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Papers by Nattapol Pruetpongpun

The Bangkok Medical Journal, 2021

To determine the effect of the respiratory protective training program of healthcare personnel (H... more To determine the effect of the respiratory protective training program of healthcare personnel (HCP) during the Coronavirus Disease 2019 (COVID-19) pandemic at a private hospital in the northern part of Thailand. MATERIALS AND METHODS: This cross-sectional study was conducted with 89 healthcare personnel (HCP) of Bangkok Hospital Phitsanulok, who required wearing a tight-fitting respirator during their duties and attended respiratory protective equipment (RPE) video-based training program regarding the general principles of respirator usage and guidelines on safely re-using RPE. A questionnaire-based assessment of participants' 3-month retention of knowledge and perception was conducted in April 2021. A qualitative fit test (QLFT) was used in terms of practice on RPE. The proportion of correct responses in the 3-month knowledge and perception score were compared with a pre-training test and an immediate post-training test using paired t-test. The same analysis was conducted with QLFT using McNemar's test. RESULT: Various types of RPE were used in each test depending on the supply. The most commonly used RPE was N95 (58.4%), the majority of N95 was 3MVLFEX 9105. Compared with the pretraining test, the proportion of correct responses in the immediate post-training test increased by 11% (p < 0.001; 95% CI 1.07-2.23). Similarly, in 3-month post-training, the percentage of correct response also increased from pre-training by 10.4% (p < 0.001; 95% CI 0.08-2.28). HCP had an excellent level of perception on using RPE during COVID-19. No significant change in perception was found between pretraining and both immediate and 3-months after training (p = 0.536 and p = 0.384 respectively) The pass rate significantly raised to 96.6% for an immediate post-training test (p < 0.001) and to 98.8% after 3-month (p < 0.001). CONCLUSION: Training has played an important role to help HCP improve their knowledge and practice regarding the usage of RPE, but has no significant effect on perception. The assessment of knowledge, perception and practice retention of RPE usage after 3-month showed the positive impacts of video-based training groups on participants' knowledge and practice. Further evaluations are needed on the interventions that enhance HPC perceptions and attitudes on safety behavior. Pre-and in-service training programs for frontline HPC during a Coronavirus 19 disease pandemic need to be considered by Thai Ministry of Public Health.

Infection Control & Hospital Epidemiology, 2016

Antimicrobial Resistance & Infection Control, 2017

treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to wo... more treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to work out the issue of emerging MDR-GNB infections.

International Journal of Antimicrobial Agents, 2014

Nosocomial infections with Acinetobacter baumannii are a global problem in intensive care units w... more Nosocomial infections with Acinetobacter baumannii are a global problem in intensive care units with high mortality rates. Increasing resistance to firstand second-line antibiotics has forced the use of colistin as last-resort treatment, and increasing development of colistin resistance in A. baumannii has been reported. We evaluated the transcriptional regulator PmrA as potential drug target to restore colistin efficacy in A. baumannii. Deletion of pmrA restored colistin susceptibility in 10 of the 12 extensively drug-resistant A. baumannii clinical isolates studied, indicating the importance of PmrA in the drug resistance phenotype. However, two strains remained highly resistant, indicating that PmrA-mediated overexpression of the phosphoethanolamine (PetN) transferase PmrC is not the exclusive colistin resistance mechanism in A. baumannii. A detailed genetic characterization revealed a new colistin resistance mechanism mediated by genetic integration of the insertion element ISAbaI upstream of the PmrC homolog EptA (93% identity), leading to its overexpression. We found that eptA was ubiquitously present in clinical strains belonging to the international clone 2, and ISAbaI integration upstream of eptA was required to mediate the colistin-resistant phenotype. In addition, we found a duplicated ISAbaI-eptA cassette in one isolate, indicating that this colistin resistance determinant may be embedded in a mobile genetic element. Our data disprove PmrA as a drug target for adjuvant therapy but highlight the importance of PetN transferase-mediated colistin resistance in clinical strains. We suggest that direct targeting of the homologous PetN transferases PmrC/EptA may have the potential to overcome colistin resistance in A. baumannii. IMPORTANCE The discovery of antibiotics revolutionized modern medicine and enabled us to cure previously deadly bacterial infections. However, a progressive increase in antibiotic resistance rates is a major and global threat for our health care system. Colistin represents one of our last-resort antibiotics that is still active against most Gram-negative bacterial pathogens, but increasing resistance is reported worldwide, in particular due to the plasmid-encoded protein MCR-1 present in pathogens such as Escherichia coli and Klebsiella pneumoniae. Here, we showed that colistin resistance in A. baumannii, a top-priority pathogen causing deadly nosocomial infections, is mediated through different avenues that result in increased activity of homologous phosphoethanolamine (PetN) transferases. Considering that MCR-1 is also a PetN transferase, our findings indicate that PetN transferases might be the Achilles heel of superbugs and that direct targeting of them may have the potential to preserve the activity of polymyxin antibiotics.

