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Linn KZ, Sutjipto S, Ng OT, Teo J, Cherng BPZ, Tan TY, Pada SK, Ooi ST, Smitasin N, Thoon KC, Huan X, De PP, Chan D, Tee NWS, Ang M, Hsu LY, Lin RTP, Ng TY, Deepak RN, Koh TH, Apisarnthanarak A, Ponnampalavanar S, Venkatachalam I, Marimuthu K. Impact of COVID-19 pandemic on carbapenem-resistant Enterobacterales incidence in the South-East Asia region: an observational study. Antimicrob Steward Healthc Epidemiol 2023; 3:e208. [PMID: 38156208 PMCID: PMC10753475 DOI: 10.1017/ash.2023.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 12/30/2023]
Abstract
The COVID-19 pandemic led to an initial increase in the incidence of carbapenem-resistant Enterobacterales (CRE) from clinical cultures in South-East Asia hospitals, which was unsustained as the pandemic progressed. Conversely, there was a decrease in CRE incidence from surveillance cultures and overall combined incidence. Further studies are needed for future pandemic preparedness.
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Affiliation(s)
- Kyaw Zaw Linn
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Stephanie Sutjipto
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jeanette Teo
- National University Hospital and National University Health System, Singapore, Singapore
| | - Benjamin Pei Zhi Cherng
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | | | | | - Say Tat Ooi
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nares Smitasin
- National University Hospital and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Xiaowei Huan
- National Centre for Infectious Diseases, Singapore, Singapore
| | | | - Douglas Chan
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Nancy Wen Sim Tee
- National University Hospital and National University Health System, Singapore, Singapore
| | - Michelle Ang
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Li Yang Hsu
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore, Singapore
| | - Raymond Tzer Pin Lin
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- National Public Health Laboratory, Singapore, Singapore
| | | | | | - Tse Hsien Koh
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | | | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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Chen Y, Yong M, Li M, Si Z, Koh CH, Lau P, Chang YW, Teo J, Chan-Park MB, Gan YH. A hydrophilic polyimidazolium antibiotic targeting the membranes of Gram-negative bacteria. J Antimicrob Chemother 2023; 78:2581-2590. [PMID: 37671807 PMCID: PMC10545527 DOI: 10.1093/jac/dkad274] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/21/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES The rise of MDR Gram-negative bacteria (GNB), especially those resistant to last-resort drugs such as carbapenems and colistin, is a global health risk and calls for increased efforts to discover new antimicrobial compounds. We previously reported that polyimidazolium (PIM) compounds exhibited significant antimicrobial activity and minimal mammalian cytotoxicity. However, their mechanism of action is relatively unknown. We examined the efficacy and mechanism of action of a hydrophilic PIM (PIM5) against colistin- and meropenem-resistant clinical isolates. METHODS MIC and time-kill testing was performed for drug-resistant Escherichia coli and Klebsiella pneumoniae clinical isolates. N-phenyl-1-naphthylamine and propidium iodide dyes were employed to determine membrane permeabilization. Spontaneous resistant mutants and single deletion mutants were generated to understand potential resistance mechanisms to the drug. RESULTS PIM5 had the same effectiveness against colistin- and meropenem-resistant strains as susceptible strains of GNB. PIM5 exhibited a rapid bactericidal effect independent of bacterial growth phase and was especially effective in water. The polymer disrupts both the outer and cytoplasmic membranes. PIM5 binds and intercalates into bacterial genomic DNA upon entry of cells. GNB do not develop high resistance to PIM5. However, the susceptibility and uptake of the polymer is moderately affected by mutations in the two-component histidine kinase sensor BaeS. PIM5 has negligible cytotoxicity on human cells at bacterial-killing concentrations, comparable to the commercial antibiotics polymyxin B and colistin. CONCLUSIONS PIM5 is a potent broad-spectrum antibiotic targeting GNB resistant to last-resort antibiotics.
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Affiliation(s)
- Yahua Chen
- Infectious Diseases Translational Research Programme, Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Melvin Yong
- Infectious Diseases Translational Research Programme, Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Ming Li
- Infectious Diseases Translational Research Programme, Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Zhangyong Si
- School of Chemistry, Chemical and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Chong Hui Koh
- School of Chemistry, Chemical and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Pearlyn Lau
- Infectious Diseases Translational Research Programme, Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Yi Wei Chang
- Infectious Diseases Translational Research Programme, Department of Biochemistry, National University of Singapore, Singapore, Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Mary B Chan-Park
- School of Chemistry, Chemical and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Yunn-Hwen Gan
- Infectious Diseases Translational Research Programme, Department of Biochemistry, National University of Singapore, Singapore, Singapore
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3
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Mo Y, Ding Y, Cao Y, Hopkins J, Ashley EA, Waithira N, Wannapinij P, Lee SJ, Ling CL, Hamers RL, Roberts T, Lubell Y, Karkey A, Akech S, Lissauer S, Opintan J, Okeke I, Eremin S, Tornimbene B, Hsu LY, Thwaites L, Lam MY, Pham NT, Pham TK, Teo J, Kwa ALH, Marimuthu K, Ng OT, Vasoo S, Kitsaran S, Anunnatsiri S, Kosalaraksa P, Chotiprasitsakul D, Santanirand P, Plongla R, Chua HH, Tiong XT, Wong KJ, Ponnampalavanar SSLS, Sulaiman HB, Mazlan MZ, Salmuna ZN, Rajahram GS, Zaili MZBM, Francis JR, Sarmento N, Guterres H, Oakley T, Yan J, Tilman A, Khalid MOR, Hashmi M, Mahmood SF, Dhiloo AK, Fatima A, Lubis IND, Wijaya H, Abad CL, Roman AD, Lazarte CCM, Mamun GMS, Asli R, Momin MHFBHA, Nyamdavaa K, Gurjav U, Bory S, Varghese GM, Gupta L, Tantia P, Sinto R, Doi Y, Khanal B, Malijan G, Lazaro J, Gunasekara S, Withanage S, Liu PY, Xiao Y, Wang M, Paterson DL, van Doorn HR, Turner P. ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance. Wellcome Open Res 2023; 8:179. [PMID: 37854055 PMCID: PMC10579854 DOI: 10.12688/wellcomeopenres.19210.2] [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] [Accepted: 06/22/2023] [Indexed: 10/20/2023] Open
Abstract
Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.
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Affiliation(s)
- Yin Mo
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
- Division of Infectious Diseases, National University Hospital, Singapore, Singapore, 119074, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Ying Ding
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Yang Cao
- Singapore Clinical Research Institute, Singapore, 139234, Singapore
| | - Jill Hopkins
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| | - Elizabeth A. Ashley
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Naomi Waithira
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Prapass Wannapinij
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Sue J. Lee
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Claire L. Ling
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
| | - Raph L. Hamers
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit (OUCRU) Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tamalee Roberts
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Yoel Lubell
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, 10400, Thailand
| | - Abhilasha Karkey
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit (OUCRU) Indonesia, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Samuel Akech
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Samantha Lissauer
- Liverpool School of Tropical Medicine (LSTM), University of Liverpool, Liverpool, England, UK
- Malawi-Liverpool-Wellcome Trust (MLW) Clinical Research Programme, Blantyre, Malawi
| | | | | | | | | | - Li Yang Hsu
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Louise Thwaites
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Minh Yen Lam
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Tieu Kieu Pham
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Jeanette Teo
- Department of laboratory Medicine, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Andrea Lay-Hoon Kwa
- Pharmacy (Research), Singapore General Hospital, Singapore, Singapore
- Emerging Infectious Diseases Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Department of Infectious Disease, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Siriluck Anunnatsiri
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Nai Mueang, Khon Kaen, Thailand
| | | | | | - Rongpong Plongla
- King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Ke Juin Wong
- Sabah Women and Children's Hospital, Kota Kinabalu, Malaysia
| | | | | | - Mohd Zulfakar Mazlan
- Department of Anesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Zeti Norfidiyati Salmuna
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | | | - Joshua R. Francis
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Nevio Sarmento
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
- Laboratorio Nacional da Saude, Ministerio da Saude, Dili, Timor-Leste
| | | | - Tessa Oakley
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Menzies school of health research, Charles Darwin University, Dili, Timor-Leste
| | - Ari Tilman
- Laboratorio Nacional da Saude, Ministerio da Saude, Dili, Timor-Leste
| | | | - Madiha Hashmi
- Dr. Ziauddin Hospital Clifton Campus, Karachi, Pakistan
| | | | | | | | - Inke Nadia D. Lubis
- Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
| | - Hendri Wijaya
- Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, Indonesia
- General Hospital H. Adam Malik, Medan, Indonesia
| | | | | | - Cecilia C. Maramba Lazarte
- Philippine General Hospital, Manila, Philippines
- University of the Philippines Manila, Manila, Metro Manila, Philippines
| | | | - Rosmonaliza Asli
- Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei-Muara District, Brunei
| | | | | | - Ulziijargal Gurjav
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Lalit Gupta
- Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pratik Tantia
- Ananta Institute of Medical Sciences and Research Center, Siyol, India
| | - Robert Sinto
- Cipto Mangunkusumo National Hospital, Faculty of Medicine, Universitas Indonesia, Depok, West Java, Indonesia
| | - Yohei Doi
- Fujita Health University Hospital, Toyoake, Japan
| | - Basudha Khanal
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Greco Malijan
- San Lazaro Hospital, Nagasaki University Collaborative Research Office, Manila, Philippines
| | - Jezreel Lazaro
- Hospital Infection Control Unit, San Lazaro Hospital, Manila, Philippines
| | | | | | - Po Yu Liu
- Taichung Veteran General Hospital, Taichung City, Vietnam
| | - Yonghong Xiao
- The First Affiliated Hospital Of Zhejiang University School Of Medicine, Hangzhou, China
| | - Minggui Wang
- Huashan Hospital, Fudan University, Shanghai, China
| | - David L. Paterson
- ADVANCE-ID, Saw Swee Hock School Of Public Health, National University of Singapore, Singapore, 117549, Singapore
- Department of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - H. Rogier van Doorn
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Paul Turner
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, 171020, Cambodia
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4
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Chan N, Sibtain N, Booth T, de Souza P, Bibby S, Mah YH, Teo J, U-King-Im JM. Machine-learning algorithm in acute stroke: real-world experience. Clin Radiol 2023; 78:e45-e51. [PMID: 36411087 DOI: 10.1016/j.crad.2022.10.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/04/2022] [Accepted: 10/15/2022] [Indexed: 11/19/2022]
Abstract
AIM To assess the clinical performance of a commercially available machine learning (ML) algorithm in acute stroke. MATERIALS AND METHODS CT and CT angiography (CTA) studies of 104 consecutive patients (43 females, age range 19-93, median age 62) performed for suspected acute stroke at a single tertiary institution with real-time ML software analysis (RAPID™ ASPECTS and CTA) were included. Studies were retrospectively reviewed independently by two neuroradiologists in a blinded manner. RESULTS The cohort included 24 acute infarcts and 16 large vessel occlusions (LVO). RAPID™ ASPECTS interpretation demonstrated high sensitivity (87.5%) and NPV (87.5%) but very poor specificity (30.9%) and PPV (30.9%) for detection of acute ischaemic parenchymal changes. There was a high percentage of false positives (51.1%). In cases of proven LVO, RAPID™ ASPECTS showed good correlation with neuroradiologists' blinded independent interpretation, Pearson correlation coefficient = 0.96 (both readers), 0.63 (RAPID™ vs reader 1), 0.69 (RAPID™ vs reader 2). RAPID™ CTA interpretation demonstrated high sensitivity (92.3%), specificity (85.3%), and negative predictive (NPV) (98.5%) with moderate positive predictive value (PPV) (52.2%) for detection of LVO (N=13). False positives accounted for 12.5% of cases, of which 27.3% were attributed to arterial stenosis. CONCLUSION RAPID™ CTA was robust and reliable in detection of LVO. Although demonstrating high sensitivity and NPV, RAPID™ ASPECTS interpretation was associated with a high number of false positives, which decreased clinicians' confidence in the algorithm. However, in cases of proven LVO, RAPID™ ASPECTS performed well and had good correlation with neuroradiologists' blinded interpretation.
