1
|
Chen CC, Lai CC, Huang HL, Su YT, Chiu YH, Toh HS, Chiang SR, Chuang YC, Lu YC, Tang HJ. Antimicrobial ability and mechanism analysis of Lactobacillus species against carbapenemase-producing Enterobacteriaceae. J Microbiol Immunol Infect 2020; 54:447-456. [PMID: 32102749 DOI: 10.1016/j.jmii.2020.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study aims to investigate the antimicrobial ability and mechanism analysis of Lactobacillus species against carbapenemase-producing Enterobacteriaceae (CPE). METHODS Five Lactobacillus spp. strains and 18 CPE clinical isolates were collected. Their anti-CPE effects were assessed by agar well diffusion and broth microdilution assay, as well as time-kill test. Finally, the specific anti-CPE mechanism, especially for the effect of organic acids was determined using broth microdilution method. RESULTS All of five Lactobacilli isolates displayed the potent activity against most CPE isolates with mean zones of inhibition ranging 10.2-21.1 mm. The anti-CPE activity was not affected by heating, catalase, and proteinase treatment. Under the concentration of 50% LUC0180 cell-free supernatant (CFS), lactic acid, and mix acid could totally inhibit the growth of carbapenem-resistant Klebsiella pneumoniae (CPE0011), and acetic acid could inhibit 67.8%. In contrast, succinic acid and citric acid could not inhibit the growth of CPE0011. While we decreased the concentration to 25%, only lactic acid and mix acid displayed 100% inhibition. In contrast, succinic acid, citric acid and acetic acid did not show any inhibitory effect. CONCLUSIONS Lactobacillus strains exhibit potent anti-CPE activity, and lactic acid produced by Lactobacillus strains is the major antimicrobial mechanism.
Collapse
Affiliation(s)
- Chi-Chung Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Food Science, National Chiayi University, Chiayi, Taiwan.
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan.
| | - Hui-Ling Huang
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Yu-Ting Su
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Yu-Hsin Chiu
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
| | - Han-Siong Toh
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
| | - Shyh-Ren Chiang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
| | - Ying-Chen Lu
- Department of Food Science, National Chiayi University, Chiayi, Taiwan.
| | - Hung-Jen Tang
- Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
| |
Collapse
|
2
|
Toh HS, Yang CT, Yang KL, Ku HC, Liao CT, Kuo S, Tang HJ, Ko WC, Ou HT, Ko NY. Reduced economic burden of AIDS-defining illnesses associated with adherence to antiretroviral therapy. Int J Infect Dis 2019; 91:44-49. [PMID: 31740407 DOI: 10.1016/j.ijid.2019.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We assessed the economic burden of AIDS-defining illnesses (ADIs), which was further stratified by adherence to antiretroviral therapy (ART). METHODS AND MATERIALS A nationwide longitudinal cohort of 18,234 incident cases with HIV followed for 11years was utilized. Adherence to ART was measured by medication possession ratio (MPR). Generalized estimating equations modeling was used to estimate the cost impact of ADIs. RESULTS Having opportunistic infections increased the annual cost by 9% (varicella-zoster virus infection) to 98% (cytomegalovirus disease), while the annual costs increased by 26% (Kaposi's sarcoma) to 95% (non-Hodgkin's lymphoma) in the year when AIDS-related cancer occurred. ADIs occurred more frequently in the years with low adherence for ART compared to the high-adherence years (e.g., 0.1≤MPR<0.8 vs. MPR≥0.8, event rate of cytomegalovirus disease 4.03% vs. 0.51%). The annual baseline costs in the years with MPR<0.1, 0.1≤MPR<0.8, and MPR≥0.8 were $250, $4,752, and $8,990 (in 2018 USD), respectively. The economic impact of ADIs in the years with low adherence (MPR<0.1) was larger than that in the high-adherence years (MPR≥0.8) (e.g., MPR<0.1 vs. MPR≥0.8, annual cost increased by 244% vs. 9% when candidiasis occurred). CONCLUSIONS Adherence to ART may increase the baseline medical costs but mitigate the incidence and economic burden of ADIs.
