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Chew CWY, Young BE, Tambyah PA, Vasoo S, Chan CEZ. Bidirectional Evolution of SARS-CoV-2 Virus in Immunocompromised Hosts. Influenza Other Respir Viruses 2024; 18:e13266. [PMID: 38462553 PMCID: PMC10925721 DOI: 10.1111/irv.13266] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 03/12/2024] Open
Affiliation(s)
| | - Barnaby E. Young
- National Centre for Infectious DiseasesSingaporeSingapore
- Tan Tock Seng HospitalSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Paul A. Tambyah
- Division of Infectious Diseases, Department of MedicineNational University HospitalSingaporeSingapore
- Infectious Diseases Translational Research ProgramNational University of SingaporeSingaporeSingapore
| | - Shawn Vasoo
- National Centre for Infectious DiseasesSingaporeSingapore
- Tan Tock Seng HospitalSingaporeSingapore
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Conrad E. Z. Chan
- National Centre for Infectious DiseasesSingaporeSingapore
- Defence Medical and Environmental Research InstituteDSO National LaboratoriesSingaporeSingapore
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2
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Gu Y, Shunmuganathan B, Qian X, Gupta R, Tan RSW, Kozma M, Purushotorman K, Murali TM, Tan NYJ, Preiser PR, Lescar J, Nasir H, Somani J, Tambyah PA, Smith KGC, Renia L, Ng LFP, Lye DC, Young BE, MacAry PA. Employment of a high throughput functional assay to define the critical factors that influence vaccine induced cross-variant neutralizing antibodies for SARS-CoV-2. Sci Rep 2023; 13:21810. [PMID: 38071323 PMCID: PMC10710454 DOI: 10.1038/s41598-023-49231-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
The scale and duration of neutralizing antibody responses targeting SARS-CoV-2 viral variants represents a critically important serological parameter that predicts protective immunity for COVID-19. In this study, we describe the development and employment of a new functional assay that measures neutralizing antibodies for SARS-CoV-2 and present longitudinal data illustrating the impact of age, sex and comorbidities on the kinetics and strength of vaccine-induced antibody responses for key variants in an Asian volunteer cohort. We also present an accurate quantitation of serological responses for SARS-CoV-2 that exploits a unique set of in-house, recombinant human monoclonal antibodies targeting the viral Spike and nucleocapsid proteins and demonstrate a reduction in neutralizing antibody titres across all groups 6 months post-vaccination. We also observe a marked reduction in the serological binding activity and neutralizing responses targeting recently newly emerged Omicron variants including XBB 1.5 and highlight a significant increase in cross-protective neutralizing antibody responses following a third dose (boost) of vaccine. These data illustrate how key virological factors such as immune escape mutations combined with host demographic factors such as age and sex of the vaccinated individual influence the strength and duration of cross-protective serological immunity for COVID-19.
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Affiliation(s)
- Yue Gu
- Antibody Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUH-Cambridge Immune Phenotyping Centre, National University of Singapore, Singapore, Singapore
| | - Bhuvaneshwari Shunmuganathan
- Antibody Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xinlei Qian
- Antibody Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rashi Gupta
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Rebecca S W Tan
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mary Kozma
- Antibody Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Kiren Purushotorman
- Antibody Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tanusya M Murali
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nikki Y J Tan
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peter R Preiser
- Antimicrobial Resistance Interdisciplinary Research Group (AMR-IRG), Singapore-MIT Alliance in Research and Technology (SMART), Singapore, 138602, Singapore
- School of Biological Science (SBS), Nanyang Technological University (NTU), 60 Nanyang Dr, Singapore, 637551, Singapore
| | - Julien Lescar
- School of Biological Science (SBS), Nanyang Technological University (NTU), 60 Nanyang Dr, Singapore, 637551, Singapore
- NTU Institute of Structural Biology, Nanyang Technological University, 59 Nanyang Drive, Singapore, 636921, Singapore
| | - Haziq Nasir
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Jyoti Somani
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Paul A Tambyah
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Kenneth G C Smith
- NUH-Cambridge Immune Phenotyping Centre, National University of Singapore, Singapore, Singapore
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, CB2 0AW, UK
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Laurent Renia
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - David C Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases (NCID), Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Barnaby E Young
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Centre for Infectious Diseases (NCID), Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Paul A MacAry
- Antibody Engineering Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore.
