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Chen PK, Lee YT, Liu CY, Thuy TTD, Anh K, Wu JJ, Liao CH, Huang YT, Chen YC, Kao CY. A 19-year longitudinal study to characterize carbapenem-nonsusceptible Acinetobacter isolated from patients with bloodstream infections and the contribution of conjugative plasmids to carbapenem resistance and virulence. J Microbiol Immunol Infect 2024; 57:288-299. [PMID: 38350841 DOI: 10.1016/j.jmii.2024.01.008] [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: 07/01/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND This study aimed to characterize carbapenem-nonsusceptible Acinetobacter (CNSA) isolated from patients with bacteremia from 1997 to 2015. METHODS A total of 173 CNSA (12.3%) was recovered from 1403 Acinetobacter isolates. The presence of selected β-lactamase genes in CNSA was determined by PCR amplification. The conjugation test was used to determine the transferability of metallo-β-lactamase (MBL)-carrying plasmids. Whole genome sequencing in combination with phenotypic assays was carried out to characterize MBL-plasmids. RESULTS In general, a trend of increasing numbers of CNSA was observed. Among the 173 CNSA, A. baumannii (54.9%) was the most common species, followed by A. nosocomialis (23.1%) and A. soli (12.1%). A total of 49 (28.3%) CNSA were extensively drug-resistant, and all were A. baumannii. The most common class D carbapenemase gene in 173 CNSA was blaOXA-24-like (32.4%), followed by ISAba1-blaOXA-51-like (20.8%), ISAba1-blaOXA-23 (20.2%), and IS1006/IS1008-blaOXA-58 (11.6%). MBL genes, blaVIM-11,blaIMP-1, and blaIMP-19 were detected in 9 (5.2%), 20 (11.6%), and 1 (0.6%) CNSA isolates, respectively. Transfer of MBL genes to AB218 and AN254 recipient cells was successful for 7 and 6 of the 30 MBL-plasmids, respectively. The seven AB218-derived transconjugants carrying MBL-plasmids produced less biofilm but showed higher virulence to larvae than recipient AB218. CONCLUSIONS Our 19-year longitudinal study revealed a stable increase in CNSA during 2005-2015. blaOXA-24-like, ISAba1-blaOXA-51-like, and ISAba1-blaOXA-23 were the major determinants of Acinetobacter carbapenem resistance. MBL-carrying plasmids contribute not only to the carbapenem resistance but also to A. baumannii virulence.
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Affiliation(s)
- Pek Kee Chen
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veteran General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Ying Liu
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tran Thi Dieu Thuy
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kieu Anh
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiunn-Jong Wu
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan
| | - Chun-Hsing Liao
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yu-Tsung Huang
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Health Innovation Center, National Yang Ming Chiao Tung University, Taiwan; Microbiota Research Center, National Yang Ming Chiao Tung University, Taiwan.
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Hussein HR, Chang CY, Zheng Y, Yang CY, Li LH, Lee YT, Chen JY, Liang YC, Lin CJ, Chang YC, Geo HN, Noor SM, Kiew LV, Chen FR, Chang CC. Immune-stealth VP28-conjugated heparin nanoparticles for enhanced and reversible anticoagulation. Nanotechnology 2024; 35:175102. [PMID: 38262054 DOI: 10.1088/1361-6528/ad21a2] [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: 11/16/2023] [Accepted: 01/23/2024] [Indexed: 01/25/2024]
Abstract
Heparins are a family of sulfated linear negatively charged polysaccharides that have been widely used for their anticoagulant, antithrombotic, antitumor, anti-inflammatory, and antiviral properties. Additionally, it has been used for acute cerebral infarction relief as well as other pharmacological actions. However, heparin's self-aggregated macrocomplex may reduce blood circulation time and induce life-threatening thrombocytopenia (HIT) complicating the use of heparins. Nonetheless, the conjugation of heparin to immuno-stealth biomolecules may overcome these obstacles. An immunostealth recombinant viral capsid protein (VP28) was expressed and conjugated with heparin to form a novel nanoparticle (VP28-heparin). VP28-heparin was characterized and tested to determine its immunogenicity, anticoagulation properties, effects on total platelet count, and risk of inducing HIT in animal models. The synthesized VP28-heparin trimeric nanoparticle was non-immunogenic, possessed an average hydrodynamic size (8.81 ± 0.58 nm) optimal for the evasion renal filtration and reticuloendothelial system uptake (hence prolonging circulating half-life). Additionally, VP28-heparin did not induce mouse death or reduce blood platelet count when administered at a high dosein vivo(hence reducing HIT risks). The VP28-heparin nanoparticle also exhibited superior anticoagulation properties (2.2× higher prothrombin time) and comparable activated partial thromboplastin time, but longer anticoagulation period when compared to unfractionated heparin. The anticoagulative effects of the VP28-heparin can also be reversed using protamine sulfate. Thus, VP28-heparin may be an effective and safe heparin derivative for therapeutic use.
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Affiliation(s)
- Hussein Reda Hussein
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, 30068 Hsinchu, Taiwan
- Department of Botany and Microbiology, Faculty of Science, Al-Azhar University, Assiut branch 71524, Egypt
| | - Chia-Yu Chang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, 30068 Hsinchu, Taiwan
| | - Yini Zheng
- Department of Materials Science and Engineering, City University of Hong Kong, Hong Kong
| | - Chih-Yu Yang
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Li-Hua Li
- Department of Pathology and laboratory medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Jun-Yi Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yu-Chaun Liang
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei 11529, Taiwan
| | - Chuan-Ju Lin
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei 11529, Taiwan
| | - Yu-Chia Chang
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei 11529, Taiwan
| | - Hui Nee Geo
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Suzita Mohd Noor
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Lik Voon Kiew
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, 30068 Hsinchu, Taiwan
- Department of Pharmacology, Faculty of Medicine, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fu-Rong Chen
- Department of Materials Science and Engineering, City University of Hong Kong, Hong Kong
| | - Chia-Ching Chang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, 30068 Hsinchu, Taiwan
- Department of Electrophysics, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 30068, Taiwan
- International College of Semiconductor Technology, National Yang Ming Chiao Tung University, 30010 Hsinchu, Taiwan
- Institute of Physics, Academia Sinica, Taipei 10529, Taiwan
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Chen CH, Fu YC, Lee YT, Hsieh KS, Shen CF, Cheng CM. Corrigendum: Efficacy of a paper-based interleukin-6 test strip combined with a spectrum-based optical reader for sequential monitoring and early recognition of respiratory failure in elderly pneumonia-a pilot study. Front Pharmacol 2023; 14:1250358. [PMID: 38026925 PMCID: PMC10679929 DOI: 10.3389/fphar.2023.1250358] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fphar.2023.1166923.].
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Affiliation(s)
- Cheng-Han Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics and Structural, Congenital Heart and Echocardiography Center, School of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Chen CH, Fu YC, Lee YT, Hsieh KS, Shen CF, Cheng CM. Efficacy of a paper-based interleukin-6 test strip combined with a spectrum-based optical reader for sequential monitoring and early recognition of respiratory failure in elderly pneumonia-a pilot study. Front Pharmacol 2023; 14:1166923. [PMID: 37214473 PMCID: PMC10196015 DOI: 10.3389/fphar.2023.1166923] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction: Community-acquired pneumonia (CAP) is lethal in elderly individuals who are more vulnerable to respiratory failure and require more emergency ventilation support than younger individuals. Interleukin-6 (IL-6) plays a crucial role and has predictive value in CAP; high serum IL-6 concentrations in adults are associated with high respiratory failure and mortality rates. Early detection of IL-6 concentrations can facilitate the timely stratification of patients at risk of acute respiratory failure. However, conventional enzyme-linked immunosorbent assay (ELISA) IL-6 measurement is laborious and time-consuming. Methods: The IL-6 rapid diagnostic system combined with a lateral flow immunoassay-based (LFA-based) IL-6 test strip and a spectrum-based optical reader is a novel tool developed for rapid and sequential bedside measurements of serum IL-6 concentrations. Here, we evaluated the correlation between the IL-6 rapid diagnostic system and the ELISA and the efficacy of the system in stratifying high-risk elderly patients with CAP. Thirty-six elderly patients (median age: 86.5 years; range: 65-97 years) with CAP were enrolled. CAP diagnosis was established based on the Infectious Diseases Society of America (IDSA) criteria. The severity of pneumonia was assessed using the CURB-65 score and Pneumonia Severity Index (PSI). IL-6 concentration was measured twice within 24 h of admission. Results: The primary endpoint variable was respiratory failure requiring invasive mechanical or non-invasive ventilation support after admission. IL-6 rapid diagnostic readouts correlated with ELISA results (p < 0.0001) for 30 samples. Patients were predominantly male and bedridden (69.4%). Ten patients (27.7%) experienced respiratory failure during admission, and five (13.9%) died of pneumonia. Respiratory failure was associated with a higher mortality rate (p = 0.015). Decreased serum IL-6 concentration within 24 h after admission indicated a lower risk of developing respiratory failure in the later admission course (Receiver Operating Characteristic [ROC] curve = 0.696). Conclusion: Sequential IL-6 measurements with the IL-6 rapid diagnostic system might be useful in early clinical risk assessment and severity stratification of elderly patients with pneumonia. This system is a potential point-of-care diagnostic device for sequential serum IL-6 measurements that can be applied in variable healthcare systems.
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Affiliation(s)
- Cheng-Han Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics and Structural, Congenital Heart and Echocardiography Center, School of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Chiang TT, Huang TW, Sun JR, Kuo SC, Cheng A, Liu CP, Liu YM, Yang YS, Chen TL, Lee YT, Wang YC. Biofilm formation is not an independent risk factor for mortality in patients with Acinetobacter baumannii bacteremia. Front Cell Infect Microbiol 2022; 12:964539. [PMID: 36189355 PMCID: PMC9523115 DOI: 10.3389/fcimb.2022.964539] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 12/01/2022] Open
Abstract
In the past decades, due to the high prevalence of the antibiotic-resistant isolates of Acinetobacter baumannii, it has emerged as one of the most troublesome pathogens threatening the global healthcare system. Furthermore, this pathogen has the ability to form biofilms, which is another effective mechanism by which it survives in the presence of antibiotics. However, the clinical impact of biofilm-forming A. baumannii isolates on patients with bacteremia is largely unknown. This retrospective study was conducted at five medical centers in Taiwan over a 9-year period. A total of 252 and 459 patients with bacteremia caused by biofilm- and non-biofilm-forming isolates of A. baumannii, respectively, were enrolled. The clinical demographics, antimicrobial susceptibility, biofilm-forming ability, and patient clinical outcomes were analyzed. The biofilm-forming ability of the isolates was assessed using a microtiter plate assay. Multivariate analysis revealed the higher APACHE II score, shock status, lack of appropriate antimicrobial therapy, and carbapenem resistance of the infected strain were independent risk factors of 28-day mortality in the patients with A. baumannii bacteremia. However, there was no significant difference between the 28-day survival and non-survival groups, in terms of the biofilm forming ability. Compared to the patients infected with non-biofilm-forming isolates, those infected with biofilm-forming isolates had a lower in-hospital mortality rate. Patients with either congestive heart failure, underlying hematological malignancy, or chemotherapy recipients were more likely to become infected with the biofilm-forming isolates. Multivariate analysis showed congestive heart failure was an independent risk factor of infection with biofilm-forming isolates, while those with arterial lines tended to be infected with non-biofilm-forming isolates. There were no significant differences in the sources of infection between the biofilm-forming and non-biofilm-forming isolate groups. Carbapenem susceptibility was also similar between these groups. In conclusion, the patients infected with the biofilm-forming isolates of the A. baumannii exhibited different clinical features than those infected with non-biofilm-forming isolates. The biofilm-forming ability of A. baumannii may also influence the antibiotic susceptibility of its isolates. However, it was not an independent risk factor for a 28-day mortality in the patients with bacteremia.
