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Biomedical subjects

V Thamlikitkul

Publications and source records attributed to V Thamlikitkul.

At least 19 recordsLinked to original sources
PubMed2001

Ribotyping of Burkholderia pseudomallei from clinical and soil isolates in Thailand.

Burkholderia pseudomallei is a soil saprophyte that causes melioidosis in humans and animals. Restriction fragment length polymorphism of the ribosomal DNA regions (ribotyping) were analyzed in 577 isolates comprising 371 clinical and 206 soil isolates collected throughout Thailand in 1997. A total of 77 distinct ribotype patterns consisting of 2-9 bands with sizes ranging from 2.8 to >23 kb were found. Twelve major ribotypes were identified of which types 3, 8 and 23 were commonly found (278/577, 48.2%) in both clinical (217/371, 58.5%) and environmental isolates (61/206, 29.6%). Three unique environmental types were found whereas a unique clinical type was not observed. Even though ribotypes show high heterogeneity in the rDNA region, the unique environmental patterns were clearly different from the clinical patterns as clearly seen by UPGMA dendrogram. Moreover, the three major types (types 3, 8 and 23) were discovered in nearly half of B. pseudomallei isolates. Subtyping of these major ribotypes in correlation with clinical profiles may help researchers to identify the virulence factor of the organism.

Arabinose↗
PubMed2001

Bacterial infections in hospitalized patients in Thailand in 1997 and 2000.

Two surveys to determine the patterns of bacterial infections and trends in resistance to antibiotics of bacteria causing infections in patients admitted to hospitals in Thailand were conducted in 36 and 37 hospitals throughout Thailand in June 1997 and February 2000. Approximately 50 per cent of infections in hospitalized patients in Thailand were hospital-acquired infections. Urinary tract and lower respiratory tract were the most common sites of infections. Eighty per cent of infections were caused by gram negative bacteria. Gram negative bacteria causing infections in 2000 were more resistant to most commonly used antibiotics when compared with those in 1997. The prevalence of gram positive bacteria causing hospital-acquired infections significantly increased during this period. The trend of increase in resistance in most gram positive bacteria in 2000 was not clearly observed.

Anti-Bacterial Agents↗
PubMed2001

Microbial killing activity of peracetic acid.

In vitro killing activity of peracetic acid (Perasafe) at a concentration of 0.26 per cent w/v was tested against Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Salmonella typhi, Salmonella paratyphi A, Acinetobacter baumannii, Sternotrophomonas maltophilia, Enterococcus faecium, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus (MRSA), Bacillus subtilis spore, Mycobacterium tuberculosis and human immuno-deficiency virus type I. Exposure to Peracetic acid (0.26% w/v) for 10 minutes resulted in massive killing of all the aforementioned organisms and spore.

Bacteria↗
PubMed2000

Genotype analysis of Burkholderia pseudomallei using randomly amplified polymorphic DNA (RAPD): indicative of genetic differences amongst environmental and clinical isolates.

