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Khawcharoenporn T, Hanvivattanakul S. Safety profiles of homologous and heterologous regimens containing three major types of COVID-19 vaccine among people living with HIV. Int J STD AIDS 2024; 35:262-273. [PMID: 38048705 DOI: 10.1177/09564624231220090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Existing data on adverse effects (AEs) of homologous and heterologous COVID-19 vaccine regimens among people living with HIV (PLHIV) are limited. METHODS A prospective cohort study was conducted among Thai PLHIV during 2021-2022. Vaccine types and AEs were collected using an online survey. RESULTS Of the 398 vaccinated PLHIV, 92% had CD4 count ≥200 cells/µL and 96% were virologically suppressed at enrolment; 38% received two doses and 62% received three doses of COVID-19 vaccines. Inactivated, viral vector and mRNA were the most common vaccine types received as the first, second, and booster doses, respectively. For the first and second vaccine doses, the most common AEs were fever (15% and 11%) and injection site pain (11% and 11%). The mRNA vaccine significantly caused more overall AEs, injection pain, fatigue, and rashes than the other two types. For a booster dose, viral vector vaccine significantly caused more injection site pain and headache than the other two types. The majority of AEs of the first, second and booster doses spontaneously recovered without treatment. By multivariable analysis, receipt of viral vector or mRNA vaccine and age less than 40 years were independently associated with AEs of the primary series vaccines, while having AEs from the previous dose and female sex were independent factors associated with AEs of a booster vaccine. CONCLUSIONS Our study suggested the safety of homologous and heterologous regimens containing the three types of COVID-19 vaccines among PLHIV and identified those who required close monitoring for vaccine AEs.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand
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Suksamai S, Sajak S, Thongphubeth K, Khawcharoenporn T. A Prospective Quasi-Experimental Study of Multifaceted Interventions Including Computerized Drug Utilization Evaluation to Improve an Antibiotic Stewardship Program. J Patient Saf 2024:01209203-990000000-00198. [PMID: 38372558 DOI: 10.1097/pts.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE This study aimed to determine and evaluate interventions that improve an antibiotic stewardship program (ASP) in reduction of the amount of antibiotic use and errors in drug utilization evaluation (DUE) form completion. METHODS A prospective quasi-experimental study was conducted to evaluate the effectiveness of the multifaceted interventions (preauthorization with computerized DUE, self-supervised checklists, and short active reminders of the antibiotic guidelines recommendations) incorporating an ASP among hospitalized internal medicine patients in a Thai tertiary care center. The preintervention period was from January to December 2018, and the postintervention period was from February 2019 to January 2020. RESULTS A total of 9188 and 9787 patient data were analyzed during the preintervention and postintervention periods, respectively. The overall median antibiotic use (defined daily dose/1000 bed-days) was significantly decreased in the postintervention period compared with the preintervention period (867.68 versus 732.33; P < 0.001). The reduction in antibiotic use was predominantly observed among broad-spectrum antibiotics, including cefoperazone/sulbactam (15.35 versus 9.75; P = 0.04), cefepime (13.09 versus 6.37; P = 0.003), ciprofloxacin (32.99 versus 17.83; P < 0.001), piperacillin/tazobactam (99.23 versus 91.93; P = 0.03), meropenem (2.01 versus 0.99; P < 0.001), imipenem/cilastatin (9.53 versus 4.59; P = 0.04), and colistin (74.70 versus 22.34; P < 0.0001). The overall rate of errors in DUE form completion was significantly decreased after the intervention (40% versus 28%; P < 0.001). The incidence of carbapenem-resistant Enterobacteriaceae infections/colonization was significantly lower in the postintervention period (0.27 versus 0.12/1000 bed-days; P = 0.02). CONCLUSIONS The study multifaceted interventions incorporating ASP were associated with significant reduction in the amount of broad-spectrum antibiotic use, DUE form completion errors, and incidence of carbapenem-resistant Enterobacteriaceae infection/colonization.
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Affiliation(s)
- Sunudtha Suksamai
- From the Department of Internal Medicine, Faculty of Medicine, Thammasat University
| | | | | | - Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Sritipsukho P, Khawcharoenporn T, Siribumrungwong B, Damronglerd P, Suwantarat N, Satdhabudha A, Chaiyakulsil C, Sinlapamongkolkul P, Tangsathapornpong A, Bunjoungmanee P, Nanthapisal S, Tanprasertkul C, Sritipsukho N, Mingmalairak C, Apisarnthanarak A, Tantiyavarong P. Real-life effectiveness of COVID-19 vaccine during the Omicron variant-dominant pandemic: how many booster doses do we need? Emerg Microbes Infect 2023; 12:2174779. [PMID: 36715323 PMCID: PMC9936995 DOI: 10.1080/22221751.2023.2174779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The surge in coronavirus disease 2019 (COVID-19) caused by the Omicron variants of the severe acute respiratory syndrome coronavirus 2 necessitates researches to inform vaccine effectiveness (VE) and other preventive measures to halt the pandemic. A test-negative case-control study was conducted among adults (age ≥18 years) who were at-risk for COVID-19 and presented for nasopharyngeal real-time polymerase chain reaction testing during the Omicron variant-dominant period in Thailand (1 January 2022-15 June 2022). All participants were prospectively followed up for COVID-19 development for 14 days after the enrolment. Vaccine effectiveness was estimated and adjusted for characteristics associated with COVID-19. Of the 7971 included individuals, there were 3104 cases and 4867 controls. The adjusted VE among persons receiving 2-dose, 3-dose, and 4-dose vaccine regimens for preventing infection and preventing moderate-to-critical diseases were 33%, 48%, 62% and 60%, 74%, 76%, respectively. The VE were generally higher among those receiving the last dose of vaccine within 90 days compared to those receiving the last dose more than 90 days prior to the enrolment. The highest VE were observed in individuals receiving the 4-dose regimen, CoronaVac-CoronaVac-ChAdOx1 nCoV-19-BNT162b2 for both preventing infection (65%) and preventing moderate-to-critical diseases (82%). Our study demonstrated increased VE along with an increase in number of vaccine doses received. Current vaccination programmes should focus on reducing COVID-19 severity and mandate at least one booster dose. The heterologous boosters with viral vector and mRNA vaccines were highly effective and can be used in individuals who previously received the primary series of inactivated vaccine.
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Affiliation(s)
- Paskorn Sritipsukho
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand,Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Thana Khawcharoenporn
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand,Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand, Thana Khawcharoenporn Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Boonying Siribumrungwong
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand,Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pansachee Damronglerd
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Nuntra Suwantarat
- Department of Internal Medicine, Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Araya Satdhabudha
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chanapai Chaiyakulsil
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | | - Pornumpa Bunjoungmanee
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sira Nanthapisal
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand,Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chamnan Tanprasertkul
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand,Department of Obstetrics & Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Naiyana Sritipsukho
- Thammasat Postdoctoral Fellowship, Thammasat University, Pathumthani, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Anucha Apisarnthanarak
- Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand,Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pichaya Tantiyavarong
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Pienthong T, Chancharoenrat W, Sajak S, Phetsaen S, Hanchai P, Thongphubeth K, Khawcharoenporn T. Risk categorization and outcomes among healthcare workers exposed to COVID-19: A cohort study from a Thai tertiary-care center. J Microbiol Immunol Infect 2023:S1684-1182(23)00011-7. [PMID: 36725439 PMCID: PMC9852258 DOI: 10.1016/j.jmii.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND A risk categorization tool for healthcare workers (HCWs) exposed to COVID-19 is crucial for preventing COVID-19 transmission and requires validation and modification according to local context. METHODS From January to December 2021, a prospective cohort study was conducted among Thai HCWs to evaluate the performance of the specifically-created risk categorization tool, which classified HCWs into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups based on types of activities, duration of exposure, and protective methods used during exposure. Subsequent measures were determined for the HCWs based on the risk categories. RESULTS 1891 HCWs were included; 52%, 25% and 23% were LR, IR, and HR, respectively. COVID-19 was diagnosed in 1.3%, 5.1% and 27.3% of LR, IR and HR HCWs, respectively (P <0.001). Independent factors associated with COVID-19 were household or community exposure [adjusted odds ratio (aOR), 1588.68; P <0.001), being HR (aOR, 11.94; P <0.001), working at outpatient departments (aOR, 2.54; P <0.001), and no history of COVID-19 vaccination (aOR, 2.05; P = 0.01). The monthly rates of COVID-19 among LR, IR, and HR HCWs significantly decreased after the incremental rate of full vaccination. In-hospital transmission between HCWs occurred in 8% and was mainly due to eating at the same table. CONCLUSION The study risk categorization tool can differentiate risks of COVID-19 among the HCWs. Prevention of COVID-19 should be focused on HCWs with the identified risk factors and behaviors associated with COVID-19 development and encouraging receipt of full vaccination.
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Affiliation(s)
- Thanus Pienthong
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Sirinporn Sajak
- Infection Control Department, Thammasat University Hospital, Pathumthani, Thailand
| | - Suphannee Phetsaen
- Infection Control Department, Thammasat University Hospital, Pathumthani, Thailand
| | - Padcharadda Hanchai
- Infection Control Department, Thammasat University Hospital, Pathumthani, Thailand
| | | | - Thana Khawcharoenporn
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand,Corresponding author. Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
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Khawcharoenporn T, Chancharoenrat W, Sajak S, Phetsaen S, Hanchai P, Thongphubeth K, Pienthong T. 1893. Risk Categorization and Outcomes among Healthcare Workers Exposed to COVID-19: A Cohort Study from A Thai Tertiary-care Center. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
A risk categorization tool for healthcare workers (HCWs) exposed to severe acute respiratory syndrome coronavirus-2 is crucial for preventing coronavirus disease 2019 (COVID-19) transmission and requires validation and modification according to local context. We conducted this study to evaluate the performance of the study risk categorization tool and COVID-19-related outcomes among HCWs.
Methods
From 1 January to 31 December 2021, a prospective cohort study was conducted among COVID-19 exposing HCWs at a Thai tertiary-care center. The study risk categorization tool was specifically created in this study and modified from the United States Centers for Disease Control and Prevention recommendations, which classified HCWs into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups based on types of activities, duration of exposure, and protective methods used during exposure. Subsequent measures were determined for the HCWs based on the risk categories. The primary outcome was the difference in rates of COVID-19 in the LR, IR and HR HCWs.
Results
There were 1,892 HCWs included; 52%, 25% and 23% were LR, IR, and HR, respectively. The median age was 30 years (IQR, 26-36 years). The majority was female (79%) and nurses (33%). The most common risk activities were being in the same room with closed space without wearing a mask with COVID-19 cases (75%). COVID-19 was diagnosed in 157 HCWs and 27%, 5% and 1% of HR, IR and LR HCWs, respectively (P< 0.001). By multivariable analysis, factors associated with COVID-19 included household or community exposure [adjusted odds ratio (aOR), 1588.68; P< 0.001], being HR group (aOR, 11.94; P< 0.001), working at outpatient departments (aOR, 2.54; P< 0.001), and no history of COVID-19 vaccination (aOR, 2.05; P=0.01). The monthly rates of COVID-19 among LR, IR, and HR HCWs significantly decreased after the incremental rate of full vaccination. In-hospital transmission between HCWs occurred in 8% and was mainly due to eating at the same table (58%).
