NATIONAL

ANTIBIOTIC
RESISTANCE
SURVEILLANCE
REPORT 2022

Antibiotic Resistance Surveillance Reference Laboratory

Bacteriology Unit, Infectious Disease Research Centre
Institute for Medical Research
National Institutes of Health, Malaysia
CONTENTS
Executive summary ............................................................................................. 4

Staphylococcus aureus........................................................................................ 8

Methicillin-resistant Staphylococcus aureus (MRSA) ..................................... 11

Streptococcus pneumoniae................................................................................ 16

Enterococcus spp. .............................................................................................. 20

Enterococcus faecium ....................................................................................... 20

Enterococcus faecalis ........................................................................................ 22

Acinetobacter baumannii ................................................................................. 25

Escherichia coli ................................................................................................. 31

Klebsiella pneumoniae...................................................................................... 41

Pseudomonas aeruginosa ................................................................................. 50

Salmonella enterica sp. Typhi .......................................................................... 54

Salmonella sp. .................................................................................................. 55

Neisseria gonorrhoeae ...................................................................................... 58

List of contributing hospitals ........................................................................... 59

Acknowledgement ............................................................................................. 60

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ACRONYMS AND ABBREVIATIONS

BAL Bronchoalveolar lavage

CLSI Clinical Laboratory Standards Institute
EUCAST European Committee on Antimicrobial Susceptibility Testing
MRSA Methicillin- resistant Staphylococcus aureus
O&G Obstetrics and gynaecology
NSAR National Antibiotic Resistance Surveillance
VRE Vancomycin-resistant Enterococci

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Executive summary
The surveillance data was analysed based on the antibiotic susceptibility
testing of bacteria, isolated from clinical samples of patients admitted to
participating hospitals. A total of 522557 isolates were reported in 45
hospitals and 1 public health laboratory. However, based on first isolate per
patient, only 282659 isolates were analyzed for NSAR 2022. Forty-three of
the hospital microbiology laboratories were government hospitals and 2
were university hospitals. These hospitals were distributed in all 13 states
in Malaysia. The data was collected from January until December 2022. The
analysis was carried out using the WHONET 2021 software, whenever
there are 30 or more isolates. The percentage of resistance may be high in
instances where the numbers of isolates tested were low. The interpretive
criteria for susceptibility or resistance were as outlined by CLSI Performing
Standards for Antimicrobial Susceptibility testing guideline. When the
interpretation zones were not available in the CLSI, the EUCAST
guidelines were referred.

The percentage of Staphylococcus aureus isolated from blood in 2022 was

25.3% which was slightly lower than in the year 2021 (26.9%). A decrease
in resistance rates for Staphylococcus aureus were observed for penicillin,
rifampicin, clindamycin, erythromycin, gentamicin, and linezolid in 2022
compared to 2021. There was also a decrease in MRSA rate from 7.0% in
2021 to 6.0% in 2022. Most MRSA cases were from medical, surgical, and
orthopaedic wards. For Streptococcus pneumoniae, 36.6% of the isolates
were from blood and 35.0% was from respiratory specimens. A decreasing
trend in resistance was observed for all antibiotics tested except for
ceftriaxone which was not reported before, however, was at 1.3% in 2022.
Resistance to penicillin for Streptococcus pneumoniae isolated from all
specimens has been in the range of 0 to 3.4% for the past five years (2018-
2022) and 31.7% of the isolates were resistant to erythromycin.
Additionally, no vancomycin resistance was observed in 2022. The
resistance rate to vancomycin was noted to be higher in 2022 among
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Enterococcus faecium and Enterococcus faecalis. Nevertheless, comparing
between the two spp, vancomycin resistance level is much higher in
Enterococcus faecium. In 2022, 4.0% of Enterococcus faecium was resistant
to vancomycin, compared to only 3.0% in Enterococcus faecalis. In contrast,
a decrease in resistance rates were noted for most of antibiotics tested for
Acinetobacter baumannii, isolated from all clinical samples. The antibiotics
include ampicillin/sulbactam, ceftazidime, cefoperazone/sulbactam,
imipenem, meropenem, gentamicin and amikacin. Cefoperazone/sulbactam
showed a decreased resistance rate at 28.7% compared to the year before.
Most Acinetobacter baumannii infections occurred among patients in ICU,
medical, and surgical wards. Ceftazidime and cefotaxime resistance have
increased to 14.0% and 21.9% respectively in 2022, compared to 13.5% and
20.9% respectively in 2021 for Escherichia coli. Similarly, an increasing
pattern is observed for cefuroxime as well as cefepime. Carbapenem
resistance rate has reduced to 1.2% for imipenem and meropenem in 2022.
In 2021, the resistance rates were 1.4% and 1.3% respectively. Nevertheless,
isolates from urine tend to display a higher carbapenems resistance rate
compared to data from overall isolates. A decreasing trend of resistance was
observed in most antibiotics tested for Klebsiella pneumoniae. The
resistance rate to third generation cephalosporins such as cefotaxime and
ceftazidime for all isolates has decreased from 24.5% and 22.5% in 2021 to
24.0% and 21.4% in 2022, respectively. Similarly, the resistance to
imipenem and meropenem has also decreased from 4.9% and 5.6%
respectively in 2021 to 4.4% and 5.0% in 2022. The resistance rate for
Klebsiella pneumoniae isolated from blood was higher than those seen for
isolates from all clinical specimens. This was observed for many antibiotics
tested. Nevertheless, the overall resistance level for blood originated
isolates has shown to be decreased. Similarly, Klebsiella pneumoniae
isolated from urine also showed a decreasing resistance pattern to many
antibiotics tested. Pseudomonas aeruginosa also demonstrated a decreased
resistance rate to most antibiotics tested. These include imipenem and
meropenem, with the resistance rate reported at 6.8% and 7.1%

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 respectively. Overall, the resistance rates to all antibiotics for Pseudomonas
aeruginosa are still less than 10%. For Salmonella enterica serotype Typhi,
ciprofloxacin resistance has increased to 27.3% in 2022. Data was derived
for isolates from all clinical samples. Similarly, an increment was also
observed for ciprofloxacin resistance among Salmonella sp. originating from
blood specimens from 1.0% in 2021 to 3.5% in 2022. Ciprofloxacin resistance
level for stool isolates also displayed a similar pattern. Ampicillin and
ceftriaxone resistance has also increased from 28% and 3.4% in 2021 to
30.5% and 3.8% respectively.

