We report isolation of Francisella novicida-causing bacteremia in a woman from Thailand who was receiving chemotherapy for ovarian cancer. The organism was isolated from blood cultures and identifi ed by 16S rDNA and PPIase gene analyses. Diagnosis and treatment were delayed due to unawareness of the disease in this region.F rancisella novicida, a rare human pathogen, has recently been considered to be a subspecies of F. tularensis on the basis of DNA similarity (1,2). The reservoir and transmission route of F. novicida were not clearly defi ned. Since the fi rst isolation of F. novicida, to our knowledge, only 5 patients with suspected infection have been reported (3-5). F. novicida, however, has neither been isolated nor associated with human disease in Thailand. We report a case of F. novicida infection in a Thai patient who was undergoing chemotherapy. The StudyIn October 2007, a 37-year-old woman from Thailand sought treatment at Siriraj Hospital (a 2,400-bed university hospital in Bangkok, Thailand) with a history of fever for 1 week. She was a hairdresser residing in a suburban area of Prachuap Khiri Khan, a southern province of Thailand. She denied history of blood transfusion, animal contact, and travel abroad. She had not been aware of being bitten by insects recently. There was no incidence of unusual animal death in the area in which she resided. Five months before seeking treatment, she received a diagnosis of advanced stage clear cell adenocarcinoma of the ovary with metastasis to peritoneum, spleen, uterus, and multiple abdominal lymph nodes. Chemotherapy was planned. Initial laboratory screening showed increased liver enzyme levels and abnormal hepatitis markers confi rming chronic active hepatitis B virus infection. Chemotherapy was delayed while she was treated with lamivudine. A follow-up visit in early September showed that her liver function biochemistry results had returned to within normal limits. Chemotherapy with carboplastin and paclitaxel was then initiated.At the time of admission, 25 days after the start of chemotherapy, the patient had fever (39 o C), blood pressure 90/60 mm Hg, and pulse rate 75 beats/min. She also had an episode of gastrointestinal hemorrhage with melena. It was believed that fever and gastrointestinal bleeding were complications from chemotherapy; thus, microbiologic investigation was not promptly initiated. Abnormal laboratory fi ndings included anemia (hemoglobin 80 g/L) and leukocytosis with marked neutrophilia (Figure). Urine and stool cultures showed insignifi cant growth.Two samples of blood cultures from peripheral lines were obtained using BacT/Alert FA bottles (bioMérieux, Durham, NC, USA) on day 10 of hospital admission and incubated in the continuous monitoring BacT/Alert 3D system (bioMérieux). Both blood culture bottles grew small pleomorphic gram-negative coccobacillus after incubation for 2 days. Samples from positive bottles were subcultured onto 5% (vol/vol) sheep blood agar, MacConkey agar, and chocolate agar. A slow-growing bacterium was recove...

There is increasing recognition that the intestinal microbiota govern human well-being and prevent diseases. Intestinal colonization by antibiotic-resistant pathogens, however, can lead to the spread of resistance as well as serious infections. Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) represent particularly dangerous pathogens, which are known to asymptomatically colonized the intestinal tract in the community. Here, we performed a 16s rRNA metagenomics sequence analysis to analyze differences in the microbiota composition between ESBL-E carriers and non-carriers in Thailand, where ESBL-E carriage rates are notoriously high. The most notable difference we detected was that the phylum Bacteroidetes, and in particular, the species Bacteroides uniformis, were significantly more abundant in ESBL-E non-carriers than carriers. The Shannon diversity index in non-carriers (5.10 ± 0.69) was also lower than that in ESBL-E carriers (5.39 ± 0.48) without statistical significance (p = 0.13). The overall beta diversity difference of the intestinal microbiota of ESBL-E carriers as compared to non-carriers was statistically significant (Adonis on weighted unifrac: R2=0.14, P =0.005). Furthermore, ESBL-E carriage was significantly lower in farmers than other occupations. Our findings suggest that a dynamic interaction exists between microbiota diversity and ESBL-E carriage, which is possibly driven by dietary composition and may be exploited using probiotic approaches to control the spread of ESBL-E.

