Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Antimicrobial resistance rates changes according to the amount of the antimicrobial agent in clinically important strain isolated from blood cultures

혈액배양에서 분리된 임상적 주요 균주의 항균제사용량에 따른 내성률 변화

  • Kim, Jae-Jung (Department of Laboratory Medicine, St. Mary's Hospital, Daejeon Catholic university)
  • 김재중 (가톨릭대학교 대전성모병원 진단검사의학과)
  • Received : 2016.02.29
  • Accepted : 2016.05.12
  • Published : 2016.05.31
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Abstract

The purpose of the study is to investigate the correlation between the amount of antimicrobial agent (Defined Daily Dose, DDD) and antimicrobial resistance rate (%). The treatment of infectious diseases is becoming increasingly difficult, due to the increase in the number of multi-drug resistant bacteria, making it a clinically significant problem. Among the various factors, antimicrobial abuse is a major cause of antimicrobial resistance. The study was conducted on inpatients in a secondary university hospital in the central region utilizing the hospital's computerized statistical data and microbiological program of laboratory medicine from January 2010 to December 2014 pertaining to the dose of antimicrobial drugs for Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli strains isolated from blood culture. We analyzed the antimicrobial resistance rate per dose with the Pearson correlation coefficient. A significant (positive?) correlation was detected between the cefepime dose and the resistance of E. coli (P<0.033; r=0.907), while a significant negative correlation was found between the tobramycin dose and the resistance of E.coli. (P<0.028; r=-0.917). The aminoglycoside resistance of A. baumannii showed a significant negative correlation (P<0.048; r=-0.881), and the aminoglycoside resistance of E. coli showed a significant negative correlation as well (P<0.001; r=-0.992). In conclusion, the amount of antimicrobial agent (Defined Daily Dose, DDD) (is partly related to) the bacterial strain and its antimicrobial resistance rate (%).

본 논문의 목적은 항균제 사용량(Defined Daily Dose. DDD)과 세균의 내성률(%)과의 상관성을 보고자 하였다. 항균제 내성은 최근 다제 내성균들의 증가로 인하여 감염증의 치료가 점점 더 어려워져 임상적으로 중대한 문제가 되고 있다. 그리고, 여러 요인들 중에서 항균제 오남용은 항균제 내성의 주요 원인이 되고 있다. 중부권지역의 일개 2차 대학병원의 입원환자를 대상으로 병원전산통계 자료와 진단검사의학과의 미생물 프로그램을 이용하여 2010년 1월부터 2014년 12월 까지 혈액배양에서 분리 동정된 Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli 균주에 대하여 항균제 사용량에 따른 균주의 내성률과의 상관성을 분석하기 위하여 균주 내성률과 항균제 사용량을 각각 조사하였다. 사용량에 따른 항균제 내성률은 pearson상관분석을 실시하였다. 그 결과 cefepime사용량과 cefepime 내성 E. coli에서 유의한 상관관계가 있었고(P<0.033;r=0.907), tobramycin사용량과 tobramycin 내성 E.coli에서도 유의한 음의 상관관계가 있었다(P<0.028;r=-0.917). Aminoglycoside계열 내성 A.baumannii가 유의한 음의 상관관계를 나타냈고(P<0.048;r=-0.881), aminoglycoside계열 내성 E. coli도 유의한 음의 상관관계를 나타냈다(P<0.001;r=-0.992). 결론적으로 항균제 사용량은 일부 세균에서 내성률과 상관성이 있었다.

