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Warangkhana Wanla,1 Wasan Katip,2,3 Sakon Supakul,2 Porntipa Apiwatnakorn,4 Sompong Khamsarn1 1Department of Pharmacy, Lamphun Hospital, Lamphun, Thailand; 2Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 3Pharmaceutical Care Training Center (PCTC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; 4Department of Internal Medicine, Lamphun Hospital, Thailand Background: Gram-negative bacteria are becoming increasingly resistant to carbapenems and are related to the use of carbapenems. Thus, the main objective of this study was to compare the appropriateness of prescribing carbapenem before and after using an antimicrobial restriction system without infectious diseases consultation. Materials and methods: A retrospective cross-sectional before and after study was conducted in Lamphun Hospital to limit the prescription of carbapenems. Data were obtained by a review of the medical records and electronic databases from the period September 2014 to January 2015 (before) and from September 2015 to January 2016 (after). Results: A total of 360 antibacterial prescriptions were analyzed. The appropriateness of prescribing was higher after using the antimicrobial restriction (55.0%) than before using the antimicrobial restriction system (38.3%; p=0.001). The amount of carbapenem in the defined daily dose per 1,000 bed days increased by 3.48% after using the antimicrobial restriction system when compared with before using the antimicrobial restriction system, which was not statistically significant (p=0.611). The incidence rates of nosocomial infections caused by resistance of Enterobacteriaceae to ertapenem before and after the intervention to limit antimicrobial therapy was found to have decreased from 4.80 to 0.95 infections per 1,000 patient days, respectively (p=1.00). The expenditure for carbapenems in the average value of baht per patient was found to have decreased by 36.33% after using the antimicrobial restriction system when compared with before using the antimicrobial restriction system (p=0.001). Conclusion: These results suggest that antimicrobial restriction systems can increase the appropriateness of prescribing antibiotics. The expenditure for carbapenem was found to decrease after using the antimicrobial restriction system when compared with before using the antimicrobial restriction system, even without infectious diseases consultation. However, the amount of carbapenem in the defined daily dose per 1,000 bed days was not found to reduce after using the antimicrobial restriction system. Keywords: antimicrobial restriction system, appropriate prescribing, carbapenem use, DDD

Objective: To generate epidemiological information regarding antibiotic use and antimicrobial resistance (AMR) in targeted communities for use by the Thailand AMR Containment and Prevention Program., Material and Method: A survey of antibiotics sold by 215 grocery stores and retail shops located in the target communities was done by the local people who were instructed to purchase specified antibiotics and to present to such stores and shops with symptoms of sore throat, backache, common cold, acute diarrhea, inflamed uterus, and dysuria. The purchased drugs were then identified and recorded. Contamination of extended-spectrum β-lactamase (ESBL)-producing E. coli was identified in 174 samples of foods and open water sources collected from the target communities. Carriage of ESBL-producing E. coli in gastrointestinal tracts of 534 adults living in the target communities was performed by stool sample culture. One thousand three hundred one patients with upper respiratory infection (URI) and 235 patients with acute diarrhea who attended the tambon health promoting hospitals located in the target communities were monitored for their clinical outcomes of treatments. The patients with URI and acute diarrhea with no indication of antibiotic received symptomatic treatments as appropriate and they were followed via telephone contact every few days until all symptoms related to URI and acute diarrhea disappeared. The data were analyzed by descriptive statistics., Results: Antibiotics were sold to the local people who were presenting with common ailments at many grocery stores and retail shops in their respective communities. In almost all cases, antibiotics were inappropriately given. Overall prevalence of ESBL-producing E. coli contamination in foods and open water sources was 26.4%. ESBL-producing E. coli was isolated from fresh meat and open water sources in many samples. Overall prevalence of ESBL-producing E. coli carriage in gastrointestinal tracts of the adults cultured was 66.5%. All patients with URI and acute diarrhea who had no indication of antibiotics and did not receive antibiotics had either cure or favorable response within seven days of start of symptomatic treatment., Conclusion: Antibiotics are widely available and are inappropriately sold and given by grocery stores and retail shops located within local communities in Thailand. Antibiotic-resistant bacteria commonly and freely circulate within the community. Patients with URI and acute diarrhea with no indication for antibiotic therapy can be treated without antibiotics. Findings and observations from this study will be used as part of a social marketing campaign on prevention and containment of AMR to educate people living within communities in Thailand.

