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Izar GM, Tan TY, Laurino IRA, Nobre CR, Vivas MPM, Gusso-Choueri PK, Felix CSA, Moreno BB, Abessa DMS, de Andrade JB, Martinez ST, da Rocha GO, Albergaria-Barbosa ACR. Plastic pellets make Excirolana armata more aggressive: Intraspecific interactions and isopod mortality differences between populations. Sci Total Environ 2024; 911:168611. [PMID: 37984664 DOI: 10.1016/j.scitotenv.2023.168611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/18/2023] [Revised: 10/18/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
Plastic pellets represent a significant component of microplastic (< 5 mm) pollution. Impacts caused by plastic pellets involve physical harm and toxicity related to ingestion and non-ingestion (such as the release of chemicals in leachates). The latter is the main route of exposure for invertebrate macrobenthic populations. This study aimed to compare the toxicity of plastic pellets in distinct marine macrobenthic populations, considering the influence of sediment characteristics (organic matter and grain size) and quality (contamination by hydrophobic chemicals) on ecotoxicological effects, as well as the influence of color on the toxicity of beach-stranded plastic pellets. We performed three experiments on plastic pellet exposure using Excirolana armata from beaches with high and low pellet density. When exposed to pellets, populations that inhabit beaches without pellets demonstrate higher mortality than those inhabiting beaches with high pellet densities. The mortality of E. armata to pellets was higher when the exposure occurred in sediment with high organic matter (OM), suggesting that chemicals were transferred from pellets to OM. Yellowish beach-stranded pellets induced higher mortality of E. armata than the white tones did. We also observed lethargic (near-dead) and dead individuals being preyed upon by healthy individuals, a cannibalistic behavior that raises an ecological concern regarding the negative effects of this exposure on intraspecific interactions in marine macrobenthic populations.
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Affiliation(s)
- G M Izar
- Interdisciplinary Center of Energy and Environment (CIEnAm), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil; Marine Geochemistry Laboratory, Institute of Geoscience, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil.
| | - T Y Tan
- Aquaculture and Fisheries Group, Wageningen University & Research, Wageningen, the Netherlands; Wageningen Marine Research, Wageningen University & Research, Yerseke, the Netherlands
| | - I R A Laurino
- Laboratory of Management, Ecology and Marine Conservation/Oceanographic Institute (IO-USP) - Praça Oceanográfico, 191 - Butantã, São Paulo, SP 05508-120, Brazil
| | - C R Nobre
- Institute of Marine Sciences, Federal University of São Paulo (IMar/UNIFESP), Rua Dr. Carvalho de Mendonça, 144, 11070-102, Santos, São Paulo, Brazil
| | - M P M Vivas
- Interdisciplinary Center of Energy and Environment (CIEnAm), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil
| | - P K Gusso-Choueri
- Biosciences Institute, São Paulo State University (UNESP), Praça Infante Dom Henrique, s/n, 11330-900 São Vicente, São Paulo, Brazil; Department of Ecotoxicology, Santa Cecília University, Rua Oswaldo Cruz, 277, 1045-0907 Santos, São Paulo, Brazil
| | - C S A Felix
- Interdisciplinary Center of Energy and Environment (CIEnAm), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil; Institute of Chemistry, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil
| | - B B Moreno
- Department of Ecotoxicology, Santa Cecília University, Rua Oswaldo Cruz, 277, 1045-0907 Santos, São Paulo, Brazil; Institute of Marine Sciences, Federal University of São Paulo (IMar/UNIFESP), Rua Dr. Carvalho de Mendonça, 144, 11070-102, Santos, São Paulo, Brazil
| | - D M S Abessa
- Biosciences Institute, São Paulo State University (UNESP), Praça Infante Dom Henrique, s/n, 11330-900 São Vicente, São Paulo, Brazil
| | - J B de Andrade
- Interdisciplinary Center of Energy and Environment (CIEnAm), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil; SENAI-CIMATEC, Av. Orlando Gomes, 1845 - Piatã, 41650-010 Salvador, BA, Brazil; National Institute of Science and Technology in Energy and Environment (INCT), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil
| | - S T Martinez
- SENAI-CIMATEC, Av. Orlando Gomes, 1845 - Piatã, 41650-010 Salvador, BA, Brazil
| | - G O da Rocha
- Interdisciplinary Center of Energy and Environment (CIEnAm), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil; Institute of Chemistry, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil; National Institute of Science and Technology in Energy and Environment (INCT), Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil
| | - A C R Albergaria-Barbosa
- Marine Geochemistry Laboratory, Institute of Geoscience, Federal University of Bahia (UFBA), Rua Barão de Jeremoabo, s/n, Campus Ondina, 40170-115 Salvador, Bahia, Brazil
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Chen J, Zhong J, Chang Y, Zhou Y, Koo SH, Tan TY, Lei H, Ai Y. Rapid and Accurate Antimicrobial Susceptibility Testing Using Label-Free Electrical Impedance-Based Microfluidic Platform. Small 2024; 20:e2303352. [PMID: 37794624 DOI: 10.1002/smll.202303352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/01/2023] [Indexed: 10/06/2023]
Abstract
Antimicrobial resistance has become a serious threat to the global public health. Accurate and rapid antimicrobial susceptibility testing (AST) allows evidence-based prescribing of antibiotics to improve patient care and clinical outcomes. Current culture-based AST assays are inherently limited by the doubling time of bacterial reproduction, which require at least 24 h to have a decisive result. Herein, a label-free electrical impedance-based microfluidic platform designed to expedite and streamline AST procedure for clinical practice is presented. Following a 30-min exposure of bacterial samples to antibiotics, the presented high-throughput, single-bacterium level impedance characterization platform enables a rapid 2-min AST assay. The platform facilitates accurate analysis of individual bacterial viability, as indicated by changes in electrical characteristics, thereby enabling the determination of antimicrobial resistance. Moreover, the potential clinical applicability of this platform is demonstrated by testing different E. coli strains against five antibiotics, yielding 100% categorical agreements compared to standard culture methods.
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Affiliation(s)
- Jiahong Chen
- Guangdong Provincial Key Laboratory of Food Quality and Safety/National-Local Joint Engineering Research Center for Machining and Safety of Livestock and Poultry Products, College of Food Science, South China Agricultural University, Guangzhou, 510642, China
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, 510642, China
| | - Jianwei Zhong
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore
| | - Yifu Chang
- Joint Key Laboratory of the Ministry of Education, Institute of Applied Physics and Materials Engineering, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, China
| | - Yinning Zhou
- Joint Key Laboratory of the Ministry of Education, Institute of Applied Physics and Materials Engineering, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, China
| | - Seok Hwee Koo
- Department of Laboratory Medicine, Changi General Hospital, Singapore, 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore, 529889, Singapore
| | - Hongtao Lei
- Guangdong Provincial Key Laboratory of Food Quality and Safety/National-Local Joint Engineering Research Center for Machining and Safety of Livestock and Poultry Products, College of Food Science, South China Agricultural University, Guangzhou, 510642, China
- Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou, 510642, China
| | - Ye Ai
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 8 Somapah Road, Singapore, 487372, Singapore
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Linn KZ, Sutjipto S, Ng OT, Teo J, Cherng BPZ, Tan TY, Pada SK, Ooi ST, Smitasin N, Thoon KC, Huan X, De PP, Chan D, Tee NWS, Ang M, Hsu LY, Lin RTP, Ng TY, Deepak RN, Koh TH, Apisarnthanarak A, Ponnampalavanar S, Venkatachalam I, Marimuthu K. Impact of COVID-19 pandemic on carbapenem-resistant Enterobacterales incidence in the South-East Asia region: an observational study. Antimicrob Steward Healthc Epidemiol 2023; 3:e208. [PMID: 38156208 PMCID: PMC10753475 DOI: 10.1017/ash.2023.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 12/30/2023]
Abstract
The COVID-19 pandemic led to an initial increase in the incidence of carbapenem-resistant Enterobacterales (CRE) from clinical cultures in South-East Asia hospitals, which was unsustained as the pandemic progressed. Conversely, there was a decrease in CRE incidence from surveillance cultures and overall combined incidence. Further studies are needed for future pandemic preparedness.
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Affiliation(s)
- Kyaw Zaw Linn
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Stephanie Sutjipto
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jeanette Teo
- National University Hospital and National University Health System, Singapore, Singapore
| | - Benjamin Pei Zhi Cherng
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | | | | | - Say Tat Ooi
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nares Smitasin
- National University Hospital and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Xiaowei Huan
- National Centre for Infectious Diseases, Singapore, Singapore
| | | | - Douglas Chan
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Nancy Wen Sim Tee
- National University Hospital and National University Health System, Singapore, Singapore
| | - Michelle Ang
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Li Yang Hsu
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore, Singapore
| | - Raymond Tzer Pin Lin
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- National Public Health Laboratory, Singapore, Singapore
| | | | | | - Tse Hsien Koh
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | | | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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Ang D, Koo SH, Chan YH, Tan TY, Soon GH, Tan CK, Lin KW, Krishnasamy-Balasubramanian JK, Wong YJ, Kumar R, R R, Tan Y, Ong PLJ, Tan YLJ, Li JW, Kwek ABE, Ang TL. Clinical trial: seven-day vonoprazan- versus 14-day proton pump inhibitor-based triple therapy for first-line Helicobacter pylori eradication. Aliment Pharmacol Ther 2022; 56:436-449. [PMID: 35665947 DOI: 10.1111/apt.17070] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/17/2022] [Accepted: 05/23/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND One-week triple therapy with vonoprazan is endorsed by Japanese guidelines as an alternative to proton pump inhibitor (PPI)-based triple therapy for first-line Helicobacter pylori eradication. This contrasts with Western guidelines recommending 2-week PPI-based triple therapy. AIM To verify the non-inferiority of 1-week vonoprazan-based triple therapy versus 2-week PPI-based triple therapy as first-line H. pylori eradication in a multiracial Asian cohort. METHODS Randomised controlled trial of treatment-naïve patients with H. pylori infection assigned 1:1 to either 7 days amoxicillin 1 g + clarithromycin 500 mg + vonoprazan 20 mg twice per day or 14 days amoxicillin 1 g + clarithromycin 500 mg + omeprazole OR esomeprazole OR rabeprazole 20 mg twice/day. Subjects were randomly assigned to each PPI 1:1:1 Demographics, H. pylori resistance, CYP 2C19 genotype, eradication success and safety profiles were compared between groups. RESULTS Between June 2019 and June 2021, 252 of 1097 subjects screened were randomised. 244 (age [SD] 51.7 [14.6]) received vonoprazan- (n = 119) or PPI-based (n = 125) triple therapy. Eradication rates by intention-to-treat analysis were 87.4% (vonoprazan-based triple therapy) versus 88.0% (PPI-based triple therapy. By per protocol analysis: 96.3% (vonoprazan-based triple therapy) versus 94.0% (PPI-based triple therapy). Clarithromycin resistance predicted treatment failure on multivariate analysis: RR 11.4; 95% CI [1.4-96.3], p = 0.025. No significant differences in CYP 2C19 genotypes or adverse events occurred between groups. CONCLUSION One-week vonoprazan-based triple therapy achieved comparable efficacy to 2-week PPI-based triple therapy and was well tolerated.
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Affiliation(s)
- Daphne Ang
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Yoo Lin School of Medicine, National University of Singapore, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Gaik Hong Soon
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Chin Kimg Tan
- Department of Gastroenterology, Changi General Hospital, Singapore
| | | | | | - Yu Jun Wong
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Rahul Kumar
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Rajesh R
- Department of Gastroenterology, Changi General Hospital, Singapore
| | - Yiyuan Tan
- Department of Gastroenterology, Changi General Hospital, Singapore
| | | | | | - James Weiquan Li
- Department of Gastroenterology, Changi General Hospital, Singapore
| | | | - Tiing Leong Ang
- Department of Gastroenterology, Changi General Hospital, Singapore
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Tan SY, How CH, Poon BH, Tan TY, Siau C. Rostered Routine Testing: A Necessary Evil? Open Forum Infect Dis 2022; 9:ofab549. [PMID: 35024370 PMCID: PMC8689919 DOI: 10.1093/ofid/ofab549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
We report our institution’s experience of detecting a staff member who was infected with severe acute respiratory syndrome coronavirus 2 while he was asymptomatic, as part of a rostered routine testing program, and how the institution was able to undertake measures to curb the spread, hence reducing the impact on the daily operations of our institution.
