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Prevalence and genotypic relatedness of carbapenem resistance among multidrug-resistant P. aeruginosa in tertiary hospitals across Thailand  [cached]
Khuntayaporn Piyatip,Montakantikul Preecha,Mootsikapun Piroon,Thamlikitkul Visanu
Annals of Clinical Microbiology and Antimicrobials , 2012, DOI: 10.1186/1476-0711-11-25
Abstract: Background Increased infection caused by multidrug resistant (MDR) Pseudomonas aeruginosa has raised awareness of the resistance situation worldwide. Carbapenem resistance among MDR (CR-MDR) P. aeruginosa has become a serious life-threatening problem due to the limited therapeutic options. Therefore, the objectives of this study were to determine the prevalence, the antibiotic susceptibility patterns and the relatedness of CR-MDR P. aeruginosa in tertiary hospitals across Thailand. Methods MDR P. aeruginosa from eight tertiary hospitals across Thailand were collected from 2007–2009. Susceptibility of P. aeruginosa clinical isolates was determined according to the Clinical and Laboratory Standards Institute guideline. Selected CR-MDR P. aeruginosa isolates were genetically analyzed by pulsed-field gel electrophoresis. Results About 261 clinical isolates were identified as MDR P. aeruginosa and approximately 71.65% were found to be CR-MDR P. aeruginosa. The result showed that the meropenem resistance rate was the highest reaching over 50% in every hospitals. Additionally, the type of hospitals was a major factor affecting the resistance rate, as demonstrated by significantly higher CR-MDR rates among university and regional hospitals. The fingerprinting map identified 107 clones with at least 95% similarity. Only 4 clones were detected in more than one hospital. Conclusions Although the antibiotic resistance rate was high, the spreading of CR-MDR was found locally. Specific strains of CR-MDR did not commonly spread from one hospital to another. Importantly, clonal dissemination ratio indicated limited intra-hospital transmission in Thailand.
Prevalence of selected sexually and blood-borne infections in Injecting drug abuser inmates of bandar abbas and roodan correction facilities, Iran, 2002
Davoodian, Parivash;Dadvand, Habib;Mahoori, Khatereh;Amoozandeh, Alireza;Salavati, Alborz;
Brazilian Journal of Infectious Diseases , 2009, DOI: 10.1590/S1413-86702009000500008
Abstract: human immunodeficiency virus (hiv) and other blood borne viral infections like hepatitis b virus (hbv) and hepatitis c virus (hcv) are major health issues especially in young and growing population of developing countries. all around the globe correctional facilities are known as potential source of spreading such disease. during summer 2002, hiv, hcv antibodies, hepatitis b surface (hbs) antigen and rapid plasma reagin (rpr) test were checked in venous blood samples of 252 injecting drug abuser prisoners from correctional facilities in southern iran. overall hiv, hcv and hbv infection rate was 15.1% (38/249), 64.8% (163/249), and 4.7% (12/249), respectively. hcv infection rate of hiv positive cases was 94% (35/38). all rpr results were negative. duration of previous drug abuse and imprisonment were correlated with hiv and hcv infection (p value = 0.0003 and 0.015 & p value =0.02 and 0.02). considering the higher prevalence of hiv and hcv infection in correctional facilities compared to general population of iran, warrants immediate multidisciplinary approaches targeted at controlling further spread of these infections primarily among prisoners and secondarily preventing them to act as carrier to general population.
