Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012: A nationwide multicenter study

Bongyoung Kim, Yeonjae Kim, Hyeonjun Hwang, Jieun Kim, Shin Woo Kim, In Gyu Bae, Wonseok Choi, Sook In Jung, Hye Won Jeong, Hyunjoo Pai

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption. Data on total antibiotic prescriptions, patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad-spectrum antibiotics and carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin as antibiotics against multidrug-resistant (MDR) pathogens. A 15.1% decrease in total antibiotic consumption was observed in 2012 compared to that observed in 2004. In contrast, a 10.2% and 70.7% increase in broad-spectrum antibiotics and antibiotics against MDR pathogens were observed, respectively, in the same period. The resistance rate of Escherichia coli to 3rd CEPs (17.6% in 2004, 21.7% in 2008, and 33.8% in 2012, P <.001) and ciprofloxacin (37.5% in 2004, 38.7% in 2008, and 46.6% in 2012, P = .001) demonstrated a significantly increasing trend. Similarly, the resistance rate of Klebsiella pneumoniae to 3rd CEPs (34.3% in 2004, 33.7% in 2008, and 44.5% in 2012, P <.001) gradually increased. Resistance of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem significantly increased throughout the study period (A baumanii: 8.9% in 2004, 40.8% in 2008, and 65.3% in 2012, P <.001; P aeruginosa: 25.1% in 2004, 31.5% in 2008, and 29.7% in 2008, P = .050). The consumption of carbapenems and FQs demonstrated significant positive correlation for resistance of E coli or K pneumoniae to 3rd CEPs as well as E coli or K pneumoniae to ciprofloxacin. Increasing resistance of A baumanii to ciprofloxacin was significantly correlated with increasing consumption of FQs; increasing resistance of A baumanii to imipenem was significantly correlated with increasing consumption of carbapenems. In conclusion, overall antimicrobial resistance increased and consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens subsequently increased in Korean hospitals.

Original languageEnglish
Article numbere13719
JournalMedicine (United States)
Volume97
Issue number51
DOIs
Publication statusPublished - 2018 Dec 1

Fingerprint

Korea
Microbial Drug Resistance
Multicenter Studies
Anti-Bacterial Agents
Carbapenems
Fluoroquinolones
Ciprofloxacin
Imipenem
Cephalosporins
Escherichia coli
Pneumonia
Polymyxins
Oxazolidinones
Acinetobacter
Glycopeptides
Klebsiella pneumoniae
beta-Lactams
Pseudomonas aeruginosa
Prescriptions
Inpatients

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012 : A nationwide multicenter study. / Kim, Bongyoung; Kim, Yeonjae; Hwang, Hyeonjun; Kim, Jieun; Kim, Shin Woo; Bae, In Gyu; Choi, Wonseok; Jung, Sook In; Jeong, Hye Won; Pai, Hyunjoo.

In: Medicine (United States), Vol. 97, No. 51, e13719, 01.12.2018.

Research output: Contribution to journalArticle

Kim, Bongyoung ; Kim, Yeonjae ; Hwang, Hyeonjun ; Kim, Jieun ; Kim, Shin Woo ; Bae, In Gyu ; Choi, Wonseok ; Jung, Sook In ; Jeong, Hye Won ; Pai, Hyunjoo. / Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012 : A nationwide multicenter study. In: Medicine (United States). 2018 ; Vol. 97, No. 51.
@article{6a881ab57ab34bbbaf0244f40edd5fe6,
title = "Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012: A nationwide multicenter study",
abstract = "The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption. Data on total antibiotic prescriptions, patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad-spectrum antibiotics and carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin as antibiotics against multidrug-resistant (MDR) pathogens. A 15.1{\%} decrease in total antibiotic consumption was observed in 2012 compared to that observed in 2004. In contrast, a 10.2{\%} and 70.7{\%} increase in broad-spectrum antibiotics and antibiotics against MDR pathogens were observed, respectively, in the same period. The resistance rate of Escherichia coli to 3rd CEPs (17.6{\%} in 2004, 21.7{\%} in 2008, and 33.8{\%} in 2012, P <.001) and ciprofloxacin (37.5{\%} in 2004, 38.7{\%} in 2008, and 46.6{\%} in 2012, P = .001) demonstrated a significantly increasing trend. Similarly, the resistance rate of Klebsiella pneumoniae to 3rd CEPs (34.3{\%} in 2004, 33.7{\%} in 2008, and 44.5{\%} in 2012, P <.001) gradually increased. Resistance of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem significantly increased throughout the study period (A baumanii: 8.9{\%} in 2004, 40.8{\%} in 2008, and 65.3{\%} in 2012, P <.001; P aeruginosa: 25.1{\%} in 2004, 31.5{\%} in 2008, and 29.7{\%} in 2008, P = .050). The consumption of carbapenems and FQs demonstrated significant positive correlation for resistance of E coli or K pneumoniae to 3rd CEPs as well as E coli or K pneumoniae to ciprofloxacin. Increasing resistance of A baumanii to ciprofloxacin was significantly correlated with increasing consumption of FQs; increasing resistance of A baumanii to imipenem was significantly correlated with increasing consumption of carbapenems. In conclusion, overall antimicrobial resistance increased and consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens subsequently increased in Korean hospitals.",
author = "Bongyoung Kim and Yeonjae Kim and Hyeonjun Hwang and Jieun Kim and Kim, {Shin Woo} and Bae, {In Gyu} and Wonseok Choi and Jung, {Sook In} and Jeong, {Hye Won} and Hyunjoo Pai",
year = "2018",
month = "12",
day = "1",
doi = "10.1097/MD.0000000000013719",
language = "English",
volume = "97",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "51",