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Affiliation(s)
- N Chan
- Department of Neuroradiology, King's College Hospital, London, UK; Department of Interventional Neuroradiology, The Royal London Hospital, London, UK.
| | - N Sibtain
- Department of Neuroradiology, King's College Hospital, London, UK
| | - T Booth
- Department of Neuroradiology, King's College Hospital, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - P de Souza
- Department of Neuroradiology, The Royal London Hospital, London, UK
| | - S Bibby
- Department of Neuroradiology, King's College Hospital, London, UK
| | - Y-H Mah
- Department of Neurology, King's College Hospital, London, UK
| | - J Teo
- Department of Neurology, King's College Hospital, London, UK
| | - J M U-King-Im
- Department of Neuroradiology, King's College Hospital, London, UK
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5
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Roaldsen MB, Eltoft A, Wilsgaard T, Christensen H, Engelter ST, Indredavik B, Jatužis D, Karelis G, Kõrv J, Lundström E, Petersson J, Putaala J, Søyland MH, Tveiten A, Bivard A, Johnsen SH, Mazya MV, Werring DJ, Wu TY, De Marchis GM, Robinson TG, Mathiesen EB, Valente M, Chen A, Sharobeam A, Edwards L, Blair C, Christensen L, Ægidius K, Pihl T, Fassel-Larsen C, Wassvik L, Folke M, Rosenbaum S, Gharehbagh SS, Hansen A, Preisler N, Antsov K, Mallene S, Lill M, Herodes M, Vibo R, Rakitin A, Saarinen J, Tiainen M, Tumpula O, Noppari T, Raty S, Sibolt G, Nieminen J, Niederhauser J, Haritoncenko I, Puustinen J, Haula TM, Sipilä J, Viesulaite B, Taroza S, Rastenyte D, Matijosaitis V, Vilionskis A, Masiliunas R, Ekkert A, Chmeliauskas P, Lukosaitis V, Reichenbach A, Moss TT, Nilsen HY, Hammer-Berntzen R, Nordby LM, Weiby TA, Nordengen K, Ihle-Hansen H, Stankiewiecz M, Grotle O, Nes M, Thiemann K, Særvold IM, Fraas M, Størdahl S, Horn JW, Hildrum H, Myrstad C, Tobro H, Tunvold JA, Jacobsen O, Aamodt N, Baisa H, Malmberg VN, Rohweder G, Ellekjær H, Ildstad F, Egstad E, Helleberg BH, Berg HH, Jørgensen J, Tronvik E, Shirzadi M, Solhoff R, Van Lessen R, Vatne A, Forselv K, Frøyshov H, Fjeldstad MS, Tangen L, Matapour S, Kindberg K, Johannessen C, Rist M, Mathisen I, Nyrnes T, Haavik A, Toverud G, Aakvik K, Larsson M, Ytrehus K, Ingebrigtsen S, Stokmo T, Helander C, Larsen IC, Solberg TO, Seljeseth YM, Maini S, Bersås I, Mathé J, Rooth E, Laska AC, Rudberg AS, Esbjörnsson M, Andler F, Ericsson A, Wickberg O, Karlsson JE, Redfors P, Jood K, Buchwald F, Mansson K, Gråhamn O, Sjölin K, Lindvall E, Cidh Å, Tolf A, Fasth O, Hedström B, Fladt J, Dittrich TD, Kriemler L, Hannon N, Amis E, Finlay S, Mitchell-Douglas J, McGee J, Davies R, Johnson V, Nair A, Robinson M, Greig J, Halse O, Wilding P, Mashate S, Chatterjee K, Martin M, Leason S, Roberts J, Dutta D, Ward D, Rayessa R, Clarkson E, Teo J, Ho C, Conway S, Aissa M, Papavasileiou V, Fry S, Waugh D, Britton J, Hassan A, Manning L, Khan S, Asaipillai A, Fornolles C, Tate ML, Chenna S, Anjum T, Karunatilake D, Foot J, VanPelt L, Shetty A, Wilkes G, Buck A, Jackson B, Fleming L, Carpenter M, Jackson L, Needle A, Zahoor T, Duraisami T, Northcott K, Kubie J, Bowring A, Keenan S, Mackle D, England T, Rushton B, Hedstrom A, Amlani S, Evans R, Muddegowda G, Remegoso A, Ferdinand P, Varquez R, Davis M, Elkin E, Seal R, Fawcett M, Gradwell C, Travers C, Atkinson B, Woodward S, Giraldo L, Byers J, Cheripelli B, Lee S, Marigold R, Smith S, Zhang L, Ghatala R, Sim CH, Ghani U, Yates K, Obarey S, Willmot M, Ahlquist K, Bates M, Rashed K, Board S, Andsberg G, Sundayi S, Garside M, Macleod MJ, Manoj A, Hopper O, Cederin B, Toomsoo T, Gross-Paju K, Tapiola T, Kestutis J, Amthor KF, Heermann B, Ottesen V, Melum TA, Kurz M, Parsons M, Valente M, Chen A, Sharobeam A, Edwards L, Blair C. Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial. Lancet Neurol 2023; 22:117-126. [PMID: 36549308 DOI: 10.1016/s1474-4422(22)00484-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. METHODS TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014-000096-80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). FINDINGS From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9-81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88-1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74-2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53-8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67-1·94; p=0·64). INTERPRETATION In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. FUNDING Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health.
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Affiliation(s)
- Melinda B Roaldsen
- Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway
| | - Agnethe Eltoft
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology and Neurorehabilitation, University of Basel, Basel, Switzerland; University Department of Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Bent Indredavik
- Department of Medicine, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway; Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dalius Jatužis
- Faculty of Medicine, Vilnius University, Center of Neurology, Vilnius, Lithuania
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia; Rīga Stradiņš University, Riga, Latvia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Erik Lundström
- Department of Medicine and Neurology, Uppsala University, Uppsala, Sweden
| | - Jesper Petersson
- Department of Neurology, Lund University, Institute for Clinical Sciences Lund, Lund, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Mary-Helen Søyland
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway; Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Arnstein Tveiten
- Department of Neurology, Hospital of Southern Norway, Kristiansand, Norway
| | - Andrew Bivard
- Department of Medicine, Royal Melbourne Hospital, Melbourne Brain Centre, Melbourne, VIC, Australia
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - David J Werring
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Gian Marco De Marchis
- Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University of Basel, Basel, Switzerland
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ellisiv B Mathiesen
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.