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Affiliation(s)
- Tsung-Ta Chiang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Tzu-Wen Huang
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jun-Ren Sun
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yuag-Meng Liu
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- *Correspondence: Yung-Chih Wang, ; Yi-Tzu Lee,
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Yung-Chih Wang, ; Yi-Tzu Lee,
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Wang YC, Lee YT, Matsuura K, Liu X, Cheng CM. Editorial: Detection Nanodevices for Infectious Diseases. Front Bioeng Biotechnol 2022; 10:962746. [PMID: 35845421 PMCID: PMC9277473 DOI: 10.3389/fbioe.2022.962746] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Koji Matsuura
- Department of Biomedical Engineering, Faculty of Engineering, Okayama University of Science, Okayama, Japan
| | - Xinyu Liu
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
- *Correspondence: Chao-Min Cheng,
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Thuy TTD, Lu HF, Kuo PY, Lin WH, Lin TP, Lee YT, Duong TTT, Wang MC, Lee YH, Wen LL, Chen YC, Kao CY. Whole-genome-sequence-based characterization of an NDM-5-producing uropathogenic Escherichia coli EC1390. BMC Microbiol 2022; 22:150. [PMID: 35668362 PMCID: PMC9172118 DOI: 10.1186/s12866-022-02562-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Urinary tract infection (UTI) is one of the most common outpatient bacterial infections. In this study, we isolated and characterized an extensively-drug resistant (XDR) NDM-5-producing Escherichia coli EC1390 from a UTI patient by using whole-genome sequencing (WGS) in combination with phenotypic assays. Methods Antimicrobial susceptibility to 23 drugs was determined by disk diffusion method. The genome sequence of EC1390 was determined by Nanopore MinION MK1C platform. Conjugation assays were performed to test the transferability of EC1390 plasmids to E. coli recipient C600. Phenotypic assays, including growth curve, biofilm formation, iron acquisition ability, and cell adhesion, were performed to characterize the function of EC1390 plasmids. Results Our results showed that EC1390 was only susceptible to tigecycline and colistin, and thus was classified as XDR E. coli. A de novo genome assembly was generated using Nanopore 73,050 reads with an N50 value of 20,936 bp and an N90 value of 7,624 bp. WGS analysis showed that EC1390 belonged to the O101-H10 serotype and phylogenetic group A E. coli. Moreover, EC1390 contained 2 conjugative plasmids with a replicon IncFIA (pEC1390-1 with 156,286 bp) and IncFII (pEC1390-2 with 71,840 bp), respectively. No significant difference was observed in the bacterial growth rate in LB broth and iron acquisition ability between C600, C600 containing pEC1390-1, C600 containing pEC1390-2, and C600 containing pEC1390-1 and pEC1390-2. However, the bacterial growth rate in nutrition-limited M9 broth was increased in C600 containing pEC1390-2, and the cell adhesion ability was increased in C600 containing both pEC1390-1 and pEC1390-2. Moreover, these plasmids modulated the biofilm formation under different conditions. Conclusions In summary, we characterized the genome of XDR-E. coli EC1390 and identified two plasmids contributing to the antimicrobial resistance, growth of bacteria in a nutrition-limited medium, biofilm formation, and cell adhesion. Supplementary Information The online version contains supplementary material available at 10.1186/s12866-022-02562-6.
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Affiliation(s)
- Tran Thi Dieu Thuy
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Hsu-Feng Lu
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung City, Taiwan
| | - Pei-Yun Kuo
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Ping Lin
- Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tran Thi Thuy Duong
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Ming-Cheng Wang
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Hong Lee
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan
| | - Li-Li Wen
- Department of Clinical Laboratory, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yu-Chen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan.
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Lee CC, Lee YT, Wang CH, Chiu IM, Tsai W, Lin YR, Li CH, Hsu CW, Lai PF, Chen JH, Tsai JCH, Tsai SH, How CK. Guidelines for COVID-19 Laboratory Testing for Emergency Departments From the New Diagnostic Technology Team of the Taiwan Society of Emergency Medicine. J Acute Med 2022; 12:45-52. [PMID: 35860709 PMCID: PMC9283118 DOI: 10.6705/j.jacme.202206_12(2).0001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 tests have different turnaround times (TATs), accuracy levels, and limitations, which emergency physicians should be aware of. Nucleic acid amplification tests (NAATs) can be divided into standard high throughput tests and rapid molecular diagnostic tests at the point of care (POC). The standard NAAT has the advantages of high throughput and high accuracy with a TAT of 3-4 hours. The POC molecular test has the same advantages of high accuracy as standard high throughput PCR, but can be done in 13-45 minutes. Roche cobas Liat is the most commonly used machine in Taiwan, displaying 99%-100% sensitivity and 100% specificity, respectively. Abbott ID NOW is an isothermal PCR-based POC machine with a sensitivity of 79% and a specificity of 100%. A high rate of false positives and false negatives is associated with rapid antigen testing. Antibody testing is mostly used as part of public health surveys and for testing for immunity.
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Affiliation(s)
- Chien-Chang Lee
- National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan
| | - Yi-Tzu Lee
- Taipei Veterans General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Chih-Hung Wang
- National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan
| | - I-Min Chiu
- Kaohsiung Chang Gung Memorial Hospital Department of Emergency Medicine Chang Gung University College of Medicine, Kaohsiung Taiwan
| | - Weide Tsai
- Mackay Memorial Hospital Department of Emergency Medicine Taipei Taiwan
| | - Yan-Ren Lin
- Changhua Christian Hospital Department of Emergency and Critical Care Medicine Changhua Taiwan
| | - Chih-Huang Li
- Chang-Gung Memorial Hospital Department of Emergency Medicine Linkou Medical Center, Taoyuan Taiwan
| | - Chin Wang Hsu
- School of Medicine Department of Emergency Linkou Medical Center, Taoyuan Taiwan
| | - Pei-Fang Lai
- Buddhist Tzu Chi General Hospital Department of Emergency Medicine Hualien Taiwan
| | - Jiann-Hwa Chen
- Cathay General Hospital Department of Emergency Medicine Taipei Taiwan
| | - Jeffrey Che-Hung Tsai
- Taichung Veterans General Hospital Department of Emergency Medicine Puli Branch, Nantou Taiwan
| | - Shih-Hung Tsai
- Tri-Service General Hospital Department of Emergency Medicine National Defense Medical Center, Taipei Taiwan
| | - Chorng-Kuang How
- Kinmen Hospital Department of Emergency Medicine Ministry of Health and Welfare, Kinmen Taiwan
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Yu WS, Chang MH, Lee HL, Lee YT, Tsai MC, Wang CC. Recurrent umbilical varix rupture with hemoperitoneum: a case report and review of literature. BMC Gastroenterol 2022; 22:160. [PMID: 35365084 PMCID: PMC8973573 DOI: 10.1186/s12876-022-02167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-traumatic hemoperitoneum was a rare event with the risk of sudden death. Spontaneous rupture of hepatocellular carcinoma is the most intuitive diagnosis when hemoperitoneum occurs in cirrhotic patients who are not regularly followed up. However, other etiologies of hemoperitoneum, such as intra-abdominal varix rupture, should be kept in mind.
Case presentation A 44-year-old man with alcoholic liver cirrhosis, Child–Pugh B was sent to our emergency department (ED) because of recurrent abdominal pain and hypovolemic shock. He had similar symptoms one month ago and was diagnosed as hepatocellular carcinoma (HCC) rupture with hemoperitoneum, therefore he underwent trans-arterial embolization (TAE). However, the follow-up magnetic resonance imaging (MRI) showed less possibility of hepatocellular carcinoma. Contrast enhanced abdominal computed tomography (CT) showed possible umbilical vein contrast agent extravasation. Exploratory laparotomy confirmed the diagnosis of rupture umbilical varix with hemoperitoneum. Conclusion Although umbilical varix rupture is a rare cause of hemoperitoneum, it should be kept in mind in cirrhotic patients with unexplained hemoperitoneum. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02167-3.
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Affiliation(s)
- W S Yu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - M H Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - H L Lee
- Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Y T Lee
- Infection Control, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - M C Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C C Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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10
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Wong D, Lee YT, Tang GPY, Chan SSC. Surgical treatment of pelvic organ prolapse in women aged ≥75 years in Hong Kong: a multicentre retrospective study. Hong Kong Med J 2022; 28:107-115. [PMID: 35354666 DOI: 10.12809/hkmj219271] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is common among older women. With the increasing lifespan and emphasis on quality of life worldwide, older women increasingly prefer surgical treatment for POP. We reviewed the surgical treatment of POP in older women to characterise its safety, effectiveness, and the type most often selected. METHODS This multicentre, retrospective study was conducted at four hospitals between 2013 and 2018. Included patients were aged ≥75 years and had undergone POP surgery. We compared patient demographic characteristics, POP severity, and surgical outcomes between reconstructive and obliterative surgeries; these comparisons were also made among vaginal hysterectomy plus pelvic floor repair (VHPFR), transvaginal mesh surgery (TVM), vaginal hysterectomy (VH) plus colpocleisis, and colpocleisis alone. RESULTS In total, 343 patients were included; 84.3% and 15.7% underwent reconstructive and obliterative surgeries, respectively. Overall, 246 (71.7%), 43 (12.5%), 20 (5.8%), and 34 (9.9%) patients underwent VHPFR, TVM, VH plus colpocleisis, and colpocleisis alone, respectively. Patients who were older (81.9 vs 79.6 y; P=0.001), had vault prolapse (38.9% vs 3.5%; P<0.001), and had medical co-morbidities (37% vs 4.8%; P<0.001) chose obliterative surgery more frequently than reconstructive surgery. Obliterative surgeries had shorter operative time (73.5 min vs 107 min; P<0.001) and fewer surgical complications (9.3% vs 28.0%; P=0.003). Vaginal hysterectomy plus pelvic floor repair had the highest rate of surgical complications (most were minor), while colpocleisis alone had the lowest rate (30.1% vs 8.8%; P=0.01). CONCLUSIONS Pelvic organ prolapse surgeries were safe and effective for older women. Colpocleisis may be appropriate as primary surgery for fragile older women.
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Affiliation(s)
- D Wong
- Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Y T Lee
- Department of Obstetrics and Gynaecology, Prince of Margaret Hospital, Hong Kong
| | - G P Y Tang
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong
| | - S S C Chan
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong
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11
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Wang YC, Lin SW, Wang IJ, Yang CY, Hong C, Sun JR, Feng PH, Lee MH, Shen CF, Lee YT, Cheng CM. Interleukin-6 Test Strip Combined With a Spectrum-Based Optical Reader for Early Recognition of COVID-19 Patients With Risk of Respiratory Failure. Front Bioeng Biotechnol 2022; 10:796996. [PMID: 35242747 PMCID: PMC8886233 DOI: 10.3389/fbioe.2022.796996] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic has had a globally devastating impact. This highly contagious virus has significantly overburdened and undermined medical systems. While most infected patients experience only mild symptoms, those who are severely affect require urgent medical interventions and some develop acute respiratory failure and require mechanical ventilation. The broad and potentially deadly impact of infection underscores the critical need for early recognition, especially for those at risk for respiratory failure. Those who are severely impacted and at high risk for respiratory failure have been found to present high levels of serum cytokines, such as interleukin-6 (IL-6). Timely diagnosis and management of those at risk for respiratory failure is crucial. Measurement of IL-6 may provide a means for distinguishing such patients. Currently, most serum IL-6 detection relies on the use of laboratory-based conventional enzyme-linked immunosorbent assays. Although some rapid assays have been developed recently, they need to be conducted by specific technicians in central laboratory settings with advanced and expensive equipment. In this study, we propose an IL-6 test strip combined with a spectrum-based optical reader for early recognition of COVID-19-infected patients at imminent risk of acute respiratory failure requiring mechanical ventilator support. For our analyses, clinical demographic data and sera samples were obtained from three medical centers, and test strip specificity and detection performance were analyzed. This would help healthcare personnel stratify the risk of respiratory failure and provide prompt, and suitable management.
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Affiliation(s)
- Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sheng-Wen Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - I-Jen Wang
- Department of Pediatrics, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - Jun-Ren Sun
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Po-Hao Feng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan
| | - Mei-Hui Lee
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Infectious Diseases, Department of Internal Medicine, Shuang Ho Hospital, Taipei, Taiwan
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Tzu Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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12
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Chen CH, Tsao YT, Yeh PT, Liao YH, Lee YT, Liao WT, Wang YC, Shen CF, Cheng CM. Detection of Microorganisms in Body Fluids via MTT-PMS Assay. Diagnostics (Basel) 2021; 12:46. [PMID: 35054213 PMCID: PMC8774610 DOI: 10.3390/diagnostics12010046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/29/2022] Open
Abstract
Early detection of microorganisms is essential for the management of infectious diseases. However, this is challenging, as traditional culture methods are labor-intensive and time-consuming. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide-phenazine methosulfate (MTT-PMS) assay has been used to evaluate the metabolic activity in live cells and can thus be used for detecting living microorganisms. With the addition of NaOH and Tris-EDTA, the same approach can be accelerated (within 15 min) and used for the quick detection of common bacterial pathogens. The assay results can be evaluated colorimetrically or semi-quantitatively. Here, the quick detection by MTT-PMS assay was further investigated. The assay had a detection limit of approximately 104 CFU/mL. In clinical evaluations, we used the MTT-PMS assay to detect clinical samples and bacteriuria (>105 CFU/mL). The negative predictive value of the MTT-PMS assay for determining bacteriuria was 79.59% but was 100% when the interference of abnormal blood was excluded. Thus, the MTT-PMS assay might be a potential "rule-out" tool for bacterial detection in clinical samples, at a cost of approximately USD 1 per test. Owing to its low cost, rapid results, and easy-to-use characteristics, the MTT-PMS assay may be a potential tool for microorganism detection.
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Affiliation(s)
- Cheng-Han Chen
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (C.-H.C.); (Y.-T.T.); (Y.-H.L.); (W.-T.L.)
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yu-Ting Tsao
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (C.-H.C.); (Y.-T.T.); (Y.-H.L.); (W.-T.L.)
| | - Po-Ting Yeh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 10002, Taiwan;
| | - Yu-Hsiang Liao
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (C.-H.C.); (Y.-T.T.); (Y.-H.L.); (W.-T.L.)
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Wan-Ting Liao
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (C.-H.C.); (Y.-T.T.); (Y.-H.L.); (W.-T.L.)
| | - Yung-Chih Wang
- National Defense Medical Center, Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, Taipei 11490, Taiwan;
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan; (C.-H.C.); (Y.-T.T.); (Y.-H.L.); (W.-T.L.)
