Ann Lab Med 2017; 37(3): 231-239  
Increasing Resistance to Extended-Spectrum Cephalosporins, Fluoroquinolone, and Carbapenem in Gram-Negative Bacilli and the Emergence of Carbapenem Non-Susceptibility in Klebsiella pneumoniae: Analysis of Korean Antimicrobial Resistance Monitoring System (KARMS) Data From 2013 to 2015
Dokyun Kim, M.D.1, Ji Young Ahn, M.D.2, Chae Hoon Lee, M.D.3, Sook Jin Jang, M.D.4, Hyukmin Lee, M.D.1, Dongeun Yong, M.D.1, Seok Hoon Jeong, M.D.1, and Kyungwon Lee, M.D.1
Department of Laboratory Medicine and Research Institute of Bacterial Resistance1, Yonsei University College of Medicine, Seoul; Department of Laboratory Medicine2, Soonchunhyang University College of Medicine, Cheonan; Department of Laboratory Medicine3, College of Medicine, Yeungnam University College of Medicine, Daegu; Department of Laboratory Medicine4, Chosun University College of Medicine, Gwangju, Korea
Correspondence to: Hyukmin Lee
Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea
Tel: +82-2-2019-3530
Fax: +82-2-2057-8926
Received: July 12, 2016; Revised: September 21, 2016; Accepted: January 24, 2017; Published online: May 1, 2017.
© The Korean Society for Laboratory Medicine. All rights reserved.

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Background: National surveillance of antimicrobial resistance becomes more important for the control of antimicrobial resistance and determination of treatment guidelines. We analyzed Korean Antimicrobial Resistance Monitoring System (KARMS) data collected from 2013 to 2015.
Methods: Of the KARMS participants, 16 secondary or tertiary hospitals consecutively reported antimicrobial resistance rates from 2013 to 2015. Data from duplicate isolates and institutions with fewer than 20 isolates were excluded. To determine the long-term trends, previous KARMS data from 2004 to 2012 were also considered.
Results: The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium from 2013 to 2015 was 66−72% and 29−31%, respectively. The resistance rates of Escherichia coli to cefotaxime and cefepime gradually increased to 35% and 31%, respectively, and fluoroquinolone resistance reached 48% in 2015. The resistance rates of Klebsiella pneumoniae to cefotaxime, cefepime, and carbapenem were 38−41%, 33−41%, and <0.1−2%, respectively, from 2013 to 2015. The carbapenem susceptibility rates of E. coli and K. pneumoniae decreased from 100% and 99.3% in 2011 to 99.0% and 97.0% in 2015, respectively. The resistance rate of Pseudomonas aeruginosa to carbapenem increased to 35% and the prevalence of carbapenem-resistant Acinetobacter baumannii increased from 77% in 2013 to 85% in 2015.
Conclusions: Between 2013 and 2015, the resistance rates of E. coli to third- and fourth-generation cephalosporins increased continuously, while carbapenem-susceptibility gradually decreased, particularly in K. pneumoniae. The prevalence of carbapenem-resistant P. aeruginosa and A. baumannii increased significantly; therefore, few treatment options remain for these resistant strains.
Keywords: Antimicrobial drug resistance, Surveillance, Acinetobacter baumannii, KARMS

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