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Health and economic impacts of antimicrobial resistance in Thailand

Authors:
P. Pumart
P. Pumart
P. Pumart
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Tuangrat Phodha at Thammasat University
Tuangrat Phodha
V. Thamlikitkul
V. Thamlikitkul
V. Thamlikitkul
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Arthorn Riewpaiboon at Mahidol University
Arthorn Riewpaiboon
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Abstract

This study assessed health and economic impacts of antimicrobial resistance (AMR) in Thailand under societal perspective by using the secondary data on hospitalizations and nosocomial infections from 1,023 hospitals. A total of 87,751 hospitalizations developed nosocomial infections due to 5 major bacteria (Escherichia coli, Klebsiella pneumoniae, Acinetobactor baumannii, Pseudomonas aeruginosa and methicillin- resistant Staphylococcus aureus) that are resistant to antibiotics in Thailand in 2010. These AMR infections resulted in additional of at least 3.24 million days of hospitalization and 38,481 deaths. Regarding an economic loss, the cost of antibiotics to be used for therapy of AMR infections were accounted for 2,539 to 6,084 million Baht. The indirect costs of morbidity and mortality due to premature deaths related to AMR were at least 40,000 million Baht (in 2010 values). The aforementioned health and economic impacts of AMR are much higher than the burden of many priority health problems in Thailand. Therefore, AMR is a major and urgent health problem in Thailand that needs comprehensive and systematic approaches at national and local levels to resolve the problem.
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Abstract Health and Economic Impacts of Antimicrobial Resistant Infections in Thailand : A Preliminary
Study
Panumart Phumart*, Tuangrat Phodha†, Visanu Thamlikitkul‡, Arthorn Riewpaiboon†, Phusit
Prakongsai§, Supon Limwattananon#
*Faculty of Pharmacy, Mahasarakham University, †Faculty of Pharmacy, Mahidol University, ‡Faculty of Medicine
Siriraj Hospital, Mahidol University, §International Health Policy Program, Ministry of Public Health, #Faculty of
Pharmaceutical Sciences, Khon Kaen University
This study assessed health and economic impacts of antimicrobial resistance (AMR) in Thailand
under societal perspective by using the secondary data on hospitalizations and nosocomial infections
from 1,023 hospitals. A total of 87,751 hospitalizations developed nosocomial infections due to 5 major
bacteria (Escherichia coli, Klebsiella pneumoniae, Acinetobactor baumannii, Pseudomonas aeruginosa and methi-