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- NUH-Cambridge Immune Phenotyping Centre, National University of Singapore, Singapore, Singapore.
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3
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Tan EX, Lim WH, Thong E, Chavatte JM, Zhang J, Lim J, Jin JY, Lim DR, Kang JY, Tang ASP, Chan KE, Tan C, Tan SN, Nah B, Huang DQ, Wang LF, Tambyah PA, Somani J, Young B, Muthiah MD. Clinical Course, Immunogenicity, and Efficacy of BNT162b2 mRNA Vaccination Against SARS-CoV-2 Infection in Liver Transplant Recipients. Transplant Direct 2023; 9:e1537. [PMID: 37745946 PMCID: PMC10513132 DOI: 10.1097/txd.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 09/26/2023] Open
Abstract
Background Immunocompromised individuals have been excluded from landmark studies of messenger RNA vaccinations for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). In such patients, the response to vaccination may be blunted and may wane more quickly compared with immunocompetent patients. We studied the factors associated with decreased antibody response to SARS-CoV-2 vaccination and risk factors for subsequent breakthrough infections in liver transplant (LT) patients undergoing coronavirus disease 2019 vaccination with at least 2 doses of messenger RNA vaccine from April 28, 2021, to April 28, 2022. Methods All LT recipients received at least 2 doses of the BNT162b2 (Pfizer BioNTech) vaccine 21 d apart. We measured the antibody response against the SARS-CoV-2 spike protein using the Roche Elecsys immunoassay to the receptor-binding domain of the SARS-CoV-2 spike protein, and the presence of neutralizing antibodies was measured by the surrogate virus neutralization test (cPass) before first and second doses of vaccination and also between 2 and 3 mo after the second dose of vaccination. Results Ninety-three LT recipients who received 2 doses of BNT162b2 were included in the analysis. The mean time from LT was 110 ± 154 mo. After 2-dose vaccination, 38.7% of LT recipients (36/93) were vaccine nonresponders on the cPass assay compared with 20.4% (19/93) on the Roche S assay. On multivariable analysis, increased age and increased tacrolimus trough were found to be associated with poor neutralizing antibody response (P = 0.038 and 0.022, respectively). The use of antimetabolite therapy in conjunction with tacrolimus approached statistical significance (odds ratio 0.21; 95% confidence interval, 0.180-3.72; P = 0.062). Breakthrough infection occurred in 18 of 88 LT recipients (20.4%). Female gender was independently associated with breakthrough infections (P < 0.001). Conclusions Among LT recipients, older age and higher tacrolimus trough levels were associated with poorer immune response to 2-dose SARS-CoV-2 vaccination. Further studies are needed to assess variables associated with breakthrough infections and, hence, who should be prioritized for booster vaccination.
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Affiliation(s)
- Eunice X. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elizabeth Thong
- Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Jinyan Zhang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Jonathan Lim
- National Centre for Infectious Diseases, Singapore
| | | | | | | | - Ansel Shao Pin Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caitlyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shi Ni Tan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Paul A. Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Jyoti Somani
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Barnaby Young
- National Centre for Infectious Diseases, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore
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4
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Chye DH, Chew CWY, Yeo HP, Tambyah PA, Young BE, Tan GGY, Tan BH, Vasoo S, Chan CEZ. Neutralization escape of emerging subvariants XBB.1.5/1.9.1 and XBB.2.3 from current therapeutic monoclonal antibodies. J Med Virol 2023; 95:e29074. [PMID: 37665160 DOI: 10.1002/jmv.29074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Affiliation(s)
- De Hoe Chye
- DSO National Laboratories, Defence Medical and Environmental Research Institute, Singapore, Singapore
| | | | - He Ping Yeo
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Paul A Tambyah
- Department of Medicine, Infectious Diseases Translational Research Program, Division of Infectious Diseases, National University Hospital, National University of Singapore, Singapore, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Gladys G Y Tan