Background: Respiratory infections have long been recognized as a primary cause of acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). Additionally, the emergence of antimicrobial resistance has led to an urgent and critical situation in developing countries, including Vietnam. This study aimed to investigate the distribution and antimicrobial resistance of bacteria in patients with AE-COPD using both conventional culture and multiplex real-time PCR. Additionally, associations between clinical characteristics and indicators of pneumonia in these patients were examined. Methods: This cross-sectional prospective study included 92 AE-COPD patients with pneumonia and 46 without pneumonia. Sputum specimens were cultured and examined for bacterial identification, and antimicrobial susceptibility was determined for each isolate. Multiplex real-time PCR was also performed to detect ten bacteria and seven viruses. Results: The detection rates of pathogens in AE-COPD patients with pneumonia were 92.39%, compared to 86.96% in those without pneumonia. A total of 26 pathogenic species were identified, showing no significant difference in distribution between the two groups. The predominant bacteria included Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae, followed by Acinetobacter baumannii and Streptococcus mitis. There was a slight difference in antibiotic resistance between bacteria isolated from two groups. The frequency of H. influenzae was notably greater in AE-COPD patients who experienced respiratory failure (21.92%) than in those who did not (9.23%). S. pneumoniae was more common in patients with stage I (44.44%) or IV (36.36%) COPD than in patients with stage II (17.39%) or III (9.72%) disease. ROC curve analysis revealed that C-reactive protein (CRP) levels could distinguish patients with AE-COPD with and without pneumonia (AUC = 0.78). Conclusion: Gram-negative bacteria still play a key role in the etiology of AE-COPD patients, regardless of the presence of pneumonia. This study provides updated evidence for the epidemiology of AE-COPD pathogens and the appropriate selection of antimicrobial agents in Vietnam. [ABSTRACT FROM AUTHOR]

Background: Hospital wastewater (HWW) promotes the spread of carbapenem resistance genes (CRGs). Aeromonas carry a large number of CRGs in HWW, they may play a role as a suitable reservoir for CRGs, while resistomes in HWW are still poorly characterized regarding carbapenem resistant Aeromonas. Thus, the aim of the study was to evaluate the molecular epidemiological characteristics of carbapenem resistant Aeromonas in HWW. Methods: A total of 33 carbapenem resistant Aeromonas were isolated from HWW. Antimicrobial susceptibility testing and polymerase chain reaction (PCR) were used to assess the antimicrobial resistance profiles. Molecular typing was performed using enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) and multilocus sequence typing (MLST). The horizontal transmission mode of blaKPC was explored through conjugation and transformation experiments. The stability of blaKPC-IncP-6 plasmids was assessed through plasmid stability and in vitro competition test. The PCR mapping method was used to investigate the structural diversity of blaKPC. Results: The detection rates of blaKPC and cphA in Aeromonas were 97.0% and 39.4% respectively. Aeromonas caviae were grouped into 13 clusters by ERIC-PCR and 12 STs by MLST. Aeromonas veronii were grouped into 11 clusters by ERIC-PCR and 4 STs by MLST. 56.3% blaKPC were located on mobilizable IncP-6 plasmids. blaKPC-IncP-6 plasmid showed high stability and low cost fitness. Conclusion: Carbapenem resistant Aeromonas from HWW mainly carried blaKPC, which exhibited great structural diversity. Aeromonas might serve as reservoirs for blaKPC and blaKPC might spread mainly through transformation in HWW. [ABSTRACT FROM AUTHOR]

We investigated the virulence gene expression of carbapenem-resistant Acinetobacter baumanii (CRAB) isolated from the respiratory samples of patients with CRAB pneumonia and those with CRAB colonization to identify the virulence genes contributing to CRAB pneumonia's development and mortality. Patients with CRAB identified from respiratory specimens were screened at a tertiary university hospital between January 2018 and January 2019. Patients were classified into CRAB pneumonia or CRAB colonization groups according to predefined clinical criteria. A. baumannii isolated from respiratory specimens was examined for the expression levels of ompA, uspA, hfq, hisF, feoA, and bfnL by quantitative reverse-transcription polymerase chain reaction. Among 156 patients with CRAB from respiratory specimens, 17 and 24 met the criteria for inclusion in the pneumonia and colonization groups, respectively. The expression level of ompA was significantly higher in the pneumonia group than in the colonization group (1.45 vs. 0.63, P = 0.03). The expression levels of ompA (1.97 vs. 0.86, P = 0.02), hisF (1.06 vs. 0.10, P < 0.01), uspA (1.62 vs. 1.01, P < 0.01), and bfnL (3.14 vs. 2.14, P = 0.03) were significantly higher in patients with 30-day mortality than in the surviving patients. Elevated expression of hisF (adjusted odds ratio = 5.93, P = 0.03) and uspA (adjusted odds ratio = 7.36, P = 0.02) were associated with 30-day mortality after adjusting for age and the Charlson score. uspA and hisF may serve as putative targets for novel therapeutic strategies. [ABSTRACT FROM AUTHOR]

