[Show abstract][Hide abstract] ABSTRACT: Longitudinal nationwide data on antimicrobial susceptibility in Proteus mirabilis from different sources are rare. The effects of the revised Clinical and Laboratory Standards Institute (CLSI) beta-lactam breakpoints on susceptibility rates and on detecting extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase-producers in this species are also seldom evaluated. The present study analyzed data from the Taiwan Surveillance of Antimicrobial Resistance program to address these issues.
[Show abstract][Hide abstract] ABSTRACT: We characterized Salmonella enterica serovar Typhi isolates from Bangladesh, Indonesia, Taiwan and Vietnam to investigate their genetic relatedness and antimicrobial resistance. The isolates from Bangladesh and Vietnam were genetically closely related but distant from those from Indonesia and Taiwan. All but a few isolates from Indonesia and Taiwan were susceptible to all antimicrobials tested. The majority of isolates from Bangladesh and Vietnam were multidrug resistant (MDR) and belonged to the widespread haplotype H58 clone. IncHI1 plasmids were detected in all MDR S. Typhi from Vietnam but in only 15% of MDR isolates from Bangladesh. Resistance genes in the majority of MDR S. Typhi from Bangladesh should reside in the chromosome. Of the isolates from Bangladesh, 82% and 40% isolates were resistant to varying concentrations of nalidixic acid and ciprofloxacin, respectively. Several resistance mechanisms including alterations in gyrase A, the presence of QnrS and enhanced efflux pumps were involved in the reduced susceptibility and resistance to fluoroquinolone. Intensive surveillance is necessary to monitor the spread of the chromosome-mediated MDR and fluoroquinolone-resistant S. Typhi emerging in Bangladesh.
Antimicrobial Agents and Chemotherapy 08/2014; · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Levofloxacin resistance in Haemophilus influenzae has increased significantly in Taiwan, from 2.0% in 2004 to 24.3% in 2010 (p<0.001). Clinical and molecular investigations of 182 levofloxacin-resistant isolates revealed that the increase was mainly the result of the spread of several clones in the elderly population in different regions.
[Show abstract][Hide abstract] ABSTRACT: A prospective, cross-sectional study was conducted at a medical center in central Taiwan to understand the prevalence, associated factors, and microbiologic features for oropharyngeal yeast colonization in human immunodeficiency virus-infected outpatients. Oral yeast colonization was detected in 127 (45 %) patients, including 21 (16.5 %) colonized by more than one species. Of the 154 isolates, Candida albicans was the most common species (114, 74 %), followed by Candida dubliniensis (10, 6.5 %), Candida glabrata (10, 6.5 %), Candida tropicalis (7, 4.5 %), and 13 others. We found that receiving antituberculous drug (p = 0.046) or atazanavir (p = 0.045) was two predictors for patients colonized by non-C. albicans species (p = 0.005) and risking mixed yeast colonization (p = 0.009). Even though our data showed that clinical antifungal drugs remained effective in vitro against the colonizing yeasts, the increased mixed yeast colonization indicates a potential issue for controlling mixed infections in hospital settings.
[Show abstract][Hide abstract] ABSTRACT: Background
The prevalence and clinical impact on mortality of carbapenem-resistant Pseudomonas aeruginosa (CRPA) is unclear in Taiwan. We aim to clarify these clinical issues by using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program.
Patients from five hospitals with their P. aeruginosa isolates collected by TSAR II-VII (2000–2010) program were considered as the potential study population. All patients with CRPA were enrolled as case patients. Patients with carbapenem-susceptible P. aeruginosa were randomly selected in a 1:1 ratio to case patients as control patients. CRPA isolates were tested for the presence of carbapenemase-producing genes. The clinical data were collected to identify risk factors for CRPA carriage and mortality of P. aeruginosa infection.
The overall prevalence of CRPA was 10.2% (349/3408), which increased significantly by the TSAR period (p = 0.007). Among the 164 enrolled patients, the risk factor for carrying CRPA was previous fluoroquinolone exposure (p = 0.004). The risk factors for mortality among 80 patients with infection by P. aeruginosa included: intensive care unit (ICU) setting, receipt of antifungal therapy, and presence of invasive devices (p = 0.001, 0.010, and 0.017; respectively). Carbapenem resistance did not play a role. Among the 82 CRPA isolates enrolled in this study, 15 isolates were found to carry carbapenemase-producing genes.
