국내 병원획득 폐렴 원인균의 경험적 항균제에 대한 내성 현황
The Status of Resistance to Empirical Antibiotics Among Pathogens Causing Hospital-Acquired Pneumonia in Busan, Korea
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Background : Although the prevalence of antibiotic resistance may vary according to region, there is no guidance developed in Korea on the use of empirical antibiotics for the treatment of hospitalacquired pneumonia (HAP). The purpose of this study was to investigate the patterns of empiric antibiotic therapy and resistance of the isolated pathogens to the empirical antibiotics in the management of HAP in Korea. Methods : A retrospective analysis was conducted using the electronic medical records of the HAP patients January 2014-December 2015 in Korea. The patterns of prescribing empirical antibiotics and resistance of the isolated pathogens to the empirical antibiotics were examined. Results : A total of 170 patients was analyzed. Piperacillin/tazobactam was the key agent in the empirical antibiotics. The most common pathogen was Staphylococcus aureus (27.9%) followed by Acinetobacter baumannii (21.6%), Klebsiella pneumoniae (11.1%), Pseudomonas aeruginosa (6.3%), Stenotrophomonas maltophilia (5.8%), Enterobacter aerogenes (5.3%), and Escherichia coli (5.3%). The resistance rates of S. aureus to ciprofloxacin was 76%. E. coli had high level of resistance rate to ciprofloxacin (80%) and low resistance rate to imipenem (10%). K. pneumoniae and P. aeruginosa showed very high level of sensitivity to imipenem (100%) and cefepime (91.7%), respectively. To piperacillin/tazobactam, E. coli, E. erogenes, K. pneumoniae, and P. aeruginosa showed high level of sensitivity (52.4-100%). A. baumannii exhibited high-level resistance rates (63.4-85.4%) to the empirical antibiotics, including cefepime, ceftazidime, ciprofloxacin, imipenem, and piperacillin/tazobactam. Conclusion : The empirical antibiotic therapy was appropriate for the initial treatment of HAP owing to the adequate antibiotic coverage. Piperacillin/tazobactam was used in most patients and the most common pathogens including Pseudomonas aeruginosa had high level of sensitivity to the drug. The high level of resistance of A. baumannii to the empirical antibiotics is one of the major challenges in treating HAP.
Abstract
Background : Although the prevalence of antibiotic resistance may vary according to region, there is no guidance developed in Korea on the use of empirical antibiotics for the treatment of hospitalacquired pneumonia (HAP). The purpose of this study was to investigate the patterns of empiric antibiotic therapy and resistance of the isolated pathogens to the empirical antibiotics in the management of HAP in Korea. Methods : A retrospective analysis was conducted using the electronic medical records of the HAP patients January 2014-December 2015 in Korea. The patterns of prescribing empirical antibiotics and resistance of the isolated pathogens to the empirical antibiotics were examined. Results : A total of 170 patients was analyzed. Piperacillin/tazobactam was the key agent in the empirical antibiotics. The most common pathogen was Staphylococcus aureus (27.9%) followed by Acinetobacter baumannii (21.6%), Klebsiella pneumoniae (11.1%), Pseudomonas aeruginosa (6.3%), Stenotrophomonas maltophilia (5.8%), Enterobacter aerogenes (5.3%), and Escherichia coli (5.3%). The resistance rates of S. aureus to ciprofloxacin was 76%. E. coli had high level of resistance rate to ciprofloxacin (80%) and low resistance rate to imipenem (10%). K. pneumoniae and P. aeruginosa showed very high level of sensitivity to imipenem (100%) and cefepime (91.7%), respectively. To piperacillin/tazobactam, E. coli, E. erogenes, K. pneumoniae, and P. aeruginosa showed high level of sensitivity (52.4-100%). A. baumannii exhibited high-level resistance rates (63.4-85.4%) to the empirical antibiotics, including cefepime, ceftazidime, ciprofloxacin, imipenem, and piperacillin/tazobactam. Conclusion : The empirical antibiotic therapy was appropriate for the initial treatment of HAP owing to the adequate antibiotic coverage. Piperacillin/tazobactam was used in most patients and the most common pathogens including Pseudomonas aeruginosa had high level of sensitivity to the drug. The high level of resistance of A. baumannii to the empirical antibiotics is one of the major challenges in treating HAP.
참고문헌 (13)
- Report on the cause of death statistics, "KOSIS", ~
- Kalil AC, "Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society", Clin Infect Dis, 63(5), pp.e61~e111 (2016)[DOI]
- 송재훈, "항생제 내성의 국내 현황 및 대책", 대한내과학회지, 77(2), pp.143~151 (2009), 대한내과학회
- Montravers P, "Current and Future Considerations for the Treatment of Hospital-Acquired Pneumonia", Adv Ther, 33(2), pp.151~166 (2016)[DOI]
- Zilberberg MD, "Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis", Crit Care, 20(1), pp.221~ (2016)[DOI]
- Ibrahim EH, "A comparative analysis of patients with earlyonset vs late-onset nosocomial pneumonia in the ICU setting", Chest, 117(5), pp.1434~1442 (2000)[DOI]
- American Thoracic Society, "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia", Am J Respir Crit Care Med, 171(4), pp.388~416 (2005)[DOI]
- Antimicrobial resistance: global report on surveillance 2014, "World Health Organization", ~
- Gastmeier P, "Early- and late-onset pneumonia: is this still a useful classification?", Antimicrob Agents Chemother, 53(7), pp.2714~2718 (2009)[DOI]
- "A press release"[URL]
- 이경원, "Increase of Ceftazidime- and Fluoroquinolone-Resistant Klebsiella pneumoniae and Imipenem-Resistant Acinetobacter spp. in Korea: Analysis of KONSAR Study Data from 2005 and 2007", Yonsei Medical Journal, 51(6), pp.901~911 (2010), 연세대학교의과대학
- 박혜진, "단일기관 내 소아에서 Acinetobacter baumannii의 감염현황의 분석", Pediatric Infection and Vaccine, 18(1), pp.23~30 (2011), 대한소아감염학회
- Munoz-Price LS, "Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases", Lancet Infect Dis, 13(9), pp.785~796 (2013)[DOI]