Objective of this study was to determine the most prevalent infections among hospitalized patients (both community-acquired and hospital-acquired), the antibiotics prescribing pattern, and their relationship with patient characteristics like age and gender. Methods: A retrospective study was conducted comprising 2646 patients with infectious diseases or complications admitted to a tertiary hospital in the Hail region of Saudi Arabia. A standardized form was used to collect information from patient's medical records. Demographic data such as age, gender, prescribed antibiotics, and culture-sensitivity tests were included in the study. Results: Males represented about two-thirds (66.5%, n = 1760) of the patients. Most patients (45.9%) who suffered from infectious diseases were between the ages of 20 and 39. The most prevalent infectious ailment was respiratory tract infection (17.65%, n = 467). Furthermore, the most common multiple infectious diseases were gallbladder calculi with cholecystitis (40.3%, n = 69). Similarly, COVID-19 had the greatest impact on people over 60. Beta-lactam antibiotics were the most commonly prescribed (37.6%), followed by fluoroquinolones (26.26%) and macrolides (13.45%). But performing culture sensitivity tests were rather uncommon (3.8%, n = 101). For multiple infections, beta-lactam antibiotics (such as amoxicillin and cefuroxime) were the most commonly prescribed antibiotics (2.26%, n = 60), followed by macrolides (such as azithromycin and Clindamycin) and fluoroquinolones (eg, ciprofloxacin and levofloxacin). Conclusion: Respiratory tract infections are the most prevalent infectious disease among hospital patients, who are primarily in their 20s. The frequency of performing culture tests is low. Therefore, it is important to promote culture sensitivity testing in order to support the prudent use of antibiotics. Guidelines for anti-microbial stewardship programs are also highly recommended. [ABSTRACT FROM AUTHOR]

Background: OXA-48-like carbapenemases have been found in a growing and varied number of carbapenemase-producing Enterobacteriaceae (CPE) isolates, and they are spreading to several countries. Although this oxacillinase leads to weak resistance to carbapenems without affecting broad-spectrum cephalosporin activity, when they are associated with other resistance mechanisms, the level of resistance to these antibiotics may be significantly higher. This weak resistance against carbapenems and cephalosporins, along with the absence of other resistance mechanisms, could render OXA-48-like harboring isolates undetected in the laboratory routine. In addition, the lack of a specific screening test for this enzyme complicates the detection of these isolates. This report characterizes the first isolates of OXA-48-like CPE detected in our laboratory. Materials and Methods: The study was carried out at the Instituto Nacional de Enfermedades Neoplasicas, Lima - Peru, between March and December 2021. OXA-48-like CPE isolates were detected as part of the routine microbiological study, and clinical data were obtained by reviewing medical records. The automated microbiological system provides the bacterial identification and antimicrobial susceptibility profile by the dilution method. Additionally, the column chromatography test is used to detect carbapenemase enzymes, including OXA48-like. Finally, the molecular identification of the OXA-48-like enzyme was carried out by Polymerase Chain Reaction PCR amplification for the blaOXA-48-like. Results: Seven OXA-48-like CPE strains were isolated. Notably, in all cases, the automated system issued a minimum inhibitory concentration (MIC) of ≥1 ug/mL for ertapenem and a MIC of >64/4 ug/mL for piperacillin/tazobactam. In addition, resistance category to imipenem and meropenem was found (2/7), at least one indeterminate category for any of these carbapenems (5/7), and other serine β-lactamases such as Extended-spectrum beta-lactamases (3/7) and AmpC (3/7). The immunochromatographic study confirmed the presence of the OXA-48-like enzyme in all isolates, while class A and class B were ruled out for them. Finally, the multiplex PCR, for the five isolates that could be recovered, showed amplification for carbapenemase OXA-48-like, while none of the other carpabemases was amplified for class A or class B carbapenemase genes. Conclusion: We confirm the emergence of OXA-48-like CPE isolates in our cancer center and highlight the need to implement surveillance and detection measures of these strains, for controlling their dissemination. We found practical and inexpensive methodologies for the detection of OXA-48-like CPE: (1) the finding of resistance to ertapenem and piperacillin/ tazobactam in the antibiogram in the absence of class A and B carbapenemases, for screening and (2) immunochromatographic study, for confirmation. [ABSTRACT FROM AUTHOR]

Introduction: The risk factors and clinical impact of carbapenem-resistant Enterobacterales (CRE) coinfection among hospitalized patients with Clostridioides difficile infection (CDI) were analyzed in this study. Materials and Methods: A clinical study was performed at the medical wards of Tainan Hospital, Ministry of Health and Welfare in southern Taiwan. Patients with CDI between January 2013 and April 2020 were included. Results: Among 238 patients included for analysis, 22 (9.2%) patients developed CRE coinfections within 14 days before or after the onset of CDI. CDI patients with CRE coinfection had longer hospitalization stays (103.0 ± 97.0 days vs 42.5 ± 109.6 days, P = 0.01) than those without CRE coinfection. In the multivariate analysis, age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01– 1.10, P = 0.02) was independently associated with CRE coinfection. In contrast, underlying old stroke (OR 0.15, 95% CI 0.03– 0.70, P = 0.02) was negatively linked to CRE coinfection. Conclusion: Among patients with CDI, CRE coinfections were associated with prolonged hospitalization for CDI. Age was an independent risk factor for CRE coinfection among patients with CDI. [ABSTRACT FROM AUTHOR]

