Trends and correlations in antimicrobial resistance indicators in 110 hospitals in Thailand, 2022-2024.

OBJECTIVE

To evaluate trends and correlations in antimicrobial resistance (AMR) indicators

METHODS

We conducted a cross-sectional study analyzing summary AMR data from 110 public hospitals in Thailand in 2022 and 2024.

RESULTS

In 2022 and 2024, the total number of hospital admissions were 3,856,503 and 3,901,396, respectively. The total number of patients with hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI) decreased from 4925 in 2022 to 4375 in 2024, corresponding to a 12% decline in AMR frequency per 100,000 admissions (adjusted rate ratio 0.88; 95% confidence interval 0.84-0.91; P <0.001). However, changes in AMR frequency and AMR proportion were weakly correlated (Spearman's rho = 0.27). Declines in the total number of patients (from 1630 to 1281) and AMR frequencies were also observed for hospital-acquired BSI due to carbapenem-resistant Klebsiella pneumoniae (CRKP) (all P <0.001). Nonetheless, the total number of patients with hospital-acquired BSI due to carbapenem-resistant Escherichia coli was 298 in 2022 and 336 in 2024, and increases in some but not all AMR frequencies were observed. No significant changes were observed in most AMR indicators for methicillin-resistant Staphylococcus aureus.

CONCLUSIONS

At the national level, the burden of hospital-acquired BSI due to CRAB and CRKP declined in Thailand during the study period. However, at the hospital level, changes in AMR indicators could be discordant. We emphasize the need for cautious interpretation of changes in multiple AMR indicators, including their underlying numerators and denominators, when assessing AMR burden at the hospital and national levels.