Mental health among healthcare personnel during COVID-19 in Asia: A systematic review

The COVID-19 pandemic has been associated with an insidious wave of psychological stress among healthcare personnel (HCP) in Asia. Mental exhaustion, burnout, fear, depression, anxiety, insomnia, and psychological stress among HCPs have intensified a daunting challenge during the COVID-19 pandemic. The consequences of such stress may negatively impact patient and HCP safety. This review article reports the associations of mental health status attributed to the COVID-19 pandemic among HCP and their impact on patient safety, and infection prevention and control practices during pandemics

Intrathecal colistin for drug-resistant Acinetobacter baumannii central nervous system infection: a case series and systematic review

AbstractTreatment limitations exist for drug-resistant Acinetobacter baumannii central nervous system (CNS) infection. We conducted a retrospective study and systematic literature review to identify patients with drug-resistant A. baumannii CNS infection who received primary or adjunct intrathecal or intraventricular (IT/IVT) colistin. In a case series of seven Thai patients and 17 patients identified in the literature, clinical and microbiological cure rates with IT/IVT colistin therapy were 83% and 92%, respectively. Three patients (13%) developed chemical ventriculitis and one (4%) experienced treatment-associated seizures. Death was associated with delayed IT/IVT colistin therapy compared to survival (mean time from diagnosis to IT/IVT colistin, 7 vs. 2 days; p 0.01). The only independent predictor of mortality was the severity of illness (APACHE II score > 19, adjusted odds ratio 49.5; 95% CI 1.7–1428.6; p 0.02). This case series suggests that administration of primary or adjunctive IT/IVT colistin therapy was effective for drug-resistant A. baumannii CNS infection

Gap analysis on antimicrobial stewardship program in central Thailand

To the Editor—Implementation of an antimicrobial stewardship program (ASP) in an acute-care setting requires several important components: hospital administration support, an appropriate ASP team (eg, infectious disease physician(s) and pharmacist(s)), ASP program goals and carefully planned interventions, a structured reporting system, adequate hospital infrastructure, and mechanisms for education. 1 Examination of these components can provide a useful gap analysis for acute-care hospitals in various resource settings to fulfill the hospital ASP goals. To evaluate the feasibility of gap analysis based on previous ASP consensus in Asia,1 we performed a survey of hospital components and analyzed the gaps to help inform the implementation of ASP in central Thailand

Rapid diagnostic test value and implementation in antimicrobial stewardship across low-to-middle and high-income countries: a mixed-methods review

Despite technological advancements in infectious disease rapid diagnostic tests (RDTs) and use to direct therapy at the per-patient level, RDT utilisation in antimicrobial stewardship programmes (ASPs) is variable across low-to-middle income and high-income countries. Key insights from a panel of seven infectious disease experts from Colombia, Japan, Nigeria, Thailand, the UK, and the USA, combined with evidence from a literature review, were used to assess the value of RDTs in ASPs. From this, a value framework is proposed which aims to define the benefits of RDT use in ASPs, separate from per-patient benefits. Expert insights highlight that, to realise the value of RDTs within ASPs, effective implementation is key; actionable advice for choosing an RDT is proposed. Experts advocate the inclusion of RDTs in the World Health Organization Model List of essential in vitro diagnostics and in iterative development of national action plans

Lagunas y obstáculos en la aplicación y el funcionamiento de los programas de administración de antimicrobianos: Resultados de una evaluación de necesidades con métodos mixtos educativos y conductuales en Francia, Estados Unidos, México e India

Antecedentes: La evidencia muestra una adherencia limitada a los principios de administración antimicrobiana (AMS). Objetivos: Identificar las lagunas educativas y las barreras sistémicas que obstaculizan la adhesión a los principios de la AMS. Métodos: Se realizó un estudio de métodos mixtos que combina un análisis temático de entrevistas cualitativas (enero-febrero de 2021) y un análisis inferencial de encuestas cuantitativas (mayo-junio de 2021). Se seleccionaron deliberadamente participantes de Francia, EE.UU., México y la India a partir de paneles en línea de profesionales de la salud para incluir a médicos infectólogos, especialistas en control de infecciones, microbiólogos clínicos, farmacólogos o farmacéuticos que se espera que apliquen los principios de la MGA en su entorno de práctica (por ejemplo, clínica, hospital académico o comunitario). Este estudio se ha guiado por un marco de análisis de carencias. Resultados: La muestra final incluyó 383 participantes (n = 33 entrevistas; n = 350 encuestas). Los resultados de los métodos mixtos indicaron que los conocimientos y habilidades de los participantes no eran óptimos para facilitar la aplicación personal y colectiva de los principios de la MGA. Los datos de la encuesta indicaron un desfase entre el conocimiento ideal y el actual de los protocolos de MGA, especialmente entre los farmacólogos (Δ0,95/4,00, p < 0,001). También se midieron las diferencias entre los niveles de conocimientos ideales y los actuales, que fueron mayores entre los especialistas en control infeccioso (Δ1,15/4,00, P < 0,001), para convencer a los directivos de los hospitales de que asignen recursos a los programas de MGA. Los obstáculos sistémicos ya existentes (por ejemplo, tiempo, financiación o formación insuficientes) se percibieron como agravados durante la pandemia COVID-19 (el 72% de los participantes en la encuesta estuvieron de acuerdo). Las deficiencias más acusadas se registraron en India y Francia. Conclusiones: Las necesidades educativas de los profesionales y los países incluidos en este estudio pueden informar las futuras actividades de desarrollo profesional continuo en AMS. Debería considerarse la posibilidad de obtener financiación adicional para abordar las barreras sistémicas percibidas. Las evaluaciones locales están justificadas para validar los resultados y la idoneidad de las intervenciones.Background: Evidence shows limited adherence to antimicrobial stewardship (AMS) principles. Objectives: To identify educational gaps and systemic barriers obstructing adherence to AMS principles. Methods: A mixed-methods study combining a thematic analysis of qualitative interviews (January-February 2021) and inferential analysis of quantitative surveys (May-June 2021) was conducted. Participants from France, the USA, Mexico and India were purposively sampled from online panels of healthcare professionals to include infectious disease physicians, infection control specialists, clinical microbiologists, pharmacologists or pharmacists expected to apply AMS principles in their practice setting (e.g. clinic, academic-affiliated or community-based hospital). A gap analysis framework guided this study. Results: The final sample included 383 participants (n = 33 interviews; n = 350 surveys). Mixed-methods findings indicated suboptimal knowledge and skills amongst participants to facilitate personal and collective application of AMS principles. Survey data indicated a gap in ideal versus current knowledge of AMS protocols, especially amongst pharmacologists (Δ0.95/4.00, P < 0.001). Gaps in ideal versus current skill levels were also measured and were highest amongst infectious control specialists (Δ1.15/4.00, P < 0.001), for convincing hospital executives to allocate resources to AMS programmes. Already existing systemic barriers (e.g. insufficient dedicated time/funding/training) were perceived as being aggravated during the COVID-19 pandemic (72% of survey participants agreed). Reported gaps were highest in India and France. Conclusions: The educational needs of professionals and countries included in this study can inform future continuous professional development activities in AMS. Additional funding should be considered to address perceived systemic barriers. Local assessments are warranted to validate results and suitability of interventions

