Population-based bloodstream infection surveillance in rural Thailand, 2007鈥�2014

Table 2 Antimicrobial resistance and temporal trends among community-onset (CO) and hospital-onset (HO) BSI pathogens in Sa Kaeo and Nakhon Phanom provinces, Thailand, 2007-2014

听	CO		HO
Antimicrobial resistance issue	% Resistant^a (n/N tested)	Temporal Trends	% Resistant^a (n/N tested)	Temporal Trends
Extended-spectrum beta-lactamase (ESBL) producing E. coli^b	27% (763/3047)	Increased from 20% in 2008-2010 to 28% in 2011-2014	51% (105/203)	No clear trend, range: 38% in 2010 to 69% in 2011
ESBL producing K. pneumoniae	23% (213/912)	No clear trend, range: 19% in 2014 to 30% in 2012	55% (68/123)	No clear trend, range: 23% in 2009 to 75% in 2013
Carbapenem-resistant Enterobacteriaceae (CRE)	5 cases	No cases before 2011. 5 cases total : 2011 (1), 2013 (1), 2014 (3)	3 cases	No cases before 2012. 3 cases total: 2012 (2), 2014 (1).
Methicillin-resistant S. aureus (MRSA)^c	7% (55/744)	No clear trend	20% (22/111)	No clear trend
Vancomycin-resistant S. aureus (VRSA)^d	0	0%	0	0%
Penicillin-resistant S. pneumoniae^e	0	0%	0	0%
Carbapenem-resistant Acinetobacter spp.	34% (84/242)	Increased from 16% in 2007 to >40% in 2008 and then decreased to 23% in 2014	69% (101/146)	No clear trend, range: 91% in 2010 to 46% in 2012
MDR Acinetobacter spp.^f	26% (56/219)	Increased from <10% in 2007 to >45% in 2010; no clear trend from 2011 (35%) to 2014 (23%)	70% (97/138)	Decrease of borderline significance (p<0.10) from 2008 to 2014

^aCalculated among isolates tested
^bData available for 2008-2014. ESBL-producing criteria: 鈮�5 mm increase in the zone of growth inhibition of ceftazidime/clavulanic acid combination disc compared to ceftazidime or cefotaxime discs alone. If confirmatory testing was not available, ESBL screening test results were used: zone of inhibition for ceftazidime 鈮�22 mm or cefotaxime 鈮�27 mm
^cMRSA criteria: prior to 2007, oxacillin disk diffusion with a zone of inhibition <10mm; from 2007, cefoxitin disk diffusion with a zone of inhibition <21 mm
^dVRSA criteria: MRSA isolates tested for vancomycin minimum inhibitory concentration (MIC) 鈮�2 ug/ml as determined by E-test (bioM茅rieux, U.S.A.)
^ePenicillin resistance criteria: oxacillin disc diffusion zone of inhibition <20 mm with confirmation by a penicillin MIC 鈮�8 渭g/mL by E-test
^fMDR Acinetobacter criteria: resistant to 3 or more drug classes: aminoglycosides, cephalosporins, fluoroquinolones, carbapenems
^gCRE criteria: resistant to imipenem, meropenem, doripenem, or ertapenem by disc diffusion (zone of inhibition <20 mm)

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