Conclusion
The study risk categorization tool can differentiate risks of COVID-19 among the HCWs. Prevention of COVID-19 should be focused on HCWs with the identified risk factors and behaviors associated with COVID-19 development and encouraging receipt of full vaccination.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | | | - Sirinporn Sajak
- Thammasat University Hospital , Pathumthani, Pathum Thani , Thailand
| | | | | | | | - Thanus Pienthong
- Faculty of Medicine, Thammasat University , Pathumthani, Pathum Thani , Thailand
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Jongmekwamsuk K, Hanvivattanakul S, Vanichanan J, Khawcharoenporn T. 1940. COVID-19 Vaccines and Related Adverse Effects among Health Sciences and Non-Health Sciences Students from Two Large Public Universities in Thailand. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Existing data on vaccine regimens received by university students and related adverse effects are limited.
Methods
An online survey study was conducted among students from 12 Health Sciences faculties (HS), including Faculty of Medicine and from 16 non-Health Sciences faculties (NHS) of two large urban Thai universities from October 2021 to January 2022. Types, doses and adverse effects (AEs) of COVID-19 vaccines received by HS and NHS were assessed.
Results
There were 1,439 participating students who had received two doses of COVID-19 vaccines. Of these 1,439 students, 522 (36%) were HS (208 were medical students), 393 (27%) were from faculties of Sciences, and 524 (37%) were from faculties of Social Sciences. The types of the first dose vaccine received were inactivated (49%), viral vector (46%) and mRNA (5%), while the types of the second dose vaccine received were viral vector (53%), inactivated (40%) and mRNA (7%). For the first dose vaccines, the most common AE of inactivated, viral vector and mRNA vaccines were muscle pain (47%, 82%, 58%, respectively). For the second dose vaccines, the most common AE were cough (47%) for inactivated vaccines and muscle pain (49% for viral vector and 56% for mRNA vaccines). Viral vector vaccines were more likely to cause fever, muscle pain, diarrhea, headache and rashes while inactivated vaccines were more likely to cause cough. The mRNA vaccines caused injection site pain more than inactivated vaccines. Tables 1 and 2 demonstrate the type and onset of AEs by types of the vaccines. Overall, the majority of AEs occurred at 24-48 hours after vaccination (57-68%), were more severe with the first dose compared to the second dose (59%) and resolved spontaneously or with symptomatic treatment without the need for hospitalization (98%). The AEs experienced by HS and NHS were different according to the types of vaccine they received. Table 1Adverse effects of the first dose of COVID-19 vaccine, stratified by type, of those who had received two doses of the vaccinesTable 2Adverse effects of the second dose of COVID-19 vaccine, stratified by type, of those who had received two doses of the vaccines.
Conclusion
The AEs experienced by the students were different according to the type and number of doses of COVID-19 vaccines. The AEs were mostly non-severe and occurred less for the second dose compared to the first dose. The study findings could serve as information provided to university students for decision making regarding COVID-19 vaccination.
Disclosures
All Authors: No reported disclosures.
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Khawcharoenporn T, Boonruang K. 1299. Effectiveness of Educational Interventions to Reduce Incidence of Occupational Exposure to Blood and Body Fluid in First-clinical-year Medical Students of A Thai University-based Medical School. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Occupational exposures to patients’ blood and body fluid are not uncommon and increase risk of blood-borne infections among medical students during their clinical clerkship. However, existing data on interventions to prevent such exposures are limited in Thailand. We conducted this study to evaluate effectiveness of the study interventions in decreasing incidences of the occupational exposures among first-clinical-year medical students (4th-year students) in a Thai university-based medical school.
Methods
A quasi-experimental study was conducted to compare the incidence of the occupational exposures between the pre-intervention period (2019 academic year) and the intervention period (2020 academic year). The interventions included an orientation session about occupation exposure prevention and procedure review for the medical students on the first day of each major department rotation and the use of LINE application to send video clips and articles for procedure review, weekly remind the students how to prevent themselves from common occupational exposures via short messages and provide Q&A sessions between the researchers and medical students regarding procedures and occupational exposure prevention.
Results
A total of 63 medical students, men (57%) and women (43%), and 66 medical students, men (47%) and women (53%) participated in the study during the pre-intervention and intervention periods, respectively. The incidence of occupational exposure among the students was significantly lower in the intervention period compared to the pre-intervention period (7.9 vs. 35.86 per 100 person-years; P< 0.001). The most common exposures were mucosal exposure (44%), needle stick injury (25%), and sharp object injuries (25%). After the exposures, there was no acquisition of syphilis and infections due to human immunodeficiency virus, hepatitis B virus and hepatitis C virus among the students in both periods.
Conclusion
The study interventions that included focused orientation and the use of LINE application to communicate with the students regarding procedure review and occupational exposure prevention were associated with significant decrease in the incidence of occupational exposure during their clinical clerkship.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
| | - Krittapol Boonruang
- Faculty of Medicine, Thammasat University , Pathumthani, Pathum Thani , Thailand
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Sritipsukho P, Khawcharoenporn T, Siribumrungwong B, Damronglerd P, Suwantarat N, Satdhabudha A, Chaiyakulsil C, Sinlapamongkolkul P, Tangsathapornpong A, Bunjoungmanee P, Nanthapisal S, Tanprasertkul C, Sritipsukho N, Mingmalairak C, Apisarnthanarak A, Tantiyavarong P. Comparing real-life effectiveness of various COVID-19 vaccine regimens during the delta variant-dominant pandemic: A test-negative case-control study. Emerg Microbes Infect 2022; 11:585-592. [PMID: 35114893 PMCID: PMC8856087 DOI: 10.1080/22221751.2022.2037398] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Data on real-life vaccine effectiveness (VE), against the delta variant (B.1.617.2) of the severe acute respiratory syndrome coronavirus 2 among various coronavirus disease 2019 (COVID-19) vaccine regimens are urgently needed to impede the COVID-19 pandemic. We conducted a test-negative case-control study to assess the VE of various vaccine regimens for preventing COVID-19 during the period when the delta variant was the dominant causative virus (≥ 95%) in Thailand (25 July 2021–23 Oct 2021). All individuals (age ≥18 years) at-risk for COVID-19, presented for nasopharyngeal real-time polymerase chain reaction (RT-PCR) testing, were prospectively enrolled and followed up for disease development. Vaccine effectiveness was estimated with adjustment for individual demographic and clinical characteristics. Of 3353 included individuals, there were 1118 cases and 2235 controls. The adjusted VE among persons receiving two-dose CoronaVac plus one BNT162b2 booster was highest (98%; 95% confidence interval [CI] 87–100), followed by those receiving two-dose CoronaVac plus one ChAdOx1 nCoV-19 booster (86%; 95% CI 74–93), two-dose ChAdOx1 nCoV-19 (83%; 95% CI 70–90), one CoronaVac dose and one ChAdOx1 nCoV-19 dose (74%; 95% CI 43–88) and two-dose CoronaVac (60%; 95% CI 49–69). One dose of CoronaVac or ChAdOx1 nCoV-19 had a VE of less than 50%. Our study demonstrated the incremental VE with the increase in the number of vaccine doses received. The two-dose CoronaVac plus one BNT162b2 or ChAdOx1 nCoV-19 booster regimens was highly effective in preventing COVID-19 during the rise of delta variant.
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Affiliation(s)
- Paskorn Sritipsukho
- Center of Excellence in Applied Epidemiology, Thammasat University.,Department of Pediatrics, Faculty of Medicine, Thammasat University
| | - Thana Khawcharoenporn
- Center of Excellence in Applied Epidemiology, Thammasat University.,Department of Internal Medicine, Faculty of Medicine, Thammasat University
| | - Boonying Siribumrungwong
- Center of Excellence in Applied Epidemiology, Thammasat University.,Department of Surgery, Faculty of Medicine, Thammasat University
| | | | - Nuntra Suwantarat
- Department of Internal Medicine, Chulabhorn International College of Medicine, Thammasat University
| | | | | | | | | | | | - Sira Nanthapisal
- Center of Excellence in Applied Epidemiology, Thammasat University.,Department of Pediatrics, Faculty of Medicine, Thammasat University
| | - Chamnan Tanprasertkul
- Center of Excellence in Applied Epidemiology, Thammasat University.,Department of Obstetrics & Gynecology, Faculty of Medicine, Thammasat University
| | | | | | - Anucha Apisarnthanarak
- Center of Excellence in Applied Epidemiology, Thammasat University.,Department of Internal Medicine, Faculty of Medicine, Thammasat University
| | - Pichaya Tantiyavarong
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University Pathumthani, Thailand, 12120
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Khawcharoenporn T, Noisang K. Incomplete contact investigation and risk of developing TB among healthcare professionals. Int J Tuberc Lung Dis 2022; 26:111-118. [PMID: 35086622 DOI: 10.5588/ijtld.21.0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Data on the impact of incomplete contact investigation on TB incidence among healthcare professionals (HCPs) after TB exposure are limited.METHODS: This was a prospective cohort study with 2-year follow-up among Thai HCPs exposed to TB to determine TB incidences and factors associated with TB development.RESULTS: Of the 398 HCPs with TB exposure, 367 (92%) participated in the study; 342 HCPs were included in the final analysis; 311 participated in contact investigations; 303 underwent chest X-ray; 252 completed baseline TB and latent TB infection screening using tuberculin skin test (TST); 210 had negative baseline TST; and 45 completed follow-up tests at 3 months. Altogether, 20 HCPs developed TB (2.92/100 person-years). TB incidences in HCPs not participating in or not completing the investigation at any step were higher than in those who completed the evaluation (11.29 and 2.90, respectively, vs. 0/100 person-years; P < 0.05). No participation in contact investigation and no baseline chest X-ray were independent factors associated with TB development (adjusted odds ratio [aOR] 6.7; P < 0.001 and aOR 8.9; P = 0.01, respectively).CONCLUSION: Study findings indicate increased risks of TB development among HCPs not undergoing or not completing contact investigations and underscore the need for interventions to improve contact investigation participation and completeness.
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Affiliation(s)
- T Khawcharoenporn
- Division of Infectious Diseases, Thammasat University, Pathumthani, Thailand
| | - K Noisang
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Pienthong T, Apisarnthanarak A, Khawcharoenporn T, Suwantarat N, Rutjanawech S, Damronglert P, Samosornsuk W, Mundy LM, Visuttichaikit S. Intestinal Basidiobolomycosis in a Patient with Idiopathic CD4 Lymphocytopenia. J Mycol Med 2022; 32:101260. [DOI: 10.1016/j.mycmed.2022.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/15/2022]
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11
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Khawcharoenporn T, Noisang K. 798. Incomplete Contact Investigation and Risk of Developing Tuberculosis Among Healthcare Professionals After Tuberculosis Exposure. Open Forum Infect Dis 2021. [PMCID: PMC8644939 DOI: 10.1093/ofid/ofab466.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB) contact investigation is recommended for healthcare professionals (HCPs) after TB exposure. However, association between no participation in or incomplete contact investigation and subsequent TB development has not been well-described. This study aims to determine TB incidences and factors associated with TB development among HCPs requiring contact investigations.
Methods
We conducted a prospective cohort study among Thai HCPs with TB exposure from January 2013 to December 2017. Contact investigations, including baseline TB and latent tuberculosis infection (LTBI) screening and follow-up at 3 months after TB exposure, were recommended to all HCPs. The two-step tuberculin skin test (TST) was used for LTBI testing. All HCPs were followed for 2 years for TB development.
