ABSTRACT
@# Nosocomial infection caused by Acinetobacter baumannii is common among immunocompromised patients. Treatment strategy is limited due to rapid resistance development and lack of novel antibiotic. Colistin has been the last line therapy with good in vitro activity against infections caused by multi-drug resistance A. baumannii. However, pharmacological updates are required to support dosing optimisation. This study aimed to determine the time-kill kinetic and resistance development after antibiotic exposure as well as post-antibiotic effect of colistin at different static concentrations in in vitro A. baumannii system. The static in vitro time-kill and post-antibiotic effect experiments were conducted against two clinical isolates as well as one reference isolate ATCC 19606. Time-kill and postantibiotic effect were studied at colistin concentrations ranging from 0.25MIC to 16.0MIC and 0.5MIC to 4.0MIC, respectively. Post-exposure resistance development was examined in time-kill study. Killing activity and post-antibiotic effect were in a concentration-dependent manner. However, delayed killing activity indicates colistin tolerance. Development of resistance after exposure was not detected except for the ATCC 19606 strain. Dosing suggestion based on the observations include administration of supplemental dose 3 MIU at 12 hours after loading dose, administration of maintenance dose 9 MIU in two divided doses and application of extended interval in renal adjustment dose. However, the information is applicable for non-colistin-heteroresistance A. baumannii with colistin MIC < 1.0 mg/L. As for heteroresistance and strain with colistin MIC > 1.0 mg/L, combination therapy would be the more appropriate treatment strategy.
ABSTRACT
Posttraumatic stress disorder (PTSD) is a psychiatric diagnosis made when someone including children who experiences traumatic stressor. Those who are exposed to a more severe trauma have highest level of PTSD. The aim of this study was to measure the prevalence of PTSD and its associated factors among 219 children who were affected by a form of natural disaster which is the tsunami waves in a rural area in Malaysia. A cross sectional study was carried out among children aged 10-12 years 6 months after the traumatic event. Child Posttraumatic Stress Disorder –Reaction Index (CPTSD-RI) was used as a screening instrument which was answered by the affected children through a self-administered questionnaire. Forty six percent of these children had PTSD symptoms; 31.1% of these children had mild, 11.4% had moderate, 3.7% had severe PTSD and none had very severe PTSD. Result also showed that 91.8% had re-experiencing symptoms, 28.3% had numbing/avoidance symptoms and 49.3% had hyperarousal symptoms. Children with low social support (Adj OR = 2.3 (95% CI: = 1.3- 4.2)), and children who experienced deaths among someone close to them (Adj OR = 3.7 (95% CI =1.2 - 11.5)) were more likely to have symptoms of PTSD. This showed that children are at higher risk of developing PTSD as early as 6 months after the event and thus early intervention should be offered to them. Future longitudinal study can be carried out among affected children to assess whether these PTSD symptoms persist over time.