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13
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Huang SW, Yeh FC, Ji YR, Su YF, Su YS, Chiang MH, Tzeng SC, Fu CY, Cheng A, Wang YC, Lee YT. Correction to: Chitosan‑based hydrogels to treat hydrofluoric acid burns and prevent infection. Drug Deliv Transl Res 2021; 12:732. [PMID: 34893968 DOI: 10.1007/s13346-021-01098-y] [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: 11/30/2022]
Affiliation(s)
- Shu-Wei Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, 11217, Taipei, Taiwan
| | - Fang-Ching Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, 40466, Taiwan
| | - You-Ren Ji
- Department of Biomedical Engineering, National Taiwan University, Taipei, 10023, Taiwan
| | - Ying-Fu Su
- Department of Emergency, Kuang Tien General Hospital, Taichung, 43303, Taiwan
| | - Ying-Shih Su
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, 11608, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 10031, Taiwan
| | - Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Shian-Chiuan Tzeng
- Department of Biomedical Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Chien-Yao Fu
- Division of Orthopedics, Taichung Armed Forces General Hospital, Taichung, 40466, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, 11217, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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14
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Yang YS, Jeng WY, Lee YT, Hsu CJ, Chou YC, Kuo SC, Chen CC, Hsu WJ, The Action Study Group, Chen HY, Sun JR. Ser253Leu substitution in PmrB contributes to colistin resistance in clinical Acinetobacter nosocomialis. Emerg Microbes Infect 2021; 10:1873-1880. [PMID: 34468294 PMCID: PMC8451652 DOI: 10.1080/22221751.2021.1976080] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Infections caused by extensively drug-resistant (XDR) Acinetobacter nosocomialis have become a challenging problem. The frequent use of colistin as the last resort drug for XDR bacteria has led to the emergence of colistin-resistant A. nosocomialis (ColRAN) in hospitals. The mechanism of colistin resistance in A. nosocomialis remains unclear. This study aimed to investigate the mechanisms underlying colistin resistance in clinical ColRAN isolates. We collected 36 A. nosocomialis isolates from clinical blood cultures, including 24 ColRAN and 12 colistin-susceptible A. nosocomialis (ColSAN). The 24 ColRAN isolates clustered with ST1272 (13), ST433 (eight), ST1275 (two), and ST410 (one) by multilocus sequence typing. There was a positive relationship between pmrCAB operon expression and colistin resistance. Further analysis showed that colistin resistance was related to an amino acid substitution, Ser253Leu in PmrB. By introducing a series of recombinant PmrB constructs into a PmrB knockout strain and protein structural model analyses, we demonstrated that the association between Ser253Leu and Leu244 in PmrB was coupled with colistin resistance in ColRAN. To the best of our knowledge, this is the first study demonstrating that the key amino acid Ser253Leu in PmrB is associated with overexpression of the pmrCAB operon and hence colistin resistance. This study provides insight into the mechanism of colistin resistance in A. nosocomialis.
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Affiliation(s)
- Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Yih Jeng
- University Center for Bioscience and Biotechnology, National Cheng Kung University, Tainan, Taiwan.,Department of Biochemistry and Molecular Biology, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Tzu Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Ju Hsu
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Cheng-Cheung Chen
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defence Medical Centre, Taipei, Taiwan
| | - Wei-Jane Hsu
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | | | - Hsing-Yu Chen
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - Jun-Ren Sun
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
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15
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Feng JY, Lee YT, Pan SW, Yang KY, Chen YM, Yen DHT, Li SY, Wang FD. Comparison of colistin-induced nephrotoxicity between two different formulations of colistin in critically ill patients: a retrospective cohort study. Antimicrob Resist Infect Control 2021; 10:111. [PMID: 34330333 PMCID: PMC8323087 DOI: 10.1186/s13756-021-00977-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported. Methods In this retrospective cohort study, we enrolled intensive care unit–admitted patients if they had culture isolates of CR-GNB and underwent intravenous treatment with colistin. The occurrence of acute kidney injury (AKI) during intravenous treatment with colistin was recorded. The occurrence of colistin-induced nephrotoxicity was compared between two formulations of colistin, Locolin®, and Colimycin®. Treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated. Results Among 195 patients, 95 who were treated with Locolin® and 100 who were treated with Colimycin® were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p = 0.040) and stage 3 (29.5% vs. 13%, p = 0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.10–4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00–6.33) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.37, 95% CI 0.18–0.77). The mortality rate was comparable between patients with and without colistin-induced nephrotoxicity. Conclusions The risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality rate. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00977-w.
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Affiliation(s)
- Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yi-Tzu Lee
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Kuang-Yao Yang
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan
| | - David Hung-Tsang Yen
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, Taiwan
| | - Fu-Der Wang
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, Taiwan. .,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Taipei, 11217, Taiwan.
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16
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Li LH, Yang YS, Sun JR, Huang TW, Huang WC, Chen FJ, Wang YC, Kuo TH, Kuo SC, Chen TL, Lee YT. Clinical and molecular characterization of Acinetobacter seifertii in Taiwan. J Antimicrob Chemother 2021; 76:312-321. [PMID: 33128052 DOI: 10.1093/jac/dkaa432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Acinetobacter seifertii, a new member of the Acinetobacter baumannii group, has emerged as a cause of severe infections in humans. We investigated the clinical and molecular characteristics of A. seifertii. PATIENTS AND METHODS This retrospective study enrolled 80 adults with A. seifertii bloodstream infection (BSI) at four medical centres over an 8 year period. Species identification was confirmed by MALDI-TOF MS, rpoB sequencing and WGS. Molecular typing was performed by MLST. Clinical information, antimicrobial susceptibility and the mechanisms of carbapenem and colistin resistance were analysed. Transmissibility of the carbapenem-resistance determinants was examined by conjugation experiments. RESULTS The main source of A. seifertii BSI was the respiratory tract (46.3%). The 28 day and in-hospital mortality rates of A. seifertii BSI were 18.8% and 30.0%, respectively. High APACHE II scores and immunosuppressant therapy were independent risk factors for 28 day mortality. The most common MLST type was ST553 (58.8%). Most A. seifertii isolates were susceptible to levofloxacin (86.2%), and only 37.5% were susceptible to colistin. Carbapenem resistance was observed in 16.3% of isolates, mostly caused by the plasmid-borne ISAba1-blaOXA-51-like genetic structure. A. seifertii could transfer various carbapenem-resistance determinants to A. baumannii, Acinetobacter nosocomialis and other A. seifertii isolates. Variations of pmrCAB and lpxCAD genes were not associated with colistin resistance of A. seifertii. CONCLUSIONS Levofloxacin and carbapenems, but not colistin, have the potential to be the drug of choice for A. seifertii infections. A. seifertii can transfer carbapenem-resistance determinants to other species of the A. baumannii group and warrants close monitoring.
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Affiliation(s)
- Li-Hua Li
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,PhD Program of Medical Biotechnology, Taipei Medical University, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jun-Ren Sun
- Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defence Medical Centre, Taipei, Taiwan.,Institute of Preventive Medicine, National Defence Medical Centre, Taipei, Taiwan
| | - Tzu-Wen Huang
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Cheng Huang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Feng-Jui Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ting-Hao Kuo
- Department of Chemistry, National Taiwan University, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Te-Li Chen
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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17
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Wang YC, Huang SW, Chiang MH, Lee IM, Kuo SC, Yang YS, Chiu CH, Su YS, Chen TL, Wang FD, Lee YT. In vitro and in vivo activities of imipenem combined with BLI-489 against class D β-lactamase-producing Acinetobacter baumannii. J Antimicrob Chemother 2021; 76:451-459. [PMID: 33057603 DOI: 10.1093/jac/dkaa421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND According to our preliminary study, BLI-489 has the potential to inhibit the hydrolysing activity of OXA-51-like β-lactamase produced by carbapenem-resistant Acinetobacter baumannii (CRAb). OBJECTIVES In the present study, the in vitro and in vivo activities of imipenem combined with BLI-489 against CRAb producing carbapenem-hydrolysing class D β-lactamases (CHDLs), namely OXA-23, OXA-24, OXA-51 and OXA-58, were determined. METHODS A chequerboard analysis of imipenem and BLI-489 was performed using 57 and 7 clinical CRAb isolates producing different CHDLs and MBLs, respectively. Four representative strains harbouring different CHDL genes were subjected to a time-kill assay to evaluate the synergistic effects. An in silico docking analysis was conducted to simulate the interactions between BLI-489 and the different families of CHDLs. The in vivo activities of this combination were assessed using a Caenorhabditis elegans survival assay and a mouse pneumonia model. RESULTS Chequerboard analysis showed that imipenem and BLI-489 had a synergistic effect on 14.3, 92.9, 100, 16.7 and 100% of MBL-, OXA-23-, OXA-24-like-, OXA-51-like- and OXA-58-producing CRAb isolates, respectively. In the time-kill assay, imipenem and BLI-489 showed synergy against OXA-24-like-, OXA-51-like- and OXA-58-, but not OXA-23-producing CRAb isolates after 24 h. The in silico docking analysis showed that BLI-489 could bind to the active sites of OXA-24 and OXA-58 to confer strong inhibition activity. The combination of imipenem and BLI-489 exhibited synergistic effects for the rescue of CRAb-infected C. elegans and mice. CONCLUSIONS Imipenem combined with BLI-489 has synergistic effects against CHDL-producing CRAb isolates.
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Affiliation(s)
- Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - I-Ming Lee
- Institute of Biological Chemistry, Academia Sinica, Taipei 115, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ying-Shih Su
- Institute of Pharmacology and Toxicology, Tzu Chi University, Hualien, Taiwan
| | - Te-Li Chen
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Der Wang
- Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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18
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Huang SW, Yeh FC, Ji YR, Su YF, Su YS, Chiang MH, Tzeng SC, Fu CY, Cheng A, Wang YC, Lee YT. Chitosan-based hydrogels to treat hydrofluoric acid burns and prevent infection. Drug Deliv Transl Res 2021; 11:1532-1544. [PMID: 34125402 DOI: 10.1007/s13346-021-01007-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
There is an urgent need for treatments for hydrofluoric acid (HF) burns and their derivative problems that prevent hydrogen ion dissociation and fluoride ion binding to tissues. This study evaluated the ability of chitosan-based hydrogels combined with a buffer solution containing either boric acid or Tris and calcium gluconate (CHS-BA-CG and CHS-Tris-CG) to repair HF burn wounds and prevent wound infections. We assessed calcium release rates and biocompatability and constructed a mouse HF burn model to assess the tissue repair effects of the hydrogels. Finally, we performed disc diffusion tests from burn tissue and quantified the bacterial counts to assess the anti-infection properties of the hydrogels. Calcium was gradually released in the CHS-BA-CG and CHS-Tris-CG groups (73% and 43%, respectively, after 48 h). The cell viabilities at 48 h after HF burn in these groups were significantly higher than those in the phosphate-buffered saline (PBS) and CG-treated groups. Histopathological evaluation showed a clear boundary between the epidermal and dermal layers in both CHS-BA-CG and CHS-Tris-CG-treated groups, indicating their effectiveness in tissue repair. In the disc diffusion test, CHS-BA-CG and CHS-Tris-CG exhibited larger inhibition zones against Acinetobacter baumannii than those for PBS and CG. The bacterial counts on HF burn wounds were significantly lower in the CHS-BA-CG and CHS-Tris-CG-treated groups than those in the PBS and CG-treated groups. The in vitro studies demonstrated the biocompatibility and antimicrobial effects of the CHS-BA-CG and CHS-Tris-CG hydrogels. Both gels also demonstrated tissue repair and anti-infection effects. Thus, chitosan-based hydrogels may be candidates for HF burn therapy.