Collapse
Affiliation(s)
- Han-Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ting Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Li Yang
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han-Chang Ku
- Department of Nursing, An Nan Hospital, China Medical University, Tainan, Taiwan; Institute of Allied Health Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Te Liao
- Division of Cardiology, Department of Internal Medicine, Chimei Medical Center, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shihchen Kuo
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Hung-Jen Tang
- Division of Infectious Diseases, Department of Internal Medicine, Chimei Medical Center, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Huang-Tz Ou
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
3
|
Chen CC, Lai CC, Huang HL, Huang WY, Toh HS, Weng TC, Chuang YC, Lu YC, Tang HJ. Antimicrobial Activity of Lactobacillus Species Against Carbapenem-Resistant Enterobacteriaceae. Front Microbiol 2019; 10:789. [PMID: 31057508 PMCID: PMC6482263 DOI: 10.3389/fmicb.2019.00789] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/27/2019] [Indexed: 12/15/2022] Open
Abstract
Objective This study aims to identify suitable lactobacilli that have anti-carbapenem-resistant Enterobacteriaceae (CRE) activity with in vitro tolerance to pepsin and bile salts. Methods Fifty-seven Lactobacillus spp. strains encompassing nine species were collected for investigation. Their viabilities in the presence of pepsin and bile salts were tested using tolerance tests. Their anti-CRE effects were assessed by agar well diffusion and broth microdilution assay, as well as time-kill test. Results Of the 57 Lactobacillus isolates collected, 31 had a less than 2-log reduction in their viability in both pepsin and bile salt tolerance tests. Of these 31 isolates, 5 (LUC0180, LUC0219, LYC0289, LYC0413, and LYC1031) displayed the greatest anti-CRE activity with a CRE zone of inhibition greater than 15 mm in agar well diffusion assays. The minimal inhibitory percentages of supernatants from these five strains against CREs ranged from 10 to 30%. With the exception of LUC0180, which had a minimal bactericidal percentage ≥ 40%, the bactericidal percentage of all the strains ranged from 20 to 40%. The inhibitory effect of the cell-free culture supernatants from these Lactobacillus strains did not change after heating but was abolished as the pH changed to 7.0. After a 24-h incubation, five of the Lactobacillus strains at a concentration of 108 CFU/ml totally inhibited the growth of carbapenem-resistant Escherichia coli (CRE316) and Klebsiella pneumoniae (CRE632). After a 48-h incubation, the growth of CRE316 was completely inhibited under each concentration of lactobacilli based on time-kill test. Furthermore, when the concentration of lactobacilli was at 108 CFU/ml, the decline in pH was faster than at other concentrations. Conclusion Some Lactobacillus strains exhibit anti-CRE activity, which suggests potential applications for controlling or preventing CRE colonization or infection.
Collapse
Affiliation(s)
- Chi-Chung Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Food Science, National Chiayi University, Chiayi, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Hospital, Tainan, Taiwan
| | - Hui-Ling Huang
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Wen-Yu Huang
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Han-Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Tzu-Chieh Weng
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Chen Lu
- Department of Food Science, National Chiayi University, Chiayi, Taiwan
| | - Hung-Jen Tang
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
4
|
Tang HJ, Lai CC, Chen CC, Zhang CC, Weng TC, Chiu YH, Toh HS, Chiang SR, Yu WL, Ko WC, Chuang YC. Colistin-sparing regimens against Klebsiella pneumoniae carbapenemase-producing K. pneumoniae isolates: Combination of tigecycline or doxycycline and gentamicin or amikacin. Journal of Microbiology, Immunology and Infection 2019; 52:273-281. [DOI: 10.1016/j.jmii.2016.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 01/04/2016] [Accepted: 03/09/2016] [Indexed: 01/08/2023]
|
5
|
Lai CC, Chen CC, Lu YC, Chen HJ, Su BA, Weng TC, Chiu YH, Toh HS, Zhang CC, Chiang SR, Chuang YC, Tang HJ. Simultaneous three Enterobacteriaceae with different bla NDM-1-encoding plasmids in a patient transferred from mainland China to Taiwan. Infect Drug Resist 2018; 11:2555-2560. [PMID: 30573984 PMCID: PMC6290869 DOI: 10.2147/idr.s179024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
New-Delhi metallo-β-lactamase1 (NDM-1) Enterobacteriaceae are increasing worldwide. Herein, we describe a single patient who carried three unusual NDM-1 carbapenem-resistant Enterobacteriaceae – Enterobacter cloacae (E. cloacae) yielded from a urine specimen and Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) from stool specimens. For E. cloacae, its bla NDM-1-encoding plasmid was pKP04NDM with a size of ~54 kb replicons with an IncN backbone. For K. pneumoniae, its blaNDM-1-encoding plasmid was pNDM-BTR with a size of ~59.6 kb and belonged to IncN. For E. coli, its main blaNDM-1-encoding plasmid was pIMP-HK1500, and the NDM-1 gene was obtained from a part of pNDM-BTR (8439 bp). These three clinical strains are reported for the first time and are assumed to be imported from mainland China to Taiwan. The three different plasmids were never reported in K. pneumoniae, E. coli, and Citrobacter spp before. Owing to their associated multidrug resistance, appropriate measures of periodic, targeted surveillance, and development of new antimicrobial agents are urgently needed.
