อุบัติการณ์ ปัจจัยเสี่ยง และผลลัพธ์ทางคลินิกของการติดเชื้อแบคทีเรียแกรมลบดื้อยาหลายขนานในกระแสเลือดของโรงพยาบาลบ้านโป่ง

Ditthawat Pathomchareansukchai

Authors

Ditthawat Pathomchareansukchai Department of Medicine, Banpong Hospital

Keywords:

Multidrug-resistant Gram-negative bacteria, Bloodstream infection, Risk factors, Clinical outcomes

Abstract

Background: Multidrug-resistant gram-negative bloodstream infection (MDR GN-BSI) is a critical global health issue associated with limited therapeutic options, increased mortality, and a substantial economic burden. However, data specifically concerning Banpong Hospital remains limited.

Objective: To determine the incidence, risk factors, and clinical outcomes of multidrug-resistant gram-negative bloodstream infection (MDR GN-BSI) at Banpong Hospital, Ratchaburi Province.

Methods: This retrospective analytical study included patients aged 15 years and older with documented gram-negative bloodstream infection between July 1, 2023, and June 30, 2025. Patients were categorized into MDR and non-MDR groups based on international standard definitions. Data were analyzed to determine the incidence, identify associated risk factors, and evaluate the impact on clinical outcomes.

Results: Among 436 patients, the incidence of MDR GN-BSI was 11.0%. The most prevalent pathogens were Escherichia coli and Klebsiella pneumoniae; however, Acinetobacter baumannii exhibited a significantly higher proportion of multidrug resistance (16.7% vs 1.5%, p<0.001). Significant risk factors associated with MDR infection included hospital-acquired infection (adjusted odds ratio [aOR] 4.50, 95% confidence interval [CI] 1.25-16.20, p=0.02), history of fluoroquinolone exposure within the past 90 days (aOR 6.61,95% CI 1.81-24.10, p=0.004) and history of MDR colonization within the past 90 days (aOR 5.92, 95% CI 1.69-20.80, p=0.01). Regarding clinical outcomes, the MDR group had a significantly higher mortality rate compared to the non-MDR group (33.3% vs 7.7%, p<0.001). MDR infection was also associated with an increased risk of septic shock (p=0.04), a longer mean hospital stay by 3.6 days (p=0.01), increased consumption of broad-spectrum antimicrobial agents, and significantly higher mean medical costs (51,502 vs. 31,721 THB per case, p=0.02).

Conclusion: MDR GN-BSI is significantly associated with higher mortality rates and an increased economic burden. Implementation of rigorous infection control and antimicrobial stewardship programs is an immediate priority.

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