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Observational Study
. 2024 Jan 11;19(1):e0294229.
doi: 10.1371/journal.pone.0294229. eCollection 2024.

Antimicrobial resistance patterns of WHO priority pathogens isolated in hospitalized patients in Japan: A tertiary center observational study

Tania Tabassum Nisa  1 , Daisaku Nakatani  1 , Fumie Kaneko  1 , Toshihiro Takeda  2 , Ken Nakata  1
Affiliations
Observational Study

Antimicrobial resistance patterns of WHO priority pathogens isolated in hospitalized patients in Japan: A tertiary center observational study

Tania Tabassum Nisa et al. PLoS One. .

Abstract

Background: After issuing the "Global action plan on antimicrobial resistance" in 2015, the World Health Organization (WHO) established a priority pathogens list for supporting research and development of novel antimicrobials. We conducted a comprehensive analysis of the WHO priority organisms in a Japanese tertiary hospital to apprehend the local AMR epidemiology.

Methods: Data were obtained from electrical medical records in Osaka University Hospital between January 2010 and March 2021. The critical, high, and medium "priority pathogens list" categories of the WHO were used to compare results between the early (2010-2015) and late (2016-2021) phases.

Results: Out of 52,130 culture-positive specimens, a total of 9,872 (18.9%) contained WHO priority isolates. In comparison to early phases, late phases were likely to have higher rates of carbapenem resistance in Pseudomonas aeruginosa (15.7% vs 25.0%, P<0.001), 3rd generation cephalosporin resistance in Escherichia coli (11.5% vs 17.8%, P<0.001) as well as Klebsiella pneumoniae (1.6% vs 4.4%, P<0.001), and ampicillin resistance in Haemophilus influenzae (2.4% vs 3.9%, P<0.001). After 2015, however, the proportion of methicillin-resistant and vancomycin-intermediate Staphylococcus aureus was low. In this study, in-hospital mortality was comparable among patients with resistance to the three WHO priority pathogen types: critical (5.9%), high (3.9%), and medium (3.8%), and no significant change was observed between two phases in each category. However, significant interactions for in-hospital mortality were observed in subgroup analyses between "critical priority" AMR and the presence of comorbid conditions, such as chronic kidney disease or diabetes mellitus.

Conclusions: To implement better antimicrobial stewardship policies and practices, local priority pathogens and "high-risk" patients for in-hospital death need to be acknowledged and evaluated periodically.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. The percentage of antimicrobial resistance (AMR) in World Health Organization Priority Pathogen List (WHO PPL) isolates from the Osaka University Hospital between January 1, 2010, and March 31, 2021.
Fig 2
Fig 2. Relationship between WHO “critical priority” resistance and in-hospital mortality in various clinical profiles.
See this image and copyright information in PMC

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