Burkholderia pseudomallei is the causative agent of melioidosis, an infectious disease common in the tropics. Melioidosis is most prevalent in the northeastern part of Thailand. The diseases has diverse clinical manifestations ranging from mild localized to fatal septicemic forms. The bacterial genetic factors contributing to the severity of melioidosis have not been completely identified. We have developed a genotyping method based upon randomly amplified polymorphic DNA (RAPD) analysis. Eighteen deca-oligo nucleotide primers with 70% GC content, eight previously published 60%GC RAPD primers, and four random deca oligomers were tested on nine strains of B. pseudomallei isolated from five patients with localized and four with septicemic melioidosis. The RAPD patterns were analyzed by polyacrylamide gel electrophoresis using a laser based automated fragment analyzer, GS2000. Based upon the pattern complexity, seven pairs consisting of eight primers were chosen for further analysis. Six hundred and thirty-two samples, including duplicates/triplicates, of B. pseudomallei isolated from melioidosis patients and the environment were analyzed. Two controls were included in each run of the test samples. All the samples were tested and patterns analyzed by blinded technical staff. Apparently, the method is reproducible. This is indicated by the RAPD patterns of the two controls of between run assay. Interestingly, some RAPD patterns were more prevalent in the clinical isolates than the environmental specimens and vice versa. For example, Q162KKU4-0 and Q162KKU1-0 were found 3. 5 and 3.3 times more often in the clinical specimens (P<0.025). Likewise, Q162KKU1-1 and Q162KKU4-1 were found 18 and 37 times more often in the environment (P<0.0000001). In addition, there was a bias in the distribution of arabinose positive strains and particular RAPD patterns; RAPD patterns of B. pseudomallei that were found frequently in septicemic patients were less likely to be arabinose positive. The data suggest the existence of bacterial genetic differences between the clinical and environmental isolates of B. pseudomallei. Further analysis of the RAPD patterns searching for common polymorphic DNA fragments and systemic comparative genomic analysis of B. pseudomallei in accordance with the clinical data should reveal genetic factors involved in severity and bacterial pathogenesis of B. pseudomallei in melioidosis.

Burkholderia pseudomallei↗
PubMed1999

Epidemiology of Burkholderia pseudomallei in Thailand.

The distribution of Burkholderia pseudomallei in soil collected from four regions of Thailand and the frequency of B. pseudomallei infections in patients attending government hospitals throughout Thailand in 1997 were surveyed. A total of 3,585 soil samples collected from 896 sites in four regions of Thailand were cultured for B. pseudomallei using selective enrichment broth and modified Ashdown's agar. The organism was recovered in 4.4%, 6.1%, 20.4%, and 5.9% of the soil samples collected from the northern, central, northeastern, and southern regions, respectively, of Thailand (P < 0.0001). Burkholderia pseudomallei was cultured from 50.1% of the sites in the northeastern region compared with 13.8%, 24.5%, and 18.4% in the northern, central, and southern regions, respectively (P < 0.0001). The infection rate in patients attending government hospitals in the northeastern region (137.9 per 100,000 inpatients) was significantly higher than those in the northern (18 per 100,000 inpatients), central (13.4 per 100,000 inpatients), and southern (14.4 per 100,000 inpatients) regions, respectively (P < 0.0001). It is suggested that melioidosis, which is endemic in Thailand, is associated with the presence of B. pseudomallei in soil.

Burkholderia pseudomallei↗
PubMed1999

Epidemiology of arabinose assimilation in burkholderia pseudomallei isolated from patients and soil in Thailand.

Burkholderia pseudomallei is an environmental saprophyte that has been isolated widely from soil in Southeast Asia and the relationship between environmental contamination and clinical melioidosis has been established. It has been shown that the arabinose assimilation property of B. pseudonrallei is probably one of the determinants indicating virulence of this organism. Therefore, the distribution of arabinose assimilation biotypes of B. pseudomallei collected from four geographic regions of Thailand was studied in order to determine an association between arabinose assimilation of B. pseudomallei and the uneven distribution of melioidosis found among these four areas. A total of 830 isolates of B. pseudomallei (412 patient isolates and 418 soil isolates) collected from the patients and soil in four regions of Thailand in 1997 were tested for an ability to grow on a minimal agar medium supplemented with L-arabinose. All patient isolates except one could not utilise arabinose (Ara-). For 418 soil isolates, 232 (55.5%) isolates were identified as Ara type. They comprised 180 (62.5%), 36 (46.8%), 6 (35.3%) and 10 (27.8%) isolates derived from northeastern, southern, northern and central regions respectively. The ratios of Ara- to Ara, were 1.7, 0.9. 0.5 and 0.4 among isolates collected from northeastern, southern, northern and central regions respectively. The prevalence of Ara- in soil isolates in northeast is significantly higher than those in other regions. This observation suggests that in addition to the presence of B. pseudomallei in soil which is one of the factors contributing to a burden of melioidosis in northeastern Thailand, the distribution of more virulent biotype (Ara-) soil isolates is a factor contributing to a high prevalence of melioidosis in northeastern Thailand as well.