Results
Of the 342 HCPs with TB exposure included in the study, 311 (91%) participated in the contact investigations and 252 (74%) completed baseline TB and LTBI screening. Among the 210 HCPs with negative baseline TST, 45 (21%) completed the follow-up tests. The overall incidence of TB was 2.92/100 person-years. HCPs who did not complete follow-up TST had significantly higher TB incidence than those completed baseline and follow-up TST (3.55 vs. 0/100 person-years; P=0.01). No participation in the contact investigation and no chest radiograph performed at baseline were the independent factors associated with TB development among the HCPs [adjusted odds ratio (aOR) 6.69; P< 0.001 and aOR 8.85; P=0.01, respectively]. Contact with an index patient with concomitant TB at extrapulmonary sites (aOR 49.76, 10.03-246.99; P< 0.001) and with negative sputum AFB but positive sputum GeneXpert MTB/RIF (aOR 3.18, 1.35-7.50; P=0.008) were independently associated with no participation in the contact investigation.
Conclusion
The findings indicate the risk of TB development among the HCPs who did not undergo or complete contact investigations and underscore the need for interventions to improve contact investigation participation and completeness.
Disclosures
All Authors: No reported disclosures
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Khawcharoenporn T, Chimkhong W, Roestpricha V. Use of Template Documents with Guidance to Improve the Quality of Human Subjects Research Protocol Submissions to a Thai Research Ethics Committee. J Empir Res Hum Res Ethics 2021; 16:501-513. [PMID: 34125621 DOI: 10.1177/15562646211025470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A pre-post study was conducted to evaluate the utility of template documents specifically created to assist research protocol submissions to a Thai research ethics committee (REC). A total of 172 protocols during the 2014-2016 preintervention period were matched to 172 protocols during the 2017-2019 postintervention period by type of principal investigator and REC review category. The intervention was associated with a significant reduction in initial REC requirement deficiencies in the information sheet and informed consent form, resubmission turn-around time by the principal investigator, and time form protocol submission to REC approval. The most significant postintervention improvements were for information about the consent process and listed risks of study participation. In this study, utilization of a structured protocol template with guidance instructions was associated with measurable improvement in the quality of research protocol submissions and REC review process.
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Affiliation(s)
- Thana Khawcharoenporn
- Department of Internal Medicine, Faculty of Medicine, 37699Thammasat University, Pathumthani, Thailand.,Human Research Ethics Committee of Thammasat University (Medicine), 37699Thammasat University, Pathumthani, Thailand
| | - Wilaiwan Chimkhong
- Human Research Ethics Committee of Thammasat University (Medicine), 37699Thammasat University, Pathumthani, Thailand
| | - Varanya Roestpricha
- Human Research Ethics Committee of Thammasat University (Medicine), 37699Thammasat University, Pathumthani, Thailand
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13
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Khawcharoenporn T, Srirach C, Chunloy K. Educational Interventions Improved Knowledge, Attitude, and Practice to Prevent HIV Infection among HIV-Negative Heterosexual Partners of HIV-Infected Persons. J Int Assoc Provid AIDS Care 2021; 19:2325958219899532. [PMID: 31955656 PMCID: PMC6971971 DOI: 10.1177/2325958219899532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 1-year quasi-experimental study was conducted among HIV-noninfected heterosexual partners of HIV-infected patients cared at a Thai tertiary care hospital. The educational interventions comprised a 1-hour educational session, a condom use teaching session, focus group discussion, and free HIV testing. Of the 88 seronegative partners enrolled, 53 and 35 underwent the educational interventions once and twice, respectively. After the educational interventions, the median score for knowledge on HIV infection and transmission prevention significantly increased (28 versus 21; P < .001). After the interventions, higher proportions of the participants would use treatment of the HIV-infected partners (77% versus 58%) and preexposure prophylaxis (59% versus 38%) as methods to prevent HIV transmission and have a regular HIV blood test every 6 months (94% versus 81%). Among the 35 participants who participated in the educational interventions twice, most of the knowledge and positive attitudes were retained. The rates of regular HIV testing every 6 months had increased significantly from baseline to 1 year later (29% to 74%, respectively). None of the participants developed HIV infection. These findings suggest that the study interventions could improve knowledge about HIV infection and transmission prevention, attitude and practices toward prevention, and increase regular HIV testing among the seronegative partners.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Chanika Srirach
- HIV/AIDS Care Unit, Thammasat University Hospital, Pathum Thani, Thailand
| | - Krongtip Chunloy
- HIV/AIDS Care Unit, Thammasat University Hospital, Pathum Thani, Thailand
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14
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Chaononghin S, Visuttichaikit S, Apisarnthanarak A, Khawcharoenporn T. Disseminated Mycobacterium scrofulaceum Infection in a Patient with Anti-Interferon-γ Autoantibodies: A Case Report and Review of the Literature. Int J Mycobacteriol 2021; 9:91-94. [PMID: 32474495 DOI: 10.4103/ijmy.ijmy_182_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mycobacterium scrofulaceum is an environmental mycobacterial species rarely reported to cause disseminated infection in adults. We report the case of a disseminated M. scrofulaceum infection in a 55-year-old nonhuman immunodeficiency virus-infected Thai man with anti-interferon-γ autoantibodies. The clinical signs of the infection improved after the induction regimen with amikacin, rifampicin, ethambutol, and clarithromycin, followed by the consolidation regimen with ethambutol, clarithromycin, and trimethoprim/sulfamethoxazole. Our review of previous reported cases of this infection indicates its association with immune deficiency, complex treatment, and a high rate of unfavorable outcomes.
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Affiliation(s)
- Surachai Chaononghin
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | - Suttichai Visuttichaikit
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathumthani, Thailand
| | - Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Khlong Nueng, Pathumthani, Thailand
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15
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Khawcharoenporn T, Kanoktipakorn P. 99. Effectiveness of Antibiotic Prophylaxis Among Patients Undergoing Elective Transurethral Resection of the Prostate in the Era of Antibiotic Resistance. Open Forum Infect Dis 2020. [PMCID: PMC7777573 DOI: 10.1093/ofid/ofaa439.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Data existing on effectiveness of antibiotic prophylaxis (AP) for transurethral resection of the prostate (TURP) are limited in the era of antibiotic resistance. Methods A 4-year prospective observational cohort study was conducted among patients undergoing TURP in an academic tertiary-care hospital during 2016–2019. Patients were excluded if pre-operative (pre-op) urine cultures were not sent or grew mixed (>2) organisms, or they had pre-op urinary tract infection (UTI) or lost follow-up after TURP. Appropriateness of AP was defined as 1) correct dosing and duration and narrowest spectrum according to the hospital AP guidelines and local epidemiology and 2) being active against uropathogens isolated from the pre-op culture. Primary outcome was the rate of UTI within 30 days post TURP compared between appropriate antibiotic prophylaxis (AAP) and inappropriate antibiotic prophylaxis (IAP) groups. Results 342 patients were screened and 61 were excluded. Of the 281 patients included, 139 (49%) received AAP and 142 (51%) received IAP. The reasons for IAP were prescribing too broad-spectrum antibiotics (57%), inactive antibiotics (41%) and incorrect dosing (2%). Pre-op urine cultures were no growth in 148 patients (53%). Among the 133 positive urine cultures with 144 isolates, Escherichia coli (52%) was the most commonly isolated. Thirty-one percent of these 144 isolates produced extended-spectrum beta-lactamase (ESBL) and 23 (16%) isolates were multidrug-resistant. The resistant rates of Enterobacteriaceae were 73% for ciprofloxacin, 65% for TMP-SMX and 46% for ceftriaxone. The two most commonly prescribed prophylactic antibiotics were ceftriaxone (51%) and ciprofloxacin (34%). The rate of UTI within 30 days post-TURP was significantly higher in IAP group compared to AAP group (47% vs 27%; P< 0.001). Prescribing inactive prophylactic antibiotics was the independent factor associated with 30-day post-TURP UTI (adjusted odds ratio 2.88; P=0.001). Conclusion Appropriate antibiotic prophylaxis significantly reduced UTI within 30 days of elective TURP. Obtaining pre-op urine culture and prescribing an active prophylactic agent are critical for preventing post-TURP UTI in the era of antibiotic resistance. Disclosures All Authors: No reported disclosures
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Abstract
Polypharmacy poses risks associated with drug-drug interactions, increased adverse effects, pill burden, poor compliance and unfavorable treatment outcomes. Whether polypharmacy affects treatment outcomes among people living with HIV (PLHIV) is largely unknown. A prospective study was conducted among PLHIV followed-up at a tertiary-care clinic of an academic medical center during January 2012 to December 2017. The clinic provided comprehensive HIV care with multidisciplinary team approach focusing on treatment adherence. Polypharmacy was defined as concurrent use of 5 or more non-antiretroviral (ARV) drugs for at least one year. Of the 248 PLHIV included, 23 (9%) received polypharmacy. PLHIV with polypharmacy were older (median age 45 vs. 36 years), were more likely to have underlying diseases (65% vs. 18%) and had lower median initial CD4 counts (40 vs. 214 cells/mm3). The rates of virologic suppression at 12 months after ARV therapy were 96% and 92% in polypharmacy and non-polypharmacy groups, respectively (P = 0.70), while the median CD4 cell count increase was higher among the non-polypharmacy group at 12 months (207 vs. 403 cells/mm3; P < 0.001). There were no differences in rates of adverse effects and experienced drug-drug interactions. Hospitalization due to HIV-related diseases within 12 months after ARV initiation [adjusted odds ratio (aOR) 11.63, P = 0.004] and lower 3-item score for ARV adherence (aOR 0.49, P = 0.01) were independently associated with failure of virologic suppression at 12 months. These findings suggest that polypharmacy did not affect the virological outcomes among our PLHIV. Patients with the characteristics associated with virological failure should be closely monitored.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand
| | - Vitsaroot Tanslaruk
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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17
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Kritsanavarin U, Bloss E, Manopaiboon C, Khawcharoenporn T, Harnlakon P, Vasanti-Uppapokakorn M, Kitwattanachai P, Naprasert S, Phiphatthananon T, Visavakum P, Jetsawang B, Mock PA. HIV incidence among men who have sex with men and transgender women in four provinces in Thailand. Int J STD AIDS 2020; 31:1154-1160. [PMID: 32903141 DOI: 10.1177/0956462420921068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The HIV epidemic in Thailand is concentrated in key populations, with the highest rates in men who have sex with men (MSM) and transgender women (TG). Previous studies of HIV incidence in these groups have been limited mostly to Bangkok. We measured HIV incidence in MSM and TG in four provinces and evaluated factors associated with incident infections to inform public health prevention efforts. An analysis was conducted using data collected during a prospective observational cohort study during April 2015-May 2018 in outpatient clinics in five hospitals across four provinces in Thailand. MSM and TG aged ≥18 years, who were not known to be HIV-infected, and who reported anal intercourse with a male or TG without a condom in the past six months were enrolled. Participants were followed-up every 6 months for 18 months with questionnaires and HIV testing. A total of 40 HIV seroconversions occurred during follow-up, resulting in an HIV incidence of 3.5 per 100 person-years (95% CI 2.5, 4.8). Multivariate analyses indicated that identifying as gay (adjusted hazard ratio [AHR] 4.9; 95% CI 1.7-14.2), having receptive anal sex in the past six months (AHR 3.6; 95% CI 1.4-9.5), using alcohol (AHR 3.3; 95% CI 1.3-8.3), and taking alkyl nitrites (AHR 4.4; 95% CI 1.7-11.2) in the past six months were all independently associated with HIV infection. Overall this study found a lower HIV incidence in the highest risk population in Thailand compared with similar studies in Bangkok. Accelerated prevention efforts are needed to make the goal of 'zero new infections' possible in Thailand.
