OBJECTIVE To evaluate the expected and treatment outcomes of Thai infectious disease physicians (IDPs) regarding carbapenem-resistant Acinetobacter baumannii (CRAB) ventilator-associated pneumonia (VAP) METHODS From June 1, 2014, to March 1, 2015, survey data regarding the expected and clinical success rates of CRAB VAP treatment were collected from all Thai IDPs. The expected success rate was defined as the expectation of clinical response after CRAB VAP treatment for the given case scenario. Clinical success rate was defined as the overall reported success rate of CRAB VAP treatment based on the clinical practice of each IDP. The expected and clinical success rates were divided into low (80%) categories and were then compared with standard clinical response rates archived in the existing literature. RESULTS Of 183 total Thai IDPs, 111 (60%) were enrolled in this study. The median expected and clinical success rates were 68% and 58%, respectively. Using multivariate analysis, we determined that working in a hospital that implemented the standard intervention combined with an intensified infection control (IC) intervention for CRAB (adjusted odds ratio [aOR], 3.01; 95% confidence interval [CI], 1.17-7.73; P=.02) was associated with standard and high expected rates (>60%). Being a board-certified IDP (aOR, 5.76; 95% CI, 2.16-15.37; P60%). We identified a significant correlation between expected and clinical success rates (r=0.58; P<.001). CONCLUSIONS Awareness of IC among IDPs can improve physicians' expected and clinical success rates for CRAB VAP treatment, and treatment experience impacts overall treatment success. Infect. Control Hosp. Epidemiol. 2015;37(1):61-69.

Background To date, the cases of extraintestinal microsporidiosis have been increasingly reported in both otherwise healthy and immunocompromised individuals. Among them, microsporidial myositis is very rare (2,3). To the best of our knowledge, this is the first report of microsporidial myositis caused by Trachipleistophora hominis in a patient with HIV in Thailand. Case presentation A Thai male with HIV presented with fever and muscle pain at both anterior thighs and left arm for 3 months. Muscle biopsy was performed, and pathology exhibited neutrophils infiltrates and focal aggregations of microsporidial spores. The 18S ribosomal RNA sequence revealed the species of this microsporidium as Trachipleistophora hominis (T. hominis), and albendazole of 800 mg/day was initiated. He gradually improved, and was discharged home 6 weeks after hospitalization. Conclusion to the best of our knowledge, this is the first report of microsporidial myositis caused by Trachipleistophora hominis in a person with HIV in Thailand.

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 unfavourable.

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.

A 53-year-old Thai man with a history of pemphigus vulgaris on chronic prednisolone (30 mg/day) presented to a hospital in Thailand with a 5-month history of lower back pain. He had initially been treated with tramadol, amitriptyline, and gabapentin without relief. Two months prior to presentation, he had developed weakness of the right leg, and he presented when weakness in his right foot made it difficult for him to keep his sandal on. He denied numbness, paresthesia, urinary retention, or bowel incontinence. On physical exam, he appeared well, with a temperature of 36.6°C, a blood pressure of 141/72 mm Hg, and a pulse of 74 beats per minute. Neurologic exam showed a knee flexion score of 4/5 and a foot dorsiflexion score of 3/5 on the right and a knee flexion score of 4/5 and foot dorsiflexion on the left. Sensation was intact bilaterally. Patellar reflexes were 1ϩ bilaterally, with downward plantar reflexes. Initial laboratory investigation showed a white blood cell count of 11,000 cells/mm 3 (normal, 4,000 to 11,000 cells/mm 3 ), with 81.1% neutrophils and 0.3% eosinophils (absolute eosinophil count, 33 cells/mm 3 ). Three serial stool specimens sent for microscopic ova and parasite identification were negative.Gadolinium-enhanced magnetic resonance imaging (MRI) of the lumbosacral spine was performed (Fig. 1A), demonstrating arachnoiditis with a nonenhancing, loculated cystic lesion attached to the left aspect of the cauda equina. Based on this appearance, a parasitic infection was suspected, and neurosurgical consultation was requested. The patient was taken to the operating room for removal of the structure. The cystic lesion was identified in the intradural space, and within was found a macroscopic white helminth (Fig. 1B). The exact length of the specimen could not be determined due to fragmentation during extraction but was greater than 3 cm. Gross pathology showed a helminth with pseudosegmentation evidenced by various circumferences, while microscopic specimens demonstrated a tegumental brush border, calcareous bodies, and a lack of organoid structures (Fig. 1C). With the combination of clinical presentation and pathological findings, a diagnosis of sparganosis was made. Subsequent MRI of the brain also showed evidence of cerebral and cerebellar involvement, with white matter enhancement and serpiginous tunneling (Fig. 1D). On further history, the patient acknowledged that he frequently consumed both raw frog and raw snake meat. He again denied any other neurologic symptoms apart from those mentioned previously, and there was no evidence of cerebellar or cerebral dysfunction on exam. DISCUSSIONSparganosis is a zoonotic infection caused by cestodes of the genera Spirometra and Sparganum, members of the Diphyllobothriidae family (1; DPDx, sparganosis [Centers