cillin-resistant Staphylococcus aureus) that are resistant to antibiotics in Thailand in 2010. These AMR infec-
tions resulted in additional of at least 3.24 million days of hospitalization and 38,481 deaths. Regarding an
economic loss, the cost of antibiotics to be used for therapy of AMR infections were accounted for 2,539 to
6,084 million Baht. The indirect costs of morbidity and mortality due to premature deaths related to AMR
were at least 40,000 million Baht (in 2010 values). The aforementioned health and economic impacts of
AMR are much higher than the burden of many priority health problems in Thailand. Therefore, AMR is
a major and urgent health problem in Thailand that needs comprehensive and systematic approaches at
national and local levels to resolve the problem.
Keywords: Infections, Antimicrobial Resistance, Health Impact, Economic Impact, Thailand
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Journal of Health Systems Research Vol. 6 No. 3 Jul.-Sept. 2012
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·≈–μâπ∑ÿπ∑’ˉ¡à‡°’ˬ«°—∫°“√·æ∑¬å (direct non-medical cost)
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Journal of Health Systems Research Vol. 6 No. 3 Jul.-Sept. 2012
bidity cost) μâπ∑ÿπ¢Õß°“√‡’¬™’«‘μ°àÕπ«—¬Õ—π§«√§”π«≥
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μâ“π®ÿ≈™’æ”À√—∫√—°…“°“√μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“¥â«¬¬“μâ“π®ÿ≈™’ææ◊Èπ
∞“π∑’ˇªì𬓙◊ËÕ“¡—≠ (generic drug) ¡’¡Ÿ≈§à“ Ú,ıÛ˘ ≈â“π
∫“∑ ·≈–À“°„™â¬“μâ“π®ÿ≈™’æ∑’Ë¡’ª√–‘∑∏‘¿“æŸß·≈–‡ªìπ¬“
μâπ·∫∫ (original drug) ¡’¡Ÿ≈§à“ ˆ,¯Ù ≈â“π∫“∑ ¥—ß·¥ß
„πμ“√“ß∑’Ë ı à«πμâπ∑ÿπ∑“ßμ√ß∑’ˉ¡à‡°’ˬ«°—∫°“√·æ∑¬å ‰¥â·°à
§à“‡¥‘π∑“ß·≈–§à“Õ“À“√¢Õß≠“μ‘∑’Ë¥Ÿ·≈ºŸâªÉ«¬´÷Ëßμ‘¥‡™◊ÈÕ¥◊ÈÕ¬“
μ“√“ß∑’Ë Û °“√‡’¬™’«‘μ¢ÕߺŸâªÉ«¬∑’Ëμ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ„πªï ÚııÚ
®”π«πºŸâªÉ«¬ √âÕ¬≈–ºŸâªÉ«¬μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“ ®”π«πºŸâªÉ«¬μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“
‡™◊ÈÕ μ‘¥‡™◊ÈÕ∑’ˇ’¬™’«‘μμâ“π®ÿ≈™’æ∑’ˇ’¬™’«‘μμâ“π®ÿ≈™’æ∑’ˇ’¬™’«‘μ
A.baumannii ÚÚ,ıˆ˜ ¯Ù.ıÒ Ò˘,˜Ò
S.aureus ˘,ˆ˘¯ ˘Û.ˆÚ ˘,˜˘
K.pneumoniae ˜,¯ıı ˆÙ.ˆ˜ ı,¯
P.aeruginosa Ò,˜˘Ò ÛÚ.Ù Û,Ù˘ˆ
E.coli Û,ÒÙ ıˆ.ıÙ Ò,˜ıı
√«¡ ıÙ,ÒÙ ˜Ò.ÚÙ Û¯,Ù¯Ò
μ“√“ß∑’Ë Ú °“√μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“®”·π°μ“¡™π‘¥¢Õ߇™◊ÈÕ·≈–μ”·ÀπàߢÕß°“√μ‘¥‡™◊ÈÕ
°“√μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ (§√—Èß)
μ”·ÀπàߢÕß°“√μ‘¥‡™◊ÈÕ A.baumannii S.aureus K.pneumoniae E.coli P.aeruginosa
√–∫∫°“√À“¬„®à«π≈à“ß Ú˘,ˆ˜Ú ÒÛ,ˆ¯Û ¯,˘Û Ò,˜Ú¯ Ù,¯˘˜
√–∫∫ªí“«– Ò,ÒıÚ Ú¯¯ Ò,˜Ú¯ Ú,ÙÙ˘ Òˆ˘
·º≈ºà“μ—¥ ÙÛÚ ¯ˆÙ ÒÒı ÛÙˆ ˘Ù
°√–·‡≈◊Õ¥ ¯ˆÙ Ú,Ò˜ Ú¯¯ ÒÙÙ ˘Ù
Õ◊ËπÊ Ù,ÙÛÛ Ò,¯˜Ú Ù,Ò˜˜ ˆ,Ùı ¯ˆÙ
√«¡ Ûˆ,ııÛ Ò¯,˜Úı Òı,ÚÛ˘ ÒÒ,ÒÒˆ ˆ,ÒÒ¯
Journal of Health Systems Research Vol. 6 No. 3 Jul.-Sept. 2012
„π‚√ß欓∫“≈¡’¡Ÿ≈§à“√«¡ Ò,˜Ú ≈â“π∫“∑
