Efficacy and Safety of Oral Neomycin for the Decolonization of Carbapenem-Resistant : An Open-Label Randomized Controlled Trial.

Background: Patients with carbapenem-resistant (CRE) in the gastrointestinal (GI) tract are at risk for subsequent infections and transmission, necessitating contact precautions. Neomycin has shown in vitro activity against CRE in 66-85% of isolates. This study evaluated the efficacy and safety of neomycin for CRE decolonization.

Population pharmacokinetic/pharmacodynamic target attainment analysis of IV fosfomycin for the treatment of MDR Gram-negative bacterial infections.

Background: IV fosfomycin is used against MDR Gram-negative bacilli (GNB) but has dose-limiting side effects, especially in patients with impaired kidney function.

Objectives: To determine the optimal dosage of IV fosfomycin for patients with varying degrees of kidney function.

Methods: Adult patients receiving IV fosfomycin for treatment of GNB were eligible.

Epidemiology of ventilator-associated tracheobronchitis and ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria at a tertiary care hospital in Thailand.

Objectives: To investigate the epidemiology of MDR Gram-negative bacilli ventilator-associated tracheobronchitis (MDR GNB-VAT) and MDR GNB ventilator-associated pneumonia (MDR GNB-VAP) among mechanically ventilated patients.

Methods: We conducted a retrospective observational study among hospitalized patients who underwent continuous mechanical ventilation for ≥48 h at Siriraj Hospital, Thailand.

Results: During the 18 month study period, 1824 unique patients underwent continuous mechanical ventilation (12 216 ventilator-days).

Effectiveness of implementing a locally-developed guideline for antibiotic treatment of lower urinary tract infection in adults in Thailand.

Lower urinary tract infection (UTI) is still a major concern in clinical practice, but inappropriate antibiotics are commonly prescribed in Thailand. This study aimed to develop, implement, and evaluate the effectiveness of a clinical practice guideline (CPG) for antibiotic treatment of lower UTI in adults at Siriraj Hospital which is a university hospital in Thailand. This study comprised a retrospective cohort study development phase, and a prospective cohort study implementation phase.

Characteristics and genomic epidemiology of colistin-resistant Enterobacterales from farmers, swine, and hospitalized patients in Thailand, 2014-2017.

Background: Colistin is one of the last resort therapeutic options for treating carbapenemase-producing Enterobacterales, which are resistant to a broad range of beta-lactam antibiotics. However, the increased use of colistin in clinical and livestock farming settings in Thailand and China, has led to the inevitable emergence of colistin resistance. To better understand the rise of colistin-resistant strains in each of these settings, we characterized colistin-resistant Enterobacterales isolated from farmers, swine, and hospitalized patients in Thailand.

Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms.

Background: Pneumonia and bloodstream infections (BSI) due to extensively drug-resistant (XDR) , XDR , and carbapenem-resistant Enterobacterales (CRE) are associated with high mortality rates, and therapeutic options remain limited. This trial assessed whether combination therapy with colistin and meropenem was superior to colistin monotherapy for the treatment of these infections.

Methods: The OVERCOME (Colistin Monotherapy versus Combination Therapy) trial was an international, randomized, double-blind, placebo-controlled trial.

The risk of pig and chicken farming for carriage and transmission of containing extended-spectrum beta-lactamase (ESBL) and mobile colistin resistance () genes in Thailand.

South-East Asian countries report a high prevalence of extended-spectrum cephalosporin- (ESC-) and colistin-resistant (Col-R-). However, there are still few studies describing the molecular mechanisms and transmission dynamics of ESC-R- and, especially, Col-R-. This study aimed to evaluate the prevalence and transmission dynamics of containing extended spectrum beta-lactamases (ESBL) and mobile colistin resistance () genes using a 'One Health' design in Thailand.

Identification and characterization of plasmids carrying the mobile colistin resistance gene using optical DNA mapping.

