In vitro activity of ceftobiprole against hospital-acquired bacteria commonly causing infections in hospitalized patients at Siriraj Hospital.

Objective: To determine the in vitro activity of ceftobiprole against resistant bacteria commonly causing infections in hospitalized patients at Siriraj Hospital. Methods: The studied organisms were MRSA (32 isolates), Enterococcus sp. (30 isolates), ESBL-producing E.coli (20 isolates), ESBL-producing K.pneumoniae (20 isolates), MDR P.aeruginosa (30 isolates) and MDR A.baumannii (30 isolates). The susceptibility of ceftobiprole was determined by the disk diffusion test for all 162 isolates and the MIC was determined by the E-test method for 5 isolates of each organism. Results: All isolates of MRSA and 77% of Enterococcus sp. isolates were susceptible to ceftobiprole. All isolates of ESBL-producing E.coli and MDR A.baumannii were not susceptible to ceftobiprole. Only 10% to 20% of ESBL-producing K.pneumoniae and P.aeruginosa were susceptible to ceftobiprole. The MICs of ceftobiprole against all tested organisms were correlated with the inhibition zone diameters. Conclusion: Ceftobiprole is very active against MRSA and is moderately active against Enterococcus sp. Ceftobiprole is considered inactive or less active against ESBL-producing gram negatives, MDR P.aeruginosa and MDR A.baumannii.

In vitro activity of tigecycline against clinical isolates of multidrug-resistant Acinetobacter baumannii in Siriraj Hospital, Thailand.

In vitro activity of tigecycline against 148 strains of Acinetobacter baumannii isolated from different patients hospitalized at Siriraj Hospital, Bangkok, Thailand during 2002 to 2005 was conducted. These isolates were resistant to beta-lactams, aminoglycosides and fluoroquinolones. In vitro susceptibilities were determined by Kirby-Bauer disk diffusion, E-test and broth microdilution methods. The MIC50 and MIC90 values of tigecycline against A. baumannii determined by the broth microdilution method were 0.5 and 1 mg/L respectively. The MICs of tigecycline determined by E-test were 4-fold higher than those from the broth microdilution method. An inhibition zone of > or = 13 mm was well correlated with a tigecycline MIC of < or = 2 mg/L and had a sensitivity of 99% and a specificity of 100%. The study results indicated that 97.3% of MDR A. baumannii strains isolated from the patients hospitalized at Siriraj Hospital were susceptible to tigecycline. Tigecycline may prove to be an important antibiotic for treatment of multidrug-resistant A. baumannii infections in Thailand in the near future.

Upper respiratory tract infection in Thai adults: prevalence and prediction of bacterial causes, and effectiveness of using clinical practice guidelines.

BACKGROUND: Antibiotics are over-prescribed for Upper Respiratory tract Infection (URI). Uncertainty in differentiating bacterial from viral infection is the main reason for this practice. More evidence is needed to encourage proper use of antibiotics for URI. OBJECTIVES: 1) To determine the prevalence of Group A beta-hemolytic Streptococci (GAS) in adults with URI and clinical features associated with GAS infection. 2) To evaluate the effectiveness of management of adults with URI using the Clinical Practice Guideline (CPG). MATERIAL AND METHOD: A prospective study was conducted on adult out-patients with URI at Siriraj Hospital from April to October 2004. Throat swab cultures were performed in all participants. Patients were assessed and managed according to CPG adapted from principles of appropriate antibiotic use for treatment of acute upper respiratory tract infections in adults endorsed by the Centers for Disease Control and Prevention, USA. Clinical outcomes were evaluated by telephone interviews. RESULTS: Out of 292 patients enrolled, 55.5% had non-specific URI/common cold, 32.2% had pharyngitis/ tonsillitis, 11% had acute bronchitis and only 1.4% had acute sinusitis. The overall prevalence of GAS infection was 7.9%. GAS was isolated in 16% of the patients with pharyngitis/tonsillitis; and only 3.7% and 3.1% of the patients with non-specific URI/common cold and acute bronchitis respectively. Clinical manifestations associated with GAS were: 1)fever (T > or = 37.8 C), 2) exudate on the pharynx or tonsil, 3) tender cervical lymphadenopathy, and 4) absence of cough. The presence of < or = 3 of 4 criteria had high negative predictive value of 94.2%. None of the patients with non-specific URI/common cold, acute bronchitis and acute sinusitis had > or = 3 of 4 criteria. The clinical responses were not significantly different between those who received or did not receive antibiotics. Most of the patients had good clinical response by day 7. CONCLUSION: The prevalence of GAS infection in adults with URI was 7.9%. The clinical features of T > or = 37.8 C, exudate on pharynx or tonsil, tender cervical lymphadenopathy, and absence of cough were significantly found in the patients with GAS infection. Management of adults with URI using the CPG was effective and safe.

Serological survey of viral hepatitis A, B, and C at Thai Central Region and Bangkok: a population base study.

Hepatitis A, B, and C are important viral hepatitis infections in the Thai population. Hepatitis B vaccination was included in the Thai Expanded Program on Immunization (EPI) 10 years ago. In addition, the seroprevalence of hepatitis A has significantly changed in the last two decades. This study was done to evaluate current risk groups for hepatitis A and B infections and identify the magnitude of hepatitis C infection in the general population of Bangkok and six provinces in the Central Region of Thailand, during the period October 2000 to January 2002. This study revealed that the prevalence of anti-HAV in people younger than 25 years was low but very high in people older than 25 years. The prevalence of anti-HAV was 1.95% in Bangkok and 12.7% in other provinces in people younger than 25 years (p<0.001) while 90.9% in Bangkok and 88.2% in other provinces among people older than 25 years. Therefore, people who are older than 25 years should have a blood test for anti-HAV before getting a hepatitis A vaccination. Approximately 80% of people who are not covered by hepatitis B vaccination from EPI are at risk of hepatitis B infection and its complications. This group of people should receive hepatitis B vaccination. For hepatitis C, the prevalence is lower than 2% across age groups and areas. Therefore, current good primary prevention via blood donor screening and health education must be maintained.