Methamphetamine use and correlates in two villages of the highland ethnic Karen minority in northern Thailand: a cross sectional study
Eiko Kobori, Surasing Visrutaratna, Yuko Maeda, Siriporn Wongchai, Akiko Kada, Masako Ono-Kihara, Yoko Hayami, Masahiro Kihara
BMC International Health and Human Rights , 2009, DOI: 10.1186/1472-698x-9-11
Abstract: A cross-sectional survey examined Karen villagers from a developed and a less-developed village on February 24 and March 26, 2003 to evaluate the prevalence and social correlates of methamphetamine use in northern Thailand. Data were collected in face-to-face interviews using a structured questionnaire.The response rate was 79.3% (n = 548). In all, 9.9% (males 17.6%, females 1.7%) of villagers reported methamphetamine use in the previous year. Methamphetamine was used mostly by males and was significantly related to primary or lower education; to ever having worked in town; to having used opium, marijuana, or heroin in the past year; and to ever having been diagnosed with a sexually transmitted infection (STI).Since labor migration to towns is increasingly common among ethnic minorities, the prevention of methamphetamine use and of HIV/STI infection among methamphetamine users should be prioritized to prevent HIV in this minority population in Thailand.Historically, Thailand was once notorious for its opium production, which started in the late nineteenth century and continued until the mid twentieth century [1]. However, in modern Thailand methamphetamine is the most popular illicit drug. Of all new hospital admissions for drug treatment in Thailand in 2006, 75.6% (n = 29,235) of patients were admitted for methamphetamine use. Furthermore, 75.2% (n = 51,457) of all drug-related arrests in 2006 were methamphetamine related [2]. A household survey conducted in 2003 suggested that 0.2% of the 45 million Thai people aged 12 to 65 years had used methamphetamine during the previous year (2002), and 2.4% had used it in their lifetimes [3]. There is increasing concern that methamphetamine use is now prevalent among young people (aged 15–21 years) in Thailand. A urine test conducted among vocational school students in this age group (n = 1725) determined that 10.3% of this study group tested positive for current methamphetamine use. Additionally, 29.0% of the study group re
Incidence and risk factors of antiretroviral treatment failure in treatment-na?ve HIV-infected patients at Chiang Mai University Hospital, Thailand
Nitta Khienprasit, Romanee Chaiwarith, Thira Sirisanthana, Khuanchai Supparatpinyo
AIDS Research and Therapy , 2011, DOI: 10.1186/1742-6405-8-42
Abstract: A retrospective cohort study was conducted among HIV-infected patients initiating their first cART at Chiang Mai University Hospital, Thailand.From January 2002 to December 2008, 788 patients were enrolled; 365 were male (46.3%), and the mean age was 37.9 ± 8.6 years. The median baseline CD4 count was 57.7 cells/mm3 (IQR 22, 127). GPO-VIR? (a fixed-dose combination of lamivudine, stavudine, and nevirapine) was the most common prescribed cART (657 patients, 83.4%). Seventy-six patients developed virological failure given the cumulative incidence of 9.6%. The incidence of virological failure was 2.79 (95% CI 2.47, 3.14) cases per 100 person years. Poor adherence was the strongest predictor for virological failure. Of 535 immunologically evaluable patients, 179 (33.5%) patients developed immunological failure. A low CD4 cell count at baseline (< 100 cells/mm3) and the increment of CD4 cell count of < 50 cell/mm3 after 6 months of cART were the predictors for immunological failure (p < 0.001).This study demonstrated that even in resource-limited settings, the high rate of success could be expected in the cohort with good and sustainable drug adherence. Poor adherence, older age, and low baseline CD4 cell count are the predictors for unfavorable outcome of cART.By the year 2010, the Joint United Nations Program on HIV/AIDS (UNAIDS) estimate that there are 1,138,020 people living with HIV/AIDS in Thailand [1]. The mathematic model describing the epidemic trends using the Asia Epidemic Model software projected that there will be 10,835 new HIV cases each year [1]. In Thailand, it was only after the establishment of the National Access to Antiretroviral Program for People living with HIV/AIDS (NAPHA) in 2002 that combination antiretroviral therapy (cART) became widely available free of charge throughout the country [2]. In a previous study from Thailand, treatment with GPO-VIR? (a locally-produced generic fixed-dose combination of stavudine, lamivudine, and nevirapine) resu