Open Forum Infectious Diseases, 2016

Anti-interferon (IFN)-γ autoantibodies are increasingly recognized as a cause of adult-onset immu... more Anti-interferon (IFN)-γ autoantibodies are increasingly recognized as a cause of adult-onset immunodeficiency and increased risk for infections with intracellular pathogens. We report on disseminated Talaromyces (Penicillium) marneffei and Mycobacterium abscessus infection in a 72-year-old, human immunodeficiency virus noninfected, Thai man with anti-IFN-γ autoantibody. The patient was successfully treated with antimicrobial therapy and rituximab to control B cell-derived autoantibodies.

Antimicrobial Resistance & Infection Control, 2017

treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to wo... more treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to work out the issue of emerging MDR-GNB infections.

Abigail L. Carlson,a Nattapol Pruetpongpun,b Aubonphan Buppajarntham,b Pansachee Damronglerd,b Ne... more Abigail L. Carlson,a Nattapol Pruetpongpun,b Aubonphan Buppajarntham,b Pansachee Damronglerd,b Neil W. Anderson,c Anucha Apisarnthanarakb Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USAa; Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailandb; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USAc

Journal of Clinical Microbiology, Feb 22, 2017

A n 88-year-old Thai man with recently diagnosed autoimmune hemolytic anemia (AIHA) was started o... more A n 88-year-old Thai man with recently diagnosed autoimmune hemolytic anemia (AIHA) was started on prednisolone at 40 mg/day and azathioprine at 50 mg/day 2 weeks prior to admission. He presented with watery diarrhea, a low-grade fever, and fatigue that had started 1 week prior. His vital signs revealed a temperature of 36.4°C, a blood pressure of 80/40 mm Hg, a pulse of 120 beats/min, and a respiratory rate of 18 breaths/min. His physical examination revealed clear breath sounds bilaterally, no abdominal tenderness, and no rashes. He was empirically treated with imipenemcilastatin at 1 g/day and hydrocortisone for presumptive septic shock together with adrenal insufficiency. His blood pressure and temperature had become normalized on hospital day 2. The results for laboratory tests performed on admission were notable for a white blood cell (WBC) count of 2,800 cells/mm 3 (reference, 4,000 to 11,000 cells/mm 3) with 67.5% neutrophils and 2.5% eosinophils, a hemoglobin level of 5.8 g/dl (reference, 13.5 to 17.5 g/dl), and a platelet count of 125 ϫ 10 3 /l (reference, 140 ϫ 10 3 to 440 ϫ 10 3 /l). His liver function test results and serum creatinine level were within normal limits. The chest roentgenograph results were unremarkable. A stool examination showed 2 to 3 WBC/high-powered field (HPF) and 0 to 1 red blood cells (RBC)/HPF. The blood cultures and stool cultures performed on admission were negative. The results

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2017

A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (9... more A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care.

