accounts for 8% to 30% of clinical isolates of K. pneumoniae. .Those producing SHV-5 and SHV-12 predominated. In addi- tion, four novel beta-lactamases (CMY-8, SHV-25, SHV-26, and IMP-8) were identified in 2000 in Taiwan (38-42). Among the ESBL-producing E. coli isolates, which accounted for 1.6% to 6.7%, strains having CTX-M-3 and CMY-M-2 were disseminated in Taiwan (39,43). In Taiwan, the previous belief that characteristically susceptible strains (uniformly suscepti- ble to cephalosporins) of K. pneumoniae caused primary liver abscess, an endemic disease entity in patients with diabetes mellitus, has now been disproved because two cephalosporin- resistant K. pneumoniae strains causing primary liver abscess have been found (44-46). More than 40% of clinical isolates of nontyphoid Salmo- nella species were resistant to multiple antibiotics (ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole). Resis- tance to cefotaxime and fluoroquinolones was estimated to be low (1% to 3%) (47). P. aeruginosa, A. baumannii, and Other Bacteria P. aeruginosa, A. baumannii, and other nonfermentative gram-negative bacilli are usually resistant to various antimi- crobial agents. A high proportion of clinical isolates, particu- larly those recovered from patients in intensive-care units, that are resistant to some last-line agents (ceftazidime, amikacin, ciprofloxacin, and carbapenems) have now been found in Tai- wan (3-6,48,49). A small outbreak of infections (three patients) caused by a pan-drug-resistant P. aeruginosa (sero- group O:4) clone in an intensive-care burn unit from April 1997 to May 1997 has been identified (3) This clone had been isolated from a patient on the same unit 5 months before the outbreak (3). Among P. aeruginosa isolates with reduced sus- ceptibilities to imipenem, VIM-2 and VIM-3 are the predomi- nant metallo-beta-lactamases (50). Furthermore, clonal dissemination of VIM-3-producing P. aeruginosa has been found among hospitals in Taiwan (50). Strains of ceftazidime- and ciprofloxacin-resistant A. baumannii causing severe com- munity-acquired pneumonia have emerged (49). Infections caused by Chryseobacterium indologenes, a multidrug-resis- tant nosocomial pathogen, appear to be another emerging problem in Taiwan (5). Isolates of the Chryseobacterium genus have remarkable discrepancies of susceptibility results by the disk-diffusion and dilution method. Vancomycin is not recommended as a drug of choice for treating C. meningosep- ticum meningitis or other infections caused by Chryseobacte- rium species because these isolates are highly resistant to vancomycin when the standard agar dilution method is used (4). Several multidrug-resistant (extended-spectrum cepha- losporins, ciprofloxacin, or carbapenem resistance) Aeromo- nas species have been reported (51,52). A derepressed mutant of A. hydrophila, which overexpresses beta-lactamases and shows resistance to extended-spectrum cephalosporins, is used if treatment with cefotaxime for Aeromonas bacteremia fails (52). High prevalence of ciprofloxacin resistance for human SYNOPSIS isolates of Campylobacter jejuni (52%) and C. coli (75%) may be attributable to the widespread use of quinolones in poultry in Taiwan (53,54). Strategy for Resistance Control in the 21st Century By the end of the 20th century, many measures to control resistance problems had been instituted in Taiwan. Antibiotics had been removed from the list of available nonprescription drugs at drugstores. Antibiotic interventions had been imple- mented in many hospitals, particularly in intensive-care units, to alleviate the high prevalence of resistance among nosoco- mial pathogens. In 2000, the Council of Agriculture in Taiwan prohibited the use of several antimicrobial agents (such as avoparcin, kanamycin, kitasamycin, lasalocid, spiramycin, salinomycin, and streptomycin), which had been widely used as growth promoters or prophylactic agents in animal hus- bandry in Taiwan during the past 2 to 3 decades, because they may select for critical forms of resistance in human pathogens in food-producing animals (54). Further research is ongoing to reduce the risk for increasing resistance in human pathogens caused by antibiotic use in animal husbandry. In the new mil- lennium, the Center for Disease Control, Department of Health, in Taiwan, has made control of antimicrobial resis- tance a major goal. The two main tasks are to restrict use of antibiotics for trivial upper respiratory tract infections and to avoid inappropriate use of antibiotics for surgical prophylaxis. Acknowledgments We thank the members of SMART (Surveillance for Multicenter Antimicrobial Resistance in Taiwan), the Infectious Diseases Society of the Republic of China, and the Society of Laboratory Medicine, the Republic of China. The SMART members from 12 major hospitals in Taiwan include Po-Ren Hsueh, Lee-Jene Teng, Kwen-Tay Luh, Kwok-Woon Yu, Cheng-Yi Liu, Jang-Jih Lu, Feng-Yee Chang, Ting-I Yang, Chun-Ming Lee, Tsu-Lan Wu, Hsieh-Shong Leu, Jainn-Ming Shyr, Yeu-Jun Liu, Jen-Hsieh Wan, Jing-Jou Yang, Wen-Chien Ko, Jiunn-Jong Wu, Yi-Chueh Yang, Yin-Ching Chuang, Chang-Fang Peng, Kao-Pin Hwang, Wen-Kuei Huang, Yung-Ching Liu, and Li- Shin Wang. Dr. Hsueh is assistant professor in the Departments of Laboratory Medicine and Internal Medicine at National Taiwan University Col- lege of Medicine in Taipei, Taiwan. His research interests include the epidemiology of emerging and nosocomial infections and mecha- nisms of antimicrobial drug resistance. He is actively involved in developing a national research program for antimicrobial drug resis- tance (Surveillance for Multicenter Antimicrobial Resistance in Tai- wan-SMART). References 1. Ho M, McDonald C, Lauderdale TL, Yeh LLL, Chen PC, Shiau YR, et al. Surveillance of antibiotic resistance in Taiwan, 1998. J Microbiol Immu- nol Infect 1999;32:239-49. 2. Chang SC, Hsieh WC. Current status of bacterial antibiotic resistance in Taiwan. Journal of Infectious Diseases Society of the Republic of China 1996;7:83-8. Emerging Infectious Diseases • Vol. 8, No. 2, February 2002 135