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Chew KL, Cabang JC, Teo J. Limited in vitro susceptibility of drug-resistant non-fermenting Gram-negative organisms against newer generation antibiotics. Pathology 2022; 55:583-587. [PMID: 36567162 DOI: 10.1016/j.pathol.2022.09.007] [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] [Received: 05/08/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Joey Cruz Cabang
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
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Yong M, Chen Y, Oo G, Chang KC, Chu WHW, Teo J, Venkatachalam I, Thevasagayam NM, Sridatta PSR, Koh V, Marcoleta AE, Chen H, Nagarajan N, Kalisvar M, Ng OT, Gan YH. Dominant Carbapenemase-Encoding Plasmids in Clinical Enterobacterales Isolates and Hypervirulent Klebsiella pneumoniae, Singapore. Emerg Infect Dis 2022; 28:1578-1588. [PMID: 35876475 PMCID: PMC9328930 DOI: 10.3201/eid2808.212542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Dissemination of carbapenemase-encoding plasmids by horizontal gene transfer in multidrug-resistant bacteria is the major driver of rising carbapenem-resistance, but the conjugative mechanics and evolution of clinically relevant plasmids are not yet clear. We performed whole-genome sequencing on 1,215 clinical Enterobacterales isolates collected in Singapore during 2010–2015. We identified 1,126 carbapenemase-encoding plasmids and discovered pKPC2 is becoming the dominant plasmid in Singapore, overtaking an earlier dominant plasmid, pNDM1. pKPC2 frequently conjugates with many Enterobacterales species, including hypervirulent Klebsiella pneumoniae, and maintains stability in vitro without selection pressure and minimal adaptive sequence changes. Furthermore, capsule and decreasing taxonomic relatedness between donor and recipient pairs are greater conjugation barriers for pNDM1 than pKPC2. The low fitness costs pKPC2 exerts in Enterobacterales species indicate previously undetected carriage selection in other ecological settings. The ease of conjugation and stability of pKPC2 in hypervirulent K. pneumoniae could fuel spread into the community.
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Zajmi A, Teo J, Yeo CC. Epidemiology and Characteristics of Elizabethkingia spp. Infections in Southeast Asia. Microorganisms 2022; 10:microorganisms10050882. [PMID: 35630327 PMCID: PMC9144721 DOI: 10.3390/microorganisms10050882] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Received: 04/08/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 02/04/2023] Open
Abstract
Elizabethkingia spp. is a ubiquitous pathogenic bacterium that has been identified as the causal agent for a variety of conditions such as meningitis, pneumonia, necrotizing fasciitis, endophthalmitis, and sepsis and is emerging as a global threat including in Southeast Asia. Elizabethkingia infections tend to be associated with high mortality rates (18.2–41%) and are mostly observed in neonates and immunocompromised patients. Difficulties in precisely identifying Elizabethkingia at the species level by traditional methods have hampered our understanding of this genus in human infections. In Southeast Asian countries, hospital outbreaks have usually been ascribed to E. meningoseptica, whereas in Singapore, E. anophelis was reported as the main Elizabethkingia spp. associated with hospital settings. Misidentification of Elizabethkingia spp. could, however, underestimate the number of cases attributed to the bacterium, as precise identification requires tools such as MALDI-TOF MS, and particularly whole-genome sequencing, which are not available in most hospital laboratories. Elizabethkingia spp. has an unusual antibiotic resistance pattern for a Gram-negative bacterium with a limited number of horizontal gene transfers, which suggests an intrinsic origin for its multidrug resistance. Efforts to prevent and further understand Elizabethkingia spp. infections and limit its spread must rise to this new challenge.
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Affiliation(s)
- Asdren Zajmi
- Centre for Research in Infectious Diseases and Biotechnology (CeRIDB), Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 20400, Malaysia;
- Faculty of Health and Life Sciences, Management and Science University, Seksyen 13, Shah Alam 40100, Malaysia
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Chew Chieng Yeo
- Centre for Research in Infectious Diseases and Biotechnology (CeRIDB), Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 20400, Malaysia;
- Correspondence: ; Tel.: +60-9-627-5506
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Chew KL, Soh P, Octavia S, Teo J. Identification of Mycobacterium abscessus to subspecies level with Bruker MALDI Biotyper. Pathology 2022; 54:795-797. [DOI: 10.1016/j.pathol.2021.11.014] [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: 09/27/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
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10
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Lye P, Cheng J, Lum L, Lee Chew K, Teo J, Chew KL. Muyocopron laterale: Invasive human infection of a plant pathogen in an immunocompromised host. Clin Microbiol Infect 2022; 28:1351-1352. [PMID: 35017064 DOI: 10.1016/j.cmi.2022.01.003] [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] [Received: 11/07/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Priscillia Lye
- Department of Medicine, National University Hospital, Singapore
| | - Janet Cheng
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Lionel Lum
- Department of Medicine, National University Hospital, Singapore
| | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore.
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Chew KL, Octavia S, Go J, Ng S, Tang YE, Soh P, Yong J, Jureen R, Lin RTP, Yeoh SF, Teo J. In vitro susceptibility of Mycobacterium abscessus complex and feasibility of standardizing treatment regimens. J Antimicrob Chemother 2021; 76:973-978. [PMID: 33338230 DOI: 10.1093/jac/dkaa520] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the in vitro susceptibility of members of the Mycobacterium abscessus complex to routinely tested antibiotics and to an extended antibiotic panel. METHODS Non-duplicate isolates for which susceptibility testing results were available were included in this study. Retrospective laboratory records were reviewed, including tigecycline susceptibility results, and testing was performed with additional drugs, including vancomycin, dalbavancin, telavancin, oritavancin, rifabutin, delafloxacin, eravacycline, clofazimine and bedaquiline using broth microdilution (Sensititre, Thermo Fisher). RESULTS A total of 218 M. abscessus complex isolates were included for retrospective review, of which 151 were respiratory isolates. Of these 218 isolates, 211 were available for additional testing with the extended antibiotic panel. Of these, 146 were respiratory isolates. One isolate had a vancomycin MIC of 2 mg/L and MICs of all other isolates were >8 mg/L. All isolates had MICs of >8 mg/L for oritavancin, dalbavancin and telavancin. One isolate had a delafloxacin MIC of 4 mg/L and MICs of all other isolates were >8 mg/L. The MIC50/MIC90s of rifabutin, tigecycline, eravacycline, clofazimine and bedaquiline were 16/32, 0.5/1, 0.12/0.25, 0.12/0.25 and 0.06/0.12 mg/L, respectively. CONCLUSIONS In vitro activity was demonstrated for clofazimine, bedaquiline and eravacycline, indicating potential for inclusion as standardized therapy for M. abscessus complex infections.
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Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Sophie Octavia
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Joelle Go
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Sally Ng
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Yit Er Tang
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Patsy Soh
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Joy Yong
- Department of Pharmacy, National University Hospital, Singapore, Republic of Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Raymond Tzer Pin Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Siang Fei Yeoh
- Department of Pharmacy, National University Hospital, Singapore, Republic of Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
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Quen MTZ, Mountstephens J, Teh YG, Teo J. Medical image interpretation training with a low‐cost eye tracking and feedback system: A preliminary study. Healthc Technol Lett 2021. [DOI: 10.1049/htl2.12014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Mathieson Tan Zui Quen
- Faculty of Computing and Informatics Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
| | - J. Mountstephens
- Faculty of Computing and Informatics Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
| | - Yong Guang Teh
- Faculty of Medicine and Health Sciences Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
| | - J. Teo
- Faculty of Computing and Informatics Universiti Malaysia Sabah Kota Kinabalu Sabah Malaysia
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Chen Y, Marimuthu K, Teo J, Venkatachalam I, Cherng BPZ, De Wang L, Prakki SRS, Xu W, Tan YH, Nguyen LC, Koh TH, Ng OT, Gan YH. Acquisition of Plasmid with Carbapenem-Resistance Gene bla KPC2 in Hypervirulent Klebsiella pneumoniae, Singapore. Emerg Infect Dis 2021; 26:549-559. [PMID: 32091354 PMCID: PMC7045839 DOI: 10.3201/eid2603.191230] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The convergence of carbapenem-resistance and hypervirulence genes in Klebsiella pneumoniae has led to the emergence of highly drug-resistant superbugs capable of causing invasive disease. We analyzed 556 carbapenem-resistant K. pneumoniae isolates from patients in Singapore hospitals during 2010-2015 and discovered 18 isolates from 7 patients also harbored hypervirulence features. All isolates contained a closely related plasmid (pKPC2) harboring blaKPC-2, a K. pneumoniae carbapenemase gene, and had a hypervirulent background of capsular serotypes K1, K2, and K20. In total, 5 of 7 first patient isolates were hypermucoviscous, and 6 were virulent in mice. The pKPC2 was highly transmissible and remarkably stable, maintained in bacteria within a patient with few changes for months in the absence of antimicrobial drug selection pressure. Intrapatient isolates were also able to acquire additional antimicrobial drug resistance genes when inside human bodies. Our results highlight the potential spread of carbapenem-resistant hypervirulent K. pneumoniae in Singapore.
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Juhas M, Widlake E, Teo J, Huseby DL, Tyrrell JM, Polikanov YS, Ercan O, Petersson A, Cao S, Aboklaish AF, Rominski A, Crich D, Böttger EC, Walsh TR, Hughes D, Hobbie SN. In vitro activity of apramycin against multidrug-, carbapenem- and aminoglycoside-resistant Enterobacteriaceae and Acinetobacter baumannii. J Antimicrob Chemother 2020; 74:944-952. [PMID: 30629184 PMCID: PMC6419615 DOI: 10.1093/jac/dky546] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/17/2018] [Accepted: 11/29/2018] [Indexed: 02/01/2023] Open
Abstract
Objectives Widespread antimicrobial resistance often limits the availability of therapeutic options to only a few last-resort drugs that are themselves challenged by emerging resistance and adverse side effects. Apramycin, an aminoglycoside antibiotic, has a unique chemical structure that evades almost all resistance mechanisms including the RNA methyltransferases frequently encountered in carbapenemase-producing clinical isolates. This study evaluates the in vitro activity of apramycin against multidrug-, carbapenem- and aminoglycoside-resistant Enterobacteriaceae and Acinetobacter baumannii, and provides a rationale for its superior antibacterial activity in the presence of aminoglycoside resistance determinants. Methods A thorough antibacterial assessment of apramycin with 1232 clinical isolates from Europe, Asia, Africa and South America was performed by standard CLSI broth microdilution testing. WGS and susceptibility testing with an engineered panel of aminoglycoside resistance-conferring determinants were used to provide a mechanistic rationale for the breadth of apramycin activity. Results MIC distributions and MIC90 values demonstrated broad antibacterial activity of apramycin against Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., Morganella morganii, Citrobacter freundii, Providencia spp., Proteus mirabilis, Serratia marcescens and A. baumannii. Genotypic analysis revealed the variety of aminoglycoside-modifying enzymes and rRNA methyltransferases that rendered a remarkable proportion of clinical isolates resistant to standard-of-care aminoglycosides, but not to apramycin. Screening a panel of engineered strains each with a single well-defined resistance mechanism further demonstrated a lack of cross-resistance to gentamicin, amikacin, tobramycin and plazomicin. Conclusions Its superior breadth of activity renders apramycin a promising drug candidate for the treatment of systemic Gram-negative infections that are resistant to treatment with other aminoglycoside antibiotics.
