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Background: This study aimed to evaluate the practicality and advantage of Global Antimicrobial Resistance Surveillance System (GLASS) for surveillance of urine culture samples collected from patients with bacteriuria., Methods: GLASS has been implemented at a tertiary care university hospital in Thailand by using the web application program to collect clinical data and urine culture data from patients with positive urine culture., Results: There were 5085 urine samples from 3545 patients that were sent to our microbiology laboratory during June-December 2017. Bacteriuria was found in 1944 patients. Of those, 952 had urinary tract infection (UTI), and 1161 had colonization. Among UTI patients, hospital-acquired infection (HAI) was observed in 74.2 %, and community-acquired infection (CAI) was found in 28.7 %. E. coli and S. agalactiae were more frequently observed in CAI, but P. aeruginosa, P. mirabilis, E. faecium, and A. baumannii were more prevalent in HAI. UTI isolates demonstrated less resistance to antibiotics than colonized isolates. Non-duplicate isolates of bacteria demonstrated less resistance than duplicate isolates. E. coli, K. pneumoniae, P. aeruginosa, P. mirabilis, E. faecalis, and E. faecium causing HAI were more resistant to antibiotics than those causing CAI., Conclusion: GLASS is feasible to implement and more beneficial than laboratory-based surveillance. This study collects additional information beyond GLASS including causative bacteria and colonizing bacteria; types of UTI; and more specific criteria to distinguish HAI from CAI so that such data can be used for developing more valid local guidelines for selecting antibiotic therapy in UTI patients in addition to AMR surveillance in urine samples., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study determined the presence of important antibiotic-resistant bacteria in selected environments in Thailand, including wastewater samples from 60 hospitals; washed fluid, leachate, flies, cockroaches, and rats collected from five open markets; washed fluid from garbage trucks; and stabilized leachate from a landfill facility. At least one type of antibiotic-resistant bacteria was isolated from all samples of influent fluid before treatment in hospitals, from wastewater treatment tank content in hospitals, and from 15% of effluent fluid samples after treatment with chlorine prior to draining it into a public water source. Antibiotic-resistant bacteria were recovered from 80% of washed market fluid samples, 60% of market leachate samples, all fly samples, 80% of cockroach samples, and all samples of intestinal content of rats collected from the open markets. Antibiotic-resistant bacteria were recovered from all samples from the landfill. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and/or Klebsiella pneumoniae were the most common antibiotic-resistant bacteria recovered from all types of samples, followed by carbapenem-resistant E. coli and/or K. pneumoniae. Colistin-resistant Enterobacteriaceae, carbapenem-resistant Psuedomonas aeruginosa , carbapenem-resistant Acinetobacter baumannii , colistin-resistant Enterobacteriaceae, vancomycin-resistant Enterococci , and methicillin-resistant S. aureus were less common. These findings suggest extensive contamination by antibiotic-resistant bacteria in hospital and community environment in Thailand.

Background: Colonization with multidrug-resistant (MDR) bacteria is a major risk factor for developing subsequent MDR infections., Methods: We performed a prospective surveillance study in hospitalized patients at Siriraj Hospital. Nasal cavity, throat, inguinal area and rectal swabs were obtained within the first 48-h after admission, on day-5 after hospitalization and then every 7 days until discharge. Target bacteria included extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant- P.aeruginosa (CR-PA), carbapenem-resistant- A.baumannii (CR-AB) and methicillin-resistant S.aureus (MRSA)., Results: From January 2013-December 2014, 487 patients were enrolled. The baseline prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA at any site was 52.2%, 6.8%, 4.7% and 7.2%, respectively. After 3-week of hospitalization, the prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA increased to 71.7%, 47.2%, 18.9% and 18.9%, respectively. Multivariable analysis revealed that diabetes mellitus and recent cephalosporin exposure were the independent risk factors for baseline colonization by ESBL. The independent risk factors for CR-AB and/or CR-PA colonization were cerebrovascular diseases, previous hospitalization, transfer from another hospital/a LTCF and previous nasogastric tube use, whereas those for MRSA colonization were previous fluoroquinolone exposure and previous nasogastric tube use., Conclusions: The baseline prevalence of colonization by ESBL was relatively high, whereas the baseline prevalence of colonization by CR-PA, CR-AB and MRSA was comparable to previous studies. There was an increasing trend in MDR bacteria colonization after hospitalization., Competing Interests: The study received ethical approval from the Institutional Review Board of Faculty of Medicine Siriraj Hospital, Mahidol University. Only subjects who agreed to participate and signed informed consent forms were enrolled.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Little is known about the excess mortality caused by multidrug-resistant (MDR) bacterial infection in low- and middle-income countries (LMICs). We retrospectively obtained microbiology laboratory and hospital databases of nine public hospitals in northeast Thailand from 2004 to 2010, and linked these with the national death registry to obtain the 30-day mortality outcome. The 30-day mortality in those with MDR community-acquired bacteraemia, healthcare-associated bacteraemia, and hospital-acquired bacteraemia were 35% (549/1555), 49% (247/500), and 53% (640/1198), respectively. We estimate that 19,122 of 45,209 (43%) deaths in patients with hospital-acquired infection due to MDR bacteria in Thailand in 2010 represented excess mortality caused by MDR. We demonstrate that national statistics on the epidemiology and burden of MDR in LMICs could be improved by integrating information from readily available databases. The prevalence and mortality attributable to MDR in Thailand are high. This is likely to reflect the situation in other LMICs., Competing Interests: The authors declare that no competing interests exist.