μâπ∑ÿπ∑“ßÕâÕ¡§◊Õ§«“¡Ÿ≠‡’¬∑“߇»√…∞°‘®‡π◊ËÕß®“°
ºŸâªÉ«¬μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ‡’¬™’«‘μ°àÕπ«—¬Õ—π§«√‚¥¬
§”π«≥®“°μâπ∑ÿπº≈‘μ¿“æ¡’¡Ÿ≈§à“√«¡ Ù,¯¯ı ≈â“π∫“∑
·≈–‡¡◊ËÕ§”π«≥®“°μâπ∑ÿπ‡«≈“¡’¡Ÿ≈§à“√«¡ ı,¯ıÛ ≈â“π∫“∑
§«“¡Ÿ≠‡’¬®“°°“√¢“¥ß“π‡¡◊ËÕ‡®Á∫ªÉ«¬®“°°“√μ‘¥‡™◊ÈÕ
¥◊ÈÕ¬“μâ“π®ÿ≈™’æ·μà‰¡à‡’¬™’«‘μ¡’¡Ÿ≈§à“√«¡ ıÙ˜ ≈â“π∫“∑ ¥—ß
·¥ß„πμ“√“ß∑’Ë ı ¥—ßπ—Èπ μâπ∑ÿπ∑“ßÕâÕ¡∑—ÈßÀ¡¥®÷߇ªìπ
ÙÒ,ÙÛÚ ≈â“π∫“∑ ∂÷ß ıÒ,Ù ≈â“π∫“∑
Õ¿‘ª√“¬
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μ“√“ß∑’Ë Ù ®”π«π«—π‡©≈’ˬ·≈–®”π«π«—π√«¡∑’ËÕ¬Ÿà„π‚√ß欓∫“≈‡æ‘Ë¡¢÷Èπ¢ÕߺŸâªÉ«¬μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ
®”π«π«—π‡©≈’ˬ∑’ËÕ¬Ÿà„π‚√ß欓∫“≈‡æ‘Ë¡¢÷Èπ ®”π«π«—π√«¡∑’ËÕ¬Ÿà„π‚√ß欓∫“≈‡æ‘Ë¡¢÷Èπ
‡™◊ÈÕ ¢ÕߺŸâªÉ«¬μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ ¢ÕߺŸâªÉ«¬μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ
‰¡à‡’¬™’«‘μ‡’¬™’«‘μ‰¡à‡’¬™’«‘μ‡’¬™’«‘μ
A.baumannii ıı.¯Ò Úı.ÒÛ ˘˜ı,ˆÙ˘ Ù˜˘,Òı˘
E.coli ÙÚ.¯¯ Û.ˆ˜ ÙÒ,ÛˆÒ ıÛ,¯Ú˜
K.pneumoniae ÙÛ.˜Û Ò¯. ÙÙÙ,ÛÙ ˘Ò,ÙÛÙ
P.aeruginosa Û¯.ˆ˜ ÛÙ.Úı ÒÒ,Û˘Ò ÒÒ˘,˜Ùˆ
S.aureus Û˘.ı˘ ÚÒ.ÙÙ Û¯Ò,¯˜Ú Ò˘Ù,ˆÚÙ
√«¡ Ùı.¯¯ ÚÛ.˘¯ Ú,ÛÙ,ı˜ˆ ˘Û¯,˜˘Ò
μ“√“ß∑’Ë ı §«“¡Ÿ≠‡’¬∑“߇»√…∞°‘®®“°°“√μ‘¥‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ
μâπ∑ÿπ∑“ßμ√ß μâπ∑ÿπ∑“ßÕâÕ¡ μâπ∑ÿπ√«¡
(≈â“π∫“∑) (≈â“π∫“∑) (≈â“π∫“∑)
μâπ∑ÿπ∑“ßμ√ß μâπ∑ÿπ∑“ßμ√ß °“√‡’¬ §«“¡Ÿ≠‡’¬μâπ∑ÿπμâπ∑ÿπ
§à“¬“μâ“π ∑’ˉ¡à‡°’ˬ«°—∫™’«‘μ ®“°°“√¢“¥ º≈‘μ¿“æ ‡«≈“
®ÿ≈™’æ °“√·æ∑¬åß“π‡¡◊ËÕ‡®Á∫ªÉ«¬
·μà‰¡à‡’¬™’«‘μ
„™â¬“μâ“π „™â¬“μâ“π §à“§à“§à“μâπ∑ÿπμâπ∑ÿπ„™â¬“μâ“π®ÿ≈™’æ Ùı,ÙÛ ıı,ÒÒ
®ÿ≈™’æ®ÿ≈™’æ∑’Ë¡’ ‡¥‘π∑“ß Õ“À“√ ‡’¬º≈‘μ ‡«≈“ æ◊Èπ∞“π∑’ˇªìπ (ÙÙ,ÒÒ- (ıÙ,˜¯-
æ◊Èπ∞“π ª√–‘∑∏‘¿“æ ‡«≈“ ¿“æ ¬“™◊ËÕ“¡—≠ Ùı,ı˜) ıı,ıÛ¯)
∑’ˇªì𬓠Ÿß·≈–‡ªìπ ¢Õß (generic drug)
“¡—≠ ¬“μâπ·∫∫ ≠“μ‘
Ú,ıÛ˘ ˆ,¯Ù Û¯¯ ÒÙÚ ıÙÚ Ù,¯¯ı ı,¯ıÛ ıÙ˜ „™â¬“μâ“π®ÿ≈™’æ Ù¯,ı¯¯ ı¯,ııˆ
(Ò,ˆˆ- (Ú,Û- ∑’Ë¡’ª√–‘∑∏‘¿“æ (ÙÙ,¯Ù- (ıÙ,˜˜Ú-
Û,ˆˆ) ˆ,˜ÛÙ) Ÿß·≈–‡ªìπ¬“ Ù˘,ÚÛ¯) ı˘,Úˆ)
μâπ·∫∫
(original drug)
Ûı˜
«“√“√«‘®—¬√–∫∫“∏“√≥ÿ¢
ªï∑’Ë ˆ©∫—∫∑’Ë Û °§.-°¬. Úııı
358
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¢âÕ¡Ÿ≈¢Õß∂“π欓∫“≈À≈“¬√–¥—∫∑’ˉ¡à§√∫∂â«π ·≈–‡ªìπ
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∑—Èߪ√–‡∑»°Á‰¥â®“°°“√¢¬“¬ª√‘¡“≥¢ÕߢâÕ¡Ÿ≈®”π«ππâÕ¬
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ª√–¡“≥°“√‡∫◊ÈÕßμâπ‡∑à“π—Èπ ‚¥¬ºŸâ«‘®—¬®–ª√–“πß“π°—∫ºŸâ
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‚√ß欓∫“≈·≈–¢âÕ¡Ÿ≈‡™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æ ·≈–”π—°ß“πÀ≈—°
ª√–°—πÿ¢¿“æ·Ààß™“μ‘·≈–”π—°ß“π°≈“ß“√π‡∑»∫√‘°“√
ÿ¢¿“æ∑’Ë„Àâ¢âÕ¡Ÿ≈ºŸâªÉ«¬∑’Ë√—∫‰«â√—°…“„π‚√ß欓∫“≈
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„πª√–‡∑»‰∑¬. „π: 𑬥“ ‡°’¬√쑬‘ËßÕ—ß»ÿ≈’, πÿ»√“æ√ ‡°…¡∫Ÿ√≥å,
Õÿ…“«¥’ ¡“≈’«ß»å (∫√√≥“∏‘°“√). √“¬ß“π∂“π°“√≥å√–∫∫¬“ª√–®”
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Prevalence of nosocomial infection in Thailand 2006. J Med Assoc
Thai 2007;90:1524-9.