Purpose: The increasing multi-drug carbapenem resistance among Enterobacterales are a severe health problem limiting therapeutic options and worsen the prognosis. This study characterizes carbapenemase genes and integrons among uropathogenic carbapenem resistant Enterobacterales (CRE) isolates recovered from Mansoura University Hospitals and evaluates the effect of colistin, fosfomycin and meropenem-vaborbactam on these isolates. Patients and Methods: A total of 200 Enterobacterales isolates were collected from patients with urinary tract infections. Antimicrobial susceptibility testing was performed by the disc diffusion method. Colistin susceptibility was tested using the broth microdilution method and fosfomycin and meropenem/vaborbactam susceptibility were tested by MIC Test Strips. Carbapenem resistant isolates were screened for carbapenemase activity phenotypically using the modified carbapenem inactivation method and EDTA-modified carbapenem inactivation method and genotypically by multiplex PCR. Integrons class 1 and 2 and fosA gene were assayed by PCR. Data were statistically analyzed using the Statistical Package for Social Sciences (SPSS) version 16. The Chi-square or Fisher's exact test was used to compare groups, as appropriate. Results: Ninety-two Enterobacterales isolates were resistant to meropenem (46%); 52 E. coli and 40 K. pneumoniae strains. All CRE isolates were multi-drug resistant (MDR). Sensitivity of CRE isolates to colistin, fosfomycin and meropenem/vaborbactam were 67.4%, 82.6% and 58.7%, respectively. Carbapenemase genes were detected by multiplex PCR in 69.6% of CRE isolates (Carbapenemase producing Enterobacterales (CPE) mainly blaNDM (37%). CPE isolates were significantly more resistant to meropenem/vaborbactam than non-CPE isolates; 51.6% vs 17.8%, respectively (P = 0.003) especially blaNDM carrying isolates (70.6%). Class 1 integrons and fosA gene were detected in 91.3% and 11.9% of CRE isolates, respectively. Conclusion: This study revealed that about half of the uropathogenic Enterobacterales isolates were MDR CRE. Carbapenemase gene blaNDM was the main gene among CRE isolates. Meropenem/vaborbactam sensitivity was significantly higher on non-CPE than CPE isolates and limited by the predominance of blaNDM. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is becoming a global issue, with estimated 2.8 million people in the United States developing antibiotic-resistant diseases each year. The carriage of ESBL and Carbapenemase-producing Enterobacteriaceae among hospitalized patients is a threat to the future of antibiotic treatment. Objective: Multi-drug resistance profile, prevalence of extended-spectrum beta-lactamase and Carbapenemase-producing Gram-negative bacilli among admitted patients after surgery with suspected surgical site nosocomial infection north east Ethiopia. Material and Methods: A hospital-based cross-sectional study was conducted from April 2021 to February 2022. Socio-demographic and clinical data were assessed using a structured questionnaire. A total of 384 relevant clinical samples (pus, pus aspirates, and wound swabs) were collected aseptically and processed within 30 min by placing the swabs into the sterile test tubes having 0.5 mL of sterile normal saline. The samples were cultured on MacConkey agar, chocolate agar and blood agar, and species identification was done using standard biochemical tests. Disk diffusion antimicrobial sensitivity test was done on Mueller–Hinton agar. All the cefoxitin resistant Enterobacteriaceae isolates were checked for the presence of AmpC beta-lactamase using four cartridges of disk diffusion tablets. ESBL output validation was conducted by the combination disk test. The production of Carbapenemase was checked using modified carbapenem inactivation method. Results: The prevalence of significant bacterial nosocomial infection among surgical site infection 343 (89.32%). S. aureus 125 (36.4%) was predominant followed by E. coli 80 (23.3%) P. aeruginosa 31 (9.03%). The overall MDR rate of isolated bacteria was 251 (73.3%). About 150 (73.9%) bacteria were suspected for ESBL production and 67 (33%) AmpC beta-lactamase and 27 (13.3%) Carbapenemase-producing Gram-negative bacterial, respectively. Conclusions and Recommendations: The severity of ESBL-PE was critical, and the CPE was alarming. Meropenem and imipenem were the most effective antibiotics against ESBL-producing Enterobacteriaceae. Therefore, strict infection prevention and control measures are needed. [ABSTRACT FROM AUTHOR]

