Nationwide surveillance of antimicrobial resistance among Enterobacteriaceae in intensive care units in Taiwan

Abstract

To determine the antimicrobial resistance profiles among clinical isolates of Enterobacteriaceae in Taiwanese intensive care units (ICUs), a national surveillance of antibiotic resistance among important Enterobacteriaceae was conducted from September 2005 through November 2005 at the ICUs of ten major teaching hospitals in Taiwan. A total of 574 Enterobacteriaceae isolates recovered from various clinical samples of our ICU patients were submitted for in vitro test. Minimum inhibitory concentrations (MICs) of these isolates to 18 antimicrobial agents were determined by the broth microdilution method. The prevalences of Enterobacteriaceae isolates with phenotypic extended-spectrum beta-lactamase (ESBL) production were 26% in Klebsiella pneumoniae, 16% in Serratia marcescens, 14% in Escherichia coli, and 13% in Proteus mirabilis, in which a significantly rising prevalence of ESBL production among K. pneumoniae was noted (p = 0.002) when compared with a previous Taiwanese survey in 2000. Heterogeneous resistance to various fluoroquinolones was found among our Enterobacteriaceae isolates, except for Enterobacter cloacae. Emergence of ertapenem-resistant isolates of E. coli, K. pneumoniae, E. cloacae, and S. marcescens was noted. Gradually increasing rates of drug-resistant Enterobacteriaceae were noted in Taiwanese ICUs. Periodic surveillance of the evolutionary trend of antimicrobial resistance among ICU isolates is crucial for starting appropriately empirical antimicrobial therapy in the future.

High burden of antimicrobial resistance in Asia

“…and Escherichia coli, have been shown to have a significant impact on clinical outcome [42]. In Taiwan and Korea, there has been a rapid rise in the prevalence of ESBL-producing strains of E. coli (14% in 2005) and K. pneumoniae (11% in 2000 and 26% in 2005; P = 0.002) in Intensive Care Units [12,43]. Results from the SENTRY Asia-Pacific Surveillance Program conducted during 1998-2002 revealed prominent regional variations in the prevalence of ESBLproducing enteric Gram-negative bacilli, with Singapore, China and the Philippines having the highest prevalence rates [44].…”

“…1) [12,13,45,46]. Although no clinical Enterobacteriaceae strains with KPC carbapenemase (Ambler class A) have been noted in Korea, Japan or Taiwan [43,46], highly drugresistant KPC ␤-lactamase-producing strains have been detected and spread in the USA and China [47,48]. Another notable carbapenemase is NDM-1 (Ambler class B) [14,49,50].…”

Serratia Infections: from Military Experiments to Current Practice

“…All of the ESBLs from this study were identified as CTX-M-3, and 33% of the patients with ESBL-producing S. marcescens died (69). In another study of S. marcescens isolates recovered from several hospitals in 2005 in Taiwan, 16% showed phenotypic ESBL production (resistance to ceftazidime, ceftriaxone, or cefepime); molecular characterization of ESBLs was not conducted (199). Rates of ESBL-producing S. marcescens from South Korea range from 12.4% (72) to 30.6% (214).…”

Carbapenem susceptibility among Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae isolates obtained from patients in intensive care units in Taiwan in 2005, 2007, and 2009

“…The production of ESBL was considered positive if the diameter of the cefepime disk increased by ≥5 mm or the zone expansion was ≥50% of the original size, as suggested by M' Zali et al (2000). After the MIC data to studied carbapenem agents against the isolates of E. coli, K. pneumoniae, and E. cloacae collected in the SMART study in 2005 (Jean et al, 2009(Jean et al, 2013b, and in 2009 (Jean et al, 2013a) were obtained, these data were applied to compare the rates of non-susceptibility to carbapenem agents between CLSI and EUCAST 2013 criteria. The MIC levels of various carbapenem agents for the isolates of respective Enterobacteriaceae spp.…”