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Affiliation(s)
- Usanee Kritsanavarin
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Emily Bloss
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Chomnad Manopaiboon
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | | | | | | | | | | | | | - Prin Visavakum
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Bongkoch Jetsawang
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Philip A Mock
- Centers for Disease Control and Prevention, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
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18
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Khawcharoenporn T, Aksornchindarat W, Yodpinij N, Srisungngam S, Rudeeaneksin J, Bunchoo S, Klayut W, Sangkitporn S, Phetsuksiri B. T-SPOT ®.TB Test for Latent Tuberculosis Infection Diagnosis and Treatment Guidance in Thai Health-Care Professionals. Indian J Occup Environ Med 2020; 24:47-49. [PMID: 32435118 PMCID: PMC7227739 DOI: 10.4103/ijoem.ijoem_284_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/12/2019] [Accepted: 01/07/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Thammasat University, Pathumthani, Thailand.,Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Napat Yodpinij
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Sopa Srisungngam
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Janisara Rudeeaneksin
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Supranee Bunchoo
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Wiphat Klayut
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Benjawan Phetsuksiri
- Department of Medical Sciences, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
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19
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Khawcharoenporn T, Laichuthai W. 499. Carbapenem-resistant Enterobacteriaceae (CRE)-associated Infections and Prolonged Colonization among Hospitalized Patients Colonized by CRE. Open Forum Infect Dis 2019. [PMCID: PMC6810991 DOI: 10.1093/ofid/ofz360.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background This study aims to determine rates of subsequent carbapenem-resistance Enterobacteriaceae (CRE)-associated infections and prolonged colonization among patients colonized by CRE and to identify risk factors of such conditions. Methods This study was conducted among a cohort of hospitalized adult patients colonized by CRE at any sites from June 1, 2015 to December 31, 2018. The patients had been prospectively identified by the Infection Control (IC) Division of a Thai tertiary-care hospital. According to the hospital’s IC protocol, patients with CRE colonization/infections were isolated and underwent CRE cultured at the colonized/infected sites every week until the cultures have turned negative for 2 consecutive times. Prolonged colonization was defined as having CRE colonization more than 30 days. Results Of the 125 patients identified, 25 were excluded due to death, being transferred, or discharged within 48 hours of CRE colonization detected. The final cohort included 100 patients, the median age was 74 years, 48% were male, the most common colonized site was rectum (37%) and 20 patients (20%) developed subsequent CRE-associated infections. The median time from colonization to infection was 13 days and the most common site of infection was bloodstream (45%). Independent factors associated with subsequent CRE-associated infections were the number of colonization sites [adjusted odds ratio (aOR) 7.98, P < 0.001)], central line insertion during admission (aOR 7.97, P = 0.009) and receipt of vancomycin during admission (aOR 24.77, P = 0.02). Prolonged colonization was observed in 13 of 77 evaluable patients (17%). There were trends toward significance that the length of hospital stay and duration of antibiotic prior to colonization were associated with prolonged colonization (P < 0.10). Conclusion The findings suggest high rates of subsequent CRE-associated infections and prolonged colonization among the study population. Patients with risk factors for subsequent infections should be closely monitored and empirically-treated with antibiotics active against CRE while those with risk factors for prolonged colonization should receive continued surveillance and isolation to prevent CRE transmission. Disclosures All authors: No reported disclosures.
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Chansirikarnjana S, Apisarnthanarak A, Suwantarat N, Damronglerd P, Rutjanawech S, Visuttichaikit S, Khawcharoenporn T. Nocardia intracranial mycotic aneurysm associated with proteasome inhibitor. IDCases 2019; 18:e00601. [PMID: 31372340 PMCID: PMC6660599 DOI: 10.1016/j.idcr.2019.e00601] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/28/2022] Open
Abstract
We report a case of Nocardia farcinica ruptured intracranial mycotic aneurysm associated with bortezomib and corticosteroid treatment in a multiple myeloma patient. The patient was treated with trimethoprim-sulfamethoxazole and moxifloxacin together with surgical repairment of intracranial mycotic aneurysm.
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Affiliation(s)
| | - Anucha Apisarnthanarak
- Thammasat University Hospital, Pathumthani, 12120, Thailand.,Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Nuntra Suwantarat
- Thammasat University Hospital, Pathumthani, 12120, Thailand.,Chulabhorn International College of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Pansachee Damronglerd
- Thammasat University Hospital, Pathumthani, 12120, Thailand.,Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Sasinuch Rutjanawech
- Thammasat University Hospital, Pathumthani, 12120, Thailand.,Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | | | - Thana Khawcharoenporn
- Thammasat University Hospital, Pathumthani, 12120, Thailand.,Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
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21
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Khawcharoenporn T, Mongkolkaewsub S, Naijitra C, Khonphiern W, Apisarnthanarak A, Phanuphak N. HIV risk, risk perception and uptake of HIV testing and counseling among youth men who have sex with men attending a gay sauna. AIDS Res Ther 2019; 16:13. [PMID: 31189481 PMCID: PMC6560849 DOI: 10.1186/s12981-019-0229-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are amongst populations at-risk for HIV acquisition in Thailand. In youth MSM (aged 15-24 years), the incidence of HIV infection has substantially increased. However, data on HIV risk, risk perception and HIV testing and counseling (HTC) uptake among youth MSM in hotspots are limited. METHODS A subanalysis of a prospective study among Thai MSM attending a gay sauna was conducted. HIV risk and risk perception were assessed by an anonymous survey. The MSM were categorized as having actual "low-risk", "moderate-risk" and "high-risk" for HIV acquisition based on the validated study risk categorization tool. HTC was provided on-site with result notification within 1 h. HIV care establishment appointment was arranged by the counselors for HIV-infected participants. Care engagement within 1 year of diagnosis was subsequently assessed. RESULTS There were 358 MSM participants; 87 (24%) were youth MSM. Comparing to other MSM, youth MSM had significantly higher median number of lifetime sexual partners [2 (IQR 1-9) vs. 1 (IQR 0-1); P < 0.001), were more-likely to ever exchange sex for money (44% vs. 9%; P < 0.001) and have sexual partner who exchanged sex for money (8% vs. 1%; P < 0.001). Rates of consistent condom use in the past 3 months for anal, oral and vaginal sexes were low and not significantly different between youth and other MSM (51% vs. 61%, 26% vs. 35% and 72% vs. 61%, respectively). By using the study risk categorization tool, there were 68 youth MSM with moderate or high-risk for HIV acquisition, of which 43 (63%) had false perception of low HIV risk. Youth MSM were more likely than other MSM to accept HTC [68% vs. 33%, P < 0.001)] and to be first-time testers (42% vs. 28%, P = 0.07). By HTC, the rates of HIV infection tended to be higher among youth MSM comparing to other MSM [14/59 (24%) vs. 11/89 (12%); P = 0.07]. Among the 14 youth MSM newly-diagnosed with HIV infection, only 6 (43%) showed-up for continuity care after 1-year follow-up. CONCLUSIONS Youth MSM had substantial high HIV risk, false perception of low HIV risk and low rate of care engagement but demonstrated considerable rate of HTC uptake. Strategies to improve access to HTC, risk perception and linkage to care are needed for HIV prevention and management among the youth MSM.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Thammasat University Hospital, Pathumthani, Thailand
| | | | | | | | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Thammasat University Hospital, Pathumthani, Thailand
| | - Nittaya Phanuphak
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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Aksornchindarat W, Yodpinij N, Phetsuksiri B, Srisungngam S, Rudeeaneksin J, Bunchoo S, Klayut W, Sangkitporn S, Khawcharoenporn T. T-SPOT®.TB test and clinical risk scoring for diagnosis of latent tuberculosis infection among Thai healthcare workers. J Microbiol Immunol Infect 2019; 54:305-311. [PMID: 31221513 DOI: 10.1016/j.jmii.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/29/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Screening for latent tuberculosis infection (LTBI) is important to identify healthcare workers (HCWs) benefiting from preventive therapy. Interferon-gamma release assays (IGRAs) are sensitive and specific tests for LTBI diagnosis. However, in settings where IGRAs are not available, clinical risk assessment may be used as an alternative to diagnose LTBI. METHODS A cross-sectional study was conducted among HCWs of a tertiary-care university hospital in Thailand. All HCWs underwent T-SPOT®.TB test (T-SPOT) and assessment of LTBI clinical risks. Clinical risks associated with T-SPOT positivity were determined by multivariable logistic regression analysis and were given scores accordingly. The performance of the clinical risk scoring was evaluated in comparison to T-SPOT. RESULTS Among 140 enrolled HCWs, 125 (89%) were females, the median age was 27 years and 23 (16%) had T-SPOT positivity. Independent factors associated with T-SPOT positivity were age ≥30 years (adjusted odds ratio [aOR] 3.95; P = 0.002), working duration ≥60 months (aOR 3.75, P = 0.004) and frequency of TB contact ≥6 times (aOR 8.83, P = 0.005). The study's clinical risk scoring had the area under the curve by receiver operating curve analysis of 0.76 (P < 0.001) using T-SPOT positivity as a reference standard. The score of ≥3 had the best performance in diagnosing LTBI with sensitivity, specificity, positive predictive value and negative predictive value of 70%, 71%, 32% and 92%, respectively. CONCLUSIONS In this setting where LTBI was prevalent among HCWs but IGRAs are not widely available, the clinical risk scoring may be used as an alternative to diagnose LTBI in HCWs.
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Affiliation(s)
| | - Napat Yodpinij
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Benjawan Phetsuksiri
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Sopa Srisungngam
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Janisara Rudeeaneksin
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Supranee Bunchoo
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Wiphat Klayut
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
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Khawcharoenporn T, Aksornchindarat W, Yodpinij N, Srisungngam S, Rudeeaneksin J, Bunchoo S, Klayut W, Sangkitporn S, Phetsuksiri B. 2005. T-SPOT®.TB Test for Latent Tuberculosis Infection Diagnosis and Treatment Guidance in Thai Healthcare Professionals. Open Forum Infect Dis 2018. [PMCID: PMC6253974 DOI: 10.1093/ofid/ofy210.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Data on efficacy of T-SPOT®.TB Test (T-SPOT) in diagnosing latent tuberculosis infection (LTBI) and guiding isoniazid preventive therapy (IPT) among healthcare professionals (HCP) in tuberculosis (TB)-endemic settings are limited. Methods A prospective study was conducted among Thai HCP undergoing T-SPOT in June 2016 (initial screening) and June 2017 (follow-up). Nine-month isoniazid preventive therapy (IPT) was offered among the HCP with positive T-SPOT. The incidence of TB and the rates of conversion and reversion of T-SPOT were evaluated during the 1-year follow-up period (June 2016 to June 2017). Results A total of 140 HCP underwent initial T-SPOT; the median age was 27 years (IQR 25–31 years), 89% were female and 23 (16%) were T-SPOT-positive. Eighty-nine HCP (64%) had both initial and follow-up T-SPOTs. Among the 89 HCP, the initial and follow-up rates of T-SPOT positivity were 19% (N = 17) and 24% (N = 21), respectively. The conversion and reversion rates were 10% (N = 9) and 6% (N = 5), respectively. All of the nine HCP (100%) with T-SPOT conversion reported significant contacts with patients who had active pulmonary TB without using appropriate personal protection equipment. During the 1-year follow-up period, incidence of TB were significantly higher among HCP with T-SPOT conversion compared with HCP with persistent positive T-SPOT, HCP with T-SPOT reversion and HCP with persistent negative T-SPOT [22 vs. 8 vs. 0 vs. 0 cases/100 person-years; P < 0.001]. Of the 17 HCP with positive initial T-SPOT, 8 (47%) completed IPT. The incidence of TB was significantly lower and the T-SPOT reversion rate was significantly higher among HCP completing IPT compared with HCP declining or not completing IPT (0 vs. 11 cases/100 person-years; P < 0.001 and 63% vs. 0%; P = 0.009, respectively). Conclusion T-SPOT could be used for diagnosing LTBI, guiding IPT and identifying HCP with subsequent risk for TB. The serial T-SPOT may be used for evaluating IPT efficacy. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Thana Khawcharoenporn
- Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | | | - Sopa Srisungngam
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Supranee Bunchoo
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Wiphat Klayut
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
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Khawcharoenporn T, Srirach C, Chunloy K. 1285. Impact of an Educational Program on Knowledge, Attitude and Practice to Prevent HIV Infection Among HIV-Negative Heterosexual Partners of HIV-Infected Patients. Open Forum Infect Dis 2018. [PMCID: PMC6253168 DOI: 10.1093/ofid/ofy210.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data on knowledge, attitudes, and practices to prevent HIV transmission are limited and effective strategies to improve such knowledge, change attitudes, and reduce risk behaviors are unknown among serodiscordant couples.