Journal of clinical microbiology, Feb 1, 2017

A 53-year-old Thai man with a history of pemphigus vulgaris on chronic prednisolone (30 mg/day) p... more A 53-year-old Thai man with a history of pemphigus vulgaris on chronic prednisolone (30 mg/day) presented to a hospital in Thailand with a 5-month history of lower back pain. He had initially been treated with tramadol, amitriptyline, and gabapentin without relief. Two months prior to presentation, he had developed weakness of the right leg, and he presented when weakness in his right foot made it difficult for him to keep his sandal on. He denied numbness, paresthesia, urinary retention, or bowel incontinence. On physical exam, he appeared well, with a temperature of 36.6°C, a blood pressure of 141/72 mm Hg, and a pulse of 74 beats per minute. Neurologic exam showed a knee flexion score of 4/5 and a foot dorsiflexion score of 3/5 on the right and a knee flexion score of 4/5 and foot dorsiflexion on the left. Sensation was intact bilaterally. Patellar reflexes were 1ϩ bilaterally, with downward plantar reflexes. Initial laboratory investigation showed a white blood cell count of 11,000 cells/mm 3 (normal, 4,000 to 11,000 cells/mm 3), with 81.1% neutrophils and 0.3% eosinophils (absolute eosinophil count, 33 cells/mm 3). Three serial stool specimens sent for microscopic ova and parasite identification were negative. Gadolinium-enhanced magnetic resonance imaging (MRI) of the lumbosacral spine was performed (Fig. 1A), demonstrating arachnoiditis with a nonenhancing, loculated cystic lesion attached to the left aspect of the cauda equina. Based on this appearance, a parasitic infection was suspected, and neurosurgical consultation was requested. The patient was taken to the operating room for removal of the structure. The cystic lesion was identified in the intradural space, and within was found a macroscopic white helminth (Fig. 1B). The exact length of the specimen could not be determined due to fragmentation during extraction but was greater than 3 cm. Gross pathology showed a helminth with pseudosegmentation evidenced by various circumferences, while microscopic specimens demonstrated a tegumental brush border, calcareous bodies, and a lack of organoid structures (Fig. 1C). With the combination of clinical presentation and pathological findings, a diagnosis of sparganosis was made. Subsequent MRI of the brain also showed evidence of cerebral and cerebellar involvement, with white matter enhancement and serpiginous tunneling (Fig. 1D). On further history, the patient acknowledged that he frequently consumed both raw frog and raw snake meat. He again denied any other neurologic symptoms apart from those mentioned previously, and there was no evidence of cerebellar or cerebral dysfunction on exam. DISCUSSION Sparganosis is a zoonotic infection caused by cestodes of the genera Spirometra and Sparganum, members of the Diphyllobothriidae family (1; DPDx, sparganosis [Centers

Journal of clinical microbiology, Feb 1, 2017

Journal of clinical microbiology, Mar 1, 2017

The Bangkok Medical Journal, 2021

To determine the effect of the respiratory protective training program of healthcare personnel (H... more To determine the effect of the respiratory protective training program of healthcare personnel (HCP) during the Coronavirus Disease 2019 (COVID-19) pandemic at a private hospital in the northern part of Thailand. MATERIALS AND METHODS: This cross-sectional study was conducted with 89 healthcare personnel (HCP) of Bangkok Hospital Phitsanulok, who required wearing a tight-fitting respirator during their duties and attended respiratory protective equipment (RPE) video-based training program regarding the general principles of respirator usage and guidelines on safely re-using RPE. A questionnaire-based assessment of participants' 3-month retention of knowledge and perception was conducted in April 2021. A qualitative fit test (QLFT) was used in terms of practice on RPE. The proportion of correct responses in the 3-month knowledge and perception score were compared with a pre-training test and an immediate post-training test using paired t-test. The same analysis was conducted with QLFT using McNemar's test. RESULT: Various types of RPE were used in each test depending on the supply. The most commonly used RPE was N95 (58.4%), the majority of N95 was 3MVLFEX 9105. Compared with the pretraining test, the proportion of correct responses in the immediate post-training test increased by 11% (p < 0.001; 95% CI 1.07-2.23). Similarly, in 3-month post-training, the percentage of correct response also increased from pre-training by 10.4% (p < 0.001; 95% CI 0.08-2.28). HCP had an excellent level of perception on using RPE during COVID-19. No significant change in perception was found between pretraining and both immediate and 3-months after training (p = 0.536 and p = 0.384 respectively) The pass rate significantly raised to 96.6% for an immediate post-training test (p < 0.001) and to 98.8% after 3-month (p < 0.001). CONCLUSION: Training has played an important role to help HCP improve their knowledge and practice regarding the usage of RPE, but has no significant effect on perception. The assessment of knowledge, perception and practice retention of RPE usage after 3-month showed the positive impacts of video-based training groups on participants' knowledge and practice. Further evaluations are needed on the interventions that enhance HPC perceptions and attitudes on safety behavior. Pre-and in-service training programs for frontline HPC during a Coronavirus 19 disease pandemic need to be considered by Thai Ministry of Public Health.

Infection Control & Hospital Epidemiology, 2016

Antimicrobial Resistance & Infection Control, 2017

treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to wo... more treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to work out the issue of emerging MDR-GNB infections.

