Epidemiology, microbiology and mortality associated with community-acquired bacteremia in northeast Thailand: a multicenter surveillance study.

BackgroundNational statistics in developing countries are likely to underestimate deaths due to bacterial infections. Here, we calculated mortality associated with community-acquired bacteremia (CAB) in a developing country using routinely available databases.Methods/principal findingsInformation was obtained from the microbiology and hospital database of 10 provincial hospitals in northeast Thailand, and compared with the national death registry from the Ministry of Interior, Thailand for the period between 2004 and 2010. CAB was defined in patients who had pathogenic organisms isolated from blood taken within 2 days of hospital admission without a prior inpatient episode in the preceding 30 days. A total of 15,251 CAB patients identified, of which 5,722 (37.5%) died within 30 days of admission. The incidence rate of CAB between 2004 and 2010 increased from 16.7 to 38.1 per 100,000 people per year, and the mortality rate associated with CAB increased from 6.9 to 13.7 per 100,000 people per year. In 2010, the mortality rate associated with CAB was lower than that from respiratory tract infection, but higher than HIV disease or tuberculosis. The most common causes of CAB were Escherichia coli (23.1%), Burkholderia pseudomallei (19.3%), and Staphylococcus aureus (8.2%). There was an increase in the proportion of Extended-Spectrum Beta-Lactamases (ESBL) producing E. coli and Klebsiella pneumoniae over time.ConclusionsThis study has demonstrated that national statistics on causes of death in developing countries could be improved by integrating information from readily available databases. CAB is neglected as an important cause of death, and specific prevention and intervention is urgently required to reduce its incidence and mortality

Age- and gender- specific incidence rate of community-acquired bacteremia (CAB), northeast Thailand, 2004–2010.

<p>CAB was defined in patients who had pathogenic organisms isolated from blood taken in the first 2 days of admission and without a hospital stay within 30 days prior to the admission. The incidence rate of CAB was calculated as the number of CAB identified in the participating hospitals per 100,000 people per year.</p

Mortality rates from leading causes of death due to infectious diseases per 100,000 people per year in northeast Thailand between 2004 and 2010.

<p>Mortality rate attributable to CAB was calculated as the number of CAB patients who died within 30 days of the admission per 100,000 people per year. Death due to other infectious diseases shown was defined in patients who were admitted to the study hospitals, died within 30 days of admission, and had the primary cause of death based on ICD-10 codes of HIV disease (B20–24), tuberculosis (A15–19), lower respiratory tract infection (J09–18), and diarrhea (A09), after excluding those who died within 30 days due to CAB as described above.</p

30-day mortality associated with community-acquired bacteremia (CAB) in northeast Thailand by age group.

<p>30-day mortality associated with community-acquired bacteremia (CAB) in northeast Thailand by age group.</p

Multivariable analysis of risk factors for melioidosis.

<p>Estimated odds ratios (OR) are conditional on the matching variables (gender, age, admission date (+/−2 weeks), and diagnosis of diabetes mellitus) and adjusted for the other risk factors included in the model.</p

Recommendations for the prevention of melioidosis.

<p>Recommendations for the prevention of melioidosis.</p

Study flow diagram.

<p>Study flow diagram.</p

Increasing Incidence of Hospital-Acquired and Healthcare-Associated Bacteremia in Northeast Thailand: A Multicenter Surveillance Study

<div><p>Background</p><p>Little is known about the epidemiology of nosocomial bloodstream infections in public hospitals in developing countries. We evaluated trends in incidence of hospital-acquired bacteremia (HAB) and healthcare-associated bacteremia (HCAB) and associated mortality in a developing country using routinely available databases.</p><p>Methods</p><p>Information from the microbiology and hospital databases of 10 provincial hospitals in northeast Thailand was linked with the national death registry for 2004–2010. Bacteremia was considered hospital-acquired if detected after the first two days of hospital admission, and healthcare-associated if detected within two days of hospital admission with a prior inpatient episode in the preceding 30 days.</p><p>Results</p><p>A total of 3,424 patients out of 1,069,443 at risk developed HAB and 2,184 out of 119,286 at risk had HCAB. Of these 1,559 (45.5%) and 913 (41.8%) died within 30 days, respectively. Between 2004 and 2010, the incidence rate of HAB increased from 0.6 to 0.8 per 1,000 patient-days at risk (p<0.001), and the cumulative incidence of HCAB increased from 1.2 to 2.0 per 100 readmissions (p<0.001). The most common causes of HAB were <i>Acinetobacter</i> spp. (16.2%), <i>Klebsiella pneumoniae</i> (13.9%), and <i>Staphylococcus aureus</i> (13.9%), while those of HCAB were <i>Escherichia coli</i> (26.3%), <i>S. aureus</i> (14.0%), and <i>K. pneumoniae</i> (9.7%). There was an overall increase over time in the proportions of ESBL<i>-</i>producing <i>E. coli</i> causing HAB and HCAB.</p><p>Conclusions</p><p>This study demonstrates a high and increasing incidence of HAB and HCAB in provincial hospitals in northeast Thailand, increasing proportions of ESBL-producing isolates, and very high associated mortality.</p></div

Cumulative incidence of healthcare-associated bacteremia (HCAB) and associated death rate between 2004 and 2010 in northeast Thailand.

<p>*Patients at risk of HCAB were patients who had a hospital stay within 30 days prior to the admission.</p><p>Cumulative incidence of healthcare-associated bacteremia (HCAB) and associated death rate between 2004 and 2010 in northeast Thailand.</p