In Taiwan, the prevalence of CRPA and carriage of carbapenemase-producing genes was high. However, carbapenem resistance did not play a role in the mortality of patients with P. aeruginosa infections.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 01/2014; · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background/Purpose
After community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was identified, new community-onset, healthcare-associated MRSA (HA-MRSA-CO) infections have been noticed as MRSA infection in patients with community-onset infection who have underlying conditions resulting in frequent exposure to the healthcare system. However, previous studies have not thoroughly investigated whether HA-MRSA-CO has characteristics resembling those of CA-MRSA or hospital-onset, healthcare-associated MRSA (HA-MRSA-HO) infection.
A multicenter, retrospective study was conducted to analyze the clinical and microbiological data of patients with clinical isolates of MRSA from nine hospitals in Taiwan.
In total, 203 patients with MRSA isolates, including 27 patients with CA-MRSA (13.3%), 59 with HA-MRSA-CO (29.1%), and 117 with HA-MRSA-HO (57.6%), were studied. Compared to HA-MRSA-HO isolates, the CA-MRSA and HA-MRSA-CO isolates were associated with a higher proportion of skin and soft tissue infections (81.8% and 65.3% vs. 40.5%, p = 0.001 and p = 0.002) as well as lesser rate of resistance to ciprofloxacin (33.3% and 50.9% vs. 74.4%, p < 0.001 and p = 0.002), gentamicin (44.4% and 64.4% vs. 84.6%, p < 0.001 and p = 0.002), and trimethoprim/sulfamethoxazole (33.3% and 42.4% vs. 58.1%, p = 0.02 and p = 0.048), and a lower 30-day all-cause mortality rate (7.4% and 0% vs. 20.9%, p < 0.001). Most of the CA-MRSA isolates were classified as staphylococcal cassette chromosome mec (SCCmec) type VT (11/27, 40.7%), whereas most HA-MRSA-HO isolates were classified as SCCmec type III (66/117, 56.4%).
The CA-MRSA, HA-MRSA-CO, and HA-MRSA-HO clinical isolates significantly differed in their clinical presentations and molecular characteristics.
Journal of the Formosan Medical Association. 01/2014; 113(7):409–416.
[Show abstract][Hide abstract] ABSTRACT: We collected 110 Salmonella enterica isolates from sick pigs and determined their serotypes, genotypes using pulsed-field gel electrophoresis (PFGE), and antimicrobial susceptibility to 12 antimicrobials and compared the data with a collection of 18,280 isolates obtained from humans. The pig isolates fell into 12 common serovars for human salmonellosis in Taiwan; S. Typhimurium, S. Choleraesuis, S. Derby, S. Livingstone, and S. Schwarzengrund were the 5 most common serovars and accounted for a total of 84% of the collection. Of the 110 isolates, 106 (96%) were multidrug resistant (MDR) and 48 (44%) had PFGE patterns found in human isolates. S. Typhimurium, S. Choleraesuis, and S. Schwarzengrund were among the most highly resistant serovars. The majority of the 3 serovars were resistant to 8-11 of the tested antimicrobials. The isolates from pigs and humans sharing a common PFGE pattern displayed identical or very similar resistance patterns and Salmonella strains that caused severe infection in pigs were also capable of causing infections in humans. The results indicate that pigs are one of the major reservoirs to human salmonellosis in Taiwan. Almost all of the pig isolates were MDR, which highlights the necessity of strictly regulating the use of antimicrobials in the agriculture sector in Taiwan.