Characterization of Genotypic Mutations and Antiretroviral Resistance among Viremic HIV-Infected Patients in a High HIV Prevalence Area: Treatment Challenge and Transmission Risk  [PDF]
AliAsad Arastu, Virginia Kan
World Journal of AIDS (WJA) , 2011, DOI: 10.4236/wja.2011.13011
Abstract: There have been few reports evaluating the prevalence of genotypic mutations and antiretroviral resistance among chronic HIV-infected Veterans within the United States. This retrospective cross-sectional study characterizes the rates and changes in HIV genotypic mutations and antiretroviral resistance among viremic patients from 2001 to 2006 at the VA Medical Center located in Washington, DC. The District of Columbia is the metropolitan area with the highest HIV prevalence within the United States. De-identified, linked HIV RNA, genotypic reverse transcriptase (RT) and protease (Pr) mutations and antiretroviral resistance results were assessed for changes during the 6-year period. Aggregated clinic and antiretroviral utilization, and HIV acquisition risk data were evaluated for patients in care during this time. Among 990 viremic samples, the rate of any detected RT or Pr mutation fell from 100% in 2001 to 95% in 2006. This was primarily attributable to the 15% - 20% decrease seen for RT gene mutations against nucleoside/nucleotide class and non-nucleoside class during this period. Resistance to didanosine, stavudine, zidovudine, nevirapine and efavirenz decreased, and tenofovir resistance increased. Despite stable rates of Pr gene mutations, atazanavir resistance increased by 22% from 2003 to 2006. Some but not all changes in genotypic mutations and resistance patterns reflected our patients’ antiretroviral drug utilization. As sexual contacts (77%) and injection drug use (22%) were the leading acquisition risks disclosed by our HIV-infected patients, the high prevalence and changing patterns of HIV genotypic mutations and drug resistance among these patients have had pivotal impacts not only on HIV treatment but potential transmission into our community.
Emergence of HIV-1 drug resistance mutations among antiretroviral-na ve HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand
Sungkanuparph Somnuek,Sukasem Chonlaphat,Kiertiburanakul Sasisopin,Pasomsub Ekawat
Journal of the International AIDS Society , 2012, DOI: 10.1186/1758-2652-15-12
Abstract: Background After rapid scaling up of antiretroviral therapy in HIV-1-infected patients, the data of primary HIV-1 drug resistance in Thailand is still limited. This study aims to determine the prevalence and associated factors of primary HIV-1 drug resistance in Thailand. Methods A prospective observational study was conducted among antiretroviral-na ve HIV-1-infected Thai patients from 2007 to 2010. HIV-1 subtypes and mutations were assayed by sequencing a region of HIV-1 pol gene. Surveillance drug resistance mutations recommended by the World Health Organization for surveillance of transmitted HIV-1 drug resistance in 2009 were used in all analyses. Primary HIV-1 drug resistance was defined as the presence of one or more surveillance drug resistance mutations. Results Of 466 patients with a mean age of 38.8 years, 58.6% were males. Risks of HIV-1 infection included heterosexual (77.7%), homosexual (16.7%), and intravenous drug use (5.6%). Median (IQR) CD4 cell count and HIV-1 RNA were 176 (42-317) cells/mm3 and 68,600 (19,515-220,330) copies/mL, respectively. HIV-1 subtypes were CRF01_AE (86.9%), B (8.6) and other recombinants (4.5%). The prevalence of primary HIV-1 drug resistance was 4.9%; most of these (73.9%) had surveillance drug resistance mutations to only one class of antiretroviral drugs. The prevalence of patients with NRTI, NNRTI, and PI surveillance drug resistance mutations was 1.9%, 2.8% and 1.7%, respectively. From logistic regression analysis, there was no factor significantly associated with primary HIV-1 drug resistance. There was a trend toward higher prevalence in females [odds ratio 2.18; 95% confidence interval 0.896-5.304; p = 0.086]. Conclusions There is a significant emergence of primary HIV-1 drug resistance in Thailand after rapid scaling up of antiretroviral therapy. Although HIV-1 genotyping prior to antiretroviral therapy initiation is not routinely recommended in Thailand, our results raise concerns about the risk of early treatment failure in patients with primary HIV-1 drug resistance. Interventions to prevent the transmission of HIV-1 drug resistance and continuation of surveillance for primary HIV-1 drug resistance in Thailand are indicated.
