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Ng SC, Chu AWH, Chan WM, Yip CCY, Leung KH, So CK, Leung JNS, To KKW, Lee CK. Re-examine the transfusion transmitted risk of SARS-CoV-2 virus during a major COVID-19 outbreak in 2022. Transfus Med 2023. [PMID: 37286528 DOI: 10.1111/tme.12981] [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] [Received: 11/22/2022] [Revised: 03/16/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Although no case of COVID-19 transmission through transfusion has been reported, blood transfusion service (BTS) continues to implement pre-donation and post-donation measures to minimise the risk. In year 2022, when local healthcare system was badly impacted by a major outbreak, it opened an opportunity to re-examine the viraemia risk in these asymptomatic donors. MATERIALS AND METHODS Records were retrieved from blood donors who reported COVID-19 after donation and follow-up was also made for recipients who received their blood. Blood samples at donation were tested for SARS-CoV-2 viraemia by single-tube nested real-time RT-PCR assay designed to detect most SARS-CoV-2 variants including the prevailing delta and omicron variants. RESULTS From 1 January to 15 August 2022, the city with 7.4 M inhabitants recorded 1 187 844 COVID-19 positive cases and 125 936 successful blood donations were received. 781 donors reported to the BTS after donation with 701 being COVID-19 related (including close contact and symptoms respiratory tract infection). 525 COVID-19 were positive at the time of call back or follow-up. Of the 701 donations, they were processed into 1480 components with 1073 discarded upon donors' call back. For remaining 407 components, no recipient was found to have adverse event or COVID-19 positive. 510 samples from the above 525 COVID-19 positive donors were available and all tested negative for SARS-CoV-2 RNA. DISCUSSION With the negative SARS-CoV-2 RNA in blood donation samples and follow up data in transfusion recipients, the risk of transfusion transmitted COVID-19 appears negligible. However, current measures remains important in securing blood safety with ongoing surveillance of their effectiveness.
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Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - A W H Chu
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - W M Chan
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C C Y Yip
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - K H Leung
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
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Lui DTW, Lee CH, Chow WS, Lee ACH, Tam AR, Cheung CYY, Fong CHY, Kwok STM, Law CY, To KKW, Lam CW, Tan KCB, Woo YC, Hung IFN, Lam KSL. Development of a prediction score (ThyroCOVID) for identifying abnormal thyroid function in COVID-19 patients. J Endocrinol Invest 2022; 45:2149-2156. [PMID: 35831586 PMCID: PMC9281239 DOI: 10.1007/s40618-022-01854-y] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Thyroid dysfunction in COVID-19 carries clinical and prognostic implications. In this study, we developed a prediction score (ThyroCOVID) for abnormal thyroid function (TFT) on admission amongst COVID-19 patients. METHODS Consecutive COVID-19 patients admitted to Queen Mary Hospital were prospectively recruited during July 2020-May 2021. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were measured on admission. Multivariable logistic regression analysis was performed to identify independent determinants of abnormal TFTs. ThyroCOVID was developed based on a clinical model with the lowest Akaike information criteria. RESULTS Five hundred and forty six COVID-19 patients were recruited (median age 50 years, 45.4% men, 72.9% mild disease on admission). 84 patients (15.4%) had abnormal TFTs on admission. Patients with abnormal TFTs were more likely to be older, have more comorbidities, symptomatic, have worse COVID-19 severity, higher SARS-CoV-2 viral loads and more adverse profile of acute-phase reactants, haematological and biochemical parameters. ThyroCOVID consisted of five parameters: symptoms (malaise), comorbidities (ischaemic heart disease/congestive heart failure) and laboratory parameters (lymphocyte count, C-reactive protein, and SARS-CoV-2 cycle threshold values). It was able to identify abnormal TFT on admission with an AUROC of 0.73 (95% CI 0.67-0.79). The optimal cut-off of 0.15 had a sensitivity of 75.0%, specificity of 65.2%, negative predictive value of 93.5% and positive predictive value of 28.1% in identifying abnormal TFTs on admission amongst COVID-19 patients. CONCLUSION ThyroCOVID, a prediction score to identify COVID-19 patients at risk of having abnormal TFT on admission, was developed based on a cohort of predominantly non-severe COVID-19 patients.