- DSO National Laboratories, Defence Medical and Environmental Research Institute, Singapore, Singapore
| | - Boon Huan Tan
- DSO National Laboratories, Defence Medical and Environmental Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Conrad E Z Chan
- DSO National Laboratories, Defence Medical and Environmental Research Institute, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
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5
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Lu L, Chan CY, Chan‐Ng PPL, Than M, Tan PSY, Lim LK, Teo S, Lau PYW, Ng KH, Ang EY, Karthik SV, Aw MM, Tambyah PA, Yap HK, Lee BW. Heterogenous antibody and T-cell responses to SARS-CoV-2 mRNA vaccines among immunocompromised young people. Clin Transl Med 2023; 13:e1183. [PMID: 36658466 PMCID: PMC9852384 DOI: 10.1002/ctm2.1183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 01/21/2023] Open
Affiliation(s)
- Liangjian Lu
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Chang Yien Chan
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Pauline P. L. Chan‐Ng
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Mya Than
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Pamela S. Y. Tan
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Lee Kean Lim
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Sharon Teo
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Perry YW Lau
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Kar Hui Ng
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Elizabeth Y. Ang
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Sivaramakrishnan Venkatesh Karthik
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore
| | - Marion M. Aw
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Paul A. Tambyah
- Division of Infectious Diseases, National University Health System and Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Hui Kim Yap
- Department of PaediatricsKhoo Teck Puat – National University Children's Medical InstituteNational University Health SystemSingaporeSingapore,Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
| | - Bee Wah Lee
- Department of PaediatricsYong Loo Lin School of Medicine, National University of SingaporeSingaporeSingapore
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6
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Goh YS, Fong SW, Hor PX, Amrun SN, Lee CYP, Young BE, Chia PY, Tambyah PA, Kalimuddin S, Pada S, Tan SY, Sun LJ, Chen MIC, Leo YS, Lye DC, Ng LFP, Renia L. Conserved longitudinal alterations of anti-S-protein IgG subclasses in disease progression in initial ancestral Wuhan and vaccine breakthrough Delta infections. Front Microbiol 2022; 13:1043049. [PMID: 36483199 PMCID: PMC9723332 DOI: 10.3389/fmicb.2022.1043049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION COVID-19 has a wide disease spectrum ranging from asymptomatic to severe. While humoral immune responses are critical in preventing infection, the immune mechanisms leading to severe disease, and the identification of biomarkers of disease progression and/or resolution of the infection remains to be determined. METHODS Plasma samples were obtained from infections during the initial wave of ancestral wildtype SARS-CoV-2 and from vaccine breakthrough infections during the wave of Delta variant, up to six months post infection. The spike-specific antibody profiles were compared across different severity groups and timepoints. RESULTS We found an association between spike-specific IgM, IgA and IgG and disease severity in unvaccinated infected individuals. In addition to strong IgG1 and IgG3 response, patients with severe disease develop a robust IgG2 and IgG4 response. A comparison of the ratio of IgG1 and IgG3 to IgG2 and IgG4 showed that disease progression is associated with a smaller ratio in both the initial wave of WT and the vaccine breakthrough Delta infections. Time-course analysis revealed that smaller (IgG1 and IgG3)/(IgG2 and IgG4) ratio is associated with disease progression, while the reverse associates with clinical recovery. DISCUSSION While each IgG subclass is associated with disease severity, the balance within the four IgG subclasses may affect disease outcome. Acute disease progression or infection resolution is associated with a specific immunological phenotype that is conserved in both the initial wave of WT and the vaccine breakthrough Delta infections.
