Anucha Apisarnthanarak

Thammasat University, Krung Thep, Bangkok, Thailand

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Publications (162)732.74 Total impact

  • 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: 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). 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. 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). 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):116-21. · 3.01 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
  • [show abstract] [hide abstract]
    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: 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
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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
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    ABSTRACT: Background. In 2009, the World Health Organization (WHO) recommended "My Five Moments for Hand Hygiene" (5MHH) to optimize hand hygiene (HH). Uptake of these recommendations by healthcare workers (HCWs) remains uncertain. Methods. We prospectively observed HCW compliance to 5MHH. After observations, eligible HCWs who consented to interviews completed surveys on factors associated with HH compliance based on constructs from the transtheoretical model of behavioral change (TTM) and the theory of planned behavior (TPB). Survey results were compared with observed HCW behaviors. Results. There were 968 observations among 123 HCWs, of whom 110 (89.4%) were female and 63 (51.3%) were nurses. The mean HH compliance for all 5MHH was 23.2% (95% confidence interval [CI], 18.1%-28.3%) by direct observation versus 82.4% (95% CI, 79.9%-84.9%) by self report. The HCW 5MHH compliance was associated with critical care unit encounters ([Formula: see text]), medicine unit encounters ([Formula: see text], [Formula: see text]), immunocompromised patient encounters ([Formula: see text]), and HCW prioritized patient advocacy ([Formula: see text]). Self-reported TTM stages of action or maintenance ([Formula: see text]) and the total TPB behavior score correlated with observed 5MHH ([Formula: see text], [Formula: see text]) and with self-reported 5MHH compliance ([Formula: see text], [Formula: see text]). Conclusion. Observed HCW compliance to 5MHH was associated with the type of hospital unit, type of provider-patient encounter, and theory-based behavioral measures of 5MHH commitment.
    Infection Control and Hospital Epidemiology 11/2013; 34(11):1137-1145. · 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
  • Anucha Apisarnthanarak, Thana Khawcharoenporn, Linda M Mundy
    Infection Control and Hospital Epidemiology 08/2013; 34(8):861-3. · 4.02 Impact Factor
  • Anucha Apisarnthanarak, David K Warren
    Clinical Infectious Diseases 07/2013; · 9.37 Impact Factor
  • Article: Erratum.
    Anucha Apisarnthanarak
    Infection Control and Hospital Epidemiology 07/2013; 34(7):767. · 4.02 Impact Factor
  • Anucha Apisarnthanarak, David K Warren, Clovus Glen Mayhall
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    ABSTRACT: PURPOSE OF REVIEW: This review will focus on the epidemiology of healthcare-associated infections (HAIs) after extensive blackwater flooding as well as preventive measures. RECENT FINDINGS: There is evidence suggesting an increased incidence of HAIs and pseudo-outbreaks due to molds after extensive flooding in healthcare facilities. However, there is no strong evidence of an increased incidence of typical nosocomial infections (i.e., ventilator-associated pneumonia, healthcare-associated pneumonia, central line-associated bloodstream infection and catheter-associated urinary tract infections). The prevalence of multidrug-resistant organisms may decrease after extensive flooding, due to repeated and thorough environmental cleaning prior to re-opening hospitals. Contamination of hospital water sources by enteric Gram-negative bacteria (e.g., Aeromonas species), Legionella species and nontuberculous Mycobacterium species in flood-affected hospitals has been reported. Surveillance is an important initial step to detect potential outbreaks/pseudo-outbreaks of HAIs. Hospital preparedness policies before extensive flooding, particularly with environmental cleaning and mold remediation, are key to reducing the risk of flood-related HAIs. These policies are still lacking in most hospitals in countries that have experienced or are at risk for extensive flooding, which argues for nationwide policies to strengthen preparedness planning. SUMMARY: Additional studies are needed to evaluate the epidemiology of flood-related HAIs and the optimal surveillance and control methods following extensive flooding.
    Current Opinion in Infectious Diseases 06/2013; · 4.87 Impact Factor
  • Infection Control and Hospital Epidemiology 06/2013; 34(6):648-50. · 4.02 Impact Factor
  • Infection Control and Hospital Epidemiology 06/2013; 34(6):655-6. · 4.02 Impact Factor
  • Clinical Infectious Diseases 04/2013; 56(8):1183-5. · 9.37 Impact Factor
