Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022

s u m m a r yObjectives: To evaluate the frequency of antimicrobial-resistant bloodstream infections (AMR BSI) in Thailand.Methods: We analyzed data from 2022, generated by 111 public hospitals in health regions 1 to 12, using the AutoMated tool for Antimicrobial resistance Surveillance System (AMASS), and submitted to the Ministry of Public Health, Thailand.Multilevel Poisson regression models were used.Results: The most common cause of community-origin AMR BSI was third-generation cephalosporin-resistant Escherichia coli (3GCREC, 65.6%; 5101/7773 patients) and of hospital-origin AMR BSI was carbapenem-resistant Acinetobacter baumannii (CRAB, 51.2%, 4968/9747 patients).The percentage of patients tested for BSI was negatively associated with the frequency of community-origin 3GCREC BSI and hospitalorigin CRAB BSI (per 100,000 tested patients).Hospitals in health regions 4 (lower central region) had the highest frequency of community-origin 3GCREC BSI (adjusted incidence rate ratio, 2.06; 95% confidence interval: 1.52-2.97).Health regions were not associated with the frequency of hospital-origin CRAB BSI, and between-hospital variation was high, even adjusting for hospital level and size. Conclusion:The high between-hospital variation of hospital-origin CRAB BSI suggests the importance of hospital-specific factors.Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritized.