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

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  • International Emerging Infections Program, Thailand Ministry of Public Health – United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota; Johns Hopkins University School of Medicine, Baltimore, Maryland; National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand; Centers for Disease Control and Prevention, Atlanta, Georgia; Crown Prince Hospital, Thailand Ministry of Public Health, Sa Kaeo, Thailand; Nakhon Phanom Hospital, Thailand Ministry of Public Health, Nakhon Phanom, Thailand

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.

Author Notes

*Address correspondence to Henry C. Baggett, CDC/IEIP, DDC7 Building, 3rd Floor, Ministry of Public Health, Soi 4, Tivanon Rd., Muang, Nonthaburi 11000 Thailand. E-mail: kipb@th.cdc.gov; hbaggett@cdc.gov

Financial support: Support for this project was provided by the CDC Foundation and the Pneumococcal vaccines Accelerated Development and Introduction Plan (PneumoADIP), which is funded by GAVI Alliance and is based at the Johns Hopkins Bloomberg School of Public Health.

Authors' addresses: Julia Rhodes, Leonard F. Peruski, Possawat Jorakate, Anek Kaewpan, Somsak Thamthitiwat, Susan A. Maloney, and Henry C. Baggett, CDC/IEIP, Ministry of Public Health, Muang, Nonthaburi, Thailand, E-mails: JuliaR@th.cdc.gov, LeonardP@th.cdc.gov, PossawatJ@th.cdc.gov, AnekK@th.cdc.gov, SomsakT@th.cdc.gov, SusanM@th.cdc.gov, and KipB@th.cdc.gov. Joseph A. Hyder, Mayo Clinic, Department of Anesthesiology, Rochester, MN, E-mail: joseph.a.hyder@gmail.com. Cindy Fisher, Johns Hopkins University, School of Medicine, Baltimore, MD, E-mail: cfisher9@gmail.com. Surang Dejsirilert, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand, E-mail: surang_dej@yahoo.com. Sonja J. Olsen and Scott F. Dowell, CDC, Atlanta, GA, E-mails: sco2@cdc.gov and sfd2@cdc.gov. Somrak Chantra, Sa Kaeo Crown Prince Hospital, Muang, Sa Kaeo, Thailand, E-mail: somrakc@hotmail.com. Kittisak Tanwisaid, Nakhon Phanom Hospital, Muang, Nakhon Phanom, Thailand, E-mail: kittisak97@gmail.com.

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