Abstract
The global antimicrobial resistance surveillance system (GLASS) was launched by the World Health Organization (WHO) in 2015. GLASS is a surveillance system for clinical specimens that are sent to microbiology laboratory for clinical purposes. The unique feature of GLASS is that clinical data is combined with microbiological data, and deduplication of the microbiological results is performed. The objective of the study was to determine feasibility and benefit of GLASS for surveillance of blood culture specimens. GLASS was implemented at Siriraj Hospital in Bangkok, Thailand using a locally developed web application program (app) to transfer blood culture specimen data, and to enter clinical data of patients with positive blood culture by infection control nurses and physicians via the app installed in their smart phones. The rate of positive blood culture specimens with true infection was 15.2%. Escherichia coli was the most common cause of bacteremia. Secondary bacteremia, primary bacteremia, and central line-associated blood stream infection was observed in 61.8%, 30.6%, and 12.6% of cases, respectively. Sepsis was observed in 56.9% of patients. E.coli was significantly more common in community-acquired bacteremia, whereas Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and Acinetobacter baumannii were significantly more common in hospital-acquired bacteremia. Hospital-acquired isolates of E.coli, K.pneumoniae, A.baumannii, P.aeruginosa, S.aureus and Enterococcus faecium were more resistant to antibiotics than community-acquired isolates. In-hospital mortality was significantly higher in patients with antibiotic-resistant bacteremia than in patients with antibiotic non-resistant bacteremia (40.5% vs. 28.5%, p<0.001). The patients with antibiotic-resistant bacteremia consumed more resources than those with antibiotic non-resistant bacteremia. Blood culture results combined with patient clinical data were shown to have more benefit for surveillance of antimicrobial resistance, and to be more applicable for developing local antibiotic treatment guidelines for patients suspected of having bacteremia. However, GLASS consumed more time and more resources than the conventional laboratory-based surveillance system.
Highlights
Antimicrobial resistance (AMR) is a continually evolving public health crisis all over the world
The laboratory-based AMR surveillance system model does not provide information regarding the extent of AMR in a given population, and the data produced by this system has limited value for developing antibiotic guidelines for patients with a specific type of infection
Part II contains clinical data of patients with positive blood cultures, including the nature of the isolated organism, source or site of infection, type of infection, severity of infection, empirical antibiotics being given on the date of blood specimen collection, specific antibiotics given after the culture results were available, and clinical outcomes at the end of antibiotic treatment
Summary
Antimicrobial resistance (AMR) is a continually evolving public health crisis all over the world. The annual AMR burden in Thailand is estimated to be 100,000 new AMR infections, additional 3 million days of hospital stay, and 30,000 deaths [1]. Limitations of conventional AMR surveillance include the following: 1) the nature of the grown organism (causative agent, colonizer, or contaminant) is usually undetermined; 2) the source of infection is usually absent; 3) the type of infection (community-acquired or hospital-acquired infection) is usually unavailable; and, 4) data from the same patient who has the same isolated organisms with same antibiotic susceptibility profiles are often duplicated in the annual report of isolated organisms and their antibiotic susceptibility. The laboratory-based AMR surveillance system model does not provide information regarding the extent of AMR in a given population, and the data produced by this system has limited value for developing antibiotic guidelines for patients with a specific type of infection
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