Frequency of antimicrobial-resistant bloodstream infections in Thailand, 2022

ObjectivesTo evaluate the frequency of antimicrobial-resistant bloodstream infections (AMR BSI) in Thailand MethodsWe analyzed data from 2022, generated by 111 public hospitals in health regions 1 to 12, using the AutoMated tool for Antimicrobial resistance Surveillance System (AMASS) and submitted to the Ministry of Public Health, Thailand. Multilevel Poisson regression models were used. ResultsThe most common cause of community-origin AMR BSI was third-generation cephalosporin-resistant Escherichia coli (3GCREC, 65.6%; 5,101/7,773 patients) and of hospital-origin AMR BSI was carbapenem-resistant Acinetobacter baumannii (CRAB, 51.2%, 4,968/9,747 patients). The percentage of patients tested for BSI was negatively associated with the frequency of community-origin 3GCREC BSI and hospital-origin CRAB BSI. Hospitals in health regions 4 (lower central) had the highest frequency of community-origin 3GCREC BSI per 100,000 tested patients (adjusted incidence rate ratio, 2.06; 95% confidence interval: 1.52-2.97). Health regions were not associated with the frequency of hospital-origin CRAB BSI, although between-hospital variation was high even adjusting for hospital level and size. ConclusionThe high between-hospital variation of hospital-origin CRAB BSI suggests the importance of hospital-specific factors. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritized. HighlightsO_LIThe frequency of AMR BSI in 111 public hospitals in Thailand in 2022 was studied. C_LIO_LIThe frequency of community-origin 3GCREC BSI was different by regions. C_LIO_LIThe frequency of hospital-origin CRAB BSI varied greatly among hospitals. C_LIO_LIUnderuse of BC was associated with the higher frequency of AMR BSI per tested patients. C_LIO_LIOur findings contributed to actions against AMR at local and national levels. C_LI