Antimicrobial Susceptibility of Microorganisms Isolated from Patients with Intraabdominal Infection in Korea: a Multicenter Study

Abstract

Background: This study evaluated the antimicrobial susceptibility of pathogens isolated from Korean patients with intraabdominal infections (IAIs). Methods: This multicenter study was conducted at 6 university-affiliated hospitals in Korea between 2016 and 2018. All patients with microbiologically proven IAIs were retrospectively included, while patients with spontaneous bacterial peritonitis or continuous ambulatory peritoneal dialysis peritonitis were excluded. Identification and antimicrobial susceptibility testing were performed using automated microbiology systems. Results: A total of 2,114 non-duplicated clinical isolates were collected from 1,571 patients. Among these pathogens, 510 (24.1%) were isolated from nosocomial infections, and 848 isolates (40.1%) were associated with complicated IAIs. The distribution of the microorganisms included aerobic gram-negative (62.6% of isolates), aerobic gram-positive (33.7%), anaerobic (0.9%), and fungal (2.8%) pathogens. The most common pathogens were Escherichia coli (23.8%), followed by Enterococcus spp. (23.1%) and Klebsiella spp. (19.8%). The susceptibility rates of E. coli and Klebsiella spp. to major antibiotics were as follows: amoxicillin/clavulanate (62.5%, 83.0%), cefotaxime (61.4%, 80.7%), ceftazidime (63.7%, 83.1%), cefepime (65.3%, 84.3%), ciprofloxacin (56.4%, 86.3%), piperacillin/tazobactam (99.0%, 84.8%), amikacin (97.4%, 98.3%), and imipenem (99.8%, 98.8%). The susceptibility rates of Enterococcus spp. to ampicillin were 61.0%, amoxicillin/clavulanate, 63.6%; ciprofloxacin, 49.7%; imipenem, 65.2%; and vancomycin, 78.2%. The susceptibility rates of Pseudomonas aeruginosa and Acinetobacter spp. to imipenem were 77.4% and 36.7%, respectively. Conclusion: Enterococcus spp. with susceptibility to limited antibiotics was one of the main pathogens in Korean IAIs, along with E. coli and Klebsiella spp., which were highly susceptible to imipenem, amikacin, and piperacillin/tazobactam. Meanwhile, the low susceptibilities of E. coli or J Korean Med Sci. 2019 Dec 9;34(47):e309 https://doi.

Predictive value of immune cell counts and neutrophil-to-lymphocyte ratio for 28-day mortality in patients with sepsis caused by intra-abdominal infection

“…IAI is defined as an infection in the abdominal cavity, presenting with the clinical signs of local and systemic inflammation (pain, tenderness, fever, tachycardia and tachypnea) [ 31 , 32 ]. IAIs can be classified according to the time and severity of the infection [ 32 ]. Nosocomial IAIs are defined as infections occurring 48 hours after admission for reasons other than IAI; other IAIs are classified as being of community-onset.…”

Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults

“…According to the results of a multicenter study, in which a total of 2,114 clinical isolates from six participating university hospitals in Korea from 2016 to 2018 were analyzed, aerobic Gram-negative bacteria (62.6%), aerobic Gram-positive bacteria (33.7%), fungi (2.8%), and anaerobic bacteria (0.9%) were commonly isolated, with a high isolation rate of Gram-positive bacteria in healthcare-associated infections ( Fig. 2 ) [ 13 ]. Although it was difficult to identify the causative bacteria of complicated intra-abdominal infections by dividing the them, as these data accounted for the largest proportion of biliary tract infections, the most common causative bacteria were E. coli (23.8%), Enterococcus spp.…”

“…(19.8%) ( Fig. 2 ) [ 13 ]. In E. coli and Klebsiella spp., the proportion of ESBL-producing bacteria was 39.8% and 17.7%, respectively, and the imipenem resistance rate was 0.2% and 1.2%, respectively [ 13 ].…”

“…Revision of antibiotic treatment guidelines for intra-abdominal infections is necessary due to changes in the pathogens that cause the infections, in particular, the increase in antibiotic-resistant strains and the development of new antibiotics. With the recent publication of a multicenter study on the causative pathogens of intra-abdominal infections in Korea [ 13 ], it is intended to propose a new set of guidelines for the use of antibiotics in Korea. The guidelines also aim to serve the purpose of antibiotic stewardship by promoting proper use of antibiotics to reduce abuse or misuse, thereby reducing the induction of antibiotic resistance, costs, and adverse effects while improving the clinical prognosis [ 14 ].…”

Application of Antibiotics and Probiotics for Prevention of Antibiotic-Associated Disbiosis in Patients With Generalized Peritonitis and Enteral Dysfunction Supports Staff Awareness

“…At the present stage, bacteremia is no longer considered as the only decisive component in the diagnosis of abdominal sepsis. It is the high concentration of endotoxins and exotoxins of bacterial cells in the blood that becomes the main factor in the activation of mediator systems, in particular cytokines [12,13]. Among them, TNF, interleukins, system of complement, and interferons play an important role.…”