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Affiliation(s)
- Mario Juhas
- Institute of Medical Microbiology, University of Zürich, Gloriastrasse 30, Zürich, Switzerland
| | - Emma Widlake
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - Douglas L Huseby
- Department of Medical Biochemistry and Microbiology, Uppsala University, Husargatan 3, Uppsala, Sweden
| | - Jonathan M Tyrrell
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Yury S Polikanov
- Department of Biological Sciences, College of Liberal Arts and Sciences, University of Illinois at Chicago, 900 South Ashland Avenue, MBRB 4170, Chicago, IL, USA
| | - Onur Ercan
- Department of Medical Biochemistry and Microbiology, Uppsala University, Husargatan 3, Uppsala, Sweden
| | - Anna Petersson
- Department of Medical Biochemistry and Microbiology, Uppsala University, Husargatan 3, Uppsala, Sweden
| | - Sha Cao
- Department of Medical Biochemistry and Microbiology, Uppsala University, Husargatan 3, Uppsala, Sweden
| | - Ali F Aboklaish
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Rominski
- Institute of Medical Microbiology, University of Zürich, Gloriastrasse 30, Zürich, Switzerland
| | - David Crich
- Department of Chemistry, Wayne State University, 5101 Cass Ave, Detroit, MI, USA
| | - Erik C Böttger
- Institute of Medical Microbiology, University of Zürich, Gloriastrasse 30, Zürich, Switzerland
| | - Timothy R Walsh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Diarmaid Hughes
- Department of Medical Biochemistry and Microbiology, Uppsala University, Husargatan 3, Uppsala, Sweden
| | - Sven N Hobbie
- Institute of Medical Microbiology, University of Zürich, Gloriastrasse 30, Zürich, Switzerland
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15
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Ho PL, Ong HK, Teo J, Ow DSW, Chao SH. HEXIM1 Peptide Exhibits Antimicrobial Activity Against Antibiotic Resistant Bacteria Through Guidance of Cell Penetrating Peptide. Front Microbiol 2019; 10:203. [PMID: 30800117 PMCID: PMC6376162 DOI: 10.3389/fmicb.2019.00203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/24/2019] [Indexed: 12/16/2022] Open
Abstract
The emergence of antibiotic resistant bacteria is one of the biggest threats to human health worldwide. In 2017, World Health Organization listed the world’s most dangerous antibiotic-resistant bacteria or “superbugs,” such as carbapenem-resistant Pseudomonas aeruginosa and Escherichia coli, indicating the highest priority needs for new antibiotics. The possibility that such infectious diseases may soon be untreatable, due to decreased antibiotic efficacy, creates an urgent need for novel and alternative antimicrobials. Antimicrobial peptides are naturally occurring small molecules found in the innate immunity of mammals, plants and bacteria, and are potentially therapeutic candidates against drug-resistant bacteria. In this study, we examine the antimicrobial activities of the cytotoxic peptides derived from the basic region (BR) of the human hexamethylene bisacetamide-inducible protein 1 (HEXIM1). We found that, when fused with a cell penetrating peptide, the HEXIM1 BR peptide and its derivative, BR-RRR12, exhibited inhibitory activities against selected “superbugs.” Negligible effects on the viability of human keratinocyte cell line were observed when the bactericidal dosages of HEXIM1 BR peptides were used. Different killing kinetics were observed between the membrane permeabilizing antimicrobial peptides and HEXIM1 BR peptides, suggesting that a different antimicrobial mechanism might be utilized by the HEXIM1 BR peptides. Using an in vitro translation system based on E. coli lysates, we found that HEXIM1 BR peptides blocked bacterial translation. Taken together, we identify the HEXIM1 BR peptide as a novel antimicrobial peptide with potent inhibitory activity against antibiotic-resistant “superbugs.”
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Affiliation(s)
- Pooi Leng Ho
- Microbial Cells, Bioprocessing Technology Institute, Agency for Science, Technology and Research, Singapore, Singapore
| | - Han Kee Ong
- Expression Engineering Groups, Bioprocessing Technology Institute, Agency for Science, Technology and Research, Singapore, Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Dave Siak-Wei Ow
- Microbial Cells, Bioprocessing Technology Institute, Agency for Science, Technology and Research, Singapore, Singapore
| | - Sheng-Hao Chao
- Expression Engineering Groups, Bioprocessing Technology Institute, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
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16
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Tran TT, Vidaillac C, Yu H, Yong VFL, Roizman D, Chandrasekaran R, Lim AYH, Low TB, Tan GL, Abisheganaden JA, Koh MS, Teo J, Chotirmall SH, Hadinoto K. A new therapeutic avenue for bronchiectasis: Dry powder inhaler of ciprofloxacin nanoplex exhibits superior ex vivo mucus permeability and antibacterial efficacy to its native ciprofloxacin counterpart. Int J Pharm 2018; 547:368-376. [PMID: 29886096 DOI: 10.1016/j.ijpharm.2018.06.017] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/14/2018] [Accepted: 06/06/2018] [Indexed: 01/09/2023]
Abstract
Non-cystic fibrosis bronchiectasis (NCFB) characterized by permanent bronchial dilatation and recurrent infections has been clinically managed by long-term intermittent inhaled antibiotic therapy among other treatments. Herein we investigated dry powder inhaler (DPI) formulation of ciprofloxacin (CIP) nanoplex with mannitol/lactose as the excipient for NCFB therapy. The DPI of CIP nanoplex was evaluated against DPI of native CIP in terms of their (1) dissolution characteristics in artificial sputum medium, (2) ex vivo mucus permeability in sputum from NCFB and healthy individuals, (3) antibacterial efficacy in the presence of sputum against clinical Pseudomonas aeruginosa strains (planktonic and biofilm), and (4) cytotoxicity towards human lung epithelial cells. Despite their similarly fast dissolution rates in sputum, the DPI of CIP nanoplex exhibited superior mucus permeability to the native CIP (5-7 times higher) attributed to its built-in ability to generate highly supersaturated CIP concentration in the sputum. The superior mucus permeability led to the CIP nanoplex's higher antibacterial efficacy (>3 log10 CFU/mL). The DPI of CIP nanoplex exhibited similar cytotoxicity towards the lung epithelial cells as the native CIP indicating its low risk of toxicity. These results established the promising potential of DPI of CIP nanoplex as a new therapeutic avenue for NCFB.
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Affiliation(s)
- The-Thien Tran
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore
| | - Celine Vidaillac
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Hong Yu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore
| | - Valerie F L Yong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dan Roizman
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | | | - Albert Y H Lim
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Teck Boon Low
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Gan Liang Tan
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - John A Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Kunn Hadinoto
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore 637459, Singapore.
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17
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Yang S, Long V, Liau M, Lee S, Toh M, Teo J, Tan C, Aw D. A profile ofPropionibacterium acnesresistance and sensitivity at a tertiary dermatological centre in Singapore. Br J Dermatol 2018; 179:200-201. [DOI: 10.1111/bjd.16380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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)
- S.S. Yang
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | | | - M.M. Liau
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - S.H. Lee
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - M. Toh
- National University of Singapore; Singapore Singapore
| | - J. Teo
- Laboratory Medicine; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - C. Tan
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
| | - D. Aw
- Dermatology; National University Hospital Singapore; 1E Kent Ridge Rd Singapore 119228 Singapore
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18
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Lange B, Khan P, Kalmambetova G, Al-Darraji HA, Alland D, Antonenka U, Brown T, Balcells ME, Blakemore R, Denkinger CM, Dheda K, Hoffmann H, Kadyrov A, Lemaitre N, Miller MB, Nikolayevskyy V, Ntinginya EN, Ozkutuk N, Palacios JJ, Popowitch EB, Porcel JM, Teo J, Theron G, Kranzer K. Diagnostic accuracy of the Xpert ® MTB/RIF cycle threshold level to predict smear positivity: a meta-analysis. Int J Tuberc Lung Dis 2018; 21:493-502. [PMID: 28399963 DOI: 10.5588/ijtld.16.0702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Xpert® MTB/RIF is the most widely used molecular assay for rapid diagnosis of tuberculosis (TB). The number of polymerase chain reaction cycles after which detectable product is generated (cycle threshold value, CT) correlates with the bacillary burden.OBJECTIVE To investigate the association between Xpert CT values and smear status through a systematic review and individual-level data meta-analysis. DESIGN Studies on the association between CT values and smear status were included in a descriptive systematic review. Authors of studies including smear, culture and Xpert results were asked for individual-level data, and receiver operating characteristic curves were calculated. RESULTS Of 918 citations, 10 were included in the descriptive systematic review. Fifteen data sets from studies potentially relevant for individual-level data meta-analysis provided individual-level data (7511 samples from 4447 patients); 1212 patients had positive Xpert results for at least one respiratory sample (1859 samples overall). ROC analysis revealed an area under the curve (AUC) of 0.85 (95%CI 0.82-0.87). Cut-off CT values of 27.7 and 31.8 yielded sensitivities of 85% (95%CI 83-87) and 95% (95%CI 94-96) and specificities of 67% (95%CI 66-77) and 35% (95%CI 30-41) for smear-positive samples. CONCLUSION Xpert CT values and smear status were strongly associated. However, diagnostic accuracy at set cut-off CT values of 27.7 or 31.8 would not replace smear microscopy. How CT values compare with smear microscopy in predicting infectiousness remains to be seen.
