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The present study examined the treatment outcomes and factors related to mortality in patients with Enterobacter spp., Serratia spp., Citrobacter spp., Providencia spp., I-indole-positive Proteus spp., and Morganella spp. (ESCPIM) bloodstream infections and determined the susceptibility of ESCPIM pathogens to antimicrobial compounds. This retrospective study was performed at a university hospital in Thailand, using records from March 2017 to December 2018. Fifty-six patients with ESCPIM bacteremia were included. Approximately, half the patient cohort (55.4%) was infected with Enterobacter spp. The in-hospital mortality rate was 23.2%. Of the 56 patients studied, 20 patients (35.7%) had received a carbapenem treatment regimen, whereas 36 patients (64.3%) were treated with non-carbapenem regimens. The mortality rates in the carbapenem and non-carbapenem treatment regimens were 30% and 19.4%, respectively, although this difference was not statistically significant. In multivariate analysis of factors related to treatment outcome, only mechanical ventilator use and intensive care unit (ICU) admission significantly predicted 30-day mortality. Piperacillin/tazobactam, carbapenems, and aminoglycosides were the antimicrobial agents with most activity against the ESCPIM isolates assayed in the present study. In conclusion, patients with ESCPIM septicemia showed an in-hospital mortality rate of approximately one in four. Mechanical ventilator use and ICU admission were significant predictors of mortality. Thus, these critical conditions have to be concerned to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Immune reconstitution inflammatory syndrome (IRIS) is a common complication following the initiation of antiretroviral therapy (ART). The most commonly associated pathogens include Mycobacterium tuberculosis and Cryptococcus spp.[1] IRIS following nontuberculosis mycobacteria (NTM) infection is uncommon, particularly, IRIS following NTM conjunctivitis.[2] Herein, we present a case of Mycobacterium scrofulaceum conjunctivitis with peripheral ulcerative keratitis and orbital cellulitis in a 45-year-old patient with AIDS who developed IRIS 1 month after starting ART therapy. A combination of both systemic and topical antibiotics together with corticosteroids were used and resulted in a satisfactory outcome with no early recurrence. This case demonstrated a rare ocular IRIS manifestation involving both the external eye and orbit and to the author's knowledge is the first case in the literature in which M. scrofulaceum has been found to be involved in the eye. [ABSTRACT FROM AUTHOR]

Background: Acinetobacter baumannii has been recognized as a cause of nosocomial infection. To date, polymyxins, the last-resort therapeutic agents for carbapenem-resistant A. baumannii (CRAB). Thus, the small number of effective antibiotic options against CRAB represents a challenge to human health. This study examined the appropriate dosage regimens of colistin alone or in combination with sulbactam or fosfomycin using Monte Carlo simulation with the aims of improving efficacy and reducing the risk of nephrotoxicity. Materials and Methods: Clinical CRAB isolates were obtained from patients admitted to Phramongkutklao Hospital in 2014 and 2015. The minimum inhibitory concentration (MIC) of colistin for each CRAB isolate was determined using the broth dilution method, whereas those of sulbactam and fosfomycin were determined using the agar dilution method. Each drug regimen was simulated using the Monte Carlo technique to calculate the probability of target attainment (PTA) and the cumulative fraction of response (CFR). Nephrotoxicity based on RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria was indicated by colistin trough concentration exceeding ≥3.3 µg/mL. Results: A total of 50 CRAB isolates were included. The MIC50 and MIC90 were 64 and 128 µg/mL, respectively, for sulbactam, 256 and 2,048 µg/mL, respectively, for fosfomycin, and 1 and 4 µg/mL, respectively, for colistin. In patients with creatinine clearance of 91 – 130 m/min, the dosing regimens of 180 mg every 12 h and 150 mg every 8 h achieved ≥ 90% of target of the area under the free drug plasma concentration–time curve from 0 to 24 hr (fAUC24)/MIC ≥25 against isolates MICs of ≤0.25 and ≤0.5 µg/mL, respectively, and their rates of colistin trough concentration more than ≥3.3 µg/mL were 35 and 54%, respectively. Colistin combined with sulbactam or fosfomycin decreased the colistin MIC of CRAB isolates from 1 – 16 µg/mL to 0.0625 – 1 and 0.0625 – 2 µg/mL, respectively. Based on CFR ≥ 90%, no colistin monotherapy regimens in patients with creatinine clearance of 91 – 130 mL/min were effective against all of the studied CRAB isolates. For improving efficacy and reducing the risk of nephrotoxicity, colistin 150 mg given every 12 h together with sulbactam (≥6 g/day) or fosfomycin (≥18 g/day) was effective in patients with creatinine clearance of 91 – 130 mL/min. Additionally, both colistin combination regimens were effective against five colistin-resistant A. baumannii isolates. Conclusion: Colistin monotherapy at the maximum recommended dose might not cover some CRAB isolates. Colistin combination therapy appears appropriate for achieving the pharmacokinetic/pharmacodynamic targets of CRAB treatment. [ABSTRACT FROM AUTHOR]