Background: Carbapenem-resistant Gram-negative bacteria (CRGNB) bloodstream infection (BSI) pose a significant threat to the prognosis of hematologic malignancies (HM) patients. Understanding the distribution of pathogenic bacteria, changes in carbapenem-resistant trends, risk factors for CRGNB infections, and exploring the early detection measures can help reduce mortality. Methods: We conducted a multicenter retrospective study of Gram-negative bacteria (GNB) BSI in patients with HM in three university-affiliated hospitals in Hunan Province, China, from January 2010 to December 2020. Demographic and clinical data were collected from the hospital electronic medical records system. Results: CRGNB caused 138 (15.3%) of 902 GNB BSI. The detection rate of CRGNB increased from 6.4% in 2010– 2012 to 35.4% in 2019– 2020. The 7-day mortality rate was significantly higher in patients with CRGNB BSI than in patients with carbapenem-susceptible Gram-negative bacteria (CSGNB) BSI [31.9% (44/138) vs 9.7% (74/764), P < 0.001], and the mortality rate in patients with carbapenem-resistant non-fermenting bacteria (CRNFB) bloodstream infections was generally higher than that of carbapenem-resistant Enterobacteriaceae (CRE). Urinary catheter (OR, 2.814; CI=1.395– 5.680; P=0.004) and prior exposure to carbapenem (OR, 4.372; CI=2.881– 6.635; P< 0.001) were independent risk factors for CRGNB BSI. Analysis of co-infections showed that 50%– 85% of patients with CRGNB BSI had pulmonary infections, sputum culture results suggested that sputum culture positivity rate was as high as 57.1%– 66.7% in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) and Stenotrophomonas maltophilia BSI, and the results of antimicrobial susceptibility testing of sputum cultures were consistent with the blood cultures. Conclusion: Carbapenem resistance has dramatically increased in HM patients with GNB BSI in recent years and is associated with a worse outcome, especially for non-fermenting bacteria. In high-risk patients, early screening of the respiratory tract specimens may help to detect CRNFB colonization and protect patients from breakthrough BSI. [ABSTRACT FROM AUTHOR]

Integrated surveillance of antimicrobial resistance (AMR) using the One Health approach that includes humans, animals, food, and the environment has been recommended by responsible international organizations. The objective of this study was to determine the prevalence of AMR phenotypes in Escherichia coli and Klebsiella species isolated from humans, pigs, chickens, and wild rodents in five communities in northern Thailand. Rectal swabs from 269 pigs and 318 chickens; intestinal contents of 196 wild rodents; and stool samples from 69 pig farmers, 155 chicken farmers, and 61 non-farmers were cultured for E. coli and Klebsiella species, which were then tested for resistance to ceftriaxone, colistin, and meropenem. The prevalence of ceftriaxone-resistant E. coli and Klebsiella species in pigs, chickens, rodents, pig farmers, chicken farmers, and non-farmers was 64.3%, 12.9%, 4.1%, 55.1%, 38.7%, and 36.1%, respectively. Colistin resistance in pigs, chickens, rodents, pig farmers, chicken farmers, and non-farmers was 41.3%, 9.8%, 4.6%, 34.8%, 31.6%, and 24.6%, respectively. Meropenem resistance was not detected. The observed high prevalence of AMR, especially colistin resistance, in study food animals/humans is worrisome. Further studies to identify factors that contribute to AMR, strengthened reinforcement of existing regulations on antimicrobial use, and more appropriate interventions to minimize AMR in communities are urgently needed. [ABSTRACT FROM AUTHOR]

Sputum specimens from patient a (excluding Pa-1) and all samples from his environment formed the same cluster, while sputum specimens from patient b and isolates from his environment formed another cluster. Human-to-human transmission may be the primary route of HAIs among the Healthcare-workers (HCWs) and patients, while the contact of patients' surroundings may also contribute to the HAIs since the environment could be contaminated by patients. Keywords: carbapenem-resistant Acinetobacter baumannii; intensive care unit; whole genome sequencing; cgMLST; PFGE EN carbapenem-resistant Acinetobacter baumannii intensive care unit whole genome sequencing cgMLST PFGE 1821 1829 9 05/11/22 20220401 NES 220401 Introduction The spread of Carbapenem-resistant Organism (CRO), especially in intensive care units (ICUs), has become a serious problem and health threat worldwide.1-4 The carbapenems are antimicrobial agents with significant activity and potency against Gram-positive and Gram-negative bacteria.[5] It has been widely used in clinical studies since the first carbapenem was authorized in the United States for the treatment of microbial infections in 1985.[6] Unfortunately, since the abuse of antibiotics over the past few decades, a set of bacteria have become resistant to carbapenems. In addition, measures for patient unit with multi-drug resistant bacteria colonization/infection in this ICU were improved by enhancing the frequency of daily disinfection, air disinfection, ventilator condensate management, and avoidance of dust operations. [Extracted from the article]