Atypical Avian Influenza (H5N1)

We report the first case of avian influenza in a patient with fever and diarrhea but no respiratory symptoms. Avian influenza should be included in the differential diagnosis for patients with predominantly gastrointestinal symptoms, particularly if they have a history of exposure to poultry

Answer to photo quiz: Coinfection with Mycobacterium marinum and M. Ulcerans

The patient’s pus stain showed unstained organisms in the Gram stain (see Fig. 1C in the photo quiz), which were positive by acid-fast staining (see Fig. 1D in the photo quiz). Tissue and pus specimens were cultured at 32°C by inoculating the sediment on LJ solid medium and in a mycobacterial growth indicator tube (MGIT) (Becton, Dickinson, Sparks, MD). The cultures grew acid-fast bacilli (AFB) after 4 weeks for the pus specimen and 8 weeks for the tissue specimen. Two groups of mycobacterial colonies were identified. The first group (at 4 weeks) contained colonies that were creamy in color and turned yellow when exposed to light (photochromogenic), while the second group of colonies (at 8 weeks) appeared yellow and rough, with a welldemarcated edge. The organisms were later identified as Mycobacterium marinum and M. ulcerans, respectively (1). DNA extracted from pus and tissue samples were evaluated by PCR targeting the 16S rRNA gene and by the IS2404 insertion elements. PCR targeting the 16S rRNA gene confirmed Mycobacterium species most closely matching M. marinum and/or M. ulcerans. The sequences of the IS2404 amplicon were identical to those from M. ulcerans. Coinfections due to M. marinum and M. ulcerans, thus, were diagnosed based on cultures (M. marinum and M. ulcerans) and PCR primers specific for M. ulcerans. M. marinum and M. ulcerans were subjected to antimicrobial susceptibility testing (AST) using a broth microdilution susceptibility test (2), and both organisms were susceptible to clarithromycin, doxycycline, moxifloxacin, and rifampin. The patient was empirically treated with rifampin, clarithromycin, and streptomycin together with multiple surgical debridements of his left index finger, which resulted in a significant reduction of the inflammation and resolution of the abscess

National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles

Background We evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). Methods From January 1, 2014-November 30, 2014, we surveyed all Thai hospitals with an intensive care unit and at least 250 beds. The use of prevention practices for CAUTI, CLABSI, and VAP was assessed. High compliance (≥75%) with all components of the CLABSI and VAP prevention bundles were determined. CAUTI, CLABSI, and VAP infection rates before and after implementing infection control practices are reported. Multivariable regression was used to examine associations between infection prevention bundle compliance and infection rate changes. Results Out of 245 eligible hospitals, 212 (86.5%) responded. A total of 120 (56.6%) and 115 hospitals (54.2%) reported ≥75% compliance for all components of the CLABSI and VAP prevention bundles, respectively, and 91 hospitals (42.9%) reported using ≥ 4 recommended CAUTI-prevention practices. High compliance with all of the CLABSI and VAP bundle components was associated with significant infection rate reductions (CLABSI, 38.3%; P <.001; VAP, 32.0%; P <.001). Hospitals regularly using ≥ 4 CAUTI-prevention practices did not have greater reductions in CAUTI (0.02%; P =.99). Conclusions Compliance with practices to prevent hospital infections was suboptimal. Policies and interventions promoting bundled approaches may help reduce hospital infections for Thai hospitals

Photo quiz: A 53-year-old Thai man with progressive swelling of the left index finger

Apreviously healthy 53-year-old Thai man living in central Thailand (Pathum Thani) presented with progressive swelling of his left index finger for 4 months. He worked at an advertising company, and his hobbies included gardening and decorating corals at his home. The swelling site was located where he had been bitten by an ant while gardening near a pond