Collapse
Affiliation(s)
- Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chi-Chung Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Food Science, National Chiayi University, Chiayi, Taiwan
| | - Ying-Chen Lu
- Department of Food Science, National Chiayi University, Chiayi, Taiwan
| | - Hung-Jui Chen
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan,
| | - Bo-An Su
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan,
| | - Tzu-Chieh Weng
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan,
| | - Yu-Hsin Chiu
- Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Han-Siong Toh
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan,
| | | | - Shyh-Ren Chiang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan,
| | - Yin-Ching Chuang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Hung-Jen Tang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan, .,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan,
| |
Collapse
|
6
|
Lee MC, Liao CT, Toh HS. P6582Systematic review and network meta-analysis: the efficacy and safety of oral anticoagulants in patients with atrial fibrillation in asian. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M C Lee
- Chi-Mei Medical Center, Pharmacy, Tainan, Taiwan ROC
| | - C T Liao
- Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC
| | - H S Toh
- Chi-Mei Medical Center, Intensive care medicine, Tainan, Taiwan ROC
| |
Collapse
|
7
|
Toh HS, Liao CT, Chang WT, Tang HJ, Ku HC, Chen ZC. P5418Early detection of cardiac dysfunction in asymptomatic adult HIV-infected patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H S Toh
- Chi-Mei Medical Center, Department of intensive care unit, Tainan, Taiwan ROC
| | - C T Liao
- Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC
| | - W T Chang
- Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC
| | - H J Tang
- Chi-Mei Medical Center, Department of Infectious Diseases, Tainan, Taiwan ROC
| | - H C Ku
- Chi-Mei Medical Center, Department of Infectious Diseases, Tainan, Taiwan ROC
| | - Z C Chen
- Chi-Mei Medical Center, Cardiology, Tainan, Taiwan ROC
| |
Collapse
|
8
|
Toh HS, Maharjan J, Thapa R, Neupane KD, Shah M, Baral S, Hagge DA, Napit IB, Lockwood DNJ. Diagnosis and impact of neuropathic pain in leprosy patients in Nepal after completion of multidrug therapy. PLoS Negl Trop Dis 2018; 12:e0006610. [PMID: 29965957 PMCID: PMC6044550 DOI: 10.1371/journal.pntd.0006610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/13/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022] Open
Abstract
Objectives Neuropathic pain (NP) can occur as a chronic complication of leprosy neuropathy. NP epidemiology and its impact on patients have not been well documented. This study investigates NP prevalence and impact in the years after patients are declared “released from treatment” (RFT) following multidrug therapy (MDT) completion. Methods In this cross-sectional study, 85 RFT patients were recruited within leprosy referral services in Nepal. The Douleur Neuropathique 4 Questionnaire (DN4) was used to screen for NP. Pain severity, impacts on patients’ daily activities and mental health were measured by using the Brief Pain Inventory (BPI), Screening of Activity Limitation and Safety Awareness (SALSA), and General Health Questionnaire-12 (GHQ-12) respectively. Results 96% surveyed had been treated for multibacillary leprosy. 44 (52%) complained of pain of which 30 (68%) were diagnosed with NP. NP was not associated with age, gender, or presence of skin lesions or nerve symptoms at leprosy diagnosis. 70% of patients with NP had either history of or ongoing reactions and 47% had grade 2 disability. Nerve tenderness (p = 0.023) and current reactions (p = 0.018) were significant risk factors for NP. Patients with NP suffered significantly higher intensity pain (p = 0.023) and daily life interference (p = 0.003) and were more likely to have moderate to extreme daily activity limitations (p = 0.005). 