Table 2.
Antimicrobial resistance and temporal trends among community-onset (CO) and hospital-onset (HO) BSI pathogens in Sa Kaeo and Nakhon Phanom provinces, Thailand, 2007-2014
| CO | HO | |||
|---|---|---|---|---|
| Antimicrobial resistance issue | % Resistanta (n/N tested) | Temporal Trends | % Resistanta (n/N tested) | Temporal Trends |
| Extended-spectrum beta-lactamase (ESBL) producing E. colib | 27% (763/3047) | Increased from 20% in 2008-2010 to 28% in 2011-2014 | 51% (105/203) |
No clear trend, range: 38% in 2010 to 69% in 2011 |
| ESBL producing K. pneumoniae | 23% (213/912) |
No clear trend, range: 19% in 2014 to 30% in 2012 |
55% (68/123) |
No clear trend, range: 23% in 2009 to 75% in 2013 |
| Carbapenem-resistant Enterobacteriaceae (CRE) | 5 cases | No cases before 2011. 5 cases total : 2011 (1), 2013 (1), 2014 (3) | 3 cases | No cases before 2012. 3 cases total: 2012 (2), 2014 (1). |
| Methicillin-resistant S. aureus (MRSA)c | 7% (55/744) | No clear trend | 20% (22/111) | No clear trend |
| Vancomycin-resistant S. aureus (VRSA)d | 0 | 0% | 0 | 0% |
| Penicillin-resistant S. pneumoniaee | 0 | 0% | 0 | 0% |
| Carbapenem-resistant Acinetobacter spp. | 34% (84/242) | Increased from 16% in 2007 to >40% in 2008 and then decreased to 23% in 2014 | 69% (101/146) | No clear trend, range: 91% in 2010 to 46% in 2012 |
| MDR Acinetobacter spp.f | 26% (56/219) | Increased from <10% in 2007 to >45% in 2010; no clear trend from 2011 (35%) to 2014 (23%) | 70% (97/138) | Decrease of borderline significance (p<0.10) from 2008 to 2014 |
aCalculated among isolates tested
bData available for 2008-2014. ESBL-producing criteria: ≥5 mm increase in the zone of growth inhibition of ceftazidime/clavulanic acid combination disc compared to ceftazidime or cefotaxime discs alone. If confirmatory testing was not available, ESBL screening test results were used: zone of inhibition for ceftazidime ≤22 mm or cefotaxime ≤27 mm
cMRSA criteria: prior to 2007, oxacillin disk diffusion with a zone of inhibition <10mm; from 2007, cefoxitin disk diffusion with a zone of inhibition <21 mm
dVRSA criteria: MRSA isolates tested for vancomycin minimum inhibitory concentration (MIC) ≤2 ug/ml as determined by E-test (bioMérieux, U.S.A.)
ePenicillin resistance criteria: oxacillin disc diffusion zone of inhibition <20 mm with confirmation by a penicillin MIC ≥8 μg/mL by E-test
fMDR Acinetobacter criteria: resistant to 3 or more drug classes: aminoglycosides, cephalosporins, fluoroquinolones, carbapenems
gCRE criteria: resistant to imipenem, meropenem, doripenem, or ertapenem by disc diffusion (zone of inhibition <20 mm)