Aim: Appropriate drug exposure is as crucial as proper selection and timely antibiotic administration in sepsis treatment. However, evidence is lacking regarding the current dosing regimen to achieve pharmacodynamic targets in patients with sepsis. This study aimed to describe ceftriaxone pharmacokinetic (PK) parameters and establish optimal dosing regimens for sepsis patients. Methods: This study investigated the pharmacokinetics of ceftriaxone in sepsis patients receiving ceftriaxone 2 g every 12 or 24 h. Blood samples (11–14 samples per patient) were collected within the first 24 h post-administration. PK parameters were estimated from unbound plasma concentrations using a non-linear mixed-effects modelling approach (NONMEM® software). Monte Carlo simulations were conducted to evaluate the probability of target attainment of standard and high-dose ceftriaxone at various minimum inhibitory concentrations (MICs). Results: Population PK analysis of 238 concentration-time data points from 20 patients revealed that a two-compartment model best described ceftriaxone PK. Glomerular filtration rate (GFR), serum albumin, and body weight significantly affected clearance, volume of distribution, and intercompartmental clearance, respectively. Simulation results demonstrated that the standard dose of 2 g every 24 h was adequate for pathogens with MIC ≤1 mg L ^-1 . For pathogens with higher MICs (2–8 mg L ^-1 ), particularly in patients with GFR >130 mL min ^-1 , a dose of 2 g every 12 h may be more appropriate. Conclusion: Standard ceftriaxone (2 g intravenous q 24 h, 30-min infusion) was adequate for susceptible pathogens, whereas modified regimens were warranted for patients infected with less susceptible organisms with augmented renal clearance.

Background: Ocular candidiasis is a serious metastatic complication of candidemia that may lead to irreversible visual impairment. Although recent meta-analyses suggest an overall prevalence of approximately 10%, real-world data from Southeast Asia remain limited. Regional differences in Candida species distribution, antifungal resistance patterns, and health-care resources may influence both the incidence of ocular candidiasis and the utilization of ophthalmic evaluation in routine practice. Methods: We conducted a retrospective cohort study of patients aged ≥15 years with candidemia at a 900-bed tertiary-care university hospital in southern Thailand between January 2014 and August 2025. Only the first episode of candidemia per patient was included. Ophthalmic evaluation was defined as a dilated funduscopic examination performed by an ophthalmologist within 4 weeks of candidemia onset. Ocular candidiasis was classified as Candida chorioretinitis or Candida endophthalmitis according to established definitions. Multivariable logistic regression was used to identify factors independently associated with receipt of ophthalmic evaluation. Results: Among 337 patients with candidemia, 67 (19.9%) underwent ophthalmic evaluation. Ocular candidiasis was diagnosed in 9 of 67 evaluated patients (13.4%), corresponding to an overall incidence of 2.7% in the entire cohort. Five patients (7.5%) had Candida chorioretinitis and four (6.0%) had Candida endophthalmitis, including two concordant and two discordant cases. Visual symptoms were assessable in 35 patients, among whom only 4 (11.4%) reported visual complaints; most patients with ocular candidiasis were asymptomatic at diagnosis. Candida albicans and Candida tropicalis accounted for 55.6% and 44.4% of ocular candidiasis cases, respectively, and bilateral ocular involvement was observed in 77.8%.Ophthalmic findings led to modification of antifungal therapy in 7 of 9 patients with ocular candidiasis (77.8%), most commonly through addition or switching to an azole-based regimen and/or prolongation of treatment duration. In multivariable analysis, vasopressor use at candidemia onset was independently associated with a lower likelihood of ophthalmic evaluation, whereas early infectious diseases consultation were independently associated with increased odds of receiving ophthalmic evaluation. Conclusions: In this Southeast Asian cohort, ophthalmic evaluation was infrequently performed but yielded clinically actionable findings and frequently altered antifungal management. The observed incidence of ocular candidiasis among examined patients was higher than that reported in Western countries. Underutilization of ophthalmic evaluation appears to reflect illness severity and care pathway factors rather than low disease burden, suggesting that the true incidence of ocular candidiasis may be underestimated. Integrating ophthalmic evaluation into standardized candidemia care pathways may improve detection of ocular involvement, particularly in resource-limited settings.

