{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T20:06:16Z","timestamp":1769198776039,"version":"3.49.0"},"reference-count":14,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The Korean National Healthcare\u2013associated Infections Surveillance System (KONIS) monitors multidrug\u2013resistant (MDR) bacterial infections in intensive care units (ICUs). However, simultaneously monitoring hundreds of ICUs remains challenging. Our study aimed to visualize the trends of MDR gram\u2013negative bacterial infections in ICUs monitored by KONIS.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We evaluated KONIS data from 137 ICUs (2006\u20132011) and from 368 ICUs (2017\u20132022). Pneumonia, urinary tract infection, and bloodstream infection caused by <jats:italic><jats:italic>Klebsiella pneumoniae<\/jats:italic><\/jats:italic>, <jats:italic><jats:italic>Pseudomonas aeruginosa<\/jats:italic><\/jats:italic>, and <jats:italic><jats:italic>Acinetobacter baumannii<\/jats:italic><\/jats:italic> were analyzed. Transformation was employed to convert the infection rate graphs of each ICU into arrows. The length and angle of the arrows reflect changes in carbapenem susceptibility and infection rate, respectively. ICUs are categorized into red (rapid shift from susceptible to resistant bacteria and increased infection rate), yellow (slow shift from susceptible to resistant bacteria and decreased infections rate), and green (shift from resistant to susceptible bacteria) groups. The proportional changes in each ICU category were compared during the first and last five years of the study periods.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>For <jats:italic><jats:italic>K. pneumoniae<\/jats:italic><\/jats:italic>, the proportion of red category ICUs increased (0% to 17%, p-value 0.586), while the proportions of yellow (33.3% to 7%, p-value 0.288) and green category ICUs (66.6% to 36%, p-value 0.290) decreased. For <jats:italic><jats:italic>P. aeruginosa<\/jats:italic><\/jats:italic>, the proportions of red (12% to 27%, p-value 0.016) and green category ICUs (38% to 46%, p-value 0.358) increased, while the proportion of yellow category ICUs decreased (8% to 2%, p-value 0.043). For <jats:italic><jats:italic>A. baumannii<\/jats:italic><\/jats:italic>, the proportions of red (19% to 14%, p-value 0.649) and yellow category ICUs (5% to 1%, p-value 0.187) decreased, while the proportion of green category ICUs increased (19% to 72%, p-value &lt;0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Graph transformation allowed the observation of MDR Gram-negative bacterial infection trends in ICUs. Further studies should aim to confirm whether our arrow indicators are useful for infection control and in identifying factors for reducing infections.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0330765","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T17:29:15Z","timestamp":1756402155000},"page":"e0330765","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Visualization of multidrug-resistant bacterial infection trends in the intensive care units"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5870-2223","authenticated-orcid":true,"given":"Woojae","family":"Jeon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2013Mi","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong Youn","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ki\u2013Ho","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8951-5032","authenticated-orcid":true,"given":"Mi Suk","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"pone.0330765.ref001","unstructured":"Korean Disease Control and Prevention Agency. Annual report of the Korean national healthcare-associated infections surveillance system (KONIS) 2022. 2022."},{"issue":"1","key":"pone.0330765.ref002","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jhin.2015.06.002","article-title":"Trends in the incidence rate of device-associated infections in intensive care units after the establishment of the Korean Nosocomial Infections Surveillance System","volume":"91","author":"JY Choi","year":"2015","journal-title":"J Hosp Infect"},{"issue":"4","key":"pone.0330765.ref003","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jhin.2017.04.003","article-title":"Validation of the Korean National Healthcare-associated Infections Surveillance System (KONIS): an intensive care unit module report","volume":"96","author":"YG Kwak","year":"2017","journal-title":"J Hosp Infect"},{"issue":"3","key":"pone.0330765.ref004","article-title":"Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance","volume":"100","author":"EJ Kim","year":"2018","journal-title":"J Hosp Infect"},{"issue":"3","key":"pone.0330765.ref005","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1016\/j.ajic.2019.07.020","article-title":"Ten-year surveillance of central line-associated bloodstream infections in South Korea: Surveillance not enough, action needed","volume":"48","author":"EJ Kim","year":"2020","journal-title":"Am J Infect Control"},{"issue":"4","key":"pone.0330765.ref006","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.jhin.2015.12.012","article-title":"Trends in the distribution and antimicrobial susceptibility of causative pathogens of device-associated infection in Korean intensive care units from 2006 to 2013: results from the Korean Nosocomial Infections Surveillance System (KONIS)","volume":"92","author":"JY Choi","year":"2016","journal-title":"J Hosp Infect"},{"key":"pone.0330765.ref007","doi-asserted-by":"crossref","first-page":"606976","DOI":"10.3389\/fmed.2020.606976","article-title":"Trends in the Epidemiology of Candidemia in Intensive Care Units From 2006 to 2017: Results From the Korean National Healthcare-Associated Infections Surveillance System","volume":"7","author":"EJ Kim","year":"2020","journal-title":"Front Med (Lausanne)"},{"key":"pone.0330765.ref008","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jhin.2023.05.010","article-title":"Impact of COVID-19 pandemic on healthcare-associated infections at intensive care units in South Korea: data from the Korean National Healthcare-Associated Infections Surveillance System (KONIS)","volume":"138","author":"Y-M Lee","year":"2023","journal-title":"J Hosp Infect"},{"issue":"10","key":"pone.0330765.ref009","article-title":"Changing epidemiology of pathogenic bacteria over the past 20 years in Korea","volume":"38","author":"MH Bae","year":"2023","journal-title":"J Korean Med Sci"},{"key":"pone.0330765.ref010","author":"Clinical and Laboratory Standards Institute","year":"2023","edition":"33"},{"issue":"6","key":"pone.0330765.ref011","doi-asserted-by":"crossref","DOI":"10.1128\/JCM.00203-19","article-title":"Understanding and Addressing CLSI Breakpoint Revisions: a Primer for Clinical Laboratories","volume":"57","author":"RM Humphries","year":"2019","journal-title":"J Clin Microbiol"},{"issue":"2","key":"pone.0330765.ref012","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.ajic.2023.06.020","article-title":"External and internal validation of healthcare-associated infection data collected by the Korean National healthcare-associated Infections Surveillance System (KONIS)","volume":"52","author":"JE Song","year":"2024","journal-title":"Am J Infect Control"},{"key":"pone.0330765.ref013","author":"World Health Organization","year":"2022"},{"key":"pone.0330765.ref014","author":"Centers for Disease Control and Prevention","year":"2023"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330765","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T17:29:19Z","timestamp":1756402159000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0330765"}},"subtitle":[],"editor":[{"given":"Ali","family":"Amanati","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0330765","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]}}}