革兰阴性杆菌对超广谱头孢菌素、氟喹诺酮类和碳青霉烯类药物的耐药性增加以及肺炎克雷伯菌中碳青霉烯类药物不敏感性的出现：对2013年至2015年韩国抗菌药物耐药性监测系统（KARMS）数据的分析
Increasing Resistance to Extended-Spectrum Cephalosporins, Fluoroquinolone, and Carbapenem in Gram-Negative Bacilli and the Emergence of Carbapenem Non-Susceptibility in Klebsiella pneumoniae: Analysis of Korean Antimicrobial Resistance Monitoring System (KARMS) Data From 2013 to 2015.
作者信息
Kim Dokyun, Ahn Ji Young, Lee Chae Hoon, Jang Sook Jin, Lee Hyukmin, Yong Dongeun, Jeong Seok Hoon, Lee Kyungwon
机构信息
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.
Department of Laboratory Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
出版信息
Ann Lab Med. 2017 May;37(3):231-239. doi: 10.3343/alm.2017.37.3.231.
BACKGROUND
National surveillance of antimicrobial resistance becomes more important for the control of antimicrobial resistance and determination of treatment guidelines. We analyzed Korean Antimicrobial Resistance Monitoring System (KARMS) data collected from 2013 to 2015.
METHODS
Of the KARMS participants, 16 secondary or tertiary hospitals consecutively reported antimicrobial resistance rates from 2013 to 2015. Data from duplicate isolates and institutions with fewer than 20 isolates were excluded. To determine the long-term trends, previous KARMS data from 2004 to 2012 were also considered.
RESULTS
The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium from 2013 to 2015 was 66-72% and 29-31%, respectively. The resistance rates of Escherichia coli to cefotaxime and cefepime gradually increased to 35% and 31%, respectively, and fluoroquinolone resistance reached 48% in 2015. The resistance rates of Klebsiella pneumoniae to cefotaxime, cefepime, and carbapenem were 38-41%, 33-41%, and <0.1-2%, respectively, from 2013 to 2015. The carbapenem susceptibility rates of E. coli and K. pneumoniae decreased from 100% and 99.3% in 2011 to 99.0% and 97.0% in 2015, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenem increased to 35% and the prevalence of carbapenem-resistant Acinetobacter baumannii increased from 77% in 2013 to 85% in 2015.
CONCLUSIONS
Between 2013 and 2015, the resistance rates of E. coli to third- and fourth-generation cephalosporins increased continuously, while carbapenem-susceptibility gradually decreased, particularly in K. pneumoniae. The prevalence of carbapenem-resistant P. aeruginosa and A. baumannii increased significantly; therefore, few treatment options remain for these resistant strains.
背景
全国性的抗菌药物耐药性监测对于控制抗菌药物耐药性和确定治疗指南变得愈发重要。我们分析了2013年至2015年收集的韩国抗菌药物耐药性监测系统（KARMS）数据。
方法
在KARMS的参与者中，16家二级或三级医院连续报告了2013年至2015年的抗菌药物耐药率。来自重复分离株的数据以及分离株少于20株的机构的数据被排除。为了确定长期趋势，还考虑了2004年至2012年的KARMS既往数据。
结果
2013年至2015年，耐甲氧西林金黄色葡萄球菌和耐万古霉素粪肠球菌的患病率分别为66% - 72%和29% - 31%。大肠埃希菌对头孢噻肟和头孢吡肟的耐药率分别逐渐升至35%和31%，2015年氟喹诺酮类耐药率达到48%。2013年至2015年，肺炎克雷伯菌对头孢噻肟、头孢吡肟和碳青霉烯类的耐药率分别为38% - 41%、33% - 41%和<0.1% - 2%。大肠埃希菌和肺炎克雷伯菌的碳青霉烯类药物敏感率分别从2011年的100%和99.3%降至2015年的99.0%和97.0%。铜绿假单胞菌对碳青霉烯类的耐药率升至35%，耐碳青霉烯鲍曼不动杆菌的患病率从2013年的77%升至2015年的85%。
结论
在2013年至2015年期间，大肠埃希菌对第三代和第四代头孢菌素的耐药率持续上升，而碳青霉烯类药物敏感性逐渐下降，尤其是在肺炎克雷伯菌中。耐碳青霉烯铜绿假单胞菌和鲍曼不动杆菌的患病率显著增加；因此，对于这些耐药菌株，可供选择的治疗方案很少。
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