Anucha Apisarnthanarak

Thammasat University, Krung Thep, Bangkok, Thailand

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Publications (204)909.71 Total impact

  • Thana Khawcharoenporn, Krongtip Chunloy, Anucha Apisarnthanarak
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    ABSTRACT: To assess HIV risk perception and pre-exposure prophylaxis (PrEP) interest among university students, an anonymous survey was conducted among students from a large public university in Thailand. There were 641 participants; 118 (18%) were categorised into moderate or high-risk group. Of these 118 participants, 111 (94%) perceived themselves as no or low risk. Despite high levels of knowledge about HIV transmission risks, rates of consistent condom use with vaginal, oral and anal sex were all low (43%, 18% and 33%, respectively). The low rates of consistent condom use were significantly associated with false perception of low HIV risk (P < 0.05). Independent factors associated with the false perception were male sex (P < 0.001), living with a domestic partner (P = 0.004), being homosexual or bisexual (P = 0.02) and being students from non-medicine faculty (P = 0.04). Of the 641 participants, 211 (33%) were not interested in PrEP. Consistent condom use with oral sex (P = 0.004), consistent condom use with vaginal sex (P = 0.04) and being heterosexual (P = 0.02) were independently associated with no PrEP interest. Our study suggests the need for enhanced interventions to improve HIV risk perception and safe sex practices among the university students. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    International Journal of STD & AIDS 12/2014; · 1.00 Impact Factor
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    ABSTRACT: Background and objectiveLimited data exist for the performance of QuantiFERON-TB Gold In-tube Test (QFT-IT) in comparison to tuberculin skin test (TST) for detecting latent tuberculosis (LTB) in patients with human immunodeficiency virus (HIV) infection from tuberculosis (TB)-endemic Asia-Pacific countries.MethodsA cohort study of Thai HIV-infected patients without history of TB or LTB treatment was conducted from March 2012 through March 2013. Each patient underwent simultaneous TST and QFT-IT.ResultsAmong the 150 enrolled subjects, the median age was 40 years (range 17–65), 53% were male, and the median CD4 count was 367 cells/μL (range 8–1290). Reactive TST and positive QFT-IT were 16% and 13%, respectively, with low concordance between tests (kappa = 0.26); correlation between TST reaction size and level of interferon-γ was moderate (r = 0.34). Independent factors associated with discordant results were long-term smoking (adjusted odds ratio (aOR) 5.74; P = 0.002) for TST-reactive, QFT-IT-negative subjects, and age greater than 52 years (aOR 5.56; P = 0.02) and female gender (aOR 4.40; P = 0.04) for TST non-reactive, QFT-IT-positive subjects. The level of agreement between both tests improved when using a TST cut-off of ≥10 mm (kappa = 0.39).Conclusions In our setting where QFT-IT is available but has limited use due to cost, TST with a cut-off of 10 mm for reactivity should be the initial LTB test. HIV-infected women and persons older than 52 years with non-reactive TST and long-term smokers with reactive TST may benefit from subsequent QFT-IT.