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E.coli, K.pneumoniae Cephalosporins, Aminoglycosides, Fluoroquinolones Carbapenems
P.aeruginosa Cephalosporins, Aminoglycosides, Fluoroquinolones Carbapenems ·≈–/ À√◊Õ Colistin
A.baumannii Carbapenems Carbapenems ·≈–/ À√◊Õ Colistin
S.aureus Cloxacillin Vancomycin À√◊Õ Linezolid
... The ability of E. coli to acquire and produce extended-spectrum beta-lactamase (ESBL) has led the bacterium to be recognized as a "Critical tier" global priority pathogen by the World Health Organization (WHO) [9]. In Thailand, an analysis of the assessed health burden due to antimicrobial-resistant (AMR) bacteria from 2009 to 2010 showed that at least 90,000 patients per year were hospitalized with antimicrobial-resistant bacterial infections; approximately one-third of them died [10], and the total cost of treatment for AMR infections rose to USD 1.3 billion [10,11]. Recently, the National Antimicrobial Resistance Surveillance Center, Thailand (NARST), reported that in 2021, data from 51 hospitals confirmed that ESBL-producing E. coli was 46.8% resistant to cefotaxime and 38.2% resistant to ceftazidime [12]. ...
... The ability of E. coli to acquire and produce extended-spectrum beta-lactamase (ESBL) has led the bacterium to be recognized as a "Critical tier" global priority pathogen by the World Health Organization (WHO) [9]. In Thailand, an analysis of the assessed health burden due to antimicrobial-resistant (AMR) bacteria from 2009 to 2010 showed that at least 90,000 patients per year were hospitalized with antimicrobial-resistant bacterial infections; approximately one-third of them died [10], and the total cost of treatment for AMR infections rose to USD 1.3 billion [10,11]. Recently, the National Antimicrobial Resistance Surveillance Center, Thailand (NARST), reported that in 2021, data from 51 hospitals confirmed that ESBL-producing E. coli was 46.8% resistant to cefotaxime and 38.2% resistant to ceftazidime [12]. ...
Four New Sequence Types and Molecular Characteristics of Multidrug-Resistant Escherichia coli Strains from Foods in Thailand
Article
Full-text available
  • Oct 2024
The presence of antibiotic-resistant Escherichia coli in food is a serious and persistent problem worldwide. In this study, 68 E. coli strains isolated from Thai food samples were characterized. Based on antibiotic susceptibility assays, 31 of these isolates (45.59%) showed multiple antibiotic resistance (MAR) index values > 0.2, indicating high exposure to antibiotics. Among these, strain CM24E showed the highest resistance (it was resistant to ten antibiotics, including colistin and imipenem). Based on genome sequencing, we identified four isolates (namely, CF25E, EF37E, NM10E1, and SF50E) with novel Achtman-scheme multi-locus sequence types (STs) (ST14859, ST14866, ST14753, and ST14869, respectively). Clermont phylogrouping was used to subtype the 68 researched isolates into five Clermont types, mainly A (51.47%) and B1 (41.18%). The bla EC gene was found only in Clermont type A, while the bla EC-13 gene was predominant in Clermont type B1. A correlation between genotypes and phenotypes was found only in Clermont type B1, which showed a strong positive correlation between the presence of an afa operon and yersiniabactin-producing gene clusters with the colistin resistance phenotype. Strain SM47E1, of Clermont type B2, carried the highest number of predicted virulence genes. In summary, this study demonstrates the pressing problems posed by the prevalence and potential transmission of antimicrobial resistance and virulence genes in the food matrix.
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... Unskilled personnel are less aware of the adverse effects of inappropriate antibiotic use and in some cases, the antibiotic prescriptions are inappropriate (i.e., wrong drug, wrong doses, or antibiotic not necessary at all) [29]. A study conducted in Lebanese shown that, in 52% of cases, the prescription dose was inappropriate while 63.7% of physicians prescribed antibiotics with wrong duration of treatment [80]. These incorrectly prescribed antibiotics contribute to the promotion of resistant bacteria [18]. ...
