Purpose: The emergence of isoniazid-resistant tuberculosis (HR-TB) is a global public health problem, causing treatment failure and high mortality rates. This study aimed to determine the minimal inhibitory concentration (MIC) of isoniazid and detect the gene mutation in HR-TB and any association between the level of isoniazid resistance and gene mutation. Methods: We collected 74 clinical HR-TB isolates from two tertiary-care centers in Thailand. MICs were established using broth macrodilution. A line probe assay (LPA) was used to detect gene mutations that confer resistance to isoniazid, rifampicin, aminoglycosides, and fluoroquinolones. Results: Sixty-one (82.4%) isolates were monoresistant to isoniazid and 44 (72.1%) were highly resistant to isoniazid. From the clinical isolates, the range of isoniazid MICs was 0.4-16 μg/mL. The katG S315T gene mutation was the prominent mutation in both isoniazid-monoresistant TB (70.5%) and multidrug-resistant TB (72.7%) isolates. The positive predictive value (PPV) of katG was 100% in detecting high levels of isoniazid resistance. The PPV of the inhA mutation was 93.8% in detecting low levels of isoniazid resistance. Five isolates (6.8%) exhibited low-level phenotypic resistance, whereas an LPA failed to detect an isoniazid gene mutation. Our study found one HR-TB isolate with a gyrA fluoroquinoloneresistant gene mutation. Conclusion: Most HR-TB isolates had high isoniazid-resistance levels associated with the katG gene mutation. High-dose isoniazid should be used with caution in patients with HR-TB. Early detection of drug resistance by genotypic assay can help determine an appropriate regimen.

BackgroundIn recent years, the emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) and colistin-resistant Klebsiella pneumoniae (CoRKP) is one of the leading causes of nosocomial infection worldwide. It has become a public health concern and high mortality, which the few treatment options are available. Salvage treatment caused by CoRKP is still unknown. Here, we explored the 14-day and in hospital mortality to understand the threat to clinical and public health. In addition, we determined the treatment regimen for salvage therapy due to CoRKP bacteremia.MethodsThis was a single-center retrospective cohort study conducted from 2016 to 2018. A total of 96 patients with bacteremia were included; they were classified into three groups according to the infected pathogens with non-carbapenem-resistant Klebsiella pneumoniae (non-CRKP); CRKP and CoRKP. Treatment regimen, 14-day mortality and in hospital mortality were reviewed and compared.ResultsFifty-eight, 10 and 28 patients infected with non-CRKP, CRKP and CoRKP, respectively. The 14-day mortality rate of patients infected with non-CRKP, CRKP and CoRKP was 12.07%, 40% and 60.71%. In hospital mortality was 24.41%, 70% and 82.14%, respectively. All of mortality outcomes had statistically significant different between both of the CoRKP and CRKP group compare to non-CRKP group (P < 0.05). The treatment regimen associated with a favorable outcome on 14-day survival rate in patients with bacteremia due to CoRKP was the antibiotic combination therapy included aminoglycoside (gentamicin or amikacin) with fosfomycin with or without tigecycline. In addition, combination therapy should be avoided prescribing of colistin which supported by lowest survival rate.ConclusionPatients infected with CoRKP bacteremia was the highest 14-day and in hospital mortality. However, the new salvage regimen consisting of aminoglycoside with fosfomycin with or without tigecycline combination was associated with favorable the 14-day survival rate. Disclosures All authors: No reported disclosures.

Background. Multimodal computed tomography (CT) guides decision-making regarding use of thrombolytic agents in acute ischemic stroke patients. However, postcontrast acute kidney injury (PC-AKI) is a potential adverse effect of the contrast media used, which may require hemodialysis and cause a longer hospital stay. The incidence and risk factors of PC-AKI in acute ischemic stroke patients, particularly in Thailand, remain unclear. Goal. We aimed at determining the incidence and risk factors of PC-AKI in patients with acute ischemic stroke undergoing multimodal CT. Methods. We conducted a retrospective review of Thai acute ischemic stroke patients admitted to the King Chulalongkorn Memorial Hospital between January 2014 and December 2017 who received multimodal CT and thrombolytic treatment with alteplase. Result. Overall, 109 patients were included for analysis; eight patients (7.3%) developed PC-AKI. Estimated glomerular filtration rate eGFR≤30 mL/min and mechanical thrombectomy were risk factors significantly associated with PC-AKI. Conclusion. The incidence of PC-AKI in a real practice setting did not differ from previous reports. Two factors were associated with PC-AKI, eGFR≤30 mL/min and mechanical thrombectomy. Patients without these risk factors may not need to wait for the results of renal function testing prior to multimodal CT.

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Erectile dysfunction (ED) is one of the major health concerns affects the quality of life among Thai male. The treatment of ED by the first-line drugs is limited to a certain group of patients due to their side effects and costs. Alternative medicine can be beneficial for the treatment of ED. This is a randomized, double-blind, placebo-controlled, crossover study aimed to assess the efficacy and safety of Cappra ® , a traditional herbal medicine which was used in Thailand for decades, for the treatment of mild and mild to moderate ED in Thai patients. A total of 63 patients with mild or mild to moderate ED were randomized to receive Cappra ® or placebo for two weeks in the first period, followed by one week washout period. The patients were switched to the alternative treatment in the second period. The efficacy was assessed by the International Index of Erectile Function (IIEF) questionnaire and adverse events. Sixty one patients completed the study. There was an improvement of IIEF score for all domains in Cappra ® group compared with placebo group. The mean change of IIEF score from baseline for erectile function domain of Cappra ® was significantly higher than placebo (4.87 vs 3.44, p = 0.032). The most common adverse events were dizziness (13.3% Cappra ® , 9.6% placebo), face numbness (1.6% Cappra ® , 0% placebo), and tachycardia (1.6% Cappra ® , 0% placebo). The results from this study demonstrated that Cappra ® is effective and welltolerated and can be used as alternative therapy for mild and mild to moderate ED.