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    ABSTRACT: Abstract Excess black-water flooding in central Thailand resulted in closure of several healthcare facilities in the Fall of 2011. Persons living with human immunodeficiency virus (HIV) infection were presumably at risk for interruption of antiretroviral therapy (ART), with consequent treatment failure. We conducted a retrospective cohort study of ART use among patients in care at a Thai HIV clinic that closed due to excess flood water. Among 217 patients on ART who had clinic appointments within the one-month interval before the floods through the one-month interval after the clinic re-opened, seven (3%) reported non-sustained ART access. Non-sustained ART access was independently associated with prior low self-reported ART adherence (P<0.001) and less than six-months duration on the ART regimen (P=0.03). Advanced ART receipt or procurement at other flood-free healthcare facilities were strategies associated with ART access. During a flood disaster, identification and close monitoring of at-risk patients, patient-staff communication, flood preparedness plans, "HIV care access for all" policies, and collaboration among patients, healthcare providers and the government are relevant issues within preparedness plans to optimize ART access.
    AIDS Care 02/2013; · 1.60 Impact Factor
  • Anucha Apisarnthanarak, Li Yang Hsu, Thana Khawcharoenporn, Linda M Mundy
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    ABSTRACT: Emergences of carbapenem-resistant Gram-negative bacteria (CRGNB) have heightened global awareness of the prioritization of infection prevention and control (IPC) interventions to minimize infections attributed to these bacteria. Effective new antibiotic drugs for CRGNB are estimated to be at least 5 years off completion of trials and approval for use. Hence, effective IPC strategies remain at the core of clinical care and research for patients with CRGNB infection. The authors summarize current evidence and viewpoints for IPC strategies as related to the emergence, transmission and prevention of CRGNB.
    Expert Review of Anticancer Therapy 02/2013; 11(2):147-57. · 3.22 Impact Factor
  • Anucha Apisarnthanarak, Thana Khawcharoenporn, Linda M Mundy
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    ABSTRACT: We conducted a national survey among hospitals in Thailand regarding practices associated with central line placement and management. Results of the survey identified that both suboptimal and unnecessary practices are being conducted. Connectors and hubs were not disinfected before access (49%), multidose vial use (43%), and routine culture of catheter tips (21%). Physician leadership and designated catheter insertion teams were associated with less unnecessary or suboptimal reported practices.
    American journal of infection control 02/2013; 41(2):e11-e13. · 3.01 Impact Factor
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    ABSTRACT: The devastating clinical and economic implications of floods exemplify the need for effective global infection prevention and control (IPC) strategies for natural disasters. Reopening of hospitals after excessive flooding requires a balance between meeting the medical needs of the surrounding communities and restoration of a safe hospital environment. Postflood hospital preparedness plans are a key issue for infection control epidemiologists, healthcare providers, patients, and hospital administrators. We provide recent IPC experiences related to reopening of a hospital after extensive black-water floods necessitated hospital closures in Thailand and the United States. These experiences provide a foundation for the future design, execution, and analysis of black-water flood preparedness plans by IPC stakeholders.
    Infection Control and Hospital Epidemiology 02/2013; 34(2):200-6. · 4.02 Impact Factor
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    ABSTRACT: The performance of the settle plate method (SPM) compared with the microbiological air sampler method (MAS) for post-flood fungal bio-aerosol (FB) measurement was evaluated in a Thai hospital. Compared with closed-ventilation units, open-ventilation units had significantly higher median FB level by SPM on days 3 and 5 of incubation (270 vs 90 colony-forming units (cfu)/m(3) and 420 vs 180 cfu/m(3), respectively). Strong correlations between SPM and MAS results on day 3 (r = 1.60, P < 0.001) and day 5 (r = 1.49, P = 0.002) of incubation suggested the utility of SPM for post-flood FB measurement in open-ventilation units in resource-limited situations.
    The Journal of hospital infection 01/2013; · 3.01 Impact Factor

Publication Stats

1k Citations
249 Downloads
732.74 Total Impact Points

Institutions

  • 2008–2014
    • Thammasat University
      • Faculty of Medicine
      Krung Thep, Bangkok, Thailand
    • University of Hawaiʻi at Mānoa
      • Department of Medicine
      Honolulu, HI, United States
    • University of Hawai'i System
      Honolulu, Hawaii, United States
  • 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
  • 2002–2008
    • Washington University in St. Louis
      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