Health-care associated infections in Thailand 2011.

OBJECTIVE: To study the recent trend of health-care associated infections (HAIs) across Thailand. MATERIAL AND METHOD: Using the modified international HAI definitions, the investigators conducted a prospective, nationwide, multi-centered survey to determine a 1-day point-prevalence of HAIs among hospitalized patients in the 47 acute care, primary to tertiary hospitals in January 2011. RESULTS: Of total 10,762 patients (female 50.6%, mean age 44.2 +/- 27.3 years) enrolled in the study, 780 had HAIs or the average prevalence of HAIs was 7.3% (range 2.8-8.5%). Highest rates of HAIs were found in other hospitals (other type of tertiary-care facilities), intensive care units and lower respiratory tracts when stratified by type of hospital, unit of service and site of HAIs, respectively. Gram negative bacteria remained predominant among etiologic agents causing HAIs, as in prior studies. Acinetobacter spp., however emerged as the most common organism. At the time of study, 49.3% of all patients received one or more antimicrobial agents. Among the patients with HAIs, cephalosporins were the most commonly used. CONCLUSION: Recently, no significant change on nationwide prevalence and trend of HAIs in Thailand were demonstrated. Notably, Acinetobacter spp. emerged as the most common etiologic agents of HAIs.

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.