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Affiliation(s)
- Yun Shan Goh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Siew-Wai Fong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Pei Xiang Hor
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Siti Naqiah Amrun
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Cheryl Yi-Pin Lee
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Po Ying Chia
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Paul A. Tambyah
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Department of Infectious Diseases, National University Health System, Singapore, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore,Emerging Infectious Disease Program, Duke-NUS Medical School, Singapore, Singapore
| | - Surinder Pada
- Division of Infectious Diseases, Ng Teng Fong Hospital, Singapore, Singapore
| | - Seow-Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | | | - Mark I-Cheng Chen
- National Centre for Infectious Diseases, Singapore, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - David C. Lye
- National Centre for Infectious Diseases, Singapore, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lisa F. P. Ng
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore,National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laurent Renia
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore,*Correspondence: Laurent Renia,
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7
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Ang AXY, Luhung I, Ahidjo BA, Drautz‐Moses DI, Tambyah PA, Mok CK, Lau KJX, Tham SM, Chu JJH, Allen DM, Schuster SC. Airborne SARS-CoV-2 surveillance in hospital environment using high-flowrate air samplers and its comparison to surface sampling. Indoor Air 2022; 32:e12930. [PMID: 34519380 PMCID: PMC8653264 DOI: 10.1111/ina.12930] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 05/18/2023]
Abstract
Reliable methods to detect the presence of SARS-CoV-2 at venues where people gather are essential for epidemiological surveillance to guide public policy. Communal screening of air in a highly crowded space has the potential to provide early warning on the presence and potential transmission of SARS-CoV-2 as suggested by studies early in the epidemic. As hospitals and public facilities apply varying degrees of restrictions and regulations, it is important to provide multiple methodological options to enable environmental SARS-CoV-2 surveillance under different conditions. This study assessed the feasibility of using high-flowrate air samplers combined with RNA extraction kit designed for environmental sample to perform airborne SARS-CoV-2 surveillance in hospital setting, tested by RT-qPCR. The success rate of the air samples in detecting SARS-CoV-2 was then compared with surface swab samples collected in the same proximity. Additionally, positive RT-qPCR samples underwent viral culture to assess the viability of the sampled SARS-CoV-2. The study was performed in inpatient ward environments of a quaternary care university teaching hospital in Singapore housing active COVID-19 patients within the period of February to May 2020. Two types of wards were tested, naturally ventilated open-cohort ward and mechanically ventilated isolation ward. Distances between the site of air sampling and the patient cluster in the investigated wards were also recorded. No successful detection of airborne SARS-CoV-2 was recorded when 50 L/min air samplers were used. Upon increasing the sampling flowrate to 150 L/min, our results showed a high success rate in detecting the presence of SARS-CoV-2 from the air samples (72%) compared to the surface swab samples (9.6%). The positive detection rate of the air samples along with the corresponding viral load could be associated with the distance between sampling site and patient. The furthest distance from patient with PCR-positive air samples was 5.5 m. The airborne SARS-CoV-2 detection was comparable between the two types of wards with 60%-87.5% success rate. High prevalence of the virus was found in toilet areas, both on surfaces and in air. Finally, no successful culture attempt was recorded from the environmental air or surface samples.
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Affiliation(s)
- Alicia XY Ang
- Department of MedicineDivision of Infectious DiseasesNational University HospitalSingaporeSingapore
| | - Irvan Luhung
- Singapore Centre for Environmental Life Sciences EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Bintou A. Ahidjo
- Department of Microbiology and ImmunologyNational University of SingaporeSingaporeSingapore
- BSL3 Core FacilityYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Daniela I. Drautz‐Moses
- Singapore Centre for Environmental Life Sciences EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Paul A. Tambyah
- Department of MedicineDivision of Infectious DiseasesNational University HospitalSingaporeSingapore
- Department of MedicineInfectious Disease Translational Research ProgrammeYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Chee Keng Mok
- Department of Microbiology and ImmunologyNational University of SingaporeSingaporeSingapore
- BSL3 Core FacilityYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Kenny JX Lau
- Singapore Centre for Environmental Life Sciences EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Sai Meng Tham
- Department of MedicineDivision of Infectious DiseasesNational University HospitalSingaporeSingapore
| | - Justin Jang Hann Chu
- Department of Microbiology and ImmunologyNational University of SingaporeSingaporeSingapore
- BSL3 Core FacilityYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
- Department of MedicineInfectious Disease Translational Research ProgrammeYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - David M. Allen
- Department of MedicineDivision of Infectious DiseasesNational University HospitalSingaporeSingapore
- Department of MedicineInfectious Disease Translational Research ProgrammeYong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Stephan C. Schuster
- Singapore Centre for Environmental Life Sciences EngineeringNanyang Technological UniversitySingaporeSingapore
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8
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Ang AX, Luhung I, Ahidjo BA, Drautz-Moses DI, Tambyah PA, Mok CK, Lau KJ, Tham SM, Chu JJH, Allen DM, Schuster SC. Airborne SARS-CoV-2 surveillance in hospital environment using high-flowrate air samplers and its comparison to surface sampling. Indoor Air 2022; 32:e12930. [PMID: 34519380 DOI: 10.1111/ina.v32.110.1111/ina.12930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 05/18/2023]
