Molecular Analysis of Microbial Communities in Endotracheal Tube Biofilms

Ventilator-associated pneumonia is the most prevalent acquired infection of patients on intensive care units and is associated with considerable morbidity and mortality. Evidence suggests that an improved understanding of the composition of the biofilm communities that form on endotracheal tubes may result in the development of improved preventative strategies for ventilator-associated pneumonia. (n = 5). DGGE profiling of the endotracheal biofilms revealed complex banding patterns containing between 3 and 22 (mean 6) bands per tube, thus demonstrating the marked complexity of the constituent biofilms. Significant inter-patient diversity was evident. The number of DGGE bands detected was not related to total viable microbial counts or the duration of intubation.Molecular profiling using DGGE demonstrated considerable biofilm compositional complexity and inter-patient diversity and provides a rapid method for the further study of biofilm composition in longitudinal and interventional studies. The presence of oral microorganisms in endotracheal tube biofilms suggests that these may be important in biofilm development and may provide a therapeutic target for the prevention of ventilator-associated pneumonia

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: Findings of the International Nosocomial Infection Control Consortium (INICC)

Purpose: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. © 2013 Springer-Verlag Berlin Heidelberg

Clinical risk-scoring algorithm to forecast scrub typhus severity

Pamornsri Sriwongpan,1,2 Pornsuda Krittigamas,3 Hutsaya Tantipong,4 Jayanton Patumanond,5 Chamaiporn Tawichasri,6 Sirianong Namwongprom1,71Clinical Epidemiology Program, Chiang Mai University, Chiang Mai, Thailand; 2Department of Social Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; 3Department of General Pediatrics, Nakornping Hospital, Chiang Mai, Thailand; 4Department of Medicine, Chonburi Hospital, Chonburi, Thailand; 5Clinical Epidemiology Program, Thammasat University, Bangkok, Thailand; 6Clinical Epidemiology Society at Chiang Mai, Chiang Mai, Thailand; 7Department of Radiology, Chiang Mai University, Chiang Mai, ThailandPurpose: To develop a simple risk-scoring system to forecast scrub typhus severity.Patients and methods: Seven years' retrospective data of patients diagnosed with scrub typhus from two university-affiliated hospitals in the north of Thailand were analyzed. Patients were categorized into three severity groups: nonsevere, severe, and dead. Predictors for severity were analyzed under multivariable ordinal continuation ratio logistic regression. Significant coefficients were transformed into item score and summed to total scores.Results: Predictors of scrub typhus severity were age >15 years, (odds ratio [OR] =4.09), pulse rate >100/minute (OR 3.19), crepitation (OR 2.97), serum aspartate aminotransferase >160 IU/L (OR 2.89), serum albumin ≤3.0 g/dL (OR 4.69), and serum creatinine >1.4 mg/dL (OR 8.19). The scores which ranged from 0 to 16, classified patients into three risk levels: non-severe (score ≤5, n=278, 52.8%), severe (score 6–9, n=143, 27.2%), and fatal (score ≥10, n=105, 20.0%). Exact severity classification was obtained in 68.3% of cases. Underestimations of 5.9% and overestimations of 25.8% were clinically acceptable.Conclusion: The derived scrub typhus severity score classified patients into their severity levels with high levels of prediction, with clinically acceptable under- and overestimations. This classification may assist clinicians in patient prognostication, investigation, and management. The scoring algorithm should be validated by independent data before adoption into routine clinical practice.Keywords: severe scrub typhus, risk-scoring system, clinical prediction rule, prognostic predictor

Validation of a clinical risk-scoring algorithm for severe scrub typhus

Pamornsri Sriwongpan,1,2 Jayanton Patumanond,3 Pornsuda Krittigamas,4 Hutsaya Tantipong,5 Chamaiporn Tawichasri,6 Sirianong Namwongprom1,7 1Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, 2Department of Social Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, 3Clinical Epidemiology Program, Faculty of Medicine, Thammasat University, Bangkok, 4Department of General Pediatrics, Nakornping Hospital, Chiang Mai, 5Department of Medicine, Chonburi Hospital, Chonburi, 6Clinical Epidemiology Society at Chiang Mai, Chiang Mai, 7Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Objective: The aim of the study reported here was to validate the risk-scoring algorithm for prognostication of scrub typhus severity. Methods: The risk-scoring algorithm for prognostication of scrub typhus severity developed earlier from two general hospitals in Thailand was validated using an independent dataset of scrub typhus patients in one of the hospitals from a few years later. The predictive performances of the two datasets were compared by analysis of the area under the receiver-operating characteristic curve (AuROC). Classification of patients into non-severe, severe, and fatal cases was also compared. Results: The proportions of non-severe, severe, and fatal patients by operational definition were similar between the development and validation datasets. Patient, clinical, and laboratory profiles were also similar. Scores were similar in both datasets, both in terms of discriminating non-severe from severe and fatal patients (AuROC =88.74% versus 91.48%, P=0.324), and in discriminating fatal from severe and non-severe patients (AuROC =88.66% versus 91.22%, P=0.407). Over- and under-estimations were similar and were clinically acceptable. Conclusion: The previously developed risk-scoring algorithm for prognostication of scrub typhus severity performed similarly with the validation data and the first dataset. The scoring algorithm may help in the prognostication of patients according to their severity in routine clinical practice. Clinicians may use this scoring system to help make decisions about more intensive investigations and appropriate treatments. Keywords: severity, clinical prediction rule, algorithm, prognosis, Thailan

Understandings of influenza and influenza vaccination among high-risk urban dwelling Thai adults: a qualitative study

Background The 2004 outbreak of influenza A H5N1 and the WHO's recommendation for national pandemic plans has led the Thai Ministry of Public Health to develop an influenza vaccination programme for high-risk adults. To date there is no available information to guide this intervention, and how to maximize the uptake of the vaccine by the Thai population. To address this knowledge gap, this study explored factors influencing urban-dwelling Thai adults' decisions whether or not to have the vaccine. It explored their beliefs about influenza and influenza vaccination, and other influences on their decisions. Methods In-depth interviews were conducted among 20 high-risk individuals who were aged 65 and over or under 65 years with chronic diseases requiring influenza vaccination. Interviews were tape recorded and analysed following using grounded theory. Results Most participants had insufficient knowledge about influenza and influenza vaccination. Their decisions in relation to vaccination were based on a number of factors, including salience of risk, influence of others, perception of the need for preventive health care and the availability of influenza vaccine. Conclusion These findings underscore the need to consider and understand factors underlying people's vaccination decisions to create an effective influenza vaccination programme

Ergotism in Thailand caused by increased access to antiretroviral drugs: a global warning

Item does not contain fulltextErgotism is a toxic condition resulting from overexposure to the ergot compounds produced by various fungi of the genus Claviceps. Traditionally, such exposure was due to ingestion of infected grains, but long-term or excessive use of medications containing ergot derivatives or drug-drug interactions between these medications can result in ergotism. Ergotamine, typically used to treat migraine, has less than 5% bioavailability due to extensive first-pass metabolism by cytochrome P450 3A4 (CYP3A4). Concurrent intake of ergotamine and strong CYP3A4 inhibitors, such as the HIV protease inhibitors (PIs), can lead to clinical ergotism. A total of 13 cases of clinical ergotism in HIV-infected patients has been published since 1997 (most recently reviewed by Frohlich et al)