... According to a recent study in Thailand, in 2010 antimicrobial resistance was responsible for at least 3.2 million extra hospitalization days; 38,481 deaths, and for losses of $84.6-$202.8 million in direct medical costs and more than $1.3 billion in indirect costs [80]. In the United States (US), where approximately 23,000 people die each year as a direct result of AMR, estimates for the total economic cost of antibiotic resistance vary but have ranged as high as $20 billion in excess direct healthcare costs, with additional costs from lost productivity as high as $35 billion a year [88,18]. ...
Factors, impacts and possible solutions of antibiotic resistance: Review article
Article
Full-text available
  • Feb 2024
The discovery of antibiotics has helped to save the lives of an uncountable number of people. Unfortunately, their misuse and other related factors have led to the emergence and development of bacteria that are resistant to antibiotics. Antimicrobial resistance is one of the most serious threats to public health globally and threatens the ability to treat infectious diseases. The factors that contribute for the emergence and spread of antimicrobial resistance are complex non-prudent use of antibiotics in veterinary and human medicine is, in large part, responsible for the emergence of antibiotic resistance. Inappropriate prescription practices, inadequate education, poor drug quality, limited rapid diagnostic test facilities, poor hygiene, infection prevention and control practice are also other factors contribute for the emergence and spread of antimicrobial resistance. Due to the emergency of new resistant bacteria and decrease in efficiency of treating common infectious diseases, it results in failure of microbial response to standard treatment, leading to prolonged illness, higher expenditures for health care, and an immense risk of death. Considering these serious impacts of antibiotic resistance several solutions have been proposed including antibiotic stewardship, educational program, hygiene, infection prevention and control strategy, adapting rapid methods for detecting resistance bacteria as well as developing new antibiotics and alternative therapeutic agents.
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... However, the duration of hospitalization and fever was much greater in the MDR group. These findings were consistent with other investigations (5,8,9) . ...
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... 3 Gram-negative bacteria pose a significant medical challenge due to their resistance to antimicrobial agents, especially Escherichia coli, Klebsiella pneumoniae, other Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. 4 Over the past decade, these organisms have developed increased drug resistance, leading to prolonged treatment durations to eliminate them. 5 Among these Gram-negative bacteria, AmpC betalactamase (ampC) expression in bacteria is a resistance mechanism producing beta-lactamase, an enzyme with similar activity as extended-spectrum beta-lactamases (ESBLs). ...
Evaluation of a commercial multiplex real-time PCR panel for identification environmental water antibiotic-resistant bacteria in hemoculture bottles
Article
  • Jan 2025
Background: Antimicrobial resistance (AMR) is a major public health problem worldwide, and it is increasing, especially in developed and developing countries, including Thailand. Sepsis is a crisis and emergency causing the death of patients with a high mortality rate of 1 in 5 of the global population. Using inappropriate antimicrobial drugs to treat infections increases the chance of drug resistance in the microorganisms, and precise and rapid treatment is essential for patient management. Objective: This cooperative study aims to evaluate a commercial multiplex real-time PCR panel, QIAstat-Dx BCID GN Plus AMR Panel, to detect antimicrobial-resistant genes in the bloodstream. Materials and methods: Thirty bacterial samples were used to simulate bloodstream infections. The comparison between the QIAstat-Dx BCID GN Plus AMR Panel and the conventional PCR method was revealed. Results: Both methods gave concordant results for 12 samples, while results for 15 were discordant. Three samples could not be detected using the QIAstat-Dx BCID GN Plus AMR Panel because ebc gene is not included. The QIAstat-Dx BCID GN Plus AMR Panel revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 91.50%, 93.30%, 74.10%, and 98.50%, respectively. Conclusion: The study indicated that the QIAstat-Dx BCID GN Plus AMR Panel Cartridge can detect common antimicrobial-resistant genes from the bloodstream. However, additional resistant genes should be included in the panel to cover various highly prevalent antimicrobial-resistant genes based on geographical location.
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... Early research in Thailand has estimated that there are about 88,000 drug-resistant infections a year, 38,000 deaths annually and an economic loss of almost 0.6 percent of gross domestic product (GDP) due to AMR (Pumart et al., 2012). Thailand established its national action plan on AMR in 2016 (National Action Plans and Monitoring and Evaluation, 2017). ...
The unseen use of antimicrobials: Drivers of human antibiotic use in a community in Thailand and implications for surveillance
Article
Full-text available
  • Jan 2024
We investigated sociocultural and economic drivers of human antimicrobial use (AMU) in Thailand through ethnographic research, interviews, focus groups and a cross-sectional survey. This community-based study generated findings clustered around three key themes: treatment-seeking practices, medicine use, and interpretation of biomedical constructs. Participants sought care from public health facilities for chronic conditions, but medicines from the private sector were considered more powerful and were preferred for acute complaints. Many antibiotics were unrecognised as such by consumers due to the practice at private healthcare facilities of dispensing repackaged medicines without identifying labels. This unseen use of antibiotics is probably driven by economic drivers including market competition in the private sector, policy implementation drivers whereby rational drug use policies mainly target the public sector, behavioural drivers relating to treatment seeking-practices, and sociocultural drivers that influenced participants’ understanding of medical terms and concepts. Participants regarded antibiotics as reducing inflammation and were uncertain about the distinctions between anti-inflammatories, antibiotics, and pain relievers. Antimicrobial Resistance (AMR) was understood as a form of drug tolerance to be remedied by changing the medicine. Community surveys may not provide accurate estimates of AMU where people are unable to distinguish antibiotics reliably from other medicines.
