J Korean Med Sci. 2023;38(10):e75.

Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study.

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제1저자 김형준 · 교신저자 이연주

PMID 36918029 PMC10010909 DOI 10.3346/jkms.2023.38.e75 IF 3.2 호흡기내과

소속 (5)

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. yjlee1117@snubh.org.

Abstract

BACKGROUND Administration of adequate antibiotics is crucial for better outcomes in sepsis. Because no uniform tool can accurately assess the risk of multidrug-resistant (MDR) pathogens, a local antibiogram is necessary. We aimed to describe the antibiogram of MDR bacteria based on locations of sepsis onset in South Korea.

METHODS We performed a prospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 from 19 institutions (13 tertiary referral and 6 university-affiliated general hospitals) in South Korea. Patients were divided into four groups based on the respective location of sepsis onset: community, nursing home, long-term-care hospital, and hospital. Along with the antibiogram, risk factors of MDR bacteria and drug-bug match of empirical antibiotics were analyzed.

RESULTS MDR bacteria were detected in 1,596 (22.7%) of 7,024 patients with gram-negative predominance. MDR gram-negative bacteria were more commonly detected in long-term-care hospital- (30.4%) and nursing home-acquired (26.3%) sepsis, whereas MDR gram-positive bacteria were more prevalent in hospital-acquired (10.9%) sepsis. Such findings were consistent regardless of the location and tier of hospitals throughout South Korea. Patients with long-term-care hospital-acquired sepsis had the highest risk of MDR pathogen, which was even higher than those with hospital-acquired sepsis (adjusted odds ratio, 1.42; 95% confidence interval, 1.15-1.75) after adjustment of risk factors. The drug-bug match was lowest in patients with long-term-care hospital-acquired sepsis (66.8%).

CONCLUSION Gram-negative MDR bacteria were more common in nursing home- and long-term-care hospital-acquired sepsis, whereas gram-positive MDR bacteria were more common in hospital-acquired settings in South Korea. Patients with long-term-care hospital-acquired sepsis had the highest the risk of MDR bacteria but lowest drug-bug match of initial antibiotics. We suggest that initial antibiotics be carefully selected according to the onset location in each patient.

Keywords

Drug Resistance, Multiple, BacterialEpidemiologic StudiesNursing homesSepsis

Figures

**Fig. 1** Detected multidrug-resistant pathogens according to the onset of sepsis. The prevalence of multidrug-resistant pathogens differed according to the location of sepsis onset: (A) community-acquired, (B) nursing home-acquired, (C) long-term-care hospital-acquired, and (D) hospital-acquired sepsis. Long-term-care hospital- (C) and nursing home-acquired (B) sepsis revealed the highest prevalence, predominantly gram-negative bacteria. MDR = multidrug-resistant.

**Fig. 2** Prevalence of multidrug-resistant pathogen among sepsis patients according to the region and tier of hospitals. Multidrug-resistant pathogens were most predominant in patients with long-term-care hospital-acquired sepsis regardless of the (A) region and (B) tier of each center. The central region of South Korea refers to Seoul, Gyeonggi-do, Gangwon-do, and Chungcheong-do. The southern region of South Korea refers to Jeolla-do and Gyeongsang-do. Numbers indicate the proportion of patients with MDR bacteria. Higher ratios are shown with a darker color. MDR = multidrug-resistant.

**Fig. 3** Prevalence of multidrug-resistant pathogen among sepsis patients according to the primary site of infection. Multidrug-resistant pathogens were most predominant in patients with long-term-care hospital-acquired sepsis regardless of the primary site of infection. Patients with urinary tract infection had the highest rate of MDR gram-negative infection, whereas those with skin or soft tissue infection had the highest rate of MDR gram-positive bacteria. Higher ratios are shown with a darker color. MDR = multidrug-resistant.

**Fig. 4** Drug-bug match according to the onset location of sepsis. Community- (86.4%) and hospital-acquired (83.1%) sepsis had higher rates of drug-bug match, whereas nursing home- (73.9%) and long-term-care hospital-acquired (66.8%) sepsis had much lower results.

그림 출처: PubMed Central 공개 논문 (PMC10010909)

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

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