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Affiliation(s)
- D. T. W. Lui
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - C. H. Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - W. S. Chow
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - A. C. H. Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - A. R. Tam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - C. Y. Y. Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - C. H. Y. Fong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - S. T. M. Kwok
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - C. Y. Law
- Division of Chemical Pathology, Queen Mary Hospital, Hong Kong, China
| | - K. K. W. To
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - C. W. Lam
- Department of Pathology, The University of Hong Kong, Hong Kong, China
| | - K. C. B. Tan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Y. C. Woo
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - I. F. N. Hung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - K. S. L. Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Wong JSC, Wong TS, Chua GT, Wan C, Lau SH, Ho SCS, Rosa Duque JS, Wong ICK, To KKW, Tso WWY, Wong CS, Ho MHK, Kwok J, Chow CB, Tam PKH, Chan GCF, Leung WH, Lau YL, Ip P, Kwan MYW. COVID toe in an adolescent boy: a case report. Hong Kong Med J 2022; 28:175-177. [PMID: 35307653 DOI: 10.12809/hkmj219690] [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: 11/05/2022] Open
Affiliation(s)
- J S C Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - T S Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - G T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - C Wan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - S H Lau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - S C S Ho
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - J S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - I C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong.,Research Department of Practice and Policy, UCL School of Pharmacy, University College London, United Kingdom
| | - K K W To
- Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W W Y Tso
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - C S Wong
- Dermatology Division, Department of Medicine, Queen Mary Hospital, Hong Kong
| | - M H K Ho
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - J Kwok
- Division of Transplantation and Immunogenetics, Department of Pathology, Queen Mary Hospital, Hong Kong
| | - C B Chow
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - P K H Tam
- Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Hong Kong.,Dr Li Dak-Sum Research Centre, The University of Hong Kong-Karolinska Institutet Collaboration in Regenerative Medicine, The University of Hong Kong, Hong Kong
| | - G C F Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W H Leung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y L Lau
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - M Y W Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
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Kwan MYW, Chua GT, Chow CB, Tsao SSL, To KKW, Yuen KY, Lau YL, Ip P. mRNA COVID vaccine and myocarditis in adolescents. Hong Kong Med J 2021; 27:326-327. [PMID: 34393110 DOI: 10.12809/hkmj215120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Y W Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong
| | - G T Chua
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - C B Chow
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - S S L Tsao
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K K W To
- Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K Y Yuen
- Department of Microbiology, Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y L Lau
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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5
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Yang G, Lee WYW, Hung ALH, Tang MF, Li X, Kong APS, Leung TF, Yung PSH, To KKW, Cheng JCY, Lam TP. Association of serum 25(OH)Vit-D levels with risk of pediatric fractures: a systematic review and meta-analysis. Osteoporos Int 2021; 32:1287-1300. [PMID: 33704541 DOI: 10.1007/s00198-020-05814-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 06/09/2020] [Accepted: 12/30/2020] [Indexed: 12/22/2022]
Abstract
UNLABELLED The association between the risk of fractures and suboptimal vitamin D (Vit-D) status remains controversial in children. This meta-analysis suggested that serum 25(OH)Vit-D levels were lower in pediatric cases with fractures. 25-hydroxyvitamin D (25(OH)Vit-D) levels less than 50 nmol/L were associated with increased fracture risk in children. INTRODUCTION This study aimed to assess the association between serum 25(OH)Vit-D and the risk of fractures in children, and to explore the sources of heterogeneity and investigate their impact on results. METHODS Systematic review and meta-analysis were conducted for observational studies comparing serum 25(OH)Vit-D levels between fracture and non-fracture pediatric cases. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Analysis on 17 case-control and 6 cross-sectional studies (2929 fracture cases and 5000 controls) suggested that 25(OH)Vit-D was lower in fracture cases than in controls (pooled mean difference (MD) = - 3.51 nmol/L; 95% confidence interval (CI): - 5.60 to - 1.42) with a heterogeneity (I2) of 73.9%. The sensitivity analysis which merged the case-control studies that had a NOS score ≥ 4 showed a pooled MD of - 4.35 nmol/L (95% CI: - 6.64 to - 2.06) with a heterogeneity (I2) of 35.9%. Pooled odds ratio of fracture in subjects with 25(OH)Vit-D ≤ 50 nmol/L compared to subjects with 25(OH)Vit-D > 50 nmol/L was 1.29 (95% CI: 1.10 to 1.53; I2 < 1%). CONCLUSION This study indicated that serum 25(OH)Vit-D levels were lower in pediatric patients with fractures. 25(OH)Vit-D ≤ 50 nmol/L was associated with increased fracture risk in children.