13 (43%) exhibited psychological distress, and medications only reduced moderate degree (50–60%) of pain. Conclusions In our study, 35% of RFT patients had ongoing NP. Risk factors include nerve tenderness and reaction. They suffer from more daily life interference and psychological distress. Leprosy patient care should include recognition and management of NP. Leprosy could present with chronic neuropathic pain, which might severely disturb daily life and mental health of leprosy-infected patients. This complication could also occur even years after antibiotics therapy completion, and we noticed that it is associated with recent leprosy reactions and nerve tenderness on physical examination. This is the first study that describes the epidemiology of neuropathic pain in leprosy patients in Nepal. More than one-third of leprosy patients who had completed multidrug therapy, are still suffering from neuropathic pain, and this study demonstrated that it has caused a great impact to their daily activities and psychological status. Therefore, prompt recognition and management of neuropathic pain are mandatory while taking care of the patients with leprosy.
Collapse
Affiliation(s)
- Han-Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
- * E-mail:
| | - Jeni Maharjan
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Ruby Thapa
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Kapil Dev Neupane
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Mahesh Shah
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Suwash Baral
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Deanna A. Hagge
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Indra Bahadur Napit
- Mycobacterial Research Laboratories, Anandaban Hospital, The Leprosy Mission Nepal, Kathmandu, Nepal
| | - Diana N. J. Lockwood
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, England
| |
Collapse
|
9
|
Tang HJ, Lai CC, Hsueh PR, Chen CC, Wu KY, Lin YC, Zhang CC, Weng TC, Chiu YH, Toh HS, Chiang SR, Yu WL, Ko WC, Chuang YC. RNA polymerase B subunit gene mutations in biofilm-embedded methicillin-resistant Staphylococcus aureus following rifampin treatment. Journal of Microbiology, Immunology and Infection 2016; 49:394-401. [DOI: 10.1016/j.jmii.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/02/2015] [Accepted: 06/30/2015] [Indexed: 11/24/2022]
|
10
|
Tang HJ, Chen CC, Lai CC, Zhang CC, Weng TC, Chiu YH, Toh HS, Chiang SR, Yu WL, Ko WC, Chuang YC. In vitro and in vivo antibacterial activity of tigecycline against Vibrio vulnificus. J Microbiol Immunol Infect 2016; 51:76-81. [PMID: 27260781 DOI: 10.1016/j.jmii.2016.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study is to investigate the role of tigecycline in Vibrio vulnificus infection. METHODS Eight randomly selected clinical V. vulnificus isolates were studied to obtain the minimal inhibitory concentrations (MICs) of minocycline, cefotaxime, and tigecycline, and the time-kill curves of tigecycline alone or in combination with other drugs. A peritonitis mouse model was used for the evaluation of the therapeutic efficacy of tigecycline alone or cefotaxime in combination with minocycline or tigecycline. RESULTS The MIC of minocycline, cefotaxime, and tigecycline for eight clinical V. vulnificus isolates was 0.06-0.12 μg/mL, 0.03-0.06 μg/mL, and 0.03-0.06 μg/mL, respectively. In time-killing studies, at the concentration of 1 × MIC, the inhibitory effect of tigecycline persisted for 24 hours in five of eight isolates. With 2 × MIC and trough level, the inhibitory effect was noted in all isolates for 24 hours. With the combination of minocycline plus cefotaxime and tigecycline plus cefotaxime at 1/2 × MIC, the bactericidal effect was noted in 25% and 62.5% of eight isolates and synergism in 50% and 75% of isolates. With a low (1.25 × 105 CFU/mL) inoculum, all infected mice survived with tigecycline alone, tigecycline plus cefotaxime, or minocycline plus cefotaxime on the 14th day. At the inoculum of 1.25 × 106 CFU, the survival rate was 33.3% on the 14th day in the tigecycline plus cefotaxime-treated group, but none of the mice treated by tigecycline alone or minocycline plus cefotaxime survived (33.3% vs. 0%, p = 0.01 by Fisher's exact test). CONCLUSION Our in vitro combination and animal studies indicate that tigecycline could be an option for the treatment of invasive V. vulnificus infections.
