Background@#
Administration of adequate
antibiotics is crucial for better outcomes in
sepsis. Because no
uniform tool can accurately assess the
risk of multidrug-resistant (MDR) pathogens, a local
antibiogram is necessary. We aimed to describe the
antibiogram of MDR
bacteria based on locations of
sepsis onset in
South Korea. @*
Methods@#We performed a prospective
observational study of
adult patients diagnosed with
sepsis according to
Sepsis-3 from 19 institutions (13 tertiary
referral and 6 universityaffiliated
general hospitals) in
South Korea.
Patients were divided into four groups based on the respective
location of
sepsis onset
community,
nursing home, long-term-care
hospital, and
hospital. Along with the
antibiogram,
risk factors of MDR
bacteria and
drug-bug match of empirical
antibiotics were analyzed. @*Results@#MDR
bacteria were detected in 1,596 (22.7%) of 7,024
patients with gram-negative predominance. MDR
gram-negative bacteria were more commonly detected in long-termcare
hospital- (30.4%) and
nursing home-acquired (26.3%)
sepsis, whereas MDR grampositive
bacteria were more prevalent in
hospital-acquired (10.9%)
sepsis. Such findings were consistent regardless of the
location and tier of
hospitals throughout
South Korea.
Patients with long-term-care
hospital-acquired
sepsis had the highest
risk of MDR pathogen, which was even higher than those with
hospital-acquired
sepsis (adjusted
odds ratio, 1.42; 95%
confidence interval, 1.15–1.75) after
adjustment of
risk factors. The
drug-bug match was lowest in
patients with long-term-care
hospital-acquired
sepsis (66.8%). @*Conclusion@#Gram-negative MDR
bacteria were more common in
nursing home- and long-term-care
hospital-acquired
sepsis, whereas gram-positive MDR
bacteria were more common in
hospital-acquired settings in
South Korea.
Patients with long-term-care hospitalacquired
sepsis had the highest the
risk of MDR
bacteria but lowest
drug-bug match of initial
antibiotics. We suggest that initial
antibiotics be carefully selected according to the onset
location in each
patient.