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B acterial misidentification and misinterpretation of antimicrobial susceptibility test results directly impact patient safety related to inappropriate antibiotic management. Moreover, these problems potentially affect infection control practices such as patient isolation when misidentification involves multidrug-resistant organisms (MDROs). 1,2 In Thailand, a highly endemic region of MDRO and carbapenem-resistant Acinetobacter baumannii, accurate microbiological testing is essential to appropriate patient care and good clinical outcomes. [3][4][5] We report misidentification of 7 bacterial isolates during a 1-month period, which was recognized by Infectious Diseases Consultants (IDCs). Infection preventionists (IPs) conducted an investigation and implemented quality improvement (QI) strategies for improving microbiology laboratory workflow and identification protocols. METHODSThammasat University Hospital (TUH) is a 650-bed university hospital located in central Thailand. The microbiology laboratory has been operated by 3 technicians and supervised by a technical laboratory supervisor without a doctoral-level clinical microbiologist. The laboratory receives an estimated 3000 specimens for testing per month for bacteriology culture including blood cultures (1500 specimens), respiratory cultures (600 specimens), urine cultures (800 specimens), sterile body fluid cultures (30 specimens), stool cultures (50 specimens), and miscellaneous cultures (50 specimens). The majority of bacterial organisms identified are glucose-nonfermenting gram-negative bacilli (nonfermenters) (300-400 isolates per month) and gram-positive organisms (200-300 isolates per month). Blood cultures are performed using TREK80 media and the VersaTREK system (TREK diagnostics Diagnostics, Oakwood Village, OH). Media for cultures including 5% sheep blood agar (Becton Dickinson, Sparks, MD), MacConkey agar (Becton Dickinson), and Chocolate agar (Oxoid, Ottawa, Canada) were incubated in CO 2 and non-CO 2 incubators. The bacteriology identification protocol is based on Gram stain interpretation, colony morphology, and conventional biochemical testing. Technicians on service interpret the Gram stains without double checking results with other technicians and report a Gram stain result directly to primary providers by telephone and in the electronic medical record. Then, antimicrobial susceptibility testing (AST) is performed using Clinical Laboratory and Standards Institute guidelines by disk diffusion testing and E-test (bioMerieux, Marcyl'Etoile, France). Quality control is performed for each new lot of media and biochemical reagents. Temperatures of all incubators are measured daily. The VersaTREK system and AST testing quality control are performed weekly on isolates of Staphylococcus aureus (ATCC 25923, ATCC 29213), Escherichia coli (ATCC 25922), and Pseudomonas aeruginosa (ATCC 27853), which were provided by the Thai National Institution of Health (NIH). Bacteriology identification proficiency testing was performed quarterly using unknown isolate...