Abstract
Reliable methods to detect the presence of SARS-CoV-2 at venues where people gather are essential for epidemiological surveillance to guide public policy. Communal screening of air in a highly crowded space has the potential to provide early warning on the presence and potential transmission of SARS-CoV-2 as suggested by studies early in the epidemic. As hospitals and public facilities apply varying degrees of restrictions and regulations, it is important to provide multiple methodological options to enable environmental SARS-CoV-2 surveillance under different conditions. This study assessed the feasibility of using high-flowrate air samplers combined with RNA extraction kit designed for environmental sample to perform airborne SARS-CoV-2 surveillance in hospital setting, tested by RT-qPCR. The success rate of the air samples in detecting SARS-CoV-2 was then compared with surface swab samples collected in the same proximity. Additionally, positive RT-qPCR samples underwent viral culture to assess the viability of the sampled SARS-CoV-2. The study was performed in inpatient ward environments of a quaternary care university teaching hospital in Singapore housing active COVID-19 patients within the period of February to May 2020. Two types of wards were tested, naturally ventilated open-cohort ward and mechanically ventilated isolation ward. Distances between the site of air sampling and the patient cluster in the investigated wards were also recorded. No successful detection of airborne SARS-CoV-2 was recorded when 50 L/min air samplers were used. Upon increasing the sampling flowrate to 150 L/min, our results showed a high success rate in detecting the presence of SARS-CoV-2 from the air samples (72%) compared to the surface swab samples (9.6%). The positive detection rate of the air samples along with the corresponding viral load could be associated with the distance between sampling site and patient. The furthest distance from patient with PCR-positive air samples was 5.5 m. The airborne SARS-CoV-2 detection was comparable between the two types of wards with 60%-87.5% success rate. High prevalence of the virus was found in toilet areas, both on surfaces and in air. Finally, no successful culture attempt was recorded from the environmental air or surface samples.
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Affiliation(s)
- Alicia Xy Ang
- Department of Medicine, Division of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - Irvan Luhung
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Bintou A Ahidjo
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
- BSL3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Daniela I Drautz-Moses
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Paul A Tambyah
- Department of Medicine, Division of Infectious Diseases, National University Hospital, Singapore, Singapore
- Department of Medicine, Infectious Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chee Keng Mok
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
- BSL3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kenny Jx Lau
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Sai Meng Tham
- Department of Medicine, Division of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
- BSL3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, Infectious Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David M Allen
- Department of Medicine, Division of Infectious Diseases, National University Hospital, Singapore, Singapore
- Department of Medicine, Infectious Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stephan C Schuster
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
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9
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Chan AC, Tan BY, Goh Y, Tan SS, Tambyah PA. Aseptic meningitis after BNT-162b2 COVID-19 vaccination. Brain Behav Immun Health 2021; 19:100406. [PMID: 34927105 PMCID: PMC8667462 DOI: 10.1016/j.bbih.2021.100406] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/06/2021] [Accepted: 12/11/2021] [Indexed: 01/06/2023] Open
Abstract
The COVID-19 pandemic has had an unprecedented impact on healthcare systems globally, giving rise to significant morbidity and mortality. Vaccination has been widely regarded as the most important strategy to contain the pandemic. Whilst local side-effects of the BNT-162b2 (Pfizer-BioNTech) vaccine are well known, concern has emerged due to sporadic reports of immune-mediated adverse effects (Cines and Bussel, 2021; Rela et al., 2021). As of August 19, 2021, 4.54 million individuals had received COVID-19 vaccines in Singapore (Oxford Martin School UoO, 2021). We report a case series of two patients who developed aseptic meningitis after vaccination. Vaccination has been regarded as the most important strategy to contain the COVID-19 pandemic. Concern has emerged due to sporadic reports of vaccine related immune-mediated adverse effects, including myocarditis in young men. We report a case series of 2patients who developed aseptic meningitis after BNT-162b2 (Pfizer-BioNTech) COVID-19 vaccination. Aseptic meningitis might be another manifestation that clinicians need to be alerted to.
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Affiliation(s)
- Amanda Cy Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Yq Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Shaun Sy Tan
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
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10
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Chew NW, Ngiam JN, Tham SM, Lim ZY, Li TYW, Cen S, Yap ES, Tambyah PA, Santosa A, Cross GB, Sia CH. Fever as a predictor of adverse outcomes in COVID-19. QJM 2021; 114:706-714. [PMID: 33533902 PMCID: PMC7928573 DOI: 10.1093/qjmed/hcab023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/22/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/INTRODUCTION There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. AIM We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. DESIGN AND METHODS Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever-Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. RESULTS There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P<0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P<0.001). The presence of fever (OR 4.096, 95% CI 1.737-9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. DISCUSSION/CONCLUSION In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.
