Abstract
To monitor national antimicrobial resistance (AMR), the Korea Global AMR Surveillance System (Kor-GLASS) was established. This study analyzed bloodstream infection (BSI) cases from Kor-GLASS phase I from January 2017 to December 2019. Nine non-duplicated Kor-GLASS target pathogens, including Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp., and Salmonella spp., were isolated from blood specimens from eight sentinel hospitals. Antimicrobial susceptibility testing, AMR genotyping, and strain typing were carried out. Among the 20,041 BSI cases, 15,171 cases were caused by one of the target pathogens, and 12,578 blood isolates were collected for the study. Half (1,059/2,134) of S. aureus isolates were resistant to cefoxitin, and 38.1% (333/873) of E. faecium isolates were resistant to vancomycin. Beta-lactamase-non-producing ampicillin-resistant and penicillin-resistant E. faecalis isolates by disk diffusion method were identified, but the isolates were confirmed as ampicillin-susceptible by broth microdilution method. Among E. coli, an increasing number of isolates carried the blaCTX–M–27 gene, and the ertapenem resistance in 1.4% (30/2,110) of K. pneumoniae isolates was mostly (23/30) conferred by K. pneumoniae carbapenemases. A quarter (108/488) of P. aeruginosa isolates were resistant to meropenem, and 30.5% (33/108) of those carried acquired carbapenemase genes. Over 90% (542/599) of A. baumannii isolates were imipenem-resistant, and all except one harbored the blaOXA–23 gene. Kor-GLASS provided comprehensive AMR surveillance data, and the defined molecular mechanisms of resistance helped us to better understand AMR epidemiology. Comparative analysis with other GLASS-enrolled countries is possible owing to the harmonized system provided by GLASS.
Highlights
The World Health Organization (WHO) has declared that antimicrobial resistance (AMR) is one of the top ten global public health threats, and as a core element of the global action plan to control this menace, the Global AMR Surveillance System (GLASS) was launched in 2015 (World Health Organization [WHO], 2015)
15,171 Bloodstream infection (BSI) cases were caused by nine Kor-GLASS target pathogens, and among those, a total of 12,578 blood isolates were included in this study for further evaluation, of which 2,594 (17.1%) blood isolates were lost due to human error, either by handling errors (n = 2,256) or by microbial cross-contamination (n = 337)
The BSI incidence caused by Gram-negative organisms was 2.6 times greater than that caused by Grampositive organisms, and E. coli was the most common BSI-causing pathogen in this study
Summary
The World Health Organization (WHO) has declared that antimicrobial resistance (AMR) is one of the top ten global public health threats, and as a core element of the global action plan to control this menace, the Global AMR Surveillance System (GLASS) was launched in 2015 (World Health Organization [WHO], 2015). The GLASS is a case-finding-based surveillance system that collates AMR data of major pathogens with clinical data of patients with the infection (World Health Organization [WHO], 2016). As the GLASS manual standardized AMR surveillance research, global AMR monitoring became available for infection-causing bacterial pathogens under a harmonized method carried out by GLASS-enrolled countries (World Health Organization [WHO], 2015). In line with the efforts of the WHO, the Korea Disease Control and Prevention Agency (former Korea Centers for Disease Control and Prevention) established an AMR surveillance system compatible with the GLASS in 2016, which is running under the name Kor-GLASS (Lee et al, 2018a). In addition to the case-finding setup of the GLASS, KorGLASS collected all target bacterial isolates (Lee et al, 2018a). After the successful pilot phase of Kor-GLASS with six sentinel hospitals in 2016, the system was advanced to phase I (2017–2019) through (i) including two more sentinel hospitals for two additional districts, (ii) establishing an independent quality assessment center, and (iii) constructing a web-based data management system
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