Skip to content
Chapters

Part I: Antibiotic Resistance (AMR) - Global and Local Epidemiology



1.2 Local Situation of AMR



  1. The emergence of AMR has jeopardised the effective treatment of patients with infections. [5–9]

  2. AMR leads to higher drug costs, prolonged hospital stay, and adversely affects patient’s outcome. [10]

  3. The WHO estimates that AMR-related infections in Hong Kong from 2020 to 2030 resulted in 18,433 excess deaths and incurred a total economic cost of US$4.3 billion. [11]

  4. Resistance to all classes of antibiotics has developed to various extents among common and important nosocomial pathogens (Table 1.1, Table 1.2, Table 1.3).

  5. In Hong Kong, MRSA, extended-spectrum β-lactamase (ESBL)-producing E. coli and Klebsiella spp., carbapenem-resistant Acinetobacter spp. are the most common multidrug-resistant organisms. Carbapenemase-producing Enterobacterales (CPE) has emerged during the COVID-19 pandemic while VRE resurges again in recent years after the epidemic occurred in 2013–2014.

  6. Factors contributing to the rapid rising and high prevalence of AMR in Hong Kong include. [12]

Hospital: overcrowding, manpower shortage, lapse in infection control measures, inappropriate use of antibiotics, environmental contamination, lack of transparency of surveillance data and lack of incentive in healthcare administration.

Community: misuse of antimicrobials, including in animal husbandry, lack of awareness, and inadequate food and personal hygiene.

  1. The COVID-19 pandemic has worsened AMR by disrupting the hospital infection control practice, resulting in more secondary bacterial infections, and increasing the utilisation of antibiotics for in-patients. [13,14]

  2. In the Hong Kong Strategy and Action Plan on AMR 2023 to 2027, promoting antibiotic prescription according to evidence-based guidelines for doctor is one of the key strategic interventions to combat AMR (Strategic intervention 5.2). [15]

Table 1.1: Top Ten Bacterial Organisms Isolated From Different Clinical Specimens in 2023. Data From the Hospital Authority.

Blood

Lower Respiratory Specimens*

Urine†

Organism

Non-ICU/ HDU

ICU/ HDU

Organism

Non-ICU/ HDU

ICU/ HDU

Organism

Non-ICU/ HDU

Rank (%)

Rank (%)

Rank (%)

Rank (%)

Rank (%)

Escherichia coli

1 (34%)

2 (17%)

Pseudomonas aeruginosa

1 (21%)

3 (14%)

Escherichia coli

1 (52%)

Klebsiella spp.

2 (12%)

3 (11%)

Staphylococcus aureus

2 (18%)

2 (16%)

Klebsiella spp.

2 (14%)

Staphylococcus aureus

3 (11%)

4 (10%)

Klebsiella spp.

3 (14%)

1 (16%)

Enterococcus spp.

3 (9%)

Staphylococcus, coagulase negative

4 (9%)

1 (23%)

Acinetobacter baumannii

4 (6%)

5 (6%)

Proteus mirabilis

4 (7%)

Proteus mirabilis

5 (4%)

8 (2%)

Haemophilus influenzae

5 (5%)

9 (2%)

Pseudomonas aeruginosa

5 (3%)

Enterococcus spp.

6 (4%)

5 (5%)

Stenotrophomonas maltophilia

6 (5%)

4 (7%)

Citrobacter spp.

6 (3%)

Pseudomonas aeruginosa

7 (2%)

6 (3%)

Escherichia coli

7 (5%)

6 (5%)

Staphylococcus aureus

7 (2%)

Enterobacter spp.

8 (2%)

-

Enterobacter spp.

8 (3%)

7 (4%)

Streptococcus agalactiae

8 (2%)

Acinetobacter baumannii

9 (1%)

7 (2%)

Corynebacterium striatum

9 (2%)

8 (3%)

Morganella spp.

9 (1%)

Streptococcus agalactiae

10 (1%)

-

Alpha-haemolytic streptococcus

10 (1%)

10 (2%)

Staphylococcus, coagulase negative

10 (1%)

*Lower respiratory specimens include: Bronchial biopsy; Bronchial trap; Bronchial washing; Bronchoalveolar lavage; Lung biopsy; Sputum; Bronchial/Endotracheal/Tracheal/Tracheostomy/Transbronchial/Transtracheal aspirate.

†Only isolates from urine specimens with a bacterial count greater than 10⁵ CFU/mL are included.

Mycobacterium spp. and Candida spp. are excluded from the analysis.
Table 1.2: Intrinsic and Associated Resistance to Antimicrobial Agents Among Five Nosocomial Pathogens

Bacteria

Intrinsic resistance

Associated resistance

MRSA

All β-lactams¹, β-lactam/β-lactamase inhibitor combinations

Common: erythromycin, clindamycin, aminoglycosides, cotrimoxazole, fluoroquinolones

VREfm

Glycopeptides, cotrimoxazole, clindamycin, aminoglycosides

Common: ampicillin, carbapenems, fluoroquinolones, high level aminoglycoside resistance

ESBL-E

All cephalosporins including third-generation cephalosporins, (variable activity against fourth-generation cephalosporins), all penicillins and monobactams

Common: fluoroquinolones, aminoglycosides, cotrimoxazole

CRE

All β-lactams including carbapenem (except monobactam)