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Affiliation(s)
- Seow Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore
| | - Choon How How
- Department of Care and Health Integration, Changi General Hospital, Singapore
| | - Beng Hoong Poon
- Chairman Medical Board Office, Changi General Hospital, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Chuin Siau
- Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore
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La MV, Koo SH, Jiang B, Heng YX, Tan TY. A Study of Analytical and Clinical Sensitivity of Aptima SARS-CoV-2 Assay (Hologic) and Proposals of Complementary Tests for SARS-CoV-2 Detection in Low Viral Load Specimens. Curr Microbiol 2021; 79:29. [PMID: 34905087 PMCID: PMC8669225 DOI: 10.1007/s00284-021-02730-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Early and accurate detection of SARS-CoV-2 is important for diagnosis and transmission control. The use of high-throughput and automated testing allows laboratories to better deliver diagnostic testing given manpower and resource limitations. We validated the clinical and analytical performance of the Hologic Panther Aptima SARS-CoV-2 assay with an emphasis on detection of specimens with low viral loads. The clinical performance was evaluated using 245 clinical specimens, against a comparator PCR-based laboratory developed test (LDT). The analytical performance was determined by replicate testing of contrived samples in a ten-fold dilution series (CT values 32–42, based on LDT). The Aptima assay had 96.7% overall percent agreement, 100% negative percent agreement and 88.1% positive percent agreement. It was able to consistently detect SARS-CoV-2 in contrived samples with CT = 32 by LDT (calculated 2354 copies/mL). The 95% limit of detection of the Aptima assay was estimated to be at LDT CT = 33 (equivalent to 870 copies/mL). The relative light units (RLU) × 1000 for 52 true positive clinical specimens was 962.2 ± 181.5, and that for the 186 true negative specimens was 264.6 ± 14.3. The Aptima assay was a reliable method with a high overall percent agreement against our comparator LDT. We propose that samples reported as negative by the Aptima assay with RLU > 350 be tested by a secondary method, in order to improve detection of samples with very low viral loads.
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Affiliation(s)
- My-Van La
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Ying Xuan Heng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
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Lu X, Chow JJM, Koo SH, Jiang B, Tan TY, Yang D, Ai Y. Sheathless and high-throughput elasto-inertial bacterial sorting for enhancing molecular diagnosis of bloodstream infection. Lab Chip 2021; 21:2163-2177. [PMID: 33899072 DOI: 10.1039/d1lc00085c] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purification of bacteria from human blood samples is essential for rapid identification of pathogens by molecular methods, enabling faster and more accurate diagnosis of bloodstream infection than conventional gold standard blood culture methods. The inertial microfluidic method has been broadly studied to isolate biological cells of interest in various biomedical applications due to its label-free and high-throughput advantages. However, because of the bacteria's tininess, which ranges from 0.5 μm to 3 μm, they are challenging to be effectively focused and sorted out in existing inertial microfluidic devices that work well with biological cells larger than 10 μm. Efforts have been made to sort bacterial cells by utilizing extremely small channel dimensions or employing a sheath flow, which thus results in limitations on the throughput and ease of operation. To overcome this challenge, we develop a method that integrates a non-Newtonian fluid with a novel channel design to allow bacteria to be successfully sorted from larger blood cells in a channel dimension of 120 μm × 20 μm without the use of sheath flows. The throughput of this device with four parallel channels is above 400 μL per minute. The real-time polymerase chain reaction (qPCR) analysis indicates that our inertial sorting approach has a nearly 3-fold improvement in pathogen recovery compared with the commonly used lysis-centrifugation method at pathogen abundances as low as 102 cfu mL-1. With the rapid and simple purification and enrichment of bacterial pathogens, the present inertial sorting method exhibits an ability to enhance the fast and accurate molecular diagnosis of bloodstream bacterial infection.
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Affiliation(s)
- Xiaoguang Lu
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Joycelyn Jia Ming Chow
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Seok Hwee Koo
- Clinical Trials & Research Unit, Changi General Hospital, Singapore 529889, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore 529889, Singapore
| | - Dahou Yang
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore.
| | - Ye Ai
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore 487372, Singapore.
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Koo SH, Jiang B, Lim PQ, La MV, Tan TY. Development of a rapid multiplex PCR assay for the detection of common pathogens associated with community-acquired pneumonia. Trans R Soc Trop Med Hyg 2021; 115:1450-1455. [PMID: 34017992 DOI: 10.1093/trstmh/trab079] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/04/2021] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is a significant cause of mortality and morbidity globally. A microbial cause was not determined in a sizable percentage of patients with CAP; there are increasing data to suggest regional differences in bacterial aetiology. We devised a multiplex real-time PCR assay for detecting four microorganisms (Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and Burkholderia pseudomallei) of relevance to CAP infections in Asia. METHODS Analytical validation was accomplished using bacterial isolates (n=10-33 of each target organism for analytical sensitivity and n=117 for analytical sensitivity) and clinical validation using 58 culture-positive respiratory tract specimens. RESULTS The qPCR assay exhibited 100% analytical sensitivity and analytical specificity, and 100% clinical sensitivity and 94-100% clinical specificity. The limit of detection and efficiency for the multiplex PCR assay were 3-33 CFU/mL and 93-110%, respectively. The results showed that the PCR-based method had higher sensitivity than traditional culture-based methods. The assay also demonstrated an ability to semiquantify bacterial loads. CONCLUSION We have devised a reliable laboratory-developed multiplex qPCR assay, with a turnaround time of within one working day, for detection of four clinically important CAP-associated microorganisms in Asia. The availability of a test with improved diagnostic capabilities potentially leads to an informed choice of antibiotic usage and appropriate management of the patient to achieve a better treatment outcome and financial savings.
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Affiliation(s)
- Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Pei Qi Lim
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - My-Van La
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
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Tan SY, Tey HL, Lim ETH, Toh ST, Chan YH, Tan PT, Lee SA, Tan CX, Koh GCH, Tan TY, Siau C. The accuracy of healthcare worker versus self collected (2-in-1) Oropharyngeal and Bilateral Mid-Turbinate (OPMT) swabs and saliva samples for SARS-CoV-2. PLoS One 2020; 15:e0244417. [PMID: 33326503 PMCID: PMC7744114 DOI: 10.1371/journal.pone.0244417] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Self-sampling for SARS-CoV-2 would significantly raise testing capacity and reduce healthcare worker (HCW) exposure to infectious droplets personal, and protective equipment (PPE) use. METHODS We conducted a diagnostic accuracy study where subjects with a confirmed diagnosis of COVID-19 (n = 401) and healthy volunteers (n = 100) were asked to self-swab from their oropharynx and mid-turbinate (OPMT), and self-collect saliva. The results of these samples were compared to an OPMT performed by a HCW in the same patient at the same session. RESULTS In subjects confirmed to have COVID-19, the sensitivities of the HCW-swab, self-swab, saliva, and combined self-swab plus saliva samples were 82.8%, 75.1%, 74.3% and 86.5% respectively. All samples obtained from healthy volunteers were tested negative. Compared to HCW-swab, the sensitivities of a self-swab sample and saliva sample were inferior by 8.7% (95%CI: 2.4% to 15.0%, p = 0.006) and 9.5% (95%CI: 3.1% to 15.8%, p = 0.003) respectively. The combined detection rate of self-swab and saliva had a sensitivity of 2.7% (95%CI: -2.6% to 8.0%, p = 0.321). The sensitivity of both the self-collection methods are higher when the Ct value of the HCW swab is less than 30. The specificity of both the self-swab and saliva testing was 100% (95% CI 96.4% to 100%). CONCLUSION Our study provides evidence that sensitivities of self-collected OPMT swab and saliva samples were inferior to a HCW swab, but they could still be useful testing tools in the appropriate clinical settings.
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Affiliation(s)
- Seow Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
- * E-mail:
| | - Hong Liang Tey
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | | | - Song Tar Toh
- Department of Otorhinolaryngology- Head and Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Pei Ting Tan
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Sing Ai Lee
- Sheares Healthcare Group Pte Ltd, Singapore, Singapore
| | | | | | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Chuin Siau
- Department of Respiratory & Critical Care Medicine, Changi General Hospital, Singapore, Singapore
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Jumat MR, Wong P, Foo KX, Lee ICJ, Goh SPL, Ganapathy S, Tan TY, Loh AHL, Yeo YC, Chao Y, Cheng LTE, Lai SH, Goh SH, Compton S, Hwang NC. From Trial to Implementation, Bringing Team-Based Learning Online-Duke-NUS Medical School's Response to the COVID-19 Pandemic. Med Sci Educ 2020; 30:1649-1654. [PMID: 32837796 PMCID: PMC7402390 DOI: 10.1007/s40670-020-01039-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Muhammad Raihan Jumat
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Peiyan Wong
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- National University of Singapore, Singapore, Singapore
| | - Ke Xiang Foo
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Irene Cheng Jie Lee
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Suzanne Pei Lin Goh
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- KK Women’s and Children Hospital, Singapore, Singapore
| | - Sashikumar Ganapathy
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- KK Women’s and Children Hospital, Singapore, Singapore
| | - Thean Yen Tan
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Changi General Hospital, Singapore, Singapore
| | - Alwin Hwai Liang Loh
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Yen Ching Yeo
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- KK Women’s and Children Hospital, Singapore, Singapore
| | - Yinxia Chao
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Lionel Tim-Ee Cheng
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Siang Hui Lai
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Sok Hong Goh
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Scott Compton
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
| | - Nian Chih Hwang
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Singapore General Hospital, Singapore, Singapore
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11
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Lu X, Chow JJM, Koo SH, Tan TY, Jiang B, Ai Y. Enhanced Molecular Diagnosis of Bloodstream Candida Infection with Size-Based Inertial Sorting at Submicron Resolution. Anal Chem 2020; 92:15579-15586. [DOI: 10.1021/acs.analchem.0c03718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Xiaoguang Lu
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 487372 Singapore
| | - Joycelyn Jia Ming Chow
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 487372 Singapore
| | - Seok Hwee Koo
- Clinical Trials & Research Unit, Changi General Hospital, 529889 Singapore
| | - Thean Yen Tan
- Clinical Trials & Research Unit, Changi General Hospital, 529889 Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 529889 Singapore
| | - Ye Ai
- Pillar of Engineering Product Development, Singapore University of Technology and Design, 487372 Singapore
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12
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Affiliation(s)
- Kangqi Ng
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Beng Hoong Poon
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Troy Hai Kiat Puar
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Jessica Li Shan Quah
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Wann Jia Loh
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Yu Jun Wong
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Thean Yen Tan
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
| | - Jagadesan Raghuram
- Changi General Hospital, Singapore (K.N., B.H.P., T.H.K., J.L.S., W.J.L., Y.J.W., T.Y.T., J.R.)
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13
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Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, Ng OT, Marimuthu K, Ang LW, Mak TM, Lau SK, Anderson DE, Chan KS, Tan TY, Ng TY, Cui L, Said Z, Kurupatham L, Chen MIC, Chan M, Vasoo S, Wang LF, Tan BH, Lin RTP, Lee VJM, Leo YS, Lye DC. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA 2020; 323:1488-1494. [PMID: 32125362 PMCID: PMC7054855 DOI: 10.1001/jama.2020.3204] [Citation(s) in RCA: 1329] [Impact Index Per Article: 332.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has spread globally with sustained human-to-human transmission outside China. OBJECTIVE To report the initial experience in Singapore with the epidemiologic investigation of this outbreak, clinical features, and management. DESIGN, SETTING, AND PARTICIPANTS Descriptive case series of the first 18 patients diagnosed with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection at 4 hospitals in Singapore from January 23 to February 3, 2020; final follow-up date was February 25, 2020. EXPOSURES Confirmed SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES Clinical, laboratory, and radiologic data were collected, including PCR cycle threshold values from nasopharyngeal swabs and viral shedding in blood, urine, and stool. Clinical course was summarized, including requirement for supplemental oxygen and intensive care and use of empirical treatment with lopinavir-ritonavir. RESULTS Among the 18 hospitalized patients with PCR-confirmed SARS-CoV-2 infection (median age, 47 years; 9 [50%] women), clinical presentation was an upper respiratory tract infection in 12 (67%), and viral shedding from the nasopharynx was prolonged for 7 days or longer among 15 (83%). Six individuals (33%) required supplemental oxygen; of these, 2 required intensive care. There were no deaths. Virus was detectable in the stool (4/8 [50%]) and blood (1/12 [8%]) by PCR but not in urine. Five individuals requiring supplemental oxygen were treated with lopinavir-ritonavir. For 3 of the 5 patients, fever resolved and supplemental oxygen requirement was reduced within 3 days, whereas 2 deteriorated with progressive respiratory failure. Four of the 5 patients treated with lopinavir-ritonavir developed nausea, vomiting, and/or diarrhea, and 3 developed abnormal liver function test results. CONCLUSIONS AND RELEVANCE Among the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore, clinical presentation was frequently a mild respiratory tract infection. Some patients required supplemental oxygen and had variable clinical outcomes following treatment with an antiretroviral agent.