Objective: To determine bacterial colonization of skin, scalp, nares, nails, and psoriasis lesion in Thai psoriasis patients and compare findings with those of healthy controls., Material and Method: Sixty patients with chronic plaque-type psoriasis and 60 healthy controls of similar age and gender were enrolled. Swabs of nares, scalp, nails, and non-lesional skin were taken from all subjects. Swabs of lesional skin were taken from psoriasis patients. Aerobic bacteria were isolated from swab specimens., Results: Patients with psoriasis had significantly higher rate of bacteria colonization in nares, scalp, and nails than those of healthy controls. Firmicutes spp. was the most common phyla, followed by Proteobacteria spp. in both groups. Coagulase-negative staphylococci (CoNS) were the most common pathogens isolated from lesional skin, non-lesional skin, scalp, and nares of psoriasis patients. Streptococcus spp. was found only in psoriasis patients., Conclusion: Similar to findings from Caucasian psoriasis patients, Firmicutes spp. was found to be the most common phyla colonizing the skin of Asian psoriasis patients. Streptococcus spp. was found to colonize only the skin. Further studies are needed to determine the clinical significance of streptococcal skin colonization in psoriasis patients.

Objective: To determine comparative in vitro activity of sitafloxacin against clinical isolates of bacteria from Thai patients with urinary tract infection and those with lower respiratory tract infection., Material and Method: 1,255 clinical isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus spp, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Moraxella catarrhalis isolated from different Thai patients with urinary tract infection and those with lower respiratory tract infection in 2010 were included. The minimum inhibitory concentrations (MICs) of sitafloxacin, ciprofloxacin, levofloxacin, moxifloxacin, imipenem, amikacin, ampicillin, ceftazidime, ceftriaxone, penicillin, piperacillin/tazobactam, vancomycin, azithromycin and trimethoprim/sulfamethoxazole were determined by standard agar dilution method., Results: The MIC50 and MIC90 values of sitafloxacin against all tested bacteria were lowest when compared with those of levofloxacin, ciprofloxacin and moxifloxacin. Sitafloxacin was active against 51% of methicillin-resistant S. aureus (MRSA) isolates. The activity of sitafloxacin against multidrug-resistant (MDR) Gram-negative bacteria, such as, extended spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumomiae, P. aeruginosa and A. baumannii was comparable to or more than that of some beta-lactam/beta-lactamase inhibitors, cephalosporins or carbapenems., Conclusion: Sitafloxacin is more active than levofloxacin, ciprofloxacin and moxifloxacin against isolated bacteria from Thai patients with urinary tract and lower respiratory infections including antibiotic resistant bacteria, such as MRSA, ESBL-producing Gram-negatives, carbapenem-resistant A. baumannii.

Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity amongst adults in the Asia-Pacific region. Literature published between 1990 and May 2010 on the clinical and economic burden of CAP amongst adults in this region was reviewed. CAP is a significant health burden with significant economic impact in this region. Chronic obstructive pulmonary disease, cardiovascular disease, diabetes mellitus and advanced age were risk factors for CAP. Aetiological agents included Streptococcus pneumoniae, Klebsiella pneumoniae, Gram-negative bacteria, Mycobacterium tuberculosis, Burkholderia pseudomallei, Staphylococcus aureus and atypical pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella spp.), with important differences in the prevalence of these pathogens within the region. Antibiotic resistance was significant but was not linked to excess mortality. Aetiological pathogens remained susceptible to newer antimicrobial agents. Rational antibiotic use is essential for preventing resistance, and increased surveillance is required to identify future trends in incidence and aetiology and to drive treatment and prevention strategies., (Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.)

Background: Several generic piperacillin/ tazobactam formulations have been approved by Thai Food andDrugAdministration, Ministry of Public Health. Piperacillin/ tazobactam is a parenteral drug. Therefore, a study demonstrating a biological equivalence of generic piperacillin/ tazobactam is not required for drug registration in Thailand., Objective: The study was to determine microbiological equivalence of serum bacteriostatic and bactericidal activities of the sera from healthy volunteers receiving generic piperacillin/ tazobactam (PipertazA) and original piperacillin/tazobactam (Tazocin)., Material and Method: This was a randomized crossover study in 16 adult healthy volunteers. Each subject received 4.5 grams of Pipertaz and Tazocin in 50 ml of normal saline via intravenous infusion for 30 minutes. The blood samples were drawn at baseline prior to receiving the study drug, at 30 minutes after initiating infusion, and at 8 hours after initiating infusion. The serum bacteriostatic activity against E. coli ATCC 25922, K. pneumoniae, P aeruginosa ATCC 27853 and A. baumannii was performed by disk diffusion The serum bactericidal activity against E. coli ATCC 25922 was performed by Serum Bactericidal Titre., Results: The average inhibition zone diameter of the serum samples from the subjects while receiving Pipertaz against each tested organisms was <1 mm smaller than that while receiving Tazocin and such difference was not significantly different. All serum samples collected at 30 minutes after initiating Tazocin and Pipertaz had bactericidal titres 1:64 to 1:256 against E. coli ATCC 25922. All serum samples collected at 8 hours after initiating Tazocin and Pipertaz had bactericidal titres < 1:2 against E. coli ATCC 25922. The differences of serum bactericidal titres of the serum samples collected at 30 minutes (p = 0.7) and 8 hours (p = 1.0) after initiating Tazocin and Pipertaz were not statistically significant., Conclusion: The sera from healthy volunteers receiving Pipertaz contain bacteriostatic and bactericidal activities not significantly different from those receiving Tazocin.

Objective: In Siriraj Hospital, generic meropenem (Monem) has been available and was substituted for original meropenem, but the effectiveness and safety of using generic meropenem in a clinical setting are the main concern., Material and Method: From July 2007 to June 2009, hospitalized patients aged 18 or older who received meropenem for 48 hours were identified from the pharmacy database of Siriraj hospital. A retrospective study was conducted. Three hundred patients in each of original and generic meropenem groups were required to demonstrate non-inferiority of generic to original meropenem., Results: The mean age of all patients was 63 years. Most of the patients had co-morbidities. Approximately 90% of the infections were health-care associated. Drug-resistant gram-negative bacteria including ESBL producing E. coli and K. pneumoniae, P. aeruginosa and A. baumannii account for nearly 50% of all organisms. No significant difference was found regarding characteristics, type or site of infection and pathogen between generic and original groups but for more patients in the original group having cardiovascular disease and more patients in the generic group receiving immunosuppressive agents. Eighty-two to 85% received meropenem with one of appropriate indications. No statistically significant difference occurred either in an overall favorable outcome (63% vs.70.4%, p = 0.07) or in overall mortality (38% vs. 32%, p = 0.17), as well as adverse effects between the original and the generic groups., Conclusion: Generic meropenem (Monem) was not inferior to original meropenem for therapy of infections in the hospitalized patients at Siriraj Hospital.