Dr Rohaidah Hashim
Consultant Clinical Microbiologist
Head of Bacteriology Unit
Infectious Disease Research Center
Institute for Medical Research
National Institutes of Health
Selangor, Malaysia

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EDITORIAL BOARD
Dr Murnihayati Hassan
Pathologist (Clinical Microbiology)
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

Dr Siti Khairani Mohd Hafiz Ngoo

Medical Officer
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

Hana Farizah Zamri

Research Officer
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

Dr Nur Asyura Nor Amdan

Research Officer
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

Dr Mohammad Ridhuan Mohd Ali

Research Officer
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

Dr Azura Mohd Noor

Research Officer
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

Nur Damia Zahari

Research Assistant
Bacteriology Unit
Infectious Diseases Research Centre
Institute for Medical Research

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Staphylococcus aureus

A total of 32234 Staphylococcus aureus were isolated from all clinical samples in
2022 compared to 29548 isolated in 2021. The isolates were mainly from blood
(25.2%), followed by pus (20%) and tissue (17%) (Figure 1). The percentage of
Staphylococcus aureus isolated from blood was higher in 2021 (26.9%) compared
to 2022 (25.2%) while specimens isolated from pus were slightly lower in 2021
(17.7%) compared to 2022 (20%).

Blood 8130
Pus 6452
Tissue 5463
Swab 4105
Tracheal aspirate 1523
Urine 1046
Wound 980
Sputum 765
Specimens

Fluid 677
Genital 635
Eyes 563
Bone 373
ENT 332
Tracheal 301
Abscess 295
Respiratory 242
Others 192
Nasopharynx 160

0 1000 2000 3000 4000 5000 6000 7000 8000 9000

Number of isolates

Figure 1: Distribution of Staphylococcus aureus isolated based on clinical

specimens in 2022. Bars show the number of isolates isolated from several clinical
specimens in the year 2022.

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Table 1: Antibiotic resistance rate for Staphylococcus aureus isolated from all specimens. The number of samples tested
is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Penicillin G 80.6 (34564) 80.1 (32200) 78.9 (24616) 76.5 (22990) 75.9 (27561)

Rifampin 1.2 (33882) 0.8 (31987) 0.9 (26332) 1.0 (25756) 0.8 (30977)

Clindamycin 9.5 (34243) 8.0 (32949) 6.8 (28099) 6.1 (27493) 5.9 (32707)

Erythromycin 16.1 (37353) 13.8 (35529) 11.4 (29117) 10.3 (27144) 9.9 (32684)

Gentamicin 3.9 (36418) 3.4 (34825) 3.5 (28123) 3.3 (26493) 3.2 (32719)

Linezolid 0.3 (19752) 0.1 (20251) 0.3 (18469) 0.5 (17750) 0.2 (21954)

Fusidic acid* 7.7 (33255) 7.7 (30678) 8.6 (24348) 10.0 (23729) 11.2 (28892)

* Using EUCAST breakpoint

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 2018

100 2019
2020
90
Percentage (%) of resistance

2021
80
2022
70

60

50

40

30

20

10

Figure 2: Antibiotic resistance trend for Staphylococcus aureus isolated from all
samples from 2018 until 2022.

An overall decreasing trend in Staphylococcus aureus resistance was observed for

all antibiotics tested except for fusidic acid (Table 1 and Figure 2). Penicillin G,
clindamycin and erythromycin are the important drugs use for treatment of
Staphylococcus aureus infection in our clinical practice.

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Methicillin-resistant Staphylococcus aureus (MRSA)

From the total Staphylococcus aureus isolated from all clinical samples in 2022,
2045 (6 %) isolates were confirmed to be MRSA. The graph shows a decrease in
MRSA rates in comparison from 2012 (17.7 %) to 2022 (6 %) (Figure 3).

25

20 19.8
19.3
Percentage (%) of isolate

17.7 17.7 18.0

17.2
16.1
15 15 14.9

10

7.0
6.0
5

0
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022

Year

Figure 3: Trend of MRSA rates from 2012 until 2022

11 |
 372
Medical

284
Surgery

133
A&E
Department

130
Orthopaedic

122
Critical Care

106
Others

71
Mixed
0 50 100 150 200 250 300 350 400

Number of isolates

Figure 4: Distribution of MRSA isolates based on major location in 2022.

Graph shows number of MRSA isolates from several department/ward in the year 2022.

Most MRSA isolates originated from cases in medical and surgical wards (Figure
4). To be noted that this analysis is based on MRSA isolates with complete
demographic data on location and excluding others with lack of proper data.

12 |
 Blood 612
Tissue 324
Pus 221
Swab 197
Not Stated 177
Tracheal aspirate 147
Sputum 78
Bone 44
Specimens

Fluid 40
Tracheal 32
Muscle 27
Wound 26
Eyes 25
Aspirate 22
Abscess 21
Urine 18
Nose 15
Catheter 11
ENT 8

0 100 200 300 400 500 600 700

Number of isolates

Figure 5: Distribution of MRSA based on clinical specimen in 2022. Bars show the
number of isolates isolated from several clinical specimens in the year 2022.

Most of the MRSA isolates were isolated from blood (29.9 %), followed by tissue
(15.84 %) and pus specimens (10.8 %) (Figure 5).

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Table 2: Percentage of antibiotic resistance for MRSA isolated from all specimens. The number of samples tested is stated in
brackets.

Antibiotic 2018 2019 2020 2021 2022

%R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Erythromycin 68.9 (6923) 64.6 (5953) 56.7 (1836) 57.2 (1965) 57.8 (1807)

Gentamicin 11.1 (6835) 10.6 (5772) 10.8 (1656) 12.5 (1890) 11.0 (1824)

Co-trimoxazole 6.4 (6714) 4.5 (5861) 3.4 (1846) 4.2 (1994) 3.3 (1793)

Rifampicin 3.8 (6534) 2.3 (5636) 3.7 (1822) 5.1 (1887) 2.6 (1789)

Fusidic acid 13.6 (5983) 8.3 (5286) 15.3 (1620) 8.2 (1786) 24.8 (1753)

Clindamycin 39.6 (6746) 37.3 (5602) 37.2 (1834) 26.2 (2016) 38.3 (1808)

Linezolid 0.7 (4830) 0.1 (4330) 0.1 (1507) 2.2 (1655) 0.4 (1407)

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 2018
100 2019

90 2020
2021
80
Percentage (%) of resistance

2022
70

60

50

40

30

20

10

Figure 6: Antibiotic resistance trend for MRSA isolated from all samples from
2018 until 2022.

Reduction in resistance level was observed for gentamicin, co-trimoxazole,

rifampicin, and linezolid. However, increased resistance was prominent noted for
fusidic acid followed by clindamycin. No vancomycin resistant isolates were
reported in 2022 (data not shown).

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Streptococcus pneumoniae

A total of 1231 Streptococcus pneumoniae isolates were isolated in 2022. The

number is slightly less compared to 760 in 2021 and 1054 in 2020. Out of these,
451 (36.6 %) were from blood and 192 (15.6 %) were from sputum (Figure 7).

Blood 451
Sputum 192
Tracheal aspirate 150
Eyes 100
Nasopharynx 68
Pus 52
Respiratory 40
Tracheal 30
Specimens

Swab 26
Bronchial 20
Genital 17
Tissue 17
Ear 17
Cerebrospinal fluid 15
Fluid 11
Urine 10
Others 8
Secretion 7

0 100 200 300 400 500

Number of isolates

Figure 7: Distribution of Streptococcus pneumoniae based on clinical specimen.