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Affiliation(s)
- Barnaby Edward Young
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
| | - Sean Wei Xiang Ong
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
| | - Shirin Kalimuddin
- Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Jenny G. Low
- Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | | | | | - Oon-Tek Ng
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, Singapore
| | - Li Wei Ang
- National Centre for Infectious Diseases,
Singapore
| | - Tze Minn Mak
- National Centre for Infectious Diseases,
Singapore
| | | | | | | | - Thean Yen Tan
- Duke-NUS Medical School, Singapore
- Changi General Hospital, Singapore
| | | | - Lin Cui
- National Centre for Infectious Diseases,
Singapore
| | | | | | - Mark I-Cheng Chen
- National Centre for Infectious Diseases,
Singapore
- Saw Swee Hock School of Public Health,
Singapore
| | - Monica Chan
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Boon Huan Tan
- Lee Kong Chian School of Medicine,
Singapore
- DSO National Laboratories, Singapore
| | | | | | - Yee-Sin Leo
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
- Yong Loo Lin School of Medicine, Singapore
- Saw Swee Hock School of Public Health,
Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases,
Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine,
Singapore
- Yong Loo Lin School of Medicine, Singapore
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14
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Abstract
OBJECTIVES Understanding the pattern of middle-ear cholesteatoma becomes pertinent with the rise of endoscopic surgery as surgeons decide on the optimal approach to visualise and extirpate disease. With modifications to the Telmesani attic-tympanum-mastoid staging system, this study aimed to evaluate the commonest patterns of middle-ear cholesteatoma and their implications for surgical approach. METHODS A retrospective study was conducted in a single tertiary institution in Singapore. All patients undergoing cholesteatoma surgery between January 2012 and June 2015 were included. Staging of cholesteatoma was based on clinical assessment corroborated by radiological findings. RESULTS Out of the 55 ears included, 98.2 per cent had cholesteatoma involving the attic. The disease extended into the mastoid antrum and beyond in 43 cases (78.2 per cent). The facial recess and/or sinus tympanum was affected in 26 cases (47.3 per cent). CONCLUSION The majority of cholesteatoma cases present with extensive attic disease and significant mastoid involvement. In these cases, endoscopes may be best suited to adjunctive rather than exclusive use in surgery.
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Affiliation(s)
- Y Yu
- Department of Otolaryngology, Changi General Hospital, Singapore
| | - J See
- Department of Otolaryngology, Changi General Hospital, Singapore
| | - J H Ng
- Department of Otolaryngology, Changi General Hospital, Singapore
| | - D Low
- Department of Otolaryngology, Changi General Hospital, Singapore
| | - T Y Tan
- Department of Diagnostic Radiology, Changi General Hospital, Singapore
| | - H W Yuen
- Department of Otolaryngology, Changi General Hospital, Singapore
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15
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Koo SH, Teoh YL, Koh WL, Ochi H, Tan SK, Sim DMF, Jiang B, Tan AL, Tan TY, Lim SPR. Development and validation of a real-time multiplex PCR assay for the detection of dermatophytes and Fusarium spp. J Med Microbiol 2019; 68:1641-1648. [PMID: 31526456 DOI: 10.1099/jmm.0.001082] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Onychomycosis is a debilitating, difficult-to-treat nail fungal infection with increasing prevalence worldwide. The main etiological agents are dermatophytes, which are common causative pathogens in superficial fungal mycoses. Conventional detection methods such as fungal culture have low sensitivity and specificity and are time-consuming.Aim: The main objective of this study was to design, develop and validate a real-time probe-based multiplex qPCR assay for the detection of dermatophytes and Fusarium species.Methodology: The performance characteristics of the qPCR assays were evaluated. The multiplex qPCR assays targeted four genes (assay 1: pan-dermatophytes/Fusarium spp.; assay 2: Trichophyton rubrum/Microsporum spp.). Analytical validation was accomplished using 150 fungal isolates and clinical validation was done on 204 nail specimens. The performance parameters were compared against the gold standard (fungal culture) and expanded gold standard (culture in conjunction with sequencing).Results: Both the single-plex and multiplex qPCR assays performed well especially when compared against the expanded gold standard. Among the 204 tested nail specimens, the culture method showed that 125 (61.3 %) were infected with at least one organism, of which 40 yielded positive results for dermatophytes and Fusarium spp. These target organisms detected include 20 dermatophytes and 22 Fusarium spp. The developed qPCR assays demonstrated excellent limit of detection, efficiency, coefficient of determination, analytical and clinical sensitivity and specificity.Conclusion: The multiplex qPCR assays were reliable for the diagnosis of onychomycosis, with shorter turn-around time as compared to culture method. This aids in the planning of treatment strategies to achieve optimal therapeutic outcome.
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Affiliation(s)
- Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Yee Leng Teoh
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Wei Liang Koh
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Harumi Ochi
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Sher Kye Tan
- School of Chemical and Life Sciences, Singapore Polytechnic, 500 Dover Road, Singapore 139651, Singapore
| | - Diana Miao Fang Sim
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Ai Ling Tan
- Department of Microbiology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Su Ping Regina Lim
- Department of Dermatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
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Abstract
Antimicrobial resistance (AMR) results in drug-resistant infections that are harder to treat, subsequently leading to increased morbidity and mortality. In 2008, we reviewed the problem of AMR in Singapore, limiting our discussion to the human healthcare sector. Ten years later, we revisit this issue again, reviewing current efforts to contain it in order to understand the progress made as well as current and emerging challenges. Although a significant amount of work has been done to control AMR and improve antibiotic prescribing in Singapore, most of it has focused on the hospital setting, with mixed impact. The role of antibiotic use and AMR in food animals and the environment - and the link to human health - is better understood today. This issue of AMR encompasses both human health as well as animal/food safety, and efforts to control it will need to continually evolve to maintain or improve on current gains.
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Affiliation(s)
- Alvin Qijia Chua
- Department of Pharmacy, Singapore General Hospital, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Andrea Lay-Hoon Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Thean Yen Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | | | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National Centre for Infectious Diseases, Singapore
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17
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Tan NC, Koong AYL, Ng LP, Hu PL, Koh EYL, Tan KT, Moey PKS, Tan MX, Wong CS, Tan TY, Ho HJA, Chen MIC. Accuracy of urinary symptoms and urine microscopy in diagnosing urinary tract infection in women. Fam Pract 2019; 36:417-424. [PMID: 30445422 DOI: 10.1093/fampra/cmy108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women with urinary tract infections (UTIs) often present with urinary complaints such as frequency of micturition, dysuria, foul-smelling urine and other non-specific symptoms like fever. Physicians may order urine microscopy to guide empirical antibiotic prescription. However, the performance of this approach has not been assessed. OBJECTIVES This study aimed to determine the accuracy of UTI symptoms and urine microscopy associated with culture-positive UTI in Asian women. METHODS A cross-sectional study of adult women who presented with UTI-related symptoms was conducted at three public primary care clinics in Singapore. Demographic data and information on their symptoms were collected, followed by urine microscopy and culture to diagnose UTI. The sensitivity, specificity, positive (PPV), negative predictive values (NPV), accuracy (ACC) and area under curve (AUC) of combinations of symptom and urine investigations were analysed in association with culture-positive UTI, which was regarded as a benchmark. RESULTS Data on 564 women (73.9% Chinese, 11.5% Malay, 8.2% Indian) were analysed, of which 259 (45.9%) had culture-positive UTI. Frequency and foul-smelling urine, pyuria (WBC ≥10/hpf) and semi-quantitative bacterial count (≥2+) were significantly associated with positive urine culture. The ACC and AUC for single or multiple urinary and/or general symptoms were low. Urine pyuria (minimally >10/hpf) alone or in combination with symptoms and/or semi-quantitative bacterial count achieved high sensitivity (>85%) and PPV, NPV, ACC and AUC of >70%. CONCLUSION Urinary symptoms have limited accuracy in diagnosing culture-positive UTI. Concurrent urine microscopy showing presence of pyuria and/or bacterial count increased the diagnostic accuracy of culture-positive UTI.
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Affiliation(s)
- Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS Family Medicine Clinical Academic Program, Duke-NUS Medical School, Singapore
| | - Agnes Ying Leng Koong
- Department of Research, SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS Family Medicine Clinical Academic Program, Duke-NUS Medical School, Singapore
| | - Lok Pui Ng
- Department of Research, SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS Family Medicine Clinical Academic Program, Duke-NUS Medical School, Singapore
| | - Pei Lin Hu
- Department of Research, SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS Family Medicine Clinical Academic Program, Duke-NUS Medical School, Singapore
| | | | - Kee Tung Tan
- Department of Research, SingHealth Polyclinics, Singapore
| | - Peter Kirm Seng Moey
- Department of Research, SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS Family Medicine Clinical Academic Program, Duke-NUS Medical School, Singapore
| | - Mei Xuan Tan
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Hanley Jian An Ho
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Mark I-Cheng Chen
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,National Centre for Infectious Diseases, Singapore
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18
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Barkham T, Zadoks RN, Azmai MNA, Baker S, Bich VTN, Chalker V, Chau ML, Dance D, Deepak RN, van Doorn HR, Gutierrez RA, Holmes MA, Huong LNP, Koh TH, Martins E, Mehershahi K, Newton P, Ng LC, Phuoc NN, Sangwichian O, Sawatwong P, Surin U, Tan TY, Tang WY, Thuy NV, Turner P, Vongsouvath M, Zhang D, Whistler T, Chen SL. One hypervirulent clone, sequence type 283, accounts for a large proportion of invasive Streptococcus agalactiae isolated from humans and diseased tilapia in Southeast Asia. PLoS Negl Trop Dis 2019; 13:e0007421. [PMID: 31246981 PMCID: PMC6597049 DOI: 10.1371/journal.pntd.0007421] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
Background In 2015, Singapore had the first and only reported foodborne outbreak of invasive disease caused by the group B Streptococcus (GBS; Streptococcus agalactiae). Disease, predominantly septic arthritis and meningitis, was associated with sequence type (ST)283, acquired from eating raw farmed freshwater fish. Although GBS sepsis is well-described in neonates and older adults with co-morbidities, this outbreak affected non-pregnant and younger adults with fewer co-morbidities, suggesting greater virulence. Before 2015 ST283 had only been reported from twenty humans in Hong Kong and two in France, and from one fish in Thailand. We hypothesised that ST283 was causing region-wide infection in Southeast Asia. Methodology/Principal findings We performed a literature review, whole genome sequencing on 145 GBS isolates collected from six Southeast Asian countries, and phylogenetic analysis on 7,468 GBS sequences including 227 variants of ST283 from humans and animals. Although almost absent outside Asia, ST283 was found in all invasive Asian collections analysed, from 1995 to 2017. It accounted for 29/38 (76%) human isolates in Lao PDR, 102/139 (73%) in Thailand, 4/13 (31%) in Vietnam, and 167/739 (23%) in Singapore. ST283 and its variants were found in 62/62 (100%) tilapia from 14 outbreak sites in Malaysia and Vietnam, in seven fish species in Singapore markets, and a diseased frog in China. Conclusions GBS ST283 is widespread in Southeast Asia, where it accounts for a large proportion of bacteraemic GBS, and causes disease and economic loss in aquaculture. If human ST283 is fishborne, as in the Singapore outbreak, then GBS sepsis in Thailand and Lao PDR is predominantly a foodborne disease. However, whether transmission is from aquaculture to humans, or vice versa, or involves an unidentified reservoir remains unknown. Creation of cross-border collaborations in human and animal health are needed to complete the epidemiological picture. An outbreak due to a bacterium called Streptococccus agalactiae in Singapore in 2015 was caused by a clone called ST283, and was associated with consumption of raw freshwater-fish. It was considered unique as it was the only reported foodborne outbreak of this bacterium. Our new data show that invasive ST283 disease is far from unique. ST283 has been causing disease in humans and farmed fish in SE Asian countries for decades. Reports of ST283 are almost absent outside Asia. We suspect that human ST283 is fishborne in other Asian countries, as it was in Singapore, but we haven’t looked at this yet. We don’t know where ST283 originally came from; it may have been transmitted from humans to fish, or come from another animal. More studies are needed to determine ST283’s geographical extent and burden of disease, as well as its origin, how it is transmitted, and what enables it to be so aggressive. We may then be able to interrupt transmission, to the benefit of fish, farmers, and the general public.
