The Antibiotic Treatment Patterns and Factors Affecting Carbapenem-resistant Enterobacteriaceae (CRE) Clinical Outcomes in an Advanced-level Government Hospital in Eastern Thailand

Name: Suluck Soontaros

LCSH: Burapha University.Faculty of Pharmaceutical science

Classification :.DDC: 615.329

LCSH: Antibiotics

Abstract: Carbapenem-resistant Enterobacteriaceae (CRE) is a critical public health problem with in increasing prevalence worldwide during the last decade. Besides, CRE infection has a limited treatment option. The ultimate goals of this research were to 1) identify risk factors associated with CRE infection mortality, 2) investigate the antibiotic treatment patterns for CRE infection, and 3) investigate how physicians select antibiotics treatments for CRE infection. From a systematic review and meta analysis, we found that CRE was associated with an increased mortality rate. The retrospective cohort study, conducted in Chonburi Hospital, confirmed the increased mortality risk in CRE-infected patients. Besides, we found increasing readmission rate, length of stay, and the cost of treatment in CRE-infected patients. Charlson comorbidity index score, number of days with an invasive device or indwelling line, septic shock, acute respiratory failture, site of sever infection, and renal impairment were associated with increased mortality risk in CRE-infected patients. Moreover, we found that colistin, fostomycin, tigencycline, or aminoglycosides, were prescribed in a combination fashion as mainstay treatments. The qualitative study, also conducted in Chonburi Hospital, was used to investigate how physicians select antibiotics treatment patterns for CRE infection. The physicians realized that CRE resistance was an important problem; CRE was being spread increasingly in the hospital; and CRE led to various negative treatment outcomes including higher mortality rate, aggravated the severity of disease, inflated the cost of treatment, and spread the CRE epidemic. However, physicians still did not comply with the CRE treatment guidelines because of the lack of confidence and knowledge in treating CRE infection. Providing accessible necessary information, a sufficient number of infectious specialists, and drug use evaluation policy and process were reported as solutions for the CRE challenges. We concluded that CRE infection increased negative treatment outcomes. Several factors could be used to predict mortality in CRE-infected patients. Together with the understanding in how physicians treated CRE infection and why they did not comply to the treatment guidelines, this information should help developing policies to alleviate the CRE crisis, espectially in Thailand.

Burapha University. Library

Address: CHONBURI

Email: buulibrary@buu.ac.th

Name: Titinun Auamnoy

Role: Principal advisor

Name: Nattawut Leelakanok

Role: Co-advisor

Created: 2021

Modified: 2022-05-30

Issued: 2022-05-30

วิทยานิพนธ์/Thesis

application/pdf

CallNumber: Th 615.329 Su953A

eng

DegreeName: Doctor of Philosophy

Level: Doctoral Degree

Descipline: Pharmaceutical Sciences and Management

Grantor: Burapha University

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