Background: Several generic meropenem formulations have been approved by Thai Food and Drug Administration, Ministry of Public Health since 2008. Meropenem is a parenteral drug. Therefore, a study demonstrating a biological equivalence of generic meropenem is not required for drug registration in Thailand. The objective of the study was to determine microbiological equivalence of serum bacteriostatic and bactericidal activities of the sera from healthy volunteers receiving original meropenem (Meronem) and generic meropenem (Mero)., Material and Method: This was a randomized crossover study in 16 adult healthy volunteers. Each subject received one gram of Meronem and Mero in 50 ml of normal saline via intravenous infusion for 30 minutes. The blood samples were drawn at baseline prior to receiving the study drug, at 30 minutes after initiating infusion, and at 8 hours after initiating infusion. The serum bacteriostatic activity against E. coli ATCC 25922, K. pneumoniae, P. aeruginosa ATCC 27853 and A. baumannii was performed by disk diffusion. The serum bactericidal activity against E. coli ATCC 25922 was performed by Serum Bactericidal Titre., Results: The average inhibition zone diameter of the serum samples from the subjects while receiving Mero against each tested organisms was < 1 mm smaller than that while receiving Meronem and such difference was not significantly different. All serum samples taken at 30 minutes after initiating Meronem and Mero had bactericidal titres against E. coli ATCC 25922 > or = 1:256. Only 3 serum samples taken from the subjects while receiving Mero at 8 hours had less bactericidal titre for 1-fold dilution when compared with that of Meronem., Conclusion: The sera from healthy volunteers receiving Meronem and Mero had microbiological equivalence in terms of serum bacteriostatic and bactericidal activities.

In vitro killing activity of peracetic acid (Perasafe) at a concentration of 0.26 per cent w/v was tested against Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, Salmonella paratyphi A, Acinetobacter baumannii, Sternotrophomonas maltophilia, Enterococcus faecium, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus (MRSA), Bacillus subtilis spore, Mycobacterium tuberculosis and human immuno-deficiency virus type I. Exposure to Peracetic acid (0.26% w/v) for 10 minutes resulted in massive killing of all the aforementioned organisms and spore.

Background: Cellulitis is a common infection at our center. Broad-spectrum antibiotic or antibiotic combination is often prescribed for most adult patients with cellulitis. A contributing factor to the high prevalence of broad-spectrum antibiotic or antibiotic combination for cellulitis is the lack of data specific to the epidemiology and microbiology of cellulitis in Thai patients. Objective: To determine the characteristics of patients with cellulitis, the prevalence of causative bacteria and their antibiotic susceptibility, antibiotic treatment, and clinical outcomes of cellulitis in adult patients at Siriraj Hospital. Materials and Methods: The retrospective study included patients aged 18 years and older with a diagnosis of cellulitis who received medical care at Siriraj Hospital between June and December 2016. Collected data included demographic information, underlying conditions, type(s) of infection, location(s) of cellulitis, clinical features of cellulitis, culture and antibiotic susceptibility results, antibiotic prescriptions, and clinical outcomes of cellulitis. Results: Of the 970 adult cellulitis patients included, 20.6% were hospitalized and 79.4% were outpatients. The mean age of patients was 60.6±18.5 years, 75.4% had at least one underlying illness, and 55% were females. Eighty-six percent of patients had community-acquired infection. Amoxicillin-clavulanate, dicloxacillin, ceftriaxone plus clindamycin, and ceftriaxone alone were the most commonly prescribed antibiotics. Ninety-seven percent of patients had a favorable clinical outcome. The overall mortality rate was 2.0%, and the cellulitis-related mortality rate was 0.3%. Hospitalized patients had a significantly lower proportion of favorable clinical outcome than ambulatory patients. The most commonly isolated bacteria (73.7%) were Grampositive bacteria (beta-hemolytic streptococci or Staphylococcus aureus). Antibiotic combination therapy was significantly more prevalent among hospitalized patients. Patients who received antibiotic combination had a significantly less favorable outcome than those who received monotherapy. Conclusion: Seventy-seven percent of adult patients with cellulitis at Siriraj Hospital received broad-spectrum antibiotic or antibiotic combination despite the most commonly isolated bacteria being beta-hemolytic streptococci and methicillin-susceptible S. aureus (MSSA), both of which are normally treatable with a simple narrow-spectrum antibiotic. Mortality and complication rates in cellulitis were very low. Appropriate antibiotic treatment of cellulitis at Siriraj Hospital should be encouraged. [ABSTRACT FROM AUTHOR]