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KMID : 1040320150220030178
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Pediatric Infection & Vaccine
2015 Volume.22 No. 3 p.178 ~ p.185
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The Impact of the Antibiotic Burden on the Selection of its Resistance among Gram Negative Bacteria Isolated from Children
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Kim Seo-Hee
Yoo Ree-Nar
Lee Jin-A
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Abstract
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Purpose: We investigated trends in antibiotic pressure and the antibiotic susceptibility of gram negative bacteria isolated from Korean children over 10 consecutive years.
Methods: From January 2004 to December 2013, the antibiotic susceptibility of Klebsiella pneumoniae , Escherichia coli , Pseudomonas aeruginosa , and Acinetobacter baumannii blood isolates obtained from children <18 years of age was determined according to the 2009 Clinical and Laboratory Standards Institute guidelines. Antibiotic consumption data were also analyzed.
Results: The prevalence of K. pneumoniae , E. coli , P. aeruginosa , and A. baumannii bacteremia was 4.6, 3.5, 3.4, and 2.2 cases/1,000 blood cultures/year, respectively. In K. pneumoniae , resistance to the third and fourth cephalosporin did not increase significantly. However, carbapenem-resistant K. pneumoniae first appeared in 2010, and the resistance rate increased to 9% between 2012 and 2013. Resistance to 3rd and 4th cephalosporin increased from 10% to 50% in E. coli , and resistance to carbapenem rose abruptly from 11% to 71% in A. baumannii (P for trend <0.01). However, such an increase of resistance was not observed in P. aeruginosa . There is a positive correlation between the resistance rate of cefepime in E. coli and the consumption of cefepime (r=0.900, P =0.037).
Conclusion: The significant burden of antibiotic consumption and the high prevalence of antibiotic resistance to gram negative pathogen isolated from bacteremic children were observed. Empirical antibiotics should be wisely selected, and continued efforts to decrease the overall antibiotic pressure are mandatory, especially in highly resistant situations.
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KEYWORD
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Gram negative bacteria, Antibiotic resistance, Antibiotic consumption
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