Bars show the number of isolates isolated from several clinical specimens in the year 2022.

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Streptococcus pneumoniae from all clinical specimens

Table 3: Percentage of antibiotic resistance for Streptococcus pneumoniae isolated from all samples. The number of samples
tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R (no tested) %R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Penicillin G* 2.2 (183) 0.9 (219) 0 (99) 3.4 (204) 0.5 (204)

Erythromycin 33.8 (1901) 31.7 (1895) 29.1 (956) 32 (668) 31.7 (1153)

Cefotaxime* 0 (199) 0 (237) 0 (181) 0 (16) 0 (59)

Ceftriaxone* 0.7 (577) 0.7 (143) 0.4 (260) 0 (110) 1.3 (156)

Co-trimoxazole 30.6 (1714) 26.9 (1893) 26.4 (894) 30.4 (628) 27 (1052)

Vancomycin** 0.2 (1742) 0.1 (1826) 0 (910) 0 (727) 0 (1086)

*Analysis was done using non meningitis breakpoints

**Not verified at reference laboratory

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 Among the 204 strains tested in 2022, 0.5 % of them were found resistant against
Penicillin G (Table 3 and Figure 8) and this is a huge reduction in comparison to
the previous year. Among all the drugs tested, erythromycin had the highest
percentage of resistance (31.7 %). The resistance rate to erythromycin has been in
the range of 29.1 to 33.8 % in the previous years (2018-2022).
Co-trimoxazole resistance level reduced in 2022 (27 %) compared to 30.4 % in 2021.
No resistance to cefotaxime and vancomycin was reported for the fifth year in a
row.

2018

50 2019
2020
45
2021
40
2022
Percentage (%) of resistance

35

30

25

20

15

10

0
Penicillin G* Erythromycin Cefotaxime* Ceftriaxone* Co-trimoxazole Vancomycin**

Figure 8: Antibiotic resistance trend for Streptococcus pneumoniae isolated

from all samples from 2018 until 2022.

*Analysis was done using non-meningitis breakpoints

**Not verified at reference laboratory

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 Streptococcus pneumoniae from blood specimens

Table 4: Percentage of antibiotic resistance for Streptococcus pneumoniae

isolated from blood. The number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Penicillin G* 1.2 (83) 0 (109) 0 (40) 1 (97) 1 (96)
Erythromycin 28.8 (659) 29.3 (646) 30.2 (278) 24.4 (271) 32.3 (575)
Cefotaxime** 0 (89) 0 (76) 0 (38) 0 (18) 0 (10)
Ceftriaxone 0.4 (239) 0 (79) 1 (102) 0 (61) 0 (81)
Co-trimoxazole 22.4 (584) 21.2 (624) 21.8 (243) 25 (248) 21.4 (569)

*Analysis was done using non-meningitis breakpoints

**Not verified at reference laboratory

2018

50 2019
2020
45
2021
Percentage (%) of resistance

40
2022
35

30

25

20

15

10

0
Penicillin G* Erythromycin Cefotaxime* Ceftriaxone* Co-trimoxazole

Figure 9: Antibiotic resistance trend for Streptococcus pneumoniae isolated

from blood from 2018 until 2022.

Percentage of resistance for erythromycin for isolates originated from blood was
higher compared to those derived from all specimens. While lower percentage of
resistance for co-trimoxazole was observed for isolates from blood specimens
compared to all specimens.
19 |
Enterococcus spp.
Enterococcus faecium

A total of 2876 Enterococcus faecium isolates were isolated in 2022. An increase in

vancomycin resistance was observed in 2022 compared to 2021. Ampicillin and
gentamicin resistance continue to be on an increasing trend. Resistance rate to
linezolid is at the same level compared to 2021. It is considered not alarming even
though it is reported annually (Table 5 and Figure 10).

Table 5: Percentage of antibiotic resistance for Enterococcus faecium isolated

from all samples. The number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Ampicillin 89.8 (996) 90.8 (1125) 93.7 (1629) 94.8 (2796) 95.3 (2809)

Gentamicin 43.5 (614) 40.9 (721) 35.3 (1251) 24.4 (2178) 26.1 (2212)
(120μg)

Vancomycin 14.1 (1037) 10.0 (1149) 4.2 (1625) 3.1 (2788) 4.0 (2779)

Linezolid 1.0 (878) 1.2 (1052) 1.7 (1482) 1.3 (2582) 1.3 (2596)

20 |
 2018
100
2019
90 2020

80 2021
Percentage (%) of resistance

2022
70

60

50

40

30

20

10

0
Ampicillin Gentamicin Vancomycin Linezolid

Figure 10: Antibiotic resistance trend for Enterococcus faecium isolated from
all samples from 2018 until 2022.

Urine 1243
Blood 1032
Tissue 159
Fluid 154
Pus 78
Specimens

Swab 75
Catheter 49
Respiratory 27
Others 16
Bone 16
Wound 15
Sputum 6
Blood vessel 6

0 200 400 600 800 1000 1200 1400

Number of isolates

Figure 11: Distribution of Enterococcus faecium based on clinical specimens in

2022. Bars show the number of isolates isolated from several clinical specimens in the
year 2022.
The majority of the Enterococcus faecium were from urine (43.2 %) and followed
by blood (35.9 %) (Figure 11).
21 |
Enterococcus faecalis

Urine 2475
Blood 1165
Tissue 579
Swab 258
Pus 218
Fluid 152
Not Stated 151
Bone 108
Specimens

Wound 54
Respiratory 52
Catheter 40
Genital 33
Bile 26
Placenta 20
Cathether 18
Others 16
Bone marrow 11
Blood vessel 10
Sputum 9

0 500 1000 1500 2000 2500 3000

No of isolates

Figure 12: Distribution of Enterococcus faecalis based on clinical specimens in

2022. Bars show the number of isolates isolated from several clinical specimens in the
year 2022.

A total of 5395 Enterococcus faecalis isolates were isolated in 2022. Similar to

Enterococcus faecium, majority of Enterococcus faecalis isolates were isolated
from urine (45.8 %) followed by blood (21.6 %) (Figure 12).

22 |
Vancomycin resistance rate in 2022 was 0.8% higher than in 2021 (Table 6 and
Figure 13). Apart from vancomycin and linezolid, other antibiotics resistance rate
decreased in 2022 in comparison to 2021. For example, gentamicin resistance rate
was observed to be decreased in 2022 compared to 2021 from 18.5 % to 17.2 %.
While ampicillin was decreased from 7.7 % to 7 % in 2021 compared to 2022.

Table 6: Percentage of antibiotic resistance for Enterococcus faecalis isolated

from all samples. The number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Ampicillin 5.4 (1953) 5.8 (2184) 5.3 (3576) 7.7 (4057) 7.0 (5140)

Gentamicin 22.5 (1200) 18.0 (1325) 17.7 (2756) 18.5 (3456) 17.2 (4271)
(120μg)

Vancomycin 2.2 (1994) 2.0 (2185) 2.3 (3528) 2.2 (4045) 3.0 (5048)

Linezolid 4.5 (1669) 4.4 (1952) 3.9 (3309) 4.4 (3799) 4.5 (4776)

Figure 13: Antibiotic resistance trend for Enterococcus faecalis isolated from all
samples from 2018 until 2022.