PLoS ONE 01/2014; 9(4):e95772. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our multicenter nationwide surveillance data indicated that erythromycin (ERY)-resistance among Group A Streptococcus (GAS) in Taiwan declined from 53.1% in 1998-2000 to 14.6% in 2002-2004 and 10.7% in 2006-2010 (p <0.01). The present study aimed to assess the epidemiology of GAS in Taiwan and identify factors associated with ERY-resistance. All 127 ERY-resistant (ERY-R) and 128 randomly selected ERY-susceptible (ERY-S) isolates from 1998-2010 were emm typed. ERY-R isolates were also characterized by ERY-resistance phenotype and mechanisms, and pulsed-field gel electrophoresis (PFGE). Multilocus sequence typing was performed on selected ERY-R isolates. The predominant emm types in ERY-R isolates were emm22 (33, 26.0%), emm12 (24, 18.9%), emm4 (21, 16.5%), and emm106 (15, 11.8%). In ERY-S isolates, emm12 (27, 21.9%), emm1 (18, 14.1%), emm106 (16, 12.5%), and emm11 (9, 7.1%) predominated. The most common ERY-resistance phenotype was M (70.9%) with all but one carrying mef(A), followed by cMLSB (26.8%) carrying erm(B) or erm(TR). ERY-R isolates of the emm12-ST36 lineage with the cMLSB phenotype was mostly present before 2004 while emm22-ST46 with the M phenotype predominated in later years. Recovery from respiratory (throat) specimens was an independent factor associated with ERY-resistance. The emm1 and emm11 isolates were significantly associated with ERY-S GAS while emm22 was detected only in ERY-R GAS. In addition, emm106 isolates were prevalent in abscess/pus isolates whereas emm12 isolates were strongly associated with respiratory (throat) origin. In addition to identifying factors associated with ERY-resistance in GAS, our study provides helpful information on the changing GAS epidemiology in Taiwan.
Journal of clinical microbiology 12/2013; · 4.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Genetic determinants of a blaNDM-1-positive, multidrug-resistant bacterial isolate that caused active infection was investigated by DNA sequencing. Two plasmids, pKOX_NDM1 and pKOX-R1, were identified for the Klebsiella oxytoca strain E718. Sequence annotation revealed a blaNDM-1 gene in pKOX_NDM1 and two extended-spectrum-β-lactamase producers (blaCTX-M-3 and blaSHV-12) plus a wide array of resistance genes in pKOX-R1. These findings highlight the difficulty in treating multidrug-resistant bacterial infections and the potential danger of emerging resistant enterobacteria.
Antimicrobial Agents and Chemotherapy 06/2013; · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Serratia marcescens is an important nosocomial pathogen and the characteristic property of resistance conferred by extended-spectrum beta-lactamase or a novel AmpC cephalosporinase was not unusual in Taiwan. This study investigated the trends in antimicrobial resistance in S. marcescens from a nationwide surveillance in Taiwan. MATERIALS AND METHODS: S. marcescens isolates were collected biennially between 2002 and 2010 from medical centers and regional hospitals throughout Taiwan, as part of the Taiwan Surveillance of Antimicrobial Resistance program. Minimal inhibitory concentrations were determined by the Clinical and Laboratory Standards Institute reference broth microdilution method. RESULTS: A total of 403 nonduplicate S. marcescens isolates were collected, mostly from respiratory samples (157, 39.0%), followed by the urinary tract samples (90, 22.3%). Overall, 99.3% isolates were susceptible to imipenem, 93.8% to ceftazidime, 89.2% to minocycline, 87.8% to amikacin, 86.8% to cefepime, 82.9% to aztreonam, 73.2% to ceftriaxone, 72.7% to levofloxacin, 63.8% to ciprofloxacin, 60.8% to trimethoprim/sulfamethoxazole (TMP/SMX), and 59.6% to gentamicin. A significantly increased susceptibility rate after 2004 was observed for the following antibiotics: amikacin (73.8% vs. 97.1%), gentamicin (40.0% vs. 72.4%), ciprofloxacin (53.8% vs. 70.4%), ceftriaxone (53.8% vs. 86.0%), cefepime (74.4% vs. 95.1%), aztreonam (72.5% vs. 89.7%), and TMP/SMX (41.3% vs. 73.7%). CONCLUSION: In this 8-year study, the susceptibility of S. marcescens to ceftazidime and imipenem remained consistently high in Taiwan. S. marcescens isolates demonstrated relatively higher resistance to ciprofloxacin and levofloxacin, and therefore continued surveillance of antimicrobial resistance, especially for fluoroquinolone, is warranted.