International Journal of Antimicrobial Agents, 2014

Nosocomial infections with Acinetobacter baumannii are a global problem in intensive care units w... more Nosocomial infections with Acinetobacter baumannii are a global problem in intensive care units with high mortality rates. Increasing resistance to firstand second-line antibiotics has forced the use of colistin as last-resort treatment, and increasing development of colistin resistance in A. baumannii has been reported. We evaluated the transcriptional regulator PmrA as potential drug target to restore colistin efficacy in A. baumannii. Deletion of pmrA restored colistin susceptibility in 10 of the 12 extensively drug-resistant A. baumannii clinical isolates studied, indicating the importance of PmrA in the drug resistance phenotype. However, two strains remained highly resistant, indicating that PmrA-mediated overexpression of the phosphoethanolamine (PetN) transferase PmrC is not the exclusive colistin resistance mechanism in A. baumannii. A detailed genetic characterization revealed a new colistin resistance mechanism mediated by genetic integration of the insertion element ISAbaI upstream of the PmrC homolog EptA (93% identity), leading to its overexpression. We found that eptA was ubiquitously present in clinical strains belonging to the international clone 2, and ISAbaI integration upstream of eptA was required to mediate the colistin-resistant phenotype. In addition, we found a duplicated ISAbaI-eptA cassette in one isolate, indicating that this colistin resistance determinant may be embedded in a mobile genetic element. Our data disprove PmrA as a drug target for adjuvant therapy but highlight the importance of PetN transferase-mediated colistin resistance in clinical strains. We suggest that direct targeting of the homologous PetN transferases PmrC/EptA may have the potential to overcome colistin resistance in A. baumannii. IMPORTANCE The discovery of antibiotics revolutionized modern medicine and enabled us to cure previously deadly bacterial infections. However, a progressive increase in antibiotic resistance rates is a major and global threat for our health care system. Colistin represents one of our last-resort antibiotics that is still active against most Gram-negative bacterial pathogens, but increasing resistance is reported worldwide, in particular due to the plasmid-encoded protein MCR-1 present in pathogens such as Escherichia coli and Klebsiella pneumoniae. Here, we showed that colistin resistance in A. baumannii, a top-priority pathogen causing deadly nosocomial infections, is mediated through different avenues that result in increased activity of homologous phosphoethanolamine (PetN) transferases. Considering that MCR-1 is also a PetN transferase, our findings indicate that PetN transferases might be the Achilles heel of superbugs and that direct targeting of them may have the potential to preserve the activity of polymyxin antibiotics.

Open Forum Infectious Diseases, 2016

Anti-interferon (IFN)-γ autoantibodies are increasingly recognized as a cause of adult-onset immu... more Anti-interferon (IFN)-γ autoantibodies are increasingly recognized as a cause of adult-onset immunodeficiency and increased risk for infections with intracellular pathogens. We report on disseminated Talaromyces (Penicillium) marneffei and Mycobacterium abscessus infection in a 72-year-old, human immunodeficiency virus noninfected, Thai man with anti-IFN-γ autoantibody. The patient was successfully treated with antimicrobial therapy and rituximab to control B cell-derived autoantibodies.

Antimicrobial Resistance & Infection Control, 2017

treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to wo... more treat MDRGNB infections. This finding pointed that strict antibiotic policies were required to work out the issue of emerging MDR-GNB infections.

Abigail L. Carlson,a Nattapol Pruetpongpun,b Aubonphan Buppajarntham,b Pansachee Damronglerd,b Ne... more Abigail L. Carlson,a Nattapol Pruetpongpun,b Aubonphan Buppajarntham,b Pansachee Damronglerd,b Neil W. Anderson,c Anucha Apisarnthanarakb Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USAa; Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailandb; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USAc

