Predisposing Factors Associated with Third-Generation Cephalosporin-Resistant in a Rural Community Hospital in Thailand.

BACKGROUND

Various predisposing factors contribute to the emergence and dissemination of the multidrug-resistant (MDR) phenotype in and . Understanding these factors is crucial for guiding appropriate antimicrobial therapy and infection control strategies. This study investigated the predisposing factors contributing to the MDR characteristics of and isolated in a community hospital in northeastern Thailand.

METHODS

This case-control study utilized retrospective data from bacterial culture, as well as demographic, clinical, and antibiotic susceptibility records collected during 5 years (January 2016-December 2020). and isolates were analyzed from various clinical samples, including blood, urine, pus, sputum, and other body fluids. Data were analyzed using descriptive statistics and univariate logistic regression.

RESULTS

In total, 660 clinical isolates were analyzed (421 and 239 ). Blood was the most common source of the detection of (63.0%) and sputum was the most common source of (51.0%). The median ages of patients were 67 and 63 years for and , respectively. cases were significantly associated with prior antibiotic use (OR = 1.79, 95% CI: 1.17-2.74 = 0.008). MDR was observed in 50.1% of and 29.7% of ( < 0.001). compared to had lower resistance to third-gen cephalosporins (64.9% versus 95.8%) and carbapenems (8.0% versus 6.9%). ICU admission was the only factor significantly associated with MDR (OR = 2.40, 95% CI: 1.11-5.20 = 0.026). No significant differences were observed in gender, age, or comorbidities between MDR cases. Antibiotic usage patterns also differed, with more likely to receive third-gen cephalosporins compared to carbapenems (OR = 3.02, 95% CI:1.18-7.74 = 0.021).

CONCLUSIONS

The use of third-generation cephalosporin may drive MDR more than . Prior antibiotic exposure was linked to bloodstream infections, while MDR showed greater clinical severity. These findings highlighted the need for improved antibiotic stewardship in rural hospitals.