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Affiliation(s)
- G Yang
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - W Y W Lee
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A L H Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - M F Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - X Li
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A P S Kong
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P S H Yung
- JC Sports Medicine and Health Sciences Centre, Lui Che Woo Institute of Innovative Medicine, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K K W To
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong SAR, China
- Joint Research Laboratory of Promoting Globalization of Traditional Chinese Medicines between Shanghai Institute of Materia Medica, Chinese Academy of Sciences and The Chinese University of Hong Kong, Hong Kong SAR, China
| | - J C Y Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - T P Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
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6
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Lee CK, Leung JNS, Cheng P, Lung DC, To KKW, Tsang DNC. Absence of SARS-CoV-2 viraemia in a blood donor with COVID-19 post-donation. Transfus Med 2020; 31:223-224. [PMID: 33015920 PMCID: PMC7677860 DOI: 10.1111/tme.12724] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022]
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, SAR, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, SAR, China
| | - P Cheng
- Public Health Laboratory Centre, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
| | - D C Lung
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - K K W To
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - D N C Tsang
- Public Health Laboratory Centre, Centre for Health Protection, Department of Health, Hong Kong, SAR, China
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7
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Affiliation(s)
- K K W To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Microbiology, Queen Mary Hospital, Hong Kong
| | - K Y Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Department of Microbiology, Queen Mary Hospital, Hong Kong
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8
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To KKW, Zhou J, Song YQ, Hung IFN, Yuen KY. Innate immune defect predisposing to severe influenza in a Chinese population. Hong Kong Med J 2019; 25 Suppl 7:27-29. [PMID: 31761767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- K K W To
- Department of Microbiology, The University of Hong Kong
| | - J Zhou
- Department of Microbiology, The University of Hong Kong
| | - Y Q Song
- School of Biomedical Sciences, The University of Hong Kong
| | - I F N Hung
- Department of Medicine, The University of Hong Kong
| | - K Y Yuen
- Department of Microbiology, The University of Hong Kong
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9
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To KKW, Chan KH, Ho J, Pang PKP, Ho DTY, Chang ACH, Seng CW, Yip CCY, Cheng VCC, Hung IFN, Yuen KY. Respiratory virus infection among hospitalized adult patients with or without clinically apparent respiratory infection: a prospective cohort study. Clin Microbiol Infect 2019; 25:1539-1545. [PMID: 31004768 PMCID: PMC7129190 DOI: 10.1016/j.cmi.2019.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 01/03/2019] [Revised: 04/05/2019] [Accepted: 04/10/2019] [Indexed: 01/23/2023]
Abstract
Objectives To determine the viral epidemiology and clinical characteristics of patients with and without clinically apparent respiratory tract infection. Methods This prospective cohort study was conducted during the 2018 winter influenza season. Adult patients with fever/respiratory symptoms (fever/RS group) were age- and sex-matched with patients without fever/RS (non-fever/RS group) in a 1:1 ratio. Respiratory viruses were tested using NxTAG™ Respiratory Pathogen Panel IVD, a commercially-available multiplex PCR panel. Results A total of 214 acutely hospitalized patients were included in the final analysis, consisting of 107 with fever/RS (fever/RS group), and 107 age- and sex-matched patients without fever/RS (non-fever/RS group). Respiratory viruses were detected in 34.1% (73/214) of patients, and co-infection occurred in 7.9% (17/214) of patients. The incidence of respiratory virus was higher in the fever/RS group than in the non-fever/RS group (44.9% (48/107) versus 23.4% (25/107), p 0.001). Influenza B virus, enterovirus/rhinovirus and coronaviruses were detected more frequently in the fever/RS group, whereas parainfluenza virus 4B and adenovirus were detected more frequently in the non-fever/RS group. Among the non-fever/RS group, chest discomfort was more common among patients tested positive for respiratory viruses than those without respiratory virus detected (44% (11/25) versus 22% (18/82), p 0.04). Conclusions Respiratory viruses can be frequently detected among hospitalized patients without typical features of respiratory tract infection. These patients may be a source of nosocomial outbreaks.