    Respirology 12/2014; · 2.78 Impact Factor
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    ABSTRACT: Background: Clinical Pharmacist (CP) is an emerging career in Thailand. We evaluated the efficacy of antimicrobial stewardship programs (ASP) featuring CP with or without infectious diseases consultation (IDC) in Thailand. Methods: From 1/1/12-9/30/12, all patients with infections admitted to 4 medicine units were prospectively followed until hospital discharge for the impact of ASP with or without IDC for outcomes: inappropriate antibiotic use, antibiotic de-escalation, duration of antibiotic use, hospital length of stay (LOS), and mortality. Patients were retrospectively categorized as patients who had CP input without IDC (Group 1), CP input and IDC (Group 2), and no CP input or IDC (Group 3). All groups received basic ASP supervised by hospital pharmacy during the study period. CP was responsible for making daily rounds, alert treating physicians on antibiotic use, and reminders on antibiotic de-escalation. Appropriate antibiotic use was retrospectively evaluated for prehoc prescribing criteria. Results: The cohort was comprised of 574 patients (G1 = 104; G2 = 320; G3 = 150), with no difference in demographics in G1 and G2. Compared to G3, G1 and G2 patients were more likely to have comorbidities and advanced age. Most antibiotic prescriptions were for empirical therapy (373/574; 65%) while antibiotic prescriptions were most often prescribed for respiratory tract infection (287/574; 50%). By multivariate analysis, G1 was associated with <7days duration of antibiotic use (adjusted Odds Ratio 19.6; P<0.001), while G2 was associated with less inappropriate antibiotic use (aOR = 0.03; P<0.001), antibiotic de-escalation (aOR = 3.7; P<0.001), and <7 days duration of antibiotic use (aOR = 6.81; P<0.001). Compared to G3 (as reference), G1 and G2 were less likely to be prescribed inappropriate antibiotic use (P<0.001), have de-escalation of antibiotics (P<0.001), receive antibiotics <7 days (P<0.001) and have subjects with shorter hospital LOS (P<0.001). There were no group differences in mortality. Conclusion: This study suggests the feasibility and efficacy of ASP featuring CP, with or without IDC, among hospitalized patients in Thailand. Appropriate antibiotic use, antibiotic de-escalation, <7 day antibiotic regimens, and shorter hospital LOS was associated with CP participation on medical teams.
    IDWeek 2014 Meeting of the Infectious Diseases Society of America; 10/2014
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    ABSTRACT: We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.
    American Journal of Infection Control 09/2014; 42(9):942-56. · 2.73 Impact Factor
  • 09/2014; 35(9):1198-1200.
  • Sarah S. Tang, Anucha Apisarnthanarak, Li Yang Hsu
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    ABSTRACT: Alexander Fleming's discovery of penicillin heralded an age of antibiotic development and healthcare advances that are premised on the ability to prevent and treat bacterial infections both safely and effectively. The resultant evolution of antimicrobial resistant mechanisms and spread of bacteria bearing these genetic determinants of resistance is acknowledged to be one of the major public health challenges globally, and threatens to unravel the gains of the past decades. We describe the major mechanisms of resistance to β-lactam antibiotics - the most widely used and effective antibiotics currently - in both Gram-positive and Gram-negative bacteria, and also briefly detail the existing and emergent pharmacological strategies to overcome such resistance. The global epidemiology of the four major types of bacteria that are responsible for the bulk of antimicrobial-resistant infections in the healthcare setting - methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobactericeae, and Acinetobacter baumannii - are also briefly described.
    Advanced Drug Delivery Reviews 08/2014; · 12.89 Impact Factor
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    ABSTRACT: HIV/AIDS remains one of the most serious public health problems in Thailand. This study aimed to assess the health-related quality of life (HRQOL) and its related factors among people living with HIV/AIDS (PLWHA) in Thailand. A cross-sectional study was conducted with 259 patients at a tertiary care hospital. HRQOL was assessed using the Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. Socio-demographics and clinical status were measured using a self-administered questionnaire. Multiple linear regression models were used to explore associations between socio-demographic status, clinical status, and HRQL. Multiple linear regression analyses showed that employment status was strongly related to better overall physical and mental health summary scores (PHS, MHS). In addition, patients with disclosure of HIV status, aged over 50 years, and having at least a rating of good health in the nurses' opinion were the independent positive predictive factors for overall PHS. While being on antiretroviral therapy (ART) and good compliance with ART were positive predictive factors for overall MHS. Improving and strengthening quality of life among PLWHAs are important goals for HIV/AIDS services. Regular assessment of HRQL can provide potential information for intervention to improve quality of life.
    The Southeast Asian journal of tropical medicine and public health 07/2014; 45(4):834-42. · 0.61 Impact Factor
  • American journal of infection control. 06/2014; 42(6):690-1.
