Causative agents and resistance among hospital-acquired and ventilator-associated pneumonia patients at Srinagarind Hospital, northeastern Thailand.

Abstract. Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) have an impact on health care costs and mortality. The aim of this study was to identify the causative agents, antibiotics prescribed, cost of treatment and drug resistance trends among HAP and VAP patients at a tertiary-care hospital in northeastern Thailand during 2008 and 2009. The incidences of HAP in 2008 and 2009 were 0.7/1,000 and 0.55/1,000 hospital days, respectively. The incidences of VAP in 2008 and 2009 were 13.6/1,000 and 12.6/1,000 ventilator days, respectively. About 70% of HAP were caused by Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae; and 70% of VAP were caused by A. baumannii, P. aeruginosa, and K. pneumoniae. The ranking in the causative agents of HAP and VAP was not different, but more antimicrobial resistant organisms were seen in 2009. More than half of the costs of nosocomial infection treatment in 2008 and 2009 were the costs for HAP and VAP, 16.8 and 17.5 million Baht, respectively. Fewer A. baumannii and P. aeruginosa isolates were sensitive to carbapenems. Only one-fifth of A. baumannii isolates were sensitive to cefoperazone/sulbactam. The only two antimicrobial agents with consistently good activity against A. baumannii were tigecycline (approximately 85%) and colistin (approximately 99%). Fifty-seven point six percent of P. aeruginosa isolates were sensitive to ceftazidime, 72.4% were sensitive to piperacillin/tazobactam, 95.9% were sensitive to netilmycin and 99.2% were sensitive to colistin. Forty-seven percent of K. pneumoniae isolates were extended spectrum beta-lactamase and sensitive to carbapenems. Methicillin-resistant S. aureus was the cause of 6-7% of HAP/VAP cases in our study.

Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection.

OBJECTIVE: Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients. METHODS: Consecutive patients who had influenza-like illness less than seven days and had been tested for H1N1 by the real-time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests. RESULTS: There were 6494 patients had flu-like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09-7·40), 6·25 (1·42-27·49), 1·69 (1·08-2·66), and 0·31 (0·12-0·79), respectively. CONCLUSIONS: Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource-limited health care facilities.