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Affiliation(s)
- K K W To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K-H Chan
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - J Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - P K P Pang
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - D T Y Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - A C H Chang
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - C W Seng
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - C C Y Yip
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - V C C Cheng
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - I F N Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - K-Y Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China; State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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10
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Cheng VCC, Chen JHK, So SYC, Wong SCY, Yan MK, Chau PH, Lee WM, To KKW, Chan JFW, Hung IFN, Ho PL, Yuen KY. Use of fluoroquinolones is the single most important risk factor for the high bacterial load in patients with nasal and gastrointestinal colonization by multidrug-resistant Acinetobacter baumannii. Eur J Clin Microbiol Infect Dis 2015; 34:2359-66. [PMID: 26373714 DOI: 10.1007/s10096-015-2489-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
Gastrointestinal colonization by carbapenem-resistant Acinetobacter baumannii (CRAB) and multidrug-resistant Acinetobacter baumannii (MRAB) provides an important reservoir for clinical infections and hospital outbreaks. We conducted a 7-month study in a 3200-bed healthcare network to investigate the prevalence of gastrointestinal colonization of CRAB and MRAB in Hong Kong. Between 1 June and 31 December 2014, a total of 17,760 fecal specimens from 9469 patients were screened. Testing showed that 340 (1.9%) specimens from 224 (2.6%) patients were CRAB-positive, which included 70 (0.39%) MRAB-positive specimens from 54 (0.57%) patients. The presence of wound or ulcer, use of broad-spectrum antibiotics in the preceding 6 months, and residence in elderly homes are independent risk factors for gastrointestinal colonization of CRAB. Quantitative bacterial counts in various body sites (rectal, nasal, axilla, wound, catheterized urine, if available) were performed in 33 (61.1%) of 54 MRAB patients. Ten (30.3%) and 8 (24.2%) patients had high bacterial load (defined as over 3 log10) in rectal and nasal swabs, with a median of 5.04 log10 cfu/ml of rectal swab and 4.89 log10 cfu/ml of nasal swab in saline diluent, respectively. Nine (81.8%) of 11 patients with wounds had high bacterial load in wound swabs, with a median of 5.62 log10 cfu/ml. Use of fluoroquinolones 6 months before admission was the only significant factor associated with high bacterial load in nasal and rectal swabs. With the implementation of directly observed hand hygiene before meals and medications to all conscious hospitalized patients, no hospital outbreaks were observed during our study period.
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Affiliation(s)
- V C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.,Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - J H K Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - S Y C So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - S C Y Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - M K Yan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - P H Chau
- School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - W M Lee
- Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K K W To
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - J F W Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - I F N Hung
- Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - P L Ho
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K Y Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
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11
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12
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Chan KH, Yan MK, To KKW, Lau SK, Woo PC, Cheng VCC, Li WS, Chan JFW, Tse H, Yuen KY. Use of the human colorectal adenocarcinoma (Caco-2) cell line for isolating respiratory viruses from nasopharyngeal aspirates. J Med Virol 2013; 85:874-9. [PMID: 23508913 PMCID: PMC7167083 DOI: 10.1002/jmv.23538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 12/24/2022]
Abstract
The human colorectal adenocarcinoma‐derived Caco‐2 cell line was evaluated as a means isolating common respiratory viruses from nasopharyngeal aspirates for the diagnosis of respiratory diseases. One hundred eighty‐nine direct immunofluorescence positive nasopharyngeal aspirates obtained from patients with various viral respiratory diseases were cultured in the presence of Caco‐2 cells or the following conventional cell lines: LLC‐MK2, MDCK, HEp‐2, and A549. Caco‐2 cell cultures effectively propagated the majority (84%) of the viruses present in nasopharyngeal aspirate samples compared with any positive cultures obtained using the panel cells (78%) or individual cell line MDCK (38%), HEp‐2 (21%), LLC‐MK2 (27%), or A549 (37%) cell lines. The differences against individual cell line were statistically significant (P = < 0.000001). Culture in Caco‐2 cells resulted in the isolation of 85% (36/42) of viruses which were not cultivated in conventional cell lines. By contrast, 80% (24/30) of viruses not cultivated in Caco‐2 cells were isolated using the conventional panel. The findings indicated that Caco‐2 cells were sensitive to a wide range of viruses and can be used to culture a broad range of respiratory viruses. J. Med. Virol. 85:874–879, 2013. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- K H Chan
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong, Hong Kong Special Administrative Region, China.
