title: Antibiotic use in Thailand: quantifying impact on blood culture yield and estimates of pneumococcal bacteremia incidence.
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.
authors.affiliation: Thailand Ministry of Public Health - United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Julia
authors.initials: J
authors.lastname: Rhodes
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Hyder
authors.forename: Leonard F
authors.initials: LF
authors.lastname: Peruski
authors.forename: Cindy
authors.initials: C
authors.lastname: Fisher
authors.forename: Possawat
authors.initials: P
authors.lastname: Jorakate
authors.forename: Anek
authors.initials: A
authors.lastname: Kaewpan
authors.forename: Surang
authors.initials: S
authors.lastname: Dejsirilert
authors.forename: Somsak
authors.initials: S
authors.lastname: Thamthitiwat
authors.forename: Sonja J
authors.initials: SJ
authors.lastname: Olsen
authors.forename: Scott F
authors.initials: SF
authors.lastname: Dowell
authors.forename: Somrak
authors.initials: S
authors.lastname: Chantra
authors.forename: Kittisak
authors.initials: K
authors.lastname: Tanwisaid
authors.forename: Susan A
authors.initials: SA
authors.lastname: Maloney
authors.forename: Henry C
authors.initials: HC
authors.lastname: Baggett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004363:Drug Utilization; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011159:Population Surveillance; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents