Gompol Suwanpimolkul

A randomized trial of 2% chlorhexidine tincture compared with 10% aqueous povidone–iodine for venipuncture site disinfection: Effects on blood culture contamination rates☆

BACKGROUND Contaminated blood cultures have been recognized as a bothersome issue, and continue to cause frustration for clinicians. Skin antiseptics can prevent blood culture contamination. To our knowledge, there have been no randomized studies to compare 2% alcoholic chlorhexidine and 10% aqueous povidone-iodine for venipuncture site disinfection. OBJECTIVE This study aimed to evaluate the efficacy of venipuncture site disinfection with 2% chlorhexidine in 70% alcohol and 10% aqueous povidone-iodine in preventing blood culture contamination. PATIENTS AND METHODS A prospectively randomized investigator-blinded trial was conducted in all patients in the medical wards and emergency room (ER) at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from August to October, 2006. Venipuncture sites were disinfected with 2% chlorhexidine in 70% alcohol or 10% aqueous povidone-iodine, and blood cultures were taken by students, residents, or nurses. RESULTS Of 2146 blood cultures, 108 (5.03%) were contaminated with skin flora. The blood culture contamination rate with 2% alcoholic chlorhexidine was 3.2% (34 of 1068), compared with a rate of 6.9% (74 of 1078) (P<0.001) with 10% aqueous povidone-iodine. In medical wards, the contamination rates were 2.6% and 3.9% with 2% alcoholic chlorhexidine and 10% aqueous povidone-iodine (P=0.2). In ER, the contamination rates were 4.3% and 12.5% with 2% alcoholic chlorhexidine and 10% aqueous povidone-iodine (P<0.001). The most common contaminant was coagulase-negative Staphylococcus (80.6%), followed by Corynebacterium (7.4%), Micrococcus (6.5%), and Bacillus (5.5%). CONCLUSION Two percent alcoholic chlorhexidine is superior to 10% aqueous povidone-iodine for venipuncture site disinfection before obtaining blood cultures.

Autochthonous visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected patient: the first in thailand and review of the literature.

We report a case of visceral leishmaniasis in a human immunodeficiency virus (HIV)-infected 37-year-old Thai fisherman who presented with nephritonephrotic syndrome, fever, anemia, and thrombocytopenia. Bone marrow biopsy revealed many amastigotes within macrophages. Kidney biopsy showed membranoproliferative glomerulonephritis. Polymerase chain reaction (PCR) and nucleotide sequence analysis of the internal transcribed spacer 1 of the small subunit ribosomal RNA gene in blood and kidney biopsy specimens showed Leishmania species previously described in a Thai patient with visceral leishmaniasis. Only four autochthonous cases of leishmaniasis have been reported in Thailand since 1996. To the best of our knowledge, this is the first report of autochthonous visceral leishmaniasis in an HIV-infected Thai. With an increasing number of patients with autochthonous leishmaniasis in association with the presence of potential vector, it remains to be determined whether this vector-borne disease will become an emerging infectious disease in Thailand.

Real-Life Clinical Practice of Using the Xpert MTB/RIF Assay in Thailand.