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Affiliation(s)
- B Lange
- Centre for Chronic Immunodeficiency, Division of Infectious Diseases, Department of Internal Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - P Khan
- London School of Hygiene & Tropical Medicine, London, UK
| | - G Kalmambetova
- National TB Reference Laboratory, National Centre of Phthisiology, Bishkek, Kyrgyzstan
| | - H A Al-Darraji
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - D Alland
- Division of Infectious Disease, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - U Antonenka
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany
| | - T Brown
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - M E Balcells
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Blakemore
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - C M Denkinger
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - K Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - H Hoffmann
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany
| | - A Kadyrov
- National TB Reference Laboratory, National Centre of Phthisiology, Bishkek, Kyrgyzstan
| | - N Lemaitre
- Laboratoire de Bactériologie-Hygiène, Centre Hospitalier Universitaire, Université de Lille-Nord de France, Unité Mixte de Recherche 8204, F-59021, Institut National de la Santé et de la Recherche Médicale U1019, Lille, France
| | - M B Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - V Nikolayevskyy
- Synlab MVZ Gauting, Institute of Microbiology and Laboratory Medicine, World Health Organization Supranational Reference Laboratory of Tuberculosis, Gauting, Germany, Department of Medicine, Imperial College London, UK
| | - E N Ntinginya
- Mbeya Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - N Ozkutuk
- Celal Bayar University Faculty of Medicine, Department of Medical Microbiology, Manisa, Turkey
| | - J J Palacios
- Regional Mycobacteria Reference Center, Hospital Universitario Central de Asturias, Oviedo
| | - E B Popowitch
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - J M Porcel
- Pleural Medicine Unit, Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain
| | - J Teo
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - G Theron
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - K Kranzer
- Department of Science & Technology/National Research Foundation of Excellence for Biomedical Tuberculosis Research, and South African Medical Research Council Centre for Molecular and Cellular Biology, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa, National Reference Laboratory for Mycobacteria, FZ Borstel, Germany
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19
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Kalimuddin S, Chen SL, Lim CTK, Koh TH, Tan TY, Kam M, Wong CW, Mehershahi KS, Chau ML, Ng LC, Tang WY, Badaruddin H, Teo J, Apisarnthanarak A, Suwantarat N, Ip M, Holden MTG, Hsu LY, Barkham T. 2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data. Clin Infect Dis 2018; 64:S145-S152. [PMID: 28475781 DOI: 10.1093/cid/cix021] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Streptococcus agalactiae (group B Streptococcus [GBS]) has not been described as a foodborne pathogen. However, in 2015, a large outbreak of severe invasive sequence type (ST) 283 GBS infections in adults epidemiologically linked to the consumption of raw freshwater fish occurred in Singapore. We attempted to determine the scale of the outbreak, define the clinical spectrum of disease, and link the outbreak to contaminated fish. Methods Time-series analysis was performed on microbiology laboratory data. Food handlers and fishmongers were screened for enteric carriage of GBS. A retrospective cohort study was conducted to assess differences in demographic and clinical characteristics of patients with invasive ST283 and non-ST283 infections. Whole-genome sequencing was performed on human and fish ST283 isolates from Singapore, Thailand, and Hong Kong. Results The outbreak was estimated to have started in late January 2015. Within the study cohort of 408 patients, ST283 accounted for 35.8% of cases. Patients with ST283 infection were younger and had fewer comorbidities but were more likely to develop meningoencephalitis, septic arthritis, and spinal infection. Of 82 food handlers and fishmongers screened, none carried ST283. Culture of 43 fish samples yielded 13 ST283-positive samples. Phylogenomic analysis of 161 ST283 isolates from humans and fish revealed they formed a tight clade distinguished by 93 single-nucleotide polymorphisms. Conclusions ST283 is a zoonotic GBS clone associated with farmed freshwater fish, capable of causing severe disease in humans. It caused a large foodborne outbreak in Singapore and poses both a regional and potentially more widespread threat.
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Affiliation(s)
| | - Swaine L Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Genome Institute of Singapore
| | - Cindy T K Lim
- Saw Swee Hock School of Public Health, National University Singapore
| | | | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Michelle Kam
- Department of Internal Medicine, Singapore General Hospital
| | | | - Kurosh S Mehershahi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Man Ling Chau
- Environmental Health Institute, National Environment Agency
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency
| | - Wen Ying Tang
- Department of Laboratory Medicine, Tan Tock Seng Hospital
| | | | - Jeanette Teo
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore
| | | | - Nuntra Suwantarat
- Infectious Disease Division, Thammasat University Hospital, and.,Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Margaret Ip
- Department of Microbiology, Chinese University of Hong Kong, Shatin; and
| | | | - Li Yang Hsu
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Saw Swee Hock School of Public Health, National University Singapore
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20
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Marimuthu K, Venkatachalam I, Khong WX, Koh TH, Cherng BPZ, Van La M, De PP, Krishnan PU, Tan TY, Choon RFK, Pada SK, Lam CW, Ooi ST, Deepak RN, Smitasin N, Tan EL, Lee JJ, Kurup A, Young B, Sim NTW, Thoon KC, Fisher D, Ling ML, Peng BAS, Teo YY, Hsu LY, Lin RTP, Ong RTH, Teo J, Ng OT. Clinical and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Adult Inpatients in Singapore. Clin Infect Dis 2018; 64:S68-S75. [PMID: 28475792 DOI: 10.1093/cid/cix113] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Since 2010, the incidence of carbapenem-resistant Enterobacteriaceae (CRE) has been increasing in Singapore. We analyzed the clinical and molecular epidemiology of CRE among adult inpatients in Singapore. Methods Quarterly incidence of unique subjects (per 100000 patient-days) with positive clinical and surveillance cultures for CRE were estimated based on mandatory data submitted to the National Public Health Laboratory by public hospitals between 2010 and 2015. CRE-positive adult inpatients were prospectively recruited from 6 public sector hospitals between December 2013 and April 2015. Subjects answered a standardized epidemiologic questionnaire and provided samples for this study. Further clinical information was extracted from subjects' electronic medical records. Whole-genome sequencing was performed on study isolates to determine transmission clusters. Results Incidence of CRE clinical cultures among adult inpatients plateaued from 2013 (range: 7.73 to 10.32 per 100000 patient-days) following an initial increase between 2010 and end-2012. We prospectively recruited 249 subjects. Their median age was 65 years, 108 (43%) were female, and 161 (64.7%) had carbapenemase-producing Enterobacteriaceae (CPE). On multivariate analysis, prior carbapenem exposure (OR: 3.23; 95% CI: 1.67-6.25) and hematological malignancies (OR: 2.85; 95% CI: 1.10-7.41) were associated with non-carbapenemase-producing CRE (NCPE) (n = 88) compared with CPE (n = 161) subjects. Among 430 CRE isolates from the 249 subjects, 307(71.3%) were CPE, of which 154(50.2%) were blaKPC-positive, 97(31.6%) blaNDM-positive, and 42 (13.7%) blaOXA-positive. Klebsiella pneumoniae (n = 180, 41.9%), Escherichia coli (n = 129, 30.0%) and Enterobacter cloacae (n = 62, 14.4%) were the main Enterobacteriaceae species. WGS (n = 206) revealed diverse bacterial strain type (STs). The predominant blaKPC-positive plasmid was pHS102707 (n = 62, 55.4%) and the predominant blaNDM-positive plasmid was pNDM-ECS01 (n = 46, 48.9%). Five transmission clusters involving 13 subjects were detected. Conclusions Clinical CRE trend among adult inpatients showed stabilization following a rapid rise since introduction in 2010 potentially due to infection prevention measures and antimicrobial stewardship. More work is needed on understanding CPE transmission dynamics.