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13
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Gill H, Kwok H, To KKW, Ho PL, Mak HKF, Chim CS, Kwong YL. Positron emission tomography in the diagnosis of disseminated pyomyositis due to PVL-negative methicillin-resistant Staphylococcus aureus. QJM 2013; 106:485-6. [PMID: 22690009 DOI: 10.1093/qjmed/hcs088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Gill
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
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14
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Chan JFW, Wong SSY, Leung SSM, Fan RYY, Ngan AHY, To KKW, Lau SKP, Yuen KY, Woo PCY. First report of chronic implant-related septic arthritis and osteomyelitis due to Kytococcus schroeteri and a review of human K. schroeteri infections. Infection 2012; 40:567-73. [PMID: 22392020 PMCID: PMC3461212 DOI: 10.1007/s15010-012-0250-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/09/2012] [Indexed: 11/29/2022]
Abstract
We report the first case of Kytococcus schroeteri implant-related septic arthritis and osteomyelitis, identified by phenotypic tests and 16S rRNA sequencing, which responded to implant removal and doxycycline. 16S rRNA sequencing was useful for the accurate and rapid identification of the organism as it exhibited three different colonial morphologies in vitro.
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Affiliation(s)
- J. F. W. Chan
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
| | - S. S. Y. Wong
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong SAR China
| | - S. S. M. Leung
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
| | - R. Y. Y. Fan
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
| | - A. H. Y. Ngan
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
| | - K. K. W. To
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong SAR China
| | - S. K. P. Lau
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong SAR China
| | - K.-Y. Yuen
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong SAR China
| | - P. C. Y. Woo
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong SAR China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Research Centre of Infection and Immunology, The University of Hong Kong, Pokfulam, Hong Kong SAR China
- Carol Yu Centre for Infection, The University of Hong Kong, 102 Pokfulam Road, Pokfulam, Hong Kong SAR China
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15
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To KKW, Chan KH, Fung YF, Yuen KY, Ho PL. Azithromycin treatment failure in macrolide-resistant Mycoplasma pneumoniae pneumonia. Eur Respir J 2010; 36:969-71. [DOI: 10.1183/09031936.00041910] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Cheng VCC, Chan JFW, Tai JWM, Ho YY, Li IWS, To KKW, Ho PL, Yuen KY. Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region. Emerg Health Threats J 2010; 2:e9. [PMID: 22460290 PMCID: PMC3167649 DOI: 10.3134/ehtj.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Revised: 10/07/2009] [Accepted: 10/11/2009] [Indexed: 11/18/2022]
Abstract
Vancomycin-resistant enterococci (VRE) have emerged in many parts of the world, but have only been reported sporadically in Hong Kong. We report an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in a neurosurgical unit at a tertiary teaching hospital between 3 March and 3 April 2009 in Hong Kong. During the outbreak investigation, clinical samples from 193 (91.5%) of 211 patients who had stayed in the neurosurgical unit and 506 environmental samples were screened for VREfm. Besides the index case, another 3 (1.6%) out of 192 patients were found to be positive for VREfm. Two (0.4%) out of 506 environmental samples were positive for VREfm. All four clinical and two environmental isolates were found to be clonally related by pulse-field gel electrophoresis. The risk factors for nosocomial acquisition of VREfm included advanced age (P=0.047), presence of nasogastric tubing (P=0.002) and tracheostomy (P<0.001), and the use of β-lactam antibiotics (P<0.001) and vancomycin (P=0.001). Contrary to other VRE outbreaks in which the spread was rapid, the neurosurgical patients' immobilization because of coma and mechanical ventilation dependency, and the vigilant practice of hand hygiene by health-care workers successfully limited the number of secondary cases despite the delayed recognition of the index case. All patients with VREfm were labeled in the hospital network information system so that stringent infection control measures with contact precautions would be carried out once these patients were readmitted to prevent its spread in our locality.