Common: fluoroquinolones, aminoglycosides, cotrimoxazole

CRAB

Cross-resistance to other β-lactams is common

Common: fluoroquinolones, aminoglycosides, cotrimoxazole

¹ Except anti-MRSA cephalosporins such as ceftaroline.
CRAB, Carbapenem-resistant Acinetobacter baumannii; CRE, Carbapenem-resistant Enterobacterales; ESBL-E, extended-spectrum-β-lactamases-producing Enterobacterales; VREfm, vancomycin-resistant Enterococcus faecium
Table 1.3: Non-Susceptibility of Common Bacterial Isolates From Blood Specimens in HA Hospitals in 2023

Organisms

% Non-susceptible*

Minocycline

Penicillin

Ampicillin

Cloxacillin

Ampicillin-sulbactam

Amoxicillin-clavulanate

Piperacillin-tazobactam

Cefuroxime (parenteral)

Cefotaxime

Ceftazidime

Cefoperazone-sulbactam

Cefepime

Meropenem

Ertapenem

Imipenem

Cotrimoxazole

Erythromycin

Clindamycin

Gentamicin

Amikacin

Ciprofloxacin

Levofloxacin

Vancomycin

Fusidic acid

Rifampicin

Escherichia coli

-

-

79

-

-

30

9.8

34

32

15

-

18

-

0.6

-

-

-

-

26

3.4

-

36

-

-

-

Klebsiella spp.

-

-

99

-

-

23

16

22

18

12

-

11

1.4

1.5

-

-

-

-

7.8

2.0

-

16

-

-

-

Proteus spp.

-

-

74

-

-

35

2.9

28

24

4.0

-

9.5

-

0.0

-

-

-

-

25

2.6

-

48

-

-

-

Pseudomonas aeruginosa

-

-

-

-

-

-

8.5

-

-

5.0

12

3.3

8.6

-

13

-

-

-

-

0.3

7.8

17

-

-

-

Enterobacter spp.†

-

-

-

-

-

96

20

36

25

18

-

5.3

1.4

5.3

-

-

-

-

3.3

1.1

-

5.2

-

-

-

Acinetobacter spp.

15

-

-

-

49

-

57

-

-

28

49

57

61

-

57

22

-

-

30

21

52

57

-

-

-

Enterobacter aerogenes‡

-

-

-

-

-

97

47

49

40

29

-

4.4

0.0

1.8

-

-

-

-

5.1

1.7

-

8.7

-

-

-

Staphylococcus aureus

-

-

-

46

-

-

-

-

-

-

-

-

-

-

-

0.2

23

22

19

-

-

-

0.0

9.2

0.8

Viridans group streptococci

-

16

-

-

-

-

-

-

-

-

-

-

-

-

-

-

29

21

-

-

-

5.4

0.0

-

-

Enterococcus spp.§

-

-

44

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

34

-

-

55

1.9

-

-

Non-susceptible percentages from less than 70% of the total isolates tested for susceptibility to that drug are not reported.

*Non-susceptible is defined as an isolate tested as Intermediate, Resistant to that particular drug.

†Excluding Enterobacter aerogenes

‡Formerly known as Klebsiella aerogenes

§Excluding viridans group streptococci
Table 1.4: Estimates of Microorganisms Significantly Associated With AMR, Hong Kong, 2019–2023

Antibiotic-resistant microorganism

Specimen Type

Number of cases by year§

2019

2020

2021

2022

2023

MRSA

Blood only

806

793

879

843

824

ESBL-producing E. coli

Blood only

1,881

1,805

1,684

1,465

1,726

ESBL-producing Klebsiella spp.

Blood only

381

381

353

388

373

Carbapenem-resistant Acinetobacter spp.

Blood only

91

112

101

145

122

MRSA

All clinical specimens

12,742

11,617

12,612

14,527

17,680

ESBL-producing E. coli

All clinical specimens

16,651

14,997

16,092

15,188

16,999

ESBL-producing Klebsiella spp.

All clinical specimens

5,092

4,714

4,776

4,508

5,916

Carbapenem-resistant Acinetobacter spp.

All clinical specimens

3,340

3,366

3,858

5,074

5,416

Ceftazidime-resistant Pseudomonas aeruginosa

All clinical specimens

977

993

1,106

1,060

1,143

Vancomycin-resistant Enterococcus spp.*

All clinical specimens

15

16

129

296

310

Erythromycin-resistant Streptococcus pyogenes†

All clinical specimens

555

231

159

119

199

Clostridioides difficile‡

Stool only

-

2,665

3,246

3,164

3,242

*VRE isolated from stool and rectal swabs, as well as High Risk Screening on Haemodialysis and VRE Targeted Screening on Admission, are excluded. The majority of these isolates are vancomycin-resistant Enterococcus faecium (95%).

†Erythromycin-resistant strains are also resistant to other macrolides, such as clarithromycin and azithromycin.

‡Previously known as Clostridium difficile. Figure for year 2019 is not available.

§ The annual number of cases was estimated by using microbiological results from all HA laboratories. Each patient was counted only once in the calculation. The figures for Clostridioides difficile was extracted from the Standard Report of the Hospital Authority Clostridioides difficile Surveillance Programme. [613]



Previous Page
Next Page