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Affiliation(s)
- Timothy Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
- * E-mail: (TB); (SLC)
| | - Ruth N. Zadoks
- Institute of Biodiversity Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mohammad Noor Amal Azmai
- Department of Biology, Faculty of Science, and Laboratory of Marine Biotechnology, Institute of Bioscience, Universiti Putra Malaysia, Selangor, Malaysia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vu Thi Ngoc Bich
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | - Man Ling Chau
- Environmental Health Institute, National Environment Agency, Singapore
- National Centre for Food Science, Singapore Food Agency, Singapore
| | - David Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Ramona A. Gutierrez
- Environmental Health Institute, National Environment Agency, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Mark A. Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Tse Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore
| | - Elisabete Martins
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Kurosh Mehershahi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
| | - Nguyen Ngoc Phuoc
- Faculty of Fisheries, University of Agriculture and Forestry, Hue University, Hue City, Vietnam
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health (MOPH)-US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Pongpun Sawatwong
- Thailand Ministry of Public Health (MOPH)-US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Uraiwan Surin
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Wen Ying Tang
- Molecular Biology Laboratory, Tan Tock Seng Hospital, Singapore
| | - Nguyen Vu Thuy
- National Hospital for Obstetrics & Gynaecology, Hanoi, Vietnam
| | - Paul Turner
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Defeng Zhang
- Key Laboratory of Tropical & Subtropical Fishery Resource Application & Cultivation, Ministry of Agriculture and Rural Affairs, Pearl River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Guangzhou, People’s Republic of China
| | - Toni Whistler
- Thailand Ministry of Public Health (MOPH)-US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Swaine L. Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Infectious Diseases Group, Genome Institute of Singapore, Singapore
- * E-mail: (TB); (SLC)
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19
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Tan TY, Ong M, Cheng Y, Ng LSY. Hypermucoviscosity, rmpA, and aerobactin are associated with community-acquired Klebsiella pneumoniae bacteremic isolates causing liver abscess in Singapore. Journal of Microbiology, Immunology and Infection 2019; 52:30-34. [DOI: 10.1016/j.jmii.2017.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/25/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
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Chan MKL, Koo SH, Quek Q, Pang WS, Jiang B, Ng LSY, Tan SH, Tan TY. Development of a real-time assay to determine the frequency of qac genes in methicillin resistant Staphylococcus aureus. J Microbiol Methods 2018; 153:133-138. [PMID: 30267717 DOI: 10.1016/j.mimet.2018.09.017] [Citation(s) in RCA: 5] [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: 06/05/2018] [Revised: 09/24/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The emergence of antiseptic resistance and/or antiseptic-resistance genes in methicillin-resistant Staphylococcus aureus (MRSA) may result in failure of decolonization treatments. Plasmid-encoded efflux pump genes qacA/B and qacC (smr) confer tolerance to chlorhexidine and quaternary ammonium compounds. The objective of this study was to develop and validate a multiplex real time-PCR assay for detection of antiseptic-resistance genes, apply the assay on 200 MRSA isolates and explore if carriage of these genes was associated with resistance to topical antibiotics. METHODOLOGY A SYBR-Green based multiplex real time-PCR assay was developed to detect qacA/B, qacC, and mecA (internal control) simultaneously. The multiplex assay was compared against conventional single-plex PCR followed by agarose gel electrophoresis, using DNA from the first 73 MRSA isolates, followed by multiplex testing of the remaining 127 MRSA isolates. All 200 MRSA isolates were tested for susceptibility to mupirocin, retapamulin, neomycin, bacitracin and octenidine. The genetic diversity of the isolates was investigated by spa-typing. RESULTS The concordance between multiplex and conventional PCR, in assignments of qacA/B and qacC status were 99%(72/73) and 100%(73/73) respectively. Among 200 MRSA isolates, 48(24%) and 44(23%) were found to harbour qacA/B and qacC genes, respectively. These isolates remained susceptible to many common decolonization agents, except mupirocin. The predominant spa-types were t020 and t1081 (41 and 32 isolates respectively). CONCLUSION The real-time assay performed acceptably for the detection of qac genes. A high prevalence of antiseptic-resistance genes were detected in the MRSA isolates in our population and appeared to be associated with spa-type t1081.
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Affiliation(s)
- Maurice Kok Leong Chan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Seok Hwee Koo
- Clinical trials and Research Unit, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Qingyao Quek
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, 535 Clementi Road, 599489, Singapore
| | - Wan Sia Pang
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, 535 Clementi Road, 599489, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Lily Siew Yong Ng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Si Huei Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
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21
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Quah J, Jiang B, Tan PC, Siau C, Tan TY. Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis 2018; 18:451. [PMID: 30180811 PMCID: PMC6122562 DOI: 10.1186/s12879-018-3366-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 08/29/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The impact of different classes of microbial pathogens on mortality in severe community-acquired pneumonia is not well elucidated. Previous studies have shown significant variation in the incidence of viral, bacterial and mixed infections, with conflicting risk associations for mortality. We aimed to determine the risk association of microbial aetiologies with hospital mortality in severe CAP, utilising a diagnostic strategy incorporating molecular testing. Our primary hypothesis was that respiratory viruses were important causative pathogens in severe CAP and was associated with increased mortality when present with bacterial pathogens in mixed viral-bacterial co-infections. METHODS A retrospective cohort study from January 2014 to July 2015 was conducted in a tertiary hospital medical intensive care unit in eastern Singapore, which has a tropical climate. All patients diagnosed with severe community-acquired pneumonia were included. RESULTS A total of 117 patients were in the study. Microbial pathogens were identified in 84 (71.8%) patients. Mixed viral-bacterial co-infections occurred in 18 (15.4%) of patients. Isolated viral infections were present in 32 patients (27.4%); isolated bacterial infections were detected in 34 patients (29.1%). Hospital mortality occurred in 16 (13.7%) patients. The most common bacteria isolated was Streptococcus pneumoniae and the most common virus isolated was Influenza A. Univariate and multivariate logistic regression showed that serum procalcitonin, APACHE II severity score and mixed viral-bacterial infection were associated with increased risk of hospital mortality. Mixed viral-bacterial co-infections were associated with an adjusted odds ratio of 13.99 (95% CI 1.30-151.05, p = 0.03) for hospital mortality. CONCLUSIONS Respiratory viruses are common organisms isolated in severe community-acquired pneumonia. Mixed viral-bacterial infections may be associated with an increased risk of mortality.
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Affiliation(s)
- Jessica Quah
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, SingHealth, 2 Simei Street 3, Postal Code, Singapore, 529889, Singapore.
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Poh Choo Tan
- Department of Advanced Nursing Practice, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Chuin Siau
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, SingHealth, 2 Simei Street 3, Postal Code, Singapore, 529889, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, SingHealth, Singapore, Singapore
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22
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Chan M, Koo SH, Jiang B, Lim PQ, Tan TY. Comparison of the Biofire FilmArray Respiratory Panel, Seegene AnyplexII RV16, and Argene for the detection of respiratory viruses. J Clin Virol 2018; 106:13-17. [PMID: 30007137 PMCID: PMC7185839 DOI: 10.1016/j.jcv.2018.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/18/2018] [Accepted: 07/05/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Respiratory infections are common reasons for hospital admission, and are associated with enormous economic burden due to significant morbidity and mortality. The wide spectrum of microbial agents underlying the pathology renders the diagnosis of respiratory infections challenging. Molecular diagnostics offer an advantage to the current serological and culture-based methods in terms of sensitivity, coverage, hands-on time, and time to results. OBJECTIVES This study aimed to compare the clinical performance of three commercial kits for respiratory viral detection. STUDY DESIGN The performance of FilmArray Respiratory Panel, AnyplexII RV16, and Argene was compared using clinical respiratory samples (n = 224, comprising 189 nasopharyngeal swabs in Universal Transport Medium (UTM) and 35 endotracheal aspirates), based on common overlapping targets across the platforms. Influenza A "equivocal" and "no-subtype" samples by FilmArray were further compared to a laboratory-developed Influenza A/B test. RESULTS AND CONCLUSIONS The overall performance of all three platforms appeared to be comparable with regards to sensitivities (95.8-97.9%) and specificities (96.1-98.0%), detection of coinfections, and distinguishment of influenza from non-influenza cases. "Equivocal" and "no-subtype" samples by FilmArray mostly represented weak Influenza A by laboratory-developed test. Lower respiratory tract samples had comparable final-run success-rates and discordant-rates as compared to UTM. Coronavirus HKU1, which was not targeted by AnyplexII RV16, were detected as OC43. The expected test volume would be the main determinant for the selection of platform. Among the platforms, the FilmArray is the most automated but is of the lowest-throughput and has the highest reagent cost.
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Affiliation(s)
- Maurice Chan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Seok Hwee Koo
- Clinical Trials & Research Unit, Changi General Hospital, Singapore
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Pei Qi Lim
- Clinical Trials & Research Unit, Changi General Hospital, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore.
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23
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Cai Y, Venkatachalam I, Tee NW, Tan TY, Kurup A, Wong SY, Low CY, Wang Y, Lee W, Liew YX, Ang B, Lye DC, Chow A, Ling ML, Oh HM, Cuvin CA, Ooi ST, Pada SK, Lim CH, Tan JWC, Chew KL, Nguyen VH, Fisher DA, Goossens H, Kwa AL, Tambyah PA, Hsu LY, Marimuthu K. Prevalence of Healthcare-Associated Infections and Antimicrobial Use Among Adult Inpatients in Singapore Acute-Care Hospitals: Results From the First National Point Prevalence Survey. Clin Infect Dis 2018; 64:S61-S67. [PMID: 28475790 DOI: 10.1093/cid/cix103] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. Methods Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-care hospitals between July 2015 and February 2016, using the PPS methodology developed by the European Centre for Disease Prevention and Control. Factors independently associated with HAIs were determined using multivariable regression. Results Of the 5415 patients surveyed, there were 646 patients (11.9%; 95% confidence interval [CI], 11.1%-12.8%) with 727 distinct HAIs, of which 331 (45.5%) were culture positive. The most common HAIs were unspecified clinical sepsis (25.5%) and pneumonia (24.8%). Staphylococcus aureus (12.9%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens implicated in HAIs. Carbapenem nonsusceptibility rates were highest in Acinetobacter species (71.9%) and P. aeruginosa (23.6%). Male sex, increasing age, surgery during current hospitalization, and presence of central venous or urinary catheters were independently associated with HAIs. A total of 2762 (51.0%; 95% CI, 49.7%-52.3%) patients were on 3611 systemic antimicrobial agents; 462 (12.8%) were prescribed for surgical prophylaxis and 2997 (83.0%) were prescribed for treatment. Amoxicillin/clavulanate was the most frequently prescribed (24.6%) antimicrobial agent. Conclusions This survey suggested a high prevalence of HAIs and AMU in Singapore's acute-care hospitals. While further research is necessary to understand the causes and costs of HAIs and AMU in Singapore, repeated PPSs over the next decade will be useful to gauge progress at controlling HAIs and AMU.
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Affiliation(s)
- Yiying Cai
- Department of Pharmacy, Singapore General Hospital.,Department of Pharmacy, National University of Singapore
| | | | - Nancy W Tee
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital
| | - Asok Kurup
- Infectious Diseases Care, Mount Elizabeth (Orchard) Hospital
| | - Sin Yew Wong
- Infectious Disease Specialists, Gleneagles Hospital
| | - Chian Yong Low
- Novena Medical Specialists, Mount Elizabeth (Novena) Hospital
| | - Yang Wang
- Division of Nursing, Raffles Hospital, Departments of
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital
| | - Yi Xin Liew
- Department of Pharmacy, Singapore General Hospital
| | | | | | - Angela Chow
- Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital.,Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital
| | | | - Helen M Oh
- Division of Infectious Diseases, Changi General Hospital
| | | | - Say Tat Ooi
- Department of General Medicine, Khoo Teck Puat Hospital
| | - Surinder K Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital
| | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Center
| | | | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Van Hai Nguyen
- School of Pharmacy, Memorial University, St John's, NL, Canada
| | - Dale A Fisher
- Division of Infectious Disease, National University Hospital, and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Belgium; and
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital.,Department of Pharmacy, National University of Singapore.,Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Paul A Tambyah
- Division of Infectious Disease, National University Hospital, and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Yang Hsu
- Infectious Diseases and.,Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital
| | - Kalisvar Marimuthu
- Infectious Diseases and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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24
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Kalimuddin S, Chen SL, Lim CTK, Koh TH, Tan TY, Kam M, Wong CW, Mehershahi KS, Chau ML, Ng LC, Tang WY, Badaruddin H, Teo J, Apisarnthanarak A, Suwantarat N, Ip M, Holden MTG, Hsu LY, Barkham T. 2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data. Clin Infect Dis 2018; 64:S145-S152. [PMID: 28475781 DOI: 10.1093/cid/cix021] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Streptococcus agalactiae (group B Streptococcus [GBS]) has not been described as a foodborne pathogen. However, in 2015, a large outbreak of severe invasive sequence type (ST) 283 GBS infections in adults epidemiologically linked to the consumption of raw freshwater fish occurred in Singapore. We attempted to determine the scale of the outbreak, define the clinical spectrum of disease, and link the outbreak to contaminated fish. Methods Time-series analysis was performed on microbiology laboratory data. Food handlers and fishmongers were screened for enteric carriage of GBS. A retrospective cohort study was conducted to assess differences in demographic and clinical characteristics of patients with invasive ST283 and non-ST283 infections. Whole-genome sequencing was performed on human and fish ST283 isolates from Singapore, Thailand, and Hong Kong. Results The outbreak was estimated to have started in late January 2015. Within the study cohort of 408 patients, ST283 accounted for 35.8% of cases. Patients with ST283 infection were younger and had fewer comorbidities but were more likely to develop meningoencephalitis, septic arthritis, and spinal infection. Of 82 food handlers and fishmongers screened, none carried ST283. Culture of 43 fish samples yielded 13 ST283-positive samples. Phylogenomic analysis of 161 ST283 isolates from humans and fish revealed they formed a tight clade distinguished by 93 single-nucleotide polymorphisms. Conclusions ST283 is a zoonotic GBS clone associated with farmed freshwater fish, capable of causing severe disease in humans. It caused a large foodborne outbreak in Singapore and poses both a regional and potentially more widespread threat.