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013; · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Emerging carbapenem resistance among Acinetobacter baumannii clinical isolates is a worldwide problem. Infections caused by A. baumannii are increasing and demonstrate high mortality rates. This study aimed to establish a nationwide surveillance of antimicrobial susceptibility, carbapenemase genes, and clonal relationships of A. baumannii clinical isolates in Taiwan. METHODS: Clinical isolates of Acinetobacter calcoaceticus-A. baumannii (ACB) complex collected by the Taiwan Surveillance of Antimicrobial Resistance-V program between July 2006 and September 2006 were used in this study. Genospecies identification was verified by 16S-23S rRNA intergenic-spacer sequences. Carbapenemase genes were detected by polymerase chain reaction. Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) was applied for identification of clonal relationships. RESULTS: Among the 151 ACB-complex isolates collected, 134 (88.7%) were A. baumannii, 12 (8.0%) were A. pittii, and five (3.3%) were A. nosocomialis. A. baumannii isolates showed higher resistance rates to ciprofloxacin, amikacin, and ampicillin/sulbactam than A. pittii or A. nosocomialis (all p < 0.001). The most commonly detected carbapenemase genes were blaOxA-51 (n = 135), followed by blaOxA-24 (n = 4), blaOxA-23 (n = 2), and blaOxA-58 (n = 1). Three major A. baumannii clones were found throughout Taiwan, and showed significantly higher resistance rates to ciprofloxacin, amikacin, and ampicillin/sulbactam than the other A. baumannii isolates (100% vs. 68.7%, p < 0.001; 98.4% vs. 61.5%, p < 0.001; and 66.7% vs. 39.8%, p = 0.004; respectively). MLST showed that these major clones were sequence type 2 and belonged to international clonal complex 2. CONCLUSIONS: Our results demonstrate clonal spreading of A. baumannii in Taiwan hospitals and that these clones were more resistant to many antimicrobial agents. Efforts to prevent and control A. baumannii colonization/infections and prudent use of antibiotics to reduce antimicrobial selective pressure should be emphasized.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013; · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Longitudinal national data on resistance in Enterococcus faecalis and E. faecium from different sources in Taiwan are rare. The present study analyzed data from the Taiwan Surveillance of Antimicrobial Resistance program to address this issue. Between 2002 and 2010, a total of 1696 E. faecalis and 452 E. faecium isolates were studied. Although these 2 species together comprised similar percentages of all enterococci in each study year (94.1-97.2%, P = 0.19), the proportion of E. faecium increased from 12.4% in 2002 to 27.3% in 2010 (P < 0.001). The most noteworthy change in susceptibilities of these 2 species was vancomycin resistance in E. faecium (VREfm), which increased from 0.3% in 2004 to 24.9% in 2010 (P < 0.001). VREfm prevalence differed significantly between geographic regions, patient age groups, and locations. Multidrug resistance was very common in both species even in isolates from outpatients (82.7% for E. faecalis and 98.1% for E. faecium), at rates similar to those from intensive care unit (ICU) and non-ICU patients (80.5-80.9% in E. faecalis and 97.2-98.6% in E. faecium). Nonsusceptibility to linezolid was <0.5% in both species. All tested isolates were susceptible to daptomycin. Continuous surveillance of VRE prevalence and survey of community reservoirs of multidrug-resistant enterococci are warranted.
Diagnostic microbiology and infectious disease 02/2013; · 2.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acute bacterial pericarditis is a rare but devastating complication of Staphylococcus aureus bacteremia (SAB). We herein describe the case of a previously healthy 81-year-old woman with SAB complicated by pericarditis that evolved into cardiac tamponade despite the administration of optimal antimicrobial therapy for 11 days. Three adhesion factor genes, fnbA, clfA and clfB, were identified in the causative isolate.
