PLoS ONE (Jan 2024)

Frequency and mortality rate following antimicrobial-resistant bloodstream infections in tertiary-care hospitals compared with secondary-care hospitals.

  • Cherry Lim,
  • Viriya Hantrakun,
  • Preeyarach Klaytong,
  • Chalida Rangsiwutisak,
  • Ratanaporn Tangwangvivat,
  • Chadaporn Phiancharoen,
  • Pawinee Doung-Ngern,
  • Somkid Kripattanapong,
  • Soawapak Hinjoy,
  • Thitipong Yingyong,
  • Archawin Rojanawiwat,
  • Aekkawat Unahalekhaka,
  • Watcharaporn Kamjumphol,
  • Kulsumpun Khobanan,
  • Pimrata Leethongdee,
  • Narisorn Lorchirachoonkul,
  • Suwimon Khusuwan,
  • Suwatthiya Siriboon,
  • Parinya Chamnan,
  • Amornrat Vijitleela,
  • Traithep Fongthong,
  • Krittiya Noiprapai,
  • Phairam Boonyarit,
  • Voranadda Srisuphan,
  • Benn Sartorius,
  • John Stelling,
  • Paul Turner,
  • Nicholas P J Day,
  • Direk Limmathurotsakul

DOI
https://doi.org/10.1371/journal.pone.0303132
Journal volume & issue
Vol. 19, no. 5
p. e0303132

Abstract

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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 secondary-data 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 patient-days 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, p0.20). Due to the higher frequencies, all-cause in-hospital mortality rates following hospital-origin AMR BSI per 100,000 patient-days 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.