Background: Antibiotic resistance is often reported and great concerned as one of public health problems especially people living with poverty in developing countries including Thailand. The hill tribe people is defined as vulnerable population for antibiotic resistance in Thailand due to poor economic and education status particularly the Lahu people who is the second greatest group of the hill tribe people in Thailand. The study aimed to estimate the prevalence, factors associated with, and typing major species of bacteria with antibiotic drugs resistance among the Lahu hill tribe people in northern Thailand.Methods: A cross-sectional study was conducted to gather the information from the participants. A validated questionnaire was used for data collection. Participants who presented an illness related to infectious diseases were eligible to participate the study and were asked to obtain specific specimen; sputum, urine or stool. Antibiotic susceptibility was tested by Kirbey Bauer's disc diffusion test. Chi-square and logistic regression were used to detect the associations between variables at the significant level of α = 0.05.Results: A total of 240 participants were recruited into the study. The majority had urinary tract infection (67.9%) with two major pathogenic species of the infection; Escherichia coli (12.8%), and Enterobacter cloacae (8.0%). The prevalence of antibiotic resistance was 16.0%. Escherichia coli and Klebsiella pneumoniae species were found to have multidrug resistance that was greater than that of other species, while ampicillin was found to have the greatest drug resistance. It was found that those who had poor knowledge of antibiotic use had a 2.56-fold greater chance (95% CI = 1.09-5.32) of having antibiotic resistance than did those who had good knowledge of antibiotic use, and those who had poor antibiotic use behaviors had a 1.79-fold greater chance (95% CI = 1.06-4.80) of having antibiotic resistance than did those who had good antibiotic use behaviors.Conclusion: Effective public health interventions are urgently needed to reduce antibiotic drug resistance among the Lahu people by improving their knowledge and skills regarding the proper use of antibiotics and eventually minimizing antibiotic resistance. Moreover, health care professionals should strictly follow the standard guideline to prescribe antibiotics. [ABSTRACT FROM AUTHOR]

Objective: To investigate the extent of antibiotic-resistant bacteria and antibiotic residue contamination in fresh raw foods sold at wholesale markets in Thailand, which may be the important drivers of antibiotic-resistant bacteria colonization and antibiotic-resistant bacterial infection in Thai population. Materials and Methods: Fresh raw foods, including food from animal products, seafoods, vegetables, fruits, and honey were purchased from two large wholesale markets in Thailand. Food samples were cultured for antibiotic-resistant bacteria and tested for the presence and amount of antibiotic residue. Results: Among 521 samples for bacterial culture, 86.9% grew at least one kind of bacteria. Enterobacteriaceae were commonly isolated and were commonly resistant to ampicillin (76.7% to 100%). ESBL-producers and ceftriaxone-resistant Enterobacteriaceae were prevalent in swine and duck samples (56.7% to 91.7%). Some isolates were resistant to co-amoxiclav (13.3% to 60.0%) and cefoxitin (5.0% to 30.0%). Coltin resistant Enterobacteriaceae were observed in pork meat (1.4%) and chicken offal (7.0%). Ertapenem-resistant Enterobacteriaceae were detected in cha-om (26.7%). Among 501 samples for antibiotic residue testing, 37.1% contained at least one antibiotic residue. Enrofloxacin was the most prevalent antibiotic residue, followed by doxycycline and tilmicosin. Although most samples contained less antibiotics than the maximum residue limit (MRL), 7.0% contained an amount of at least one antibiotic above the MRL. Conclusion: Many fresh raw foods sold at wholesale markets in Thailand were contaminated with antibiotic-resistant bacteria, and some contained antibiotic residues. Therefore, Thai people are at risk of being colonized with antibiotic-resistant bacteria and developing antibiotic-resistant bacterial infection due to consuming foods contaminated with antibiotic-resistant bacteria or containing antibiotic residues. [ABSTRACT FROM AUTHOR]

Introduction: Contamination by Staphylococcus aureus of food produced from animal sources may have diverse and multifactorial causes that depend on geographical distribution. The goal of this study was to isolate and characterise S. aureus strains from contaminated fermented pork sausage, which is a local food of northeastern Thailand. Material and Methods: S. aureus strains were isolated from local pork sausage, and the presence of classical enterotoxins was determined by PCR and reversed passive latex agglutination. These results were compared with strains derived from hospitalised patients and healthy carriers. Additionally, production of extracellular enzymes and haemolysin, biofilm formation, and antibiotic susceptibility were assessed. Results: S. aureus was identified in 36 sausage isolates (60%). The strains positive for staphylococcal enterotoxin A were more frequently found in isolates from sausage and healthy carriers than in those from patients. All tested S. aureus strains were positive for DNase, lipase, proteinase, haemolysin, and biofilm formation; notably, strains isolated from food and healthy carriers displayed similar values. Most isolates were resistant to penicillin and ampicillin, while none were to methicillin. Conclusions: Thai fermented pork sausages are associated with a high risk of staphylococcal food poisoning, which may be linked to contamination caused by carriers. Dissemination of knowledge regarding best practices in sanitation and hygiene is important in local communities. [ABSTRACT FROM AUTHOR]

