# Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022

## TL;DR

This study analyzed antimicrobial-resistant bloodstream infections in 111 Thai hospitals in 2022 to identify patterns and factors affecting their frequency.

## Contribution

The study provides region- and hospital-level insights into AMR BSI frequency in Thailand using a national surveillance system.

## Key findings

- Community-origin AMR BSI was most commonly caused by third-generation cephalosporin-resistant Escherichia coli.
- Hospital-origin AMR BSI was most commonly caused by carbapenem-resistant Acinetobacter baumannii.
- Underuse of blood culture testing was linked to higher AMR BSI frequency per tested patients.

## Abstract

To evaluate the frequency of antimicrobial-resistant bloodstream infections (AMR BSI) in Thailand.

We 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.

The most common cause of community-origin AMR BSI was third-generation cephalosporin-resistant Escherichia coli (3GCREC, 65.6%; 5101/7773 patients) and of hospital-origin AMR BSI was carbapenem-resistant Acinetobacter baumannii (CRAB, 51.2%, 4968/9747 patients). The percentage of patients tested for BSI was negatively associated with the frequency of community-origin 3GCREC BSI and hospital-origin CRAB BSI (per 100,000 tested patients). Hospitals in health regions 4 (lower central region) had the highest frequency of community-origin 3GCREC BSI (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, and between-hospital variation was high, even adjusting for hospital level and size.

The 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.

•The frequency of AMR BSI in 111 public hospitals in Thailand in 2022 was studied.•The frequency of community-origin 3GCREC BSI was different by regions.•The frequency of hospital-origin CRAB BSI varied greatly among hospitals.•Underuse of BC was associated with the higher frequency of AMR BSI per tested patients.•Our findings contributed to actions against AMR at local and national levels.

The frequency of AMR BSI in 111 public hospitals in Thailand in 2022 was studied.

The frequency of community-origin 3GCREC BSI was different by regions.

The frequency of hospital-origin CRAB BSI varied greatly among hospitals.

Underuse of BC was associated with the higher frequency of AMR BSI per tested patients.

Our findings contributed to actions against AMR at local and national levels.