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Affiliation(s)
- Shu-Wei Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, 11217, Taipei, Taiwan
| | - Fang-Ching Yeh
- Division of Infectious Diseases, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, 40466, Taiwan
| | - You-Ren Ji
- Department of Biomedical Engineering, National Taiwan University, Taipei, 10023, Taiwan
| | - Ying-Fu Su
- Department of Emergency, Kuang Tien General Hospital, Taichung, 43303, Taiwan
| | - Ying-Shih Su
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, 11608, Taiwan.,Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 10031, Taiwan
| | - Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, 11490, Taiwan
| | - Shian-Chiuan Tzeng
- Department of Biomedical Engineering, National Taiwan University, Taipei, 10617, Taiwan
| | - Chien-Yao Fu
- Division of Orthopedics, Taichung Armed Forces General Hospital, Taichung, 40466, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Chi Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, 11217, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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19
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Lee YT, Sun JR, Wang YC, Chiu CH, Kuo SC, Chen TL, Yang YS. Corrigendum to "Multicentre study of risk factors for mortality in patients with Acinetobacter bacteraemia receiving colistin treatment'' [International Journal of Antimicrobial Agents 55 (2020) 105956]. Int J Antimicrob Agents 2021; 57:106333. [PMID: 33858734 DOI: 10.1016/j.ijantimicag.2021.106333] [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: 11/18/2022]
Affiliation(s)
- Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jun-Ren Sun
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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20
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Lee YT, Huang TW, Liu IF, Kuo SC, Yang YS, Lin PY, Liu CP, Liu YM, Chen TL, Wang FD, Wang YC. The prediction values of carbapenemase detection methods and carbapenem susceptibility testing for clinical outcomes of patients with Acinetobacter bacteremia under carbapenem treatment. J Microbiol Immunol Infect 2021; 55:257-265. [PMID: 33875365 DOI: 10.1016/j.jmii.2021.03.013] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/27/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Carbapenem-resistant Acinetobacter species have emerged as notorious pathogens causing nosocomial infections. Several phenotypic methods have been developed for detecting carbapenemase production in Enterobacteriaceae. The accuracy of these methods in the prediction of carbapenemase production in Acinetobacter species has not been studied well. METHODS This retrospective study enrolled adult patients with Acinetobacter bacteremia from four medical centers in Taiwan between 2012 and 2016. Their demographics and clinical outcomes were recorded. The carbapenem susceptibility of the Acinetobacter species was determined using the agar diffusion method. The carbapenemase genes were detected by PCR. Four phenotypic methods, including the modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test, and CarbAcineto NP test were carried out to determine the production of carbapenemase. RESULTS We analyzed 257 adults who received initial carbapenem monotherapy for the treatment of Acinetobacter bacteremia. Shock within three days of bacteremia and acquisition of carbapenem non-susceptible isolates were independently associated with a higher 14-day and 30-day mortality in patients with Acinetobacter bacteremia. Among the four phenotypic tests for carbapenemase detection, MHT using the imipenem disc displayed the greatest sensitivity (94%; 95% confidence interval [CI], 89-97%) and specificity (81%; 95% CI, 73-88%) for predicting imipenem non-susceptibility. CONCLUSION Carbapenem non-susceptibility and shock were independent risk factors for mortality in patients with Acinetobacter bacteremia. The MHT could predict the carbapenem susceptibility of Acinetobacter isolates. It is a cheap and quick assay, which could be applied in clinical practice.
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Affiliation(s)
- Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Wen Huang
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Fan Liu
- Division of Cardiology, Department of Medicine, Cheng Hsin General Hospital, Taipei City, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Ying Lin
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yuag-Meng Liu
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Der Wang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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21
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Dutta P, Lu YJ, Hsieh HY, Lee TY, Lee YT, Cheng CM, Fan YJ. Detection of Candida albicans Using a Manufactured Electrochemical Sensor. Micromachines (Basel) 2021; 12:166. [PMID: 33567542 PMCID: PMC7915424 DOI: 10.3390/mi12020166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/13/2023]
Abstract
Candida albicans is a commensal fungus that is responsible for a lot of nosocomial infections in immunocompromised people. Cell culture is currently the predominant method for diagnosing candidiasis, but it is time consuming. In this study, we developed a rapid screen procedure by devising a method for detecting C. albicans with the use of electrochemical sensors. Through this experiment, we propose a method for the detection of C. albicans in the system through the use of personal glucose meters. The hemicellulase was used to break down the cell wall of C. albicans to glucose and oligo, which can be detected by a glucose meter. The spiked samples were prepared suspending C. albicans in urine and serum, demonstrating the feasibility of the developed method in a real situation.
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Affiliation(s)
- Prakhar Dutta
- International Ph.D. Program for Biomedical Engineering, Graduate Institute of Biomedical Materials & Tissue Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wuxing St., Taipei 11031, Taiwan;
| | - Yi-Jung Lu
- Division of Family and Operative Dentistry, Department of Dentistry, Taipei Medical University Hospital, Taipei 11031, Taiwan;
| | - Han-Yu Hsieh
- Department of Signal Transduction, Research Institute for Microbial Disease, Osaka University, 3-1 Yamada-oka, Suita, Osaka 565-0871, Japan;
| | - Tyng-Yuh Lee
- Institute of Biomedical Engineering, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu 30013, Taiwan; (T.-Y.L.); (C.-M.C.)
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, No. 101, Section 2, Kuang-Fu Road, Hsinchu 30013, Taiwan; (T.-Y.L.); (C.-M.C.)
| | - Yu-Jui Fan
- International Ph.D. Program for Biomedical Engineering, Graduate Institute of Biomedical Materials & Tissue Engineering, School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wuxing St., Taipei 11031, Taiwan;
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22
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Huang SW, Sun MT, Lee WS, Su YS, Lee YT, Chiang MH, Wang YC, Yang YS, Tzeng SC, Huang YM, Lin FH. Cancer as an infectious disease: A different treatment alternative using a combination of tigecycline and pyrvinium pamoate - An example of breast cancer. J Microbiol Immunol Infect 2021; 55:51-59. [PMID: 33610508 DOI: 10.1016/j.jmii.2020.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tigecycline is an antibiotic that well tolerated for treating complicated infections. It has received attention as an anti-cancer agent and expected to solve two major obstacles, sides effects that accompany chemotherapy and drug resistance, in the breast cancer treatment. However, previous studies reported that the levels in the blood are typically low of tigecycline, so higher doses are needed to treat cancer, that may increase the risk of side effects. To achieve better anti-cancer effects for tigecycline, we need to find a novel adjunct agent. METHODS In this study, we used different concentration of pyrvinium pamoate combined with tigecycline to treat cell. And assess the effect of two drugs in inhibit cell proliferation, induce cell autophagy, or increase cell apoptosis to evaluate the consequent of combined therapy. RESULTS We observed that after the combined therapy, the cell cycle arrest at G1/s phase, the level of p21 increased, but decreased the levels of CDK2. Others, two drugs via different mechanisms to inhibit cancer cell proliferation and with selective cytotoxic to different cell lines. That could enhance the effect of breast cancer treatment. CONCLUSION Combining low dose of tigecycline use with pyrvinium pamoate is a novel approach for breast cancer treatment. Appropriate combined therapy in breast cancer is recommended to improve outcomes. Other problems like drug resistance occur in patients or the microbes surrounding breast tissues would confer susceptibility to cancers then influence the effectiveness of treatment, which could be improved through combined therapy.
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Affiliation(s)
- Shu-Wei Huang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan.
| | - Ming-Tsung Sun
- Department of Internal Medicine, Hualien Armed Forces General Hospital, Hualien, 97144, Taiwan.
| | - Wen-Sen Lee
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, 11608, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 10031, Taiwan
| | - Ying-Shih Su
- Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Medical Center, Taipei Medical University, Taipei, 11608, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 10031, Taiwan.
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, 11217, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan.
| | - Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, 11490, Taiwan.
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan.
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, 11490, Taiwan.
| | - Shian-Chiuan Tzeng
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Min Huang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, 23561, Taiwan; Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 10031, Taiwan.
| | - Feng-Huei Lin
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Biomedical Engineering and Nanomedicine, National Health Research Institute, Miaoli, 35053, Taiwan.
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23
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Chiu CH, Lee YT, Lin YC, Kuo SC, Yang YS, Wang YC, Liu YH, Lin JC, Chang FY, Chen TL. Bacterial membrane vesicles from Acinetobacter baumannii induced by ceftazidime are more virulent than those induced by imipenem. Virulence 2021; 11:145-158. [PMID: 32043433 PMCID: PMC7051140 DOI: 10.1080/21505594.2020.1726593] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Patients with Acinetobacter baumannii bacteremia treated with antipseudomonal cephalosporins showed higher 14-day mortality than patients treated with antipseudomonal carbapenems. We hypothesized that the bacterial membrane vesicles (BMVs) induced by antipseudomonal cephalosporins are more virulent than BMVs induced by antipseudomonal carbapenems. To simulate the clinical condition with inadequate antimicrobial treatment, carbapenem-resistant A. baumannii was treated with ceftazidime (an antipseudomonal cephalosporin) or imipenem (an antipseudomonal carbapenem) at 1/2 the minimum inhibitory concentration. BMVs and BMV-carried lipopolysaccharide were measured by nanoparticle tracking analysis and western blotting, respectively. Cytokine expression in RAW264.7 macrophages or mice serum induced by the BMVs was determined by ELISA, fluorescent bead-based immunoassay or western blotting. The virulence of the BMVs was assessed in mice. Liquid chromatography tandem-mass spectrometry was used to determine the protein contents of the BMVs. We found that ceftazidime induced a higher number of BMVs (CAZ-BMV), which carried more LPS, and induced higher expression levels of iNOS, IL-1β, and IL-6 in macrophages, higher expression of many cytokines in mice, more neutrophil infiltration in lung interstitium, and higher mortality in mice than imipenem-induced BMVs (IMP-BMV). When adjusted to same amount of LPS, CAZ-BMV still led to higher mortality than IMP-BMV. Proteomic analysis revealed different protein contents in CAZ-BMV and IMP-BMV. In conclusion, A. baumannii BMVs induced by ceftazidime are more virulent than BMVs induced by imipenem.
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Affiliation(s)
- Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chun Lin
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Graduate Institute of Pathology and Parasitology, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Han Liu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Li Chen
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
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24
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Cheng A, Sun HY, Tsai YT, Lu PL, Lee SSJ, Lee YT, Wang YC, Liu PY, Chien JY, Hsueh PR, Chang SY, Wu UI, Sheng WH, Chen YC, Chang SC. Longitudinal non-cystic fibrosis trends of pulmonary Mycobacterium abscessus disease from 2010 to 2017: spread of the "globally successful clone" in Asia. ERJ Open Res 2021; 7:00191-2020. [PMID: 33532483 PMCID: PMC7836708 DOI: 10.1183/23120541.00191-2020] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/30/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Mycobacterium abscessus (MAB) has emerged as the predominant pulmonary non-tuberculous mycobacterial pathogen in parts of Asia, including Taiwan. The reasons for the significant increase in MAB infections in the non-cystic fibrosis (CF) populations are poorly understood. The study aimed to elucidate whether this increase is related to the spread of the globally successful clone of MAB. METHODS We performed multilocus sequence typing of 371 nonduplicated MAB pulmonary isolates from 371 patients sampled between 2010-2017 at seven hospitals across Taiwan. RESULTS In total, 183 (49.3%) isolates were M. abscessus subsp. abscessus (MAB-a), 187 (50.4%) were M. abscessus subsp. massiliense (MAB-m), and 1 (0.3%) was M. abscessus subsp. bolletii (MAB-b). MAB-a sequence type (ST)1 (23.7%) and ST127 (3.8%), followed by MAB-m ST48 (16.2%), ST117 (15.1%), ST23 (8.6%) were most common overall. Of MAB-a strains, 50 (27.3%) belonged to novel STs and 38 (10.2%) were singleton strains, while of MAB-m strains, only 10 (5.3%) were novel and 8 (2.2%) were singletons. From 2010 to 2017, the frequency of the historically dominant ST1 declined from 28.6% to 22.5%, whereas the recently emerged globally successful clonal cluster 3, ST23 and ST48, increased from 14.3% to 40.0%. CONCLUSIONS The dominance of ST1 particularly in the last 2 years of this study appears to be declining, while ST23, reported in outbreaks among CF and post-surgical cohorts across the Americas and Europe, alongside the closely related ST48, is present among non-CF populations in Taiwan. These trends need to be confirmed with further ongoing studies to track the molecular epidemiology of clinical MAB isolates worldwide.
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Affiliation(s)
- Aristine Cheng
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yun Sun
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Tzu Tsai
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Liang Lu
- Dept of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Dept of Internal Medicine, Dept of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yi-Tzu Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Dept of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Chih Wang
- Dept of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Yu Liu
- Dept of Internal Medicine, Taichung, Veterans General Hospital, Taichung, Taiwan
| | - Jung-Yien Chien
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Ren Hsueh
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Dept of Laboratory Medicine, National Taiwan University Hospital, Taiwan
| | - Shu-Yuan Chang
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Un-In Wu
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wang-Huei Sheng
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yee-Chun Chen
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shan-Chwen Chang
- Dept of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
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25
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Liao PH, Kao CC, How CK, Yang YS, Chen MC, Hung-Tsang Yen D, Lee YT. Initial white blood cell count and revised Baux score predict subsequent bloodstream infection in burn patients: A retrospective analysis of severe burn patients from the Formosa color dust explosion of 2015. J Formos Med Assoc 2020; 120:1719-1728. [PMID: 33342706 DOI: 10.1016/j.jfma.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Infections are the most common complications among hospitalized severe burn patients. However, limited literature reports early effective predictors of bloodstream infections (BSI) among burn patients. This study aimed to identify cost-effective biomarkers and valuable clinical scoring systems in the emergency department (ED) for the prediction of subsequent BSI in mass burn casualties. METHODS In 2015, a flammable cornstarch-based powder explosion resulted in 499 burn casualties in Taiwan. A total of 35 patients were admitted at Taipei Veterans General Hospital. These severe burn patients (median total body surface area [TBSA] 54%) were young and previously healthy. We assessed the potential of various parameters to predict subsequent BSI, including initial laboratory tests performed at the ED, TBSA, and multiple scoring systems. RESULTS Fourteen patients (40.0%) had subsequent BSI. The most common causative pathogen was the Acinetobacter baumannii (Ab) group, mostly carbapenem resistant and associated with a poor outcome. The area under the receiver operating characteristic curve revealed that the revised Baux score, TBSA, and initial white blood cell count had excellent discrimination ability in predicting subsequent BSI (0.898, 0.889, and 0.821, respectively). The rate of subsequent BSI differed significantly at the cut-off points of revised Baux score >76, TBSA >55%, and WBC count >16,200/mm3. CONCLUSION The initial WBC count at the ED, TBSA, and revised Baux score were good and cost-effective biomarkers for predicting subsequent BSI after burn injuries.