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Affiliation(s)
| | - Swaine L Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Genome Institute of Singapore
| | - Cindy T K Lim
- Saw Swee Hock School of Public Health, National University Singapore
| | | | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Michelle Kam
- Department of Internal Medicine, Singapore General Hospital
| | | | - Kurosh S Mehershahi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Man Ling Chau
- Environmental Health Institute, National Environment Agency
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency
| | - Wen Ying Tang
- Department of Laboratory Medicine, Tan Tock Seng Hospital
| | | | - Jeanette Teo
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore
| | | | - Nuntra Suwantarat
- Infectious Disease Division, Thammasat University Hospital, and.,Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Margaret Ip
- Department of Microbiology, Chinese University of Hong Kong, Shatin; and
| | | | - Li Yang Hsu
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Saw Swee Hock School of Public Health, National University Singapore
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25
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Marimuthu K, Venkatachalam I, Khong WX, Koh TH, Cherng BPZ, Van La M, De PP, Krishnan PU, Tan TY, Choon RFK, Pada SK, Lam CW, Ooi ST, Deepak RN, Smitasin N, Tan EL, Lee JJ, Kurup A, Young B, Sim NTW, Thoon KC, Fisher D, Ling ML, Peng BAS, Teo YY, Hsu LY, Lin RTP, Ong RTH, Teo J, Ng OT. Clinical and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Adult Inpatients in Singapore. Clin Infect Dis 2018; 64:S68-S75. [PMID: 28475792 DOI: 10.1093/cid/cix113] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Since 2010, the incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing in Singapore. We analyzed the clinical and molecular epidemiology of CRE among adult inpatients in Singapore. Methods Quarterly incidence of unique subjects (per 100000 patient-days) with positive clinical and surveillance cultures for CRE were estimated based on mandatory data submitted to the National Public Health Laboratory by public hospitals between 2010 and 2015. CRE-positive adult inpatients were prospectively recruited from 6 public sector hospitals between December 2013 and April 2015. Subjects answered a standardized epidemiologic questionnaire and provided samples for this study. Further clinical information was extracted from subjects' electronic medical records. Whole-genome sequencing was performed on study isolates to determine transmission clusters. Results Incidence of CRE clinical cultures among adult inpatients plateaued from 2013 (range: 7.73 to 10.32 per 100000 patient-days) following an initial increase between 2010 and end-2012. We prospectively recruited 249 subjects. Their median age was 65 years, 108 (43%) were female, and 161 (64.7%) had carbapenemase-producing Enterobacteriaceae (CPE). On multivariate analysis, prior carbapenem exposure (OR: 3.23; 95% CI: 1.67-6.25) and hematological malignancies (OR: 2.85; 95% CI: 1.10-7.41) were associated with non-carbapenemase-producing CRE (NCPE) (n = 88) compared with CPE (n = 161) subjects. Among 430 CRE isolates from the 249 subjects, 307(71.3%) were CPE, of which 154(50.2%) were blaKPC-positive, 97(31.6%) blaNDM-positive, and 42 (13.7%) blaOXA-positive. Klebsiella pneumoniae (n = 180, 41.9%), Escherichia coli (n = 129, 30.0%) and Enterobacter cloacae (n = 62, 14.4%) were the main Enterobacteriaceae species. WGS (n = 206) revealed diverse bacterial strain type (STs). The predominant blaKPC-positive plasmid was pHS102707 (n = 62, 55.4%) and the predominant blaNDM-positive plasmid was pNDM-ECS01 (n = 46, 48.9%). Five transmission clusters involving 13 subjects were detected. Conclusions Clinical CRE trend among adult inpatients showed stabilization following a rapid rise since introduction in 2010 potentially due to infection prevention measures and antimicrobial stewardship. More work is needed on understanding CPE transmission dynamics.
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Affiliation(s)
- Kalisvar Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore
| | | | - Wei Xin Khong
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | | | - My Van La
- National Public Health Laboratory, Ministry of Health of Singapore
| | - Partha Pratim De
- Department of Laboratory Medicine, Tan Tock Seng Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Prabha Unny Krishnan
- National Public Health Laboratory, Ministry of Health of Singapore.,Department of Laboratory Medicine, Tan Tock Seng Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Raymond Fong Kok Choon
- Division of Infectious Diseases, Department of Medicine, Changi General Hospital, Singapore
| | - Surinder Kaur Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital, Singapore
| | - Choong Weng Lam
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore
| | - Say Tat Ooi
- Department of Infectious Diseases, Khoo Teck Puat Hospital, Singapore
| | | | - Nares Smitasin
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Eng Lee Tan
- Centre of Biomedical and Life Sciences, Singapore Polytechnic
| | - Jia Jun Lee
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | - Barnaby Young
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nancy Tee Wen Sim
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Yong Loo Lin School of Medicine, National University of Singapore.,Department of Pediatrics, KK Women's and Children's Hospital, Singapore
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore.,Division of Infectious Diseases, National University Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Control, Singapore General Hospital
| | - Brenda Ang Sze Peng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yik-Ying Teo
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS).,Department of Statistics & Applied Probability, Faculty of Science, National University of Singapore.,Life Sciences Institute, National University of Singapore.,Genome Institute of Singapore
| | - Li Yang Hsu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Saw Swee Hock School of Public Health, National University Health System
| | - Raymond Tzer Pin Lin
- National Public Health Laboratory, Ministry of Health of Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Rick Twee-Hee Ong
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Oon Tek Ng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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26
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King AD, Wong LYS, Law BKH, Bhatia KS, Woo JKS, Ai QY, Tan TY, Goh J, Chuah KL, Mo FKF, Chan KCA, Chan ATC, Vlantis AC. MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia. AJNR Am J Neuroradiol 2017; 39:515-523. [PMID: 29284600 DOI: 10.3174/ajnr.a5493] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/28/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging can detect nasopharyngeal carcinoma that is hidden from endoscopic view, but for accurate detection carcinoma confined within the nasopharynx (stage T1) must be distinguished from benign hyperplasia of the nasopharynx. This study aimed to document the MR imaging features of stage T1 nasopharyngeal carcinoma and to attempt to identify features distinguishing it from benign hyperplasia. MATERIALS AND METHODS MR images of 189 patients with nasopharyngeal carcinoma confined to the nasopharynx and those of 144 patients with benign hyperplasia were reviewed and compared in this retrospective study. The center, volume, size asymmetry (maximum percentage difference in area between the right and left nasopharyngeal halves), signal intensity asymmetry, deep mucosal white line (greater contrast enhancement along the deep tumor margin), and absence/distortion of the adenoidal septa were evaluated. Differences were assessed with logistic regression and the χ2 test. RESULTS The nasopharyngeal carcinoma center was lateral, central, or diffuse in 134/189 (70.9%), 25/189 (13.2%), and 30/189 (15.9%) cases, respectively. Nasopharyngeal carcinomas involving the walls showed that a deep mucosal white line was present in 180/183 (98.4%), with a focal loss of this line in 153/180 (85%) cases. Adenoidal septa were absent or distorted in 111/111 (100%) nasopharyngeal carcinomas involving the adenoid. Compared with benign hyperplasia, nasopharyngeal carcinoma had a significantly greater volume, size asymmetry, signal asymmetry, focal loss of the deep mucosal white line, and absence/distortion of the adenoidal septa (P < .001). Although size asymmetry was the most accurate criterion (89.5%) for nasopharyngeal carcinoma detection, use of this parameter alone would have missed 11.9% of early-stage T1 nasopharyngeal carcinomas. CONCLUSIONS MR imaging features can help distinguish stage T1 nasopharyngeal carcinoma from benign hyperplasia in most cases.
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Affiliation(s)
- A D King
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - L Y S Wong
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - B K H Law
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - K S Bhatia
- Imaging Department (K.S.B.), St Mary's Hospital, Imperial College Healthcare, National Health Service Trust, London, UK
| | - J K S Woo
- Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
| | - Q-Y Ai
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - T Y Tan
- Department of Radiology (T.Y.T.), Changi General Hospital, Singapore
| | - J Goh
- Departments of Diagnostic Radiology (J.G.)
| | - K L Chuah
- Pathology (K.L.C.), Tan Tock Seng Hospital, Singapore
| | - F K F Mo
- Clinical Oncology (F.K.F.M., A.T.C.C.)
| | - K C A Chan
- Department of Chemical Pathology (K.C.A.C.), State Key Laboratory in Oncology in South China, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, S.A.R., China
| | | | - A C Vlantis
- Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
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27
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Mendez AR, Tan TY, Low HY, Otto KH, Tan H, Khoo X. Micro-textured films for reducing microbial colonization in a clinical setting. J Hosp Infect 2017; 98:83-89. [PMID: 28797757 DOI: 10.1016/j.jhin.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/01/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transmission of microbes in the hospital environment occurs frequently through human interactions with high-touch surfaces such as patient beds and over-bed tables. Although stringent cleaning routines are implemented as a preventive measure to minimize transmission of microbes, it is desirable to have high-touch surfaces made of antimicrobial materials. Physical texturing of solid surfaces offers a non-bactericidal approach to control the colonization of such surfaces by microbes. AIM To investigate the efficacy of micro-textured polycarbonate films in reducing bacterial load on over-bed tables in a hospital ward. METHODS Two different micro-patterns were fabricated on polycarbonate film via a thermal imprinting method. Micro-textured films were then mounted on patient over-bed tables in a general hospital ward and the bacterial load monitored over 24 h. Total colony counts, which represented on-specific bacterial loading, and meticillin-resistant Staphylococcus aureus counts were monitored at each time-point. FINDINGS Over a period of 24 h, both micro-textured surfaces showed consistently lower bacterial load as compared to the unpatterned polycarbonate and the bare over-bed table laminate. This study supports the findings of earlier laboratory-scale studies that microscale physical texturing can reduce bacterial colonization on a solid surface. CONCLUSION Results of the current study suggest that micro-textured surfaces could provide a viable method for reducing microbial contamination of high-touch surfaces in hospitals.
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Affiliation(s)
- A R Mendez
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore
| | - T Y Tan
- Operations, Changi General Hospital, Singapore
| | - H Y Low
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore.
| | - K H Otto
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore; Design Factory, Department of Mechanical Engineering, Aalto University, Finland
| | - H Tan
- Operations, Changi General Hospital, Singapore
| | - X Khoo
- Engineering Product Development Pillar, Singapore University of Technology and Design, Singapore
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Chan DP, Lee KC, Lee SS, Tan TY. Community-based molecular epidemiology study of hepatitis C virus infection in injection drug users. Hong Kong Med J 2017; 23 Suppl 5:27-30. [PMID: 28943522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- D Pc Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong
| | - K Ck Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong
| | - S S Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong
| | - T Y Tan
- Division of International Epidemiology and Population Studies, John E. Fogarty International Center, National Institutes of Health, USA
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Tan TY, Jiang B, Ng LSY. Faster and economical screening for vancomycin-resistant enterococci by sequential use of chromogenic agar and real-time polymerase chain reaction. Journal of Microbiology, Immunology and Infection 2017; 50:448-453. [DOI: 10.1016/j.jmii.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/07/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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Chang YT, Coombs G, Ling T, Balaji V, Rodrigues C, Mikamo H, Kim MJ, Rajasekaram DG, Mendoza M, Tan TY, Kiratisin P, Ni Y, Barry W, Xu Y, Chen YH, Hsueh PR. Epidemiology and trends in the antibiotic susceptibilities of Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region, 2010-2013. Int J Antimicrob Agents 2017; 49:734-739. [PMID: 28435019 DOI: 10.1016/j.ijantimicag.2017.01.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 08/22/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 10/19/2022]
Abstract
This study was conducted to investigate the epidemiology and antimicrobial susceptibility patterns of Gram-negative bacilli (GNB) isolated from intra-abdominal infections (IAIs) in the Asia-Pacific region (APR) from 2010-2013. A total of 17 350 isolates were collected from 54 centres in 13 countries in the APR. The three most commonly isolated GNB were Escherichia coli (46.1%), Klebsiella pneumoniae (19.3%) and Pseudomonas aeruginosa (9.8%). Overall, the rates of extended-spectrum β-lactamase (ESBL)-producing E. coli and K. pneumoniae were 38.2% and 24.3%, respectively, and they were highest in China (66.6% and 38.7%, respectively), Thailand (49.8% and 36.5%, respectively) and Vietnam (47.9% and 30.4%, respectively). During 2010-2013, the rates of ESBL-producing E. coli and K. pneumoniae isolates causing community-associated (CA) IAIs (collected <48 h after admission) were 26.0% and 13.5%, respectively, and those causing hospital-associated (HA) IAIs were 48.0% and 30.6%, respectively. Amikacin, ertapenem and imipenem were the most effective agents against ESBL-producing isolates. Piperacillin/tazobactam displayed good in vitro activity (91.4%) against CA ESBL-producing E. coli. For other commonly isolated Enterobacteriaceae, fluoroquinolones, cefepime and carbapenems exhibited better in vitro activities than third-generation cephalosporins. Amikacin possessed high in vitro activity against all GNB isolates (>80%) causing IAIs, except for Acinetobacter calcoaceticus-baumannii (ACB) complex (30.9% for HA-IAI isolates). All of the antimicrobial agents tested exhibited <45% in vitro activity against ACB complex. Antimicrobial resistance is a persistent threat in the APR and continuous monitoring of evolutionary trends in the susceptibility patterns of GNB causing IAIs in this region is mandatory.