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... AMR has been responsible for considerable proportion of morbidity and associated mortality, treatment failures, and heightened nosocomial infections, confounding choices for healthcare management, and increasing costs. Deaths due to AMR have been estimated to be at least 23,000 in the USA (CDC 2019), 33,000 in Europe (Cassini et al. 2019), 38,000 in Thailand (Pumart et al. 2012), and 58,000 babies alone in India (Laxminarayan et al. 2013). The numbers in Europe amounted to 5.5% of all the infections (Cassini et al. 2019). ...
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Investigating the Production and Synergistic Antibacterial Activity of Bacteriocin-Like Substance from Brevibacillus laterosporus SA-14 (TISTR 2453) for Enhanced Wound Healing
Article
  • Feb 2025
The rise in antimicrobial-resistant (AMR) bacteria, especially Methicillin-resistant Staphylococcus aureus (MRSA), is a global health concern. Bacteriocins are promising antibiotic alternatives. This study aimed to enhance the production of bacteriocin-like substances (BLS) from Brevibacillus laterosporus SA-14 (TISTR 2453) by optimizing nutrients, evaluating antibacterial activity, assessing synergy with vancomycin, and testing the cytotoxicity and wound healing effects on human keratinocytes. The results showed that when the SA-14 strain was cultured in half-formula Luria-Bertani broth (LB/2) with added carbon sources (glucose, sucrose, and lactose), all cultures reached the late log phase at 24 h, and antibacterial activity was exhibited against various MRSA strains after 48 h, except for the LB/2 supplemented with glucose, likely due to carbon catabolite repression. However, the addition of nitrogen sources, including skim milk, peptone, and beef extract resulted in high antibacterial activity at 48 h, with skim milk being the most effective for BLS production. The BLS was precipitated with 80 % ammonium sulfate, achieving a 38.09 % yield and a protein concentration of 6.97 ± 1.12 mg/mL. The SDS-PAGE analysis revealed five bands of proteins with molecular weights of 25–250 kDa. The minimum inhibitory concentration of BLS ranged from 0.44 to 0.87 mg/mL, with an minimum bactericidal concentration) of 0.87 mg/mL for all MRSA strains. A synergistic effect with vancomycin was observed at 0.22 mg/mL BLS and 1 μg/mL vancomycin, with an fractional inhibitory concentration index of 1.00, indicating an additive effect. At a concentration of 0.22 mg/mL, BLS was non-cytotoxic to HaCaT cells and promoted complete wound healing after 48 h. Therefore, BLS produced by the SA-14 strain is suitable for controlling AMR, especially MRSA, and has the potential for application in wound dressings in the future.
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Challenges and success stories of the implementation of infection control and antimicrobial stewardship strategies: proceedings of the 5th Global Ministerial Summit on Patient Safety, 2023
Article
Full-text available
  • Feb 2024
The 5th edition of the Global Ministerial Summit on Patient Safety was held in Montreux, Switzerland, in February 2023, delayed by three years due to the COVID-19 pandemic. The overarching theme of the summit was “ Less Harm, Better Care – from Resolution to Implementation ”, focusing on the challenges of implementation of infection prevention and control (IPC) strategies as well as antimicrobial stewardship programs (ASP) around the world. IPC strategies and ASP are of increasing importance due to the substantial burden of healthcare-associated infections and antimicrobial resistance threatening patient safety. Here, we summarize countries’ and regional experiences and activities related to the implementation of IPC strategies and ASP shared at the meeting. Full implementation of effective programs remains a major challenge in all settings due to limited support by political and healthcare leaders, and human and financial constraints. In addition, the COVID-19 pandemic challenged already well-established programs. By enforcing sustained implementation by dedicated, cross-disciplinary healthcare personnel with a broad skill set, a reduction in healthcare-associated infections and multidrug-resistant pathogens can be achieved, leading ultimately to improved patient safety.