Keywords

References

  1. K. Lee, H. S. Lee, S. J. Jang, A. J. Park, M. H. Lee, W. K. Song, "Antimicrobial resistance surveillance of bacteria in 1999 in Korea with a special reference to resistance of enterococci to vancomycin and gramnegative bacilli to third generation cephalosporin, imipenem, and fluoroquinolone", J Korean Med Sci, 16, 262-270, 2001. DOI: http://dx.doi.org/10.3346/jkms.2001.16.3.262
  2. S. E. Cosgrove, "The relationship between antimicrobial resistance and patient outcomes, mortality, length of hospital stay, and health care costs", Clin Infect Dis, 42(Suppl 2), S82-9, 2006. DOI: http://dx.doi.org/10.1086/499406
  3. J. H. Song, S. I. Jung, K. S. Ko, N. Y. Kim, J. S. Son, H. H. Chang, "High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study)", Antimicrob Agents Chemother, 48, 2101-7, 2004. DOI: http://dx.doi.org/10.1128/AAC.48.6.2101-2107.2004
  4. WHO. "WHO Global Strategy for containment of antimicrobial resistance", 2001.
  5. E. Ayse, C. Aylin, B. Hurrem, A. Mustafa, M. Cevik, H. Samore, E. Onder, "Evaluation of antibiotic use in hospital with an antibiotic restriction policy", International Journal of Antimicrobial Agent, 21, 303-312, 2003.
  6. E. Bergogne-Berein, and K. J. Towner, "Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological feastres", Clin. Microbiol, Rev. 9, 148. 1996.
  7. J. Y. Oh, J. W. Cho, J. C. Park and J. C. Lee, " Molecular typing of Acinetobacter baumannii strains by randomly amplified polymorphic DNA(RAPD) analysis", J. Korean Soc. Microbioa, 35, 129, 2000.
  8. S. J. Oh, S. U. Lee, H. Y. Hwang, I. K. Bae, H. S. Jo, B. H. Lee and S. H. Jeong, "Prevalence of class A extended spectrum-lactamases in clinical isolates of Acinetobacter baumannii and Pseudomonas aeruginosa", Korean J. Lab. Med, 26, 14. 2006. DOI: http://dx.doi.org/10.3343/kjlm.2006.26.1.14
  9. K. O. Park, H. C. Son, K. K. Bae and S. H. Jeong, "Molecular epidemiology of infection caused by OXA-23 or IMP-1 ${\beta}$-lactamase-producing Acinetobacter baumannii", Korean J. Clin. Microbiol, 8, 121. 2005.
  10. K. H. Park, D. L. Kim, "The Correlation between Antimicrobial Use Density and Rate of Bacterial Resistance in a University Hospital over a Six-year Period", J Korean Soc. Chemother, 17, 177-188. 1999.
  11. S. K. Park, M. S. Kim, "Trend of Antimicrobial Susceptibility and Multiple drug Resistance Patterns of Salmonella entericia Serovar Enteritidis Isolation from Foodborne Patients in Seoul between 2001 and 2005", J Food Hygiene and Safety, 21, 23-30. 2006.
  12. I. H. Cha, S. H. Jin, "Serological Distribution and Properties of Antibiotic Resistance of Escherichia coli from Patients with Diarrhea", J Life Science, 10, 262-272. 2000.
  13. H. Goossens, M. Ferech, R. Vander Stichele, M. Elseviers, "Outpatient antibiotic use in Europe and association with resistance: a cross-national database study", Lancet, 365, 579-87. 2005. DOI: http://dx.doi.org/10.1016/S0140-6736(05)70799-6
  14. L. Y. Hsu, T. Y. Tan, V. H. Tam, A. Kwa, D. A. Fisher, T. H. Koh, "Surveillance and correlation of antibiotic prescription and resistance of Gram-negative bacteria in Singaporean hospitals", Antimicrob Agents Chemother, 54, 1173-8. 2010. DOI: http://dx.doi.org/10.1128/AAC.01076-09
