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Multicenter Study
. 2014 Oct 13;9(10):e109324.
doi: 10.1371/journal.pone.0109324. eCollection 2014.

Increasing incidence of hospital-acquired and healthcare-associated bacteremia in northeast Thailand: a multicenter surveillance study

Maliwan Hongsuwan  1 , Pramot Srisamang  2 , Manas Kanoksil  3 , Nantasit Luangasanatip  1 , Anchalee Jatapai  1 , Nicholas P Day  4 , Sharon J Peacock  5 , Ben S Cooper  4 , Direk Limmathurotsakul  6
Affiliations
Multicenter Study

Increasing incidence of hospital-acquired and healthcare-associated bacteremia in northeast Thailand: a multicenter surveillance study

Maliwan Hongsuwan et al. PLoS One. .

Abstract

Background: 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.

Methods: 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.

Results: 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 Acinetobacter spp. (16.2%), Klebsiella pneumoniae (13.9%), and Staphylococcus aureus (13.9%), while those of HCAB were Escherichia coli (26.3%), S. aureus (14.0%), and K. pneumoniae (9.7%). There was an overall increase over time in the proportions of ESBL-producing E. coli causing HAB and HCAB.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Age- and gender- specific incidence rates of hospital-acquired bacteremia (HAB) between 2004 and 2010 in northeast Thailand.
Figure 2
Figure 2. Age- and gender- specific cumulative incidence rates of healthcare-associated bacteremia (HCAB) between 2004 and 2010 in northeast Thailand.
See this image and copyright information in PMC

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