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Affiliation(s)
- N W Chew
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Address correspondence to Dr C.-H. Sia, c/o Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228.
| | - J N Ngiam
- Department of Medicine, National University Health System, Singapore
| | - S M Tham
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - Z Y Lim
- Department of Medicine, National University Health System, Singapore
| | - T Y W Li
- Department of Medicine, National University Health System, Singapore
| | - S Cen
- Department of Medicine, National University Health System, Singapore
| | - E S Yap
- Department of Haematology, National Cancer Institute Singapore, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P A Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Santosa
- Division of Rheumatology, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - G B Cross
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - C -H Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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11
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Zhao H, Zhang Y, Chen Y, Ho NRY, Sundah NR, Natalia A, Liu Y, Miow QH, Wang Y, Tambyah PA, Ong CWM, Shao H. Accessible detection of SARS-CoV-2 through molecular nanostructures and automated microfluidics. Biosens Bioelectron 2021; 194:113629. [PMID: 34534949 PMCID: PMC8435073 DOI: 10.1016/j.bios.2021.113629] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022]
Abstract
Accurate and accessible nucleic acid diagnostics is critical to reducing the spread of COVID-19 and resuming socioeconomic activities. Here, we present an integrated platform for the direct detection of SARS-CoV-2 RNA targets near patients. Termed electrochemical system integrating reconfigurable enzyme-DNA nanostructures (eSIREN), the technology leverages responsive molecular nanostructures and automated microfluidics to seamlessly transduce target-induced molecular activation into an enhanced electrochemical signal. Through responsive enzyme-DNA nanostructures, the technology establishes a molecular circuitry that directly recognizes specific RNA targets and catalytically enhances signaling; only upon target hybridization, the molecular nanostructures activate to liberate strong enzymatic activity and initiate cascading reactions. Through automated microfluidics, the system coordinates and interfaces the molecular circuitry with embedded electronics; its pressure actuation and liquid-guiding structures improve not only analytical performance but also automated implementation. The developed platform establishes a detection limit of 7 copies of RNA target per μl, operates against the complex biological background of native patient samples, and is completed in <20 min at room temperature. When clinically evaluated, the technology demonstrates accurate detection in extracted RNA samples and direct swab lysates to diagnose COVID-19 patients.
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Affiliation(s)
- Haitao Zhao
- Institute for Health Innovation & Technology, National University of Singapore, Singapore
| | - Yan Zhang
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Yuan Chen
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Nicholas R Y Ho
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore
| | - Noah R Sundah
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Auginia Natalia
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Yu Liu
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore
| | - Qing Hao Miow
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yu Wang
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul A Tambyah
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Catherine W M Ong
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Huilin Shao
- Institute for Health Innovation & Technology, National University of Singapore, Singapore; Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore; Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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12
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Chia DKA, Lim Z, Ang JJ, Tambyah PA, Lau KSH, Ong J, Chow VTK, Allen DM, Fung J, Lau KJX, Luhung I, Schuster SC, Lee CN, Kim G, So JBY, Lomanto D, Shabbir A. Coronavirus viability in surgical plume and methods for safe disposal: a preclinical model. Br J Surg 2021; 109:15-20. [PMID: 34792098 DOI: 10.1093/bjs/znab385] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022]
Abstract
Smoke generated by cautery devices used during surgery may contain infective particles and may cause transmission of airborne viruses. This study determines whether live viruses are present in surgical smoke and evaluates the effectiveness of several proposed methods of removal so as to improve safety of healthcare workers.