}

TY - JOUR

T1 - Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012

T2 - A nationwide multicenter study

AU - Kim, Bongyoung

AU - Kim, Yeonjae

AU - Hwang, Hyeonjun

AU - Kim, Jieun

AU - Kim, Shin Woo

AU - Bae, In Gyu

AU - Choi, Wonseok

AU - Jung, Sook In

AU - Jeong, Hye Won

AU - Pai, Hyunjoo

PY - 2018/12/1

Y1 - 2018/12/1

N2 - The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption. Data on total antibiotic prescriptions, patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad-spectrum antibiotics and carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin as antibiotics against multidrug-resistant (MDR) pathogens. A 15.1% decrease in total antibiotic consumption was observed in 2012 compared to that observed in 2004. In contrast, a 10.2% and 70.7% increase in broad-spectrum antibiotics and antibiotics against MDR pathogens were observed, respectively, in the same period. The resistance rate of Escherichia coli to 3rd CEPs (17.6% in 2004, 21.7% in 2008, and 33.8% in 2012, P <.001) and ciprofloxacin (37.5% in 2004, 38.7% in 2008, and 46.6% in 2012, P = .001) demonstrated a significantly increasing trend. Similarly, the resistance rate of Klebsiella pneumoniae to 3rd CEPs (34.3% in 2004, 33.7% in 2008, and 44.5% in 2012, P <.001) gradually increased. Resistance of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem significantly increased throughout the study period (A baumanii: 8.9% in 2004, 40.8% in 2008, and 65.3% in 2012, P <.001; P aeruginosa: 25.1% in 2004, 31.5% in 2008, and 29.7% in 2008, P = .050). The consumption of carbapenems and FQs demonstrated significant positive correlation for resistance of E coli or K pneumoniae to 3rd CEPs as well as E coli or K pneumoniae to ciprofloxacin. Increasing resistance of A baumanii to ciprofloxacin was significantly correlated with increasing consumption of FQs; increasing resistance of A baumanii to imipenem was significantly correlated with increasing consumption of carbapenems. In conclusion, overall antimicrobial resistance increased and consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens subsequently increased in Korean hospitals.

AB - The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption. Data on total antibiotic prescriptions, patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad-spectrum antibiotics and carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin as antibiotics against multidrug-resistant (MDR) pathogens. A 15.1% decrease in total antibiotic consumption was observed in 2012 compared to that observed in 2004. In contrast, a 10.2% and 70.7% increase in broad-spectrum antibiotics and antibiotics against MDR pathogens were observed, respectively, in the same period. The resistance rate of Escherichia coli to 3rd CEPs (17.6% in 2004, 21.7% in 2008, and 33.8% in 2012, P <.001) and ciprofloxacin (37.5% in 2004, 38.7% in 2008, and 46.6% in 2012, P = .001) demonstrated a significantly increasing trend. Similarly, the resistance rate of Klebsiella pneumoniae to 3rd CEPs (34.3% in 2004, 33.7% in 2008, and 44.5% in 2012, P <.001) gradually increased. Resistance of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem significantly increased throughout the study period (A baumanii: 8.9% in 2004, 40.8% in 2008, and 65.3% in 2012, P <.001; P aeruginosa: 25.1% in 2004, 31.5% in 2008, and 29.7% in 2008, P = .050). The consumption of carbapenems and FQs demonstrated significant positive correlation for resistance of E coli or K pneumoniae to 3rd CEPs as well as E coli or K pneumoniae to ciprofloxacin. Increasing resistance of A baumanii to ciprofloxacin was significantly correlated with increasing consumption of FQs; increasing resistance of A baumanii to imipenem was significantly correlated with increasing consumption of carbapenems. In conclusion, overall antimicrobial resistance increased and consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens subsequently increased in Korean hospitals.

UR - http://www.scopus.com/inward/record.url?scp=85058907936&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058907936&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000013719

DO - 10.1097/MD.0000000000013719

M3 - Article

C2 - 30572507

AN - SCOPUS:85058907936

VL - 97

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 51

M1 - e13719

ER -