Implementation of global antimicrobial resistance surveillance system (GLASS) in patients with bacteremia

PLoS One. 2018 Jan 3;13(1):e0190132. doi: 10.1371/journal.pone.0190132. eCollection 2018.

Abstract

The global antimicrobial resistance surveillance system (GLASS) was launched by the World Health Organization (WHO) in 2015. GLASS is a surveillance system for clinical specimens that are sent to microbiology laboratory for clinical purposes. The unique feature of GLASS is that clinical data is combined with microbiological data, and deduplication of the microbiological results is performed. The objective of the study was to determine feasibility and benefit of GLASS for surveillance of blood culture specimens. GLASS was implemented at Siriraj Hospital in Bangkok, Thailand using a locally developed web application program (app) to transfer blood culture specimen data, and to enter clinical data of patients with positive blood culture by infection control nurses and physicians via the app installed in their smart phones. The rate of positive blood culture specimens with true infection was 15.2%. Escherichia coli was the most common cause of bacteremia. Secondary bacteremia, primary bacteremia, and central line-associated blood stream infection was observed in 61.8%, 30.6%, and 12.6% of cases, respectively. Sepsis was observed in 56.9% of patients. E.coli was significantly more common in community-acquired bacteremia, whereas Klebsiella pneumoniae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and Acinetobacter baumannii were significantly more common in hospital-acquired bacteremia. Hospital-acquired isolates of E.coli, K.pneumoniae, A.baumannii, P.aeruginosa, S.aureus and Enterococcus faecium were more resistant to antibiotics than community-acquired isolates. In-hospital mortality was significantly higher in patients with antibiotic-resistant bacteremia than in patients with antibiotic non-resistant bacteremia (40.5% vs. 28.5%, p<0.001). The patients with antibiotic-resistant bacteremia consumed more resources than those with antibiotic non-resistant bacteremia. Blood culture results combined with patient clinical data were shown to have more benefit for surveillance of antimicrobial resistance, and to be more applicable for developing local antibiotic treatment guidelines for patients suspected of having bacteremia. However, GLASS consumed more time and more resources than the conventional laboratory-based surveillance system.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Bacteremia / drug therapy*
  • Bacteremia / microbiology
  • Drug Resistance, Bacterial*
  • Humans
  • Internet
  • Population Surveillance*
  • World Health Organization

Substances

  • Anti-Bacterial Agents

Grants and funding

This work was supported by the Health Systems Research Institute (Thailand), https://www.hsri.or.th/en. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.