Internal Medicine 01/2013; 52(3):389-391. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The genetic features of the antimicrobial resistance of a multidrug resistant Klebsiella pneumoniae strain harboring bla NDM-1 were investigated to increase our understanding of the evolution of NDM-1. The strain, KPX, came from a Taiwanese patient with a hospitalization history in New Delhi. Complete DNA sequencing was performed; and the genes responsible for antimicrobial resistance were systematically examined and isolated by library screening. KPX harbored two resistance plasmids, pKPX-1 and pKPX-2, which are 250-kb and 141-kb in size, respectively, with bla NDM-1 present on pKPX-1. The plasmid pKPX-1 contained genes associated with the IncR and IncF groups, while pKPX-2 belonged to the IncF family. Each plasmid carried multiple antimicrobial resistance genetic determinants. The gene responsible for resistance to carbapenems was found on pKPX-1 and that for resistance to aztreonam was found on pKPX-2. To our surprise, we discovered that bla NDM-1 exists on pKPX-1 as multiple copies in the form of tandem repeats. Amplification of bla NDM-1 was found to occur by duplication of an 8.6-kb unit, with the copy number of the repeat varying from colony to colony. This repeat sequence is identical to that of the pNDM-MAR except for two base substitutions. The copy number of bla NDM-1 of colonies under different conditions was assessed by Southern blotting and quantitative PCR. The bla NDM-1 sequence was maintained in the presence of the antimicrobial selection; however, removal of antimicrobial selection led to the emergence of susceptible bacterial populations with a reduced copy number or even the complete loss of the bla NDM-1 sequence. The dynamic nature of the NDM-1 sequence provides a strong argument for judicious use of the broad-spectrum antimicrobials in order to reduce the development and spread of antimicrobial resistance among pathogens.
PLoS ONE 01/2013; 8(4):e62774. · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the complete genome sequence of Z172, a representative strain of sequence type 239-staphylococcal cassette chromosome mec type III (ST239-SCCmec type III) hospital-associated methicillin-resistant Staphylococcus aureus in Taiwan. Strain Z172 also exhibits a vancomycin-intermediate and daptomycin-nonsusceptible phenotype.
[Show abstract][Hide abstract] ABSTRACT: Salmonella enterica serovar Typhimurium is a major zoonotic pathogen with a high prevalence of antimicrobial resistance. This pathogen can disseminate across borders and spread far distances via the food trade and international travel. In this study, we compared the genotypes and antimicrobial resistance of 378 S. Typhimurium isolates collected in Taiwan and Denmark between 2009 and 2010. Genotyping revealed that many S. Typhimurium strains were concurrently circulating in Taiwan, Denmark and other countries in 2009 and 2010. When compared to the isolates collected from Denmark, the isolates from Taiwan displayed a significantly higher level of resistance to 11 of the 12 tested antimicrobials. Seven genetic clusters (A-G) were designated for the isolates. A high percentage of the isolates in genetic clusters C, F and G were multidrug-resistant. Of the isolates in cluster C, 79.2% were ASSuT-resistant, characterized by resistance to ampicillin, streptomycin, sulfamethoxazole, and tetracycline. In cluster F, 84.1% of the isolates were ACSSuT-resistant (resistant to ASSuT and chloramphenicol). Cluster G was unique to Taiwan and characterized in most isolates by the absence of three VNTRs (ST20, ST30 and STTR6) as well as a variety of multidrug resistance profiles. This cluster exhibited very high to extremely high levels of resistance to several first-line drugs, and among the seven clusters, it displayed the highest levels of resistance to cefotaxime and ceftazidime, ciprofloxacin and gentamicin. The high prevalence of antimicrobial resistance in S. Typhimurium from Taiwan highlights the necessity to strictly regulate the use of antimicrobials in the agriculture and human health care sectors.
International journal of food microbiology 12/2012; 161(2):69-75. · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We report the complete genome sequence of Klebsiella oxytoca E718, a New Delhi metallo-β-lactamase-1 (NDM-1)-producing strain isolated from a renal transplant patient. The genome contains a 6,097,032-bp chromosome and two multidrug resistance plasmids with sizes of 324,906 bp and 110,781 bp.
