Epidemiology and burden of multidrug-resistant bacterial infection in a developing country.
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.
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Cherry
0000-0003-2555-6980
C
Lim
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Emi
E
Takahashi
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Maliwan
M
Hongsuwan
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Vanaporn
V
Wuthiekanun
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Visanu
V
Thamlikitkul
Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand.
Soawapak
S
Hinjoy
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
Nicholas Pj
0000-0003-2309-1171
NP
Day
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|London School of Hygiene and Tropical Medicine, London, United Kingdom.|University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
Sharon J
0000-0002-1718-2782
SJ
Peacock
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.|Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Direk
0000-0001-7240-5320
D
Limmathurotsakul
D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D017281:Cost of Illness; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003906:Developing Countries; D024901:Drug Resistance, Multiple, Bacterial; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology
Acinetobacter; E. coli; Enterococcus; K. pneumoniae; P. aeruginosa; Staphylococcus aureus; antimicrobial resistant; epidemiology; global health