Age- and gender- specific incidence rates of hospital-acquired bacteremia (HAB) between 2004 and 2010 in northeast Thailand.

<p>Age- and gender- specific incidence rates of hospital-acquired bacteremia (HAB) between 2004 and 2010 in northeast Thailand.</p

Pathogenic organisms associated with hospital-acquired bacteremia (HAB) or healthcare-acquired bacteremia (HCAB).

<p>Pathogenic organisms associated with hospital-acquired bacteremia (HAB) or healthcare-acquired bacteremia (HCAB).</p

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

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

Incidence rates of hospital-acquired bacteremia (HAB) and associated death rate between 2004 and 2010 in northeast Thailand.

<p>*Patients at risk of HAB were patients who stayed in the hospital longer than 2 days.</p><p>Incidence rates of hospital-acquired bacteremia (HAB) and associated death rate between 2004 and 2010 in northeast Thailand.</p

Age- and gender- specific cumulative incidence rates of healthcare-associated bacteremia (HCAB) between 2004 and 2010 in northeast Thailand.

<p>Age- and gender- specific cumulative incidence rates of healthcare-associated bacteremia (HCAB) between 2004 and 2010 in northeast Thailand.</p

Significant risk factors for mortality from <i>S. aureus</i> infection from multiple logistic regression analysis.

*<p>¹95% confidence intervals.</p>*<p>²p value from Likelihood ratio test.</p

The range of sites of infection in patients and outcome associated with each clinical presentation.

*<p>¹p value for the comparison between all-cause deaths and survivors.</p>*<p>²Site of deep abscesses were muscle (n = 20), retroperitoneal space (n = 7), parotid gland (n = 7), liver (n = 3), lung (n = 2), epidural space (n = 2), eye (n = 2), oropharynx (n = 2) and spleen (n = 1).</p>*<p>³Other skin and soft tissue infections includes: necrotising fasciitis (n = 9), bedsore(s) (n = 6), pustules and carbuncles (n = 5), infected wound from trauma (n = 3), infected wound from tophi (n = 2), gangrene (n = 2), cellulitis (without other skin or soft tissue lesion) (n = 2) and infection of exfoliated skin following a severe drug reaction (n = 2).</p>*<p>⁴Orthopaedic material includes: internal fixation metalwork (n = 8) and a hip replacement (n = 1).</p>*<p>⁵Intravenous devices were peripheral cannulas (n = 4), central catheters (n = 3) and an umbilical catheter (n = 1).</p>*<p>⁶Endocarditis from transthoracic echocardiographic evidence of vegetations (n = 7); 1 case clinically but died prior to echocardiogram.</p>*<p>⁷Other infections include: urinary tract infection (n = 3), tenosynovitis (n = 2), Lemierre's syndrome (n = 1) and corneal ulcer (n = 1).</p>*<p>⁸Post-operative infections include: mediastinitis (n = 4; 3 following mitral valve replacement and 1 after coronary artery bypass graft), meningitis from infected bone flap surgical wound (n = 1) and abdominal wound (n = 1).</p

Timely effective antibiotic therapy and procedures for infectious source control significantly improved outcome.

<p>Administration of an effective antibiotic on the same day as the positive culture was taken significantly reduced all-cause mortality (p<0.001), as did undergoing a procedure for infectious source control (p<0.001).</p

Association between patient characteristics and outcome for 270 patients with <i>S. aureus</i> infection.

<p>Data are number (%) unless otherwise stated.</p>*<p>¹p value for the comparison between all-cause deaths and survivors.</p>*<p>²Denominator for occupation is number of patients over the age of 16 years which is given in each square.</p>*<p>³Past medical history of any underlying chronic medical conditions reported by the patient/relative or recorded in the medical notes.</p>*<p>⁴Immunosuppression from HIV (5 untreated, 3 on anti-retroviral therapy), chemotherapy (n = 3), untreated leukaemia (n = 1), radiotherapy (n = 1) or immunosuppressive medication including prednisolone more than 30 mg/day for more than 1 week (n = 17).</p>*<p>⁵Renal disease included end stage renal failure on long-term dialysis (n = 3; 2 on haemodialysis, 1 on peritoneal dialysis) and chronic renal failure (not on dialysis) due to diabetes mellitus (n = 14), systemic lupus erythematosus (n = 1), multiple myeloma (n = 1), glomerulonephritis (n = 1) or an unknown aetiology (n = 5).</p>*<p>⁶Cardiac disease comprised congenital heart disease (n = 4), valvular heart disease including rheumatic heart disease (n = 8), ischaemic heart disease (n = 8), or arrhythmias including heart block requiring pacemaker (n = 4).</p>*<p>⁷Lung disease comprised previously treated tuberculosis (n = 9), previous empyema (n = 1), lung cancer (n = 2), long-term tracheostomy (n = 1), chronic obstructive pulmonary disease (n = 2) or asthma (n = 1).</p