HIV infection and risk factors among Bangkok prisoners, Thailand: a prospective cohort study
Hansa Thaisri, John Lerwitworapong, Suthon Vongsheree, Pathom Sawanpanyalert, Chanchai Chadbanchachai, Archawin Rojanawiwat, Wichuda Kongpromsook, Wiroj Paungtubtim, Pongnuwat Sri-ngam, Rachaneekorn Jaisue
BMC Infectious Diseases , 2003, DOI: 10.1186/1471-2334-3-25
Abstract: A prospective cohort of 689 male inmates in a Bangkok central prison was studied during 2001–2002. Follow up visits were conducted for 5 months, with testing for HIV and other infections and interviewing of demographics and risk behaviors.Among 689 male inmates, half (50.9 %) were drug injectors. About 49% of the injectors had injection during incarceration. Most (94.9%) of the injectors had shared injection paraphernalia with others. Successful follow up rate was 98.7% after 2,581 person-months observation. HIV incidence was 4.18 per 100 person – years among all inmates, and 11.10 per 100 person – years among the injection inmates. Multivariate analysis identified variables associated with HIV prevalence: history of injection [OR = 2.30, 95%CI: 1.91–2.77], positive urine opiate test [OR = 5.04, 95%CI: 2.63–9.67], history of attendance to drug withdrawal clinics [OR = 2.00, 95%CI: 1.19–3.35] and presence of tattoos on the body [OR = 1.23, 95%CI: 1.01–1.52].The main HIV risk factors of Bangkok inmates were those related to drug injection. Harm reduction measures and HIV intervention strategies should be implemented to prevent more spread of HIV among the inmates and into the community.The problem of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is usually approached from a perspective of risk behaviors and modes of transmission. In Thailand, this approach has been implemented since 1989 for HIV sentinel surveillance of certain high-risk people; e.g. commercial sex workers, injection drug users and male clients attending sexually transmitted diseases clinics [1]. As far as interventions are concerned, such an approach leaves certain target groups not presenting at the usual settings unaccounted for. For instance, men who have sex with men do not have "well-defined" physical places where they usually meet and are less likely to receive targeted HIV-1 related interventions. On the other hand, certain HIV high-risk groups in w
Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand
Joanne Csete, Karyn Kaplan, Kanna Hayashi, Nadia Fairbairn, Paisan Suwannawong, Ruth Zhang, Evan Wood, Thomas Kerr
BMC International Health and Human Rights , 2011, DOI: 10.1186/1472-698x-11-12
Abstract: We examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience.In total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention.These findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions.The United Nations estimates that about one-third of new HIV transmissions outside of sub-Saharan Africa are linked to injection drug use [1]. In some regions, including much of eastern Europe and parts of east and southeast Asia, contaminated injecting equipment is the source of the majority of new infections [2]. Ensuring access to sterile injecting equipment and to humane and scientifically sound treatment for drug dependence, including methadone maintenance therapy, should be central elements of HIV prevention in countries where injection drug use is linked to HIV transmission. Unfortunately
Risk factors associated with injection initiation among drug users in Northern Thailand
Yingkai Cheng, Susan G Sherman, Namtip Srirat, Tasanai Vongchak, Surinda Kawichai, Jaroon Jittiwutikarn, Vinai Suriyanon, Myat Razak, Teerada Sripaipan, David D Celentano
Harm Reduction Journal , 2006, DOI: 10.1186/1477-7517-3-10