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Affiliation(s)
- Kalisvar Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore
| | | | - Wei Xin Khong
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | | | - My Van La
- National Public Health Laboratory, Ministry of Health of Singapore
| | - Partha Pratim De
- Department of Laboratory Medicine, Tan Tock Seng Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Prabha Unny Krishnan
- National Public Health Laboratory, Ministry of Health of Singapore.,Department of Laboratory Medicine, Tan Tock Seng Hospital.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Raymond Fong Kok Choon
- Division of Infectious Diseases, Department of Medicine, Changi General Hospital, Singapore
| | - Surinder Kaur Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital, Singapore
| | - Choong Weng Lam
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore
| | - Say Tat Ooi
- Department of Infectious Diseases, Khoo Teck Puat Hospital, Singapore
| | | | - Nares Smitasin
- Division of Infectious Diseases, National University Hospital, Singapore
| | - Eng Lee Tan
- Centre of Biomedical and Life Sciences, Singapore Polytechnic
| | - Jia Jun Lee
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | | | - Barnaby Young
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - Nancy Tee Wen Sim
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Koh Cheng Thoon
- Yong Loo Lin School of Medicine, National University of Singapore.,Department of Pediatrics, KK Women's and Children's Hospital, Singapore
| | - Dale Fisher
- Yong Loo Lin School of Medicine, National University of Singapore.,Division of Infectious Diseases, National University Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Control, Singapore General Hospital
| | - Brenda Ang Sze Peng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yik-Ying Teo
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore.,NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS).,Department of Statistics & Applied Probability, Faculty of Science, National University of Singapore.,Life Sciences Institute, National University of Singapore.,Genome Institute of Singapore
| | - Li Yang Hsu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Saw Swee Hock School of Public Health, National University Health System
| | - Raymond Tzer Pin Lin
- National Public Health Laboratory, Ministry of Health of Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Rick Twee-Hee Ong
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Oon Tek Ng
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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21
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Khor L, Sultana R, Yeong J, Huang H, Teo J, Yuen J, Tan P. Prognostic grade grouping in prostate cancer of Singapore men. Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.052] [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: 11/29/2022]
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22
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Antelmi E, Di Stasio F, Rocchi L, Erro R, Liguori R, Ganos C, Brugger F, Teo J, Berardelli A, Rothwell J, Bhatia KP. Corrigendum to "Impaired eye blink classical conditioning distinguishes dystonic patients with and without tremor" [Park. Relat. Disord. 31 (2016) 23-27]. Parkinsonism Relat Disord 2016; 35:102. [PMID: 27989567 DOI: 10.1016/j.parkreldis.2016.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- E Antelmi
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
| | - F Di Stasio
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - L Rocchi
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - R Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna and IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - C Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - F Brugger
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - J Teo
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - A Berardelli
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy
| | - J Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
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23
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Yu H, Tran TT, Teo J, Hadinoto K. Dry powder aerosols of curcumin-chitosan nanoparticle complex prepared by spray freeze drying and their antimicrobial efficacy against common respiratory bacterial pathogens. Colloids Surf A Physicochem Eng Asp 2016. [DOI: 10.1016/j.colsurfa.2016.05.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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24
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Khong WX, Marimuthu K, Teo J, Ding Y, Xia E, Lee JJ, Ong RTH, Venkatachalam I, Cherng B, Pada SK, Choong WL, Smitasin N, Ooi ST, Deepak RN, Kurup A, Fong R, Van La M, Tan TY, Koh TH, Lin RTP, Tan EL, Krishnan PU, Singh S, Pitout JD, Teo YY, Yang L, Ng OT. Tracking inter-institutional spread of NDM and identification of a novel NDM-positive plasmid, pSg1-NDM, using next-generation sequencing approaches. J Antimicrob Chemother 2016; 71:3081-3089. [PMID: 27494913 DOI: 10.1093/jac/dkw277] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Owing to gene transposition and plasmid conjugation, New Delhi metallo-β-lactamase (NDM) is typically identified among varied Enterobacteriaceae species and STs. We used WGS to characterize the chromosomal and plasmid molecular epidemiology of NDM transmission involving four institutions in Singapore. METHODS Thirty-three Enterobacteriaceae isolates (collection years 2010-14) were sequenced using short-read sequencing-by-synthesis and analysed. Long-read single molecule, real-time sequencing (SMRTS) was used to characterize genetically a novel plasmid pSg1-NDM carried on Klebsiella pneumoniae ST147. RESULTS In 20 (61%) isolates, blaNDM was located on the pNDM-ECS01 plasmid in the background of multiple bacterial STs, including eight K. pneumoniae STs and five Escherichia coli STs. In six (18%) isolates, a novel blaNDM-positive plasmid, pSg1-NDM, was found only in K. pneumoniae ST147. The pSg1-NDM-K. pneumoniae ST147 clone (Sg1-NDM) was fully sequenced using SMRTS. pSg1-NDM, a 90 103 bp IncR plasmid, carried genes responsible for resistance to six classes of antimicrobials. A large portion of pSg1-NDM had no significant homology to any known plasmids in GenBank. pSg1-NDM had no conjugative transfer region. Combined chromosomal-plasmid phylogenetic analysis revealed five clusters of clonal bacterial NDM-positive plasmid transmission, of which two were inter-institution clusters. The largest inter-institution cluster involved six K. pneumoniae ST147-pSg1-NDM isolates. Fifteen patients were involved in transmission clusters, of which four had ward contact, six had hospital contact and five had an unknown transmission link. CONCLUSIONS A combined sequencing-by-synthesis and SMRTS approach can determine effectively the transmission clusters of blaNDM and genetically characterize novel plasmids. Plasmid molecular epidemiology is important to understanding NDM spread as blaNDM-positive plasmids can conjugate extensively across species and STs.
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Affiliation(s)
- Wei Xin Khong
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Kalisvar Marimuthu
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd 119228, NUHS Tower Block, Level 11, 117597, Singapore
| | - Jeanette Teo
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Yichen Ding
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Eryu Xia
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS), #05-01Medical Drive, 117456, Singapore
| | - Jia Jun Lee
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Rick Twee-Hee Ong
- Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore
| | | | | | - Surinder Kaur Pada
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Weng Lam Choong
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, 609606, Singapore
| | - Nares Smitasin
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Say Tat Ooi
- Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore
| | | | - Asok Kurup
- Mount Elizabeth Hospital, 3 Mount Elizabeth, 228510, Singapore
| | - Raymond Fong
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - My Van La
- National Public Health Laboratory, College of Medicine Building, 16 College Road, 169854, Singapore
| | - Thean Yen Tan
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Tse Hsien Koh
- Singapore General Hospital, Outram Road, 169608, Singapore
| | - Raymond Tzer Pin Lin
- National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore.,National Public Health Laboratory, College of Medicine Building, 16 College Road, 169854, Singapore
| | - Eng Lee Tan
- Singapore Polytechnic, 500 Dover Road, 139651, Singapore
| | | | | | - Johann D Pitout
- Division of Microbiology, 1829 Ranchlands Blvd NW, Calgary, AB T3G 2A7, Canada.,Departments of Pathology and Laboratory Medicine, Microbiology Immunology and Infectious Diseases, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.,Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Yik-Ying Teo
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Centre for Life Sciences (CeLS), #05-01Medical Drive, 117456, Singapore.,Centre for Infectious Disease Epidemiology and Research, Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore.,Department of Statistics & Applied Probability, Block S16, Level 7, 6 Science Drive 2, Faculty of Science, National University of Singapore, 117546, Singapore.,Life Sciences Institute, National University of Singapore, Centre for Life 42 Sciences, #05-02, 28 Medical Drive, 117456, Singapore.,Genome Institute of Singapore, 60 Biopolis St, #02-01, 138672, Singapore
| | - Liang Yang
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, 60 Nanyang Drive, 637551, Singapore
| | - Oon Tek Ng
- Institute of Infectious Disease and Epidemiology, Communicable Disease Centre, 11 Jalan Tan Tock Seng, 308433, Singapore
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Lee SH, Teo J, Heng D, Ng WK, Zhao Y, Tan RB. Tailored Antibiotic Combination Powders for Inhaled Rotational Antibiotic Therapy. J Pharm Sci 2016; 105:1501-12. [DOI: 10.1016/j.xphs.2016.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/28/2016] [Accepted: 02/05/2016] [Indexed: 12/28/2022]
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26
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Yu H, Teo J, Chew JW, Hadinoto K. Dry powder inhaler formulation of high-payload antibiotic nanoparticle complex intended for bronchiectasis therapy: Spray drying versus spray freeze drying preparation. Int J Pharm 2016; 499:38-46. [DOI: 10.1016/j.ijpharm.2015.12.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/02/2015] [Accepted: 12/30/2015] [Indexed: 01/25/2023]
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27
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Molton JS, Lee IR, Teo J, Kalimuddin S, Lye D, Gan YH, Archuleta S. Klebsiella Liver Abscess in Singapore: Clinical and Microbiologic Determinants of an Emerging Infection. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.728] [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: 11/13/2022] Open
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28
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Li Y, Liu Y, Chew SC, Tay M, Salido MMS, Teo J, Lauro FM, Givskov M, Yang L. Complete Genome Sequence and Transcriptomic Analysis of the Novel Pathogen Elizabethkingia anophelis in Response to Oxidative Stress. Genome Biol Evol 2015; 7:1676-85. [PMID: 26019164 PMCID: PMC4494045 DOI: 10.1093/gbe/evv101] [Citation(s) in RCA: 27] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Elizabethkingia anophelis is an emerging pathogen that can cause life-threatening infections in neonates, severely immunocompromised and postoperative patients. The lack of genomic information on E. anophelis hinders our understanding of its mechanisms of pathogenesis. Here, we report the first complete genome sequence of E. anophelis NUHP1 and assess its response to oxidative stress. Elizabethkingia anophelis NUHP1 has a circular genome of 4,369,828 base pairs and 4,141 predicted coding sequences. Sequence analysis indicates that E. anophelis has well-developed systems for scavenging iron and stress response. Many putative virulence factors and antibiotic resistance genes were identified, underscoring potential host–pathogen interactions and antibiotic resistance. RNA-sequencing-based transcriptome profiling indicates that expressions of genes involved in synthesis of an yersiniabactin-like iron siderophore and heme utilization are highly induced as a protective mechanism toward oxidative stress caused by hydrogen peroxide treatment. Chrome azurol sulfonate assay verified that siderophore production of E. anophelis is increased in the presence of oxidative stress. We further showed that hemoglobin facilitates the growth, hydrogen peroxide tolerance, cell attachment, and biofilm formation of E. anophelis NUHP1. Our study suggests that siderophore production and heme uptake pathways might play essential roles in stress response and virulence of the emerging pathogen E. anophelis.