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    ABSTRACT: Summary Mycobacterium haemophilum is an environmental organism that rarely causes infections in humans. We report a patient with acquired immunodeficiency syndrome who had central nervous system infection due to M. haemophilum. The diagnosis required brain tissue procurement and molecular identification method while the treatment outcome was unfavorable.
    International Journal of STD & AIDS 05/2014; · 1.00 Impact Factor
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    ABSTRACT: An HIV transmission prevention program incorporating universal voluntary counseling and testing (UVCT) was conducted in a general practice (GP) clinic of a Thai hospital. Of the 494 participating patients, 356 (72%) accepted HIV-UVCT. Independent factors associated with HIV-UVCT acceptance included participating in the program after office hours (4-8 pm; P < .001), living with domestic partner with no marriage (P = .01), and having primary school education or less (P = .02). The main reasons for declining HIV-UVCT were time constraint (38%) and perceiving self as no risk (35%). Among the 356 patients undergoing HIV-UVCT, having moderate to high HIV risk (P < .001) and male sex (P = .01) were independently associated with low HIV risk perception. By HIV-UVCT, the rate of new HIV infection was 4 (1.1%) of 356 patients. Of these 4 newly diagnosed HIV-infected patients, 3 (75%) were homosexual men. The findings suggest feasibility of HIV-UVCT in our GP clinic and factors to be considered for improving the program.
    Journal of the International Association of Providers of AIDS Care. 04/2014;
  • Anucha Apisarnthanarak, Linda M Mundy
    Infection Control and Hospital Epidemiology 02/2014; 35(2):207-8. · 4.02 Impact Factor
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    ABSTRACT: Data for treatment and outcomes of extensively drug-resistant Acinetobacter baumannii (XDR-AB) pneumonia are limited. A retrospective cohort study of 236 adult patients with XDR-AB pneumonia was conducted between January 2009 and December 2012. The median age of subjects was 70 years (range 17–95 years), 53% were male, 55% had ventilator-associated pneumonia and 42% had been admitted to the intensive care unit. All XDR-AB isolates were susceptible only to tigecycline and colistin; 52 (22%) of the 236 subjects did not receive an agent active against XDR-AB, with an associated 28-day survival of 0%. Colistin-based two-drug combination treatment was prescribed to 166 subjects (70%); regimens included (i) colistin and high-dose sulbactam (n = 93); (ii) colistin and tigecycline (n = 43); and (iii) colistin and high-dose prolonged infusion of a carbapenem (n = 30). The 28-day survival rate and mean length of hospital stay were not statistically different between these three regimens (65%, 53% and 60% and 39, 39 and 38 days, respectively). Predictors of mortality included Acute Physiology and Chronic Health Evaluation (APACHE) II score [adjusted odds ratio (aOR) = 1.11; P < 0.001 for each point increase], duration from infection onset to receipt of active regimen (aOR = 1.01; P = 0.002 for each hour delay), underlying malignancy (aOR = 3.46; P = 0.01) and chronic kidney disease (aOR = 2.85; P = 0.03). These findings suggest that the three colistin-based two-drug combination regimens may be treatment options for XDR-AB pneumonia.
