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Antimicrobial Resistance (AMR) Surveillance on Urine Culture in Public Hospitals and Clinics - Hospital Authority AMR Data (2021)

Release date: 1 February 2023

Method

Surveillance was conducted following the recommendations of the WHO GLASS Manual for Early Implementation (2015) with local adaptation as summarised below:

  • Two WHO priority organisms, namely Escherichia coli and Klebsiella pneumoniae were reported.
  • Location of onset was classified as community-onset (CO) (organism isolated from urine specimen collected in non-inpatient services or within 48 hours after hospital admission) or hospital-onset (HO) (organism isolated from urine specimen collected more than 48 hours after hospital admission).
  • For each surveillance period (one calendar year), only the first result would be reported for each patient per specimen type per organism for the same location of onset.
  • Antimicrobial susceptibility test (AST) result being “Intermediate” or “Resistant” was considered “Non-susceptible”, while AST results derived from less than ten isolates per calendar year were excluded from the analysis.
  • Only midstream urine specimens were included for analysis, and positive urine culture was defined as specimen with pure growth of organism reaching bacterial count which was equal to or greater than 105colony-forming units per millilitre (cfu/ml).
  • To avoid misleading or interference by selection bias, percentages of non-susceptibility[1] (NS%) derived from less than 70% of total isolates were not reported (or remarked to remind readers to interpret with caution).

Where appropriate, AST results for broad-spectrum antimicrobials identified by experts in HA (“Big Guns”) were examined because of their importance in treating resistant infections. 

Since the first Action Plan on AMR was published in 2017, the situation of 2016 has been chosen as the baseline for comparison. One-way Cochran-Armitage test was used to look for trends from 2016 to 2021. P-value of less than 0.05 was considered statistically significant.


Results

Overview of patients with urine culture

The total number of patients with urine culture collected increased from around 293,000 in 2020 to 331,000 in 2021 (13.0% increase). The percentage of patients with positive urine culture remained stable over the past years at around 15%.

Overview of WHO priority organisms isolated from urine (by applying WHO GLASS definition on location of onset)

The overall distribution of the two WHO priority organisms cultured from urine was similar from 2016 to 2021. The commonest organism isolated from urine in 2021 was Escherichia coli. Regarding the location of onset, Escherichia coli and Klebsiella pneumonia were predominantly CO.

Antimicrobial susceptibility test results for WHO priority organisms


Escherichia coli

The decreasing trend for amoxicillin/ clavulanate (CO: 19.6%→18.0%), cefuroxime (oral) (CO: 50.7%→39.9%; HO: 61%→51%), co-trimoxazole (CO: 39.2%→32.0%) and nitrofurantoin (CO: 2.9%→1.2%; HO: 4.3%→1.3%) continued to be observed in 2021 when compared to baseline in 2016. While new decreasing trends for cefuroxime (IV) (CO: 24.7%→23.6%), piperacillin/ tazobactam (CO: 2.4%→2.1%) and co-trimoxazole (HO: 45.4%→40.6%) were observed in 2016-2021.


Klebsiella pneumoniae

Downward trends were observed for cefuroxime (oral) (CO: 46.6%→34.2%), co-trimoxazole (HO: 37%→31.1%) and nitrofurantoin (CO: 49.9%→38.3%; HO: 54.2%→35.9%) from 2016-2020 and 2016-2021. At the same time, downward trends were newly observed for co-trimoxazole (CO: 25.1%→21.4%) and cefuroxime (oral) (HO: 49.6%→43.3%) for 2016-2021.

Recommendations

Overall, the decreasing trends of non-susceptibility could maintain for both Escherichia coli and Klebsiella pneumoniae towards most antimicrobials while new decreasing trend was also observed, further monitoring would be continued.


Acknowledgement

We would like to acknowledge stakeholders from HA, such as the Information Technology & Health Informatics Division, Quality and Safety Division, Strategy and Planning Division, and various Working Groups for the provision of input to facilitate the compilation of findings for the year 2021.

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[1]  Non-susceptibility percentage means the proportion of isolates tested for susceptibility to a particular antimicrobial, with test result being non-susceptible.