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Affiliation(s)
- Po-Hsiang Liao
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chun Kao
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Mei-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lee YT, Chen HY, Yang YS, Chou YC, Chang TY, Hsu WJ, Lin IC, Sun JR. AdeABC Efflux Pump Controlled by AdeRS Two Component System Conferring Resistance to Tigecycline, Omadacycline and Eravacycline in Clinical Carbapenem Resistant Acinetobacter nosocomialis. Front Microbiol 2020; 11:584789. [PMID: 33224122 PMCID: PMC7667285 DOI: 10.3389/fmicb.2020.584789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/06/2020] [Indexed: 02/03/2023] Open
Abstract
Carbapenem-resistant Acinetobacter nosocomialis (CRAn) is a significant public health concern. Tigecycline non-susceptible CRAn (Tn-CRAn) isolates have emerged worldwide. Tigecycline resistance is mainly related to the overexpression of AdeABC efflux pump controlled by AdeRS two-component system (TCS). Two novel tetracycline derivatives, omadacycline and eravacycline, may present a treatment option for CRAn. This study investigated the in vitro antimicrobial activity of tigecycline, omadacycline and eravacycline against clinical CRAn isolates and the contribution of efflux pumps in their resistance. Eighty-nine clinical CRAn isolates, including 57 Tn-CRAn isolates were evaluated for minimum inhibitory concentrations (MICs) by the broth microdilution. The relationship between the antimicrobial resistance and efflux pump expression was assessed by their responses to the efflux pump inhibitor 1-(1-naphthylmethyl)-piperazine (NMP). The contribution of the AdeABC efflux pump in their resistance was determined by the complementation of the AdeRS two-component system in wild-type, adeRS operon and adeB gene knockout strains. Among the 89 isolates, omadacycline and eravacycline MICs were correlated closely with those of tigecycline. They demonstrated improved potency, based on MIC90 values, by showing a 4 to 8-fold greater potency than tigecycline. The synergetic effects of tigecycline, omadacycline and eravacycline with NMP were observed in 57 (100%), 13 (22.8%), and 51 (89.5%) of Tn-CRAn isolates, respectively. Further analysis showed that the laboratory strain carrying the Type 1 adeRS operon increased the tigecycline, omadacycline and eravacycline MICs by 4-8-folds, respectively. Eravacycline demonstrated improved potency over tigecycline against populations of CRAn, including Tn-CRAn isolates. The over-expression of AdeABC efflux pumps was directly activated by the AdeRS two-component system and simultaneously reduced the susceptibilities of tigecycline, eravacycline, and omadacycline. Omadacycline and eravacycline MICs were correlated closely with those of eravacycline.
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Affiliation(s)
- Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsing-Yu Chen
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Tein-Yao Chang
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Jane Hsu
- Department of Medical Techniques, Taipei City Hospital Ren-Ai Branch, Taipei, Taiwan
| | - I-Chieh Lin
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | - Jun-Ren Sun
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
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Kang FY, How CK, Wang YC, Cheng A, Yang YS, Kuo SC, Liu CP, Liu YM, Chen TL, Lee YT. Influence of severity of infection on the effect of appropriate antimicrobial therapy for Acinetobacter baumannii bacteremic pneumonia. Antimicrob Resist Infect Control 2020; 9:160. [PMID: 32993810 PMCID: PMC7523485 DOI: 10.1186/s13756-020-00824-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/23/2020] [Indexed: 02/03/2023] Open
Abstract
Background The impact of appropriate antimicrobial therapy for A. baumannii bacteremic pneumonia has not been well established due to the inclusion of the three phenotypically indistinguishable Acinetobacter species and confounding factors including underlying diseases and severity of infection. This retrospective study aimed to evaluate the impact of appropriate antimicrobial therapy on 14-day mortality in A. baumannii bacteremic pneumonia patients after adjusting for risk factors. Methods This study was conducted at five medical centers in Taiwan between July 2012 and June 2016. A. baumannii species identification was performed using reference molecular methods. Risk factors for 14-day mortality were analyzed via logistic regression. The interaction between the Acute Physiology and Chronic Health Evaluation (APACHE) II score and appropriate antimicrobial therapy was assessed using the logistic model. Results A total of 336 patients with monomicrobial A. baumannii bacteremic pneumonia were included in this study. The overall 14-day mortality rate was 47.3%. The crude mortality of appropriate antimicrobial therapy was 35.9% (57 of 151 patients). Appropriate antimicrobial therapy was associated with a lower mortality after multivariate adjustment (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.34–0.97; p = 0.04), and the effect was influenced by APACHE II score (OR for interaction term, 0.0098; 95% CI, 0.0005–0.1885; p = 0.002). Further analysis demonstrated that appropriate antimicrobial therapy significantly reduced 14-day mortality among the patients with an APACHE II score > 35 (OR 0.0098; 95% CI 0.0005–0.1885). Conclusion Appropriate antimicrobial therapy decreases 14-day mortality of the most severely ill patients with A. baumannii bacteremic pneumonia.
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Affiliation(s)
- Fang-Yu Kang
- Department of Emergency Medicine, Taipei Veterans General Hospital, No.201, Section 2, Shipai Road, Taipei, 11217, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, No.201, Section 2, Shipai Road, Taipei, 11217, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Miaoli County, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yuag-Meng Liu
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, No.201, Section 2, Shipai Road, Taipei, 11217, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Chen YJ, He GC, Cheng JF, Lee YT, Hung YH, Chen WH, Huang YT, Liu PY. Comparative genomics reveals insights into characterization and distribution of quorum sensing-related genes in Shewanella algae from marine environment and clinical sources. Comp Immunol Microbiol Infect Dis 2020; 73:101545. [PMID: 32927298 DOI: 10.1016/j.cimid.2020.101545] [Citation(s) in RCA: 1] [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: 02/29/2020] [Revised: 08/05/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
Shewanella algae is not only the most commonly reported species in Shewanella human infections but also capable to inhabit a wide variety of habitats. Although there is evidence that quorum sensing is associated with bacterial adaptation to changing environmental conditions, little is known of the quorum sensing system in S. algae. In this study, we conducted the whole genome sequencing of S. algae strains and applied comparative genomics to reveal the core genome. Genes related to the quorum sensing system were identified by integrated bioinformatics analysis. S. algae harbor genes involved in all three main types of autoinducer systems. This study provides insights into the quorum sensing systems in S. algae, which might be valuable in the future study of cell behavior in S. algae.
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Affiliation(s)
- Ying-Ju Chen
- Bachelor Program in Health Care and Social Work for Indigenous Students, College of Humanities & Social Sciences, Providence University, Taichung 43301, Taiwan
| | - Guo-Cheng He
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chia-Yi 62102, Taiwan
| | - Jan-Fang Cheng
- Department of Energy, Joint Genome Institute, CA 94598, USA
| | - Yi-Tzu Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yu-Hsuan Hung
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chia-Yi 62102, Taiwan
| | - Wen-Huei Chen
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chia-Yi 62102, Taiwan
| | - Yao-Ting Huang
- Department of Computer Science and Information Engineering, National Chung Cheng University, Chia-Yi 62102, Taiwan.
| | - Po-Yu Liu
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan; Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan.
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Chang YY, Yang YS, Wu SL, Wang YC, Chen TL, Lee YT. Comparison of Cefepime-Cefpirome and Carbapenem Therapy for Acinetobacter Bloodstream Infection in a Multicenter Study. Antimicrob Agents Chemother 2020; 64:e02392-19. [PMID: 32179523 PMCID: PMC7269511 DOI: 10.1128/aac.02392-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/08/2020] [Indexed: 11/20/2022] Open
Abstract
Carbapenems are currently the preferred agents for the treatment of serious Acinetobacter infections. However, whether cefepime-cefpirome can be used to treat an Acinetobacter bloodstream infection (BSI) if it is active against the causative pathogen(s) is not clear. This study aimed to compare the efficacy of cefepime-cefpirome and carbapenem monotherapy in patients with Acinetobacter BSI. The population included 360 patients with monomicrobial Acinetobacter BSI receiving appropriate antimicrobial therapy admitted to four medical centers in Taiwan in 2012 to 2017. The predictors of 30-day mortality were determined by Cox regression analysis. The overall 30-day mortality rate in the appropriate antibiotic treatment group was 25.0% (90/360 patients). The crude 30-day mortality rates for cefepime-cefpirome and carbapenem therapy were 11.5% (7/61 patients) and 26.3% (21/80 patients), respectively. The patients receiving cefepime-cefpirome or carbapenem therapy were infected by Acinetobacter nosocomialis (51.8%), Acinetobacter baumannii (18.4%), and Acinetobacter pittii (12.1%). After adjusting for age, Sequential Organ Failure Assessment (SOFA) score, invasive procedures, and underlying diseases, cefepime-cefpirome therapy was not independently associated with a higher or lower 30-day mortality rate compared to that with the carbapenem therapy. SOFA score (hazard ratio [HR], 1.324; 95% confidence interval [CI], 1.137 to 1.543; P < 0.001) and neutropenia (HR, 7.060; 95% CI, 1.607 to 31.019; P = 0.010) were independent risk factors for 30-day mortality of patients receiving cefepime-cefpirome or carbapenem monotherapy. The incidence densities of 30-day mortality for cefepime-cefpirome versus carbapenem therapy were 0.40% versus 1.04%, respectively. The therapeutic response of cefepime-cefpirome therapy was comparable to that with carbapenems among patients with Acinetobacter BSI receiving appropriate antimicrobial therapy.
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Affiliation(s)
- Yea-Yuan Chang
- Division of Infectious Diseases, Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shang-Liang Wu
- School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | - Yi-Tzu Lee
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Chiang MH, Yang YS, Sun JR, Wang YC, Kuo SC, Lee YT, Chuang YP, Chen TL. Confronting Tigecycline-Resistant Acinetobacter baumannii via Immunization Against Conserved Resistance Determinants. Front Microbiol 2020; 11:536. [PMID: 32296411 PMCID: PMC7136391 DOI: 10.3389/fmicb.2020.00536] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial-resistant (AMR) bacterial infections, including those caused by Acinetobacter baumannii, have emerged as a clinical crisis worldwide. Immunization with AMR determinants has been suggested as a novel approach to combat AMR bacteria, but has not been validated. The present study targeted tigecycline (TGC) resistance determinants in A. baumannii to test the feasibility of this approach. Using bioinformatic tools, four candidates, AdeA, AdeI, AdeK, and TolC, belonging to the resistance-nodulation-division (RND) efflux pump were identified as highly conserved and exposed antigens from 15 A. baumannii genomes. Antisera generated from recombinant proteins showed the capability to reserve Hoechst 33342, a substrate of the efflux pump, in bacterial cells. The rTolC antisera had the highest complement-dependent killing and opsonophagocytosis effect compared to the sera from phosphate-buffered saline immunized mice. Among the antisera, anti-rAdeK-specific antisera decreased the minimal inhibitory concentration of TGC in 26.7% of the tested isolates. Immunization with rAdeK significantly potentiated TGC efficacy in treating TGC-resistant A. baumannii pneumonia in the murine model. The bacterial load (7.5 × 105 vs. 3.8 × 107, p < 0.01) and neutrophil infiltration in the peri-bronchial vasculature region of immunized mice was significantly lower compared to the PBS-immunized mice when TGC was administrated concomitantly. Collectively, these results suggest that active immunization against resistance determinants might be a feasible approach to combat multidrug-resistant pathogens in high risk population.
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Affiliation(s)
- Ming-Hsien Chiang
- Department and Graduate Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jun-Ren Sun
- Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Yi-Tzu Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Ping Chuang
- Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Wang YC, Ku WW, Yang YS, Kao CC, Kang FY, Kuo SC, Chiu CH, Chen TL, Wang FD, Lee YT. Is Polymicrobial Bacteremia an Independent Risk Factor for Mortality in Acinetobacter baumannii Bacteremia? J Clin Med 2020; 9:jcm9010153. [PMID: 31935954 PMCID: PMC7019703 DOI: 10.3390/jcm9010153] [Citation(s) in RCA: 13] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022] Open
Abstract
This retrospective observational study assessed the differences between monomicrobial and polymicrobial A. baumannii bacteremia and identified possible independent risk factors for 14-day mortality. There were 379 patients with A. baumannii bacteremia admitted to a tertiary care center in northern Taiwan between August 2008 and July 2015 enrolled for data analysis. Among them, 89 patients (23.5%) had polymicrobial bacteremia and 290 patients (76.5%) had monomicrobial bacteremia. No significant difference in 14-day mortality was observed between patients with monomicrobial and polymicrobial A. baumannii bacteremia (26.9% vs. 29.2%, p = 0.77). Logistic regression controlled for confounders demonstrated that polymicrobial bacteremia was not an independent predictor of mortality, whereas appropriate antimicrobial therapy was independently associated with reduced mortality. Higher 14-day mortality rates were observed in the polymicrobial bacteremic patients with concomitant isolation of Escherichia coli, Pseudomonas aeruginosa, and Enterobacter spp. from the bloodstream. Compared with patients with monomicrobial multidrug-resistant A. baumannii (MDRAb) bacteremia, those with MDRAb concomitant with Gram-negative bacilli bacteremia had a worse outcome. Polymicrobial A. baumannii bacteremia was not associated with a higher 14-day mortality rate than that of monomicrobial A. baumannii bacteremia, although more deaths were observed when certain Gram-negative bacteria were concomitantly isolated. Appropriate antimicrobial therapy remains an important life-saving measure for A. baumannii bacteremic patients.