Journal of Clinical Microbiology, Feb 22, 2017

A n 88-year-old Thai man with recently diagnosed autoimmune hemolytic anemia (AIHA) was started o... more A n 88-year-old Thai man with recently diagnosed autoimmune hemolytic anemia (AIHA) was started on prednisolone at 40 mg/day and azathioprine at 50 mg/day 2 weeks prior to admission. He presented with watery diarrhea, a low-grade fever, and fatigue that had started 1 week prior. His vital signs revealed a temperature of 36.4°C, a blood pressure of 80/40 mm Hg, a pulse of 120 beats/min, and a respiratory rate of 18 breaths/min. His physical examination revealed clear breath sounds bilaterally, no abdominal tenderness, and no rashes. He was empirically treated with imipenemcilastatin at 1 g/day and hydrocortisone for presumptive septic shock together with adrenal insufficiency. His blood pressure and temperature had become normalized on hospital day 2. The results for laboratory tests performed on admission were notable for a white blood cell (WBC) count of 2,800 cells/mm 3 (reference, 4,000 to 11,000 cells/mm 3) with 67.5% neutrophils and 2.5% eosinophils, a hemoglobin level of 5.8 g/dl (reference, 13.5 to 17.5 g/dl), and a platelet count of 125 ϫ 10 3 /l (reference, 140 ϫ 10 3 to 440 ϫ 10 3 /l). His liver function test results and serum creatinine level were within normal limits. The chest roentgenograph results were unremarkable. A stool examination showed 2 to 3 WBC/high-powered field (HPF) and 0 to 1 red blood cells (RBC)/HPF. The blood cultures and stool cultures performed on admission were negative. The results

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2017

A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (9... more A prospective study conducted in a Thai general practice clinic demonstrated a high prevalence (91.3%) of inappropriate empirical antibiotic use in women with uncomplicated cystitis and 42.6% Escherichia coli fluoroquinolone resistance. An annual update of antimicrobial resistance surveillance data of uropathogens may permit targeted treatment of patients in hospital care.

Journal of clinical microbiology, Feb 1, 2017

A 53-year-old Thai man with a history of pemphigus vulgaris on chronic prednisolone (30 mg/day) p... more A 53-year-old Thai man with a history of pemphigus vulgaris on chronic prednisolone (30 mg/day) presented to a hospital in Thailand with a 5-month history of lower back pain. He had initially been treated with tramadol, amitriptyline, and gabapentin without relief. Two months prior to presentation, he had developed weakness of the right leg, and he presented when weakness in his right foot made it difficult for him to keep his sandal on. He denied numbness, paresthesia, urinary retention, or bowel incontinence. On physical exam, he appeared well, with a temperature of 36.6°C, a blood pressure of 141/72 mm Hg, and a pulse of 74 beats per minute. Neurologic exam showed a knee flexion score of 4/5 and a foot dorsiflexion score of 3/5 on the right and a knee flexion score of 4/5 and foot dorsiflexion on the left. Sensation was intact bilaterally. Patellar reflexes were 1ϩ bilaterally, with downward plantar reflexes. Initial laboratory investigation showed a white blood cell count of 11,000 cells/mm 3 (normal, 4,000 to 11,000 cells/mm 3), with 81.1% neutrophils and 0.3% eosinophils (absolute eosinophil count, 33 cells/mm 3). Three serial stool specimens sent for microscopic ova and parasite identification were negative. Gadolinium-enhanced magnetic resonance imaging (MRI) of the lumbosacral spine was performed (Fig. 1A), demonstrating arachnoiditis with a nonenhancing, loculated cystic lesion attached to the left aspect of the cauda equina. Based on this appearance, a parasitic infection was suspected, and neurosurgical consultation was requested. The patient was taken to the operating room for removal of the structure. The cystic lesion was identified in the intradural space, and within was found a macroscopic white helminth (Fig. 1B). The exact length of the specimen could not be determined due to fragmentation during extraction but was greater than 3 cm. Gross pathology showed a helminth with pseudosegmentation evidenced by various circumferences, while microscopic specimens demonstrated a tegumental brush border, calcareous bodies, and a lack of organoid structures (Fig. 1C). With the combination of clinical presentation and pathological findings, a diagnosis of sparganosis was made. Subsequent MRI of the brain also showed evidence of cerebral and cerebellar involvement, with white matter enhancement and serpiginous tunneling (Fig. 1D). On further history, the patient acknowledged that he frequently consumed both raw frog and raw snake meat. He again denied any other neurologic symptoms apart from those mentioned previously, and there was no evidence of cerebellar or cerebral dysfunction on exam. DISCUSSION Sparganosis is a zoonotic infection caused by cestodes of the genera Spirometra and Sparganum, members of the Diphyllobothriidae family (1; DPDx, sparganosis [Centers

Journal of clinical microbiology, Feb 1, 2017

Journal of clinical microbiology, Mar 1, 2017