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Volume 13, Number 12—December 2007
Dispatch

Antimicrobial Drug Resistance in Singapore Hospitals

Li-Yang Hsu*1Comments to Author , Thean-Yen Tan†1, Roland Jureen‡, Tse-Hsien Koh§, Prabha Krishnan¶, Raymond Tzer-Pin Lin*, Nancy Wen-Sin Tee#, and Paul Ananth Tambyah*
Author affiliations: *National University of Singapore, Singapore; †Changi General Hospital, Singapore; ‡Alexandra Hospital, Singapore; §Singapore General Hospital, Singapore; ¶Tan Tock Seng Hospital, Singapore; #KK Women’s & Children’s Hospital, Singapore;

Main Article

Table

Drug-resistant clinical bacterial isolates cultured at public sector hospitals, Singapore, 2006*

Isolates All resistant isolates
 Resistant blood isolates
 Resistant ICU isolates
No. (%) of all isolates† % Range for single hospitals‡ No. (%) of 
all blood isolates† % Range for single hospitals‡ p value§ No. (%) of 
all ICU isolates† % Range for single hospitals† p 
value¶
Methicillin-resistant S. aureus 3,517 
(35.3) 18.0–44.3 497 
(39.8) 23.8–44.4 <0.01 261 
(46.7) 26.8–70.5 <0.01
Vancomycin-resistant enterococci (E. faecium or E. faecalis) 31 
(0.8) 0–1.3 5 
(1.3) 0–2.4 0.25 3 
(1.2) 0–3.2 0.46
3rd-generation cephalosporin-resistant E. coli 2,257 
(17.5) 6.1–22.8 284 
(17.9) 7.4–19.0 0.66 123 
(33.4) 12.7–41.4 <0.01
Quinolone-resistant E. coli 4,227 
(34.4) 15.2–40.1 453 
(28.6) 15.4–40.5 <0.01 150 
(41.6) 12.0–54.6 <0.01
Cephalosporin and quinolone-resistant E. coli 1,080 
(8.4) 0.8–19.9 181 
(11.4) 5.7–15.3 <0.01 79 
(21.4) 2.9–40.5 <0.01
3rd-generation cephalosporin-resistant K. pneumoniae 2,651 
(35.9) 9.6–49.7 294 
(30.6) 13.8–34.5 <0.01 187 
(37.2) 8.8–46.6 0.54
Quinolone-resistant K. pneumoniae 3,074 
(42.5) 11.5–58.3 321 
(33.6) 11.1–39.6 <0.01 183 
(36.7) 6.2–47.6 <0.01
Cephalosporin- and quinolone-resistant K. pneumoniae 1,839 
(24.9) 2.0–46.1 214 
(22.3) 6.9–35.2 0.05 135 
(26.2) 0.0–41.2 0.47
Carbapenem-resistant P. aeruginosa 477 
(9.6) 2.4–12.2 45 
(16.5) 9.1–23.1 <0.01 74 
(18.3) 3.3–27.2 <0.01
Carbapenem-resistant Acinetobacter spp. 929 
(49.6) 16.9–65.5 86 
(48.1) 18.2–66.7 0.66 164 
(59.7) 31.6–68.8 <0.01
Multidrug-resistant Acinetobacter spp.* 354 
(18.2) 3.6–26.1 34 
(17.8) 0.0–29.8 0.88 64 
(23.4) 0.0–30.2 0.02

*ICU, represents all intensive care units, including surgical, medical, pediatric, and neonatal; S. aureus, Staphylococcus aureus; E. faecium or E. faecalis, Enterococcus faecium or Enterococcus faecalis; E. coli, Escherichia coli; K. pneumoniae, Klebsiella pneumoniae; P. aeruginosa, Pseudomonas aeruginosa. Multidrug resistant is defined by resistance to ampicillin/sulbactam, carbapenems, all cephalosporins, aminoglycosides (gentamicin and amikacin), and ciprofloxacin.
†No. resistant isolates (e.g., methicillin-resistant S. aureus, carbapenem-resistant P. aeruginosa) from all clinical specimens from all hospitals. The percentage in parenthesis refers to the proportion of resistant isolates over all isolates of the same species (resistant plus susceptible).
‡Range of proportions of resistant isolates over all isolates of the same species obtained from individual hospitals, expressed as percentages.
§p value for χ2 test comparing proportion of resistant isolates in blood culture and non–blood culture isolates.
¶p value for χ2 test comparing proportion of resistant isolates in ICU vs. non–ICU culture isolates.

Main Article

1These authors contributed equally to this article.

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