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Affiliation(s)
- Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-C.W.); (Y.-S.Y.); (C.-H.C.)
| | - Wen-Wei Ku
- Division of Infectious Diseases, Department of Medicine, Taipei City Hospital Renai Branch, Taipei 10629, Taiwan;
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-C.W.); (Y.-S.Y.); (C.-H.C.)
| | - Chih-Chun Kao
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.K.); (F.-Y.K.)
| | - Fang-Yu Kang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.K.); (F.-Y.K.)
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County 35053, Taiwan;
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (Y.-C.W.); (Y.-S.Y.); (C.-H.C.)
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
- Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Fu-Der Wang
- Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-C.K.); (F.-Y.K.)
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-2-28757628; Fax: +886-2-28730052
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Kao CC, Yen DHT, Lee YT. Hiccups as the only symptom of acute myocardial infarction. Am J Emerg Med 2019; 37:1396.e1-1396.e3. [DOI: 10.1016/j.ajem.2019.04.023] [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] [Received: 02/19/2019] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022] Open
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Liu YH, Kuo SC, Yao BY, Fang ZS, Lee YT, Chang YC, Chen TL, Hu CMJ. Colistin nanoparticle assembly by coacervate complexation with polyanionic peptides for treating drug-resistant gram-negative bacteria. Acta Biomater 2018; 82:133-142. [PMID: 30316023 DOI: 10.1016/j.actbio.2018.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022]
Abstract
Amidst the ever-rising threat of antibiotics resistance, colistin, a decade-old antibiotic with lingering toxicity concern, is increasingly prescribed to treat many drug-resistant, gram-negative bacteria. With the aim of improving the safety profile while preserving the antimicrobial activity of colistin, a nanoformulation is herein developed through coacervate complexation with polyanionic peptides. Upon controlled mixing of cationic colistin with polyglutamic acids, formation of liquid coacervates was demonstrated. Subsequent stabilization by DSPE-PEG and homogenization through micro-fluidization of the liquid coacervates yielded nanoparticles 8 nm in diameter. In vitro assessment showed that the colistin antimicrobial activity against multiple drug-resistant bacterial strains was retained and, in some cases, enhanced following the nanoparticle assembly. In vivo administration in mice demonstrated improved safety of the colistin nanoparticle, which has a maximal tolerated dose of 12.5 mg/kg compared to 10 mg/kg of free colistin. Upon administration over a 7-day period, colistin nanoparticles also exhibited reduced hepatotoxicity as compared to free colistin. In mouse models of Klebsiella pneumoniae bacteremia and Acinetobacter baumannii pneumonia, treatment with colistin nanoparticles showed equivalent efficacy to free colistin. These results demonstrate coacervation-induced nanoparticle assembly as a promising approach towards improving colistin treatments against bacterial infections. STATEMENT OF SIGNIFICANCE: Improving the safety of colistin while retaining its antimicrobial activity has been a highly sought-after objective toward enhancing antibacterial treatments. Herein, we demonstrate formation of stabilized colistin nanocomplexes in the presence of anionic polypeptides and DSPE-PEG stabilizer. The nanocomplexes retain colistin's antimicrobial activity while demonstrating improved safety upon in vivo administration. The supramolecular nanoparticle assembly of colistin presents a unique approach towards designing antimicrobial nanoparticles.
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Wang YC, Huang TW, Yang YS, Kuo SC, Chen CT, Liu CP, Liu YM, Chen TL, Chang FY, Wu SH, How CK, Lee YT. Biofilm formation is not associated with worse outcome in Acinetobacter baumannii bacteraemic pneumonia. Sci Rep 2018; 8:7289. [PMID: 29740176 PMCID: PMC5940913 DOI: 10.1038/s41598-018-25661-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 01/04/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023] Open
Abstract
The effect of biofilm formation on bacteraemic pneumonia caused by A. baumannii is unknown. We conducted a 4-year multi-center retrospective study to analyze 71 and 202 patients with A. baumannii bacteraemic pneumonia caused by biofilm-forming and non-biofilm-forming isolates, respectively. The clinical features and outcomes of patients were investigated. Biofilm formation was determined by a microtitre plate assay. The antimicrobial susceptibilities of biofilm-associated cells were assessed using the minimum biofilm eradication concentration (MBEC) assay. Whole-genome sequencing was conducted to identify biofilm-associated genes and their promoters. Quantitative reverse transcription polymerase chain reaction was performed to confirm the expression difference of biofilm-associated genes. There was no significant difference in the clinical characteristics or the outcomes between patients infected with biofilm-forming and non-biofilm-forming strains. Compared with non-biofilm-forming isolates, biofilm-forming isolates exhibited lower resistance to most antimicrobials tested, including imipenem, meropenem, ceftazidime, ciprofloxacin and gentamicin; however, the MBEC assay confirmed the increased antibiotic resistance of the biofilm-embedded bacteria. Biofilm-associated genes and their promoters were detected in most isolates, including the non-biofilm-forming strains. Biofilm-forming isolates showed higher levels of expression of the biofilm-associated genes than non-biofilm-forming isolates. The biofilm-forming ability of A. baumannii isolates might not be associated with worse outcomes in patients with bacteraemic pneumonia.
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Affiliation(s)
- Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Wen Huang
- Department of Microbiology and Immunology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Chung-Ting Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yuag-Meng Liu
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hsiung Wu
- Institute of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Liu CP, Chiang TT, Liu YM, Kuo SC, Yang YS, Lee YT, Chen TL, Shih SC. A multicenter study on clinical characteristics of Acinetobacter bacteremia in patients with liver cirrhosis. J Microbiol Immunol Infect 2018; 52:956-965. [PMID: 29731384 DOI: 10.1016/j.jmii.2018.03.001] [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] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/14/2017] [Accepted: 03/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical characteristics and risk factors for mortality of Acinetobacter bacteremia in cirrhotic patients have not been investigated. METHODS Acinetobacter bacteremia cases from four medical centers were collected from 2009 to 2014, to compare between patients with and without liver cirrhosis. Risk factors for mortality of Acinetobacter bacteremia among cirrhotic patients were identified using multivariate logistic regression. RESULTS Among the patients with Acinetobacter bacteremia, 72 had liver cirrhosis and 816 had not. Patients with cirrhosis were younger (57.5 [50-71] vs. 72 [50.25-71], p < 0.001), had more solid tumor (51.4% vs. 31.4%, p = 0.001), lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (17 [12-24] vs. 20 [13-28], p = 0.012), less sourced from pneumonia (19.4% vs. 35.8%, p = 0.008), and less caused by Acinetobacterbaumannii (33.3% vs. 50.6%, p = 0.007) than those without. After matching for age, sex, and causative pathogens, the 30-day mortality (34.7% vs. 29.2%, p = 0.592) and APACHE II scores (17 vs. 17, p = 0.769) were not significant. APACHE II score (odds ratio [OR], 1.146; 95% confidence interval [CI], 1.035-1.268; p = 0.009), bacteremia caused by A. baumannii (OR, 20.501; 95% CI, 2.301-182.649; p = 0.007), and solid tumor (OR, 18.073; 95% CI, 1.938-168.504; p = 0.011) were independent risk factors for 30-day mortality of cirrhotic patients with Acinetobacter bacteremia. CONCLUSION Even though cirrhotic patients with Acinetobacter bacteremia were younger and had lower APACHE II scores than non-cirrhotic patients, the mortality rates were insignificantly different between the two groups.
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Affiliation(s)
- Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay College of Medicine, Nursing and Management, Taipei, Taiwan; Infection Control Committee, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Ta Chiang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuag-Meng Liu
- Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua County, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Yi-Tzu Lee
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Te-Li Chen
- Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Shou-Chuan Shih
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay College of Medicine, Nursing and Management, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
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Ferguson M, Bhinge R, Park J, Lee YT, Law KH. A Data Processing Pipeline for Prediction of Milling Machine Tool Condition from Raw Sensor Data. Smart Sustain Manuf Syst 2018; 2:10.1520/SSMS20180019 . [PMID: 31093603 PMCID: PMC6512847 DOI: 10.1520/ssms20180019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With recent advances in sensor and computing technology, it is now possible to use real-time machine learning techniques to monitor the state of manufacturing machines. However, making accurate predictions from raw sensor data is still a difficult challenge. In this work, a data processing pipeline is developed to predict the condition of a milling machine tool using raw sensor data. Acceleration and audio time series sensor data is aggregated into blocks that correspond to the individual cutting operations of the Computer Numerical Control (CNC) milling machine. Each block of data is preprocessed using well-known and computationally efficient signal processing techniques. A novel kernel function is proposed to approximate the covariance between preprocessed blocks of time series data. Several Gaussian process regression models are trained to predict tool condition, each with a different covariance kernel function. The model with the novel covariance function outperforms the models that use more common covariance functions. The trained models are expressed using the Predictive Model Markup Language (PMML), where possible, to demonstrate how the predictive model component of the pipeline can be represented in a standardized form. The tool condition model is shown to be accurate, especially when predicting the condition of lightly worn tools.
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Affiliation(s)
- M Ferguson
- Stanford University, Civil and Environmental Engineering, Stanford, CA, USA
| | - R Bhinge
- Infinite Uptime, Inc. Berkeley, CA, USA
| | - J Park
- Korea Advanced Institute of Science and Technology, Industrial and Systems Engineering, Daejeon, South Korea
| | - Y T Lee
- National Institute of Standards and Technology, Systems Integration Division, Gaithersburg, MD, USA
| | - K H Law
- Stanford University, Civil and Environmental Engineering, Stanford, CA, USA
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Chen CT, Wang YC, Kuo SC, Shih FH, Chen TL, How CK, Yang YS, Lee YT. Community-acquired bloodstream infections caused by Acinetobacter baumannii: A matched case-control study. J Microbiol Immunol Infect 2017; 51:629-635. [PMID: 28701266 DOI: 10.1016/j.jmii.2017.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/05/2017] [Accepted: 02/06/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acinetobacter baumannii is an important nosocomial pathogen worldwide. Its role in community-acquired infection remains controversial and has rarely been reported. METHODS Patients with monobacterial bloodstream infections caused by genomic species identified A. baumannii, admitted to Taipei Veterans General Hospital between 1999 and 2010, were selected as cases. Controls were defined as patients acquiring infection in a healthcare setting and were matched for age and sex. The clinical, epidemiologic, and microbiological characteristics of cases and controls were compared. RESULTS Cases presented with shock more frequently and had higher APACHE II scores (25 vs 19, p = 0.005). No significant differences between the two groups were noted in the sources of bloodstream infection and underlying diseases. Multidrug resistance rates were higher in nosocomial A. baumannii isolates then in those acquired in the community (81.5% vs 38.9%, p = 0.002). Patients infected in the community were more likely to receive appropriate antimicrobial therapy than those with hospital-acquired A. baumannii (10/18; 55.6% vs 11/54; 20.4%, p = 0.011). Acquisition in the community (odds ratio [OR] 5.716, 95% confidence interval [CI] 1.021-32.003, p = 0.047), respiratory tract as the infection source (OR 9.514, 95% CI 2.370-38.189, p = 0.001), and immunosuppressive therapy (OR 4.331, 95% CI 1.052-17.832, p = 0.042) were independently associated with increased 14-day mortality among patients with A. baumannii bacteremia in this cohort. CONCLUSION Community-acquired bacteremia caused by A. baumannii was rare but associated with a severe outcome. Further investigation of potential virulence factors of community-acquired A. baumannii is required.
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Affiliation(s)
- Chung-Ting Chen
- Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Fang-Huy Shih
- Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Yi-Tzu Lee
- Department of Emergency, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Lee IH, Chen CT, Lee YT, Hsu YS, Lu CL, Huang HH, Hsu TF, How CK, Yen DHT, Yang UC. A new strategy for emergency department crowding: High-turnover utility bed intervention. J Chin Med Assoc 2017; 80:297-302. [PMID: 28202338 DOI: 10.1016/j.jcma.2016.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/07/2016] [Accepted: 11/07/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study applied a new strategy, termed high-turnover utility bed intervention, to offer early admission chances for emergency department (ED) patients and alleviate ED crowding. METHODS This before-and-after observational cohort study was conducted at the ED of an urban tertiary hospital. On January 1, 2012, 14 utility beds were prepared exclusively for ED patient use. A strict 48-hour course limit for each patient was formulated to govern these high-turnover beds. The primary outcome measure for this study was ED length of stay. Secondary outcome measures were the number of ED admissions, patients who left without being seen, and revisits within 72 hours of discharge, as well as the outcomes of cardiac arrest management and ambulance diversion hours. RESULTS There were 70,515 adult ED visits enrolled during the preintervention period (January-December 2011), and 69,706 during the postintervention period (July 2012-June 2013). In the postintervention period, this new strategy offered 1401 early admission opportunities. The ambulance diversion hours decreased prominently from 5.4 hours to 1.6 hours per day. A shortening in ED length of stay from 9.7 hours to 8.0 hours was achieved, mainly in cases of nontrauma. More patients (31.2% vs. 29.7%) were admitted to the wards with a lower discharge rate in the postintervention period. Additionally, there was no difference in ED revisit within 72 hours and cardiac arrest management. CONCLUSION The high-turnover ED utility bed intervention offered improved admission chance and alleviated ED crowding output. ED efficiency improved, with shortened ED length of stay and fewer ambulance diversion hours.