Objective: To study the minimum inhibitory concentration (MIC) of sulbactam against carbapenem-resistant Acinetobacter baumannii (CR-AB) and to determine the dosage regimens reaching target time of free drug concentration remaining above the MIC (fT >MIC). Methods: Clinical isolates of CR-AB from patients admitted to Phramongkutklao Hospital, Thailand from January 2014 to December 2015 were obtained. The MIC of sulbactam for each CR-AB isolate was determined using the agar dilution method. Each sulbactam regimen was simulated using the Monte Carlo technique to calculate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) in critically ill patients. PTA was defined by how likely a specific drug dose was to reach 40%and 60% fT >MIC. The CFR was the probability of drug dose covering the MIC range of CR-AB. Dosing regimens reaching above 80%of PTA and CFR, were considered as the optimal dosage for documented and empirical therapy, respectively. Results: A total of 118 CR-AB isolates were included in the study. The percentile at the fiftieth and ninetieth MIC of sulbactam were 64 and 192 µg/mL, respectively. For a MIC of sulbactam of 4 µg/mL, all dosage regimens achieved PTA target. However, only a sulbactam dosage of 12 g intravenous daily using 2-4 h infusion or continuous infusion that covered for isolates with a sulbactam MIC of 96 µg/mL, met the PTA or CFR targets. Conclusions: The MIC of sulbactam against CR-AB is quite high. The sulbactam dose of 12 g/day using prolonged infusion was required to achieve the target fT >MIC for CR-AB treatment. [ABSTRACT FROM AUTHOR]

Objective: To determine in vitro activity of sitafloxacin compared with other antibiotics against the bacteria isolated from Thai patients with urinary tract infections and those with lower respiratory tract infections. Material and Method: One thousand one hundred thirty six clinical isolates of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus isolated from different Thai patients with urinary tract infections or lower respiratory tract infections in 2016 were included. The minimum inhibitory concentrations (MICs) of sitafloxacin, ciprofloxacin, levofloxacin, amoxicillin-clavulanate, ceftriaxone, ceftazidime, piperacillin-tazobactam, tigecycline, imipenem, meropenem, and colistin 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 and ciprofloxacin. Sitafloxacin was more active than levofloxacin, ciprofloxacin, amoxicillin-clavulanate, ceftriaxone, and ceftazidime, but it was less active than piperacillin-tazobactam, tigecycline, imipenem, meropenem, and colistin against extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates. Sitafloxacin was more active than levofloxacin, ciprofloxacin, amoxicillin-clavulanate, ceftriaxone, and ceftazidime against ESBL-producing K. pneumoniae. The activity of sitafloxacin against ESBL-producing K. pneumoniae was comparable to piperacillin-tazobactam, but it was less active than tigecycline, imipenem, meropenem, and colistin. Sitafloxacin was more active than levofloxacin, ciprofloxacin, ceftazidime, piperacillin-tazobactam, imipenem, and meropenem, but it was less active than colistin against A. baumannii isolates. The activity of sitafloxacin against P. aeruginosa isolates was comparable to levofloxacin, ciprofloxacin, ceftazidime, piperacillin-tazobactam, imipenem, and meropenem, but it was less active than colistin. The in vitro activity of sitafloxacin against methicillin-resistant S. aureus (MRSA) isolates was more than levofloxacin, but it was less than vancomycin. The activities of sitafloxacin against tested bacteria isolated from the patients in 2016 were not significantly different from those isolated in 2010. Conclusion: Sitafloxacin remains active against the common antibiotic-resistant bacteria causing urinary tract infections and lower respiratory tract infections in Thai patients isolated in 2016, including ESBL-producing E. coli, ESBL-producing K. pneumoniae, A. baumannii, P. aeruginosa, and S. aureus, after its use in Thailand for five years. [ABSTRACT FROM AUTHOR]

