Frequency and mortality rate following antimicrobial-resistant bloodstream infections in tertiary-care hospitals compared with secondary-care hospitals
Issued Date
2024-05-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85193613500
Journal Title
PLoS ONE
Volume
19
Issue
5 May
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.19 No.5 May (2024)
Suggested Citation
Lim C., Hantrakun V., Klaytong P., Rangsiwutisak C., Tangwangvivat R., Phiancharoen C., Doung-Ngern P., SomkKripattanapon S., Hinjoy S., Yingyong T., Rojanawiwat A., Unahalekhaka A., Kamjumphol W., Khobanan K., Leethongdee P., Lorchirachoonkul N., Khusuwan S., Siriboon S., Chamnan P., Vijitleela A., Fongthong T., Noiprapai K., Boonyarit P., Srisuphan V., Sartorius B., Stelling J., Turner P., Day N.P.J., Limmathurotsakul D. Frequency and mortality rate following antimicrobial-resistant bloodstream infections in tertiary-care hospitals compared with secondary-care hospitals. PLoS ONE Vol.19 No.5 May (2024). doi:10.1371/journal.pone.0303132 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98492
Title
Frequency and mortality rate following antimicrobial-resistant bloodstream infections in tertiary-care hospitals compared with secondary-care hospitals
Author(s)
Lim C.
Hantrakun V.
Klaytong P.
Rangsiwutisak C.
Tangwangvivat R.
Phiancharoen C.
Doung-Ngern P.
SomkKripattanapon S.
Hinjoy S.
Yingyong T.
Rojanawiwat A.
Unahalekhaka A.
Kamjumphol W.
Khobanan K.
Leethongdee P.
Lorchirachoonkul N.
Khusuwan S.
Siriboon S.
Chamnan P.
Vijitleela A.
Fongthong T.
Noiprapai K.
Boonyarit P.
Srisuphan V.
Sartorius B.
Stelling J.
Turner P.
Day N.P.J.
Limmathurotsakul D.
Hantrakun V.
Klaytong P.
Rangsiwutisak C.
Tangwangvivat R.
Phiancharoen C.
Doung-Ngern P.
SomkKripattanapon S.
Hinjoy S.
Yingyong T.
Rojanawiwat A.
Unahalekhaka A.
Kamjumphol W.
Khobanan K.
Leethongdee P.
Lorchirachoonkul N.
Khusuwan S.
Siriboon S.
Chamnan P.
Vijitleela A.
Fongthong T.
Noiprapai K.
Boonyarit P.
Srisuphan V.
Sartorius B.
Stelling J.
Turner P.
Day N.P.J.
Limmathurotsakul D.
Author's Affiliation
Angkor Hospital for Children
Faculty of Tropical Medicine, Mahidol University
Mahidol Oxford Tropical Medicine Research Unit
UQ Centre for Clinical Research
National Health Security Office
Thailand Ministry of Public Health
University of Washington
Nuffield Department of Medicine
Harvard Medical School
Ratchaburi Regional Hospital
Sunpasitthiprasong Hospital
Chiangrai Prachanukroh Hospital
Faculty of Tropical Medicine, Mahidol University
Mahidol Oxford Tropical Medicine Research Unit
UQ Centre for Clinical Research
National Health Security Office
Thailand Ministry of Public Health
University of Washington
Nuffield Department of Medicine
Harvard Medical School
Ratchaburi Regional Hospital
Sunpasitthiprasong Hospital
Chiangrai Prachanukroh Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
There are few studies comparing proportion, frequency, mortality and mortality rate following antimicrobial-resistant (AMR) infections between tertiary-care hospitals (TCHs) and secondary- care hospitals (SCHs) in low and middle-income countries (LMICs) to inform intervention strategies. The aim of this study is to demonstrate the utility of an offline tool to generate AMR reports and data for a secondary data analysis. We conducted a secondarydata analysis on a retrospective, multicentre data of hospitalised patients in Thailand. Routinely collected microbiology and hospital admission data of 2012 to 2015, from 15 TCHs and 34 SCHs were analysed using the AMASS v2.0 (www.amass.website). We then compared the burden of AMR bloodstream infections (BSI) between those TCHs and SCHs. Of 19,665 patients with AMR BSI caused by pathogens under evaluation, 10,858 (55.2%) and 8,807 (44.8%) were classified as community-origin and hospital-origin BSI, respectively. The burden of AMR BSI was considerably different between TCHs and SCHs, particularly of hospital-origin AMR BSI. The frequencies of hospital-origin AMR BSI per 100,000 patientdays at risk in TCHs were about twice that in SCHs for most pathogens under evaluation (for carbapenem-resistant Acinetobacter baumannii [CRAB]: 18.6 vs. 7.0, incidence rate ratio 2.77; 95%CI 1.72-4.43, p<0.001; for carbapenem-resistant Pseudomonas aeruginosa [CRPA]: 3.8 vs. 2.0, p = 0.0073; third-generation cephalosporin resistant Escherichia coli [3GCREC]: 12.1 vs. 7.0, p<0.001; third-generation cephalosporin resistant Klebsiella pneumoniae [3GCRKP]: 12.2 vs. 5.4, p<0.001; carbapenem-resistant K. pneumoniae [CRKP]: 1.6 vs. 0.7, p = 0.045; and methicillin-resistant Staphylococcus aureus [MRSA]: 5.1 vs. 2.5, p = 0.0091). All-cause in-hospital mortality (%) following hospital-origin AMR BSI was not significantly different between TCHs and SCHs (all p>0.20). Due to the higher frequencies, all-cause in-hospital mortality rates following hospital-origin AMR BSI per 100,000 patientdays at risk were considerably higher in TCHs for most pathogens (for CRAB: 10.2 vs. 3.6, mortality rate ratio 2.77; 95%CI 1.71 to 4.48, p<0.001; CRPA: 1.6 vs. 0.8; p = 0.020; 3GCREC: 4.0 vs. 2.4, p = 0.009; 3GCRKP, 4.0 vs. 1.8, p<0.001; CRKP: 0.8 vs. 0.3, p = 0.042; and MRSA: 2.3 vs. 1.1, p = 0.023). In conclusion, the burden of AMR infections in some LMICs might differ by hospital type and size. In those countries, activities and resources for antimicrobial stewardship and infection control programs might need to be tailored based on hospital setting. The frequency and in-hospital mortality rate of hospital-origin AMR BSI are important indicators and should be routinely measured to monitor the burden of AMR in every hospital with microbiology laboratories in LMICs.