Multidrug-resistant bacterial infections increasing in Thailand and likely elsewhere in Asia

A microbiologist measures the diameter of the zone showing how effective each antibiotic is against the bacteria grown. ©Mahidol Oxford Tropical Medicine Research Unit (MORU). Photographer: Direk Limmathurotsakul.

7 September 2016, Bangkok (Thailand) – Multidrug-resistant bacterial infections cause more than 19,000 excess deaths a year in Thailand alone, according to a study published today in eLife Sciences Publications.

In a first for Thailand, the study systematically examined microbiology laboratory and hospital databases from nine public hospitals in Northeast Thailand and compared them to Thailand’s national death registry to estimate that 19,122 deaths in Thailand in 2010 were excess deaths caused by multidrug-resistant bacterial infections.

Noting that Thailand’s death rate from multidrug-resistant bacterial infections was high given its smaller population relative to the United States and Europe, the study authors warned that similarly high death rates due to multidrug-resistant bacterial infection were likely to be found in other low and middle-income countries, such as China, India and Indonesia.

“Our study estimates that multidrug-resistant bacterial infections caused an excess of 19,122 deaths in Thailand in 2010. This is large compared to the 23,000 deaths a year estimated in the much more populous USA (316 million population in 2013) and the 25,000 deaths a year in the European Union (500 million population in 2007),” said study senior author Dr. Direk Limmathurotsakul, Head of Microbiology at MORU and Assistant Professor at Mahidol University (Thailand).

A microbiologist looks at the bacteria grown on agar plates with six antibiotic discs. ©Mahidol Oxford Tropical Medicine Research Unit (MORU). Photographer: Direk Limmathurotsakul.

“We also show that the proportion of multidrug-resistant bacteria found in patients is increasing and that the burden of antibiotic resistance in Thailand is deteriorating over time,” said Dr. Limmathurotsakul.

“We expect to find similar high rates of multidrug resistant bacterial infections in other low and middle income countries, particularly where broad spectrum antibiotics such as ceftriaxone, ceftazidime and carbapenem are commonly available and used, such as in China, India and Indonesia,” said Dr. Limmathurotsakul.

Antimicrobial resistance is a growing global problem. In low and middle-income countries, bacteria resistant to many commonly used antibiotics are spreading, driven by rising incomes, greater use of affordable antibiotics by both humans and animals, a lack of control of antimicrobial use in hospitals and poor control of over-the-counter sales.

The study authors said that better national estimates on the epidemiology and burden of multidrug resistant bacterial infections could be improved by integrating information from readily available databases in Thailand and other low and middle-income countries.

“The impact of drug-resistant bacterial infections is already considerable – and getting worse. If it’s not to overwhelm Asia’s prosperity and the world’s economic, health and life expectancy gains, we need to take drug resistance seriously and invest heavily in its defeat – now, “ said study collaborator Dr. Nick Day, Director of MORU and Professor at the University of Oxford (UK).

A microbiologist measures the diameter of the zone showing how effective each antibiotic is against the grown bacteria. ©Mahidol Oxford Tropical Medicine Research Unit (MORU). Photographer: Direk Limmathurotsakul

“More systematic studies should be done in low and middle-income countries. We should focus on how to compare the antimicrobial resistance situation in countries where settings, resources for diagnostic tests and laboratory methodologies are different. Finally, we will need to identify where resources and attentions are most needed to effectively fight antimicrobial resistance,” said Prof Day.

Led by researchers at Ministry of Public Health and the Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine and Siriraj Hospital, Mahidol University, in Thailand, and the University of Oxford and University of Cambridge in the United Kingdom, the study was funded by the Ministry of Public Health (Thailand) and the Wellcome Trust (UK).

“This study makes for grim reading, confirming that there were over 19,000 deaths in Thailand due to drug resistance in 2010, a figure which is likely to have risen since. It’s yet another warning to the global community that drug resistant infections are killing people now and we must not wait any longer to take action,” said Dr Jeremy Farrar, Director of the Wellcome Trust.

“Drug resistance is a global issue, which affects all of us whether we live in London or in Bangkok, and all countries need to be part of any solution. We cannot tackle drug resistant infections by isolating our actions to single countries or continents.  At the UN General Assembly later this month we urgently need governments to commit to strategies that combat drug resistance," said Dr Farrar.


Lim et al. Epidemiology and Burden of Multidrug-resistant Bacterial Infection in a Developing Country. eLife 6 Sept 2016,

For post publication access to abstract and full text:

Authors and contributors:

This work was conducted by: Cherry Lim, Emi Takahashi, Maliwan Hongsuwan, Visanu Thamlikitkul, Vanaporn Wuthiekanun, Soawapak Hinjoy, Nicholas Day, Sharon Peacock and Direk Limmathurotsakul.