Anucha Apisarnthanarak

Thammasat University, Krung Thep, Bangkok, Thailand

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Publications (209)936.79 Total impact

  • Piyaporn Apisarnthanarak, Linda M. Mundy, Anucha Apisarnthanarak
  • Journal of Patient Safety 02/2015; DOI:10.1097/PTS.0000000000000152 · 0.88 Impact Factor
  • Anucha Apisarnthanarak, Thanee Eiamsitrakoon, Linda M Mundy
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    ABSTRACT: OBJECTIVE To evaluate behavioral-based interventions to improve hand hygiene (HH) among healthcare workers (HCWs) at a Thai tertiary care center. METHODS A quasi-experimental study was performed in 6 intensive care units with computer-generated allocation. Baseline demographic characteristics, self-reported stage of HH behavioral commitment, and observed HH adherence were examined from January 1, 2012, through December 31, 2012 (preintervention), and from January 1, 2013, through December 31, 2013 (postintervention). Self-reported HH was categorized by the stages construct from the Transtheoretical Model of Health Behavior Change. The intensive care unit group randomization was to either standard-of-care HH education every 3 months (S1), intensified HH interventions (S2), or intensified HH interventions plus increased availability of alcohol-based handrub throughout the unit (S3). RESULTS Among125 HCWs from 6 intensive care units (42 in S1, 41 in S2, 42 in S3) there were 1,936 total HH observations; most HCWs (100 [ 80%]) were nurses or nurse assistants. Compared with preintervention, overall postintervention HH adherence improved in HCWs assigned to S2 (65% vs 85%; P=.02) and S3 (66% vs 95%; P=.005) but not S1 (68% vs 71%; P=.84). Improvement in HH adherence was demonstrated among HCWs who reported lower stages of HH commitment in S2 (21% vs 84%; P<.001) and S3 (24% vs 89%; P<.001) and in HCWs who self-reported higher stages of commitment in S3 (78% vs 96%; P<.001). CONCLUSIONS HCW HH programs may benefit from stage-based tailored strategies to promote sustained HH adherence. Infect Control Hosp Epidemiol 2015;00(0): 1-5.
    Infection Control and Hospital Epidemiology 02/2015; DOI:10.1017/ice.2015.1 · 4.02 Impact Factor
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    ABSTRACT: Limited knowledge of the local molecular epidemiology and the paucity of new effective antibiotics has resulted in an immense challenge in the control and treatment of extensively drug-resistant (XDR) Acinetobacter baumannii infections in Thailand. Antimicrobial combination regimens may be the only feasible treatment option in such cases. We sought to characterize the local molecular epidemiology and assess the bactericidal activity of various antibiotics individually and in combination against XDR A. baumannii in a Thai hospital. All XDR A. baumannii isolates from Thammasat University Hospital were collected between October 2010 and May 2011. Susceptibility testing was conducted according to reference broth dilution methods. Pulse-field gel electrophoresis was used to genotype the isolates. Carbapenemase genes were detected using polymerase chain reaction. In vitro testing of clinically-relevant concentrations of imipenem, meropenem, doripenem, rifampicin and tigecycline alone and in combination with polymyxin B was conducted using multiple combination bactericidal testing. Forty-nine polymyxin B-susceptible XDR A. baumannii isolates were identified. bla OXA-23 and bla OXA-51 genes were detected in all isolates. Eight clonally related clusters were identified, resulting in the initiation of several infection control measures. Imipenem, meropenem, doripenem, rifampicin, and tigecycline in combination with PB respectively, exhibited bactericidal killing in 100%, 100%, 98.0%, 100% and 87.8% isolates respectively at 24 hours. Molecular epidemiologic analysis can aid the early detection of infection outbreak within the institution, resulting in the rapid containment of the outbreak. Imipenem/meropenem/rifampicin in combination with polymyxin B demonstrated consistent bactericidal effect against 49 bla OXA-23-harbouring XDR A. baumannii clinical isolates, suggesting a role of combination therapy in the treatment of these infections.
  • 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:
    International Journal of STD & AIDS 12/2014; DOI:10.1177/0956462414564607 · 1.04 Impact Factor