Methods
A quasi-experimental study was conducted among HIV-negative adult heterosexual partners of HIV-infected patients. The intervention was an educational program consisting of a 1-hour educational session on knowledge about HIV infection and transmission prevention, a condom use teaching session, group discussion and experience sharing, and free HIV testing. Self-administered survey was conducted pre- and post-intervention on the same day to assess effectiveness of the program in improving HIV knowledge and changing attitudes toward HIV prevention. The participants were invited to participate in the program again 6 months later to assess retention of the knowledge and positive attitudes and practices to prevent HIV.
Results
A total of 88 participants were enrolled. The median age was 39 years and 49 (56%) were male. The median number of correct answers to the 30 statements about HIV infection and transmission prevention was significantly higher after the program compared with before the program (28 vs. 21; P < 0.001). After the program, higher proportions of the participants would encourage treatment of their HIV-infected partners (77% vs. 58%), use pre-exposure prophylaxis (59% vs. 38%), have a regular HIV blood test every 6 months (94% vs. 81%) and think that they and their partners can have a baby together safely with the current HIV transmission prevention strategies (48% vs. 17%) compared with before the program (all P < 0.05). Among the 35 participants who participated in the educational program twice, most of the knowledge and positive attitudes were retained. The rates of regular HIV testing every 6 months and consistent condom use had increased from baseline to 6 months later (29% to 74% and 71% to 91%, respectively). None of the participants acquired HIV from their partners.
Conclusion
The educational program was shown to be effective in improving HIV knowledge, attitudes, and practices toward HIV prevention among the seronegative partners.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Thana Khawcharoenporn
- Department of Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Khawcharoenporn T, Cole J, Claus J, Bell T, Lewis A, Zawitz C, Kessler H. A randomized controlled study of intervention to improve continuity care engagement among HIV-infected persons after release from jails. AIDS Care 2018; 31:777-784. [PMID: 30304936 DOI: 10.1080/09540121.2018.1533236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Short-term stay, multiple jail admissions and social and financial difficulties are significant obstacles for continuity care engagement (CCE) after release among HIV-infected jail detainees. However, data existing on interventions or strategies to increase post-release CCE among this population are limited. We conducted a randomized controlled study among HIV-infected detainees at Cook County Jail during 2011-2014. The intervention group received telephone contact within 2-4 days of release by a continuity clinic coordinator, who scheduled and informed the ex-detainees of their appointment date within 6 weeks post-release plus standard of care, while the control group received standard of care. The standard of care included comprehensive discharge planning, offering substance abuse treatment and provision of information on how to self-schedule an appointment with the chosen clinics. Of the 166 detainees enrolled, 56 were excluded due to being sent to prison or re-incarcerated within 6 weeks. The final cohort included 55 detainees in each of the groups. The rate of CCE within 6 weeks after release was significantly higher in the intervention group compared to the control group (58% vs. 33%; P = .007). In multivariable logistic regression analysis, being in the control group was the only factor associated with no CCE within 6 weeks (adjusted odds ratio 2.66; 95% confidence interval 1.18-6.00; P = .02). The study findings suggest that the simple telephone contact intervention significantly improved CCE among HIV-infected jail detainees.
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Affiliation(s)
- Thana Khawcharoenporn
- a Division of Infectious Diseases, Faculty of Medicine , Thammasat University , Pathumthani , Thailand.,b Rush University Medical Center , Chicago , IL , USA
| | - Joanna Cole
- b Rush University Medical Center , Chicago , IL , USA
| | | | - Thom Bell
- c The Ruth M. Rothstein CORE Center, Cook County Jail , Chicago , IL , USA
| | | | - Chad Zawitz
- c The Ruth M. Rothstein CORE Center, Cook County Jail , Chicago , IL , USA.,d Cermak Health Service Division, Cook County Jail , Chicago , IL , USA
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Khawcharoenporn T, Chuncharunee A, Maluangnon C, Taweesakulvashra T, Tiamsak P. Active monotherapy and combination therapy for extensively drug-resistant Pseudomonas aeruginosa pneumonia. Int J Antimicrob Agents 2018; 52:828-834. [PMID: 30236956 DOI: 10.1016/j.ijantimicag.2018.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/24/2018] [Accepted: 09/09/2018] [Indexed: 02/03/2023]
Abstract
Data on treatment regimens and outcomes of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) pneumonia are currently limited. A 6-year retrospective cohort study of adult patients diagnosed with XDR-PA pneumonia was conducted between January 2011 and December 2016. All XDR-PA isolates were susceptible to colistin and/or fosfomycin alone. Some XDR-PA isolates, which had minimum inhibitory concentrations for doripenem of 4 or 8 mg/L, were considered to be susceptible to 4-h prolonged infusion therapy with high-dose doripenem. Definite treatment regimens were categorized into three groups: inactive therapy, active monotherapy and active combined two-drug therapy. Outcomes were compared between the three groups. In total, 136 patients were included, and 37% had ventilator-associated pneumonia. Twenty-two, 74 and 40 patients received inactive therapy, active monotherapy and active combined two-drug therapy, respectively. Demographic and clinical characteristics were comparable between the three groups. Rates of 28-day survival and microbiological cure were significantly higher in patients who received active combined two-drug therapy compared with those who received active monotherapy and inactive therapy [90% vs 51% vs 0% (P<0.001) and 90% vs 54% vs 0% (P<0.001), respectively]. Kaplan-Meier survival analysis demonstrated a survival benefit of those who received active combined two-drug therapy over those who received active monotherapy and inactive therapy. Predictors for 28-day mortality were no infectious diseases (ID) consultations [adjusted odds ratio (aOR) 10.93; P<0.001], and receipt of inactive therapy (aOR 42.07; P<0.001) or active monotherapy (aOR 6.63; P=0.002) compared with receipt of active combined two-drug therapy. Active combined two-drug therapy was associated with better survival compared with active monotherapy for XDR-PA pneumonia. ID consultation was associated with a reduction in mortality.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
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Ongwandee S, Lertpiriyasuwat C, Khawcharoenporn T, Chetchotisak P, Thiansukhon E, Leerattanapetch N, Leungwaranan B, Manopaiboon C, Phoorisri T, Visavakum P, Jetsawang B, Poolsawat M, Nookhai S, Vasanti-Uppapokakorn M, Karuchit S, Kittinunvorakoon C, Mock P, Prybylski D, Sukkul AC, Roels T, Martin M. Implementation of a Test, Treat, and Prevent HIV program among men who have sex with men and transgender women in Thailand, 2015-2016. PLoS One 2018; 13:e0201171. [PMID: 30044867 PMCID: PMC6059477 DOI: 10.1371/journal.pone.0201171] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/10/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Antiretroviral therapy reduces the risk of serious illness among people living with HIV and can prevent HIV transmission. We implemented a Test, Treat, and Prevent HIV Program among men who have sex with men (MSM) and transgender women at five hospitals in four provinces of Thailand to increase HIV testing, help those who test positive start antiretroviral therapy, and increase access to pre-exposure prophylaxis (PrEP). Methods We implemented rapid HIV testing and trained staff on immediate antiretroviral initiation at the five hospitals and offered PrEP at two hospitals. We recruited MSM and transgender women who walked-in to clinics and used a peer-driven intervention to expand recruitment. We used logistic regression to determine factors associated with prevalent HIV infection and the decision to start antiretroviral therapy and PrEP. Results During 2015 and 2016, 1880 people enrolled. Participants recruited by peers were younger (p<0.0001), less likely to be HIV-infected (p<0.0001), and those infected had higher CD4 counts (p = 0.04) than participants who walked-in to the clinics. Overall, 16% were HIV-positive: 18% of MSM and 9% of transgender women; 86% started antiretroviral therapy and 46% of eligible participants started PrEP. A higher proportion of participants at hospitals with one-stop HIV services started antiretroviral therapy than other hospitals. Participants who started PrEP were more likely to report sex with an HIV-infected partner (p = 0.002), receptive anal intercourse (p = 0.02), and receiving PrEP information from a hospital (p<0.0001). Conclusions We implemented a Test, Treat, and Prevent HIV Program offering rapid HIV testing and immediate access to antiretroviral therapy and PrEP. Peer-driven recruitment reached people at high risk of HIV and people early in HIV illness, providing an opportunity to promote HIV prevention services including PrEP and early antiretroviral therapy. Sites with one-stop HIV services had a higher uptake of antiretroviral therapy and PrEP.
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Affiliation(s)
| | | | | | | | | | | | | | - Chomnad Manopaiboon
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
- * E-mail:
| | | | - Prin Visavakum
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Bongkoch Jetsawang
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Monsicha Poolsawat
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Somboon Nookhai
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | | | - Samart Karuchit
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Chonticha Kittinunvorakoon
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Philip Mock
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Dimitri Prybylski
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Ake-Chittra Sukkul
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Thierry Roels
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
| | - Michael Martin
- U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS and TB-Thailand, Nonthaburi, Thailand
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Suraratdecha C, Stuart RM, Manopaiboon C, Green D, Lertpiriyasuwat C, Wilson DP, Pavaputanon P, Visavakum P, Monkongdee P, Khawcharoenporn T, Tharee P, Kittinunvorakoon C, Martin M. Cost and cost-effectiveness analysis of pre-exposure prophylaxis among men who have sex with men in two hospitals in Thailand. J Int AIDS Soc 2018; 21 Suppl 5:e25129. [PMID: 30033559 PMCID: PMC6055129 DOI: 10.1002/jia2.25129] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/17/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In 2014, the Government of Thailand recommended pre-exposure prophylaxis (PrEP) as an additional HIV prevention programme within Thailand's National Guidelines on HIV/AIDS Treatment Prevention. However, to date implementation and uptake of PrEP programmes have been limited, and evidence on the costs and the epidemiological and economic impact is not available. METHODS We estimated the costs associated with PrEP provision among men having sex with men (MSM) participating in a facility-based, prospective observational cohort study: the Test, Treat and Prevent HIV Programme in Thailand. We created a suite of scenarios to estimate the cost-effectiveness of PrEP and sensitivity of the results to the model input parameters, including PrEP programme effectiveness, PrEP uptake among high-risk and low-risk MSM, baseline and future antiretroviral therapy (ART) coverage, condom use, unit cost of delivering PrEP, and the discount rate. RESULTS Drug costs accounted for 82.5% of the total cost of providing PrEP, followed by lab testing (8.2%) and personnel costs (7.8%). The estimated costs of providing the PrEP package in accordance with the national recommendation ranges from US$223 to US$311 per person per year. Based on our modelling results, we estimate that PrEP would be cost-effective when provided to either high-risk or all MSM. However, we found that the programme would be approximately 32% more cost-effective if offered to high-risk MSM than it would be if offered to all MSM, with an incremental cost-effectiveness ratio of US$4,836 per disability-adjusted life years (DALY) averted and US$7,089 per DALY averted respectively. Cost-effectiveness acceptability curves demonstrate that 80% of scenarios would be cost-effective when PrEP is provided solely to higher-risk MSM. CONCLUSION We provide the first estimates on cost and cost-effectiveness of PrEP in the Asia-Pacific region, and offer insights on how to deliver PrEP in combination with ART. While the high drug cost poses a budgeting challenge, incorporating PrEP delivery into an existing ART programme could be a cost-effective strategy to prevent HIV infections among MSM in Thailand.
