Hospital construction and renovation activities are the main cause of healthcare-associated fungal outbreaks. Infection control risk assessments (ICRAs) for renovation and construction decrease the risk of healthcare-associated fungal outbreaks, but they are typically not performed in developing countries. We reviewed an outbreak investigation to limit the construction-related fungal infections in a COVID-19 ICU in a resource-limited setting.

To the Editor-The coronavirus disease 2019 (COVID-19) pandemic is a global healthcare emergency on a scale not seen in more than a century. With the emergence of new variants, COVID-19 is becoming potentially more contagious with transmission dynamics associated with intercontinental spread. 1-4 To limit transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the hospital in Thailand, most hospitals have created special COVID-19-suspected units to care for all patients suspected to have COVID-19. At Thammasat University Hospital (Pratum Thani, Thailand), a COVID-19-suspect unit was created on February 1, 2020. This unit admits non-critically ill medical patients with special protocols (eg, specific laboratory procurement and respiratory sample collection protocol and management of patients by assigned personal for COVID-19) assigned at the initial sites of evaluation (eg, emergency department, outpatient department, emerging infectious diseases clinic) for patients admitted to the COVID-19-suspect unit. From February 1, 2020, to June 30, 2020, higher mortality was detected among patients who were admitted to this unit compared to patients admitted to regular medicine units [10 of 78 (12.8%) vs 46 of 678 (6.7%); P = .04], despite the comparable severity index between those units. The mean Charlson comorbidity index score of COVID-19-suspect unit was 2.2 (±1.7) and this score in regular medicine units was 2.4 (±1.9) (P = .56). We performed a retrospective review of the patients who were admitted to a COVID-19-suspect unit from February through June 30, 2020, to evaluate potential reasons for the higher mortality in this unit. Data collected included patient demographics, underlying diseases, the initial evaluation site (eg, delay laboratory procurements, delay time to admission, and delay in critical medical measures such as intravenous fluid and antibiotic administration), final diagnoses, and causes of mortality. Analyses were performed using SPSS software, version 15 software (IBM, Armonk, NY). Categorical data were compared using the χ 2 test or the Fisher exact test, as appropriate. We used the Mann-Whitney U test to compare continuous variables. Logistic regression was performed to assess predictors for mortality. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were computed; a significant statistical difference was defined as P < .05.

Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

Vancomycin Area Under the Curve (AUC) monitoring has been recommended to ensure successful clinical outcomes and minimize the risk of nephrotoxicity, rather than traditional trough concentration. However, vancomycin AUC monitoring by a pharmacist-led multidisciplinary team (PMT) has not been well established in Southeast Asia. This study was conducted at Thammasat University Hospital. Adult patients aged ≥ 18 years who were admitted and received intravenous vancomycin ≥48 h were included. The pre-PMT period (April 2020–September 2020) was defined as a period using traditional trough concentration, while the post-PMT period (October 2020–March 2021) was defined as a period using PMT to monitor vancomycin AUC. The primary outcome was the rate of achievement of the therapeutic target of an AUC/MIC ratio of 400–600. There was a significantly higher rate of achievement of therapeutic target vancomycin AUC during post-PMT period (66.7% vs. 34.3%, p < 0.001). Furthermore, there was a significant improvement in the clinical cure rate (92.4% vs. 69.5%, p < 0.001) and reduction in 30-day ID mortality (2.9% vs. 12.4%, p = 0.017) during the post-PMT period. Our study demonstrates that PMT was effective to help attain a targeted vancomycin AUC, improve the clinical cure rate, and reduce 30-day ID mortality. This intervention should be encouraged to be implemented in Southeast Asia.