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    ABSTRACT: The objective of the study is to assess the utility of Alvarado score in the diagnosis of acute appendicitis and the utility of computed tomographic (CT) scan for evaluation of acute appendicitis when stratified by Alvarado scores. Retrospective cohort study comprised adult patients who underwent abdominal CT for suspected acute appendicitis between January 2006 and December 2009. Two abdominal radiologists independently reviewed the CT scans; any discrepancies were resolved by a consensus review. Alvarado scores were calculated and categorized as low (0-3), equivocal (4-6), or high (7-10) probability for appendicitis. The diagnostic utility of CT scans and Alvarado score for acute appendicitis were compared with the criterion standard of combined medical chart review and pathology findings. In a cohort of 158 subjects, 73 (46.2%) had clinical diagnoses of acute appendicitis. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT scan in the diagnosis of acute appendicitis were 97.5%, 98.6%, 96.5%, 96.0%, and 98.8%, respectively. The mean Alvarado score for subjects with complicated appendicitis was significantly higher (7.95) than subjects with uncomplicated appendicitis (6.67) and those with other diagnoses (5.95). Acute appendicitis was confirmed in 2 (13.3%) of 15 subjects with low probability Alvarado scores, 16 (30.8%) of 52 subjects with equivocal scores, and 55 (60.4%) of 91 subjects with high probability scores. The CT scan had high diagnostic utility for acute appendicitis. The Alvarado score was not a reliable independent predictive tool for acute appendicitis and could not replace CT scan. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Journal of Emergency Medicine 12/2014; DOI:10.1016/j.ajem.2014.11.056 · 1.15 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; DOI:10.1111/resp.12442 · 3.50 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
  • Infection Control and Hospital Epidemiology 09/2014; 35(9):1198-1200. DOI:10.1086/677642 · 3.94 Impact Factor
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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. DOI:10.1016/j.ajic.2014.05.029 · 2.33 Impact Factor
  • Thana Khawcharoenporn, Anucha Apisarnthanarak
    International Journal of Antimicrobial Agents 08/2014; 44(2). DOI:10.1016/j.ijantimicag.2014.05.003 · 4.26 Impact Factor
  • 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; DOI:10.1016/j.addr.2014.08.003 · 12.71 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. · 0.55 Impact Factor
  • American Journal of Infection Control 06/2014; 42(6):690-1. DOI:10.1016/j.ajic.2014.02.009 · 2.33 Impact Factor
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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 cutaneous migratory and internal organ involvement. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
    International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 06/2014; 23. DOI:10.1016/j.ijid.2014.01.029 · 2.17 Impact Factor
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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; 26(4). DOI:10.1177/0956462414535750 · 1.04 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.
    04/2014; DOI:10.1177/2325957414531622
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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 04/2014; 43(4). DOI:10.1016/j.ijantimicag.2014.01.016 · 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 02/2014; 42(2):116–121. DOI:10.1016/j.ajic.2013.09.025 · 3.01 Impact Factor
  • Anucha Apisarnthanarak, Linda M Mundy
    Infection Control and Hospital Epidemiology 02/2014; 35(2):207-8. DOI:10.1086/674865 · 4.02 Impact Factor

Publication Stats

2k Citations
936.79 Total Impact Points


  • 2007–2015
    • 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
  • 2010
    • Bryn Mawr College
      Bryn Mawr, Pennsylvania, United States
  • 2009
    • Saint Louis University
      Saint Louis, Michigan, United States
    • University of Missouri - St. Louis
      Saint Louis, Michigan, United States
  • 2008
    • University of Hawai'i System
      Honolulu, Hawaii, United States
    • Honolulu University
      Honolulu, Hawaii, United States
  • 2001–2008
    • Washington University in St. Louis
      • • Department of Medicine
      • • Department of Pediatrics
      San Luis, Missouri, United States
  • 2006
    • Lampang Hospital
      Muang Nagorn Lambang, Lampang, Thailand
  • 2005
    • Udon Thani Hospital
      Ban Dua Makeng, Changwat Udon Thani, Thailand
    • Chiang Mai University
      • Faculty of Nursing
      Chiang Mai, Chiang Mai Province, Thailand
  • 2001–2003
    • University of Washington Seattle
      • Division of Allergy and Infectious Diseases
      Seattle, WA, United States
  • 2002
    • Khon Kaen University
      • Department of Medicine
      Kawn Ken, Khon Kaen, Thailand