{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:11:05Z","timestamp":1790457065685,"version":"4.1.0"},"reference-count":45,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,3]]},"abstract":"<jats:p>Bloodstream infection surveillance conducted from 2008 to 2014 in all 20 hospitals in Sa Kaeo and Nakhon Phanom provinces, Thailand, allowed us to look at disease burden, antibiotic susceptibilities, and recurrent infections caused by extended-spectrum \u03b2-lactamase (ESBL)\u2013producing <jats:italic>Escherichia coli<\/jats:italic> and <jats:italic>Klebsiella pneumoniae<\/jats:italic>. Of 97,832 blood specimens, 3,338 were positive for <jats:italic>E. coli<\/jats:italic> and 1,086 for <jats:italic>K. pneumoniae<\/jats:italic>. The proportion of <jats:italic>E. coli<\/jats:italic> isolates producing ESBL significantly increased from 19% to 22% in 2008\u20132010 to approximately 30% from 2011 to 2014 (<jats:italic>P<\/jats:italic>-value for trend = 0.02), whereas ESBL production among <jats:italic>K. pneumoniae<\/jats:italic> cases was 27.4% with no significant trend over time. Incidence of community-onset ESBL-producing <jats:italic>E. coli<\/jats:italic> increased from 5.4 per 100,000 population in 2008 to 12.8 in 2014, with the highest rates among persons aged \u2265 70 years at 79 cases per 100,000 persons in 2014. From 2008 to 2014, community-onset ESBL-producing <jats:italic>K. pneumoniae<\/jats:italic> incidence was 2.7 per 100,000, with a rate of 12.9 among those aged \u2265 70 years. Although most (93.6% of <jats:italic>E. coli<\/jats:italic> and 87.6% of <jats:italic>K. pneumoniae<\/jats:italic>) infections were community-onset, hospital-onset infections were twice as likely to be ESBL. Population-based surveillance, as described, is vital to accurately monitor emergence and trends in antimicrobial resistance, and in guiding the development of rational antimicrobial therapy recommendations.<\/jats:p>","DOI":"10.4269\/ajtmh.18-0394","type":"journal-article","created":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T07:01:50Z","timestamp":1550559710000},"page":"943-951","source":"Crossref","is-referenced-by-count":41,"title":["High Burden of Extended-Spectrum \u03b2-Lactamase\u2013Producing Escherichia coli and Klebsiella pneumoniae Bacteremia in Older Adults: A Seven-Year Study in Two Rural Thai Provinces"],"prefix":"10.4269","volume":"100","author":[{"given":"Pongpun","family":"Sawatwong","sequence":"first","affiliation":[{"name":"Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patranuch","family":"Sapchookul","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toni","family":"Whistler","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"},{"name":"Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Gregory","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"},{"name":"Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ornuma","family":"Sangwichian","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirirat","family":"Makprasert","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Possawat","family":"Jorakate","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasong","family":"Srisaengchai","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somsak","family":"Thamthitiwat","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chidchanok","family":"Promkong","sequence":"additional","affiliation":[{"name":"Nakhon Phanom Provincial Hospital, Nakhon Phanom, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pongnapat","family":"Nanvatthanachod","sequence":"additional","affiliation":[{"name":"Sa Kaeo Crown Prince Hospital, Sa Kaeo, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthita","family":"Vanaporn","sequence":"additional","affiliation":[{"name":"Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Rhodes","sequence":"additional","affiliation":[{"name":"Thailand Ministry of Public Health (MOPH)-U.S. Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Ann Intern Med","first-page":"353","article-title":"Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins","volume":"119","author":"Meyer","year":"1993"},{"key":"b2","series-title":"Antimicrob Agents Chemother","first-page":"2193","article-title":"Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care 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