    International journal of antimicrobial agents 01/2014; · 3.03 Impact Factor
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    ABSTRACT: Background Advanced source control (once-daily bathing and 4-times daily oral care with chlorhexidine aqueous solution) and thorough environmental cleaning were implemented in response to an increased incidence of colonization and infection with extremely drug-resistant (XDR) Acinetobacter baumannii in a Thai medical intensive care unit (MICU). Methods During the 12-month baseline period (P1), contact isolation, active surveillance for XDR A baumannii, cohorting of XDR A baumannii patients, twice-daily environmental cleaning with detergent-disinfectant, and antibiotic stewardship were implemented. In the 5.5-month intervention period (P2), additional measures were introduced. Sodium hypochlorite was substituted for detergent-disinfectant, and advanced source control was implemented. All interventions except cleaning with sodium hypochlorite were continued during the 12.5-month follow-up period (P3). Extensive flooding necessitating closure of the hospital for 2 months occurred between P2 and P3. Results A total of 1,365 patients were studied. Compared with P1 (11.1 cases/1,000 patient-days), the rate of XDR A baumannii clinical isolates declined in P2 (1.74 cases/1,000 patient-days; P < .001) and further in P3 (0.69 cases/1,000 patient-days; P < .001). Compared with P1 (12.15 cases/1,000 patient-days), the rate of XDR A baumannii surveillance isolates also declined in P2 (2.11 cases/1,000 patient-days; P < .001) and P3 (0.98 cases/1,000 patient-days; P < .001). Incidence of nosocomial infections remained stable. Six patients developed chlorhexidine-induced rash (1.4/1,000 patient-days); 31 patients developed mucositis (17.1/1,000 patient-days). Conclusions These results support advanced source control and thorough environmental cleaning to limit colonization and infection with XDR A baumannii in MICUs in resource-limited settings.
    American journal of infection control 01/2014; 42(2):116–121. · 3.01 Impact Factor
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    ABSTRACT: ABSTRACT We report the results of an international nosocomial infection control consortium (INICC) survei study from January 2007 through December 2012 in 503 ICUs in Latin America, Asia, Africa, and E During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Heal Safety Network (NHSN) definitions for device-associated healthcare-associated infection (DA-HA collected prospective data from 605,310 patients hospitalized in the consortium’s hospital ICUs f aggregate of 3,338,396 days. Although device utilization in INICC ICUs was similar to that reported U.S. ICUs in the CDC’s NHSN, rates of device-associated nosocomial infection were higher in the IC the INICC hospitals: the pooled rate of central line-associated bloodstream infection (CLABSI) INICC ICUs, 4.9 per 1000 central line days, is nearly five-fold higher than the 0.9 per 1000 centra days reported from comparable U.S. ICUs, and the overall rate of ventilator-associated pneumonia ( was also higher, 16.8 vs. 1.1 per 1000 ventilator-days, as was the rate of catheter-associated urinary infection (CAUTI), 5.5 vs. 1.3 per 1000 catheter-days. Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs. 10%), and to imip (42.4% vs. 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (71.2% vs. 28.8%), a imipenem (19.6% vs. 12.8%) were also higher in the INICC ICUs compared with CDC NHSN ICUs.
  • Source
    Tat Ming Ng, Christine B Teng, David C Lye, Anucha Apisarnthanarak
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    ABSTRACT: Objective. Extensively drug resistant (XDR) Acinetobacter baumannii infections are increasing. Knowledge of risk factors can help to prevent these infections. Methods. We designed a 1∶1∶1 case-case-control study to identify risk factors for XDR A. baumannii bacteremia in Singapore and Thailand. Case group 1 was defined as having infection due to XDR A. baumannii, and case group 2 was defined as having infection due to non-XDR A. baumannii. The control group comprised patients with blood cultures obtained to determine possible infection. Results. There were 93 patients in each group. Pitt bacteremia score (adjusted odds ratio [aOR], 2.570 [95% confidence interval (CI), 1.528-4.322]), central venous catheters (CVCs; aOR, 12.644 [95% CI, 2.143-74.620]), use of carbapenems (aOR, 54.391 [95% CI, 3.869-764.674]), and piperacillin-tazobactam (aOR, 55.035 [95% CI, 4.803-630.613]) were independently associated with XDR A. baumannii bacteremia. In case group 2, Pitt bacteremia score (aOR, 1.667 [95% CI, 1.265-2.196]) and third-generation cephalosporins (aOR, 2.965 [95% CI, 1.224-7.182]) were independently associated with non-XDR A. baumannii bacteremia. Concurrent infections (aOR, 3.527 [95% CI, 1.479-8.411]), cancer (aOR, 3.172 [95% CI, 1.135-8.865]), and respiratory source (aOR, 2.690 [95% CI, 1.160-6.239]) were associated with an increased risk of 30-day mortality. Survivors received more active empirical therapy (16.7% vs 9.6%; [Formula: see text]), had fewer cases of XDR bacteremia (45.8% vs 52.6%; [Formula: see text]), and received higher median definitive polymyxin B doses (840,000 units vs 700,000 units; [Formula: see text]) Conclusions. Use of CVC and broad spectrum antibiotics were unique risk factors of XDR A. baumannii bacteremia. Effective antimicrobial stewardship together with use of a CVC bundle may reduce the incidence of these infections. Risk factors of acquisition and mortality may help identify patients for early initiation of polymyxin B therapy.