Purpose: HIV treatment involves antiretroviral therapy (ART) endeavoring to suppress viral load to an undetectable level. Virologic failure occurs when ART fails to suppress and sustain an individual's viral load to less than 200 copies/mL after 6 months of therapy. In Thailand, the data among first-line antiretroviral regimen failure and determinants remains limited, especially in urban HIV clinics. We aimed to demonstrate factors of first-line antiretroviral regimen failures in an urban HIV/AIDS clinic at Phramongkutklao Hospital., Patients and Methods: A nested case control 1:4 study was conducted. Data were collected from the electronic patient database among naïve people living with HIV/AIDS (PLWHA), aged ≥18 years and receiving ART continuously for at least 2 years at Phramongkutklao Hospital from 1 January 2000 to 31 December 2019. Multiple logistic regression was used to identify the determinants of virologic failure. Adjusted HRs (AHRs) with 95% CIs were used to declare statistical significance., Results: Of 200 PLWHA included in the study, 40 participants experienced HIV virologic failure. The median time after starting ART to virologic failure was 24 months (IQR 7-96.0). Univariate and multivariate analysis showed significant factors affecting first-line antiretroviral regimen failure included being female (37.5 vs 26.88%, adjusted odds ratio 5.08 [1.05-24.6, p-value 0.043], age ≤40 yr. (62.5 vs 49.6%, adjusted odds ratio 4.59 [1.47-14.37], p-value 0.009), CD4+count ≤200 cell/µL (77.5 vs 52.5%, adjusted odds ratio 4.83 [1.28-18.9], p value 0.02), tuberculosis (42.5 vs 7.5%, adjusted odds ratio 8.66 [2.37-31.56], p value <0.001) and initiation of ART at CD4+ count <350 cell/µL (72.5 vs 48.13%, adjusted odds ratio 31.36 [6.51-151.22], p value <0.001). Estimated prevalence of virologic failure in Phramongkutklao Hospital was 5.34%., Conclusion: Our study revealed factors favoring virologic failure included being female, younger age, CD4+ count <200 cells/µL, tuberculosis and initiation of ART at CD4+ count <350 cell/µL. Multidisciplinary HIV comprehensive care teams should encourage patient adherence and support patients along HIV continuum of care to prevent virologic failure and drug resistance, especially among patients initiating ART at low CD4+ count and tuberculosis co-infection., Competing Interests: The authors declare they have no existing or potential conflict of interest relevant to this work., (© 2021 Nasomsong et al.)

Most cases of severe malaria are caused by infection of Plasmodiumfalciparum. However severe manifestations in the infection of P. knowlesi and P. vivax have been reported in recentyears. The present study reported a 24-year-old Thai male presenting with acute fever and shock. Both blood smears and PCR were positive for P. vivax. He was treated with intravenous artesunate for 3 days in combination with oral mefloquine for 2 days and oral primaquine for 14 days. He was dischargedfrom hospital without any sequelae.