This study aimed to establish the clinical features, outcomes, and factors associated with mortality in patients with Stenotrophomonas maltophilia (S. maltophilia) septicemia. The characteristics and outcome data used in this retrospective study were collected from medical records at Songklanagarind Hospital. Risk factors for survival were analyzed using χ²-tests, Kaplan–Meier curves, and Cox regression. A total of 117 patients with S. maltophilia bacteremia were analyzed. The patients’ median age was 45 years, 77 (70%) were male, 105 (90%) had comorbidities, 112 (96%) had previously undergone carbapenem therapy, and over half of the patients were on invasive medical devices. Trimethoprim-sulfamethoxazole (TMP-SMX) and fluoroquinolone showed high susceptibility rates to S. maltophilia, with 93% and 88% susceptibility, respectively. Patients who received appropriate empirical antibiotic treatment had significantly reduced 14-day, 30-day, and in-hospital mortality rates than those who did not (p < 0.001). The days of hospital stay and costs for those who received appropriate and inappropriate empirical antimicrobial treatment were 21 and 34 days (p < 0.001) and 142,463 and 185,663 baht, respectively (p < 0.002). Our results suggest that an appropriate empirical antibiotic(s) is significantly associated with lower 30-day mortality in hospitalized patients with S. maltophilia septicemia.

The study was conducted from October 2020 to March 2022 in a province in southern Thailand. The inpatients with community-acquired pneumonia (CAP) and more than 18 years old were enrolled. Of the 1511 inpatients with CAP, COVID-19 was the leading cause, accounting for 27%. Among the patients with COVID-19 CAP, mortalities, mechanical ventilators, ICU admissions, ICU stay, and hospital costs were significantly higher than of those with non-COVID-19 CAP. Household and workplace contact with COVID-19, co-morbidities, lymphocytopenia and peripheral infiltration in chest imaging were associated with CAP due to COVID-19. The delta variant yielded the most unfavorable clinical and non-clinical outcomes. While COVID-19 CAP due to B.1.113, Alpha and Omicron variants had relatively similar outcomes. Among those with CAP, COVID-19 infection as well as obesity, a higher Charlson comorbidity index (CCI) and APACHE II score were associated with in-hospital mortality. Among those with COVID-19 CAP, obesity, infection due to the Delta variant, a higher CCI and higher APACHE II score were associated with in-hospital mortality. COVID-19 had a great impact on the epidemiology and outcomes of CAP.

: Melioidosis is a potentially fatal infection caused by the bacterium Burkholderia pseudomallei. Septic arthritis caused by this infection is uncommon and difficult to treat. The role of adjunctive open arthrotomy in this type of infection has not yet been elucidated. We conducted a retrospective study of patients with microbiologically confirmed melioidosis between January 2002 and December 2022. Patients with a clinical condition of septic arthritis and positive cultures for B. pseudomallei were included. Comparisons were made between patients who received adjunctive therapy with open arthrotomy with conventional standard treatment and those who did not in terms of clinical outcomes and hospital expenditures. Of the 478 patients diagnosed with melioidosis microbiological confirmation, 81 patients had septic arthritis, accounting for 17% of cases. Among these patients, only 36 (44%) underwent adjunctive therapy with open arthrotomy. The 14-day and 30-day in-hospital mortality and length of hospital stays of patients who underwent adjunctive therapy with open arthrotomy were more favorable than those of patients who did not receive adjunctive therapy with open arthrotomy; however, the difference was not statistically significant. Patients who underwent adjunctive therapy with open arthrotomy had lower hospital expenditures (antimicrobial and non-antimicrobial costs) than those who did not undergo open arthrotomy. Adjunctive therapy with open arthrotomy for patients with septic arthritis due to melioidosis was associated with favorable clinical outcomes and significantly lower hospital expenditures.