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Affiliation(s)
- V C C Cheng
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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17
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Chan JFW, Tse H, To KKW, Li IWS, Tang BSF, Cheng VCC, Yuen KY. Q fever: underdiagnosed in Hong Kong? Hong Kong Med J 2010; 16:56-58. [PMID: 20124575] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report the first imported case of chronic Q fever with multi-organ involvement seen in Hong Kong. Although the disease is found worldwide, its chronic form is very rare in our locality. Familiarity with the clinical presentation, useful diagnostic tools, and appropriate treatment is necessary for the prevention of the serious morbidity and mortality associated with chronic Q fever. To the best of our knowledge, this article represents the first comprehensive review to compare the local experience with Q fever with international data, and establishes a management approach for this unusual infectious disease while suggesting possible explanations for its exceptionally low incidence in this locality.
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Affiliation(s)
- J F W Chan
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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18
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Cheng VCC, Tai JWM, Wong LMW, Chan JFW, Li IWS, To KKW, Hung IFN, Chan KH, Ho PL, Yuen KY. Prevention of nosocomial transmission of swine-origin pandemic influenza virus A/H1N1 by infection control bundle. J Hosp Infect 2010; 74:271-7. [PMID: 20061056 PMCID: PMC7118838 DOI: 10.1016/j.jhin.2009.09.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 09/04/2009] [Indexed: 02/04/2023]
Abstract
After the outbreak of severe acute respiratory syndrome in Hong Kong, the importance of preventing nosocomial transmission of respiratory viruses has become a top priority in infection control. During the containment and early mitigation phases of the swine-origin influenza virus (S-OIV) A H1N1 pandemic, an infection control bundle consisting of multiple coherent measures was organised by our infection control team to minimise nosocomial transmission. This included repeated open staff forum achieving high attendance; early recognition of index cases among inpatients by liberal testing; early relief of sick staff from work; directly observed hand hygiene practice during outbreaks; and monitoring of compliance with infection control practice. During the first 100 days (from 1 May to 8 August 2009) when the first 100 laboratory-confirmed patients with S-OIV and 12 infected healthcare workers (HCWs) were identified, a total of 836 asymptomatic exposed persons (184 patients and 652 HCWs) were required to undergo a seven-day medical surveillance. The infection control nurses monitored them for the onset of symptoms. Four (0.48%) exposed persons (one house officer, two non-clinical staff, and one patient) were virologically confirmed with S-OIV. Not wearing a surgical mask either by the exposed persons during contact with the index cases (4/4 vs 264/832, P = 0.010) or vice versa (4/4 vs 300/832, P = 0.017, Fisher's exact test) were found to be significant risk factors for nosocomial acquisition of S-OIV.
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Affiliation(s)
- V C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
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19
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Cheng VCC, Chan JFW, To KKW, Tai JWM, Ho PL. Detection of community-associated MRSA as a result of the unmasking effect of antibiotic treatment. J Hosp Infect 2009; 72:273-4. [PMID: 19446364 DOI: 10.1016/j.jhin.2009.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 03/20/2009] [Indexed: 11/30/2022]
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20
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Cheng VCC, Chan JFW, Tai JWM, Ho YY, Li IWS, To KKW, Ho PL, Yuen KY. Successful control of vancomycin-resistant Enterococcus faecium outbreak in a neurosurgical unit at non-endemic region. Emerging Health Threats Journal 2009. [DOI: 10.3402/ehtj.v2i0.7089] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- VCC Cheng
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China; and
- Infection Control Unit, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - JFW Chan
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China; and
| | - JWM Tai
- Infection Control Unit, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - YY Ho
- Infection Control Unit, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - IWS Li
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China; and
| | - KKW To
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China; and