2018

50 2019
2020
45
2021
40
2022
Percentage (%) of resistance

35

30

25

20

15

10

0
Ampicillin Gentamicin Vancomycin Linezolid

23 |
 Enterococcus faecium Enterococcus faecalis
20

18
Perentage (%) of resistance

16

14 14.1

12

10 10.0

4 4.2 4.0
3.1 3.0
2 2.2 2.0 2.3 2.2

0
2018 2019 2020 2021 2022

Figure 14: Trend of vancomycin resistance in Enterococcus faecium and

Enterococcus faecalis from all clinical samples from 2018 until 2022.

An increase in resistance levels was demonstrated in 2022 compared to 2021 for

both E. faecium and E. faecalis. However, steady low resistance level is shown
among E. faecalis isolates starting from 2018 to 2022 (Figure 14).

24 |
Acinetobacter baumannii

A total of 8935 Acinetobacter baumannii isolates were isolated and tested in 2022
compared to 10244 in 2021. The majority of isolates originated from tracheal
aspirates specimens (24.7 %) followed by 19.8 % of the isolates which were isolated
from blood (Figure 15).

Tracheal aspirate 2209

Blood 1772
Sputum 999
Urine 968
Tissue 629
Swab 557
Tracheal 535
Pus 245
Specimens

Fluid 201
Bronchial 191
Respiratory 137
Secretion 110
Wound 106
BAL 89
Eyes 64
Bone 54
Cathether 36
Bile 33

0 500 1000 1500 2000 2500

Number of isolates

Figure 15: Distribution of Acinetobacter baumannii based on clinical specimens

in 2022. Bars show the number of isolates isolated from several clinical specimens in the
year 2022.

25 |
Acinetobacter baumannii from all clinical specimens

Table 7: Percentage of antibiotic resistance for Acinetobacter baumannii isolated from all samples.
The number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)

31.5 (7348) 44.3 (7495) 48.5 (6463) 57.5 (9540) 48.9 (9104)
Amikacin

56.0 (7272) 51.5 (7642) 53.6 (6311) 63.8 (9530) 59.6 (8791)
Ampicillin/sulbactam
Cefoperazone/
48.6 (5369) 33.0 (4860) 29.6 (4479) 42.4 (6825) 31.5 (5824)
sulbactam
Ceftazidime 37.9 (7377) 52.2 (7337) 56.8 (6336) 67.5 (9717) 62.1 (8979)
Gentamicin 33.3 (7202) 47.7 (7513) 52.5 (6147) 60.8 (9025) 51.1 (9134)
Imipenem 41.3 (7261) 54.4 (7552) 58.1 (6435) 67.7 (9428) 62.4 (9084)
Meropenem 41.1 (7215) 55.5 (7468) 58.7 (6377) 68.8 (9432) 63.3 (9047)
Polymyxin B 0.5 (3069) 0 (11) 0 (3) 0 (371) 5.6 (18)

26 |
 2018
100 2019

90 2020
2021
80
Percentage (%) of resistance

2022
70

60

50

40

30

20

10

Figure 16: Antibiotic resistance trend for Acinetobacter baumannii isolated

from all samples from 2018 until 2022.

In 2022, apart from polymyxin B, all antibiotics tested showed decrease in

resistance rates (Table 7 and Figure 16). Percentage of resistance against
amikacin decreased from 57.5 % in 2021 to 48.9 % in 2022. Resistance towards
ampicillin/sulbactam was also observed to decrease from 63.8 % in 2021, compared
to 59.6 % in 2022. Both imipenem and meropenem resistance decreased to 62.4 %
and 63.3 % in 2022 from 67.7 % and 68.8 %, respectively in 2021.

27 |
 Critical Care 2258

Medicine 1950

Surgery 997
Department

O&G 448

Orthopedic 379

Mixed 345

Other 280

0 500 1000 1500 2000 2500

Number of isolates

Figure 17: Distribution of Acinetobacter baumannii based on location in 2022.

Graph bar shows the number of isolates isolated from several hospital departments in
the year 2022.

The majority of Acinetobacter baumannii isolates were recovered from patients in

critical care unit, medical and surgical departments (Figure 17).

28 |
Acinetobacter baumannii from blood specimens

Table 8: Percentage of antibiotic resistance for Acinetobacter baumannii isolated from blood.
The number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Ampicillin/sulbactam 48.9 (1578) 46.7 (1423) 54.4 (1409) 62.5 (2451) 60.9 (1882)
Ceftazidime 52.2 (1597) 51.6 (1319) 58.8 (1355) 68.3 (2347) 65.1 (1802)
Imipenem 54.3 (1553) 52.8 (1393) 59.3 (1421) 68.3 (2394) 65.2 (1902)
Meropenem 55.7 (1548) 54.4 (1346) 59.7 (1396) 69.9 (2386) 65.7 (1927)
Gentamicin 46.9 (1548) 45.3 (1416) 53.4 (1396) 60.8 (2334) 55.3 (1920)
Amikacin 43.2 (1588) 40.9 (1388) 48.2 (1436) 60.8 (2334) 52.4 (1915)
Cefoperazone/
30.3 (1080) 29.6 (955) 26.5 (971) 56.7 (2413) 28.7 (1264)
sulbactam
Ciprofloxacin 46.3 (1587) 43.7 (1391) 47.2 (1361) 37.3 (1739) 54.3 (1787)
Polymixin B 0 (16) 0 (11) 0 (3) 0 (3) 8.3 (12)

The percentage of antibiotic resistance for Acinetobacter baumannii isolated from blood was relatively decreased for all antibiotics
tested in 2022 compared to 2021 except for ciprofloxacin and polymyxin B which shows an increased resistance rate from 37.3 % in 2021
to 54.3 % in 2022 and from 0 % in 2021 to 8.3 % in 2022, respectively (Table 8 and Figure 18).

29 |
 2018
100
2019
90 2020
80 2021
Percentage (%) of resistance

70 2022

60

50

40

30

20

10

Figure 18: Antibiotic resistance trend for Acinetobacter baumannii isolated

from blood from 2018 until 2022.

30 |
Escherichia coli

A total of 36232 Escherichia coli isolates was included in the analysis for the year
2022. Most of them were isolated from urine (44.6 %) and followed by blood (20.1
%) (Figure 19).

Urine 16164
Blood 7281
Pus 2331
Not Stated 1867
Tissue 1547
Stool 1515
Percentage (%) of resistance

Swab 1306
Fluid 896
Genital 759
Sputum 494
Tracheal aspirate 369
Wound 279
Bile 269
Rectal 255
Cathether 250
Abscess 182
Bone 167
Eyes 158
Placenta 143
0 2000 4000 6000 8000 10000 12000 14000 16000 18000

No of isolates

Figure 19: Distribution of Escherichia coli isolates based on clinical specimens

in 2022. Bars show the number of isolates isolated from several clinical specimens in the
year 2022.