Arabinose↗
PubMed1998

Impact of an educational program on antibiotic use in a tertiary care hospital in a developing country.

A multi-cross-sectional study was conducted in a 2000-bed tertiary care university hospital in Bangkok, Thailand, from September 1993 to May 1994 to assess the effectiveness of an educational program on the use of antibiotics. Data on the study covered antibiotic usage both in-patients and out-patients. Data were collected for a 24-hour period every 2 weeks for 7 days for each 3-month period. The target population were residents, general practitioners, and sixth-year medical students. The educational program provided information derived from the data of inappropriate use of antibiotics during the pre-intervention period and guidelines on the use of antibiotics which were agreed to by a consensus among the faculty in all clinical departments. The study revealed: (1) the prevalence of antibiotic use and the cost of antibiotics during post-intervention period was significantly decreased by 20%; (2) the use of antibiotic prophylaxis for obstetrics patients and patients undergoing cataract surgery decreased significantly; (3) there was a shift from second or third generation cephalosporins to cefazolin for surgical prophylaxis; (4) the duration of perioperative antibiotic prophylaxis was reduced to under 2 days; (5) there was a shift from netilmicin or amikacin to gentamicin for the treatment of community acquired infection; and (6) the mortality, median length of hospital stay, and nosocomial infection rate among the patients who received antibiotics during the post-intervention period were not significantly different from those during the pre-intervention period. These results suggest that this educational program comprising information feedback and antibiotic usage guidelines was effective in improving antibiotic use at this tertiary care university hospital in Thailand.

Anti-Bacterial Agents↗
PubMed1997

Universal precautions: costs for protective equipment.

BACKGROUND: The amount and costs of protective equipment used to implement universal precautions in Thailand have not previously been studied. METHODS: A cross-sectional study was done to determine the frequency of clinical and laboratory procedures requiring universal precautions and the amount of protective equipment needed for each. RESULTS: The study was performed in 24 government hospitals in Thailand in December 1993. Totaling 6549 beds, these hospitals had provided service to 357,391 inpatients and 3,411,122 outpatients during the previous year. The annual number of procedures performed in these hospitals was estimated at 17.5 million, with expenditures for protective equipment of $2.4 million (U.S.) per year. The average overall cost for protective equipment was U.S. $5.37 for one inpatient stay and U.S. $0.15 for one outpatient visit. The projected national expense for these barriers was U.S. $41.5 million per annum. The cost for these barriers after the implementation of universal precautions was 2.5 times the cost before implementation. CONCLUSIONS: Overuse of sterile and examination gloves and gowns and underuse of heavy-duty gloves, masks, aprons, goggles, and boots were discovered during the study. Appropriate use of disposable and reusable universal precautions equipment would free health care dollars for other purposes.

Costs and Cost Analysis↗
PubMed1996

Non-typhoidal Salmonella bacteraemia: clinical features and risk factors.

A case control study was conducted to determine the risk factors of non-typhoidal Salmonella bacteraemia. Eighty adult patients with non-typhoidal Salmonella bacteraemia admitted to Siriraj Hospital from January to December 1993 served as the cases. The controls comprised 3 groups: group 1, 80 adult in-patients with Escherichia coli bacteraemia; group 2, 80 adult in-patients who did not have bacteraemia and had been admitted to the hospital during the same period as the cases; group 3, 80 in-patients who did not have Salmonella bacteraemia and matched the cases in terms of gender, age, hospital services and admission date. AIDS and corticosteroid use were the major risk factors for acquiring non-typhoidal Salmonella bacteraemia with an odds ratio of 7.27 to 12.31 (95% confidence interval of 3.39 to 29.40). Almost all patients with non-typhoidal Salmonella bacteraemia presented with a fever for a median duration of 7 days. AIDS patients usually had concomitant opportunistic infections. Salmonella group D was the most common serogroup. Most patients were treated with co-trimoxazole, quinolones, ceftriaxone and ampicillin. Localized suppurative complications were observed in 14% of the patients; the overall mortality rate was 36.3%, 12% of whom died prior to receiving appropriate antibiotics for Salmonella.