Objective: To determine the microbiological activity in serum and urine of healthy subjects against extended-spectrum betalactamase (ESBL)-producing Escherichia coli compared between original brand and generic oral fosfomycin trometamol. Materials and Methods: This randomized crossover study was conducted at Siriraj Hospital. Fourteen healthy subjects with a mean age of 34.14 years received a single 3-gram dose of either original brand fosfomycin trometamol (Monurol®) or generic oral fosfomycin trometamol (Fosfomet®). After a 1-week washout, both groups were switched to the other medication and the process was repeated. Blood samples and urine samples were collected from each subject at baseline before drug administration, and then at 1, 2, 5, and 8 hours after taking the study drug. Another urine sample was collected on day 2 of the study. Inhibitory activity against ESBL-producing E. coli was evaluated by disk diffusion method, and bactericidal activity was evaluated by broth microdilution method. Results: Inhibitory activity and bactericidal activity in serum and urine samples against ESBL-producing E. coli was highest between 2 and 5 hours after administration of the study drugs. Inhibitory and bactericidal activity in serum samples were both less and shorter than those observed in urine samples. Urine samples continued to demonstrate high inhibitory and bactericidal activity at 24 hours after drug administration. There were no significant differences in inhibitory or bactericidal activities in serum or urine samples when compared between administration of original brand fosfomycin trometamol (Monurol®) and administration of generic oral fosfomycin trometamol (Fosfomet®). Mild diarrhea was the only adverse event observed, and there was no significant difference in this side effect between groups. Conclusion: Inhibitory activity, bactericidal activity, and rate of adverse events were all found to be comparable between original brand fosfomycin trometamol (Monurol®) and generic oral fosfomycin trometamol (Fosfomet®). [ABSTRACT FROM AUTHOR]

A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care. [ABSTRACT FROM AUTHOR]

The Global Antimicrobial Resistance Surveillance System (GLASS) is one of the pillars of the global action plan on antimicrobial resistance launched by the World Health Organization in 2015. This study was conducted to determine the feasibility and benefits of GLASS as a component of antimicrobial stewardship strategies in three provincial hospitals in Thailand. Data on the types of bacteria isolated and their antibiotic susceptibility during January–December 2019 and January–April 2020 were retrieved from the microbiology laboratory of each participating hospital. Laboratory-based antibiograms from 2019 and GLASS-based antibiograms from 2020 were created and compared. A total of 14,877 and 3580 bacterial isolates were obtained during January–December 2019 and January–April 2020, respectively. The common bacteria isolated in both periods were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. Hospital-acquired infection (HAI)-related bacteria were observed in 59.0%, whereas community-acquired infection (CAI)-related bacteria were observed in 41.0% of isolates. Antibiotic resistance in CAIs was high and may have been related to the misclassification of colonized bacteria as true pathogens and HAIs as CAIs. The results of this study on AMR surveillance using GLASS methodology may not be valid owing to several inadequate data collections and the problem of specimen contamination. Given these considerations, related personnel should receive additional training on the best practices in specimen collection and the management of AMR surveillance data using the GLASS approach. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a threat to achieving the United Nation's (UN) sustainable development goals (SDGs). The behavior of stakeholders has directly influenced the extent of AMR and understanding underpinning knowledge and attitudes is an important step towards understanding these behaviors. The aim of this study was to develop and validate a novel questionnaire, utilizing the theory of Appreciative Inquiry, to measure knowledge and attitudes around antibiotic resistance amongst community pharmacists throughout Thailand. A survey tool was developed using the Appreciative Inquiry theory, and was piloted in a non-probability sample of practicing community pharmacists. Descriptive and inferential statistics were applied and the tool validated, using a three-step psychometric validation process. A total of 373 community pharmacists participated in the study. The survey tool was found to be valid and reliable. The "Knowledge" domain of the survey tool showed an acceptable level of reliability (Cronbach's alpha 0.64); while the "Attitude" domain showed an excellent reliability level (Cronbach's alpha 0.84). This new survey tool has been designed to measure attitudes and knowledge of antibiotic resistance by utilizing the Discovery phase of Appreciative Inquiry theory amongst community pharmacists in Thailand. This survey tool has the potential to be used by other researchers across different settings. [ABSTRACT FROM AUTHOR]

Background Increasing awareness of and understanding about antimicrobial resistance (AMR), promoting changes in behavior, and monitoring of AMR in the community are challenging, as AMR is associated with many contributing factors that are difficult to assess individually. This study aimed to determine the effectiveness of a community-based AMR campaign for improving awareness, understanding, and behavior relating to antibiotic use and AMR in Thailand and to assess if fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae could be a proxy composite indicator of AMR in the community. Methods This study was conducted in 4 communities that are home to approximately 400 000 people. A self-administered questionnaire on awareness, understanding, and behavior relating to antibiotic use and AMR was responded to by 20 521 and 19 634 adults before and immediately after the AMR campaign, respectively, at the household level. Fecal samples were collected from 534 adults before the AMR campaign and from 709 adults at 18 months after the AMR campaign to determine presence of ESBL-producing Enterobacteriaceae. Results Awareness, understanding, and behavior relating to antibiotic use and AMR, as assessed by a self-administered questionnaire, were significantly improved after the AMR campaign. The fecal carriage rate of ESBL-producing Enterobacteriaceae decreased from 66.5% before to 44.6% after the AMR campaign (P <.01). Conclusions Our AMR campaign was effective for improving awareness, understanding, and behavior relating to antibiotic use and AMR among people in the community at the household level, and the prevalence of fecal carriage of ESBL-producing Enterobacteriaceae seemed to be decreased after the AMR campaign. Fecal carriage rate of ESBL-producing Enterobacteriaceae may be a proxy composite indicator of AMR in the community. [ABSTRACT FROM AUTHOR]

