Higher Frequency and Mortality Rate of Antimicrobial-resistant Bloodstream Infections in Tertiary-care Hospitals Compared with Secondary-care Hospitals in Thailand

Abstract

AbstractThere are few studies comparing proportion, frequency, mortality and mortality rate of antimicrobial-resistant (AMR) bacterial infections between tertiary-care hospitals (TCHs) and secondary-care hospitals (SCHs) in low and middle-income countries (LMICs) to inform infection control strategies. We evaluated bloodstream infections (BSIs) from 2012 to 2015 in 15 TCHs and 34 SCHs in Thailand. There were differences in the proportions (%) of BSI caused by AMR strains for some pathogens between TCHs and SCHs. Of 19,665 patients with AMR BSI, 6,746 (34.3%) died. Among patients with AMR BSI, there were no or minimal differences in mortality proportion for all AMR pathogens between TCHs and SCHs. However, the frequency and mortality rates of AMR BSI were considerably higher in TCHs for most pathogens. For example, the mortality rate of hospital-origin carbapenem-resistantAcinetobacter baumanniiBSI in TCHs was nearly three times higher than that in SCHs (10.2 vs. 3.6 per 100,000 patient-days at risk, mortality rate ratio 2.77; 95% confidence interval 1.71 to 4.48, p<0.0001). Targets of and resources for antimicrobial stewardship and infection control programs in LMICs may need to be tailored based on hospital type and size, as burden of AMR infections could differ by hospital setting.