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Abstract
No studies have quantified the impact of pre-culture antibiotic use on the recovery of individual blood-borne pathogens or on population-level incidence estimates for Streptococcus pneumoniae. We conducted bloodstream infection surveillance in Thailand during November 2005–June 2008. Pre-culture antibiotic use was assessed by reported use and by serum antimicrobial activity. Of 35,639 patient blood cultures, 27% had reported pre-culture antibiotic use and 24% (of 24,538 tested) had serum antimicrobial activity. Pathogen isolation was half as common in patients with versus without antibiotic use; S. pneumoniae isolation was 4- to 9-fold less common (0.09% versus 0.37% by reported antibiotic use; 0.05% versus 0.45% by serum antimicrobial activity, P < 0.01). Pre-culture antibiotic use by serum antimicrobial activity reduced pneumococcal bacteremia incidence by 32% overall and 39% in children < 5 years of age. Our findings highlight the limitations of culture-based detection methods to estimate invasive pneumococcal disease incidence in settings where pre-culture antibiotic use is common.
Highlights
MATERIALS AND METHODSAntibiotic use is common among pediatric and adult patients presenting in both inpatient and outpatient settings.1 The scope and magnitude of antibiotic use is not well defined, in low and middle income nations where antibiotics are often available without prescription
Differences in S. pneumoniae isolation were even greater when antibiotic use was defined by serum antimicrobial activity or by a combined measure of reported use or serum activity
This lower culture yield significantly reduced the estimated incidence of pneumococcal bacteremia overall and in children < 5 years of age, by 32% and 39%, respectively, when antibiotic use was defined by serum antimicrobial activity
Summary
MATERIALS AND METHODSAntibiotic use is common among pediatric and adult patients presenting in both inpatient and outpatient settings.1 The scope and magnitude of antibiotic use is not well defined, in low and middle income nations where antibiotics are often available without prescription. Using active, populationbased surveillance from two provinces in rural Thailand, we measured the prevalence of antibiotic use before blood culture and its impact on S. pneumoniae isolation and on estimates of the incidence of pneumococcal bacteremia requiring hospitalization. Antibiotic use before blood culture defined by reported use* and by serum antimicrobial activity; Sa Kaeo and Nakhon Phanom, Thailand, November 2005 to June 2008
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