Background: Increasing bacterial resistance to antibiotics is a serious problem worldwide. We sought to record the acquisition of antibiotic-resistant Escherichia coli (E. coli) in healthy infants in Northern Thailand and investigated potential determinants. Methods: Stool samples from 142 infants after birth, at ages 2wk, 2mo, 4 to 6mo, and 1y, and parent stool samples were screened for E. coli resistance to tetracycline, ampicillin, co-trimoxazole, and cefazoline by culture, and isolates were further investigated for multiresistance by disc diffusion method. Pulsed-field gel electrophoresis was performed to identify persistent and transmitted strains. Genetic comparison of resistant and transmitted strains was done by multilocus sequence typing (MLST) and strains were further investigated for extra- and intra-intestinal virulence factors by multiplex PCR. Results: Forty-seven (33%) neonatal meconium samples contained resistant E. coli. Prevalence increased continuously: After 1y, resistance proportion (tetracycline 80%, ampicillin 72%, co-trimoxazole 66%, cefazoline 35%) almost matched those in parents. In 8 infants (6%), identical E. coli strains were found in at least 3 sampling time points (suggesting persistence). Transmission of resistant E. coli from parents to child was observed in only 8 families. MLST showed high diversity. We could not identify any virulence genes or factors associated with persistence, or transmission of resistant E. coli. Full-term, vaginal birth and birth in rural hospital were identified as risk factors for early childhood colonization with resistant E. coli. Conclusion: One third of healthy Thai neonates harboured antibiotic-resistant E. coli in meconium. The proportion of resistant E. coli increased during the first year of life almost reaching the value in adults. We hypothesize that enhancement of infection control measures and cautious use of antibiotics may help to control further increase of resistance. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Colistin has been used for therapy of carbapenem-resistant Gram-negative infections in Thailand, especially carbapenem-resistant A. baumannii and P. aeruginosa , for more than 10 years. However, the prevalence of colistin-resistant A. baumannii or P. aeruginosa is still less than 5%. Colistin-resistant Enterobacteriaceae has been increasingly reported globally over the past few years and the use of colistin in food animals might be associated with an emergence of colistin resistance in Enterobacteriaceae. This study aimed to determine the effect of colistin exposure in hospitalized patients who received colistin on development of colistin-resistant (CoR) Escherichia coli (EC) or Klebsiella pneumoniae (KP) colonization and infection. Methods: A prospective observational study was performed in adult hospitalized patients at Siriraj Hospital who received colistin for treatment of infections during December 2016 and November 2017. The surveillance culture samples were collected from the stool and the site of infection of each patient who received colistin at the study enrollment, days 3 and 7 after the study enrollment, and once a week thereafter for determination of CoR EC and CoR KP. CoR EC and CoR KP were also tested for a presence of mcr-1 gene. Results: One hundred thirty-nine patients were included. Overall prevalence of CoR EC or CoR KP colonization was 47.5% among 139 subjects. Prevalence of CoR EC or CoR KP colonization was 17.3% of subjects at study enrollment, and 30.2% after study enrollment. Use of fluoroquinolones, aminoglycosides, and colistin was found to be significantly associated with CoR EC or CoR KP colonization. The mcr-1 gene was detected in 13.0% of CoR EC or CoR KP isolates, and in 27.3% of subjects with CoR EC or CoR KP colonization. CoR EC or CoR KP colonization persisted in 65.2% of the subjects at the end of the study. Five patients with CoR KP infections received combination antibiotics and they were alive at hospital discharge. Conclusions: Prevalence of CoR EC or CoR KP colonization in hospitalized patients receiving colistin was high and it was associated with the use of colistin. Therefore, patients who receive colistin are at risk of developing CoR EC or CoR KP colonization and infection. [ABSTRACT FROM AUTHOR]

Advances in genome sequencing technologies and genome-wide association studies (GWAS) have provided unprecedented insights into the molecular basis of microbial phenotypes and enabled the identification of the underlying genetic variants in real populations. However, utilization of genome sequencing in clinical phenotyping of bacteria is challenging due to the lack of reliable and accurate approaches. Here, we report a method for predicting microbial resistance patterns using genome sequencing data. We analyzed whole genome sequences of 1,680 Streptococcus pneumoniae isolates from four independent populations using GWAS and identified probable hotspots of genetic variation which correlate with phenotypes of resistance to essential classes of antibiotics. With the premise that accumulation of putative resistance-conferring SNPs, potentially in combination with specific resistance genes, precedes full resistance, we retrogressively surveyed the hotspot loci and quantified the number of SNPs and/or genes, which if accumulated would confer full resistance to an otherwise susceptible strain. We name this approach the 'distance to resistance'. It can be used to identify the creep towards complete antibiotics resistance in bacteria using genome sequencing. This approach serves as a basis for the development of future sequencing-based methods for predicting resistance profiles of bacterial strains in hospital microbiology and public health settings. [ABSTRACT FROM AUTHOR]