31 |
Escherichia coli from all clinical specimens

Table 9: Percentage of antibiotic resistant Escherichia coli isolated from all clinical specimens from 2018 until 2022. The
number of samples tested is stated in brackets.

Antibiotics 2018 2019 2020 2021 2022

% R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested)
Amikacin 0.9 (28624) 0.8 (27090) 1.2 (24279) 1.6 (24074) 1.9 (31298)
Amoxicillin/ 17.0 (29771) 15.2 (30076) 15.3 (27365) 17.4 (24702) 16.1 (30591)
clavulanic acid
Cefuroxime 24.5 (31817) 24.5 (30798) 23.6 (27213) 24.1 (25718) 26.1 (32834)
Cefotaxime 24.3 (29368) 22.2 (30654) 21.4 (26795) 20.9 (25213) 21.9 (32475)
Ceftazidime 16.4 (31265) 14.6 (30539) 13.6 (27238) 13.5 (26105) 14 (33448)
Cefepime 11.6 (30046) 11.7 (29542) 11.3 (25973) 11.5 (25658) 12.1 (32880)
Ciprofloxacin 23.0 (31150) 24.9 (30766) 25.8 (27375) 25.9 (24946) 26.2 (32178)
Gentamicin 15.7 (30755) 15.3 (30334) 14.9 (25645) 15 (24447) 14.5 (32669)
Imipenem 0.6 (30418) 0.5 (30822) 0.7 (27039) 1.4 (25528) 1.2 (32810)
Meropenem 0.7 (30153) 0.6 (30043) 0.7 (26503) 1.3 (25440) 1.2 (32857)

32 |
 50
2018
45 2019
40 2020
Percentage (%) of resistance

2021
35
2022
30

25

20

15

10

Figure 20: Antibiotic resistance trend for Escherichia coli isolated from all
specimens from 2018 until 2022.

Decreased resistance rate for amoxicillin/clavulanic acid, gentamicin, imipenem and

meropenem was observed in 2022 in comparison to 2021 while the rest of antibiotics
shows an increase resistance rate towards them.

33 |
 50

45

40
Percentage (%) of resistance

35

30

25

20

15

10

Figure 21: Breakdown for antibiotic resistance trend of Escherichia coli isolated
from all specimens in 2022.

34 |
Escherichia coli from urine specimens

Table 10: Percentage of antibiotic resistant Escherichia coli isolated from urine from 2018 until 2022. The number of samples
tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

% R (no. tested) % R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Amikacin 0.9 (11270) 0.9 (10727) 1.2 (10846) 1.9 (9991) 3.2 (13454)
Ampicillin 63.3 (12702) 64.0 (13298) 62.4 (12454) 62.1 (10829) 61.7 (14303)
Amoxicillin/ 14.8 (12413) 13.2 (13213) 13.4 (12973) 15.5 (10715) 12.7 (13675)
clavulanic acid
Ampicillin/sulbactam 20.8 (8478) 18 (8959) 17 (8905) 16.7 (8508) 15.9 (12516)
Cefepime 10.8 (12328) 11.5 (12608) 11.7 (11899) 12.3 (10938) 11.9 (14405)
Cefotaxime 24.0 (12283) 22.1 (13300) 21.6 (12583) 20.4 (10915) 21.2 (14440)
Ceftazidime 16 (12874) 14.0 (13167) 13.2 (12844) 13.2 (11319) 12.8 (14912)
Cefuroxime 23.8 (13400) 23.4 (13560) 23.1 (12923) 22.8 (11169) 23.8 (14519)
Ciprofloxacin 24.4 (12910) 26.3 (13361) 27 (12923) 27.2 (10536) 27.4 (14119)
Gentamicin 15.7 (12628) 14.7 (12927) 13.7 (11649) 14.1 (10221) 13.6 (14202)
Imipenem 0.9 (12639) 0.4 (13173) 0.4 (12627) 1.4 (10666) 1.5 (14211)
Meropenem 0.9 (12316) 0.4 (12769) 0.4 (12383) 1.3 (10660) 1.5 (14261)
Co-trimoxazole 36.4 (12989) 36.2 (12914) 34.1 (12411) 33.4 (10336) 31.1 (13918)

35 |
Figure 22: Antibiotic resistance trend for Escherichia coli isolated from urine from 2018 until 2022.

2018
100
2019
90
2020
80 2021

70 2022
Percentage (%) of resistance

60

50

40

30

20

10

36 |
Escherichia coli from blood specimens

Table 11: Percentage of antibiotic resistant Escherichia coli isolated from blood from 2018 until 2022. The number of samples
tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

% R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested)
Amikacin 1.0 (5918) 1.1 (6081) 1.4 (5497) 1.5 (5377) 1.1 (6680)
Ampicillin 70.2 (6253) 71 (6458) 68.6 (5739) 68.8 (5429) 69.1 (6815)
Amoxicillin/ 16.7 (5886) 14.9 (6321) 15.6 (5981) 18 (5338) 17.2 (6404)
clavulanic acid
Ampicillin/sulbactam 23.7 (4331) 21.1 (4454) 21.7 (4385) 21 (4626) 22.3 (5770)
Cefepime 13.5 (6116) 13.3 (6412) 12.6 (5856) 12.4 (5639) 13.5 (6984)
Cefotaxime 26.9 (5968) 24.7 (6505) 23.3 (5869) 23.8 (5430) 24.3 (6768)
Ceftazidime 18.3 (6249) 16.5 (6480) 14.9 (5939) 15.1 (5654) 15.5 (6995)
Cefuroxime 27.6 (6211) 27.2 (6399) 25.7 (5850) 26.1 (5518) 27.3 (6902)
Cefoperazone/sulbactam 4.6 (678) 3.9 (745) 2.8 (648) 1.5 (722) 0.8 (593)
Ciprofloxacin 24.1 (6216) 25.8 (6511) 25.3 (5996) 26.4 (5547) 26.9 (6835)
Gentamicin 17.1 (6230) 17.1 (6513) 16.3 (5808) 15.6 (5456) 14.9 (6985)
Imipenem 0.4 (6146) 0.7 (6559) 0.7 (5942) 1.1 (5638) 0.9 (6939)
Meropenem 0.4 (6110) 0.7 (6437) 0.7 (5871) 1.2 (5619) 0.9 (6969)
Co-trimoxazole 41. 8 (5598) 43.9 (5701) 40 (5146) 40.4 (4841) 40 (6294)

37 |
 100 2018
90 2019
80 2020

Percentage (%) of resistance 70 2021

60 2022

50

40

30

20

10

Figure 23: Antibiotic resistance trend for Escherichia coli isolated from blood from 2018 until 2022.
Decreased resistance rate towards amikacin, amoxicillin/clavulanic acid, ceforazone/sulbactam, gentamicin, imipenem,
meropenem and co-trimoxazole was observed while increased resistance rate was noted for the rest of antibiotics in 2021 compared
to 2020. The resistance rate for meropenem and imipenem was observed at less than 1 % in 2022 (Table 11 and Figure 23).