Abstract: A cross-sectional survey was conducted among 2,231 drug users admitted to the Northern Drug Treatment Center in Mae Rim, Chiang Mai, Thailand, between February 1, 1999 and December 31, 2000. A multiple logistic regression was employed to identify the independent effects from potential risk factors of transition into injection.After controlling for other covariates, being 20 years of age or older, single, ever receiving education, urban residence, and having a history of smoking or incarceration were significantly associated with higher likelihood of injection initiation. Multiple sex partners and an experience of sex abuse were associated with an increased risk of injection initiation. Comparing to those whose first drug was opium, individuals using heroin as their initiation drug had greater risk of injection initiation; conversely, those taking amphetamine as their first drug had less risk of injection initiation. Age of drug initiation was negatively associated with the risk of injection initiation: the older the age of drug initiation, the less the risk of injection initiation.Injection initiation was related to several demographic factors, sexual behaviors and drug use characteristics. Understanding these factors will benefit the design of approaches to successfully prevent or delay transition into injection.A range of studies have examined the factors associated with transition from non-injection into injection drug use; however most of them are conducted in the developed world [1-5]. This transition is a critical point in a drug user's career for many reasons, particularly because it is characterized by a heightened risk of acquiring HIV and other blood-borne pathogens [6-8]. The process of initiating injection is complicated and informed by a myriad of individual, social-culture, and environmental factors. Demographic characteristics significantly associated with transition into injection in developed countries have included: being of younger age [5,9]; bein
Replicative phenotyping adds value to genotypic resistance testing in heavily pre-treated HIV-infected individuals - the Swiss HIV Cohort Study
Jan Fehr, Tracy R Glass, Séverine Louvel, Fran?ois Hamy, Hans H Hirsch, Viktor von Wyl, Jürg B?ni, Sabine Yerly, Philippe Bürgisser, Matthias Cavassini, Christoph A Fux, Bernard Hirschel, Pietro Vernazza, Gladys Martinetti, Enos Bernasconi, Huldrych F Günthard, Manuel Battegay, Heiner C Bucher, Thomas Klimkait, the Swiss HIV Cohort Study
Journal of Translational Medicine , 2011, DOI: 10.1186/1479-5876-9-14
Abstract: Patients with resistance tests between 2002 and 2006 were followed within the Swiss HIV Cohort Study (SHCS). We assessed patients' virological success after their antiretroviral therapy was switched following resistance testing. Multilevel logistic regression models with SHCS centre as a random effect were used to investigate the association between the type of resistance test and virological response (HIV-1 RNA <50 copies/mL or ≥1.5log reduction).Of 1158 individuals with resistance tests 221 with GRT+rPRT and 937 with GRT were eligible for analysis. Overall virological response rates were 85.1% for GRT+rPRT and 81.4% for GRT. In the subgroup of patients with >2 previous failures, the odds ratio (OR) for virological response of GRT+rPRT compared to GRT was 1.45 (95% CI 1.00-2.09). Multivariate analyses indicate a significant improvement with GRT+rPRT compared to GRT alone (OR 1.68, 95% CI 1.31-2.15).In heavily pre-treated patients rPRT-based resistance information adds benefit, contributing to a higher rate of treatment success.Combination antiretroviral therapy (cART) has dramatically reduced HIV related morbidity and mortality. Potent new drugs for patients with multiple drug resistance have been introduced [1-5]. Nevertheless, virological failure in treatment-experienced patients is still a major concern and therefore HIV drug resistance testing has a key role for the optimal choice of active drugs in patients with multiple drug failure. Accordingly, current guidelines recommend resistance testing for patients with multiple drug failure, but also for newly infected individuals and for pregnant women as transmission of resistant HIV mutants to therapy na?ve individuals are a rising concern [6-9].Two technical principles are in use today for resistance testing: Genotypic resistance tests (GRT) and phenotypic resistance tests (PRT). GRT is based on population gene sequencing of defined DNA segments, typically to detect mutations, which represent at least 20% of the
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