Objectives: Colistin is a last-resort antibiotic, but there has been a rapid increase in colistin resistance, threatening its use in the treatment of infections with carbapenem-resistant (CRE). Plasmid-mediated colistin resistance, in particular the gene, has been identified and WGS is the go-to method in identifying plasmids carrying genes. The goal of this study is to demonstrate the use of optical DNA mapping (ODM), a fast, efficient and amplification-free technique, to characterize plasmids carrying .

Development and Implementation of a Mobile Application for Choosing Empirical Antimicrobial Therapy for Bacteremia, Pneumonia, Urinary Tract Infection, and Skin and Soft Tissue Infection among Hospitalized Patients.

Clinical practice guidelines (CPGs) and computerized clinical decision support programs are effective antimicrobial stewardship strategies. The DigitalAMS™, a mobile-based application for choosing empirical antimicrobial therapy under the hospital’s CPGs, was implemented at Siriraj Hospital and evaluated. From January to June 2018, a cross-sectional study was conducted among 401 hospitalized adults who received ≥1 dose of antimicrobials and had ≥1 documented site-specific infection.

Colistin Monotherapy versus Colistin plus Sitafloxacin for Therapy of Carbapenem-Resistant Infections: A Preliminary Study.

The in vitro study of sitafloxacin against carbapenem-resistant (CR) demonstrated activity against most strains of CR , and the combination of colistin and sitafloxacin showed an in vitro synergistic effect against CR . This study aimed to compare efficacy and safety between colistin plus sitafloxacin with colistin alone for therapy for CR infection. This randomized controlled trial enrolled 56 patients with CR infection (28/group) during 2018-2021, and the treatment duration was 7-14 days.

Influence of occupational exposure to pigs or chickens on human gut microbiota composition in Thailand.

Pig farming's influence on human gut microbiota has been observed previously, but its pervasiveness is unclear. We therefore aimed at studying whether pig farming influenced human gut microbiota composition in Thailand and whether poultry farming did too. We collected human stool samples (71 pig farmers, 131 chicken farmers, 55 non-farmers) for 16S rRNA sequencing and performed subsequent DADA2 analyses of amplicon sequence variants.

Epidemiology of Carbapenem-Resistant Infection and Colonization in Hospitalized Patients at a University Hospital in Thailand.

Purpose: To investigate the epidemiology of carbapenem-resistant (CRE) colonization or CRE infection relative to the natural history and clinical course of CRE colonization or CRE infection in hospitalized patients during admission and after discharge.

Material And Methods: Two adult cohorts were enrolled. Cohort I comprised hospitalized patients who had CRE isolated from their clinical specimens during 2018-2020.

Active Surveillance for Carbapenem-Resistant (CRE) Colonization and Clinical Course of CRE Colonization among Hospitalized Patients at a University Hospital in Thailand.

Optimal measures for preventing and controlling carbapenem-resistant (CRE) depend on their burden. This prospective observational study investigated the prevalence and clinical course of CRE colonization in hospitalized patients at Siriraj Hospital, the largest university hospital in Thailand. Stool/rectal swab samples were collected from the patients upon admission, once weekly during hospitalization and every 1-3 months after discharge, to determine the presence of CRE in the stool.

Implementation of Clinical Practice Guidelines for Empirical Antibiotic Therapy of Bacteremia, Urinary Tract Infection, and Pneumonia: A Multi-Center Quasi-Experimental Study.

A quasi-experimental study was conducted on the implementation of locally developed clinical practice guidelines (CPGs) for empirical antibiotic (ATB) therapy of common infections (bacteremia, urinary tract infection (UTI), pneumonia) in the hospitals from January 2019 to December 2020. The CPGs were developed using data from patients with these infections at individual hospitals. Relevant CPG data pre- and post-implementation were collected and compared.

Epidemiology and Burden of Sepsis at Thailand's Largest University-Based National Tertiary Referral Center during 2019.

Data specific to the epidemiology and burden of sepsis in low- and middle-income countries are limited. This study aimed to determine the epidemiology and burden of adult patients with sepsis at Siriraj Hospital during 2019. Randomly selected adult patients who had blood cultures performed at our center during January−December 2019 were enrolled.