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Affiliation(s)
- Yingying Li
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - Yang Liu
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore
| | - Su Chuen Chew
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore Interdisciplinary Graduate School, Nanyang Technological University, Singapore
| | - Martin Tay
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore
| | | | - Jeanette Teo
- Microbiology Unit, Department of Laboratory Medicine, National University Hospital, Singapore
| | - Federico M Lauro
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Givskov
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore Costerton Biofilm Center, Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark
| | - Liang Yang
- School of Biological Sciences, Nanyang Technological University, Singapore Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore
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29
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Lee SH, Teo J, Heng D, Zhao Y, Ng WK, Chan HK, Tan LT, Tan RB. A novel inhaled multi-pronged attack against respiratory bacteria. Eur J Pharm Sci 2015; 70:37-44. [DOI: 10.1016/j.ejps.2015.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/26/2014] [Accepted: 01/10/2015] [Indexed: 01/01/2023]
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30
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Zhang J, Barbaro P, Guo Y, Alodaib A, Li J, Gold W, Adès L, Keating BJ, Xu X, Teo J, Hakonarson H, Christodoulou J. Utility of next-generation sequencing technologies for the efficient genetic resolution of haematological disorders. Clin Genet 2015; 89:163-72. [PMID: 25703294 DOI: 10.1111/cge.12573] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/01/2015] [Accepted: 02/12/2015] [Indexed: 12/22/2022]
Abstract
Next-generation sequencing (NGS) has now evolved to be a relatively affordable and efficient means of detecting genetic mutations. Whole genome sequencing (WGS) or whole exome sequencing (WES) offers the opportunity for rapid diagnosis in many paediatric haematological conditions, where phenotypes are variable and either a large number of genes are involved, or the genes are large making sanger sequencing expensive and labour-intensive. NGS offers the potential for gene discovery in patients who do not have mutations in currently known genes. This report shows how WES was used in the diagnosis of six paediatric haematology cases. In four cases (Diamond-Blackfan anaemia, congenital neutropenia (n = 2), and Fanconi anaemia), the diagnosis was suspected based on classical phenotype, and NGS confirmed those suspicions. Mutations in RPS19, ELANE and FANCD2 were found. The final two cases (MYH9 associated macrothrombocytopenia associated with multiple congenital anomalies; atypical juvenile myelomonocytic leukaemia associated with a KRAS mutation) highlight the utility of NGS where the diagnosis is less certain, or where there is an unusual phenotype. We discuss the advantages and limitations of NGS in the setting of these cases, and in haematological conditions more broadly, and discuss where NGS is most efficiently used.
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Affiliation(s)
- J Zhang
- T-Life Research Center, Fudan University, Shanghai, 200433, China.,Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China
| | - P Barbaro
- Haematology Department, The Children's Hospital at Westmead, Sydney, Australia.,Cancer Research Unit, Children's Medical Research Institute, Westmead, Australia
| | - Y Guo
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - A Alodaib
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - J Li
- Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China
| | - W Gold
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - L Adès
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Clinical Genetics Department, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
| | - B J Keating
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Human Genetics Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - X Xu
- Department of BioMedical Research, BGI-Shenzhen, Shenzhen, 518083, China.,Shenzhen Key Laboratory of Genomics, Shenzhen, China.,The Guangdong Enterprise Key Laboratory of Human Disease Genomics, Shenzhen, China
| | - J Teo
- Haematology Department, The Children's Hospital at Westmead, Sydney, Australia
| | - H Hakonarson
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Human Genetics Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Christodoulou
- Genetic Metabolic Disorders Research Unit, Western Sydney Genetics Program, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, Australia.,Discipline of Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, Australia
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Teo J, Tan SYY, Liu Y, Tay M, Ding Y, Li Y, Kjelleberg S, Givskov M, Lin RTP, Yang L. Comparative genomic analysis of malaria mosquito vector-associated novel pathogen Elizabethkingia anophelis. Genome Biol Evol 2014; 6:1158-65. [PMID: 24803570 PMCID: PMC4041001 DOI: 10.1093/gbe/evu094] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 11/13/2022] Open
Abstract
Acquisition of Elizabethkingia infections in intensive care units (ICUs) has risen in the past decade. Treatment of Elizabethkingia infections is challenging due to the lack of effective therapeutic regimens, leading to a high mortality rate. Elizabethkingia infections have long been attributed to Elizabethkingia meningoseptica. Recently, we used whole-genome sequencing to reveal that E. anophelis is the pathogenic agent for an Elizabethkingia outbreak at two ICUs. We performed comparative genomic analysis of seven hospital-isolated E. anophelis strains with five available Elizabethkingia spp. genomes deposited in the National Center for Biotechnology Information Database. A pan-genomic approach was applied to identify the core- and pan-genome for the Elizabethkingia genus. We showed that unlike the hospital-isolated pathogen E. meningoseptica ATCC 12535 strain, the hospital-isolated E. anophelis strains have genome content and organization similar to the E. anophelis Ag1 and R26 strains isolated from the midgut microbiota of the malaria mosquito vector Anopheles gambiae. Both the core- and accessory genomes of Elizabethkingia spp. possess genes conferring antibiotic resistance and virulence. Our study highlights that E. anophelis is an emerging bacterial pathogen for hospital environments.
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Affiliation(s)
- Jeanette Teo
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore
| | - Sean Yang-Yi Tan
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, SingaporeSchool of Biological Sciences, Nanyang Technological University, Singapore
| | - Yang Liu
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore
| | - Martin Tay
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, SingaporeSchool of Biological Sciences, Nanyang Technological University, Singapore
| | - Yichen Ding
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore
| | - Yingying Li
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - Staffan Kjelleberg
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, SingaporeCentre for Marine Bio-Innovation and School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Australia
| | - Michael Givskov
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, SingaporeCosterton Biofilm Center, Department of International Health, Immunology and Microbiology, Panum Institute, University of Copenhagen, Denmark
| | - Raymond T P Lin
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore
| | - Liang Yang
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, SingaporeSchool of Biological Sciences, Nanyang Technological University, Singapore
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Lee SH, Teo J, Heng D, Zhao Y, Wai Kiong N, Chan HK, Tan RB. Steroid-Decorated Antibiotic Microparticles for Inhaled Anti-Infective Therapy. J Pharm Sci 2014; 103:1115-25. [DOI: 10.1002/jps.23874] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/23/2013] [Accepted: 01/03/2014] [Indexed: 11/06/2022]
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Affiliation(s)
- Sean Yang-Yi Tan
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE) and School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore, Singapore
| | - Liang Yang
- Singapore Centre on Environmental Life Sciences Engineering (SCELSE) and School of Biological Sciences, Nanyang Technological University, Singapore 637551, Singapore.
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Crowther HJ, Lindeman R, Ho PJ, Allen E, Waite C, Matthews S, Jobburn K, Teo J, Day S, Seldon M, Rosenfeld D, Kerridge I. Health of adults living with a clinically significant haemoglobinopathy in New South Wales, Australia. Intern Med J 2013; 43:1103-10. [PMID: 23834206 DOI: 10.1111/imj.12231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/15/2012] [Accepted: 07/03/2013] [Indexed: 01/19/2023]
Abstract
AIM To comprehensively review the health needs of patients living with clinically significant haemoglobinopathies (thalassaemia and sickle-cell disease (SCD)) in New South Wales, Australia. METHODS A survey-based health needs assessment was undertaken in outpatients cared for at five tertiary institutions in metropolitan and regional centres. Sixty-three of 121 adults (approximately 80-90% of adult patients with transfusion-requiring haemoglobinopathies in New South Wales) completed an in-house and commercial health-related quality assessment survey (SF-36v2). RESULTS Subjects came from more than eight world regions, with those with SCD being more likely to be born outside of Australia than subjects with thalassaemia (P < 0.001, likelihood ratio 20.64) as well as more likely to have been refugees (26% vs 2%). The population contained socially disadvantaged subjects with 13 subjects (20.6%) having incomes below the Australian poverty line. Complications of thalassaemia were comparable to previous international reports although our subjects had a high rate of secondary amenorrhea (>12 months = 27%) and surgical splenectomy (55.6%). Use of hydroxyurea in SCD was less than expected with only 46.6% of subjects having prior use. Lack of universal access to magnetic resonance imaging-guided chelation (international best practice) was evident, although 65.5% had been able to access magnetic resonance imaging through clinical trial, or self-funding. CONCLUSIONS Patients with SCD and thalassaemia experience considerable morbidity and mortality and require complex, multidisciplinary care. This study revealed both variance from international best practice and between specialist units. The results of this research may provide the impetus for the development of clinical and research networks to enable the uniform delivery of health services benchmarked against international standards.
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Affiliation(s)
- H J Crowther
- Westmead Hospital, Sydney , New South Wales, Australia; Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney , New South Wales, Australia; University of Western Sydney, Sydney , New South Wales, Australia
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Lee SH, Teo J, Heng D, Ng WK, Chan HK, Tan RB. Synergistic combination dry powders for inhaled antimicrobial therapy: Formulation, characterization and in vitro evaluation. Eur J Pharm Biopharm 2013; 83:275-84. [DOI: 10.1016/j.ejpb.2012.09.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/27/2012] [Accepted: 09/05/2012] [Indexed: 11/28/2022]
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Venkatachalam I, Teo J, Balm MND, Fisher DA, Jureen R, Lin RTP. Klebsiella pneumoniae Carbapenemase-producing enterobacteria in hospital, Singapore. Emerg Infect Dis 2013; 18:1381-3. [PMID: 22840461 PMCID: PMC3414009 DOI: 10.3201/eid1808.110893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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38
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Liew YX, Lee W, Cai YY, Teo J, Tang SSL, Ong RWQ, Lim CLL, Lingegowda PB, Kwa ALH, Chlebicki MP. Utility and safety of procalcitonin in an antimicrobial stewardship program (ASP) in patients with malignancies. Eur J Clin Microbiol Infect Dis 2012; 31:3041-6. [PMID: 22678350 DOI: 10.1007/s10096-012-1662-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/19/2012] [Indexed: 11/24/2022]
Abstract
As data on procalcitonin utility in antibiotics discontinuation [under an antimicrobial stewardship program (ASP)] in patients with malignancies are lacking, we aimed to evaluate the utility of procalcitonin in an ASP in patients with malignancies. We conducted a retrospective review of the ASP database of all patients with malignancies in whom at least one procalcitonin level was taken and our ASP had recommended changes in carbapenem regimen, from January to December 2011. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. There were 749 carbapenem cases reviewed. Ninety-nine were suggested to either de-escalate, discontinue antibiotics, or narrow the spectrum of empiric treatment, based on procalcitonin trends. While there was no statistical difference in the mortality within 30 days post-ASP intervention (accepted: 8/65 patients vs. rejected: 9/34 patients; p = 0.076), the median duration of carbapenem therapy was significantly shorter (5 vs. 7 days; p = 0.002). Procalcitonin use safely facilitates decisions on antibiotics discontinuation and de-escalation in patients with malignancies in the ASP.