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Affiliation(s)
- Daryl K A Chia
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Zhixue Lim
- Department of Hand & Reconstructive Microsurgery, University Orthopaedic, Hand & Reconstructive Microsurgical Cluster, National University Health System, Singapore
| | - Jia Jun Ang
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Paul A Tambyah
- Division of Infectious Diseases, Department of Medicine, University Medical Cluster, National University Health System, Singapore
| | - Kelly S H Lau
- Infectious Diseases Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Joe Ong
- Infectious Diseases Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Vincent T K Chow
- Infectious Diseases Translational Research Programme, Department of Microbiology & Immunology, Yong Loo Lin School of Medicine, National University of Singapore
| | - David M Allen
- Division of Infectious Diseases, Department of Medicine, University Medical Cluster, National University Health System, Singapore
| | - Javis Fung
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Kenny J X Lau
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Irvan Luhung
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Stephan C Schuster
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore
| | - Chuen Neng Lee
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Guowei Kim
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore
| | - Jimmy B Y So
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Davide Lomanto
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Minimally Invasive Surgical Centre, Department of Surgery, National University Health System, Singapore
| | - Asim Shabbir
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, University Surgical Cluster, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Fong SW, Yeo NKW, Chan YH, Goh YS, Amrun SN, Ang N, Rajapakse MP, Lum J, Foo S, Lee CYP, Carissimo G, Chee RSL, Torres-Ruesta A, Tay MZ, Chang ZW, Poh CM, Young BE, Tambyah PA, Kalimuddin S, Leo YS, Lye DC, Lee B, Biswas S, Howland SW, Renia L, Ng LFP. Robust Virus-Specific Adaptive Immunity in COVID-19 Patients with SARS-CoV-2 Δ382 Variant Infection. J Clin Immunol 2021; 42:214-229. [PMID: 34716845 PMCID: PMC8556776 DOI: 10.1007/s10875-021-01142-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/17/2021] [Indexed: 01/08/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) that have become dominant as the pandemic progresses bear the ORF8 mutation together with multiple spike mutations. A 382-nucleotide deletion (Δ382) in the ORF7b and ORF8 regions has been associated with milder disease phenotype and less systemic inflammation in COVID-19 patients. However, its impact on host immunity against SARS-CoV-2 remains undefined. Here, RNA-sequencing was performed to elucidate whole blood transcriptomic profiles and identify contrasting immune signatures between patients infected with either wildtype or Δ382 SARS-CoV-2 variant. Interestingly, the immune landscape of Δ382 SARS-CoV-2 infected patients featured an increased adaptive immune response, evidenced by enrichment of genes related to T cell functionality, a more robust SARS-CoV-2-specific T cell immunity, as well as a more rapid antibody response. At the molecular level, eukaryotic initiation factor 2 signaling was found to be upregulated in patients bearing Δ382, and its associated genes were correlated with systemic levels of T cell-associated and pro-inflammatory cytokines. This study provides more in-depth insight into the host–pathogen interactions of ORF8 with great promise as a therapeutic target to combat SARS-CoV-2 infection.
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Affiliation(s)
- Siew-Wai Fong
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Nicholas Kim-Wah Yeo
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Yi-Hao Chan
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Yun Shan Goh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Siti Naqiah Amrun
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Nicholas Ang
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | | | - Josephine Lum
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Shihui Foo
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Cheryl Yi-Pin Lee
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Guillaume Carissimo
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Rhonda Sin-Ling Chee
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Anthony Torres-Ruesta
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Matthew Zirui Tay
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Zi Wei Chang
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Chek Meng Poh
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, Singapore City, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Paul A Tambyah
- National Centre for Infectious Diseases, Singapore City, Singapore
- Department of Medicine, National University Hospital, Singapore City, Singapore
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore City, Singapore
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore City, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore City, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore City, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore City, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore City, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Subhra Biswas
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Shanshan Wu Howland
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Laurent Renia
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
- Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore
| | - Lisa F P Ng
- A*STAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research (A*STAR), Singapore City, Singapore.
