국내 지역사회획득 폐렴 원인균의 경험적 항균제에 대한 내성 현황
The Resistance to Empirical Antibiotics among Pathogens Causing Community-Acquired Pneumonia in Korea
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Background : Antibiotic resistance has become a serious threat to manage community-acquired pneumonia (CAP). Despite the rapid emergence of drug-resistant organisms, there are no updated guidelines for the initial antibiotic management of CAP. This study was conducted to investigate the resistance of isolated pathogens to empirical antibiotics consistent with recommendations from the 2009 guidelines on the management of CAP. Methods : A retrospective clinical analysis was conducted, using electronic medical records of the CAP patients, between January 2014 and December 2015, at three teaching hospitals in Korea. The patterns of prescribing empirical antibiotics and the resistance of isolated pathogens to antibiotics were analyzed. Results : A total of 168 patients were analyzed. The most common pathogen was Acinetobacter baumannii (15.5%), followed by Streptococcus pneumoniae (15.5%), Klebsiella pneumoniae (13.1%), Pseudomonas aeruginosa (13.1%), Staphylococcus aureus (11.9%), and Haemophilus influenza (4.8%). A. baumannii exhibited high resistance rates (81-92%) to ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam, while H. influenzae showed high rates (100%) of sensitivity to the drugs. S. pneumoniae had a high level of resistance (91.3%) to azithromycin and a low resistance rate (11.5%) to ceftriaxone. K. pneumoniae and P. aeruginosa showed a high level of sensitivity to ciprofloxacin (90.9% vs. 86.4%) and piperacillin/tazobactam (90% vs. 88.9%). The resistance rate of S. aureus to ciprofloxacin was 65%, while the sensitivity rate of S. pneumoniae to levofloxacin was 96.2%. Conclusion : For the initial antibiotic management of CAP due to A. baumannii, the empirical use of ciprofloxacin, levofloxacin, meropenem, or piperacillin/tazobactam is not recommended. Moreover, azithromycin is inappropriate for empirical antibiotics to treat CAP, due to S. pneumoniae. Routine use of ciprofloxacin for empiric treatment of CAP due to S. aureus should also be avoided.
Abstract
Background : Antibiotic resistance has become a serious threat to manage community-acquired pneumonia (CAP). Despite the rapid emergence of drug-resistant organisms, there are no updated guidelines for the initial antibiotic management of CAP. This study was conducted to investigate the resistance of isolated pathogens to empirical antibiotics consistent with recommendations from the 2009 guidelines on the management of CAP. Methods : A retrospective clinical analysis was conducted, using electronic medical records of the CAP patients, between January 2014 and December 2015, at three teaching hospitals in Korea. The patterns of prescribing empirical antibiotics and the resistance of isolated pathogens to antibiotics were analyzed. Results : A total of 168 patients were analyzed. The most common pathogen was Acinetobacter baumannii (15.5%), followed by Streptococcus pneumoniae (15.5%), Klebsiella pneumoniae (13.1%), Pseudomonas aeruginosa (13.1%), Staphylococcus aureus (11.9%), and Haemophilus influenza (4.8%). A. baumannii exhibited high resistance rates (81-92%) to ciprofloxacin, levofloxacin, meropenem, and piperacillin/tazobactam, while H. influenzae showed high rates (100%) of sensitivity to the drugs. S. pneumoniae had a high level of resistance (91.3%) to azithromycin and a low resistance rate (11.5%) to ceftriaxone. K. pneumoniae and P. aeruginosa showed a high level of sensitivity to ciprofloxacin (90.9% vs. 86.4%) and piperacillin/tazobactam (90% vs. 88.9%). The resistance rate of S. aureus to ciprofloxacin was 65%, while the sensitivity rate of S. pneumoniae to levofloxacin was 96.2%. Conclusion : For the initial antibiotic management of CAP due to A. baumannii, the empirical use of ciprofloxacin, levofloxacin, meropenem, or piperacillin/tazobactam is not recommended. Moreover, azithromycin is inappropriate for empirical antibiotics to treat CAP, due to S. pneumoniae. Routine use of ciprofloxacin for empiric treatment of CAP due to S. aureus should also be avoided.
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