Candidemia in Siriraj Hospital: epidemiology and factors associated with mortality.

OBJECTIVE: To study the epidemiology of candidemia and to identify risk factors for mortality among adult patients MATERIAL AND METHOD: Retrospective analysis of patients with candidemia in a 2400-bed tertiary-care university hospital in Bangkok, Thailand from June 2006 to May 2009. RESULTS: During the study period, 147 patients (50% male) with clinically significant candidemia were identified, with a mean age of 61 years. The underlying conditions included renal failure (47%), abdominal surgery within 30 days (31%), diabetes (27%), hematologic malignancies (25%), solid malignancies (25%), neutropenia (23%), and liver disease (11%). Nearly all patients (98%) received antibacterial therapy within 30 days. The four most common Candida species were C. albicans (39%), C. tropicalis (28%), C. glabrata (22%) and C. parapsilosis (6%). Only sixty-nine patients (47%) received appropriate antifungal therapy within 72 hours. The 28-day all-cause mortality was 59%. By multivariate analysis, the independent risk factors associated with mortality were neutropenia from chemotherapy OR = 9.12 (2.94-28.31), septic shock OR = 3.66 (1.54-8.66), ICU admission OR = 3.18 (1.27-7.92), inappropriate antifungal therapy within 72 hours OR = 2.38 (1.07-5.28) and renal failure OR = 2.34 (1.07-5.13). CONCLUSION: Adult patients with candidemia had a high mortality rate particularly those receiving an inappropriate antifungal therapy. Empirical antifungal therapy should be considered in selected patients on the basis of underlying conditions, severity of illness and risk factors for mortality.

Multiplex PCR for detection of clarithromycin resistance and simultaneous species identification of Mycobacterium avium complex.

Multiplex PCR (mPCR) was established for the simultaneous detection of clarithromycin (CLR) resistance and species identification of Mycobacterium avium complex (MAC). mPCR was tested on 218 MAC clinical isolates. CLR-resistance was detected by mPCR in 31 of 35 isolates identified by a microdilution method. Of the remaining 187 susceptible isolates identified by mPCR, 183 isolates had MIC < or = 8 microg/ml (susceptible), 3 with MIC of 16 (intermediate resistant) and 1 with MIC of > or = 32 microg/ml (resistant). Comparing with the PCR-restriction enzyme analysis, mPCR concordantly identified 185 isolates either as being M. avium or M. intracellulare, whereas one isolate was misidentified and 32 isolates could not be identified. Comparing with reference methods, the mPCR showed the sensitivity, specificity, positive predictive and negative predictive value of 89, 100, 100, and 98% for detection of CLR resistance; 92, 98, 99, and 78% for identification of M. avium; and 57, 100, 100, and 89% for identification of M. intracellulare, respectively.

Infection due to nontuberculous Mycobacterium other than MAC in AIDS patients at Siriraj hospital during 1998-2000: saprophyte vs pathogen.

HIV is a major health problem in Thailand. These patients are vulnerable to opportunistic infections, especially Mycobacterium tuberculosis and MAC infection. However, NTM was considered a rare disease in Thailand before the AIDS era. In this study, there were 38 HIV seropositive patients with NTM (other than MAC) identified from clinical specimens during the 3 year period 1998-2000 at Siriraj Hospital, which has a higher prevalence than the previous report. Among these patients, 29 cases were likely to have had definite infection from NTM, 5 cases possibly had NTM as a pathogen, and 4 cases had NTM as colonization. The most common site of infection was the lung (87%) and most common symptoms were cough (62.2%), fever (34.2%), weight loss (42.1%), and lymphadenopathy (5.3%). The outcome was poor because many NTM are not susceptible to standard medication for tuberculosis which is the empirical treatment for the majority of HIV seropositive patients with a clinical finding suspected of mycobacterial infection. The fatality rate was as high as 58.6 per cent. Awareness of NTM as a potential pathogen in HIV seropositive patientsand adjustment of medications even before the availability of culture results may improve the outcome of treatment of NTM infection in HIV seropositive patients.