    Infection Control and Hospital Epidemiology 01/2014; 35(1):49-55. · 4.02 Impact Factor
  • Anucha Apisarnthanarak, Li Yang Hsu, Tze-Peng Lim, Linda M Mundy
    Infection Control and Hospital Epidemiology 01/2014; 35(1):98-99. · 4.02 Impact Factor
  • Source
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    ABSTRACT: The diagnosis of gnathostomiasis typically includes a triad of eosinophilia, migratory skin lesions, and exposure risk. The cutaneous manifestations are protean yet often involve intermittent migratory swellings and creeping skin eruptions with abscesses or nodules, which vary in onset and duration. We report the first case of gnathostomiasis presenting as fever and eosinophilia without migratory cutaneous involvement [Au?1].
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 01/2014; · 2.17 Impact Factor
  • Thana Khawcharoenporn, Anucha Apisarnthanarak
    International Journal of Antimicrobial Agents. 01/2014;
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    ABSTRACT: Pulmonary infection ([Formula: see text]) and an infectious diseases consultation ([Formula: see text]) were associated with carbapenem de-escalation; pulmonary infection and septic shock were associated with unsuccessful de-escalation. Successful de-escalaltion was associated with lower mortality (0% vs 23%; [Formula: see text]) and shorter duration of carbapenem use (4 vs 10 days; [Formula: see text]).
    Infection Control and Hospital Epidemiology 12/2013; 34(12):1310-3. · 4.02 Impact Factor
  • Anucha Apisarnthanarak, Sumana Jitpokasem, Linda M Mundy
    Infection Control and Hospital Epidemiology 11/2013; 34(11):1235-1237. · 4.02 Impact Factor

Publication Stats

2k Citations
909.71 Total Impact Points

Institutions

  • 2007–2014
    • Thammasat University
      • Faculty of Medicine
      Krung Thep, Bangkok, Thailand
  • 2013
    • University of Texas Medical Branch at Galveston
      Galveston, Texas, United States
    • Mahidol University
      Krung Thep, Bangkok, Thailand
  • 2009
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
    • Advocate Illinois Masonic Medical Center
      Chicago, Illinois, United States
  • 2008–2009
    • Saint Louis University
      Saint Louis, Michigan, United States
    • University of Hawaiʻi at Mānoa
      • Department of Medicine
      Honolulu, HI, United States
    • University of Hawai'i System
      Honolulu, Hawaii, United States
  • 2001–2008
    • Washington University in St. Louis
      • Department of Medicine
      San Luis, Missouri, United States
  • 2006
    • Lampang Hospital
      Muang Nagorn Lambang, Lampang, Thailand
  • 2001–2006
    • University of Washington Seattle
      • • Department of Medicine
      • • Department of Pediatrics
      • • Division of Allergy and Infectious Diseases
      Seattle, WA, United States
  • 2005
    • Udon Thani Hospital
      Ban Dua Makeng, Changwat Udon Thani, Thailand
    • Chiang Mai University
      • Faculty of Nursing
      Chiang Mai, Chiang Mai Province, Thailand