetobacters to carbapenem. Resistance rates of Gram-positive cocci were: 70% of Staphylococcus aureus to oxacillin; 88% and 16% of Enterococcus faecium to ampicillin and vancomycin, respectively. Seventy-two percent of pneumococci were nonsusceptible to penicillin. The resistance rates of Enterobacteriaceae were: Escherichia coli, 28% to fluoroquinolone; Klebsiella pneumoniae, 27% to ceftazidime, and 20% to cefoxitin; and Enterobacter cloacae, > or =40% to cefotaxime and ceftazidime. The resistance rates of P. aeruginosa were 21% to ceftazidime, 17% to imipenem, and those of the acinetobacters were > or =61% to ceftazidime, aminoglycosides, fluoroquinolone and cotrimoxazole. Thirty-five percent of non-typhoidal salmonellae were ampicillin resistant, and 66% of Haemophilus influenzae were beta-lactamase producers. Notable changes over the 1997-2001 period were: increases in vancomycin-resistant E. faecium, and amikacin- and fluoroquinolone-resistant acinetobacters. With the increasing prevalence of resistant bacteria, nationwide surveillance has become more important for optimal patient management, for the control of nosocomial infection, and for the conservation of the newer antimicrobial agents.

Fig. 1

The trend of resistance of Staphylococcus isolates to oxacillin and erythromycin, and Enterococcus to ampicillin, and of penicillin G-nonsusceptible S. pneumoniae. OXA, oxacillin; ERY, erythromycin; AMP, ampicillin; PEN, penicillin G; R, resistant; NS, nonsusceptible; SAU, S. aureus; CNS, coagulase-negative Staphylococcus; EFM, E. faecium; SPN, S. pneumoniae.

Fig. 2

The trend of resistance of Enterococcus isolates to vancomycin at large (≥1,000 beds), and medium (<1,000 beds) hospitals. S, Seoul; NS, non-Seoul; Med, medium.

Fig. 3

Trend of resistance of E. coli and H. influenzae isolates to ampicillin, K. pneumoniae to cefoxitin, P. aeruginosa to amikacin, and Acinetobacter spp. to amikacin and imipenem. AMP, ampicillin; AMK, amikacin; FOX, cefoxitin; IMP, imipenem; ECO, E. coli; KPN, K. pneumoniae; ACI, Acinetobacter spp.; PAE, P. aeruginosa; HIN, H. influenzae.

Fig. 4

Trend of resistance of Enterobacteriaceae, P. aeruginosa and Acinetobacter isolates to fluoroquinolone. ECO, E. coli; KPN, K. pneumoniae; ECL, E. cloacae; SMA, S. marcescens; PAE, P. aeruginosa; ACI, Acinetobacter spp.

Fig. 5

Trend of resistance of P. aeruginosa and Acinetobacter isolates to ceftazidime and imipenem at large and medium hospitals. S, Seoul; NS, non-Seoul; Med, medium.