Background:Antimicrobial resistance of bacterial pathogens that cause urinary tract infec- tions is a leading concern in Korea. This study analyzed the urine culture results and antimi- crobial susceptibility trend in different types of healthcare facilities including long-term care hospitals. The aim of the study was to derive relevant information for the empirical treatment of patients with antibiotics.
Methods: We analyzed the species and antimicrobial susceptibility of the isolates from urine cultures received at the Seoul Clinical Laboratories from 2018 to 2020. Organisms were iden- tified using Microflex MALDI Biotyper (Bruker Daltonik GmbH, Germany). Antimicrobial susceptibility was tested using the Vitek 2 automated system (bioMérieux, France).
Results: The most frequently isolated organism was Escherichia coli. In general and small and medium sized hospitals, Enterococcus faecalis was the next most frequently isolated or- ganism. In long term care hospitals (LTCH), Proteus mirabilis was the next most frequently isolated organism. A total of 37-70% of E. Coli, 51-76% of Klebsiella pneumoniae, and 52- 85% of P. mirabilis strains were cefotaxime resistant. The incidence of fluoroquinolone-resis- tant isolates for the aforementioned strains was 48-86%, 51-83%, and 60-95% respectively. A total of 8-22% of isolates of K. pneumoniae were carbapenem-resistant. The incidence of carbapenem resistant K. pneumoniae in LTCH increased sharply from 8% in 2018 to 38-40% in 2020. The incidence of glycopeptide-resistant E. faecalis was 27-80%.
Conclusion: This study demonstrated that the use of fluroquinolones and -lactam antibiot- ics recommended for empirical antibiotic therapy was limited considering the high prevalence of antibiotic resistant organism. Antimicrobial stewardship programs and infection control programs may also play an important role considering the high prevalence of antimicrobial- resistant organisms especially in LTCH.

Keywords: Antimicrobial resistance, Long-term care hospital, Urine culture