Cherry Lim1, Viriya Hantrakun2, Nittaya Teerawattanasook3, Pramot Srisamang4, Prapit Teparrukkul5, Nithima Sumpradit6, Paul Turner7, Nicholas Pj Day8, Ben S Cooper8, Sharon J Peacock9, Direk Limmathurotsakul10. 1. 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. Electronic address: cherry@tropmedres.ac. 2. Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. 3. Department of Clinical Pathology, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand. 4. Pediatrics, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand. 5. Department of Internal Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand. 6. Thai Food and Drug Administration, Ministry of Public Health, Bangkok, Thailand. 7. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia. 8. 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. 9. University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom. 10. 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. Electronic address: direk@tropmedres.ac.
Abstract
OBJECTIVES: The magnitude of impact caused by low blood culture utilization on estimates of the proportions and incidence rates of antimicrobial-resistant (AMR) bacterial infections is largely unknown. METHODS: We used routine electronic databases of microbiology, hospital admission and drug prescription at Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand, from 2011 to 2015, and bootstrap simulations. RESULTS: The proportions of Escherichia coli and Klebsiella pneumoniae bacteraemias caused by 3rd generation cephalosporin resistant isolates (3GCREC and 3GCRKP) were estimated to increase by 13 and 24 percentage points (from 44% to 57% and from 51% to 75%), respectively, if blood culture utilization rate was reduced from 82 to 26 blood culture specimens per 1,000 patient-days. Among patients with hospital-origin bloodstream infections, the proportion of 3GCREC and 3GCRKP whose first positive blood culture was taken within ±1 calendar day of the start of a parenteral antibiotic at the study hospital was substantially lower than those whose first positive blood culture was taken later into parenteral antibiotic treatment (30% versus 79%, p<0.001; and 37% versus 86%, p<0.001). Similar effects were observed for methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter spp. and carbapenem-resistant Pseudomonas aeruginosa. CONCLUSION: Impacts of low blood culture utilization rate on the estimated proportions and incidence rates of AMR infections could be high. We recommend that AMR surveillance reports should additionally include blood culture utilization rate and stratification by exposure to a parenteral antibiotic at the hospital.
OBJECTIVES: The magnitude of impact caused by low blood culture utilization on estimates of the proportions and incidence rates of antimicrobial-resistant (AMR) bacterial infections is largely unknown. METHODS: We used routine electronic databases of microbiology, hospital admission and drug prescription at Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand, from 2011 to 2015, and bootstrap simulations. RESULTS: The proportions of Escherichia coli and Klebsiella pneumoniae bacteraemias caused by 3rd generation cephalosporin resistant isolates (3GCREC and 3GCRKP) were estimated to increase by 13 and 24 percentage points (from 44% to 57% and from 51% to 75%), respectively, if blood culture utilization rate was reduced from 82 to 26 blood culture specimens per 1,000 patient-days. Among patients with hospital-origin bloodstream infections, the proportion of 3GCREC and 3GCRKP whose first positive blood culture was taken within ±1 calendar day of the start of a parenteral antibiotic at the study hospital was substantially lower than those whose first positive blood culture was taken later into parenteral antibiotic treatment (30% versus 79%, p<0.001; and 37% versus 86%, p<0.001). Similar effects were observed for methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter spp. and carbapenem-resistant Pseudomonas aeruginosa. CONCLUSION: Impacts of low blood culture utilization rate on the estimated proportions and incidence rates of AMR infections could be high. We recommend that AMR surveillance reports should additionally include blood culture utilization rate and stratification by exposure to a parenteral antibiotic at the hospital.
Authors: Valeria Fabre; Aaron M Milstone; Sara C Keller; Karen C Carroll; Sara E Cosgrove Journal: Infect Control Hosp Epidemiol Date: 2018-09-18 Impact factor: 3.254
Authors: Nittaya Teerawattanasook; Patricia M Tauran; Prapit Teparrukkul; Vanaporn Wuthiekanun; David A B Dance; Mansyur Arif; Direk Limmathurotsakul Journal: Am J Trop Med Hyg Date: 2017-07-19 Impact factor: 2.345
Authors: Cherry Lim; Elizabeth A Ashley; Raph L Hamers; Paul Turner; Thomas Kesteman; Samuel Akech; Alejandra Corso; Mayfong Mayxay; Iruka N Okeke; Direk Limmathurotsakul; H Rogier van Doorn Journal: Clin Microbiol Infect Date: 2021-06-07 Impact factor: 13.310