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Affiliation(s)
- I-Hsin Lee
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Biomedical Informatics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chung-Ting Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Tzu Lee
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yueh-Shuang Hsu
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Ling Lu
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsien-Hao Huang
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Teh-Fu Hsu
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| | - David Hung-Tsang Yen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Emergency Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ueng-Cheng Yang
- Institute of Biomedical Informatics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Lee Y, Lee YT, Wang YC, Chen CT, Sun JR, Liu CP, Liu YM, Kuo SC, Chiu CH, Yang YS, Lin JC, Chen TL. Risk of Mortality of Catheter-Related Bloodstream Infections Caused by Acinetobacter Species: Is Early Removal of the Catheters Associated With a Better Survival Outcome? J Intensive Care Med 2016; 33:361-369. [PMID: 27872410 DOI: 10.1177/0885066616677710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 01/03/2023]
Abstract
PURPOSE Bloodstream infections (BSIs) caused by Acinetobacter species have been extensively reported, however, which majorly focused on respiratory tract infections. The risk of mortality and the effect of early catheter removal on survival in catheter-related BSIs (CRBSIs) caused by Acinetobacter spp. remain unclear. This study aims to investigate that. METHODS This is a retrospective multicentric study conducted in Taiwan from 2012 to 2014. Patients with at least 1 positive blood culture and catheter culture for the same Acinetobacter spp., showing symptoms and signs of CRBSIs, were included (n = 119). Risk factors for 30-day mortality were analyzed using a logistic regression model. The characteristics of patients with early catheter removal (within 48 hours after CRBSIs) were compared to those without removal matching for age, sex, and disease severity. RESULTS There were no differences in 30-day mortality with regard to causative Acinetobacter spp., catheter type, site, and appropriateness of antimicrobial therapy. Patients with higher Acute Physiologic and Chronic Health Evaluation (APACHE) II scores (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.02-1.23; P = .014), shock (OR: 6.43; 95% CI: 1.28-32.33; P = .024), and longer hospitalization before CRBSIs (OR: 1.04; 95% CI: 1.00-1.08; P = .027) had a significantly higher 30-day mortality rate. Early removal of catheters after CRBSIs was not associated with better survival benefits. CONCLUSION Higher disease severity (APACHE II score), shock, and longer hospitalization before bacteremia were independently associated with a higher 30-day mortality in CRBSIs caused by Acinetobacter spp. In previous published guidelines, infected catheters were suggested to be removed in CRBSIs caused by gram-negative bacilli. Even though early removal of catheters did not associate with a better survival outcome in current results, it should be judiciously evaluated according to the clinical conditions and risks individually. For better elucidation of these issues, further well-controlled prospective study may be warranted.
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Affiliation(s)
- Yi Lee
- 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,2 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- 3 Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,4 School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yung-Chih Wang
- 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Ting Chen
- 3 Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jun-Ren Sun
- 5 Clinical Microbiology Laboratory, Division of Clinical Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Pan Liu
- 6 Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,7 Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yuan-Meng Liu
- 8 Division of Infectious Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shu-Chen Kuo
- 9 National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Chun-Hsiang Chiu
- 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Sung Yang
- 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chung Lin
- 1 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,2 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Te-Li Chen
- 2 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,10 Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Lee YT, Chiang MC, Kuo SC, Wang YC, Lee IH, Chen TL, Yang YS. Carbapenem Breakpoints for Acinetobacter baumannii Group: Supporting Clinical Outcome Data from Patients with Bacteremia. PLoS One 2016; 11:e0163271. [PMID: 27644087 PMCID: PMC5028070 DOI: 10.1371/journal.pone.0163271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/05/2016] [Indexed: 11/28/2022] Open
Abstract
The carbapenem breakpoints set by different organizations for Acinetobacter are discordant, but supporting clinical data are lacking. This study aimed to provide the first clinical outcome data to support the carbapenem breakpoints for Acinetobacter baumannii (Ab) group in patients with bacteremia. This study included 117 adults who received carbapenems for treatment of Ab group bacteremia in Taipei Veterans General Hospital over an 8-year period. We analyzed 30-day mortality rates among patient groups acquiring isolates with different carbapenem minimal inhibitory concentrations (MICs). The carbapenem MIC breakpoint derived from classification and regression tree (CART) analysis to delineate the risk of 30-day mortality was between MICs of ≤ 4 mg/L and ≥ 8 mg/L. Mortality rate was higher in patients acquiring isolates with carbapenem MIC ≥ 8 mg/L than ≤ 4 mg/L, by bivariate (54.9% [28/51] vs 25.8% [17/66]; P = 0.003) and survival analysis (P = 0.001 by log-rank test). Multivariate analysis using logistic regression and Cox regression models including severity of illness indices demonstrated that treating patients with Ab group bacteremia caused by isolates with a carbapenem MIC ≥ 8 mg/L with carbapenem was an independent predictor of 30-day mortality (odds ratio, 5.125; 95% confidence interval [CI], 1.946-13.498; P = 0.001, and hazard ratio, 2.630; 95% CI, 1.431-4.834; P = 0.002, respectively). The clinical outcome data confirmed that isolates with MIC ≤ 4 mg/L were susceptible to carbapenem, and those with MIC ≥ 8 mg/L were resistant in patients with Ab group bacteremia.
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Affiliation(s)
- Yi-Tzu Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mei-Chun Chiang
- Division of Preventive Medicine, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Chen Kuo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institute, Maoli County, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Hsin Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Biomedical Informatics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Li Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chiu CH, Liu YH, Wang YC, Lee YT, Kuo SC, Chen TL, Lin JC, Wang FD. In vitroactivity of SecA inhibitors in combination with carbapenems against carbapenem-hydrolysing class D β-lactamase-producingAcinetobacter baumannii. J Antimicrob Chemother 2016; 71:3441-3448. [DOI: 10.1093/jac/dkw331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/09/2016] [Accepted: 07/16/2016] [Indexed: 01/24/2023] Open
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Ziegler AD, Echaubard P, Lee YT, Chuah CJ, Wilcox BA, Grundy-Warr C, Sithithaworn P, Petney TN, Laithevewat L, Ong X, Andrews RH, Ismail T, Sripa B, Khuntikeo N, Poonpon K, Tungtang P, Tuamsuk K. Untangling the Complexity of Liver Fluke Infection and Cholangiocarcinoma in NE Thailand Through Transdisciplinary Learning. Ecohealth 2016; 13:316-327. [PMID: 26822781 DOI: 10.1007/s10393-015-1087-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/19/2015] [Revised: 10/22/2015] [Accepted: 11/19/2015] [Indexed: 06/05/2023]
Abstract
This study demonstrates how a transdisciplinary learning approach provided new insights for explaining persistent Opisthorchis viverrini infection in northern Thailand, as well as elucidating problems of focusing solely on the parasite as a means of addressing high prevalence of cholangiocarcinoma. Researchers from diverse backgrounds collaborated to design an investigative homestay program for 72 Singaporean and Thai university students in five northeast Thai villages. The students explored how liver fluke infection and potential cholangiocarcinoma development are influenced by local landscape dynamics, aquatic ecology, livelihoods, food culture and health education. Qualitative fieldwork was guided daily by the researchers in a collaborative, co-learning process that led to viewing this health issue as a complex system, influenced by interlinked multidimensional factors. Our transdisciplinary experience has led us to believe that an incomplete understanding of these linkages may reduce the efficacy of interventions. Further, viewing liver fluke infection and cholangiocarcinoma as the same issue is inadvisable. Although O. viverrini infection is an established risk factor for the development of cholangiocarcinoma, multiple factors are known to influence the likelihood of acquiring either. Understanding the importance of the current livelihood transition, landscape modification and the resulting mismatch between local cultures and new socio-ecological settings on cholangiocarcinoma initiation and liver fluke transmission is of critical importance as it may help readjust our view of the respective role of O. viverrini and other socioeconomic risk factors in cholangiocarcinoma etiology and refine intervention strategies. As demonstrated in this study, transdisciplinary approaches have the potential to yield more nuanced perspectives to complex diseases than research that focuses on specific aspects of their epidemiology. They may therefore be valuable when designing effective solutions to context-sensitive diseases such as liver fluke infection and cholangiocarcinoma.
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Affiliation(s)
- A D Ziegler
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore.
| | - P Echaubard
- Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Biology, Laurentian University, Sudbury, ON, Canada
| | - Y T Lee
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - C J Chuah
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - B A Wilcox
- Global Health Asia, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - C Grundy-Warr
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - P Sithithaworn
- Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - T N Petney
- Department of Ecology and Parasitology, Karlsruhe Institute of Technology, Kornblumenstrasse 13, Karlsruhe, Germany
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - L Laithevewat
- Office of Prevention and Control 8, Udonthani Province, Thailand
| | - X Ong
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - R H Andrews
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Liver Fluke and Cholangiocarcinoma Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - T Ismail
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, AS2-04-21, 1 Arts Link, Singapore, 117570, Singapore
| | - B Sripa
- Tropical Disease Research Laboratory, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - N Khuntikeo
- Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - K Poonpon
- Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - P Tungtang
- Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - K Tuamsuk
- Department of English Language, Faculty of Humanities and Social Sciences, Khon Kaen University, Khon Kaen, Thailand
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Chen CT, Chiu PC, Tang CY, Lin YY, Lee YT, How CK, Yen DHT, Huang MS. Prognostic factors for survival outcome after in-hospital cardiac arrest: An observational study of the oriental population in Taiwan. J Chin Med Assoc 2016; 79:11-6. [PMID: 26341452 DOI: 10.1016/j.jcma.2015.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In-hospital cardiac arrest (IHCA) is a catastrophic complication for patients while admitted in a medical institution. The outcome of IHCA remains poor, and understanding of the prognostic factors for survival outcome after IHCA is lacking, specifically in an oriental population. METHODS A retrospective observational cohort study of 382 patients with IHCA who required resuscitation was conducted in an urban tertiary hospital in Taiwan. Return of spontaneous circulation (ROSC) and survival to hospital discharge were the primary outcome measures. RESULTS The incidence of IHCA was 3.25 per 1000 admissions. These patients had a mean age of 67.2 ± 21.7 years and were mostly men (66.5%). The rate of successful ROSC was 66%, and the rate of survival to hospital discharge was 11.8%. A stepwise decrease in ROSC was observed with additional resuscitation efforts. Independent predictors for survival to hospital discharge were being female, a resuscitation duration of <20 minutes, and no use of epinephrine during resuscitation. A 68% ROSC success rate and an 84% survival to discharge rate was recorded in patients receiving resuscitation for <30 minutes. Young patients seemed the most likely to benefit from longer resuscitation attempts (>30 minutes), as observed in survival to hospital discharge. CONCLUSION Based on data from a single hospital registry in East Asia, a shorter duration of resuscitation was demonstrated to be a predictor of immediate survival with ROSC and survival to hospital discharge.
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Affiliation(s)
- Chung-Ting Chen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Po-Chi Chiu
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ching-Ying Tang
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yan-Ying Lin
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yi-Tzu Lee
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| | - David Hung-Tsang Yen
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Mu-Shun Huang
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Chen PC, Chien KL, Su TC, Jeng JS, Hsu HC, Lee YT. Carotid Atherosclerosis Progression and Risk of Cardiovascular Events in a Community in Taiwan. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.109] [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: 11/12/2022] Open
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Chiu CH, Lee YT, Wang YC, Yin T, Kuo SC, Yang YS, Chen TL, Lin JC, Wang FD, Fung CP. A retrospective study of the incidence, clinical characteristics, identification, and antimicrobial susceptibility of bacteremic isolates of Acinetobacter ursingii. BMC Infect Dis 2015; 15:400. [PMID: 26423424 PMCID: PMC4590261 DOI: 10.1186/s12879-015-1145-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 09/23/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Acinetobacter ursingii bacteremia is rarely reported. We investigated the incidence and clinical features of A. ursingii bacteremia, performance of the identification system, and antimicrobial susceptibility of the isolates. Acinetobacter ursingii bacteremia patients were compared with A. baumannii bacteremia patients. METHODS In this 9-year retrospective study, A. ursingii was identified using 16S rRNA and 16S-23S rRNA internal transcribed spacer sequence analysis. The performances of the Vitek 2, Phoenix, and matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometer systems for identifying isolates were tested. Pulsed-field gel electrophoresis (PFGE) was used to determine the clonality of the isolates. The minimal inhibitory concentrations of the antimicrobials were determined using the Vitek 2 system. RESULTS Nineteen patients were identified. Acinetobacter ursingii was noted in 1.5-5.2 % of all Acinetobacter bacteremia cases. For the PFGE analysis, two isolates had smeared DNA, two had 93 % similarity, and 15 had similarity <80 %. Among 16 patients with complete medical records, 10 (62.5 %) had no identifiable source of A. ursingii bacteremia. Most patients (n = 12) had underlying malignant disease. Patients with A. ursingii bacteremia had lower Acute Physiology and Chronic Health Evaluation II scores than those with A. baumannii bacteremia (median [interquartile range], 17.1 [10.0-24.7] vs. 24.9 [14.6-35.1]). Patients with A. ursingii bacteremia were also less likely admitted to the intensive care unit than patients with A. baumannii bacteremia (18.8 % vs 63.5 %, p value < 0.01). About half of the patients with A. ursingii (50.8 %) and A. baumannii bacteremia (62.5 %) had received inappropriate antimicrobial therapy within 48 h after bacteremia onset. However, patients with A. ursingii bacteremia had significantly lower 14-day (6.25 % vs 29.8 %, p value = 0.04) and 28-day mortality rates (6.25 % vs 37.3 %, p value = 0.02) than patients with A. baumannii bacteremia. Nine isolates (47.4 %) were correctly identified as A. ursingii and the other 10 isolates (52.6 %) were incorrectly identified as A. lwoffii by the Vitek 2 system. The Phoenix system incorrectly identified all 19 isolates. The MALDI-TOF mass spectrometer system correctly identified all 19 isolates. All the A. ursingii isolates were resistant or showed intermediate susceptibility to ceftriaxone and ceftazidime, but were susceptible to levofloxacin and imipenem. CONCLUSIONS Acinetobacter ursingii is a rare pathogen that mostly caused primary bacteremia in patients with malignancies. Patients with A. ursingii bacteremia had significantly lower disease severity and mortality rates than patients with A. baumannii bacteremia.