38 |
Figure 22 and Figure 23 show five-year trend of antibiotic resistance of
Escherichia coli isolated from urine and blood. In 2022, it was observed that
ampicillin resistance rate has remained as high as 61.7 % and 69.1 % for
Escherichia coli isolated from urine and blood, respectively. From the figure, it is
clearly shown that carbapenem resistance (meropenem and imipenem) decreased
at the rate of less than 1 % in 2022 as compared to 2021 for blood isolates however
increased resistance rate is observed in 2022 for both antibiotics for urine isolates.

39 |
 Meropenem resistant Escherichia coli
2.0
1.8
Percentage (%) of resistance

1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
All specimens Urine Blood

Imipenem resistant Escherichia coli

2.0
1.8
Percentage (%) of resistance

1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
All specimens Urine Blood

Figure 24: Distribution of carbapenem-resistant Escherichia coli isolates based

on the clinical specimens in the year 2022. Bar chart shows the percentage of A)
meropenem-resistant Escherichia coli and B) imipenem-resistant Escherichia coli isolated
from all specimens or urine, and blood only.

40 |
Klebsiella pneumoniae

A total of 33564 Klebsiella pneumoniae was isolated in 2022. Most of the isolates
were from sputum (21.9 %), followed by urine (19.6 %) and blood (19.5 %).

Sputum 7361
Urine 6587
Blood 6550
Aspirate 3300
Pus 2075
Tissue 1889
Swab 1405
Specimens

Fluid 930
Tracheal 628
Genital 549
Rectal 421
Respiratory 343
Wound 300
Bronchial 250
Eyes 225
Secretion 221
BAL 191
Bone 185

0 1000 2000 3000 4000 5000 6000 7000 8000

Number of isolates

Figure 25: Distribution of Klebsiella pneumoniae isolates based on clinical

specimens. Bars show the number of isolates isolated from several clinical specimens in
the year 2022.

41 |
Table 12: Percentage of antibiotic resistant Klebsiella pneumoniae isolated from all clinical specimens from 2018 until 2022.
The number of samples tested is stated in brackets.

Antibiotics 2018 2019 2020 2021 2022

% R (no. tested) % R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Amikacin 3.1 (30022) 1.8 (28497) 2 (24799) 2.5 (25825) 2.6 (31328)
Amoxicillin/ 23.3 (29909) 20.1 (30470) 20.4 (27375) 23.4 (25674) 21.8 (30163)
clavulanic acid
Ampicillin/sulbactam NA 25.8 (23261) 26.5 (20208) 28.3 (21904) 27.5 (26495)
Cefepime 18.2 (30185) 16.4 (29798) 17.1 (26093) 19.3 (27004) 18 (32507)
Cefotaxime 26.1 (29592) 22.2 (30840) 22.6 (27004) 24.5 (26341) 24 (31934)
Ceftazidime 23.5 (31596) 19.8 (30510) 20.4 (27051) 22.5 (27211) 21.4 (32890)
Cefuroxime 27.2 (31874) 25.1 (31104) 25.7 (27122) 28.3 (26797) 27.7 (32335)
Cefoperazone/sulbactam NA 13.3 (2375) 8.7 (2433) 12.8 (3111) 9.0 (2297)
Ciprofloxacin 10.8 (31382) 11.6 (31371) 14 (27343) 15.5 (26277) 15.8 (31759)
Gentamicin 10.8 (31067) 8.5 (30801) 9.4 (25896) 10.3 (25850) 9.6 (32483)
Imipenem 1.9 (30322) 1.7 (31143) 2.4 (27129) 4.9 (27217) 4.4 (32726)
Meropenem 2.3 (30410) 2.1 (30151) 2.8 (26470) 5.6 (27153) 5.0 (32703)
Co-trimoxazole NA 24.9 (28765) 25.3 (24838) 27.7 (24609) 25.7 (30368)

42 |
 50 2018
2019
45
2020
40
2021
Percentage (%) of resistance
35 2022

30

25

20

15

10

Figure 26: Antibiotic resistance trend of Klebsiella pneumoniae isolated from all specimens from 2018 until 2022.
All the antibiotics show a decreased resistance rate in 2022 in comparison to 2021 except for amikacin and ciprofloxacin. The
resistance rate for meropenem and imipenem was observed to be decreased from 4.9 % and 5.6 % in 2021 to 4.4 % and 5.0 % in
2022, respectively (Table 12 and Figure 26).

43 |
 50
45
Percentage (%) of resistance

40
35
30
25
20
15
10
5
0

Figure 27: Breakdown for antibiotic resistance trend of Klebsiella pneumoniae

isolated from all specimens in 2022.

44 |
Klebsiella pneumoniae from urine specimens

Table 13: Percentage of antibiotic resistant Klebsiella pneumoniae isolated from urine from 2018 until 2022. The number of
samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

% R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested)
Amikacin 5.1 (4906) 3.3 (4476) 2.7 (4609) 3.5 (4347) 6 (5661)
Amoxicillin/ 27.0 (5326) 24.7 (5458) 24.7 (5564) 26.7 (4678) 24.5 (5795)
clavulanic acid
Ampicillin/sulbactam 35.8 (3799) 33.4 (3817) 32.1 (3801) 32.4 (3682) 29.1 (5272)
Piperacillin/tazobactam 14.8 (4952) NA 12.9 (4924) 15 (4501) 17.8 (5784)
Cefepime 22.5 (5183) 20.8 (5123) 23.4 (5055) 24.8 (4707) 22.8 (5998)
Cefotaxime 35.3 (5113) 31 (5407) 30.6 (5314) 30.6 (4681) 30 (6048)
Ceftazidime 31.4 (5434) 25.9 (5290) 26.6 (5425) 27.4 (4879) 25.7 (6247)
Cefuroxime 34.9 (5643) 33.4 (5525) 33.9 (5447) 34.1 (4809) 32.9 (6034)
Cefoperazone/sulbactam 15.3 (359) 12.4 (542) 12.8 (549) 14 (457) 9.1 (494)
Ciprofloxacin 16.4 (5480) 16.5 (5463) 19 (5444) 20.1 (4559) 19 (5924)
Gentamicin 16.4 (5466) 13.6 (5419) 12.5 (4937) 13.3 (4521) 18.6 (5924)
Imipenem 3.1 (5407) 2.2 (5363) 2.7 (5344) 4.4 (4612) 5.5 (5956)
Meropenem 3.7 (5262) 2.8 (5193) 3.1 (5270) 5.3 (4601) 6.4 (5969)
Co-trimoxazole 33.6 (5554) 31.8 (5066) 31.9 (5162) 32.1 (4445) 29.9 (5831)

45 |
 2018

50 2019
2020
45
2021
40 2022
Percentagee (%) of resistance

35

30

25

20

15

10

Figure 28: Antibiotic resistance trend of Klebsiella pneumoniae isolated from urine from 2018 until 2022.
Resistance rates against amikacin, piperacillin/taxobactam, gentamicin, imipenem and meropenem show an increment in 2022
in comparison to 2021 while the rest show a decreased resistance rate in a recent year compared to 2021.