Background Delayed diagnosis of tuberculosis (TB) and drug-resistant TB are major challenges of TB control in Thailand. This study assessed the practicality of the Xpert MTB/RIF assay in a real-life setting with high prevalence of human immunodeficiency virus (HIV) infection and pulmonary tuberculosis (PTB). Methods This prospective study was conducted at 3 large tertiary care hospitals. Patients who had suspected PTB were enrolled into the study. Expectorated sputum samples were sent for staining, mycobacterial culture, and Xpert MTB/RIF. Results Four hundred ninety-four patients were enrolled. From 355 cases with final diagnosis of PTB, 263 (71.8%) had definite diagnosis and 92 cases had probable diagnosis. Among TB culture-positive cases, Xpert MTB/RIF had 100% and 81% sensitivity in sputum smear-positive and smear-negative groups, respectively. The specificity was 95.7%. The sensitivity and positive predictive value of Xpert MTB/RIF in culture-negative but clinically diagnosed PTB was 37.8% and 83.8%, respectively. Centrifugation was required in 59% cases with scanty sputum. Five cases were false-positive by Xpert MTB/RIF in patients with nontuberculous mycobacteria, old PTB scar, and immune reconstitution syndrome. Discordant rifampicin susceptibility results of Xpert MTB/RIF and mycobacteria growth indicator tube (MGIT) were confirmed by using rpoB gene sequencing, which raised the sensitivity of Xpert MTB/RIF in detecting rifampicin resistance to 93.8%. Conclusions Xpert MTB/RIF is an effective tool in diagnosing PTB but will be more cost-effective for sputum-negative patients and in settings with high prevalence of rifampicin resistance. Early diagnosis of TB results in early treatment and implementation of strategies to limit spreading of TB. Sputum centrifugation may increase the yield of Xpert MTB/RIF.

Utility of urine lipoarabinomannan (LAM) in diagnosing tuberculosis and predicting mortality with and without HIV: prospective TB cohort from the Thailand Big City TB Research Network

OBJECTIVES To evaluate the applicability and accuracy of the urine lipoarabinomannan (LAM) test in tuberculosis (TB)/HIV co-infected patients and HIV-negative patients with disseminated TB. METHODS Frozen urine samples obtained at baseline from patients in the TB research cohort with proven culture-positive TB were selected for blinded urine LAM testing. One hundred and nine patients were categorized into four groups: (1) HIV-positive patients with TB; (2) HIV-negative patients with disseminated TB; (3) HIV-negative immunocompromised patients with TB; and (4) patients with diseases other than TB. The sensitivity of urine LAM testing for culture-positive TB, specificity of urine LAM testing for patients without TB, positive predictive value (PPV), and negative predictive value (NPV) were assessed. RESULTS The sensitivity of the urine LAM test in group 1 patients with a CD4 T-cell count of >100, ≤100, and ≤50 cells/mm3 was 38.5%, 40.6%, and 45%, respectively. The specificity and PPV of the urine LAM test were >80%. The sensitivity of the test was 20% in group 2 and 12.5% in group 3, and the specificity and PPV were 100% for both groups. A positive urine LAM test result was significantly associated with death. CONCLUSIONS This promising diagnostic tool could increase the yield of TB diagnosis and may predict the mortality rate of TB infection, particularly in TB/HIV co-infected patients.

A decennium of etiology and antimicrobial susceptibility patterns in patients with infective endocarditis at a university hospital, Thailand

Infective endocarditis is an infection with a high mortality rate. Antimicrobial therapy is important for treatment, but data on antimicrobial susceptibilities are limited. This retrospective study analyzed data on the causative microorganisms and antimicrobial susceptibility patterns in patients with infective endocarditis 18 years of age or older who received inpatient care between 2006 and 2015 at King Chulalongkorn Memorial Hospital. A total of 213 patients fulfilled the inclusion criteria. Streptococcus spp. (54.5%) was the most common organism. Viridans streptococcus (46%) was the leading pathogen, followed by Group B streptococcus (27%). The majority of Streptococcus spp. were susceptible to penicillin (82.7%). Among Streptococcus spp., Streptococcus suis had the highest MIC90 of penicillin and cefotaxime (1.65 and 0.95 μg/ml, respectively). There was a statistically significant increase in the MICs of penicillin and cefotaxime for Streptococcus suis (P = 0.03 and 0.04). Only 45.5% of Streptococcus suis and 77.5% of Viridans streptococcus were susceptible to penicillin. All Enterococcus spp. and Staphylococcus spp. were susceptible to vancomycin. In conclusion, the prevalence of Group B streptococcus isolates increased among patients with infective endocarditis in Thailand. Streptococcus suis had the highest MIC90 and proportion of isolates not susceptible to penicillin. Rigorous restriction of the use of antimicrobial agents in animal feeds should be a primary concern.