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Affiliation(s)
- Chutima Suraratdecha
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
| | - Robyn M Stuart
- Burnet InstituteMelbourneVictoriaAustralia
- Department of Mathematical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Chomnad Manopaiboon
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| | - Dylan Green
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
| | | | | | | | - Prin Visavakum
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| | - Patama Monkongdee
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
| | - Thana Khawcharoenporn
- Division of Infectious DiseasesFaculty of MedicineThammasat UniversityPathumthaniThailand
| | | | | | - Michael Martin
- Division of Global HIV and TBCenters for Disease Control and PreventionAtlantaGAUSA
- Division of Global HV and TBThailand Ministry of Public Health‐U.S. CDC CollaborationNonthaburiThailand
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Khawcharoenporn T, Damronglerd P, Chunloy K, Sha BE. Enhanced inpatient rounds, appointment reminders, and patient education improved HIV care engagement following hospital discharge. Int J STD AIDS 2018; 29:641-649. [PMID: 29402187 DOI: 10.1177/0956462417749420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Human immunodeficiency virus (HIV) care engagement post hospital discharge is often suboptimal. Strategies to improve follow-up are needed. A quasi-experimental study was conducted among hospitalized HIV-infected patients between the period from 1 January 2013 to 30 June 2014 (preintervention period) and 1 July 2014 to 31 December 2015 (intervention period). During the intervention period, an HIV care team consisting of an Infectious Diseases physician, a nurse, a pharmacist, a social worker, and an HIV-infected volunteer made daily inpatient rounds. Prior to discharge, patients received a structured HIV education session and an outpatient appointment was scheduled for them with two telephone reminder calls following discharge. There were 240 HIV-infected patients enrolled (120 in each study period), of which the median age was 37 years (interquartile range [IQR] 28-44 years), 58% were male, 39% were newly diagnosed with HIV infection, 46% were hospitalized because of AIDS-related conditions, and the median CD4 cell count on admission was 158 cells/µl (IQR 72-382 cells/µl). The rate of HIV care engagement within 30 days after discharge was significantly higher in the intervention period compared to the preintervention period (95% versus 69%; P < 0.001). Independent factors associated with no care engagement within 30 days were patients in the preintervention period (adjusted odds ratio [aOR] 6.36; P < 0.001) and new diagnosis of HIV infection (aOR 2.77; P = 0.009). The study findings suggest that enhanced inpatient rounds, appointment reminders, and patient education were shown to be associated with improved HIV care engagement after hospital discharge. Patients with a new diagnosis of HIV infection benefit from more intense outreach. ClinicalTrials.gov Identifier: NCT02578654.
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Affiliation(s)
- Thana Khawcharoenporn
- 1 Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,2 HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand
| | - Pansachee Damronglerd
- 1 Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,2 HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand
| | - Krongtip Chunloy
- 2 HIV/AIDS Care Unit of Thammasat University Hospital, Pathumthani, Thailand
| | - Beverly E Sha
- 3 Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
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Apisarnthanarak A, Ratz D, Khawcharoenporn T, Patel PK, Weber DJ, Saint S, Greene MT. National Survey of Practices to Prevent Methicillin-Resistant Staphylococcus aureus and Multidrug-Resistant Acinetobacter baumannii in Thailand. Clin Infect Dis 2018; 64:S161-S166. [PMID: 28475783 DOI: 10.1093/cid/cix045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background We evaluated the extent to which hospital characteristics, infection control practices, and compliance with prevention bundles impacted multidrug-resistant organism (MDRO) infections in Thai hospitals. Methods From 1 January 2014 to 30 November 2014, we surveyed all Thai hospitals with an intensive care unit and ≥250 beds. Infection control practices for methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumannii (MDR-AB) were assessed. Linear regression was used to examine associations between hospital characteristics and prevention bundle compliance and changes in MDRO infection rates. Results A total of 212 of 245 (86.5%) eligible hospitals responded. Most hospitals regularly used several fundamental infection control practices for MRSA and MDR-AB (ie, contact precautions, private room/cohorting, hand hygiene, environmental cleaning, and antibiotic stewardship); advanced infection control practices (ie, active surveillance, chlorhexidine bathing, decolonization for MRSA, and hydrogen peroxide vaporizer for MDR-AB) were used less commonly. Facilities with ≥75% compliance with the MRSA prevention bundle experienced a 17.4% reduction in MRSA rates (P = .03). Although the presence of environmental cleaning services (41.3% reduction, P = .01) and a microbiology laboratory (82.8% reduction, P = .02) were among characteristics associated with decreases in MDR-AB rates, greater compliance with the MDR-AB prevention bundle did not lead to reductions in MDR-AB rates. Conclusions Although fundamental MRSA and MDR-AB control practices are used regularly in most Thai hospitals, compliance with more comprehensive bundled prevention approaches is suboptimal. Improving compliance with bundled infection prevention approaches and promoting the integration of certain hospital factors into infection control efforts may help reduce MDRO infections in Thai hospitals.
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Affiliation(s)
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | | | - Payal K Patel
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.,University of Michigan Division of Infectious Diseases, and
| | - David J Weber
- University of North Carolina School of Public Health, Chapel Hill
| | - Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.,University of Michigan Division of General Medicine, Ann Arbor ; and
| | - M Todd Greene
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System.,University of Michigan Division of General Medicine, Ann Arbor ; and
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Pruetpongpun N, Khawcharoenporn T, Damronglerd P, Suwantarat N, Apisarnthanarak A, Rutjanawech S. Inappropriate Empirical Treatment of Uncomplicated Cystitis in Thai Women: Lessons Learned. Clin Infect Dis 2018; 64:S115-S118. [PMID: 28475789 DOI: 10.1093/cid/cix088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care.
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Affiliation(s)
| | | | | | - Nuntra Suwantarat
- Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
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Apisarnthanarak A, Ratz D, Greene MT, Khawcharoenporn T, Weber DJ, Saint S. National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles. Am J Infect Control 2017; 45:805-810. [PMID: 28256264 DOI: 10.1016/j.ajic.2017.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
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.
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Khawcharoenporn T, Phetsuksiri B, Rudeeaneksin J, Srisungngam S, Apisarnthanarak A. QuantiFERON-TB Gold In-Tube Test for Tuberculosis Prevention in HIV-Infected Patients. Jpn J Infect Dis 2017; 70:502-506. [PMID: 28367883 DOI: 10.7883/yoken.jjid.2016.480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Optimal testing strategies for diagnosing latent tuberculosis infection and the administration of isoniazid preventive therapy (IPT) remain uncertain among human immunodeficiency virus (HIV)-infected patients. A 4-year prospective study was conducted among Thai HIV-infected patients who underwent simultaneous tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube Test (QFT-IT) at care entry. Based on baseline test results, patients were categorized into the following 4 groups: i) QFT-IT-positive, TST-reactive; ii) QFT-IT-positive, TST-non-reactive; iii) QFT-IT-negative, TST-reactive; and iv) QFT-IT-negative, TST-non-reactive. The QFT-IT-positive patients were offered 9-month IPT and were QFT-IT tested annually. Of the 150 enrolled patients, 8, 12, 16, and 114 patients were assigned to groups 1, 2, 3, and 4, respectively. Sixteen of 19 QFT-IT-positive patients (84%) completed IPT. The incidence of tuberculosis was significantly higher in patients who declined IPT than in those underwent treatment (11.11 vs. 0 case/100 patient-year; P < 0.001). Among the 16 patients completing IPT, 11 (69%) and 2 (12%) had QFT-IT reversion at 1 and 2 years after IPT, respectively. The remaining 3 (19%) did not demonstrate any reversion, and their baseline interferon-γ (IFN-γ) levels were above 1.2 IU/mL. Initial QFT-IT-guided IPT was effective in preventing tuberculosis. Serial QFT-IT for evaluating IPT effectiveness had limitations because of delayed or lack of reversion, especially for patients with high baseline IFN-γ levels.