We describe the case of a 51-year-old man with a history of gout and no overt diabetes mellitus or chronic kidney disease who presented with rapidly progressive severe pneumonia and septic shock after substantial exposure to stagnant floodwater in Southern Thailand. He developed severe pneumonia, septic shock, and multiorgan failure requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) and continuous renal replacement therapy (CRRT). Blood cultures grew Burkholderia pseudomallei, with persistent bacteremia and evidence of disseminated infection, including necrotizing pneumonia with extensive cavitation and multiple visceral abscesses. Despite appropriate intensive antimicrobial therapy, source control, and advanced organ support, the clinical course was complicated by multidrug-resistant ventilator-associated pneumonia and refractory septic shock. The patient died on day 27 of hospitalization. This case highlights that severe disseminated melioidosis may occur in close temporal association with substantial floodwater exposure even in patients without overt diabetes mellitus or chronic kidney disease; however, the route of acquisition, environmental bacterial burden, and exposure inoculum were not established.

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.

Background: Ocular candidiasis is a serious metastatic complication of candidemia that may lead to irreversible visual impairment. Although recent meta-analyses suggest an overall prevalence of approximately 10%, real-world data from Southeast Asia remain limited. Regional differences in Candida species distribution, antifungal resistance patterns, and health-care resources may influence both the incidence of ocular candidiasis and the utilization of ophthalmic evaluation in routine practice. Methods: We conducted a retrospective cohort study of patients aged ≥15 years with candidemia at a 900-bed tertiary-care university hospital in southern Thailand between January 2014 and August 2025. Only the first episode of candidemia per patient was included. Ophthalmic evaluation was defined as a dilated funduscopic examination performed by an ophthalmologist within 4 weeks of candidemia onset. Ocular candidiasis was classified as Candida chorioretinitis or Candida endophthalmitis according to established definitions. Multivariable logistic regression was used to identify factors independently associated with receipt of ophthalmic evaluation. Results: Among 337 patients with candidemia, 67 (19.9%) underwent ophthalmic evaluation. Ocular candidiasis was diagnosed in 9 of 67 evaluated patients (13.4%), corresponding to an overall incidence of 2.7% in the entire cohort. Five patients (7.5%) had Candida chorioretinitis and four (6.0%) had Candida endophthalmitis, including two concordant and two discordant cases. Visual symptoms were assessable in 35 patients, among whom only 4 (11.4%) reported visual complaints; most patients with ocular candidiasis were asymptomatic at diagnosis. Candida albicans and Candida tropicalis accounted for 55.6% and 44.4% of ocular candidiasis cases, respectively, and bilateral ocular involvement was observed in 77.8%. Ophthalmic findings led to modification of antifungal therapy in 7 of 9 patients with ocular candidiasis (77.8%), most commonly through addition or switching to an azole-based regimen and/or prolongation of treatment duration. In multivariable analysis, vasopressor use at candidemia onset was independently associated with a lower likelihood of ophthalmic evaluation, whereas early infectious diseases consultation was independently associated with increased odds of receiving ophthalmic evaluation. Conclusions: In this Southeast Asian cohort, ophthalmic evaluation was infrequently performed but yielded clinically actionable findings and frequently altered antifungal management. The observed incidence of ocular candidiasis among examined patients was higher than that reported in Western countries. Underutilization of an ophthalmic evaluation appears to reflect illness severity and care pathway factors rather than low disease burden, suggesting that the true incidence of ocular candidiasis may be underestimated. Integrating ophthalmic evaluation into standardized candidemia care pathways may improve detection of ocular involvement, particularly in resource-limited settings.