Antibiotic Resistance Patterns of Enterobacteriaceae Isolated from Patients with Healthcare-Associated Infections
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Background: There have been recent proposals to categorize healthcare-associated infections (HCAIs) separately from community-acquired infections (CAIs). The aim of this study was to compare the antibiotic resistance of pathogens causing CAIs, HCAIs, and hospital-acquired infections (HAIs) in Korea, and to investigate the need for different empirical antibiotics therapy for CAIs and HCAIs. Materials and Methods: This prospective study was conducted in a university hospital between March and December 2019. Inpatients who underwent a bacterial culture within 2 days of hospitalization, with a Enterobacteriaceae strain identified at the infection site and available antibiotic susceptibility results, were included in the analysis. Infections were classified as CAIs, HCAIs or HAIs, depending on the source. Results: Of the 146 patients included in the analysis, the prevalence of fluoroquinoloneresistant Enterobacteriaceae was 18.8%, 38.5%, and 55.0%; the prevalence of pathogens showing third-generation cephalosporins resistance was 8.3%, 50.0%, and 60.0%; and the prevalence of pathogens showing piperacillin-tazobactam resistance was 8.3%, 7.7%, 15.0% in the CAIs, HCAIs, and HAIs groups, respectively. The prevalence of extended-spectrum beta-lactamase-positive pathogens was 6.3%, 47.3%, and 55.0% in the CAIs, HCAIs, and HAIs group, respectively, with no significant difference between the HCAIs and HAIs groups. Resistance patterns of the HCAIs group more closely resembled those of the HAIs group than those of the CAIs group. Conclusion: The pathogens isolated from patients with HCAIs showed resistance patterns that were more similar to those of patients with HAIs than those with CAIs. Thus, CAIs and HCAIs should be distinguished from each other when selecting antibiotic agents.
Abstract
Background: There have been recent proposals to categorize healthcare-associated infections (HCAIs) separately from community-acquired infections (CAIs). The aim of this study was to compare the antibiotic resistance of pathogens causing CAIs, HCAIs, and hospital-acquired infections (HAIs) in Korea, and to investigate the need for different empirical antibiotics therapy for CAIs and HCAIs. Materials and Methods: This prospective study was conducted in a university hospital between March and December 2019. Inpatients who underwent a bacterial culture within 2 days of hospitalization, with a Enterobacteriaceae strain identified at the infection site and available antibiotic susceptibility results, were included in the analysis. Infections were classified as CAIs, HCAIs or HAIs, depending on the source. Results: Of the 146 patients included in the analysis, the prevalence of fluoroquinoloneresistant Enterobacteriaceae was 18.8%, 38.5%, and 55.0%; the prevalence of pathogens showing third-generation cephalosporins resistance was 8.3%, 50.0%, and 60.0%; and the prevalence of pathogens showing piperacillin-tazobactam resistance was 8.3%, 7.7%, 15.0% in the CAIs, HCAIs, and HAIs groups, respectively. The prevalence of extended-spectrum beta-lactamase-positive pathogens was 6.3%, 47.3%, and 55.0% in the CAIs, HCAIs, and HAIs group, respectively, with no significant difference between the HCAIs and HAIs groups. Resistance patterns of the HCAIs group more closely resembled those of the HAIs group than those of the CAIs group. Conclusion: The pathogens isolated from patients with HCAIs showed resistance patterns that were more similar to those of patients with HAIs than those with CAIs. Thus, CAIs and HCAIs should be distinguished from each other when selecting antibiotic agents.
참고문헌 (24)
- Lee H, "Antimicrobial resistance of major clinical pathogens in South Korea, May 2016 to April 2017: first one-year report from Kor-GLASS", Euro Surveill, 23, pp.1800047~ (2018)
- Fasugba O, "Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies", BMC Infect Dis, 15, pp.545~ (2015)
- Cardoso T, "Classification of healthcare-associated infection: a systematic review 10 years after the first proposal", BMC Med, 12, pp.40~ (2014)
- Friedman ND, "Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections", Ann Intern Med, 137, pp.791~797 (2002)
- "National Healthcare Safety Network (NHSN) patient safety component manual"[URL]
- Garner JS, "CDC definitions for nosocomial infections, 1988", Am J Infect Control, 16, pp.128~140 (1988)
- Chalmers JD, "Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study", Clin Infect Dis, 53, pp.107~113 (2011)
- Guimarães C, "Pneumonia associated with health care versus community acquired pneumonia: different entities, distinct approaches", Rev Port Pneumol, 17, pp.168~171 (2011)
- Ha YE, "Clinical implications of healthcare-associated infection in patients with community-onset acute pyelonephritis", Scand J Infect Dis, 43, pp.587~595 (2011)
- Schreiber MP, "Resistant pathogens in nonnosocomial pneumonia and respiratory failure: is it time to refine the definition of health-care-associated pneumonia?", Chest, 137, pp.1283~1288 (2010)
- Giannella M, "Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia", Clin Microbiol Infect, 18, pp.786~794 (2012)
- Siegman-Igra Y, "Reappraisal of community-acquired bacteremia: a proposal of a new classification for the spectrum of acquisition of bacteremia", Clin Infect Dis, 34, pp.1431~1439 (2002)
- Swenson BR, "Choosing antibiotics for intra-abdominal infections: what do we mean by “high risk”?", Surg Infect (Larchmt), 10, pp.29~39 (2009)
- Matlow AG, "Control of antibiotic-resistant bacteria in the office and clinic", CMAJ, 180, pp.1021~1024 (2009)
- Kollef MH, "Epidemiology, microbiology and outcomes of healthcare-associated and community-acquired bacteremia: a multicenter cohort study", J Infect, 62, pp.130~135 (2011)
- Lenz R, "The distinct category of healthcare associated bloodstream infections", BMC Infect Dis, 12, pp.85~ (2012)
- Wu CL, "Antimicrobial drug-resistant microbes associated with hospitalized community-acquired and healthcareassociated pneumonia: a multi-center study in Taiwan", J Formos Med Assoc, 112, pp.31~40 (2013)
- Shorr AF, "Healthcare-associated bloodstream infection:A distinct entity? Insights from a large U.S. database", Crit Care Med, 34, pp.2588~2595 (2006)
- Micek ST, "Health care-associated pneumonia and community-acquired pneumonia: a single-center experience", Antimicrob Agents Chemother, 51, pp.3568~3573 (2007)
- 강철인, "Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections", Infection and Chemotherapy, 50(1), pp.67~100 (2018), 대한감염학회
- Dalhoff A, "Resistance surveillance studies: a multifaceted problem--the fluoroquinolone example", Infection, 40, pp.239~262 (2012)
- Seo YB, "Randomized controlled trial of piperacillin-tazobactam, cefepime and ertapenem for the treatment of urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli", BMC Infect Dis, 17, pp.404~ (2017)
- Holmes AH, "Understanding the mechanisms and drivers of antimicrobial resistance", Lancet, 387, pp.176~187 (2016)
- Kim HY, "Microbiological characteristics of unresolved acute uncomplicated cystitis", Microb Drug Resist, 22, pp.387~391 (2016)