46 |
Klebsiella pneumoniae from blood specimens

Table 14: Percentage of antibiotic resistant Klebsiella pneumoniae isolated from blood from 2018 until 2022. The number of
samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

% R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested) % R (no. tested)

Amoxicillin/ 28.0 (5309) 25.2 (5179) 25.1 (5281) 30.3 (5605) 27.1 (6076)
clavulanic acid
Ampicillin/sulbactam 37.0 (4229) 33 (3982) 34.4 (3983) 36.5 (4991) 35.9 (5424)
Piperacillin/tazobactam 18.5 (5240) NA 16.4 (4909) 20.6 (5581) 21.1 (6182)
Cefepime 26.8 (5552) 24.5 (5241) 23.6 (5202) 26.9 (5945) 25.8 (6592)
Cefotaxime 35.2 (5485) 31.3 (5277) 31.1 (5217) 33.3 (5740) 32.8 (6425)
Ceftazidime 33.0 (5668) 29.2 (5264) 28.4 (5292) 31 (5937) 29.6 (6614)
Cefuroxime 36.7 (5639) 34.3 (5200) 34.2 (5179) 36.6 (5788) 35.7 (6508)
Cefoperazone/sulbactam 20.8 (616) 17 (648) 11.3 (533) 17.7 (761) 10.8 (527)
Gentamicin 14.4 (5627) 11.1 (5299) 12 (5146) 11.7 (5739) 11.5 (6585)
Imipenem 3.1 (5567) 3.2 (5300) 3.2 (5270) 7.4 (5923) 6.4 (6562)
Meropenem 3.5 (5534) 3.5 (5227) 3.7 (5222) 8.5 (5914) 7.4 (6570)

47 |
 2018

50 2019
2020
45
2021

40 2022

35
Percentage (%) of resistance

30

25

20

15

10

Figure 29: Antibiotic resistance trend of Klebsiella pneumoniae isolated from blood from 2018 until 2022.
Apart from piperacillin/tazobactam, all the antibiotics show a decreased resistance rate in 2022 in comparison to 2021.

48 |
An apparent decreasing antibiotic resistance trend was observed in 2022
compared to 2021 for most antibiotics tested for K. pneumoniae isolated from urine
and blood. Higher carbapenem (imipenem and meropenem) resistance rate was
noted for K. pneumoniae isolated from blood compared to the urine isolates.

49 |
Pseudomonas aeruginosa

A total of 23238 Pseudomonas aeruginosa was isolated in 2022. The majority of

them were isolated from sputum (18.7 %) and followed by urine (15.1 %) and
tracheal aspirate (14.7 %).

Sputum 4349
Urine 3510
Tracheal aspirate 3420
Tissue 2763
Blood 2223
Swab 1951
Pus 1232
Specimens

Fluid 695
Bone 517
Tracheal 515
Eyes 473
Wound 398
Respiratory 300
ENT 271
Bronchial 248
Broncho-alveolar lavage 161
Others 125
Muscle 87

0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

Number of isolates

Figure 30: Distribution of Pseudomonas aeruginosa isolates based on clinical

specimens. Bars show the number of isolates isolated from several clinical specimens in
the year 2022.

50 |
Table 15: Percentage of antibiotic resistant Pseudomonas aeruginosa isolated from all clinical specimens from 2018 until
2022. The number of samples tested is stated in brackets.

Antibiotics 2018 2019 2020 2021 2022

%R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested) %R (no. tested)
Amikacin 2.6 (23506) 4.1 (23174) 4.7 (19979) 4.7 (19412) 3.5 (23145)
Cefepime 3.8 (22960) 6.1 (22731) 6.4 (19645) 6.8 (19159) 5 (23020)
Ceftazidime 5.0 (23695) 7.4 (22861) 8.2 (19922) 8.4 (19427) 6.7 (22636)
Ciprofloxacin 3.9 (23646) 5.8 (23718) 6.3 (19990) 6 (19357) 4.8 (23117)
Gentamicin 3.4 (32184) 5.5 (23280) 6.3 (19329) 8.2 (18760) 4.7 (23155)
Imipenem 5.2 (22386) 7.7 (22748) 8.1 (19652) 8.6 (19327) 6.8 (23025)
Meropenem 5.1 (22553) 7.7 (22224) 8.4 (19278) 8.7 (19322) 7.1 (23081)
Piperacillin/ tazobactam 6.5 (23273) 5.8 (23199) 6.6 (20003) 6.7 (19370) 5.3 (23131)
Colistin 0.6 (4381) 0.3 (3709) 3.3 (2930) 8.2 (1444) 1.3 (1264)

51 |
 2018
2019
2020
10 2021
9 2022
Percentage (%) of resistance

8
7
6
5
4
3
2
1
0

Figure 31: Antibiotic resistance trend for Pseudomonas aeruginosa isolated from
all specimens from 2018 until 2022.
Decreased resistance rate was noted for all antibiotics tested in 2022 in comparison to 2021.
Resistance rate for imipenem and meropenem was observed to be decreased from 8.6 % to
8.7 % and 6.8 to 7.1 % respectively in 2022. As observed, the decreased resistance rate for
colistin is quite outstanding where it is almost six times lower in 2022 in comparison to
2021 (Table 15 and Figure 31).

52 |
 10.0

9.0

8.0
Percentage (%) of resistance

7.0

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Figure 32: Breakdown for antibiotic resistance trend of Pseudomonas

aeruginosa isolated from all specimens in 2022.

53 |
Salmonella enterica sp. Typhi

Table 16: Percentage of antibiotic resistance for Salmonella enterica sp. Typhi
isolated from all samples. The number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Ampicillin 15.5 (103) 3.9 (102) 9.1 (33) 5.3 (57) 2.0 (49)
Ceftriaxone 1 (101) 1.0 (97) 0 (31) 1.6 (62) 2.1 (48)
Ciprofloxacin 8.9 (101) 2.0 (102) 3.0 (33) 0 (56) 27.3 (44)
Chloramphenicol 8.1 (86) 2.7 (37) 10.0 (20) 6.3 (32) 7.1 (28)
Co-trimoxazole 7.9 (101) 3.0 (100) 6.5 (31) 5.4 (56) 4.1 (49)

2018
50
2019
45
2020
40 2021
Percentage (%) of resistance

2022
35

30

25

20

15

10

0
Ampicillin Ceftriaxone Ciprofloxacin Chloramphenicol Co-trimoxazole

Figure 33: Antibiotic resistance trend for Salmonella enterica sp. Typhi isolated
from all samples from 2018 until 2022.

Salmonella enterica sp. Typhi isolates show an increased resistance rate against all the
tested antibiotics except for ampicillin and co-trimoxazole in 2022 as compared to 2021.
The outstanding increment of resistance rate can be observed for ciprofloxacin where it was
0 % of resistance rate in 2021 in comparison to 27.3 % in 2022.