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Antimicrobial resistance, virulence profile, and genetic analysis of ESBL-producing Escherichia coli isolated from Nile tilapia in fresh markets and supermarkets in Thailand
Article
Full-text available
This study investigated the prevalence and antimicrobial resistance (AMR) of Escherichia coli (E. coli) in Nile tilapia from fresh markets and supermarkets. A total of samples (n = 828) were collected from Nile tilapia including fish flesh (n = 276), liver and kidney (n = 276), and intestine (n = 276). Overall prevalence of fecal coliforms (61.6%) and E. coli (53.0%) were observed. High prevalence of E. coli was found in the intestine (71.4%), followed by the liver and kidney (45.7%). The highest prevalence of resistance was commonly found against tetracycline (78.5%), ampicillin (72.8%), and sulfamethoxazole (45.6%) with resistance to only tetracycline (15.2%) as the most common antibiogram. The prevalence of multidrug resistance (MDR) (54.4%) and Extended-spectrum beta-lactamases (ESBLs) (5.7%) were examined. The predominant virulence genes (n = 158) were st (14.6%), followed by eaeA (0.6%). The blaTEM (73.4%), tetA (65.2%), and qnrS (57.6%). There is statistical significance between Nile tilapia from fresh markets and supermarkets. Based on logistic regression analysis, ampicillin-resistant E. coli was statistically associated with the phenotypic resistance to tetracycline and trimethoprim, and the presence of blaTEM and tetA (p < 0.05). Further investigation of AMR transference and their mechanisms is needed for AMR control.
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Clinical and Financial Outcomes Due to Methicillin Resistant Staphylococcus aureus Surgical Site Infection: A Multi-Center Matched Outcomes Study
Article
Full-text available
The clinical and financial outcomes of SSIs directly attributable to MRSA and methicillin-resistance are largely uncharacterized. Previously published data have provided conflicting conclusions. We conducted a multi-center matched outcomes study of 659 surgical patients. Patients with SSI due to MRSA were compared with two groups: matched uninfected control patients and patients with SSI due to MSSA. Four outcomes were analyzed for the 90-day period following diagnosis of the SSI: mortality, readmission, duration of hospitalization, and hospital charges. Attributable outcomes were determined by logistic and linear regression. In total, 150 patients with SSI due to MRSA were compared to 231 uninfected controls and 128 patients with SSI due to MSSA. SSI due to MRSA was independently predictive of readmission within 90 days (OR = 35.0, 95% CI 17.3-70.7), death within 90 days (OR = 7.27, 95% CI 2.83-18.7), and led to 23 days (95% CI 19.7-26.3) of additional hospitalization and 61,681(9561,681 (95% 23,352-100,011) of additional charges compared with uninfected controls. Methicillin-resistance was not independently associated with increased mortality (OR = 1.72, 95% CI 0.70-4.20) nor likelihood of readmission (OR = 0.43, 95% CI 0.21-0.89) but was associated with 5.5 days (95% CI 1.97-9.11) of additional hospitalization and 24,113 (95% 4,521-43,704) of additional charges. The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.
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Attributable Hospital Cost and Length of Stay Associated with Health Care-Associated Infections Caused by Antibiotic-Resistant Gram-Negative Bacteria
Article
Full-text available
Determination of the attributable hospital cost and length of stay (LOS) are of critical importance for patients, providers, and payers who must make rational and informed decisions about patient care and the allocation of resources. The objective of the present study was to determine the additional total hospital cost and LOS attributable to health care-associated infections (HAIs) caused by antibiotic-resistant, gram-negative (GN) pathogens. A single-center, retrospective, observational comparative cohort study was performed. The study involved 662 patients admitted from 2000 to 2008 who developed HAIs caused by one of following pathogens: Acinetobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., or Pseudomonas spp. The attributable total hospital cost and LOS for HAIs caused by antibiotic-resistant GN pathogens were determined by comparison with the hospital costs and LOS for a control group with HAIs due to antibiotic-susceptible GN pathogens. Statistical analyses were conducted by using univariate and multivariate analyses. Twenty-nine percent of the HAIs were caused by resistant GN pathogens, and almost 16% involved a multidrug-resistant GN pathogen. The additional total hospital cost and LOS attributable to antibiotic-resistant HAIs caused by GN pathogens were 29.3% (P < 0.0001; 95% confidence interval, 16.23 to 42.35) and 23.8% (P = 0.0003; 95% confidence interval, 11.01 to 36.56) higher than those attributable to HAIs caused by antibiotic-susceptible GN pathogens, respectively. Significant covariates in the multivariate analysis were age >or=12 years, pneumonia, intensive care unit stay, and neutropenia. HAIs caused by antibiotic-resistant GN pathogens were associated with significantly higher total hospital costs and increased LOSs compared to those caused by their susceptible counterparts. This information should be used to assess the potential cost-efficacy of interventions aimed at the prevention of such infections.
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Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship
Article
Full-text available
  • Oct 2009
  • CLIN INFECT DIS
Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection (ARI). A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI. In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from 18,588to18,588 to 29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4-12.7 days, and attributable mortality was 6.5%. The societal costs were 10.7−10.7-15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of $13.35 million in 2008 dollars in this patient cohort. The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.