Journal of bacteriology 10/2012; 194(19):5454. · 3.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Streptococcus pneumoniae is one of the leading pathogens causing community-acquired infection with high mortality rates in elderly patients. Emerging antibiotic resistance was found in past decades. Continuous surveillance to monitor changes in antibiotic resistance of S pneumoniae and associated risk factors are important clinical issues. METHODS: Isolates of S pneumoniae collected from six hospitals participating in the Taiwan Surveillance of Antimicrobial Resistance (TSAR) program III (2002) - VI (2008) were enrolled in this study. Bacterial susceptibilities were determined by minimum inhibitory concentration. The clinical data of source patients were collected retrospectively. RESULTS: A total of 330 nonduplicate S pneumoniae isolates were enrolled in this study. Sputum was the most common specimen source, followed by pus. The mean age of the source patients was 38 years among these 330 patients, and 247 had various infections caused by S pneumoniae. The overall in-hospital mortality rate was 6% and most (60%)of the mortality occurred in patients older than 65 years. The mortality rates among the patients age 65 years and older and those age 5 years and younger were 12.9% (9 of 70) and 2.4% (2 of 83), respectively. The rates of nonsusceptibility to penicillin by the meningitis criteria (PNSP-M) were 69.0% in 2002, 81.0% in 2004, 73.7% in 2006, and 74.5% in 2008. Resistance to erythromycin and trimethoprim/sulfamethoxazole remained high. Using multivariate analysis, patients with PNSP isolates were more likely to have a history of antibiotic exposure within the previous 15 days compared with patients with penicillin-susceptible (PSSP) isolates (nonmeningitis criteria: 29.70% vs. 18.34%, p = 0.0288; meningitis criteria: 25.30% vs. 9.88%, p = 0.006). Shock at presentation was the risk factor for in-hospital mortality. CONCLUSION: Our study demonstrated that the rates of penicillin nonsusceptibility among S pneumoniae remained high in Taiwan during the study period. Previous antibiotic exposure was the only risk factor for subsequent acquisition of penicillin- nonsusceptible S pneumoniae compared with penicillin-susceptible S pneumoniae. Judicious antibiotic use is important to control the spread of drug nonsusceptible S pneumoniae.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 09/2012; · 1.63 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Acinetobacter baumannii complex (ABC) has emerged as an important pathogen causing a variety of infections. Longitudinal multicenter surveillance data on ABC from different sources in Taiwan have not been published. Using data from the Taiwan Surveillance of Antimicrobial Resistance (TSAR) conducted biennially, we investigated the secular change in resistance of 1640 ABC from 2002 to 2010 (TSAR period III to VII) to different antimicrobial agents and identified factors associated with imipenem-resistant and extensively drug-resistant ABC (IRABC and XDRABC).
Isolates were collected by TSAR from the same 26 hospitals located in all 4 regions of Taiwan. Minimum inhibitory concentrations (MIC) were determined by reference broth microdilution method. Isolates nonsusceptible to all tested aminoglycosides, fluoroquinolones, β-lactam, β-lactam/β-lactam inhibitors, and carbapenems were defined as extensively drug-resistant (XDR). Multivariate logistic regression analysis was performed to assess the relationship between predictor variables among patients with resistant ABC and patients with non-resistant ABC.
The prevalence of IRABC increased from 3.4% in 2002 to 58.7% in 2010 (P < 0.001; odds ratio [OR], 2.138; 95% confidence interval [CI], 1.947 to 2.347) and that of XDRABC increased from 1.3% in 2002 to 41.0% in 2010 (P < 0.001; OR, 1.970; 95% CI, 1.773-2.189). The rates of non-susceptibility to other antimicrobial agents remained high (>55%) over the years with some fluctuations before and after TSAR V (2006) on some agents. Multivariate analysis revealed that recovery from elderly patients, origins other than blood, from ICU settings, or geographic regions are independent factors associated with IRABC and XDRABC. Although the prevalence of XDRABC increased in all four regions of Taiwan over the years, central Taiwan had higher prevalence of XDRABC starting in 2008. Susceptibility to polymyxin remained high (99.8%).
This longitudinal multicenter surveillance program revealed significant increase and nationwide emergence of IRABC and XDRABC in Taiwan over the years. This study also identified factors associated with IRABC and XDRABC to help guide empirical therapy and at-risk groups requiring more intense interventional infection control measures with focused surveillance efforts.