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Affiliation(s)
| | - Benjawan Phetsuksiri
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health
| | - Janisara Rudeeaneksin
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health
| | - Sopa Srisungngam
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health
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Sutthiruk N, Botti M, Considine J, Driscoll A, Hutchinson A, Malathum K, Cucunawangsih C, Wiwing V, Puspitasari V, Shanmugakani RK, Akeda Y, Kodera T, Santanirand P, Tomono K, Yamanaka T, Moriuchi H, Kitajima H, Horikoshi Y, Lavrinenko A, Azizov I, Tabriz N, Kozhamuratov M, Serbo Y, Yang D, Lee W, Bae IK, Lee JH, Lee H, Kim JO, Jeong SH, Lee K, Peremalo T, Madhavan P, Hamzah S, Than L, Wong EH, Desa MNM, Ng KP, Geronimo M, Tayzon MF, Maño MJ, Chow A, Hon PY, Win MK, Ang B, Leo YS, Chow A, Hon PY, See T, Ang B, Marin RA, de Sousa MA, Kieffer N, Nordmann P, Poirel L, Laochareonsuk W, Petyu S, Wanasitchaiwat P, Thana S, Bunyaphongphan C, Boonsomsuk W, Maneepongpermpoon P, Jamulitrat S, Sureshkumar D, Supraja K, Sharmila S, Cucunawangsih C, Setiawan B, Lumbuun N, Nakayama H, Ota T, Shirane N, Matuoka C, Kodama K, Ohtsuka M, Bacolcol SAA, Velmonte M, Alde A, Chavez K, Esteban AJ, Lee AJ, Hsieh TC, Shio-ShinJean, Huang HJ, Huang SJ, Huang YH, Cheng PC, Yu SF, Tsao SM, Lee YT, Li CF, Lu MC, Pruetpongpun N, Khawcharoenporn T, Damronglerd P, Suwantarat N, Apisarnthanarak A, Rutjanawech S, Cushinotto L, McBride P, Williams H, Liu H, Hang PT, Anh DPP, Le N, Khu D, Nguyen L, Castillo RB, Sureshkumar D, Gopalakrishnan R, Ramasubramanian V, Sreevidya S, Jayapradha R, Umetsu A, Noda T, Hashimoto K, Hayashi A, Kabashima M, Jadczak U, Elvelund K, Johnsen M, Borgen B, Lingaas E, Mao CH, Chang FC, Liu CP, Chao RH, Chang FC, Liu CP, Pawapotako J, Prasertpan C, Malaihuan W, Uirungroj P, Prasertpan C, Saenjum C, Ouirungrog T, Uirungroj P, Borrell S, Bass P, Worth L, Xian-li Z, Xiao-long L, Xue-hua Y, Wei R, Zeng ZX, Kong MY, Lai CKC, Lee SY, Tsang NC, O’Donoghue MM, Boost MV, Suen LKP, Siu GK, Mui KW, Lai CKC, Tsang DNC, Sato Y, Tateishi M, Mihashi M, Flor JP, Bautista M, De Roxas VJ, Vergara J, Añonuevo NA, Kwek M, Acuin J, Sanchez AJ, Bathan A, Jantan JB, Guek CC, Kian EC, Pirido PA, Aron NFBM, Estacio LM, Palana FA, Gracia M, Shamsuddin NSB, Castro KT, Baloria M, Adam FB, Wei Z, Fong PB, Kalisvar M, Chow A, Ang B, Chuang IJ, Yi-ChunCho, Chiu YF, Chen LC, Lin YC, Dong SX, Lee YC, Kuan HC, Lin HH, Chi CC, Lu CT, Chang FC, Liu CP, Ya-Fen T, Li-Hsiang S, Jien-Wei L, Chao H, ChangChien P, Chen W, Lai C, Ara L, Mowla SMN, Vashkar SMK, Chan WF, ChunYau MY, LingChong KK, OnLi T, Kaur R, Yan NP, Chiu GCS, Cheung CWY, Ching PTY, Ching RHC, Lam CHS, Kan CH, Lee SSY, Chen CP, Chan RFY, Leung AFY, Wong ILC, Lam SS, Chan QWL, Chan C, Kaur R, Nematian SSS, Palenik CJ, Askarian M, Nematian SSS, Palenik CJ, Hatam N, Askarian M, Nakamura I, Fujita H, Tsukimori A, Kobayashi T, Sato A, Fukushima S, Matsumoto T, Flor JP, Añonuevo NA, Bautista M, Vergara J, De Roxas VJ, Kwek M, Flor JP, Bautista M, Vergara J, De Roxas VJ, AndreiAñonuevo N, Kwek M, Ho YM, Kum JQ, Poh BF, Marimuthu K, Ang B, Liu TY, Chu SM, Chen HZ, Chen TC, Chen Y, Tsao YC, Skuntaniyom S, Malathum K, Tipluy P, Paengta S, wongsaen R, thanomphan S, Tariyo S, Thongchuea B, Khamfu P, Thanomphan S, Songtaweesin WN, Anugulruengkit S, Samransamruajkit R, Sosothikul D, Tansrijitdee O, Nakphunsung A, Srimuan P, Sophonphan J, ThanyaweePuthanakit, Payuk K, Picheansathian W, Viseskul N, DeNardo E, Leslie R, Cartner T, Barbosa L, Werner HP, Brill FHH, Kawagoe JY, De Nardo E, Wilson SE, Macinga D, Mays-Suko P, Duley C, Hang PT, Hang TTT, Hanh TTM, Gordon C, Sureshkumar D, Durairaj R, Rohit A, Saravanakumar S, Hemalatha J, Hirano R, Sakamoto Y, Yamamoto S, Tachibana N, Miura M, Hieda F, Sakai Y, Watanabe H, Velmonte M, Bacolcol SA, Alde A, Chavez K, Esteban AJ, Lee AJ, Chow A, Lim JW, Hon PY, Hein AA, Tin G, Lim V, Ang B, Chow A, Hein AA, Lim JW, Hon PY, Lim V, Tin G, Ang B, Chow A, Tin G, Hein AA, Lim V, Lim JW, Hon PY, Ang B, Chao HC, Yeh CY, Lo MF, Chao HC, Piwpong C, Rajborirug S, Preechawetchakul P, Pruekrattananapa Y, Sangsuwan T, Jamulitrat S, Wongsaen R, Paengta S, Nilchon N, Thanompan S, Tariyo S, Le N, Khu D, Kolesnichenko S, Azizov I, Lavrinenko A, Tishkambayev Y, Lavrinenko A, Azizov I, Tishkambayev Y, Alibecov A, Kolesnichenko S, Serbo Y, Nam Y, Park JH, Hong YJ, Kim TS, Park JS, Park KU, Kim EC, Aziegbemhin SA, Enabulele O, Tung YS, Chen AC, Huang SM, Yang YY, Wu LH, Lin CC, Chang FC, Liu CP, Lien TH, Chang JH, Huang YS, Chen YS, Saenjum C, Sirilun S, Ouirungrog T, Ouirungroj P, Trakulsomboon S, Prasajak P, Kwok MWN, Ng LSH, Wong LMT, Poon LSL, Lai MKL, Cheng HHS, Fong SK, Leung CFY, Hasegawa J, Shirakawa H, Wakai S, Mieno M, Hatakeyama S, Tateishi M, Mihashi M, Sato Y, Saenjum C, Deeudom M, Tharavichitkul P, Ouirungrog T, Ouirungroj P, Chinniah T, Tan J, Prabu K, Alam S, Wynn AK, Ahmad R, Sidek A, Samsuddin DA, Ajis N, Ahmad A, Magon S, Chu B, Kuang J, Gao Y, Wang S, Hao Y, Liu R, Li D, Wang H, Yan NP, Nishio H, Mori H, Morokuma Y, Yamada T, Kiyosuke M, Yasunaga S, Toyoda K, Shimono N, Babenko D, Turmuhambetova A, Cheşcă A, Toleman MA, Babenko D, Turmuhambetova A, Cheşcă A, Toleman MA, Babenko D, Turmuhambetova A, Azizov I, Cheşcă A, Toleman MA, Akhmaltdinova LL, Turmuhambetova A, Cheşcă A, Babenko D, Magsakay MA, Macatibag A, Tayzon MF, Lerios JK, Azizov I, Lavrineko A, Babenko D, Sheck E, Edelstein M, Liu TY, Li LY, Chan CW, Pan HC, Chen TC, Vanishakije W, Jaikampun W, Cheng PC, Huang HJ, Huang SJ, Huang YH, Li SY, Yu SF, Li JF, Wu YP, Lee YT, Lin CH, Chang PC, Tariyo S, Paengta S, Wongsaen R, Thanompan S, Skuntaniyom S, Malathum K, Sukkra S, Zaman K, Zaman SF, Zaman F, Aziz A, Faisal SB, Traskine M, Ruiz-Guiñazú J, Borys D, Zaman K, Zaman SF, Zaman F, Aziz A, Faisal SB, Traskine M, Ruiz-Guiñazú J, Borys D, Lam WWY, Chow M, Choy L, Kam J, Salleh SA, Yacob R, Yusof SR, Jalil NA, Flor JP, Añonuevo NA, Bautista M, De Roxas VJ, Vergara J, Millan ML, Kwek M, Acuin JL, Lee AJ, Velmonte MA, Bacolcol SAA, Alde A, Chavez K, Esteban AJ, Ting CI, Dissayasriroj S, Chinniah TR, Prabu K, Ahmad R, Magon S, DiniSuhaimi J, Mirasin A, Morni N, Chu B, Samsuddin A, Ahmad A, Sidek A, Ajis N, AbuBakar A, Shafiee A, Safar J, Yan NP, Annie L, Ling FY, Edna L, Kristine L, Shinomiya S, Yamamoto K, Kjiwara K, Yamaguchi M, Chow A, Tin G, Zhang W, Hon PY, Poh BF, Marimuthu K, Ang B, Chan MC, Wang CC, Huang SJ, Huang HJ, Yu SF, Huang HY, Cheng PC, Li JF, Lee YT, Lai CL, Lu MC, Kosol S, Sakolwirat W, Paepong P, Jansanga S, Jaisamoot P, Thongnuanual N, Srithong C, Somsakul S, Malathum K, Plongpunth S, Punpop M, Malathum P, Malathum K, Thanomphan S, Wongsaen R, Peautiwat K, boon kirdram N, Picheansathian W, Klunklin P, Samethadka G, Suzuki N, Asada H, Katayama M, Komano A, Sato A, Nakamura I, Watanabe H, Matsumoto T, Seo HK, Hwang JH, Shin MJ, Kim SY, Kim ES, Song KH, Kim HB, Un LS, Vong CI, Flor JP, Añonuevo NA, Bautista M, De Roxas VJ, Vergara J, Kwek M, Koh J, Agustinus S, Hassan RBA, Thinn YP, Ng B, Tun SP, Ha SMT, Xiaoting X, Li L, Chuang L, Niroshika AMC, Perera KAK, Fernando DKDG, Hemamala BR, Yeh CY, Chao HC, Yang HC, Chiu HJ, Shih YL, Chien YS, Lin WY, Pan CY, Chang YY, Yea CY, Chu MH, Lee LC, Chiu HJ, Shih YL, Yang HC, Yu-Hsiu L, Siao-Pei G, Pak-On L, Mei-Fe S, Jyh-Jou C, Yu-Hsiu L, Yong-Yuan C, Kuo SY, Lin YH, Zhang JS, Leung PO, Sie MF, Chen JJ, Chen YR, Lin YH, Chen YL, Taou CF, Chen HS, Tang HJ, Chen SY, Chen YY, Der Wang F, Shih TP, Chen CY, Chen SJ, Wu MC, Yang WJ, Chou ML, Yu ML, Li LC, Chu CW, Tsou WH, Wu WC, Cheng WC, Sun CC, Shih TP, Chen CY, Lu SH, Chen SJ, Yang HL, Lu CY, Yu ML, Li LC, Chu CW, Tsou WH, Wu WC, Cheng WC, Sun CC, Hirunprapakorn N, Malathum K, Apivanich S, Pornmee T, Beowsomboon C, Rajborirug S, Pruekrattananapa Y, Sangsuwan T, Jamulitrat S, Kumkoom I, Kasatpibal N, Chitreecheur J, Kasatpibal N, Whitney JD, Saokaew S, Kengkla K, Heitkemper MM, Apisarnthanarak A, Muntajit T, Apivanich S, Malathum K, Somsakul S, Phan HT, Dinh APP, Nguyen TTK. Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC). Antimicrob Resist Infect Control 2017. [PMCID: PMC5333188 DOI: 10.1186/s13756-017-0176-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Khawcharoenporn T, Chuncharunee A, Maluangnon C, Taweesakulvashra T, Tiamsak P. Treatment and Outcomes of Extensively Drug-resistant Pseudomonas
aeruginosa Nosocomial Pneumonia. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khawcharoenporn T, Damronglerd P, Chunloy K. Enhanced Inpatient Round, Appointment Reminder and Patient Education Improved Human Immunodeficiency Virus (HIV) Care Engagement After Hospital Discharge. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Khawcharoenporn T, Konsantad A. Impact of Educational Program and Guidelines Implementation on Outcomes and Process of Care among Patients with Nonsevere Sepsis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Khawcharoenporn T, Apisarnthanarak A, Phanuphak N. Active targeted HIV testing and linkage to care among men who have sex with men attending a gay sauna in Thailand. AIDS Care 2016; 29:355-364. [PMID: 27855485 DOI: 10.1080/09540121.2016.1259450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Existing data on the feasibility of human immunodeficiency virus (HIV) testing and counseling (HTC) and linkage to care among men who have sex with men (MSM) in hotspots are currently limited. A prospective study on active targeted HTC and linkage to care among MSM (≥18 years old) was conducted at a gay sauna in Thailand from November 2013 to October 2015. HIV risks and risk perception were evaluated through an anonymous survey. HIV testing with result notification and care appointment arrangement were provided on-site. Of the 358 participants; median age was 30 years; 206/358(58%) were at high risk for HIV acquisition; 148/358(41%) accepted HTC, all of whom either had prior negative HIV tests [98/148 (66%)] or had not known their HIV status [50/148 (34%)]. The three most common reasons for declining HTC were prior HIV testing within 6 months (48%), not ready (19%) and perceiving self as no risk (11%). Of the 262 moderate- and high-risk participants, 172 (66%) had false perception of low HIV risk which was significantly associated with declining HTC. Among the 148 participants undergoing HTC, 25 (17%) were HIV-infected. Having false perception of low risk (P = 0.004) and age <30 years (P = 0.02) were independently associated with HIV positivity. Only 14 of the 25 HIV-infected participants (56%) could be contacted after the result notification, of whom 12 (86%) had established HIV care and received immediate antiretroviral therapy. The active targeted HTC and facilitating care establishment was feasible among MSM attending the gay sauna but required strategies to improve accuracy of HIV-risk perception and linkage to care.