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Affiliation(s)
- Ya-Ting Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Thomas Ling
- Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - V Balaji
- Christian Medical College, Vellore, India
| | - Camilla Rodrigues
- P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | | | - Min-Ja Kim
- Korea University Anam Hospital, Seoul, South Korea
| | | | | | | | | | | | | | - Yingchun Xu
- Peking Union Medical College Hospital, Beijing, China
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Medicine, Graduate Institute of Medicine, Sepsis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Mok Y, Tan TY, Tay TR, Wong HS, Tiew PY, Kam JW, Siao C. Do we need transbronchial lung biopsy if we have bronchoalveolar lavage Xpert® MTB/RIF? Int J Tuberc Lung Dis 2017; 20:619-24. [PMID: 27084815 DOI: 10.5588/ijtld.15.0463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies evaluating the role of transbronchial lung biopsy (TBLB) in diagnosing pulmonary tuberculosis (PTB) date back decades and have shaped current practice. However, with the recent advent of bronchoalveolar lavage (BAL) Xpert® MTB/RIF, it is time to re-evaluate the role of TBLB. OBJECTIVE To assess the impact of BAL and TBLB with the addition of BAL Xpert on diagnostic PTB yields and time to treatment initiation in sputum-scarce or acid-fast bacilli (AFB) smear-negative PTB patients. METHODS We retrospectively reviewed all sputum-scarce or AFB smear-negative patients who underwent both BAL and TBLB for suspected PTB between March 2011 and October 2013. Xpert was performed on all BAL specimens. RESULTS Of 158 patients included in our analysis, 44 were culture-proven PTB. Ninety-four per cent of the patients had AFB smear-negative BAL samples. The sensitivity and specificity of Xpert in AFB smear-negative BAL samples were respectively 60% and 98%. The addition of BAL Xpert expedited the institution of PTB treatment while having diagnostic yields comparable to those of conventional BAL with TBLB. CONCLUSIONS The use of BAL Xpert may obviate the need for TBLB in increasing the diagnostic yield of PTB in sputum-scarce or AFB smear-negative patients.
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Affiliation(s)
- Y Mok
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - T Y Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - T R Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - H S Wong
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - P Y Tiew
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - J W Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - C Siao
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Torumkuney D, Chaiwarith R, Reechaipichitkul W, Malatham K, Chareonphaibul V, Rodrigues C, Chitins DS, Dias M, Anandan S, Kanakapura S, Park YJ, Lee K, Lee H, Kim JY, Lee Y, Lee HK, Kim JH, Tan TY, Heng YX, Mukherjee P, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2012-14 in Thailand, India, South Korea and Singapore. J Antimicrob Chemother 2016; 71 Suppl 1:i3-19. [PMID: 27048580 DOI: 10.1093/jac/dkw073] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To provide susceptibility data for community-acquired respiratory tract isolates of Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis collected in 2012-14 from four Asian countries. METHODS MICs were determined using Etest(®) for all antibiotics except erythromycin, which was evaluated by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide/clindamycin interpretation, breakpoints were adjusted for incubation in CO2 where available. RESULTS Susceptibility of S. pneumoniae was generally lower in South Korea than in other countries. Penicillin susceptibility assessed using CLSI oral or EUCAST breakpoints ranged from 21.2% in South Korea to 63.8% in Singapore. In contrast, susceptibility using CLSI intravenous breakpoints was much higher, at 79% in South Korea and ∼95% or higher elsewhere. Macrolide susceptibility was ∼20% in South Korea and ∼50%-60% elsewhere. Among S. pyogenes isolates (India only), erythromycin susceptibility (∼20%) was lowest of the antibiotics tested. In H. influenzae antibiotic susceptibility was high except for ampicillin, where susceptibility ranged from 16.7% in South Korea to 91.1% in India. South Korea also had a high percentage (18.1%) of β-lactamase-negative ampicillin-resistant isolates. Amoxicillin/clavulanic acid susceptibility for each pathogen (PK/PD high dose) was between 93% and 100% in all countries except for H. influenzae in South Korea (62.5%). CONCLUSIONS Use of EUCAST versus CLSI breakpoints had profound differences for cefaclor, cefuroxime and ofloxacin, with EUCAST showing lower susceptibility. There was considerable variability in susceptibility among countries in the same region. Thus, continued surveillance is necessary to track future changes in antibiotic resistance.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - R Chaiwarith
- Faculty of Medicine, Chiang Mai University, Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Tambon Sribhoom, Muang, Chiang Mai 50200, Thailand
| | - W Reechaipichitkul
- Khon Kaen University Faculty of Medicine, Srinagarind Hospital, 123 Mittraphap Highway, Tambol Naimuang, Muang District, Khon Kaen 40002, Thailand
| | - K Malatham
- Mahidol University Faculty of Medicine Ramathibodi Hospital, 270 Rama VI. Road, oong Phayathai, Ratchathewi, Bangkok 10400, Thailand
| | - V Chareonphaibul
- GlaxoSmithKline Thailand, 12th Floor, Wave Place, 55 Wireless Road, Lumpini, Patumwan, Bangkok 10330, Thailand
| | - C Rodrigues
- Hinduja Hospital and Medical Research Centre, Department of Microbiology, Veer Savarkar Marg, Mahim, Mumbai 400 016, India
| | - D S Chitins
- Choithram Hospital and Research Centre, Department of Microbiology, Manik Bagh Road, Indore 452 014 (M/P), India
| | - M Dias
- St John's Medical College Hospital, Department of Microbiology, Sarjapur Road, Bangalore 560 034, India
| | - S Anandan
- Christian Medical College, Department of Microbiology, Vellore 632 004, India
| | - S Kanakapura
- GlaxoSmithKline India, No. 5 Embassy Links, Cunningham (SRT) Road, Bangalore 560 052, India
| | - Y J Park
- The Catholic University of Korea, Seoul St Mary's Hospital, 222 Banpo-daero, Seocho-Gu, Seoul, South Korea
| | - K Lee
- Yonsei University College of Medicine, Severance Hospital, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, South Korea
| | - H Lee
- Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, South Korea
| | - J Y Kim
- Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, South Korea
| | - Y Lee
- Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, South Korea
| | - H K Lee
- The Catholic University of Korea, Uijongbu St Mary's Hospital, 271, Cheonbo-ro, Ukjeongbu-si, Gyeonggi-do, Korea
| | - J H Kim
- GlaxoSmithKline Korea, LS Yongsan Tower, 9th Floor, Hangang 191, Yongsan-gu, Seoul, South Korea
| | - T Y Tan
- Changi General Hospital Pte Ltd (Reg. No. 198904226R), 2 Simei Street 3, Singapore 529889
| | - Y X Heng
- Changi General Hospital Pte Ltd (Reg. No. 198904226R), 2 Simei Street 3, Singapore 529889
| | - P Mukherjee
- GlaxoSmithKline Singapore, (Reg. No. 198102938K), 150 Beach Road, No. 22-00 Gateway West, Singapore 189720
| | - I Morrissey
- IHMA Europe Sàrl, 9A Route de la Corniche, Epalinges 1066, Switzerland
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Ng YD, Yong PEO, Tie TK, Seah J, See M, Fong RKC, Shafi H, Tan TY, Yeo QM. Evaluation of a Microbiologist-Initiated Service to Improve Antibiotic Prescribing for Bacteremia. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.705] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yee Ding Ng
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Pu En Ow Yong
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Teck Kim Tie
- Pharmacy, Changi General Hospital, Singapore, Singapore
- Changi General Hospital, Singapore, Singapore
| | - Jonathan Seah
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Michelle See
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | | | - Humaira Shafi
- Medicine, Infectious Disease, Changi General Hospital, Singapore, Singapore
| | | | - Qiu Min Yeo
- Pharmacy, Changi General Hospital, Singapore, Singapore
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Tan TY, Ng LSY, Kwang LL, Rao S, Eng LC. Clinical characteristics and antimicrobial susceptibilities of anaerobic bacteremia in an acute care hospital. Anaerobe 2016; 43:69-74. [PMID: 27890724 DOI: 10.1016/j.anaerobe.2016.11.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 05/07/2014] [Revised: 11/17/2016] [Accepted: 11/24/2016] [Indexed: 11/25/2022]
Abstract
This study investigated the clinical features of anaerobic bacteraemia in an acute-care hospital, and evaluated the antimicrobial susceptibility of these isolates to commonly available antibiotics. Microbiological and epidemiological data from 2009 to 2011were extracted from the laboratory information system and electronic medical records. One hundred and eleven unique patient episodes consisting of 116 anaerobic isolates were selected for clinical review and antibiotic susceptibility testing. Susceptibilities to amoxicillin-clavulanate, clindamycin, imipenem, metronidazole, moxifloxacin, penicillin and piperacillin-tazobactam were performed using Etest strips with categorical interpretations according to current CLSI breakpoints. Metronidazole-resistant and carbapenem-resistant anaerobic Gram-negative bacilli were screened for the nim and cfiA genes. Clinical data was obtained retrospectively from electronic medical records. During the 3 year period, Bacteroides fragilis group (41%), Clostridium species (14%), Propionibacterium species (9%) and Fusobacterium species (6%) were the most commonly isolated anaerobes. Patients with anaerobic bacteraemia that were included in the study were predominantly above 60 years of age, with community-acquired infections. The most commonly used empiric antibiotic therapies were beta-lactam/beta-lactamase inhibitor combinations (44%) and metronidazole (10%). The crude mortality was 25%, and appropriate initial antibiotic therapy was not significantly associated with improved survival. Intra-abdominal infections (39%) and soft-tissue infections (33%) accounted for nearly three-quarters of all bacteraemia. Antibiotics with the best anaerobic activity were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and metronidazole, with in-vitro susceptibility rates of 95%, 95%, 94% and 92% respectively. Susceptibilities to penicillin (31%), clindamycin (60%) and moxifloxacin (84%) were more variable. Two multidrug-resistant isolates of Bacteroides species were positive for nim and cfiA genes respectively, while another two imipenem-resistant Fusobacterium species were negative for cfiA genes. This study demonstrated that anaerobic bacteraemia in our patient population was predominantly associated with intra-abdominal and soft-tissue infections. Overall antibiotic resistance was high for penicillin and clindamycin, and the presence of emerging resistance to carbapenems and metronidazole warrants further monitoring.
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Affiliation(s)
- Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - Lily Siew Yong Ng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Lee Ling Kwang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Suma Rao
- Department of Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Li Ching Eng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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Torumkuney D, Chaiwarith R, Reechaipichitkul W, Malatham K, Chareonphaibul V, Rodrigues C, Chitkins DS, Dias M, Anandan S, Kanakapura S, Park YJ, Lee K, Lee H, Kim JY, Lee Y, Lee HK, Kim JH, Tan TY, Heng YX, Mukherjee P, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2012-14 in Thailand, India, South Korea and Singapore. J Antimicrob Chemother 2016; 71:3628. [PMID: 27559118 PMCID: PMC7297303 DOI: 10.1093/jac/dkw332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Khong WX, Marimuthu K, Teo J, Ding Y, Xia E, Lee JJ, Ong RTH, Venkatachalam I, Cherng B, Pada SK, Choong WL, Smitasin N, Ooi ST, Deepak RN, Kurup A, Fong R, Van La M, Tan TY, Koh TH, Lin RTP, Tan EL, Krishnan PU, Singh S, Pitout JD, Teo YY, Yang L, Ng OT. Tracking inter-institutional spread of NDM and identification of a novel NDM-positive plasmid, pSg1-NDM, using next-generation sequencing approaches. J Antimicrob Chemother 2016; 71:3081-3089. [PMID: 27494913 DOI: 10.1093/jac/dkw277] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Owing to gene transposition and plasmid conjugation, New Delhi metallo-β-lactamase (NDM) is typically identified among varied Enterobacteriaceae species and STs. We used WGS to characterize the chromosomal and plasmid molecular epidemiology of NDM transmission involving four institutions in Singapore. METHODS Thirty-three Enterobacteriaceae isolates (collection years 2010-14) were sequenced using short-read sequencing-by-synthesis and analysed. Long-read single molecule, real-time sequencing (SMRTS) was used to characterize genetically a novel plasmid pSg1-NDM carried on Klebsiella pneumoniae ST147. RESULTS In 20 (61%) isolates, blaNDM was located on the pNDM-ECS01 plasmid in the background of multiple bacterial STs, including eight K. pneumoniae STs and five Escherichia coli STs. In six (18%) isolates, a novel blaNDM-positive plasmid, pSg1-NDM, was found only in K. pneumoniae ST147. The pSg1-NDM-K. pneumoniae ST147 clone (Sg1-NDM) was fully sequenced using SMRTS. pSg1-NDM, a 90 103 bp IncR plasmid, carried genes responsible for resistance to six classes of antimicrobials. A large portion of pSg1-NDM had no significant homology to any known plasmids in GenBank. pSg1-NDM had no conjugative transfer region. Combined chromosomal-plasmid phylogenetic analysis revealed five clusters of clonal bacterial NDM-positive plasmid transmission, of which two were inter-institution clusters. The largest inter-institution cluster involved six K. pneumoniae ST147-pSg1-NDM isolates. Fifteen patients were involved in transmission clusters, of which four had ward contact, six had hospital contact and five had an unknown transmission link. CONCLUSIONS A combined sequencing-by-synthesis and SMRTS approach can determine effectively the transmission clusters of blaNDM and genetically characterize novel plasmids. Plasmid molecular epidemiology is important to understanding NDM spread as blaNDM-positive plasmids can conjugate extensively across species and STs.
