전국 주요 병원에서 분리된 호기성 그람음성 간균의 항균제 감수성

Abstract

Background : In Korea aerobic gram-negative bacilli have been reported to be highly resistant to commonly used antimicrobial agents. Recent reports showed increased resistance to third generation cephalosporins, fluoroquinolones or imipenem. However, such studies were mainly performed in tertiary care hospitals. The aim of the study was to compare the resistance patterns in non-tertiary care hospitals with those in tertiary care. Methods : Data were collected from 72 hospitals with over 200 bed capacity from 1994 to 1995. The resistance rates of 30,599 isolates from 67 hospitals were analyzed using WHONET III program. For simplicity, only the resistance rates, not including intermediate resistance, were compared. Results : Among the 13 species, E. coli was the most common isolates (33.2%), followed by P. aeruginosa (23.8%). Isolates of Enterobacteriaceae showed high resistance rates to commonly used drugs: ampicillin (83%), cephalothin (50%), gentamicin (31%), tobramycin(30%), cotrimoxazole (40%), and tetracycline (54%). The mean resistance rates of P. aeruginosa isolates were over 30% to carbenicillin, piperacillin, ticarcillin, gentamicin, tobramycin, and either ciprofloxacin or ofloxacin, but lower to amikacin(26%), aztreonam(17%), ceftazidime(12%), and imipenem(11%). The resistance rates in non-tertiary care hospitals were not significantly different, with the exceptions: E. coli to ciprofloxacin or ofloxacin, 23% in tertiary care hospitals in Seoul vs 13% in non-tertiary care hospitals in non-Seoul area; P. aeruginosa to imipenem, 3% in tertiary cre hospitals in Seoul vs 14~19% in other hospitals with bed capacity of 500 to 1,000. Conclusion : Resistant rates of even E. coli to commonly used drugs are very high in both tertiary and non-tertiary care hospitals. Third generation cephalosporin-resistant E. coli or K. pneumoniae is a problem in non-tertiary care hospitals, too. Ciprofloxacin- or ofloxacin-resistant E. coli are more prevalent in tertiary care hospitals, and the increase of imipenem-resistant P. aeruginosa in some tertiary and non-tertiary care hospitals is a new problem.