| | - PL Ho
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China; and
| | - KY Yuen
- Carol Yu Centre for Infection, Queen Mary Hospital, Hong Kong Special Administrative Region, China; and
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21
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Cheng VCC, Li IWS, Wu AKL, Tang BSF, Ng KHL, To KKW, Tse H, Que TL, Ho PL, Yuen KY. Effect of antibiotics on the bacterial load of meticillin-resistant Staphylococcus aureus colonisation in anterior nares. J Hosp Infect 2008; 70:27-34. [PMID: 18632184 DOI: 10.1016/j.jhin.2008.05.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 05/09/2008] [Indexed: 10/21/2022]
Abstract
Prevalence of hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) infection or colonisation has been associated with antimicrobial consumption. The impact of antibiotic treatment on nasal colonisation is unknown. We conducted a three-month prospective study of 116 patients with extranasal MRSA infection or colonisation, whose nasal MRSA bacterial loads were determined during and after various antibiotic courses over a period of three weeks. Environmental swabs were also taken from the near patient environment. Concomitant nasal MRSA carriage was observed in 76.7% of extranasal MRSA-colonised or -infected patients. The median nasal MRSA bacterial load increased significantly from 2.78 (range 0-6.15) to 5.30 (range 2.90-8.41) log(10) cfu per swab (cfu/swab) (P<0.001) over 21 days during beta-lactam therapy. It also increased from 0 (range 0-4.00) to 4.30 (range 0-7.46) log(10)cfu/swab (P=0.039) over 14 days during fluoroquinolone therapy. Median bacterial loads were significantly higher for beta-lactam- and fluoroquinolone-treated patients on day 7 [4.78, range 0-7.30], day 14 [4.30, range 0-7.60] and day 21 [5.30, range 2.90-8.41] than controls not receiving antibiotics (P<0.05). These loads then decreased by 2-5log(10)cfu/swab 2 weeks after discontinuation of antibiotics. The environment of patients receiving beta-lactam agents (relative risk: 3.55; 95% confidence interval: 1.30-9.62; P=0.018) or fluoroquinolones (4.32; 1.52-12.31; P=0.008) demonstrated more MRSA contamination than the environment around control patients (0.79; 0.67-0.93; P=0.002). Patients on beta-lactam or fluoroquinolone therapy have increased incidence of MRSA colonisation and higher nasal bacterial loads, and appear to spread their MRSA into the near patient environment.
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Affiliation(s)
- V C C Cheng
- Department of Microbiology, Research Centre of Infection and Immunology, The University of Hong Kong, Hong Kong SAR, China
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22
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Calcagno AM, Fostel JM, To KKW, Salcido CD, Martin SE, Chewning KJ, Wu CP, Varticovski L, Bates SE, Caplen NJ, Ambudkar SV. Single-step doxorubicin-selected cancer cells overexpress the ABCG2 drug transporter through epigenetic changes. Br J Cancer 2008; 98:1515-24. [PMID: 18382425 PMCID: PMC2386965 DOI: 10.1038/sj.bjc.6604334] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [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] [Indexed: 01/26/2023] Open
Abstract
Understanding the mechanisms of multidrug resistance (MDR) could improve clinical drug efficacy. Multidrug resistance is associated with ATP binding cassette (ABC) transporters, but the factors that regulate their expression at clinically relevant drug concentrations are poorly understood. We report that a single-step selection with low doses of anti-cancer agents, similar to concentrations reported in vivo, induces MDR that is mediated exclusively by ABCG2. We selected breast, ovarian and colon cancer cells (MCF-7, IGROV-1 and S-1) after exposure to 14 or 21 nM doxorubicin for only 10 days. We found that these cells overexpress ABCG2 at the mRNA and protein levels. RNA interference analysis confirmed that ABCG2 confers drug resistance. Furthermore, ABCG2 upregulation was facilitated by histone hyperacetylation due to weaker histone deacetylase 1-promoter association, indicating that these epigenetic changes elicit changes in ABCG2 gene expression. These studies indicate that the MDR phenotype arises following low-dose, single-step exposure to doxorubicin, and further suggest that ABCG2 may mediate early stages of MDR development. This is the first report to our knowledge of single-step, low-dose selection leading to overexpression of ABCG2 by epigenetic changes in multiple cancer cell lines.
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Affiliation(s)
- A M Calcagno
- Laboratory of Cell Biology, Center for Cancer Research, National Cancer Institute, NIH, DHHS, Bethesda, MD 20892, USA
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