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Cited by 36Antibiotic Use and ResistanceBacterial Identification and Susceptibility TestingAntibiotic Resistance in Bacteria

Impact of low blood culture usage on rates of antimicrobial resistance

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Lim, Cherry, Hantrakun, Viriya, Teerawattanasook, Nittaya, Srisamang, Pramot, Teparrukkul, Prapit, Sumpradit, Nithima, Turner, Paul, Day, Nicholas PJ +3 more·2021·Journal of Infection
DOI 10.1016/j.jinf.2020.10.040PMC PMC7994019
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Abstract

OBJECTIVES: The magnitude of impact caused by low blood culture utilization on estimates of the proportions and incidence rates of antimicrobial-resistant (AMR) bacterial infections is largely unknown. METHODS: We used routine electronic databases of microbiology, hospital admission and drug prescription at Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand, from 2011 to 2015, and bootstrap simulations. RESULTS: The proportions of Escherichia coli and Klebsiella pneumoniae bacteraemias caused by 3rd generation cephalosporin resistant isolates (3GCREC and 3GCRKP) were estimated to increase by 13 and 24 percentage points (from 44% to 57% and from 51% to 75%), respectively, if blood culture utilization rate was reduced from 82 to 26 blood culture specimens per 1,000 patient-days. Among patients with hospital-origin bloodstream infections, the proportion of 3GCREC and 3GCRKP whose first positive blood culture was taken within ±1 calendar day of the start of a parenteral antibiotic at the study hospital was substantially lower than those whose first positive blood culture was taken later into parenteral antibiotic treatment (30% versus 79%, p<0.001; and 37% versus 86%, p<0.001). Similar effects were observed for methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter spp. and carbapenem-resistant Pseudomonas aeruginosa. CONCLUSION: Impacts of low blood culture utilization rate on the estimated proportions and incidence rates of AMR infections could be high. We recommend that AMR surveillance reports should additionally include blood culture utilization rate and stratification by exposure to a parenteral antibiotic at the hospital.

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  • There is a potential effect of selection bias in passive microbial surveillance data, bias introduced by low rates of diagnostic culture utilisation, and incomplete representation of AMR patterns due to differences in antimicrobial usage between private and public health-care sectors.

    “We also acknowledge the potential effect of selection bias in passive microbial surveillance data, bias introduced by low rates of diagnostic culture utilisation,74 while differences in antimicrobial usage between private and public health-care sectors might lead to incomplete representation of AMR patterns.”

    From Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050 (2024) · cites this paper as [74]

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Research works printed but not linked: 24

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Authors
Lim, C., Hantrakun, V., Teerawattanasook, N., Srisamang, P., Teparrukkul, P., Sumpradit, N., Turner, P., Day, N. P., Cooper, B. S., Peacock, S. J., & Limmathurotsakul, D.
Affiliations
  • Mahidol University (TH)
  • Sappasithiprasong Hospital (TH)
  • Ministry of Public Health (TH)
  • Angkor Hospital for Children (KH)
  • University of Cambridge (GB)
Corresponding author
  • Lim, Cherry
  • Limmathurotsakul, Direk
ORCID
Venue
Journal of Infection
Publisher
Elsevier BV
Published
2021-03
Volume
82
Issue
3
Pages
355-362
ISSN
0163-4453 (ISSN-L)
DOI
10.1016/j.jinf.2020.10.040
PMC
PMC7994019
OpenAlex
W3109266211
Cited by
36
References
0
Citations by year
2026: 4 · 2025: 9 · 2024: 11 · 2023: 3 · 2022: 8 · 2021: 1
FWCI
1.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Infection (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by)
  • Apollo (cc-by)
Funders
  • Wellcome Trust
  • Medical Research Council
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
antimicrobial resistance, bloodstream infection, Escherichia coli bacteraemia, Klebsiella pneumoniae, third-generation cephalosporin resistance, methicillin-resistant Staphylococcus aureus, carbapenem resistance, Acinetobacter, Pseudomonas aeruginosa, antimicrobial resistance surveillance
MeSH terms
Blood Culture, Anti-Bacterial Agents, Humans, Microbial Sensitivity Tests, Thailand, Drug Resistance, Bacterial, Methicillin-Resistant Staphylococcus aureus

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