Epidemiology and burden of multidrug-resistant bacterial infection in a developing country

Cherry Lim, Emi Takahashi, Maliwan Hongsuwan, Vanaporn Wuthiekanun, Visanu Thamlikitkul, Soawapak Hinjoy, Nicholas Pj Day, Sharon J Peacock, Direk Limmathurotsakul, Cherry Lim, Emi Takahashi, Maliwan Hongsuwan, Vanaporn Wuthiekanun, Visanu Thamlikitkul, Soawapak Hinjoy, Nicholas Pj Day, Sharon J Peacock, Direk Limmathurotsakul

Abstract

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.

Keywords: Acinetobacter; E. coli; Enterococcus; K. pneumoniae; P. aeruginosa; Staphylococcus aureus; antimicrobial resistant; epidemiology; global health.

Conflict of interest statement

The authors declare that no competing interests exist.

Figures

Figure 1.. Location of participating hospitals.
Figure 1.. Location of participating hospitals.
These were situated in (1) Nong Khai, (2) Udon Thani, (3) Nakhon Phanom, (4) Chaiyaphum, (5) Mukdahan, (6) Yasothon, (7) Burirum, (8) Sisaket, and (9) Ubon Ratchathani provinces. DOI:http://dx.doi.org/10.7554/eLife.18082.003
Figure 2.. Trends in proportions of Staphylococcus…
Figure 2.. Trends in proportions of Staphylococcus aureus bacteraemia being caused by MRSA in Northeast Thailand.
(A) community-acquired, (B) healthcare-associated and (C) hospital-acquired Staphylococcus aureus bacteraemia. DOI:http://dx.doi.org/10.7554/eLife.18082.005
Figure 3.. Trends in proportions of Escherichia…
Figure 3.. Trends in proportions of Escherichia coli bacteraemia being caused by E. coli non-susceptible to extended-spectrum cephalosporins in Northeast Thailand.
(A) community-acquired, (B) healthcare-associated and (C) hospital-acquired E. coli bacteraemia. DOI:http://dx.doi.org/10.7554/eLife.18082.007
Figure 4.. Trends in proportions of Klebsiella…
Figure 4.. Trends in proportions of Klebsiella pneumoniae bacteraemia being caused by K. pneumoniae non-susceptible to extended-spectrum cephalosporins in Northeast Thailand.
(A) community-acquired, (B) healthcare-associated and (C) hospital-acquired K. pneumoniae bacteraemia. DOI:http://dx.doi.org/10.7554/eLife.18082.010
Figure 5.. Trends in proportions of Pseudomonas…
Figure 5.. Trends in proportions of Pseudomonas aeruginosa bacteraemia being caused by P. aeruginosa non-susceptible to carbapenem in Northeast Thailand.
(A) community-acquired, (B) healthcare-associated and (C) hospital-acquired Pseudomonas aeruginosa bacteraemia. DOI:http://dx.doi.org/10.7554/eLife.18082.012
Figure 6.. Trends in proportions of Acinetobacter…
Figure 6.. Trends in proportions of Acinetobacter spp bacteraemia being caused by Acinetobacter spp non-susceptible to carbapenem in Northeast Thailand.
(A) community-acquired, (B) healthcare-associated and (C) hospital-acquired Acinetobacter spp bacteraemia. DOI:http://dx.doi.org/10.7554/eLife.18082.014
Figure 7.. Forest plot of mortality in…
Figure 7.. Forest plot of mortality in patients with MDR bacteraemia compared with non-MDR bacteraemia in Northeast Thailand.
(A) Community-acquired bacteraemia. (B) Healthcare-associated bacteraemia. (C) Hospital-acquired bacteraemia. DOI:http://dx.doi.org/10.7554/eLife.18082.016

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