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Affiliation(s)
- Wei Xin Khong
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Kalisvar Marimuthu
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, 117597, Singapore
| | - Jeanette Teo
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Yichen Ding
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Eryu Xia
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS), #05-01Medical Drive, 117456, Singapore
| | - Jia Jun Lee
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Rick Twee-Hee Ong
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore
| | | | | | - Surinder Kaur Pada
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Weng Lam Choong
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Nares Smitasin
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Say Tat Ooi
- Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore
| | | | - Asok Kurup
- Mount Elizabeth Hospital, 3 Mount Elizabeth, 228510, Singapore
| | - Raymond Fong
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - My Van La
- National Public Health Laboratory, College of Medicine Building, 16 College Road, 169854, Singapore
| | - Thean Yen Tan
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Tse Hsien Koh
- Singapore General Hospital, Outram Road, 169608, Singapore
| | - Raymond Tzer Pin Lin
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore.,National Public Health Laboratory, College of Medicine Building, 16 College Road, 169854, Singapore
| | - Eng Lee Tan
- Singapore Polytechnic, 500 Dover Road, 139651, Singapore
| | | | | | - Johann D Pitout
- Division of Microbiology, 1829 Ranchlands Blvd NW, Calgary, AB T3G 2A7, Canada.,Departments of Pathology and Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Yik-Ying Teo
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS), #05-01Medical Drive, 117456, Singapore.,Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore.,Department of Statistics & Applied Probability, Block S16, Level 7, 6 Science Drive 2, Faculty of Science, National University of Singapore, 117546, Singapore.,Life Sciences Institute, National University of Singapore, Centre for Life 42 Sciences, #05-02, 28 Medical Drive, 117456, Singapore.,Genome Institute of Singapore, 60 Biopolis St, #02-01, 138672, Singapore
| | - Liang Yang
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Oon Tek Ng
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
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Chen YT, Ahmad Murad K, Ng LS, Seah JT, Park JJ, Tan TY. In Vitro Efficacy of Six Alternative Antibiotics against Multidrug Resistant Escherichia Coli and Klebsiella Pneumoniae from Urinary Tract Infections. Ann Acad Med Singap 2016; 45:245-50. [PMID: 27412057] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Increasing resistance in Escherichia coli and Klebsiella pneumoniae to firstline antibiotics makes therapeutic options for urinary tract infections (UTIs) challenging. This study investigated the in vitro efficacies of 6 antibiotics against multidrug resistant (MDR) uropathogens. MATERIALS AND METHODS Minimum inhibitory concentrations to ceftibuten, cefpodoxime, fosfomycin, mecillinam, temocillin, and trimethoprim were determined against 155 MDR-isolates of E. coli and K. pneumoniae. The presence of extended-spectrum beta-lactamases (ESBL) and plasmid-borne AmpC enzymes was determined by phenotypic testing with genotyping performed by multiplex polymerase chain reaction. RESULTS Temocillin demonstrated highest susceptibility rates for both E. coli (95%) and K. pneumoniae (95%) when breakpoints for uncomplicated UTIs were applied; however, temocillin susceptibility was substantially lower when "systemic infection" breakpoints were used. Fosfomycin demonstrated the best in vitro efficacy of the orally available agents, with 78% and 69% of E. coli and K. pneumoniae isolates susceptible, respectively. The next most effective antibiotics were ceftibuten (45%) and mecillinam (32%). ESBL and ampC genes were present in 47 (30%) and 59 (38%) isolates. CONCLUSION This study demonstrated few oral therapeutic options for MDR-uropathogens, with fosfomycin demonstrating the best in vitro activity.
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Affiliation(s)
- Yu Ting Chen
- Department of Laboratory Medicine, Changi General Hospital, Singapore
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Lau YW, Vikneswaran T, Tan TY, Tang IP. Sinonasal angioleiomyoma. Med J Malaysia 2016; 71:154-155. [PMID: 27495895] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Angioleiomyoma of the nasal cavity is an extremely rare benign neoplasm. It usually occurs in the lower extremities. Up to date, only few cases of angioleiomyoma have been reported. First case of angioleiomyoma of nasal cavity was reported in 1966. We report a rare case of angioleiomyoma arising from the right maxillary sinus. CASE REPORT A 43-year-old lady presented with recurrent epistaxis and right nasal obstruction for two months duration. Clinical examination revealed a huge right nasal mass obstructing the right nasal cavity. The tumour was excised completely via endoscopic endonasal surgical approach. Histopathological examination confirmed the tumour is sinonasal angioleiomyoma. Postoperatively, she recovered well without any recurrence after a year of followup. CONCLUSION This tumour has an excellent prognosis and recurrence is extremely rare if excised completely.
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Affiliation(s)
- Y W Lau
- Sarawak General Hospital, Dept of ORL-HNS, Kuching, Sarawak, Malaysia.
| | - T Vikneswaran
- Sarawak General Hospital, Dept of ORL-HNS, Kuching, Sarawak, Malaysia
| | - T Y Tan
- Sarawak General Hospital, Dept of ORL-HNS, Kuching, Sarawak, Malaysia
| | - I P Tang
- University Malaysia Sarawak, Otorhinolaryngology Head and Neck Surgery, Lot 77, Seksyen 22, Kuching Town Land District, Jalan Tun Ahmad Zaidi Adruce, 93150 Kuching, Kuching, Sarawak 93150, Malaysia
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Chan M, Jiang B, Ng SYL, Tan TY. Novel cost-effective quality control approach for the Cepheid Xpert CT/NG assay for the detection of Chlamydia Trachomatis and Neisseria Gonorrhoeae. J Microbiol Methods 2016; 125:87-90. [PMID: 27091503 DOI: 10.1016/j.mimet.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/18/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/22/2022]
Abstract
The Xpert CT/NG is a rapid assay for detection of Neisseria gonorrhoeae and Chlamydia trachomatis. QC materials must be formulated to emulate human specimens, and are prohibitively expensive. A creative, cost-effective QC approach is proposed. The acceptable sample types for the Xpert CT/NG assay were extended to include eye swabs.
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Affiliation(s)
- Maurice Chan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Boran Jiang
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Siew Yong Lily Ng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Jean SS, Coombs G, Ling T, Balaji V, Rodrigues C, Mikamo H, Kim MJ, Rajasekaram DG, Mendoza M, Tan TY, Kiratisin P, Ni Y, Weinman B, Xu Y, Hsueh PR. Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract infections in the Asia-Pacific region: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010-2013. Int J Antimicrob Agents 2016; 47:328-34. [PMID: 27005459 DOI: 10.1016/j.ijantimicag.2016.01.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
A total of 9599 isolates of Gram-negative bacteria (GNB) causing urinary tract infections (UTIs) were collected from 60 centres in 13 countries in the Asia-Pacific region from 2010-2013. These isolates comprised Enterobacteriaceae species (mainly Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Klebsiella oxytoca, Enterobacter cloacae and Morganella morganii) and non-fermentative GNB species (predominantly Pseudomonas aeruginosa and Acinetobacter baumannii). In vitro susceptibilities were determined by the agar dilution method and susceptibility profiles were determined using the minimum inhibitory concentration (MIC) interpretive breakpoints recommended by the Clinical and Laboratory Standards Institute in 2015. Production of extended-spectrum β-lactamases (ESBLs) amongst E. coli, K. pneumoniae, P. mirabilis and K. oxytoca isolates was determined by the double-disk synergy test. China, Vietnam, India, Thailand and the Philippines had the highest rates of GNB species producing ESBLs and the highest rates of cephalosporin resistance. ESBL production and hospital-acquired infection (isolates obtained ≥48 h after admission) significantly compromised the susceptibility of isolates of E. coli and K. pneumoniae to ciprofloxacin, levofloxacin and most β-lactams, with the exception of imipenem and ertapenem. However, >87% of ESBL-producing E. coli strains were susceptible to amikacin and piperacillin/tazobactam, indicating that these antibiotics might be appropriate alternatives for treating UTIs due to ESBL-producing E. coli. Fluoroquinolones were shown to be inappropriate as empirical therapy for UTIs. Antibiotic resistance is a serious problem in the Asia-Pacific region. Therefore, continuous monitoring of evolutionary trends in the susceptibility profiles of GNB causing UTIs in Asia is crucial.
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Affiliation(s)
- Shio-Shin Jean
- Emergency Medicine, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Thomas Ling
- Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - V Balaji
- Christian Medical College, Vellore, India
| | - Camilla Rodrigues
- P.D. Hinduja National Hospital & Medical Research Center, Mumbai, India
| | | | - Min-Ja Kim
- Korea University Anam Hospital, Seoul, South Korea
| | | | | | | | | | | | | | - Yingchun Xu
- Peking Union Medical College Hospital, Beijing, China
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Tan TY, Hsu LY, Alejandria MM, Chaiwarith R, Chinniah T, Chayakulkeeree M, Choudhury S, Chen YH, Shin JH, Kiratisin P, Mendoza M, Prabhu K, Supparatpinyo K, Tan AL, Phan XT, Tran TTN, Nguyen GB, Doan MP, Huynh VA, Nguyen SMT, Tran TB, Van Pham H. Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region. Med Mycol 2016; 54:471-7. [PMID: 26868904 DOI: 10.1093/mmy/myv114] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [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: 12/02/2015] [Accepted: 12/09/2015] [Indexed: 11/14/2022] Open
Abstract
Bloodstream infections caused by Candida species are of increasing importance and associated with significant mortality. We performed a multi-centre prospective observational study to identify the species and antifungal susceptibilities of invasive bloodstream isolates of Candida species in the Asia-Pacific region. The study was carried out over a two year period, involving 13 centers from Brunei, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Identification of Candida species was performed at each study center, and reconfirmed at a central laboratory. Susceptibility testing was performed using a commercial broth dilution panel (Sensititre YeastOne YST-010, Thermofisher, United Kingdom) with susceptibility categorisation (S = susceptible, S-DD = susceptible dose-dependent) applied using breakpoints from the Clinical Laboratory Standards Institute. Eight hundred and sixty-one Candida isolates were included in the study. The most common species were C. albicans (35.9%), C. tropicalis (30.7%), C. parapsilosis (15.7%), and C. glabrata (13.6%). Non-albicans species exceeded C. albicans species in centers from all countries except Taiwan. Fluconazole susceptibility was almost universal for C. albicans (S = 99.7%) but lower for C. tropicalis (S = 75.8%, S-DD = 6.1%), C. glabrata (S-DD = 94.9%), and C. parapsilosis (S = 94.8%). Echinocandins demonstrated high rates of in vitro susceptibility (S>99%) against C. albicans, C. tropicalis, and C. parapsilosis This study demonstrates that non-albicans species are the most common isolates from bloodstream infections in most countries in the Asia-Pacific region, with C. tropicalis as the predominant species. Because of the prevalence of reduced susceptibility to fluconazole in non-albicans species, the study indicates that echinocandins should be the antifungal of choice in clinically unstable or high-risk patients with documented candidemia.
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Affiliation(s)
- Thean Yen Tan
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Li Yang Hsu
- National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - Marissa M Alejandria
- University of the Philippines - Philippine General Hospital, Taft Avenue, Ermita, Manila 1000, Metro Manila, Philippines
| | - Romanee Chaiwarith
- Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Sribhoom, Muang District, Chiang Mai, Thailand
| | - Terrence Chinniah
- Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Jalan Putera Al-Muhtadee Billah / Jalan Tutong Brunei Darussalam BA1710
| | | | | | - Yen Hsu Chen
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan National Chiao Tung University, HsinChu City, Taiwan Center for Dengue Fever Control and Research, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Jong Hee Shin
- Chonnam National University Hospital, 42 Jebongro, Dongku, Gwangju, Korea 501-575
| | | | - Myrna Mendoza
- National Kidney and Transplant Institute Hospital, East Ave, Diliman, Quezon City, Metro Manila, Philippines
| | - Kavitha Prabhu
- Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Jalan Putera Al-Muhtadee Billah / Jalan Tutong Brunei Darussalam BA1710
| | - Khuanchai Supparatpinyo
- Maharaj Nakorn Chiang Mai Hospital, 110 Intavaroros Road, Sribhoom, Muang District, Chiang Mai, Thailand
| | - Ai Ling Tan
- Singapore General Hospital, Outram Rd, Singapore 169608
| | - Xuan Thi Phan
- Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam
| | - Thi Thanh Nga Tran
- Cho Ray Hospital, 201B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam
| | - Gia Binh Nguyen
- Bach Mai Hospital, 78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam
| | - Mai Phuong Doan
- Bach Mai Hospital, 78 Giai Phong, Phuong Mai, Dong Da, Hanoi, Vietnam
| | - Van An Huynh
- Nhan Dan Gia Dinh Hospital, 01 No Trang Long, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Su Minh Tuyet Nguyen
- Nhan Dan Gia Dinh Hospital, 01 No Trang Long, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Thanh Binh Tran
- Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, Ward 8, District 5, Ho Chi Minh City, Vietnam
| | - Hung Van Pham
- Nguyen Tri Phuong Hospital, 468 Nguyen Trai Street, Ward 8, District 5, Ho Chi Minh City, Vietnam
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Viswanath SK, Jie L, Meng QS, Yuen C, Tan TY. An Android app for recording hand hygiene observation data. J Hosp Infect 2015; 92:344-5. [PMID: 26601602 DOI: 10.1016/j.jhin.2015.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/15/2022]
Affiliation(s)
- S K Viswanath
- Engineering Product Development, Singapore University of Technology and Design, Singapore
| | - L Jie
- Infection Control, Changi General Hospital, Singapore
| | - Q S Meng
- Infection Control, Changi General Hospital, Singapore
| | - C Yuen
- Engineering Product Development, Singapore University of Technology and Design, Singapore
| | - T Y Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore.
