HEALTHCARE-ASSOCIATED INFECTIONS AT SELECTED HOSPITALS IN THAILAND

This study aimed to determine the prevalence of healthcare-associated infections (HAIs), all-cause mortality, document the bacterial pathogens isolated in HAIs, and determine the risk factors associated with HAIs and all-cause mortality at selected hospitals in Thailand. A survey with a total time frame of 10 days was conducted at selected 50 hospitals across Thailand during January 2014: 19 primary government hospitals, 15 secondary government hospitals, 13 tertiary government hospitals, 2 private hospitals and 1 government university hospital. Of 15,475 cases reviewed, 688 patients had 791 HAIs (1.1 HAI per infected patient). The rate of HAI was 4.4% (95%CI: 4.1-4.8): 7.3% (95%CI: 4.6-9.3) at the university hospital surveyed, 5.0% (95%CI: 4.6-5.4) at the tertiary hospitals surveyed, 3.9% (95%CI: 3.4-4.6) at the secondary hospitals surveyed, 2.0% (95%CI: 1.3-2.7) at the primary hospitals surveyed, and 1.6% (95%CI: 0.5-2.8) at the private hospitals surveyed. The ward with the frequent number of HAI was the intensive care unit (17%). The two most commonly affected age ranges were those aged >60 years and <1 year. Of the 791 HAIs found in this survey, the 3 most frequently reported types of HAI were: respiratory tract infections (n=377, 48%), urinary tract infections (n=176, 22%) and surgical site infections (n=55, 7%). Of the 688 patients with a HAI, 24% died within three months of this survey. The most frequently reported bacterial pathogen was Acinetobacter species (17%). On multivariate analysis, HAIs were significantly associated with patient age <1 year, a university hospital, having major surgery, urinary catheterization, being on a respiratory ventilator, having a tracheostomy, and having central venous catheterization (p <0.05). Death was associated with patient age <1 year, a university hospital, being on a surgical or medical ward, being on a ventilator, and having a central venous catheter (p <0.05). HAIs are major public health problems in the studied hospitals and result in substantial mortality.

Risk factors for multi-drug resistant Acinetobacter baumannii nosocomial infection

OBJECTIVE

To assess factors associated with multi-drug resistant Acinetobacter baumannii (MDR-AB) nosocomial infection.

MATERIAL AND METHOD

This hospital-based case-control study was conducted in patients admitted to Siriraj Hospital, Bangkok, Thailand between January 1, 2005 and December 31, 2005. The study population consisted of 155 cases with MDR-AB nosocomial infection and 310 controls without nosocomial infection. The cases were matched with controls by age and ward of admission with a ratio of 1:2.

RESULTS

The average age of the present study population was 63.5 +/- 18.7 years among cases and 62.9 +/- 18.2 years among controls. The mean of length of stay in hospital among cases was 4.9 +/- 1.4 weeks and controls 1.8 +/- 1.0 weeks. The most common site of MDR-AB nosocomial infection was lower respiratory tract (74.8%). The antimicrobial susceptibility of MDR-AB was 3.9% to cetriaxone and 42.1% to cefoperazone/sulbactam. Multiple logistic regression analysis showed the following associated factors with MDR-AB nosocomial infection: duration of admission prior to MDR-AB nosocomial infection > 1 week (OR = 2.06; 95% CI 1.09-3.89), indwelling urinary catheter > 1 week (OR = 8.24; 95% CI 3.81-17.82), mechanical ventilation > 1 week (OR = 5.73; 95% CI 2.96-11.10), central venous line > 1 week (OR = 3.29; 95% CI 1.48-7.31), nasogastric intubation > 1 week (OR = 6.22; 95% CI 3.24-11.93), prior administration of 3rd-4th generation cephalosporins (OR = 1.80; 95% CI 1.04-3.13), metrodazole (OR = 2.59; 95% CI 1.21-5.56), and piperacillin-tazobactam (OR = 4.68; 95% CI 1.93-11.32).

CONCLUSION

A case-control study in medical and surgical patients in Siriraj Hospital in 2005 revealed risk factors for AB nosocomial infection. Prolonged admission of more than 2 weeks, use of devices, and prior treatment with certain antimicrobials were found to be significant risk factors for the infection. To reduce the infection, strict infection control measures must be applied to the patients with these risk factors. Education to medical personnel and enforcement of infection control practices are all needed to reduce antimicrobial resistant bacterial nosocomial infection.