Collapse
Affiliation(s)
- Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan
| | - Chi-Chung Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liou Ying, Tainan, Taiwan
| | | | - Tzu-Chieh Weng
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Hsin Chiu
- Department of Medicine, Chi Mei Medical Center, Liou Ying, Tainan, Taiwan
| | - Han-Siong Toh
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Shyh-Ren Chiang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wen-Liang Yu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, National Cheng Kung University Medical College and Hospital, Tainan, Taiwan.
| | - Yin-Ching Chuang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Medicine, Chi Mei Medical Center, Liou Ying, Tainan, Taiwan.
| |
Collapse
|
11
|
Abstract
A new class of 'soft' particles, micelles, is detected electrochemically via 'nano-impacts' for the first time. Short, sharp bursts of current are used to indicate the electrical contact of a single CTAB (cetyltrimethylammonium bromide) micelle with an electrode via the oxidation of the bromide content. The variation in CTAB concentration for such 'nano-impact' experiments shows that a significant number of 'spikes' are observed above the CMC (critical micelle concentration) and this is attributed to the formation of micelles. A comparison with dynamic light scattering is also reported.
Collapse
Affiliation(s)
- H S Toh
- Department of Chemistry , Physical and Theoretical Chemistry Laboratory , Oxford University , South Parks Road , Oxford , OX1 3QZ , UK .
| | - R G Compton
- Department of Chemistry , Physical and Theoretical Chemistry Laboratory , Oxford University , South Parks Road , Oxford , OX1 3QZ , UK .
| |
Collapse
|
12
|
Toh HS, Jiang MY, Tay HT. Invasive pulmonary aspergillosis in severe complicated influenza A. J Formos Med Assoc 2013; 112:810-1. [DOI: 10.1016/j.jfma.2013.10.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 11/25/2022] Open
|
13
|
Lu PL, Liu YC, Toh HS, Lee YL, Liu YM, Ho CM, Huang CC, Liu CE, Ko WC, Wang JH, Tang HJ, Yu KW, Chen YS, Chuang YC, Xu Y, Ni Y, Chen YH, Hsueh PR. Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009-2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents 2012; 40 Suppl:S37-43. [PMID: 22749057 DOI: 10.1016/s0924-8579(12)70008-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In 2009, the Study for Monitoring Antimicrobial Resistance Trends (SMART) was expanded to include surveillance of Gram-negative pathogens causing urinary tract infections (UTIs) in the Asia-Pacific region. A total of 1762 isolates were collected from 38 centers in 11 countries from patients with UTIs in 2009 and 2010. In vitro susceptibilities were determined by the broth microdilution method and susceptibility profiles were determined using minimum inhibitory concentration (MIC) interpretive criteria, as recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2010 (M100-S20), in 2011 (M100-S21), and in 2012 (M100-S22). Enterobacteriaceae comprised 86.0% of the isolates, of which Escherichia coli (56.5%) and Klebsiella pneumoniae (13.8%) were the two most common species. Amikacin was the most effective antibiotic (91.7%), followed by ertapenem (86.9%), imipenem (86.6%), and piperacillin-tazobactam (84.9%). Rates of susceptibility were 50.3% for cefoxitin and ranged from 50.3% to 74.2% for the third- and fourth-generation cephalosporins. For ciprofloxacin and levofloxacin, the susceptibility rates were 51.4% and 54.4%, respectively. Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae comprised 28.2% of all isolates. We also found a high rate of resistance to carbapenems among Acinetobacter baumannii and Pseudomonas aeruginosa causing UTI. Interestingly, according to 2012 CLSI breakpoints, approximately 33.4% of ESBL producers were still susceptible to ceftazidime. However, this in vitro efficacy of ceftazidime needs to be validated in vivo by clinical data. The lowered CLSI interpretive breakpoints for piperacillin-tazobactam, carbapenems, and some cephalosporins in 2011-2012 for Enterobacteriaceae resulted in an approximate 5% drop in susceptibility rates for each drug, with the exception of imipenem for which the susceptibility rate dropped from 99.4% according to 2010 criteria to 91.2% according to 2011 criteria. With the updated CLSI criteria, the antimicrobial resistance threat from UTI pathogens in the Asia Pacific area was revealed to be more prominent.