A large-scale surveillance is an important measure to monitor the regional spread of antimicrobial resistance. We prospectively studied the prevalence and molecular characteristics of clinically important Gram-negative bacilli, including Escherichia coli (EC), Klebsiella pneumoniae (KP), Acinetobacter baumannii complex (ABC), and Pseudomonas aeruginosa (PA) from blood, respiratory tract, urine, and sterile sites at 47 hospitals across Thailand. Among 187,619 isolates, 93,810 isolates (50.0%) were critically drug-resistant. Of which, 12,915 isolates (13.8%) were randomly selected for molecular characterization. EC was most commonly isolated from all specimens, except the respiratory tract in which ABC was predominant. Prevalence of extended-spectrum cephalosporin resistance (ESCR) was higher in EC (42.5%) than KP (32.0%), but carbapenem-resistant (CR)-KP (17.2%) was 4.5-fold higher than CR-EC (3.8%). A majority of ESCR-/CR-EC and KP carried bla CTX-M (64.6%-82.1%). bla NDM and bla OXA-48-like were the most prevalent carbapenemase genes in CR-EC/CR-KP (74.9%/52.9% and 22.4%/54.1%, respectively). Besides, 12.9%/23.0% of CR-EC/CR-KP co-carried bla NDM and bla OXA-48-like. Among ABC, 41.9% were extensively drug-resistant (XDR), and 35.7% were multidrug-resistant (MDR), while PA showed XDR/MDR at 6.3%/16.5%. A. baumannii (AB) was the most common species among ABC isolates. The major carbapenemase gene in MDR-AB/XDR-AB was bla OXA-23-like (85.8%/93.0%), which had much higher rates than other ABC species. bla IMP , bla VIM , bla OXA-40-like, and bla OXA-58-like were also detected in ABC at lower rates. The most common carbapenemase gene in MDR-/XDR-PA was bla IMP (29.0%/30.6%), followed by bla VIM (9.5%/25.3%). The findings reiterate an alarming situation of drug resistance that requires serious control measures.

The pharmacodynamic profiling undertaken in the current study provides insights that allow prescribers to select more appropriate empirical antibiotic regimens for the treatment of infection caused by these common GNB pathogens at this Thai hospital. While higher doses and PI of β-lactams improve exposures against EC, KP and PA, this approach will not sufficiently enhance their potency against AB, thus alternative therapies should be considered for this organism.

(1) Background: Resistant Pseudomonas aeruginosa (PA) infections have limited treatment options. Data on the activity of ceftolozane-tazobactam (C-T) against PA in Thailand are limited. Objectives: The objective of this study was to identify the in vitro activity of C-T against general and resistant PA isolates from patients with real clinical infections from the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) compared to other antibiotics and to study the resistant molecular patterns of those PA strains which were resistant to C-T. (2) Materials and Methods: This was an in vitro susceptibility study of 100 PA isolates plus an additional seven resistant PA isolates collected from MSMC patients. All PA isolates were tested with susceptibility broth (Sensititre™) and C-T minimal inhibitory concentration (MIC) test strips (Liofilchem, Roseto degli, Abruzzi, Italy). The C-T-resistant PA isolates were analyzed for six β-lactamase genes (blaCTX-M, blaNDM, blaIMP, blaVIM, blaOXA-23 and blaOXA-48) and the mcr-1 gene. (3) Results: A total of 100 PA isolates were collected between January 2020 and January 2021 and between February 2021 and September 2021 for the additional 7 resistant isolates. There were 18 resistant PA isolates (6 MDR, 11 XDR and 1 pan-drug resistant isolate). The overall susceptibility of the initial 100 PA isolates and the 18 resistant PA isolates was 94% and 44.5%, respectively, for C-T. The C-T susceptibility rates for isolates non-susceptible to ceftazidime, piperacillin-tazobactam, carbapenems and antipseudomonal β-lactams were 65.5%, 69.7%, 50% and 44.5%, respectively. Among the 10 isolates which were resistant to C-T, there were only 3 isolates found to have the resistant gene, which included 1 for blaIMP, 1 for blaVIM and 1 for blaNDM. (4) Conclusions: Although C-T was the best susceptibility antibiotic overall for PA isolates and MDR PA isolates at the MSMC, most of the XDR PA isolates and the PDR PA isolate were not susceptible to C-T. The mechanisms for C-T resistance involved multiple factors including the presence of blaIMP, blaVIM and blaNDM.