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Affiliation(s)
- Thana Khawcharoenporn
- a Division of Infectious Diseases, Faculty of Medicine , Thammasat University , Pathumthani , Thailand.,b HIV/AIDS Care Unit of Thammasat University Hospital , Pathumthani , Thailand
| | - Anucha Apisarnthanarak
- a Division of Infectious Diseases, Faculty of Medicine , Thammasat University , Pathumthani , Thailand.,b HIV/AIDS Care Unit of Thammasat University Hospital , Pathumthani , Thailand
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Apisarnthanarak A, Ratz D, Greene T, Khawcharoenporn T, Weber DJ, Saint S. National Survey of Practices to Prevent Healthcare Associated Infections in Thailand: The Role of Prevention Bundles. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - David Ratz
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Todd Greene
- Department of Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
| | | | - David J. Weber
- Medicine, Pediatrics, Epidemiology, University of North Carolina, School of Public Health, Chapel Hill, North Carolina
| | - Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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Khawcharoenporn T, Konsantad A. Impact of the educational program on outcomes among patients with sepsis hospitalized from the ED. Am J Emerg Med 2016; 35:179-182. [PMID: 27771221 DOI: 10.1016/j.ajem.2016.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand.
| | - Ariya Konsantad
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani 12120, Thailand
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Khawcharoenporn T, Chunloy K, Apisarnthanarak A. Uptake of HIV testing and counseling, risk perception and linkage to HIV care among Thai university students. BMC Public Health 2016; 16:556. [PMID: 27405648 PMCID: PMC4942919 DOI: 10.1186/s12889-016-3274-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/05/2016] [Indexed: 11/24/2022] Open
Abstract
Background HIV testing and counseling (HTC) with linkage to care after known infection are key components for HIV transmission prevention. This study was conducted to assess HTC uptake, HIV risk perception and linkage to care among Thai university students. Methods An outreach HTC program was conducted in a large public university in Thailand from January 2013 to December 2014. The program consisted of brief HIV knowledge assessment, free HTC, HIV risk assessment and education provided by the healthcare personnel. Students were categorized into low, moderate and high-risk groups according to the pre-defined HIV risk characteristics. Results One-thousand-eight-hundred-one students participated in the program, 494 (27 %) underwent HTC. Independent characteristics associated with no HTC uptake included female sex (P < 0.001), lower HIV knowledge score (P < 0.001), younger age (P < 0.001) and students from non-health science faculties (P = 0.02). Among the 494 students undergoing HTC, 141 (29 %) were categorized into moderate or high-risk group, of whom 45/141 (32 %) had false perception of low HIV risk. Being heterosexual was independently associated with false perception of low HIV risk (P = 0.04). The rate of new HIV infection diagnosis was 4/494 (0.8 %). Of these 4 HIV-infected students, 3 (75 %) were men who have sex with men and only 2 of the 4 students (50 %) showed up for HIV continuity care. Conclusions An outreach HIV prevention program with HTC was feasible and beneficial in detecting HIV risk and infection among the university students. However, interventions to improve HTC uptake, HIV risk perception and linkage to care are needed.
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Affiliation(s)
- Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. .,HIV/AIDS Care Unit of Thammasat Univesity Hospital, Pathumthani, Thailand.
| | - Krongtip Chunloy
- HIV/AIDS Care Unit of Thammasat Univesity Hospital, Pathumthani, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.,HIV/AIDS Care Unit of Thammasat Univesity Hospital, Pathumthani, Thailand
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Abstract
Macrocytosis has been increasingly observed in HIV-infected population and is an early indicator of bone marrow toxicity. A retrospective study was conducted among these patients in a HIV clinic to assess risk factors of macrocytosis. We found that lamivudine was strongly associated with macrocytosis (OR = 24.6 [2.9–3223.0], P = 0.001). This association may be due to lamivudine's effect on erythrocyte synthesis.
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Apisarnthanarak A, Damronglerd P, Meesing A, Rutjanawech S, Khawcharoenporn T. Impact of Physicians’ Mindfulness Attitudes toward Prevention of Catheter-Associated Urinary Tract Infection. Infect Control Hosp Epidemiol 2016; 35:1198-200. [DOI: 10.1086/677642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pruetpongpun N, Khawcharoenporn T, Damronglerd P, Suthiwartnarueput W, Apisarnthanarak A, Rujanavej S, Suwantarat N. Disseminated Talaromyces marneffei and Mycobacterium abscessus in a Patient With Anti-Interferon-γ Autoantibodies. Open Forum Infect Dis 2016; 3:ofw093. [PMID: 27419165 PMCID: PMC4943537 DOI: 10.1093/ofid/ofw093] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/06/2016] [Indexed: 11/22/2022] Open
Abstract
Anti-interferon (IFN)-γ autoantibodies are increasingly recognized as a cause of adult-onset immunodeficiency and increased risk for infections with intracellular pathogens. We report on disseminated Talaromyces (Penicillium) marneffei and Mycobacterium abscessus infection in a 72-year-old, human immunodeficiency virus noninfected, Thai man with anti-IFN-γ autoantibody. The patient was successfully treated with antimicrobial therapy and rituximab to control B cell-derived autoantibodies.
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Affiliation(s)
| | | | | | | | | | | | - Nuntra Suwantarat
- Chulabhorn International College of Medicine , Thammasat University , Pathumthani , Thailand
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Buppajarntham A, Apisarnthanarak A, Khawcharoenporn T, Rutjanawech S, Singh N. National Survey of Thai Infectious Disease Physicians on Treatment of Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia: The Role of Infection Control Awareness. Infect Control Hosp Epidemiol 2016; 37:61-9. [PMID: 26510383 DOI: 10.1017/ice.2015.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP) METHODS From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (80%) categories and were then compared with standard clinical response rates archived in the existing literature. RESULTS Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17-7.73; P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16-15.37; P60%). We identified a significant correlation between expected and clinical success rates (r=0.58; P<.001). CONCLUSIONS Awareness of IC among IDPs can improve physicians' expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success. Infect. Control Hosp. Epidemiol. 2015;37(1):61-69.
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Affiliation(s)
- Aubonphan Buppajarntham
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Anucha Apisarnthanarak
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Thana Khawcharoenporn
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Sasinuch Rutjanawech
- 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand
| | - Nalini Singh
- 2Division of Infectious Diseases,Children's National Medical Center,Department of Pediatrics,Epidemiology and Global Health,George Washington University,School of Medicine and Health Sciences,School of Public Health,Washington DC,United States
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Limvorapitak W, Khawcharoenporn T. Incidence, Risk Factors, and Outcomes of Febrile Neutropenia in Thai Hematologic Malignancy Patients Receiving Chemotherapy: A 6-year Retrospective Cohort Study. Asian Pac J Cancer Prev 2015; 16:5945-50. [DOI: 10.7314/apjcp.2015.16.14.5945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Khawcharoenporn T, Apisarnthanarak A, Sangkitporn S, Rudeeaneksin J, Srisungngam S, Bunchoo S, Phetsuksiri B. Tuberculin Skin Test and QuantiFERON(®)-TB Gold In-Tube Test for Diagnosing Latent Tuberculosis Infection among Thai Healthcare Workers. Jpn J Infect Dis 2015; 69:224-30. [PMID: 26255736 DOI: 10.7883/yoken.jjid.2015.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cross-sectional study was conducted on the performance of the tuberculin skin test (TST) and QuantiFERON(®)-TB Gold In-Tube test (QFT-IT) for detecting latent tuberculosis infection among Thai healthcare workers (HCWs). Each HCW underwent both the TST and QFT-IT during the annual health screening. Among the 260 HCWs enrolled, the median age was 30 years (range 19-60 years), 92% were women, 64% were nurses and nurse assistants, 78% were Bacillus Calmette Guérin vaccinated, and 37% had previously taken the TST. Correlation between TST reaction size and the interferon-γ level was weak (r = 0.29; P < 0.001). Of the HCWs, 38% and 20% had a reactive TST and a positive QFT-IT, respectively. Using QFT-IT positivity as a standard for latent tuberculosis diagnosis, the cut-off for TST reactivity with the best performance was ≥13 mm with a sensitivity, specificity, false positivity, and false negativity of 71%, 70%, 30%, and 29%, respectively (area under the curve 0.73; P < 0.001). The independent factor associated with a false reactive TST was a previous TST (adjusted odds ratio 1.83; P = 0.04). Our findings suggest that the QFT-IT may be the preferred test among HCWs with previous TST. In settings where the QFT-IT is not available, appropriate cut-offs for TST reactivity should be evaluated for use among HCWs.
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Chuncharunee A, Khawcharoenporn T. Lemierre's Syndrome Caused by Klebsiella pneumoniae in a Diabetic Patient: A Case Report and Review of the Literature. Hawaii J Med Public Health 2015; 74:260-6. [PMID: 26279962 PMCID: PMC4536737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lemierre's syndrome is characterized by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. This infection is usually caused by Fusobacterium spp. In this report, we present a rare case of Klebsiella pneumoniae-associated Lemierre's syndrome in a patient with poorly-controlled diabetes mellitus. The infection was complicated by septic emboli in many organs, which led to the patient's death, despite combined antibiotics, anticoagulant therapy, and surgical intervention. Therein, a literature review was performed for reported cases of Lemierre's syndrome caused by Klebsiella pneumoniae and the results are summarized here.
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Chatkittikunwong G, Khawcharoenporn T. Hepatitis B revaccination in HIV-infected vaccine non-responders: is double dosing always necessary? Int J STD AIDS 2015; 27:850-5. [PMID: 26185040 DOI: 10.1177/0956462415596498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
Abstract
Limited data exist on hepatitis B revaccination strategies for HIV-infected individuals who do not develop immunity after the first vaccination series. A retrospective cohort study was conducted to assess the immunogenicity of the second series of hepatitis B vaccine given in standard dosing (SD) and double dosing (DD) strategies among Thai HIV-infected adults during the period from January 2006 to December 2014. Of the 120 eligible patients, 68 (57%) were men, median age was 38 years old, 87 (73%) received SD and 33 (27%) received DD revaccination. The demographic and clinical characteristics of SD and DD groups were comparable. The overall vaccine response rate was significantly higher in DD group than SD group (97% vs. 70%; p = 0.001). Independent factors associated with no response to hepatitis B revaccination were receipt of SD vaccine (adjusted odds ratio [aOR] 16.04; p = 0.009), age ≥ 40 years (aOR 3.66; p = 0.009) and CD4 cell count at the time of revaccination less than 450 cells/µL (aOR 2.96; p = 0.04). These findings suggest that DD hepatitis B revaccination series should be given in HIV-infected patients who were at least 40 years old or had CD4 counts less than 450 cells/µL after no response to the first vaccination series.
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Affiliation(s)
| | - Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Apisarnthanarak A, Khawcharoenporn T, Mundy LM. Air Quality of a Hospital after Closure for Black-Water Flood: An Occupational-Health Concern? Infect Control Hosp Epidemiol 2015; 33:1285-6. [DOI: 10.1086/668445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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