Collapse
Affiliation(s)
- Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Toh HS, Chuang YC, Huang CC, Lee YL, Liu YM, Ho CM, Lu PL, Liu CE, Chen YH, Wang JH, Ko WC, Yu KW, Liu YC, Chen YS, Tang HJ, Hsueh PR. Antimicrobial susceptibility profiles of Gram-negative bacilli isolated from patients with hepatobiliary infections in Taiwan: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2006-2010. Int J Antimicrob Agents 2012; 40 Suppl:S18-23. [PMID: 22749054 DOI: 10.1016/s0924-8579(12)70005-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigated the trends in antimicrobial resistance among species of Gram-negative bacilli isolated from patients with hepatobiliary tract infections in Taiwan during the period 2006-2010 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). During the study period, 1032 isolates of Gram-negative bacilli that had been collected from patients with hepatobiliary infections were tested for susceptibility to 12 antimicrobial agents in accordance with the Clinical and Laboratory Standards Institute guidelines. Enterobacteriaceae accounted for the majority (n = 874, 84.7%) of isolates and Escherichia coli was the most common pathogen (n = 323, 31.3%). There were significantly more E. coli (P = 0.001) and Proteus mirabilis (P = 0.031) isolates collected from patients who had been hospitalized for less than 48 h and significantly more Serratia marcescens (P = 0.035) and Pseudomonas aeruginosa (P = 0.008) isolates collected from patients who had been hospitalized for 48 h or longer. The prevalence of extended-spectrum β-lactamase (ESBL)-producing pathogens was low. The decline in susceptibility rates with time was remarkable for ceftazidime (P = 0.036), ciprofloxacin (P = 0.029), and levofloxacin (P = 0.018). The most effective antibiotics, i.e., those that were active against more than 90% of Enterobacteriaceae, were amikacin, cefepime, imipenem, ertapenem, and piperacillin-tazobactam. Susceptibility of P. aeruginosa to anti-pseudomonal agents was greater than 80%. In this study, we found an overall increase in resistance to antimicrobial agents among Gram-negative bacilli isolated from patients with hepatobiliary tract infections in Taiwan. Surveillance of antimicrobial susceptibility and updates of treatment guidelines are recommended to help achieve optimal therapy for patients with hepatobiliary infections.
Collapse
Affiliation(s)
- Han-Siong Toh
- Department of Infectious Diseases, Chi Mei Medical Center, Tainan City, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Liu YM, Chen YS, Toh HS, Huang CC, Lee YL, Ho CM, Lu PL, Ko WC, Chen YH, Wang JH, Tang HJ, Yu KW, Liu YC, Chuang YC, Xu Y, Ni Y, Liu CE, Hsueh PR. In vitro susceptibilities of non-Enterobacteriaceae isolates from patients with intra-abdominal infections in the Asia-Pacific region from 2003 to 2010: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents 2012; 40 Suppl:S11-7. [DOI: 10.1016/s0924-8579(12)70004-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
Tang HJ, Chen CC, Cheng KC, Toh HS, Su BA, Chiang SR, Ko WC, Chuang YC. In vitro efficacy of fosfomycin-containing regimens against methicillin-resistant Staphylococcus aureus in biofilms. J Antimicrob Chemother 2012; 67:944-50. [PMID: 22258931 DOI: 10.1093/jac/dkr535] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To compare the in vitro antibacterial efficacy of antistaphylococcal antibiotics in combination with fosfomycin or rifampicin, using a biofilm model. METHODS The antibacterial activities of fusidic acid, linezolid, vancomycin, teicoplanin, rifampicin, minocycline, fosfomycin and tigecycline, individually and in fosfomycin or rifampicin combinations, were measured against planktonic or biofilm-embedded methicillin-resistant Staphylococcus aureus (MRSA) with susceptible and resistant breakpoint concentrations (SBCs and RBCs, respectively), using the MTT-staining method and by counting the number of cfu in the biofilms. RESULTS Linezolid alone at its SBC, and fosfomycin, linezolid, minocycline and tigecycline at their RBCs, exhibited killing effects on biofilm-embedded MRSA (P < 0.0001). Of the eight fosfomycin combinations studied, fosfomycin combined with linezolid, minocycline, vancomycin or teicoplanin at their respective SBCs, exhibited