Antibiotic Use in Thailand: Quantifying Impact on Blood Culture Yield and Estimates of Pneumococcal Bacteremia Incidence

• Published in: The American journal of tropical medicine and hygiene 2010-08, Vol.83 (2), p.301-306
• Main Authors: RHODES, Julia, HYDER, Joseph A, CHANTRA, Somrak, TANWISAID, Kittisak, MALONEY, Susan A, BAGGETT, Henry C, PERUSKI, Leonard F, FISHER, Cindy, JORAKATE, Possawat, KAEWPAN, Anek, DEJSIRILERT, Surang, THAMTHITIWAT, Somsak, OLSEN, Sonja J, DOWELL, Scott F
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - drug therapy; Bacteremia - epidemiology; Bacteremia - microbiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Child; Child, Preschool; Drug Utilization; Human bacterial diseases; Humans; Incidence; Infant; Infectious diseases; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumococcal Infections - epidemiology; Pneumococcal Infections - microbiology; Population Surveillance; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - isolation & purification; Thailand - epidemiology; Young Adult
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.2010.09-0584

No studies have quantified the impact of pre-culture antibiotic use on the recovery of individual blood-borne pathogens or on population-level incidence estimates for Streptococcus pneumoniae. We conducted bloodstream infection surveillance in Thailand during November 2005-June 2008. Pre-culture antibiotic use was assessed by reported use and by serum antimicrobial activity. Of 35,639 patient blood cultures, 27% had reported pre-culture antibiotic use and 24% (of 24,538 tested) had serum antimicrobial activity. Pathogen isolation was half as common in patients with versus without antibiotic use; S. pneumoniae isolation was 4- to 9-fold less common (0.09% versus 0.37% by reported antibiotic use; 0.05% versus 0.45% by serum antimicrobial activity, P < 0.01). Pre-culture antibiotic use by serum antimicrobial activity reduced pneumococcal bacteremia incidence by 32% overall and 39% in children < 5 years of age. Our findings highlight the limitations of culture-based detection methods to estimate invasive pneumococcal disease incidence in settings where pre-culture antibiotic use is common.