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Prevalence and impacts of nosocomial infection in Thailand 2001
Article
Full-text available
  • Jan 2006
To study the prevalence and impacts of nosocomial infection (N.I.) in Thailand. A point prevalence study on N.I. was carried out in 42 hospitals across Thailand in March 2001. The impacts of N.I. were done in the same hospitals by matched control groups in a period prevalence study March 12-25, 2001. The point prevalence rate of N.I. in 42 hospitals involving 18,456 patients across Thailand in March 2001 was 6.4%. The prevalence was higher in male than female patients (7.8% vs 5.0%). The prevalence rates of over 10% were found in 4 hospitals. The infection rate was highest in surgical followed in rank by medical, pediatric and orthopedic departments (9.1%, 7.6%, 6.1% and 5.8%) respectively. The commonest site of the infection was the lower respiratory tract, followed by urinary tract, surgical site and skin and soft tissue (34.1%, 21.5%, 15.0% and 10.5%). Gram-negative bacteria were isolated in 75.3% and gram-postive 18.4%. Penicillins, cephalosporins, aminoglycosides were the most used antimicrobials (31.2%, 25.2%, 12.3%). A period prevalence study on 53,882 patients during a 2 week period in March 2001 showed an infection rate of 2.5%. By matched control group study, an episode of N.I. was associated with 10.1 to 12.5 extra hospital days. The cost of antimicrobials for treatment of an episode of N.I. was 5919.50 baht (148 U.S. dollars). Thirteen point eight per cent of patients with N.I. died, 6.7% directly due to N.I. Nosocomial infection is common in hospitalized patients in Thailand and is associated high mortality rate and economic burden.
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A national prevalence study on nosocomial infections 1988
Article
  • Aug 1989
A National survey of N.I. in Thailand was done in April 1988. Twenty-three hospitals throughout the country were enrolled. Of the 6,805 patients studied, 52 per cent were males and 48 per cent were females. The prevalence rate of nosocomial infections was 11.7 per cent. The highest rate was found in the second biggest (regional) hospitals (18.8%). There were minor variations in the rates of infection in each age group. The infection rate was highest in intensive care units (35.1%) followed by orthopaedic (20.4%) and paediatric (15.7%) departments respectively. Urinary infections were the commonest (25.8%). Surgical wound infections ranked second (19.6%). Skin infections were as high as 11.8 per cent. P. aeruginosa were the commonest bacterial isolates (22%) followed by E. coli (18.1%) and Klebsiella species (14.0%). Antimicrobials were prescribed in 52 per cent of patients, and, in a large number, for prophylactic purposes. It is concluded that N.I. are the main health problems affecting more than 200,000 patients annually in Thailand. Urgent studies and interventions are clearly needed.
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Efficacy of hospital infection control in Thailand 1988-1992
Article
  • Mar 1996
  • J HOSP INFECT
Hospital infection control in Thailand was initiated in 1971, but it was not until 1987 that active infection control activities actually started. To evaluate the efficacy of the infection control programme, two national prevalence studies of hospital acquired infection (HAI) were undertaken. The HAI prevalence rate in 1988 was 11.7%; this was reduced to 7.3% four years later. The reduction of HAI was found in hospitals of all sizes, in all types of infection and almost all services. This reduction happened despite a shortage of infection control personnel. Co-operation of administrators, doctors and nurses is essential for success in HAI control. Such co-operation has been successfully created by the Nosocomial Infection Control Group of Thailand.
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Prevalence of nosocomial infection in Thailand 2006
Article
  • Sep 2007
To study the prevalence of nosocomial infection (NI). A point prevalence study was done in 20 hospitals across the country in August 2006. The present study was done in 20 hospitals: three university, five regional, five provincial, and seven other hospitals. 9,865 patients were included Male and female patients were almost equal in number with an average age of 42.7 years. The NI proportion was 6.5%, 7.0% in male and 5.9% in female patients. The prevalence rate of NI was highest in university and other hospitals (7.6%), followed by provincial (6.0%), and regional hospital (4.9%). There were two hospitals, one regional and one other hospital with NI prevalence rates over 10%. All three university hospitals had NI exceeding 7%. The infection rate was highest in ICU (22.6%), followed by surgical (6.8%), medical and orthopedic (6.7% each) departments. The commonest site of NI was lower respiratory tract (36.1%) followed by urinary tract (25.5%). Causative organisms were identified in 70.8% of all sites of infection and over 63% were by bacteria. Gram-negative bacteria were responsible for 70.2% and gram-positive bacteria for 19.9% of all pathogens. Pseudomonas aeruginosa, Klebsiella spp., Acinetobacter baumannii, MRSA, and enterococci were the leading bacterial isolates. At the time of the present study, 47.0% of patients were receiving antimicrobials. Cephalosporins, penicillins, and aminoglycosides were most commonly used The prevalence rate of NI in Thailand in 2006 was 6.5%, similar to previous studies. Changes in NI rates in certain hospitals, even though subtle, need additional studies to improve the efficacy of NI control.
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  • Jan 2009
  • 1175-84
  • Stewardship
stewardship. Clin Infect Dis 2009;49:1175-84.