enhanced antibacterial activities (P < 0.0001) when compared with the control group, and outperformed rifampicin combinations (P < 0.01). The killing effects of fosfomycin combinations at their respective RBCs were better than those at their respective SBCs (P < 0.05). Significantly enhanced killing effects were observed with fosfomycin in combination with vancomycin or teicoplanin, compared with vancomycin or teicoplanin alone. For 10 randomly selected MRSA isolates, the results of colony counting in biofilms were comparable with those of the MTT-staining method. CONCLUSIONS Fosfomycin enhanced the activities of linezolid, minocycline, vancomycin and teicoplanin. These combinatorial treatments were even better than rifampicin combination regimens, and may provide therapeutic advantages in catheter-related or prosthetic joint infections.
Collapse
Affiliation(s)
- Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Weng TC, Chen CC, Toh HS, Tang HJ. Ibuprofen worsens Streptococcus pyogenes soft tissue infections in mice. J Microbiol Immunol Infect 2011; 44:418-23. [PMID: 21697021 DOI: 10.1016/j.jmii.2011.04.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 08/20/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Group A streptococcus (GAS) is a common cause of soft tissue infection. Nonsteroidal anti-inflammatory drugs have been reported to worsen GAS soft tissue infections. METHODS A mouse model of GAS soft tissue infection was developed. The extent of cutaneous lesions, tissue damage, release of inflammatory cytokines, and survival rates were compared between mice with and without ibuprofen administration after GAS soft tissue infection. RESULTS All twelve mice without ibuprofen administration survived for at least 10 days. In contrast, mortality rate of 14 mice with ibuprofen therapy was 72.5%. Ibuprofen-treated mice exhibited more evident macrophage infiltration and tissue damage in the GAS-infected soft tissues. In GAS-infected mice, tissue levels of interleukin 6 and tumor necrosis factor alpha were significantly higher in ibuprofen-treated mice than those in the control group. CONCLUSIONS The results supported the concept that ibuprofen use in GAS soft tissue infections might induce the development of severe necrotizing infections and increase mortality rate.
Collapse
Affiliation(s)
- Tzu-Chieh Weng
- Department of Infectious Diseases, Chi Mei Medical Center, Tainan, Taiwan
| | | | | | | |
Collapse
|
18
|
Toh HS, Tay HT, Kuar WK, Weng TC, Tang HJ, Tan CK. Risk factors associated with Sphingomonas paucimobilis infection. J Microbiol Immunol Infect 2011; 44:289-95. [PMID: 21524965 DOI: 10.1016/j.jmii.2010.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 07/20/2010] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Sphingomonas paucimobilis is rarely isolated from clinical specimens and it is associated with a great variety of infections. The aim of this study is to investigate the microbiological and clinical features of S paucimobilis infection in southern Taiwan. METHODS S paucimobilis isolates from the microbiology laboratory of Chi-Mei Medical Center and their relevant clinical data from October 2005 to October 2009 were retrospectively reviewed. RESULTS A total of 55 patients with documented S paucimobilis infections were identified. Among them, 29 (52.7%) have community-acquired infections and 13 of them presented with primary bacteremia (44.8%). Multivariate logistic regression showed that community-acquired infection [adjusted odds ratio 13.473, 95% confidence interval (CI) 1.79-101.41, p = 0.01], diabetes mellitus (adjusted odds ratio 7.03, 95% CI 1.16-42.66, p = 0.03), and alcoholism (adjusted OR 10.87, 95% CI 1.00-117.69, p = 0.05) were significant risk factors for S paucimobilis primary bacteremia. Most of those who have health care-associated S paucimobilis infections presented with pneumonia (10 of 26, 38.5%) and only 7.7% presented with catheter-related infection. The overall mortality rate was 5.5%. CONCLUSION Community-acquired S paucimobilis infections were not uncommon, mainly presenting with primary bacteremia. Multivariate analysis showed that community-acquired infection, diabetes mellitus, and alcoholism were significant risk factors for primary bacteremia.