54 |
Salmonella sp.

Salmonella sp. from blood specimens

Table 17: Percentage of antibiotic resistance for Salmonella sp. isolated from
blood. The number of samples tested is stated in brackets.

2018 2019 2020 2021 2022

Antibiotic %R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Ampicillin 15.4 (799) 11.9 (1039) 14.0 (738) 16.8 (806) 16.6 (936)
Ceftriaxone 1.3 (764) 0.6 (1007) 0.8 (714) 1.1 (801) 2.4 (901)
Ciprofloxacin 2.1 (714) 1.3 (1019) 0.8 (734) 1.0 (782) 3.5 (858)
Chloramphenicol 5.3 (563) 3.0 (724) 5.5 (506) 5.7 (598) 7.2 (621)
Co-trimoxazole 5.8 (777) 3.4 (1016) 4.1 (715) 5.7 (784) 5.6 (910)

Isolates of Salmonella sp. from blood specimens show remarkable increasing resistance rate
for all tested antibiotic except for co-trimoxazole s in 2022 as compared to 2021 (Table 17
and Figure 34).

2018
2019
20
2020
18
2021
16 2022
Percentage (%) of resistance

14

12

10

0
Ampicillin Ceftriaxone Ciprofloxacin Chloramphenicol Co-trimoxazole

Figure 34: Antibiotic resistance trend for Salmonella sp. isolated from blood
sample from 2018 until 2022.

55 |
Salmonella sp. from stool specimens

Table 18: Percentage of antibiotic resistance for Salmonella sp. isolated from
stool. The number of samples tested is stated in brackets.

2018 2019 2020 2021 2022

Antibiotic %R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Ampicillin 23.7 (1762) 26.9 (2083) 25.8 (2292) 28.0 (1705) 30.5 (1947)
Ceftriaxone 1.9 (1817) 2.1 (2041) 3.0 (911) 3.4 (1587) 3.8 (1878)
Ciprofloxacin 1.9 (1555) 2.3 (2040) 1.5 (2271) 2.7 (1599) 3.6 (1734)
Chloramphenicol 13.1 (1516) 14.1 (1587) 15.1 (629) 15.1 (1201) 18.8 (1226)
Co-trimoxazole 14 (1727) 13.0 (2045) 12.1 (2235) 13.3 (1680) 15.7 (1931)

Salmonella sp. from stool specimens showed some increment in resistance rates towards
all the tested antibiotics including ampicillin, ceftriaxone, ciprofloxacin, chloramphenicol
and co-trimoxazole in 2022 as compared to 2021 (Table 18 and Figure 35).

2018
50
2019
45
2020
40 2021
Percentage (%) of resistance

35 2022

30

25

20

15

10

0
Ampicillin Ceftriaxone Ciprofloxacin Chloramphenicol Co-trimoxazole

Figure 35: Antibiotic resistance trend for Salmonella sp. isolated from stool
sample from 2018 until 2022.

56 |
 Blood Stool

3.6
Percentage (%) of resistance

2.9
2.7

2.3
2.1
1.9

1.5
1.3
1.0
0.8

2018 2019 2020 2021 2022

Year

Figure 36: Trend of ciprofloxacin resistance among Salmonella sp. from blood
and stool from 2018 until 2022.

57 |
Neisseria gonorrhoeae

Table 19: Percentage of antibiotic resistance for Neisseria gonorrhoeae. The

number of samples tested is stated in brackets.

Antibiotic 2018 2019 2020 2021 2022

%R %R %R %R %R
(no. tested) (no. tested) (no. tested) (no. tested) (no. tested)
Penicillin G 57.9 (420) 55.0 (393) 60.0 (279) 56.5 (161) 60 (245)

Ceftriaxone* 2.2 (414) 2.9 (381) 1.7 (294) 0.6 (168) 2.1 (239)

Ciprofloxacin 66 (418) 71.7 (378) 66.0 (294) 70.9 (175) 71.6 (257)

Tetracycline 77.2 (394) 82.1 (363) 75.6 (266) 79.2 (168) 76.1 (243)

*Not verified by reference laboratory

Penicillin G Ceftriaxone* Ciprofloxacin Tetracycline

100

90

80
Percentage (%) of resistance

70

60

50

40

30

20

10

0
2017 2018 2019 2020 2021

Figure 37: Antibiotic resistance trend for Neisseria gonorrhoeae from 2018 until
2022.
Resistance rates of penicillin G, ceftriaxone and ciprofloxacin for N. gonorrhoeae is
increased in 2022 as compared to 2021 (Table 19 and Figure 36). However, tetracycline
showed some decrease in the resistance rates against the respected species.

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 List of contributing hospitals

The list of hospitals contributing to the 2022 data is as listed.

Major & State Hospitals
Hospital Tuanku Fauziah, Kangar
Hospital Sultanah Bahiyah, Alor Setar
Hospital Pulau Pinang
Hospital Raja Permaisuri Bainun, Ipoh
Hospital Selayang
Hospital Sungai Buloh
Hospital Kuala Lumpur
Hospital Tengku Ampuan Rahimah, Klang
Hospital Tuanku Jaafar, Seremban
Hospital Melaka
Hospital Sultanah Aminah, Johor Bahru
Hospital Tengku Ampuan Afzan, Kuantan
Hospital Sultanah Nur Zahirah, Kuala Terengganu
Hospital Raja Perempuan Zainab II, Kota Bharu
Hospital Queen Elizabeth, Kota Kinabalu
Hospital Umum Sarawak
Specialists and District Hospitals
Hospital Sultan Abdul Halim, Sungai Petani
Hospital Kulim
Hospital Langkawi
Hospital Bukit Mertajam
Hospital Taiping
Hospital Teluk Intan
Hospital Ampang
Hospital Serdang
Hospital Putrajaya
Hospital Kajang
Hospital Tuanku Ampuan Najihah, Kuala Pilah
Hospital Sultanah Fatimah, Muar
Hospital Sultan Ismail, JB
Hospital Segamat
Hospital Kuala Lipis
Hospital Sultan Haji Ahmad Shah, Temerloh
Hospital Kemaman
Hospital Tanah Merah
Hospital Kuala Krai
Hospital Duchess of Kent, Sandakan
Hospital Sibu
Hospital Miri
Hospital Bintulu
Hospital Taiping
Hospital Angkatan Tentera Tuanku Mizan
Hospital Alor Gajah
University Hospitals
UKM Medical Centre (PPUKM)
UM Medical Centre (PPUM)
National Public Health Laboratory
Makmal Kesihatan Awam Kota Bharu

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Acknowledgement

We would like to thank all clinical microbiologists, scientific officers, and

laboratory technicians for their contributions in this surveillance of antibiotic
resistance data. We are very grateful for the continuous technical support given
by Mr Mohd Zainuldin Taib, former Senior Researcher from the Institute for
Medical Research.

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