Vancomycin overuse in Siriraj Hospital.

OBJECTIVE: An emergence of vancomycin resistant organisms particularly vancomycin-resistant enterococci (VRE) has become a serious public health concern. To prevent and control the spread of vancomycin resistant organisms, the prudent use of vancomycin is strongly recommended by the Hospital Infection Control Practices Advisory Committee (HICPAC). MATERIAL AND METHOD: A 6-week prospective observational study of vancomycin use was conducted in hospitalized patients at Siriraj Hospital from February to March 2005. Indications of initiating and continuing vancomycin were categorized according to HICPAC recommendations. Factors related to the appropriateness of vancomycin use were also evaluated. RESULTS: At initiation, vancomycin was inappropriately and empirically prescribed 19/222 times (8.6%) and 166/222 times (74.8%), respectively. After microbiological results were obtained, the rate of inappropriate prescription continued 132/222 times (59.5%). Furthermore, inappropriate use was significantly correlated with the type of department. There was a higher rate in the Department of Pediatrics, Surgery and Ophthalmology when compared with that of the Department of Medicine (p = 0.001). The inappropriate use also correlated with topical use (p < 0.001), intravenous administration (p = 0.012) and no consultation with an infectious disease specialist (p = 0.001). The overuse did not improve the clinical outcome. CONCLUSION: A substantial rate of inappropriate use of vancomycin was found in Siriraj Hospital. Intervention to improve appropriateness of vancomycin use should be urgently implemented to prevent and control the emergence of vancomycin resistant organisms.

Mycobacterium tuberculosis infection among HIV/AIDS patients in Thailand: clinical manifestations and outcomes.

A one year retrospective study, was conducted at Bamrasnaradura Hospital, Nonthaburi Province, Bangkok, Thailand, of 271 subjects with both TB and HIV/AIDS. Single males (median age group 31 to 40 years) were most likely to develop co-infection. The commonest clinical manifestations on initial presentation included a low grade fever, cough, weight loss, lymphadenopathy with pancytopenia, and lung infiltrates. Multi-drug resistant TB (MDR-TB) was found in 26.6% of the subjects which was significantly associated with a past history of anti-TB treatment (p = 0.005; OR=2.5); it was also significantly associated with disseminated TB (p = 0.022; OR=1.9) and mortality (p= 0.013; OR=2.8). Analysis of clinical outcomes showed that 46.7% were lost to follow-up and 13.3% had died by the time of follow-up. Among those who survived, only 11.4% had been successfully treated; the rest had not improved due to relapse (2.9%), therapeutic failure (8.8%), treatment in progress (5.9%), and failure to complete treatment (10.7%).

Fatal nosocomial infection in medical wards of a University Hospital.

Nosocomial infection is one of the most common morbidity among hospitalized patients. While study dealing with epidemiologic pattern of those in living patients are numerous, studies focusing on patients who died of them are few. In this prevalence study, we found that patients having fatal nosocomial infections presented some distinguishable features. From May 1982 to December 1983, 109 out of 300 cases had fatal nosocomial infections (36.3%). There was a total of 168 episodes of infection in these patients (1.5 episodes per patient). The ages ranged from 13-91 years and both sexes were equally affected. Septicemia was the most common infection related directly to death (a causal relationship). Pneumonia was commonly contributing to death while urinary tract infection was the most common infection not related to death. Most patients had either rapidly fatal or ultimately fatal underlying diseases. The infections disease episodes in both types of underlying diseases were not significantly different. There was a bimodal age group distribution of those who died of infections (30 and 60 years). The peak survival was rather short (mode of 20.0 days) and the fatal infection occurred early in the hospitalized course (mode of 5.0 days). These data suggested that the prevalence of fatal nosocomial infection was high severe infection occurred early and types of infection may be a predictor of fatal outcome,. Any intervention focusing on prevention of severe infection, such as septicemia and pneumonia, should be encouraging.