Collapse
Affiliation(s)
- Han-Siong Toh
- Department of Infectious Diseases, Chi-Mei Medical Center, Tainan, Taiwan
| | | | | | | | | | | |
Collapse
|
19
|
Padovani R, Bernardi G, Quai E, Signor M, Toh HS, Morocutti G, Spedicato L. Retrospective evaluation of occurrence of skin injuries in interventional cardiac procedures. Radiat Prot Dosimetry 2005; 117:247-50. [PMID: 16461491 DOI: 10.1093/rpd/nci757] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Interventional cardiology procedures can involve high doses to patients and, in particular, to patients' skin, the tissue at greatest risk of deterministic injuries. The evaluation of skin dose from interventional procedures is recommended, but difficult because of the amount of different X-ray fields and projections used in a procedure. For this reason, a retrospective follow-up study has been developed to identify skin injuries in patients submitted to one or more cardiac interventions in the Udine hospital between 1998 and 2002. Seventy-eight patients with a cumulative dose-area product >300 Gy cm2 were selected from 3332 patients, who underwent 5039 procedures. In this group the maximum skin dose was 6.7 Gy. The clinical follow-up, performed using the LENT-SOMA methodology, has not detected skin injuries and this result allows a frequency to be estimated for skin injuries in patients undergoing repeated cardiac procedures of <3 x 10(-4) in our centre.
Collapse
Affiliation(s)
- R Padovani
- Medical Physics Institute, S. Maria della Misericordia Hospital, Udine, Italy.
| | | | | | | | | | | | | |
Collapse
|
20
|
Bernardi G, Padovani R, Desmet W, Peterzol A, Giannuleas JD, Neofotistou E, Manginas A, Olivari Z, Cosgrave J, Alfonso F, Garcia J, Bosmans H, Dowling A, Toh HS, Morocutti G, Vano E. A study to validate the method based on DIMOND quality criteria for cardiac angiographic images. Radiat Prot Dosimetry 2005; 117:263-8. [PMID: 16461538 DOI: 10.1093/rpd/nci704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A method based on image quality criteria (QC) for cine-angiography was developed to measure the quality of cine-angiograms (CA). A series of 30 CA for left ventriculography (LV) and left and right coronary angiography (LCA, RCA) have been scored and 172 readings were obtained. Standard deviation of quality scores indicated the reproducibility of the method. Each part of CA was examined separately, giving scores for LV, LCA and RCA and a total score (TS), with clinical (C) and technical (T) criteria defined and examined separately. In 83% of the studies TS was >0.8 and with standard deviation from 0.02 to 0.21. In general, LV had a lower score and greater disagreement compared with RCA and LCA. Disagreement was greater in T, compared with C. In conclusion, these results indicate that QC, translated into a scoring system, yields reproducible data on the quality of cardiac images.
Collapse
Affiliation(s)
- G Bernardi
- Unità Operativa di Cardiologia, Az. Osp. S. Maria della Misericordia, Piazzale della Misericordia, 15, 33100 Udine, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Toh HS. Weight configurations of trained perceptrons. Int J Neural Syst 1993; 4:231-46. [PMID: 8293229 DOI: 10.1142/s0129065793000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We strive to predict the function mapping and rules performed by a trained perceptron from studying the weights. We derive a few properties of the trained weights and show how the perceptron's representation of knowledge, rules and functions depend on these properties. Two types of perceptrons are studied--one case with continuous inputs and one hidden layer, the other a simple binary classifier with boolean inputs and no hidden units.
Collapse
Affiliation(s)
- H S Toh
- Department of Medical Physics and Biophysics, University of Nijmegen, The Netherlands
| |
Collapse
|