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Loke SC, Karandikar A, Ravanelli M, Farina D, Goh JPN, Ling EA, Maroldi R, Tan TY. Superior cervical ganglion mimicking retropharyngeal adenopathy in head and neck cancer patients: MRI features with anatomic, histologic, and surgical correlation. Neuroradiology 2015; 58:45-50. [PMID: 26423907 DOI: 10.1007/s00234-015-1598-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/26/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To describe the unique MRI findings of superior cervical ganglia (SCG) that may help differentiate them from retropharyngeal lymph nodes (RPLNs). METHODS A retrospective review of post-treatment NPC patients from 1999 to 2012 identified three patients previously irradiated for NPC that were suspected of having recurrent nodal disease in retropharyngeal lymph nodes during surveillance MRI. Subsequent surgical exploration revealed enlarged SCG only; no retropharyngeal nodal disease was found. A cadaveric head specimen was also imaged with a 3T MRI before and after dissection. In addition, SCG were also harvested from three cadaveric specimens and subjected to histologic analysis. RESULTS The SCG were found at the level of the C2 vertebral body, medial to the ICA. They were ovoid on axial images and fusiform and elongated with tapered margins in the coronal plane. T2-weighted (T2W) signal was hyperintense. No central elevated T1-weighted (T1W) signal was seen within the ganglia in non-fat-saturated sequences to suggest the presence of a fatty hilum. Enhancement after gadolinium was present. A central "black dot" was seen on axial T2W and post-contrast images in two of the three SCG demonstrated. Histology showed the central black line was comprised of venules and interlacing neurites within the central portion of the ganglion. CONCLUSIONS The SCG can be mistaken for enlarged RPLNs in post-treatment NPC patients. However, there are features which can help differentiate them from RPLNs, preventing unnecessary therapy. These imaging findings have not been previously described.
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Affiliation(s)
- S C Loke
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, Podium Block, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - A Karandikar
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, Podium Block, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore
| | - M Ravanelli
- Department of Radiology, University of Brescia, Brescia, Italy
| | - D Farina
- Department of Radiology, University of Brescia, Brescia, Italy
| | - J P N Goh
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, Podium Block, 11 Jalan Tan Tock Seng, Singapore, 308433, Republic of Singapore.
| | - E A Ling
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - R Maroldi
- Department of Radiology, University of Brescia, Brescia, Italy
| | - T Y Tan
- Department of Radiology, Changi General Hospital, Singapore, Republic of Singapore
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Miyake N, Tsurusaki Y, Koshimizu E, Okamoto N, Kosho T, Brown NJ, Tan TY, Yap PJJ, Suzumura H, Tanaka T, Nagai T, Nakashima M, Saitsu H, Niikawa N, Matsumoto N. Delineation of clinical features in Wiedemann-Steiner syndrome caused by KMT2A mutations. Clin Genet 2015; 89:115-9. [PMID: 25810209 DOI: 10.1111/cge.12586] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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: 12/09/2014] [Accepted: 03/06/2015] [Indexed: 01/24/2023]
Abstract
Wiedemann-Steiner syndrome (WSS) is an autosomal dominant congenital anomaly syndrome characterized by hairy elbows, dysmorphic facial appearances (hypertelorism, thick eyebrows, downslanted and vertically narrow palpebral fissures), pre- and post-natal growth deficiency, and psychomotor delay. WSS is caused by heterozygous mutations in KMT2A (also known as MLL), a gene encoding a histone methyltransferase. Here, we identify six novel KMT2A mutations in six WSS patients, with four mutations occurring de novo. Interestingly, some of the patients were initially diagnosed with atypical Kabuki syndrome, which is caused by mutations in KMT2D or KDM6A, genes also involved in histone methylation. KMT2A mutations and clinical features are summarized in our six patients together with eight previously reported patients. Furthermore, clinical comparison of the two syndromes is discussed in detail.
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Affiliation(s)
- N Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Y Tsurusaki
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - E Koshimizu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - N Okamoto
- Department of Medical Genetics, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - T Kosho
- Department of Medical Genetics, Shinshu University School of Medicine, Matsumoto, Japan
| | - N J Brown
- Department of Clinical Genetics, Austin Health, Heidelberg, Australia.,Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - T Y Tan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - P J J Yap
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, Australia
| | - H Suzumura
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - T Tanaka
- Department of Pediatrics and Clinical research, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - T Nagai
- Department of Pediatrics, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - M Nakashima
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - H Saitsu
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - N Niikawa
- Health Science University of Hokkaido, Hokkaido, Japan
| | - N Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Abstract
INTRODUCTION Fertility in women declines with increasing age. With the deferment of marriage and childbearing, couples are turning to assisted reproductive technology to counteract this decline. We aimed to evaluate the results of in vitrofertilisation (IVF)/intracytoplasmic sperm injection (ICSI) in women of different age groups, and highlight the cost-effectiveness of IVF treatment in these groups while assessing its implications on the national healthcare provision model. METHODS Retrospective analysis of 3,412 stimulated IVF/ICSI cycles in a hospital-based IVF centre was performed from January 2008 to December 2010. Patients were stratified into seven age groups: < 30 years; 30-35 years; 36-37 years; 38 years; 39 years; 40-44 years; and ≥ 45 years. RESULTS Age had a significant effect on the number of cycles leading to embryo transfer (p < 0.001). The number of oocytes retrieved decreased across the various age groups (p < 0.001) and was the highest among women aged < 30 (mean 18.5 ± 10.3) years. With increasing age, there was a trend toward a lower fertilisation rate. Age also had a significant effect on the rates of clinical pregnancy, live birth and multiple pregnancies (p < 0.001). CONCLUSION Patients aged < 30 years had the best IVF outcomes, reflecting optimal reproductive capacity. Age-related decline in fertility starts after 30 years. Women opting for IVF should be counselled about age-specific success rates while taking into account individual risk factors.
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Affiliation(s)
| | - S K Lau
- Department of Reproductive Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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Abstract
Jacobson's nerve schwannoma is a rare middle ear tumour presenting as a mass along the cochlear promontory. It can be differentiated from other masses along the promontory based on clinical findings, and computed tomography and magnetic resonance imaging features. For small-sized masses, it is possible to differentiate the various middle ear schwannomas from one another. We present the case of a 40-year-old woman with a ten-year history of left hearing loss who was diagnosed with Jacobson's nerve schwannoma.
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Hsu LY, Lee DG, Yeh SP, Bhurani D, Khanh BQ, Low CY, Norasetthada L, Chan T, Kwong YL, Vaid AK, Alejandria I, Mendoza M, Chen CY, Johnson A, Tan TY. Epidemiology of invasive fungal diseases among patients with haematological disorders in the Asia-Pacific: a prospective observational study. Clin Microbiol Infect 2015; 21:594.e7-11. [PMID: 25749561 DOI: 10.1016/j.cmi.2015.02.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 11/23/2014] [Revised: 01/12/2015] [Accepted: 02/22/2015] [Indexed: 12/15/2022]
Abstract
We conducted a 2-year multicentre prospective observational study to determine the epidemiology of and mortality associated with invasive fungal diseases (IFDs) among patients with haematological disorders in Asia. Eleven institutions from 8 countries/regions participated, with 412 subjects (28.2% possible, 38.3% probable and 33.5% proven IFDs) recruited. The epidemiology of IFDs in participating institutions was similar to Western centres, with Aspergillus spp. (65.9%) or Candida spp. (26.7%) causing the majority of probable and proven IFDs. The overall 30-day mortality was 22.1%. Progressive haematological disorder (odds ratio [OR] 5.192), invasive candidiasis (OR 3.679), and chronic renal disease (OR 6.677) were independently associated with mortality.
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Affiliation(s)
- L Y Hsu
- National University Hospital, National University Health System, Singapore.
| | - D G Lee
- Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S P Yeh
- China Medical University Hospital, Taiwan
| | - D Bhurani
- Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - B Q Khanh
- National Institute of Hematology and Blood Transfusion, Hanoi, Viet Nam
| | - C Y Low
- Singapore General Hospital, Singapore
| | | | - T Chan
- Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Y L Kwong
- Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - A K Vaid
- Maedanta Medicity, Gurgaon, India
| | - I Alejandria
- National Kidney and Transplant Institute, Quezon City, Philippines
| | - M Mendoza
- National Kidney and Transplant Institute, Quezon City, Philippines
| | - C Y Chen
- National Taiwan University Hospital, Taiwan
| | - A Johnson
- International Health Management Associates, Inc., Schaumburg, IL, USA
| | - T Y Tan
- Changi General Hospital, Singapore
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Ng LSY, Kwang LL, Rao S, Tan TY. Anaerobic bacteraemia revisited: species and susceptibilities. Ann Acad Med Singap 2015; 44:13-18. [PMID: 25703492] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION This retrospective study was performed to evaluate the frequency of anaerobic bacteraemia over a 10-year period, and to provide updated antibiotic susceptibilities for the more clinically relevant anaerobes causing blood stream infection. MATERIALS AND METHODS Data were retrieved from the laboratory information system for the period 2003 to 2012. During this time, blood cultures were inoculated in Bactec™ Plus vials (BD, USA) and continuously monitored in the Bactec™ 9000 blood culture system (BD, USA). Anaerobic organisms were identified using commercial identification kits, predominantly API 20 A (bioMérieux, France) supplemented with Vitek ANC cards (bioMérieux, France) and AN-Ident discs (Oxoid, United Kingdom). A representative subset of isolates were retrieved from 2009 to 2011 and antimicrobial susceptibilities to penicillin, amoxicillin-clavulanate, clindamycin, imipenem, moxifloxacin, piperacillin-tazobactam and metronidazole were determined using the Etest method. RESULTS Anaerobes comprised 4.1% of all positive blood culture with 727 obligate anaerobes recovered over the 10-year period, representing a positivity rate of 0.35%. The only significant change in anaerobe positivity rates occurred between 2003 and 2004, with an increase of 0.2%. The Bacteroides fragilis group (45%) were the predominant anaerobic pathogens, followed by Clostridium species (12%), Propioniobacterium species (11%) and Fusobacterium species (6%). The most active in vitro antibiotics were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and metronidazole, with susceptibilities of 95.0%, 93.3%, 90.8% and 90.8% respectively. Resistance was high to penicillin, clindamycin and moxifl oxacin. However, there were apparent differences for antibiotic susceptibilities between species. CONCLUSION This study indicates that the anaerobes comprise a small but constant proportion of bloodstream isolates. Antibiotic resistance was high to some antibiotics, but metronidazole, the beta-lactam/beta-lactamase inhibitors and carbapenems retained good in vitro activity.
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Affiliation(s)
- Lily S Y Ng
- Department of Laboratory Medicine, Changi General Hospital, Singapore
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Sia KJ, Kong CKL, Tan TY, Tang IP. Kimura's Disease: Diagnostic Challenge and Treatment Modalities. Med J Malaysia 2014; 69:281-283. [PMID: 25934961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
CASE REPORT Five cases of Kimura's disease had been treated in our centre from year 2003 to 2010. All cases were presented with head and neck mass with cervical lymphadenopathy. Surgical excision was performed for all cases. Definite diagnosis was made by histopathological examination of the resected specimens. One out of five cases developed tumour recurrence four years after resection. CONCLUSION Surgical excision is our choice of treatment because the outcome is immediate and definite tissue diagnosis is feasible after resection. Oral corticosteroid could be considered as an option in advanced disease. However, tumour recurrence is common after cessation of steroid therapy.
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Affiliation(s)
- K J Sia
- University of Malaya, Otorhinolaryngology Department, Malaysia.
| | - C K L Kong
- Sibu Hospital, Department of Diagnostic Imaging, Sarawak, Malaysia
| | - T Y Tan
- Sarawak General Hospital, ORL Department, Kuching, Sarawak, Malaysia
| | - I P Tang
- University Malaysia Sarawak, Faculty of Medicine, ORL Department, Jalan Datuk Mohd Musa, 94300 Kota Samarahan, Sarawak, Malaysia
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50
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Mok Y, Tan TY, Tay TR, Wong HS, Tiew PY, Kam JW, Siau C. The Accuracy of Xpert MTB/RIF Assay in Bronchoalveolar Specimens and Its Impact on Pulmonary Tuberculosis (PTB) Management. Chest 2014. [DOI: 10.1378/chest.1992976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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