AIDS-Related Opportunistic Infections↗
PubMed1992

Blood culture: comparison of outcomes between switch-needle and no-switch techniques.

BACKGROUND: Because blood culture is a common test at our institution, we hoped to save money and reduce the risk of needlestick injury by modifying our current technique for the preparation of culture specimens without increasing the risk of contamination. METHODS OBJECTIVE: To compare the contamination rates of blood culture specimens obtained by the conventional method of switching to another sterile needle before inoculation with those of specimens obtained by a method without switching. DESIGN: Cross-over study. SETTING: Department of Medicine of university hospital. PARTICIPANTS: Nursing personnel working in seven acute care medical wards in Siriraj Hospital, Bangkok, Thailand. INTERVENTIONS: From March to June 1991, participating nurses prepared blood culture specimens by means of both switch-needle and no-switch techniques in a cross-over study. All blood culture specimens were submitted to microbiology laboratory to determine the growth of microorganisms. MEASUREMENT: Growth in a culture was considered to be "true positive" or "contamination" by predetermined criteria. RESULTS: Total number of blood culture specimens was 1619; of these, 813 were prepared by switch-needle technique and 806 were prepared by no-switch technique. The contamination rates were 7.6% and 8.3% for switch-needle and no-switch techniques, respectively (p = 0.61). CONCLUSIONS: The switch-needle technique may not be necessary for obtaining blood culture specimens unless the needle is obviously contaminated. The no-switch technique for the preparation of blood culture specimens is more convenient and less expensive; it also poses less risk of needlestick injury.

Bacteriological Techniques↗
PubMed1992

Pharmacokinetics of rheumatic fever prophylaxis regimens.

The pharmacokinetics of benzathine penicillin G (1,200,000 IU given intramuscularly), penicillin V (250 mg given orally twice daily), erythromycin stearate (250 mg given orally twice daily) and roxithromycin (150 mg given orally once daily) were investigated. The drugs were given prophylactically to prevent the recurrence of rheumatic fever to 20 patients attending a rheumatic fever clinic in a study of crossover design. Serum antibiotic concentrations were determined by microbiological assay at intervals of up to 28 days after intramuscular injection and immediately before and 1-2 h after the fifth oral dose. The concentrations of penicillin G in all serum samples obtained on day 28 after parenteral benzathine penicillin G administration were greater than 0.01 mg/dl. Most patients had no detectable penicillin V or erythromycin in blood samples drawn immediately before the fifth dose. The concentration of roxithromycin at 24 h after the dose was greater than 1.2 mg/dl in all patients. Based on the pharmacokinetic profiles, it is suggested that 1,200,000 IU benzathine penicillin G given every 4 weeks is an appropriate regimen for preventing the recurrence of rheumatic fever in Thai adults. Roxithromycin had much better pharmacokinetics than penicillin V and erythromycin stearate, and is probably the best alternative regimen to intramuscular penicillin G.

Adult↗
PubMed1991

Efficacy of dosage schedule for rational dosage prescribing of gentamicin.