This retrospective study was conducted to evaluate the characteristics and outcomes of patients with ventilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia (S. maltophilia), focusing on the impact of appropriate empirical antimicrobial treatment. Of the enrolled 240 patients with VAP due to S. maltophilia (median age: 45 years) in a tertiary-care hospital in southern Thailand between January 2010 and December 2021, 90% had medical comorbidities and 91% had previously received carbapenems. In addition, only 45% of the patients were initially admitted to the intensive care unit. Patients administered appropriate empirical antimicrobial treatment including colistin alone and colistin plus TMP-SMX or fluoroquinolone-based regimens had significantly lower 14-day, 30-day, and in-hospital mortalities, compared with those who did not receive appropriate empirical antimicrobial treatment (21% and 2% vs. 31%; 30% and 5% vs. 44%; and 30% and 12% vs. 53%, respectively). Thus, the use of appropriate empirical antimicrobial treatments led to a significantly reduced length of hospital stay, duration of ventilation, and hospital costs. The current study suggests that the use of appropriate empirical antimicrobial treatment based on susceptibility testing without considering pharmacokinetic properties and administration dosages improves the outcomes of patients with VAP due to S. maltophilia.

Background/Objectives: Achromobacter bacteremia is uncommon, difficult to treat and lacks historically consistent organism-specific susceptibility criteria. We described its clinical characteristics, antimicrobial exposure, susceptibility patterns, treatment, and outcomes over 20 years. Methods: We retrospectively reviewed adults with Achromobacter-positive blood cultures at a Thai tertiary-care hospital during 2006–2025. The first eligible episode per patient was used for patient-level analyses. Historical susceptibility categories were retained as reported. Available matched blood-isolate minimum inhibitory concentrations (MICs) were retrospectively interpreted using Clinical and Laboratory Standards Institute (CLSI) M100, 36th edition. Results: Forty-nine eligible episodes occurred in 47 patients, of which 43/47 (91.5%) were nosocomial. Prior systemic antibiotics and carbapenems had been received by 43/45 (95.6%) and 26/45 (57.8%) patients, respectively. Prior carbapenem exposure was associated with meropenem non-susceptibility (50.0% vs. 11.1%; odds ratio (OR) 7.64, p = 0.010). Thirty-day mortality was 23/46 (50.0%). Non-survivors had higher median National Early Warning Score (NEWS) than survivors (6 vs. 3; p = 0.005). Mortality was lower among patients receiving active than inactive empiric therapy (39.4% vs. 76.9%; OR 0.20, p = 0.047), but the association attenuated after adjustment for vasopressor use. Historical disk and contemporary MIC categories were not fully concordant in the small matched subset (n = 7). Conclusions: Achromobacter bacteremia occurred predominantly as a nosocomial infection in heavily antibiotic-exposed patients and was associated with high mortality. Prior carbapenem exposure was associated with meropenem non-susceptibility, while mortality was closely related to acute illness severity. Historical susceptibility results should be interpreted in the context of the testing method and breakpoint framework.

Objective: Infections caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a global health problem due to its multidrug resistance, often leading to treatment failure. This study aimed to assess the synergistic activity of fosfomycin plus colistin combination against clinical CRPA isolates from ventilator-associated pneumonia (VAP) patients.Material and Methods: This cross-sectional study retrospectively collected clinical data on 40 VAP patients with CRPA infections in 2023. CRPA clinical isolates were obtained between 2022 and 2023 from the sputum of VAP patients as part of the carbapenem-resistant isolate collection. The susceptibility to carbapenems, fosfomycin, and colistin was evaluated on CRPA isolates using the broth microdilution method. The synergistic activity of fosfomycin and colistin combination against CRPA isolates was assessed using the checkerboard assay. The time-kill study was then conducted on CRPA isolates that exhibited treatment synergism with the combination.Results: The most common comorbidities were chronic pulmonary disease and diabetes mellitus, which were found in 73% and 70% of VAP patients with CRPA infection. Previous carbapenem exposure was observed in 93% of the patients. Since VAP diagnosis, these patients were on a ventilator for a median of 13 days with an interquartile range of 10-22 days. Approximately 92% and 95% of the CRPA isolates exhibited high and low carbapenem and colistin resistance, respectively. In contrast, only 3 (7%) isolates were extremely resistant to fosfomycin, classifying as the non-wild type (bacterial isolates with reduced susceptibility or resistance). Synergism between fosfomycin and colistin was only observed in 2 (5%) isolates. Time-kill kinetics of these 2 isolates revealed a ≥2-log reduction in 1/4 minimum inhibitory concentration of fosfomycin and colistin.Conclusion: In vitro findings indicate that the synergistic activity of fosfomycin combined with colistin against CRPA isolates was rare. While this combination showed potential activity in these few isolates, further studies are needed to determine its clinical relevance and effectiveness in treating severe CRPA infections.