Epidemiology and burden of multidrug-resistant bacterial infection in a developing country.

Cherry Lim,Sharon J Peacock,Visanu Thamlikitkul,Emi Takahashi,Soawapak Hinjoy,Nicholas Pj Day,Maliwan Hongsuwan,Vanaporn Wuthiekanun,Direk Limmathurotsakul

doi:10.7554/elife.18082

Abstract

Little is known about the excess mortality caused by multidrug-resistant (MDR) bacterial infection in low- and middle-income countries (LMICs). We retrospectively obtained microbiology laboratory and hospital databases of nine public hospitals in northeast Thailand from 2004 to 2010, and linked these with the national death registry to obtain the 30-day mortality outcome. The 30-day mortality in those with MDR community-acquired bacteraemia, healthcare-associated bacteraemia, and hospital-acquired bacteraemia were 35% (549/1555), 49% (247/500), and 53% (640/1198), respectively. We estimate that 19,122 of 45,209 (43%) deaths in patients with hospital-acquired infection due to MDR bacteria in Thailand in 2010 represented excess mortality caused by MDR. We demonstrate that national statistics on the epidemiology and burden of MDR in LMICs could be improved by integrating information from readily available databases. The prevalence and mortality attributable to MDR in Thailand are high. This is likely to reflect the situation in other LMICs.

Highlights

The emergence of antimicrobial resistance (AMR) is of major medical concern, in lowand middle-income countries (LMICs) (World Health Organization, 2014; Laxminarayan et al, 2013)
We reported an increase in the incidence of community-acquired bacteraemia (CAB), healthcare-associated bacteraemia (HCAB) and hospital-acquired bacteraemia (HAB) over the study period, and that bacteraemia was associated with high case fatality rates (37.5%, 41.8% and 45.5%, respectively) (Kanoksil et al, 2013; Hongsuwan et al, 2014)
Of 10,022 patients with first episodes of bacteraemia caused by S. aureus, Enterococcus spp, E. coli, K. pneumoniae, P. aeruginosa and Acinetobacter spp., 226 patients (2%) were excluded because the causative organisms were tested for susceptibility to fewer than three antimicrobial categories

Summary

Introduction

The emergence of antimicrobial resistance (AMR) is of major medical concern, in lowand middle-income countries (LMICs) (World Health Organization, 2014; Laxminarayan et al, 2013). In LMICs, antibiotic use is increasing with rising incomes, affordable antimicrobials and the lack of stewardship in hospital and poor control of over-the-counter sales. This is driving the emergence and spread of multidrug-resistant (MDR) pathogens in community and hospital settings. A recent report from the International Nosocomial Infection Control Consortium (INICC) showed that the prevalence of AMR organisms causing hospital-acquired infections (HAI) in ICUs in LMICs is much higher than those in the United States (US) (Rosenthal et al, 2014)

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