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By analysing three case studies--Singapore, Cambodia and Myanmar--this article investigates health security partnerships formed by Southeast Asian countries during the COVID-19 pandemic, focusing on their responses to China and India's vaccine diplomacy. It argues that a combination of factors--the capability of national governments in responding to the pandemic and the cost of doing so, as well as the credibility of vaccines and geopolitical relationships with potential partners--led to a divergence in partnerships. Singapore did not rely on Chinese vaccine donations but its acceptance of assistance from China was a diplomatic move to maintain a balanced policy amidst the United States-China strategic rivalry. In contrast, Cambodia and Myanmar were obliged to partner with either China or India due to their limited capacity to manage the crisis as well as their lack of financial resources and access to top-tier vaccines. Geopolitics also played a role. China became a leading partner for Cambodia due to the strong strategic relationship they had formed before the pandemic, while the governments of Myanmar--before and after the military coup in February 2021--based their partnerships on varying political and geopolitical considerations. Keywords: COVID-19, vaccine diplomacy, Singapore, Cambodia, Myanmar., By the end of 2022, Southeast Asia had reported more than 35 million confirmed cases of COVID-19 and 360,000 related deaths. (1) Stringent lockdowns resulted in severe economic downturns, affecting [...]

The coronavirus pandemic has been raging across the globe for more than two years, claiming over 6 million lives and severely upending daily routines. It is no wonder that the production and distribution of COVID-19 vaccines, known as the most effective and widespread tool in the fight against this sad chapter in recent history, has become an essential element of international politics. Both the race for geopolitical leverage and the emerging health technologies have affected Ankara, which has been seeking its niche in the post-COVID-19 international system. Though its Sputnik V vaccine deal with Russia casted doubt on Turkiye's intentions as part of the Euro-Atlantic common front, the country has emerged as a generous humanitarian aid provider and secured its place among a handful of nations who can boast homegrown SARS-CoV-2 vaccines. This article uses the soft power theoretical framework to analyze Turkiye's vaccine diplomacy and its role in the country's efforts to maintain and boost its stakes in the global power configuration. Keywords: Turkiye, COVID-19, Vaccine Diplomacy, Soft Power, Introduction The COVID-19 pandemic has become the 5th documented one since the 1918 Spanish flu, the most severe influenza outbreak of the 20th century. First discovered in the Chinese city [...]

Bloodstream infection (BSI) is defined by positive blood cultures in a patient with systemic signs of infection and may be either secondary to a documented source or primary-that is, without identified origin. Community-acquired BSIs in immunocompetent adults usually involve drug-susceptible bacteria, while healthcare-associated BSIs are frequently due to multidrug-resistant (MDR) strains. Early adequate antimicrobial therapy is a key to improve patient outcomes, especially in those with criteria for sepsis or septic shock, and should be based on guidelines and direct examination of available samples. Local epidemiology, suspected source, immune status, previous antimicrobial exposure, and documented colonization with MDR bacteria must be considered for the choice of first-line antimicrobials in healthcare-associated and hospital-acquired BSIs. Early genotypic or phenotypic tests are now available for bacterial identification and early detection of resistance mechanisms and may help, though their clinical impact warrants further investigations. Initial antimicrobial dosing should take into account the pharmacokinetic alterations commonly observed in ICU patients, with a loading dose in case of sepsis or septic shock. Initial antimicrobial combination attempting to increase the antimicrobial spectrum should be discussed when MDR bacteria are suspected and/or in the most severely ill patients. Source identification and control should be performed as soon as the hemodynamic status is stabilized. De-escalation from a broad-spectrum to a narrow-spectrum antimicrobial may reduce antibiotic selection pressure without negative impact on mortality. The duration of therapy is usually 5-8 days though longer durations may be discussed depending on the underlying illness and the source of infection. This narrative review covers the epidemiology, diagnostic workflow and therapeutic aspects of BSI in ICU patients and proposed up-to-date expert statements., Author(s): Jean-François Timsit [sup.1] [sup.2], Etienne Ruppé [sup.2] [sup.3], François Barbier [sup.4], Alexis Tabah [sup.5], Matteo Bassetti [sup.6] Author Affiliations: (1) AP-HP, Hôpital Bichat, Medical and Infectious Diseases ICU, , [...]

The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting., Author(s): Jean-François Timsit [sup.1] [sup.2], Matteo Bassetti [sup.3], Olaf Cremer [sup.4], George Daikos [sup.5], Jan de Waele [sup.6], Andre Kallil [sup.7], Eric Kipnis [sup.8], Marin Kollef [sup.9], Kevin Laupland [sup.10], [...]