Abstract

Antimicrobial resistance among bacterial pathogens causing urinary tract infection (UTI) is a leading concern, with a high level of Gram-negative organisms resistant to trimethoprim/sulfamethoxazole and fluoroquinolones in Korea. The Korean Association of Urogenital Tract Infection and Inflammation has conducted multicenter surveillance studies for antimicrobial resistance since 2002. The present article reviews the current status of antimicrobial resistance among uropathogens in Korea based on the last 2008 study. Main etiologic pathogens of community-acquired UTI were E. coli (60.0%), E. faecalis (10.2%) and K. pneumoniae (4.1%). Nosocomial pathogens causing UTI were E. coli (38.7%), K. pneumoniae (15.1%) and P. aeruginosa (6.5%). Community-acquired UTIs were divided by uncomplicated UTI and complicated UTI. These are categorized by uncomplicated cystitis, uncomplicated pyelonephritis, complicated UTI with pyelonephritis and complicated UTI without pyelonephritis. Ciprofloxacin resistance rates in community-acquired E. coli were 24.8%, 18.4%, 25.0% and 40.9% for each category, respectively. In contrast, nosocomial E. coli showed higher resistance rate (76.4%) against ciprofloxacin. Among E. coli isolates form uncomplicated cystitis, the resistance rates to TMP/SMX, cefuroxime, cefpodoxime and amikacin were 32.4%, 9.9%, 6.4% and 0.3%, respectively. The concordance rate of the empirical antimicrobial agents were 66.7% in nosocomial UTI and 86.3% in community-acquired UTI. Among E. coli and K. pneumoniae isolates, 9.9% and 22.8% were extended spectrum β-lactamase (ESBL) producers, respectively. These results demonstrated that several uropathogens isolated in Korea have high resistance to various classes of antimicrobial agents. Fluoroquinolone-resistant E. coli and ESBL-producing K. pneumoniae constitute serious problem for UTI in Korea.

• Keywords: Urinary tract infection, Antimicrobial resistance