Thailand medical study warns of growing numbers of antimicrobial-resistant bloodstream infections acquired in hospitals

Thailand Medical: A Growing Challenge for Thailand’s Medical Sector
In 2022, a comprehensive study conducted across 111 public hospitals in Thailand aimed to uncover the growing issue of antimicrobial-resistant (AMR) bloodstream infections (BSIs). Researchers from the Ministry of Public Health (MoPH) in Thailand, Mahidol Oxford Tropical Medicine Research Unit, and Brigham and Women’s Hospital, Harvard Medical School-USA, worked collaboratively to address the rising concern over AMR infections. These institutions joined forces in an effort to better understand the incidence and impact of these infections on the country’s healthcare system.


Thailand medical study warns of growing numbers of antimicrobial-resistant
bloodstream infections acquired in hospitals

AMR infections have become a significant public health threat, not only in Thailand but worldwide. As bacteria become more resistant to antibiotics, medical treatments become increasingly difficult, leading to higher rates of illness and death. This Thailand Medical News report highlights the findings of a 2022 study, shedding light on the alarming frequency of AMR bloodstream infections in Thailand, and calls for urgent action to combat the issue.
 
Key Findings of the Study
The research focused on analyzing data from over 3.9 million hospital admissions across 111 hospitals in Thailand. The study revealed two major types of AMR infections: community-origin AMR BSI, primarily caused by third-generation cephalosporin-resistant Escherichia coli (3GCREC), and hospital-origin AMR BSI, mainly caused by carbapenem-resistant Acinetobacter baumannii (CRAB).

Community-Origin Infections: The study found that 65.6% of community-origin AMR BSI cases were due to 3GCREC, affecting 5,101 out of 7,773 patients tested. Regions in the lower central part of Thailand exhibited the highest rates of 3GCREC infections, with an adjusted incidence rate ratio of 2.06, indicating a higher frequency of infections compared to other regions.
 
Hospital-Origin Infections: CRAB infections were the leading cause of hospital-origin AMR BSI, accounting for 51.2% of cases, with 4,968 out of 9,747 hospital patients affected. The study noted considerable variation in the frequency of CRAB infections across hospitals, pointing to significant disparities in hospital-level factors such as infection control practices and antimicrobial stewardship.

Blood Culture Testing: A Key Factor in Infection Rates
One of the most striking findings of the study was the relationship between blood culture (BC) testing and the observed frequency of AMR infections. Hospitals that underutilized BC testing had higher frequencies of AMR infections. The study found that hospitals with low BC utilization primarily tested patients with severe infections or those who had failed empirical treatments, leading to a higher likelihood of detecting AMR pathogens in these patients. This selective testing practice inflated the perceived frequency of AMR infections among those tested, while many other patients went undiagnosed, masking the true burden of AMR BSI in hospitals.
 
The study also emphasized the importance of early BC testing. Hospitals that tested patients within the first two days of admission reported lower frequencies of community-origin 3GCREC BSI, highlighting the need for timely diagnostic interventions.
 
Regional Variations in Infection Rates
Another significant finding of the study was the regional differences in infection rates. Hospitals in Thailand’s health regions 4 (lower central) and 12 had the highest and lowest frequencies of community-origin 3GCREC BSI, respectively. This variation suggests that different regions may face unique challenges in combating AMR infections, possibly due to factors such as antibiotic usage patterns, local healthcare practices, and public awareness of antimicrobial resistance.
 
The study found no strong regional differences in hospital-origin CRAB infections, but between-hospital variation remained high. This finding underscores the importance of hospital-specific interventions, particularly in regions with the highest frequencies of AMR BSI.
 
Hospital-Specific Factors Driving AMR Infection Rates
The study's findings indicated that hospital-level factors play a crucial role in determining the frequency of hospital-origin CRAB infections. Larger hospitals, particularly advanced-level referral hospitals (Level A), reported higher frequencies of CRAB BSI. This trend is likely due to the more complex and severe cases these hospitals handle, including patients requiring intensive care, prolonged intubation, or urinary catheters - all of which increase the risk of infection.
 
In addition to the severity of cases, the effectiveness of infection prevention and control (IPC) measures and antimicrobial stewardship (AMS) activities were identified as critical factors. The large variation in CRAB infection rates across hospitals suggests that some facilities may have more effective IPC and AMS programs than others. Hospitals with less effective infection control measures may inadvertently contribute to the spread of AMR pathogens.
 
The Path Forward: Recommendations for Combating AMR in Thailand
The study highlighted several areas where urgent action is needed to curb the spread of AMR BSI in Thailand. First and foremost, hospitals with the highest frequencies of AMR infections must prioritize improvements in their infection control and antimicrobial stewardship programs. This includes reinforcing hand hygiene protocols, ensuring proper sterilization of medical equipment, and optimizing the use of antibiotics to prevent overuse and misuse.
 
Secondly, diagnostic stewardship must be strengthened across the country. Hospitals that underutilize blood culture testing should adopt more robust diagnostic practices to ensure early detection and treatment of AMR infections. This may involve increasing the frequency of BC testing, especially within the first two days of hospital admission, as well as improving the availability of diagnostic tools in lower-level hospitals.
 
Public health initiatives aimed at reducing the unnecessary use of antibiotics in the community should also be prioritized. The study found that the overuse of antibiotics in certain regions contributed to the high rates of community-origin AMR infections, making public awareness campaigns essential to educating the public on the dangers of antibiotic resistance.
 
Conclusion: A Call for Collaborative Efforts
In conclusion, the findings of this study emphasize the urgent need for coordinated efforts to tackle the growing threat of antimicrobial-resistant bloodstream infections in Thailand. Hospitals must strengthen their infection control and antimicrobial stewardship programs to reduce the spread of hospital-acquired infections. Additionally, diagnostic stewardship practices must be enhanced to ensure timely and accurate detection of infections, particularly in hospitals with lower diagnostic capacities.
 
On a broader level, public health authorities must engage with communities to reduce the overuse of antibiotics and promote greater awareness of the dangers posed by AMR. By addressing these key areas, Thailand can take significant strides toward reducing the burden of AMR BSI and improving health outcomes for its population.
 
The study findings were published on a preprint server and is currently being peer reviewed.
https://www.medrxiv.org/content/10.1101/2024.06.01.24308013v1
 
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