In our pilot study of 30 patients who were on gentamicin, the adequate peak level (5-10 mg/dl) was found in 27 per cent, trough level (less than 2 mg/dl) in 67 per cent and both peak and trough level in only 10 per cent. We have several reasons to believe that it is due to inappropriate dosage prescribing. The objective of the study is to test the efficacy of using a recommended dosage schedule for rational dosage prescribing of gentamicin. All medical residents were invited to attend a 2-hour session on gentamicin pharmacokinetics. The problems and the use of recommended dosage schedule were extensively discussed. Then serum gentamicin levels were re-monitored by Fluorescence Polarization Immunoassay (TDx). Of 73 gentamicin recipients, 39 (53%, C gr.) were given at the correct dosage according to the schedule and 34 (47%, IC gr) were given incorrectly. The characteristics of the patients in both groups were not different. The appropriate peak, trough, peak and trough levels in C gr were 87, 80, 67 per cent respectively compared with 24, 80 and 9 per cent in the IC group, p less than 10(-4) for peak, peak and trough. The incidence of nephrotoxicity was not different between the two groups. The patients' outcomes were difficult to assess because most of the patients received antibiotic combinations. However, case fatality of documented gram-negative infection tended to be less in the C group. It is concluded that dosage schedule can improve rational dosage prescribing of gentamicin. Most of the patients given gentamicin may not need monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Protocols↗
PubMed1991

Native valve infective endocarditis at Siriraj Hospital, 1982-1989.

During January 1982 to June 1989, there were 105 evaluable adult cases of native valve infective endocarditis admitted to Department of Medicine, Siriraj Hospital. The incidence was approximately 2.6 per 1,000 admissions. The male to female ratio was 1.4 and the mean age was 31.6 years. Thirty (28.5%) were cases associated with intravenous drug abuse. All non-addicts had pre-existing cardiac lesions susceptible to endocarditis especially rheumatic mitral regurgitation, aortic regurgitation, VSD and PDA. The clinical features of cases without intravenous drug abuse were low grade fever for few weeks, malaise, dyspnea and heart murmur. The addicts with endocarditis presented with acute febrile illness and pulmonary symptoms. Mucocutaneous embolic lesions were detected in one third of the patients. Echocardiography detected vegetations in 50 per cent of the patients. Streptococci were the most common causative agent in 93 per cent of non-addicts whereas the same percentage in addicts were caused by S. aureus. Most of the patients were treated with beta lactams (pen G, ampicillin or cloxacillin) alone or combined with aminoglycosides (streptomycin or gentamicin) for a duration from 10 days to 16 week. Six cases had valve replacement operation due to intractable heart failure and valve ring abscess, 2 had embolectomy of major arteries and 2 had craniotomy due to intracerebral hemorrhage. The overall case fatality rate was 14 per cent. The causes of death were heart failure, cerebral complications and severe pulmonary infections. Clinical response was observed sooner in non-addict patients.

Adult↗
PubMed1991

Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers.

Sixty-five adult asymptomatic chronic carriers of hepatitis B virus were enrolled to the randomized controlled efficacy study of Phyllanthus amarus. Thirty-four received Phyllanthus amarus 600 mg per day for 30 days and 31 received placebo in identical capsules. The conversion rate of HBsAg was 6 per cent in the study group at day 30. When 20 subjects in the Phyllanthus amarus group were given a further 30-day treatment and 22 placebo recipients given Phyllanthus amarus 1,200 mg per day for 30 days, the conversion was observed in 1 (5%) in the higher dose group. Adverse effects were not observed in all patients receiving the plant. The results indicated that Phyllanthus amarus, whole plant except root, grown in the central part of Thailand, given at the studied dosage and duration, had a very minimal effect on eradication of HBsAg from Thai adult asymptomatic chronic carriers.

Adolescent↗
PubMed1991

Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults.

One hundred and fifty-two adult patients with pharyngotonsillitis were enrolled in the randomized double blind study to assess the efficacy of Andrographis paniculata. The patients were randomized to receive either paracetamol or 3 g/day of Andrographis paniculata or 6 g/day of Andrographis paniculata for 7 days. The baseline characteristics of the patients among the three groups were not different. The efficacy of paracetamol or high dose Andrographis paniculata was significantly more than that of low dose Andrographis paniculata at day 3 in terms of the relief of fever and sore throat. The clinical effects were not different at day 7. Minimal and self limiting side effects were found in about 20 per cent in each group.

Acetaminophen↗