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Affiliation(s)
- Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Yi-Tzu Lee
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
- Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Ti Yin
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
- School of Nursing, National Yang-Ming University, Taipei, Taiwan.
| | - Shu-Chen Kuo
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Te-Li Chen
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Fu-Der Wang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
| | - Chang-Phone Fung
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, Republic of China.
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Kuo SC, Lee YT, Yang Lauderdale TL, Huang WC, Chuang MF, Chen CP, Su SC, Lee KR, Chen TL. Contribution of Acinetobacter-derived cephalosporinase-30 to sulbactam resistance in Acinetobacter baumannii. Front Microbiol 2015; 6:231. [PMID: 26284030 PMCID: PMC4517069 DOI: 10.3389/fmicb.2015.00231] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 03/09/2015] [Indexed: 11/13/2022] Open
Abstract
The sulbactam resistance rate in Acinetobacter baumannii has increased worldwide. Previous reports have shown that the β-lactamase blaTEM-1 confers resistance to sulbactam in A. baumannii. The purpose of this study was to examine whether other β-lactamases, including the Acinetobacter-derived cephalosporinase (ADC), OXA-23, OXA-24/72, and OXA-58 families, also contribute to sulbactam resistance in A. baumannii. The correlation between these β-lactamases and the sulbactam minimal inhibitory concentration (MIC) was determined using A. baumannii clinical isolates from diverse clonality, which were collected in a nationwide surveillance program from 2002 to 2010 in Taiwan. A possible association between the genetic structure of ISAba1-blaADC-30 and sulbactam resistance was observed because this genetic structure was detected in 97% of sulbactam-resistant strains compared with 10% of sulbactam-susceptible strains. Transformation of ISAba1-blaADC-30 into susceptible strains increased the sulbactam MIC from 2 to 32 μg/ml, which required blaADC-30 overexpression using an upstream promoter in ISAba1. Flow cytometry showed that ADC-30 production increased in response to sulbactam, ticarcillin, and ceftazidime treatment. This effect was regulated at the RNA level but not by an increase in the blaADC-30 gene copy number as indicated by quantitative PCR. Purified ADC-30 decreased the inhibitory zone created by sulbactam or ceftazidime, similarly to TEM-1. In conclusion, ADC-30 overexpression conferred resistance to sulbactam in diverse clinical A. baumannii isolates.
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Affiliation(s)
- Shu-Chen Kuo
- Institute of Clinical Medicine, Schsool of Medicine, National Yang-Ming University Taipei, Taiwan ; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes Taipei, Taiwan ; Division of Infectious Diseases, Taipei Veterans General Hospital Taipei, Taiwan
| | - Yi-Tzu Lee
- Institute of Clinical Medicine, Schsool of Medicine, National Yang-Ming University Taipei, Taiwan ; Emergency Department, Taipei Veterans General Hospital Taipei, Taiwan
| | - Tsai-Ling Yang Lauderdale
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes Taipei, Taiwan
| | - Wei-Cheng Huang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes Taipei, Taiwan
| | - Ming-Fen Chuang
- Division of Infectious Diseases, Taipei Veterans General Hospital Taipei, Taiwan
| | - Chien-Pei Chen
- Division of Infectious Diseases, Taipei Veterans General Hospital Taipei, Taiwan
| | - Shey-Chiang Su
- Department of Internal Medicine, Mackay Memorial Hospital Hsin-Chu, Taiwan
| | - Kuan-Rong Lee
- Department of Molecular Medicine and Institute of Life Science, National Tsing Hua University Hsin-Chu, Taiwan
| | - Te-Li Chen
- Institute of Clinical Medicine, Schsool of Medicine, National Yang-Ming University Taipei, Taiwan ; Division of Infectious Diseases, Taipei Veterans General Hospital Taipei, Taiwan
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Yang YS, Lee YT, Wang YC, Chiu CH, Kuo SC, Sun JR, Yin T, Chen TL, Lin JC, Fung CP, Chang FY. Molecular epidemiology of carbapenem non-susceptible Acinetobacter nosocomialis in a medical center in Taiwan. Infect Genet Evol 2015; 31:305-11. [PMID: 25724091 DOI: 10.1016/j.meegid.2015.02.017] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 02/11/2015] [Accepted: 02/19/2015] [Indexed: 02/07/2023]
Abstract
The mechanism by which carbapenem non-susceptible Acinetobacter nosocomialis (CNSAN) is disseminated is rarely described in the literature. In this study, we delineated the molecular epidemiology of CNSAN isolated from patients in a medical center in Taiwan. Fifty-four non-duplicate bloodstream isolates of CNSAN were collected at the Taipei Veterans General Hospital between 2001 and 2007. Pulsed-field gel electrophoresis (PFGE) was performed to determine their clonal relationship. Carbapenem-resistance genes and associated genetic structures were detected by polymerase chain reaction (PCR) mapping. Southern hybridization was performed to determine the plasmid location of carbapenem-resistance genes. Transmissibility of these genes to Acinetobacterbaumannii was demonstrated by conjugation tests. The overall carbapenem non-susceptibility rate among A. nosocomialis isolates during the study period was 21.6% (54/250). PFGE revealed three major pulsotypes: H (n=23), I (n=10), and K (n=8). The most common carbapenem-resistance gene was blaOXA-58 (43/54, 79.6%), containing an upstream insertion sequence IS1006 and a truncated ISAba3 (IS1006-ΔISAba3-like-blaOXA-58). All isolates belonging to the pulsotypes H, I, and K carried plasmid located IS1006-ΔISAba3-like-blaOXA-58. A common plasmid carrying ISAba1-blaOXA-82 was found in six isolates, which belonged to five pulsotypes. A type 1 integron that carried blaIMP-1 was detected in different plasmids of seven isolates, which belonged to five pulsotypes. Plasmids carrying these carbapenem-resistant determinants were transmissible from A. nosocomialis to A. baumannii via conjugation. In this medical center, CNSAN mainly emerged through clonal dissemination; propagation of plasmids and integrons carrying carbapenem-resistant determinants played a minor role. This study showed that plasmids carrying carbapenem-resistant determinants are transmissible from A. nosocomialis to A. baumannii.
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Affiliation(s)
- Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Tzu Lee
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chun-Hsiang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shu-Chen Kuo
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan
| | - Jun-Ren Sun
- Clinical Microbiology Laboratory Division of Clinical Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ti Yin
- Department of Nursing, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Te-Li Chen
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Cheng-Hsin General Hospital, Taipei, Taiwan.
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Phone Fung
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Ku WW, Kung CH, Lee CH, Tseng CP, Wu PF, Kuo SC, Chen TL, Lee YT, Wang FD, Fung CP. Evolution of carbapenem resistance in Acinetobacter baumannii: An 18-year longitudinal study from a medical center in northern Taiwan. Journal of Microbiology, Immunology and Infection 2015; 48:57-64. [DOI: 10.1016/j.jmii.2013.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/13/2013] [Accepted: 07/16/2013] [Indexed: 10/26/2022]
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Liu YM, Lee YT, Kuo SC, Chen TL, Liu CP, Liu CE. Comparison between bacteremia caused by Acinetobacter pittii and Acinetobacter nosocomialis. J Microbiol Immunol Infect 2015; 50:62-67. [PMID: 25735795 DOI: 10.1016/j.jmii.2015.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/30/2014] [Accepted: 01/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Patients with Acinetobacter pittii and Acinetobacter nosocomialis bacteremia have lower mortality rates than those with Acinetobacter baumannii bacteremia. However, it is unknown whether these organisms differ in outcomes of bacteremic patients. We conducted this study to answer this question. METHODS In this retrospective study conducted at a teaching hospital in Taiwan, we enrolled all 86 patients who had developed A. pittii bacteremia and those with A. nosocomialis bacteremia from 2000 to 2008 while matching for age, sex, Acute Physiology and Chronic Health Evaluation II score, and appropriate antimicrobial therapy. After adjustment, we accessed the clinical characteristics and 14- and 28-day mortalities. RESULTS We found that the patients with A. pittii bacteremia had multiple comorbidities less often and received invasive procedures less frequently. The 14-day mortality rate of patients with A. pittii or A. nosocomialis bacteremia was 14% and 7%, respectively, whereas their 28-day mortality rate was 17% and 9%, respectively. Using the mortality rate in patients with A. nosocomialis bacteremia as a reference, the odds ratios for the 14- and 28-day crude morality in those with A. pittii were 2.16 [95% confidence interval (CI), 0.77-6.05] and 2.06 (95% CI, 0.82-5.15), respectively, whereas the adjusted odds ratios for 14- and 28-day mortality were 1.89 (95% CI, 0.56-6.14) and 1.67 (95% CI, 0.59-4.78) respectively. CONCLUSION Our 8-year study showed that the mortality rate of A. pittii bacteremia was higher but the difference was not statistically significant.
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Affiliation(s)
- Yuag-Meng Liu
- Division of Infectious Diseases, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Tzu Lee
- Institutes of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Emergency Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chen Kuo
- Institutes of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan; Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Te-Li Chen
- Institutes of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Infectious Diseases, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Chang-Pan Liu
- Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
| | - Chun-Eng Liu
- Division of Infectious Diseases, Changhua Christian Hospital, Changhua, Taiwan.
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Wu HH, Chen YT, Shih CJ, Lee YT, Kuo SC, Chen TL. Association between recent use of proton pump inhibitors and nontyphoid salmonellosis: a nested case-control study. Clin Infect Dis 2014; 59:1554-8. [PMID: 25091310 DOI: 10.1093/cid/ciu628] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 11/13/2022] Open
Abstract
BACKGROUND The association between proton pump inhibitors (PPIs) and nontyphoid salmonellosis (NTS) continues to be debated. The current study was designed to determine the association between use of oral PPIs and the diagnosis of NTS. METHODS The Taiwan National Health Insurance Research Database from 2000 to 2010 was searched for cases of NTS, defined by the International Classification of Disease, Ninth revision, Clinical Modification. A nested case-control study in hospitalized population was conducted using 4 controls for each case patient (14 736 case patients and 58 944 controls), matched for age, month and year of entry, Charlson comorbidity index score, and well-known predisposing factors for NTS, including autoimmune diseases, acquired immunodeficiency syndrome, diabetes, cirrhosis, transplantation, gastrointestinal operations or diseases, and malignancies. RESULTS Persons with NTS had a higher rate of using oral PPIs within the prior year (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.95-2.24; P < .001). The association was greatest for current PPI use (adjusted OR, 5.39; 95% CI, 4.79-6.06; P < .001). Although use of H2-receptor antagonists (adjusted OR, 1.84; 95% CI, 1.71-1.98), antibiotics (5.21; 4.81-5.64), steroids (3.18; 2.99-3.39), and nonsteroidal anti-inflammatory drugs (2.37; 2.26-2.48) within the 30 days were also associated with NTS, the linkage between PPI use and NTS remained significant in the subgroup without these medications. CONCLUSIONS The use of oral PPIs was associated with the occurrence of NTS. The risk waned with time after discontinuation.
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Affiliation(s)
- Hau-Hsin Wu
- Office of Preventive Medicine, Centers for Disease Control, Taipei
| | - Yung-Tai Chen
- Divisions of Nephrology, Taipei Veterans General Hospital Department of Medicine, Taipei City Hospital Heping Fuyou Branch
| | - Chia-Jen Shih
- Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan School of Medicine, National Yang-Ming University
| | - Yi-Tzu Lee
- Institutes of Clinical Medicine, School of Medicine, National Yang-Ming University Emergency Department, Taipei Veterans General Hospital
| | - Shu-Chen Kuo
- Institutes of Clinical Medicine, School of Medicine, National Yang-Ming University National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan Township, Miaoli County
| | - Te-Li Chen
- Institutes of Clinical Medicine, School of Medicine, National Yang-Ming University Cheng Hsin General Hospital, Taipei, Taiwan
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