  15. N. van de Sande-Bruinsma, H. Grundmann, D. Verloo, E. Tiemersma, J. Monen, H. Goossens, "Antimicrobial drug use and resistance in Europe", Emerg Infect Dis, 14, 1722-30. 2008. DOI: http://dx.doi.org/10.3201/eid1411.070467
  16. S. G. Park, J. H. Jeong, "Antibiotic Susceptibility of Salmonella spp. Isolated From Diarrhoea Patients in Seoul From 1996 to 2001", J Food Hygiene and Safety, 17, 61-70. 2002.
  17. X. Corbella, A. Montero, M. Pujol, M. A. Domiguez, J. Ayats and M. J. Argerich, "emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multi resistant Acinetobacter baumannii", J. Clin. Microbiol, 38, 4086. 2000.
  18. H. Seppala, T. Klaukka, J. Vuopio-Varkila, A. Muotiala, H. Helenius, K. Lager, P. Huoviene, "The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptocococci in Finland. Finnish study group for antimicrobial resistance", N Engl J Med, 337, 441-6, 1997. DOI: http://dx.doi.org/10.1056/NEJM199708143370701
  19. D. J. Austin, K. G. Kristinsson, R. M. Anderson, "The relationship between the volume of antimicrobial consumption in human communities and the frequency of resistance", Proc Natl Acad Sci USA, 96, 1152-6, 1999. DOI: http://dx.doi.org/10.1073/pnas.96.3.1152
  20. A. J. Zillich, J. M. Sutherland, S. J. Wilson, D. J. Diekema, E. J. Ernst, T. E. Vaughn, B. N. Doebbeling, "Antimicrobial use control measures to prevent and control antimicrobial resistance in US hospitals", Infect Control Hosp Epidemiol, 27, 1088-95, 2006. DOI: http://dx.doi.org/10.1086/507963
  21. A. Y. Peleg, H. Seifert, D. L. Paterson, "Acinetobacter baumannii: emergence of a successful pathogen", Clin Micorbiol Rev, 21, 538-82. 2008. DOI: http://dx.doi.org/10.1128/CMR.00058-07
  22. R. M. Mera, L. A. Miller, H. Amrine-Madsen, D. F. Sahm, "Acinetobacter baumannii 2002-2008: increase of carbapenem associated multi-class resistance in the United States", Microb Drug Resist, 16, 209-15. 2010. DOI: http://dx.doi.org/10.1089/mdr.2010.0052
  23. Y. A. Song, S. I. Jung, M. O. Chang, H. J. Ban, N. C. Jin, "Relationship between Antibiotic Use and Antibiotic Resistance in Major Nosocomial Pathogens at a University Hospital", Chonnam Medical Journal, 44(3), 137-143. 2008. DOI: http://dx.doi.org/10.4068/cmj.2008.44.3.137
  24. C. Bantar, E. Vesco, C. Heft, F. Salamone, M. Krayeski, H. Gomez, M. A. Coassolo, A. Fiorillo, D. Franco, C. Arango, F. Duret, M. E. Oliva, "Replacement of broad spectrum cephalosporins by piperacillin-tazobactam impact on sustained high rates of bacterial resistance", Antimicrob Agents Chemother, 48, 392-5, 2004. DOI: http://dx.doi.org/10.1128/AAC.48.2.392-395.2004
  25. Y. K. Yoon, M. J. Kim, J. W. Sohn, "Survillance of Antimicrobial Use and Antimicrobial Resistance", Infect Chemother. 40(2), 93-101. 2008. DOI: http://dx.doi.org/10.3947/ic.2008.40.2.93
  26. D. Guillemot, "How to evaluate and predict the epidemologic impact of antibiotic use in humans: the pharmacoepidemiolgic approach", Clin Microbiol Infect, 7(Suppl 5), 19-23, 2001. DOI: http://dx.doi.org/10.1046/j.1469-0691.2001.00069.x
  27. S. M. Choi, E. J. Park, S. Park, "Antibiotic Consumption and Expenditures for Acute Upper Respiratory Tract Infections in Outpatients", Yakhak Hoeji, 57(3), 199-204, 2013.
  28. S. Park, S. M. Chae, "Quality Assessment of Outpatient Antibiotic Consumptions in Korea Compared with Other Countries", Yakhak Hoeji Vol. 58(3), 200-207, 2014.