Safety and Efficacy of Ivermectin for the Prevention and Treatment of COVID-19: A Double-Blinded Randomized Placebo-Controlled Study.

The safety and efficacy of ivermectin for the prevention and treatment of COVID-19 are still controversial topics. From August to November 2021, we conducted a double-blinded, randomized controlled trial at Siriraj Hospital, Thailand. Eligible participants were adults ≥ 18 years with suspected COVID-19 who underwent a SARS-CoV-2 RT-PCR test.

Mortality in Thai Nursing Homes Based on Antimicrobial-Resistant Carriage and COVID-19 Lockdown Timing: A Prospective Cohort Study.

Antimicrobial-resistant carriage and the coronavirus disease 2019 (COVID-19) lockdown measures may impact the incidence all-cause mortality rate among nursing home residents. To determine the all-cause mortality rate in the presence/absence of antimicrobial-resistant carriage and the incidence all-cause mortality rate before and during COVID-19 pandemic lockdown, this prospective closed-cohort study was conducted at various types of nursing homes in Bangkok, Thailand, from June 2020 to December 2021. The elderly residents included 142 participants (aged ≥60 years) living in nursing homes ≥3 months, who did not have terminal illnesses.

A simple cut and stretch assay to detect antimicrobial resistance genes on bacterial plasmids by single-molecule fluorescence microscopy.

Antimicrobial resistance (AMR) is a fast-growing threat to global health. The genes conferring AMR to bacteria are often located on plasmids, circular extrachromosomal DNA molecules that can be transferred between bacterial strains and species. Therefore, effective methods to characterize bacterial plasmids and detect the presence of resistance genes can assist in managing AMR, for example, during outbreaks in hospitals.

Surveillance of Antimicrobial Resistance Phenotypes in Selected Communities in Thailand.

Integrated surveillance of antimicrobial resistance (AMR) using the 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 and 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 and species, which were then tested for resistance to ceftriaxone, colistin, and meropenem.

Impact of Antibiotic Authorisation at Three Provincial Hospitals in Thailand: Results from a Quasi-Experimental Study.

Implementing antimicrobial stewardship (AMS) at non-university hospitals is challenging. A quasi-experimental study was conducted to determine the impact of customised antibiotic authorisation implementation on antimicrobial consumption and clinical outcomes at three provincial hospitals in Thailand. Customised pre-authorisation of selected restricted antibiotics and post-authorisation of selected controlled antibiotics were undertaken and implemented at each hospital by the local AMS team with guidance from the AMS team at the university hospital.

Feasibility, Challenges, and Benefits of Global Antimicrobial Resistance Surveillance System Implementation: Results from a Multicenter Quasi-Experimental Study.

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.

Optical DNA Mapping of Plasmids Reveals Clonal Spread of Carbapenem-Resistant in a Large Thai Hospital.

Carbapenem-resistant (CR-KP) in patients admitted to hospitals pose a great challenge to treatment. The genes causing resistance to carbapenems are mostly found in plasmids, mobile genetic elements that can spread easily to other bacterial strains, thus exacerbating the problem. Here, we studied 27 CR-KP isolates collected from different types of samples from 16 patients admitted to the medical ward at Siriraj Hospital in Bangkok, Thailand, using next generation sequencing (NGS) and optical DNA mapping (ODM).

Feasibility of implementing antimicrobial stewardship programs in acute-care hospitals: A nationwide survey in Thailand.

A nationwide survey was conducted in 399 acute-care hospitals in Thailand. Most had a designated antimicrobial stewardship program (ASP), but <20% had an infectious disease physician on the team. The most frequently cited challenges in ASP implementation were the increased workload, followed by a lack of antimicrobial stewardship knowledge and a lack of hospital administrator concern.

One Health drivers of antibacterial resistance: Quantifying the relative impacts of human, animal and environmental use and transmission.

Objectives: Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how 'One Health', where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 "National Strategic Plan on Antimicrobial Resistance" (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU).