Danchaivijitr S

First report of methicillin-resistant Staphylococcus aureus with reduced susceptibility to vancomycin in Thailand.

ABSTRACT To investigate whether there are methicillin-resistantStaphylococcus aureus (MRSA) strains with reduced susceptibility to vancomycin in Thailand, a total of 155 MRSA strains isolated from patients hospitalized between 1988 and 1999 in university hospitals in Thailand were tested for glycopeptide susceptibility. All the strains were classified as susceptible to vancomycin and teicoplanin when judged by NCCLS criteria for glycopeptide susceptibility using the agar dilution MIC determination. Vancomycin MICs at which 50 and 90% of the isolates tested were inhibited (MIC50 and MIC90, respectively) were 0.5 and 1 μg/ml, respectively, with a range of 0.25 to 2 μg/ml. For teicoplanin, MIC50 and MIC90 were 2 μg/ml, with a range of 0.5 to 4 μg/ml. However, one-point population analysis identified three MRSA strains, MR135, MR187, and MR209, which contained subpopulations of cells that could grow in 4 μg of vancomycin per ml. The proportions of the subpopulations were 2 × 10−4, 1.5 × 10−6, and 4 × 10−7, respectively. The subsequent performance of a complete population analysis and testing for the emergence of mutants with reduced susceptibility to vancomycin (MIC ≥ 8 μg/ml) confirmed that these strains were heterogeneously resistant to vancomycin. Two of these strains caused infection that was refractory to vancomycin therapy. Pulsed-field gel electrophoresis showed that the two strains had identical SmaI macrorestriction patterns and that they were one of the common types of MRSA isolated in the hospital. This is the first report of heterogeneous resistance to vancomycin in Thailand and an early warning for the possible emergence of vancomycin resistance in S. aureus in Southeast Asia.

Impact of an educational program on antibiotic use in a tertiary care hospital in a developing country.

A multi-cross-sectional study was conducted in a 2000-bed tertiary care university hospital in Bangkok, Thailand, from September 1993 to May 1994 to assess the effectiveness of an educational program on the use of antibiotics. Data on the study covered antibiotic usage both in-patients and out-patients. Data were collected for a 24-hour period every 2 weeks for 7 days for each 3-month period. The target population were residents, general practitioners, and sixth-year medical students. The educational program provided information derived from the data of inappropriate use of antibiotics during the pre-intervention period and guidelines on the use of antibiotics which were agreed to by a consensus among the faculty in all clinical departments. The study revealed: (1) the prevalence of antibiotic use and the cost of antibiotics during post-intervention period was significantly decreased by 20%; (2) the use of antibiotic prophylaxis for obstetrics patients and patients undergoing cataract surgery decreased significantly; (3) there was a shift from second or third generation cephalosporins to cefazolin for surgical prophylaxis; (4) the duration of perioperative antibiotic prophylaxis was reduced to under 2 days; (5) there was a shift from netilmicin or amikacin to gentamicin for the treatment of community acquired infection; and (6) the mortality, median length of hospital stay, and nosocomial infection rate among the patients who received antibiotics during the post-intervention period were not significantly different from those during the pre-intervention period. These results suggest that this educational program comprising information feedback and antibiotic usage guidelines was effective in improving antibiotic use at this tertiary care university hospital in Thailand.

Universal precautions: Costs for protective equipment

BACKGROUND The amount and costs of protective equipment used to implement universal precautions in Thailand have not previously been studied. METHODS A cross-sectional study was done to determine the frequency of clinical and laboratory procedures requiring universal precautions and the amount of protective equipment needed for each. RESULTS The study was performed in 24 government hospitals in Thailand in December 1993. Totaling 6549 beds, these hospitals had provided service to 357,391 inpatients and 3,411,122 outpatients during the previous year. The annual number of procedures performed in these hospitals was estimated at 17.5 million, with expenditures for protective equipment of

Prevalence of Nosocomial Infection in Thailand 2006

2.4 million (U.S.) per year. The average overall cost for protective equipment was U.S.

Effect of an education program on the prevention of ventilator-associated pneumonia: A multicenter study.

5.37 for one inpatient stay and U.S.

The Second Thai National Prevalence Study on Nosocomial Infections 1992.

0.15 for one outpatient visit. The projected national expense for these barriers was U.S.

A national prevalence study on nosocomial infections 1988.

41.5 million per annum. The cost for these barriers after the implementation of universal precautions was 2.5 times the cost before implementation. CONCLUSIONS Overuse of sterile and examination gloves and gowns and underuse of heavy-duty gloves, masks, aprons, goggles, and boots were discovered during the study. Appropriate use of disposable and reusable universal precautions equipment would free health care dollars for other purposes.