title: Trends in the distribution and antimicrobial susceptibility of causative pathogens of device-associated infection in Korean intensive care units from 2006 to 2013: results from the Korean Nosocomial Infections Surveillance System (KONIS).
abstract: BACKGROUND
  For all countries, information on pathogens causing healthcare-associated infections is important in order to develop proper strategies for preventing and treating nosocomial infections.
  
  
  OBJECTIVE
  To assess the change in frequencies and antimicrobial resistance of pathogens causing device-associated infections (DAIs) in intensive care units (ICUs) in South Korea between July 2006 and June 2014.
  
  
  METHODS
  Data from the Korean Nosocomial Infections Surveillance System (KONIS) were analysed, including three major DAI types in ICUs.
  
  
  RESULTS
  The frequency of Gram-negative bacteria gradually increased for central line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) (from 24.6% to 32.6% and from 52.8% to 73.5%, respectively). By contrast, the frequency of Gram-positive bacteria decreased from 58.6% to 49.2% for CLABSI, and from 44.3% to 23.8% for VAP (P < 0.001). Staphylococcus aureus was the most frequent causative pathogen in CLABSI throughout the surveillance period, but for VAP was replaced as the most frequent pathogen by Acinetobacter baumannii as of 2010. Candida albicans was the most frequent pathogen for catheter-associated urinary tract infection. The meticillin resistance rate in S. aureus decreased from 95% to 90.2% (P < 0.001); amikacin resistance in Klebsiella pneumoniae and Escherichia coli decreased from 43.8% to 14.7% and from 15.0% to 1.8%, respectively (P < 0.001); imipenem resistance in A. baumannii increased from 52.9% to 89.8% (P < 0.001).
  
  
  CONCLUSIONS
  The proportion of Gram-negative bacteria as nosocomial pathogens for CLABSI and VAP has increased. The prevalence of A. baumannii causing DAIs in Korean ICUs has increased rapidly, as has the rate of carbapenem resistance in these bacteria.
authors.affiliation: Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: SERAN@yuhs.ac.
authors.forename: J Y
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
authors.forename: Y G
authors.initials: YG
authors.lastname: Kwak
authors.affiliation: Infection Control Office, Inje University Sanggye Paik Hospital, Seoul, South Korea.
authors.forename: H
authors.initials: H
authors.lastname: Yoo
authors.affiliation: Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: S-O
authors.initials: SO
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: H B
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Infection Prevention and Control, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, South Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
authors.forename: H Y
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Infection Control Office, Korea University Guro Hospital, Seoul, South Korea.
authors.forename: S R
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, South Korea.
authors.forename: T H
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Kwandong University College of Medicine, Gangneung, South Korea.
authors.forename: H
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Infection Control, Kyunghee University Hospital, Seoul, South Korea.
authors.forename: H K
authors.initials: HK
authors.lastname: Chun
authors.affiliation: Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea.
authors.forename: J-S
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Eulji University School of Medicine, Eulji General Hospital, Seoul, South Korea.
authors.forename: B W
authors.initials: BW
authors.lastname: Eun
authors.affiliation: Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, Ilsan, South Korea.
authors.forename: D W
authors.initials: DW
authors.lastname: Kim
authors.affiliation: Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Osong, South Korea.
authors.forename: H-S
authors.initials: HS
authors.lastname: Koo
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, South Korea.
authors.forename: E-H
authors.initials: EH
authors.lastname: Cho
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: K
authors.initials: K
authors.lastname: Lee
mesh_terms: D002177:Candidiasis / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D062665:Epidemiological Monitoring; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D056910:Republic of Korea / Q000453:epidemiology
keywords: Device-associated infections; Healthcare-associated infection; Pathogen; Resistance; Surveillance