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Affiliation(s)
- Y X Liew
- Department of Pharmacy, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Kalamangalam GP, Teo J, Sethi NK, Luaute J, Fischer C. Can cerebral microbleeds cause an acute stroke syndrome? Neurol Clin Pract 2012; 2:91-92. [DOI: 10.1212/cpj.0b013e31825ab82d] [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: 11/15/2022]
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Tan CW, Najm J, Morel-Kopp MC, Teo J, Chen Q, Felbor U, Ward CM. Severe FX deficiency caused by a previously unidentified 4-bp deletion compound heterozygous with a large deletion involving FVII and FX genes. Haemophilia 2011; 18:e55-8. [PMID: 22126652 DOI: 10.1111/j.1365-2516.2011.02707.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Teo J, Kwa ALH, Loh J, Chlebicki MP, Lee W. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital. Eur J Clin Microbiol Infect Dis 2011; 31:947-55. [DOI: 10.1007/s10096-011-1391-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
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42
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Dimyan M, Teo J, Reis J, Rothwell J, Cohen L. PTMS32 Learning a new motor skill in chronic stroke: effects of levodopa and brain stimulation. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60685-8] [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: 11/16/2022]
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Teo J, Pietro PD, Biagio FS, Capozzoli M, Deng YM, Barr I, Caldwell N, Ong KL, Sato M, Tan R, Lin R. VereFlu™: an integrated multiplex RT-PCR and microarray assay for rapid detection and identification of human influenza A and B viruses using lab-on-chip technology. Arch Virol 2011; 156:1371-8. [PMID: 21503642 PMCID: PMC7087244 DOI: 10.1007/s00705-011-0999-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 03/31/2011] [Indexed: 12/16/2022]
Abstract
Threatening sporadic outbreaks of avian influenza and the H1N1 pandemic of 2009 highlight the need for rapid and accurate detection and typing of influenza viruses. In this paper, we describe the validation of the VereFlu™ Lab-on-Chip Influenza Assay, which is based on the integration of two technologies: multiplex reverse transcription (RT)-PCR followed by microarray amplicon detection. This assay simultaneously detects five influenza virus subtypes, including the 2009 pandemic influenza A (H1N1), seasonal H1N1, H3N2, H5N1 and influenza B virus. The VereFlu™ assay was clinically validated in Singapore and compared against reference methods of real-time PCR, virus detection by immunofluorescence of cell cultures and sequencing. A sensitivity and specificity of 96.8% and 92.8%, respectively, was demonstrated for pandemic H1N1; 95.7% and 100%, respectively, for seasonal H1N1; 91.2% and 97.6%, respectively, for seasonal H3N2; 95.2% and 100%, respectively, for influenza B. Additional evaluations carried out at the World Health Organization (WHO) Collaborating Centre, Melbourne, Australia, confirmed that the test was able to reliably detect H5N1. This portable, fast time-to-answer (3 hours) device is particularly suited for diagnostic applications of detection, differentiation and identification of human influenza virus subtypes.
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Affiliation(s)
- Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, 119074 Singapore
| | - Patrizia Di Pietro
- CCI Group, Molecular Diagnostic Business Unit, Microfluidics Division, STMicroelectronics, Stradale Primosole 50, 95121 Catania, Italy
| | - Floriana San Biagio
- CCI Group, Molecular Diagnostic Business Unit, Microfluidics Division, STMicroelectronics, Stradale Primosole 50, 95121 Catania, Italy
| | - Monica Capozzoli
- CCI Group, Molecular Diagnostic Business Unit, Microfluidics Division, STMicroelectronics, Stradale Primosole 50, 95121 Catania, Italy
| | - Yi-Mo Deng
- WHO Collaborating Centre for Reference and Research on Influenza, 10 Wreckyn St, North Melbourne, VIC Australia
| | - Ian Barr
- WHO Collaborating Centre for Reference and Research on Influenza, 10 Wreckyn St, North Melbourne, VIC Australia
| | - Natalie Caldwell
- WHO Collaborating Centre for Reference and Research on Influenza, 10 Wreckyn St, North Melbourne, VIC Australia
| | - Kian-Leong Ong
- Veredus Laboratories Pte Ltd, 83 Science Park Drive #03-02A, The Curie, Singapore Science Park, Singapore, 118258 Singapore
| | - Mitsuharu Sato
- Veredus Laboratories Pte Ltd, 83 Science Park Drive #03-02A, The Curie, Singapore Science Park, Singapore, 118258 Singapore
| | - Rosemary Tan
- Veredus Laboratories Pte Ltd, 83 Science Park Drive #03-02A, The Curie, Singapore Science Park, Singapore, 118258 Singapore
| | - Raymond Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, 119074 Singapore
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Cheeran B, Koch G, Stagg C, Baig F, Teo J. Transcranial Magnetic Stimulation: From Neurophysiology to Pharmacology, Molecular Biology and Genomics. Neuroscientist 2010; 16:210-21. [DOI: 10.1177/1073858409349901] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Noninvasive plasticity paradigms, both physiologically induced and artificially induced, have come into their own in the study of the effects of genetic variation on human cortical plasticity. These techniques have the singular advantage that they enable one to study the effects of genetic variation in its natural and most relevant context, that of the awake intact human cortex, in both health and disease. This review aims to introduce the currently available artificially induced plasticity paradigms, their putative mechanisms—both in the traditional language of the systems neurophysiologist and in the evolving (and perhaps more relevant for the purposes of stimulation genomics) reinterpretation in terms of molecular neurochemistry, and highlights recent studies employing these techniques by way of examples of applications.
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Affiliation(s)
- B. Cheeran
- Department of Neurology, John Radcliffe Hospital, Headington, Oxford, UK, , Sobell Dept, Institute of Neurology, Queen Square, London, UK
| | - G. Koch
- Laboratorio di Neurologia Clinica e Comportamentale, Fondazione Santa Lucia IRCCS, and Dipartimento di Neuroscienze, Università di Roma Tor Vergata, Rome, Italy
| | - C.J. Stagg
- FMRIB Centre, University of Oxford, Department of Clinical Neurology, John Radcliffe Hospital, Headington, Oxford, UK
| | - F. Baig
- Department of Neurology, John Radcliffe Hospital, Headington, Oxford, UK
| | - J. Teo
- Sobell Dept, Institute of Neurology, Queen Square, London, UK
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Premachandran C, Khairyanto A, Sheng K, Singh J, Teo J, Yingshun X, Nanguang C, Sheppard C, Olivo M. Design, Fabrication, and Assembly of an Optical Biosensor Probe Package for OCT (Optical Coherence Tomography) Application. ACTA ACUST UNITED AC 2009. [DOI: 10.1109/tadvp.2009.2013658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Li L, Low MY, Aliwarga F, Teo J, Ge XW, Zeng Y, Bloodworth B, Koh HL. Isolation and identification of hydroxythiohomosildenafil in herbal dietary supplements sold as sexual performance enhancement products. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2009; 26:145-51. [DOI: 10.1080/02652030802368757] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lee YP, Fung DSS, Koh JBK, Wei KC, Woo BSC, Teo J. Between the rod and reason: a study on Asian parental disciplinary methods and child emotional/behavioural outcomes. Ann Acad Med Singap 2004; 33:S27-8. [PMID: 15651193] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- Y P Lee
- Institute of Mental Health, Department of Child and Adolescent Psychiatry, Singapore
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See SJ, Pan A, Seah A, Teo J, Chan LL, Wong MC. Case reports of two biopsy-proven patients with Creutzfeldt-Jakob disease in Singapore. Ann Acad Med Singap 2004; 33:651-5. [PMID: 15531964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Creutzfeldt-Jakob disease (CJD) is the most common transmissible human subacute spongiform encephalopathy. There is limited literature on CJD in Southeast Asia. We describe the clinical course and diagnostic evaluation of 2 Singapore patients with biopsy-proven CJD. CLINICAL PICTURE Two patients presented with non-specific symptoms such as withdrawal, forgetfulness, asthenia, giddiness and insomnia. Both patients had spontaneous myoclonic jerks and impairment of multiple neurologic systems (visual, pyramidal, cerebellar and neurocognitive systems). Magnetic resonance imaging and electroencephalography provided helpful supportive evidence. Diagnosis of CJD was established on brain biopsy. Histological features included spongioform degeneration, neuronal cell loss and astrocytosis. TREATMENT/OUTCOME Treatment remains palliative. Deterioration in their clinical condition was relentless, progressing to a totally dependent state within 10 to 12 months. CONCLUSION The early features of CJD can be varied and non-specific. It is important for physicians from different specialties to be cognisant of the clinical manifestations of CJD and the appearance of supportive and definitive investigations.
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Affiliation(s)
- S J See
- Department of Neurology (NNI-SGH), Singapore General Hospital, Singapore
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Lee NBC, Fung DSS, Teo J, Chan YH, Cai YM. Five-year review of adolescent mental health usage in Singapore. Ann Acad Med Singap 2003; 32:7-11. [PMID: 12625091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. MATERIALS AND METHODS Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. RESULTS Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. CONCLUSIONS There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.
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Affiliation(s)
- N B C Lee
- Department of Child and Adolescent Psychiatry, Child Guidance Clinic, Institute of Mental Health, Singapore.
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