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
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14
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Chen Y, Sundah NR, Ho NRY, Natalia A, Liu Y, Miow QH, Wang Y, Beh DLL, Chew KL, Chan D, Tambyah PA, Ong CWM, Shao H. Collaborative Equilibrium Coupling of Catalytic DNA Nanostructures Enables Programmable Detection of SARS-CoV-2. Adv Sci (Weinh) 2021; 8:e2101155. [PMID: 34278742 PMCID: PMC8420304 DOI: 10.1002/advs.202101155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/23/2021] [Indexed: 05/31/2023]
Abstract
Accessible and adaptable nucleic acid diagnostics remains a critical challenge in managing the evolving COVID-19 pandemic. Here, an integrated molecular nanotechnology that enables direct and programmable detection of SARS-CoV-2 RNA targets in native patient specimens is reported. Termed synergistic coupling of responsive equilibrium in enzymatic network (SCREEN), the technology leverages tunable, catalytic molecular nanostructures to establish an interconnected, collaborative architecture. SCREEN mimics the extraordinary organization and functionality of cellular signaling cascades. Through programmable enzyme-DNA nanostructures, SCREEN activates upon interaction with different RNA targets to initiate multi-enzyme catalysis; through system-wide favorable equilibrium shifting, SCREEN directly transduces a single target binding into an amplified electrical signal. To establish collaborative equilibrium coupling in the architecture, a computational model that simulates all reactions to predict overall performance and optimize assay configuration is developed. The developed platform achieves direct and sensitive RNA detection (approaching single-copy detection), fast response (assay reaction is completed within 30 min at room temperature), and robust programmability (across different genetic loci of SARS-CoV-2). When clinically evaluated, the technology demonstrates robust and direct detection in clinical swab lysates to accurately diagnose COVID-19 patients.
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Affiliation(s)
- Yuan Chen
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Department of Biomedical EngineeringFaculty of EngineeringNational University of SingaporeSingapore117583Singapore
| | - Noah R. Sundah
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Department of Biomedical EngineeringFaculty of EngineeringNational University of SingaporeSingapore117583Singapore
| | - Nicholas R. Y. Ho
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Institute of Molecular and Cell BiologyAgency for ScienceTechnology and ResearchSingapore138673Singapore
| | - Auginia Natalia
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Department of Biomedical EngineeringFaculty of EngineeringNational University of SingaporeSingapore117583Singapore
| | - Yu Liu
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Department of Biomedical EngineeringFaculty of EngineeringNational University of SingaporeSingapore117583Singapore
| | - Qing Hao Miow
- Department of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore117599Singapore
| | - Yu Wang
- Department of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore117599Singapore
| | - Darius L. L. Beh
- Division of Infectious DiseasesDepartment of MedicineNational University HospitalSingapore119074Singapore
| | - Ka Lip Chew
- Department of Laboratory MedicineNational University HospitalSingapore119074Singapore
| | - Douglas Chan
- Department of Laboratory MedicineNg Teng Fong General HospitalSingapore609606Singapore
| | - Paul A. Tambyah
- Department of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore117599Singapore
- Division of Infectious DiseasesDepartment of MedicineNational University HospitalSingapore119074Singapore
| | - Catherine W. M. Ong
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Department of MedicineYong Loo Lin School of MedicineNational University of SingaporeSingapore117599Singapore
- Division of Infectious DiseasesDepartment of MedicineNational University HospitalSingapore119074Singapore
| | - Huilin Shao
- Institute for Health Innovation & TechnologyNational University of SingaporeSingapore117599Singapore
- Department of Biomedical EngineeringFaculty of EngineeringNational University of SingaporeSingapore117583Singapore
- Institute of Molecular and Cell BiologyAgency for ScienceTechnology and ResearchSingapore138673Singapore
- Department of SurgeryYong Loo Lin School of MedicineNational University of SingaporeSingapore117599Singapore
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15
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Miow QH, Vallejo AF, Wang Y, Hong JM, Bai C, Teo FS, Wang AD, Loh HR, Tan TZ, Ding Y, She HW, Gan SH, Paton NI, Lum J, Tay A, Chee CB, Tambyah PA, Polak ME, Wang YT, Singhal A, Elkington PT, Friedland JS, Ong CW. Doxycycline host-directed therapy in human pulmonary tuberculosis. J Clin Invest 2021; 131:e141895. [PMID: 34128838 DOI: 10.1172/jci141895] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 06/11/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUNDMatrix metalloproteinases (MMPs) are key regulators of tissue destruction in tuberculosis (TB) and may be targets for host-directed therapy. We conducted a phase II double-blind, randomized, controlled trial investigating doxycycline, a licensed broad-spectrum MMP inhibitor, in patients with pulmonary TB.METHODSThirty patients with pulmonary TB were enrolled within 7 days of initiating anti-TB treatment and randomly assigned to receive either 100 mg doxycycline or placebo twice a day for 14 days, in addition to standard care.RESULTSWhole blood RNA-sequencing demonstrated that doxycycline accelerated restoration of dysregulated gene expression in TB towards normality, rapidly down-regulating type I and II interferon and innate immune response genes, and up-regulating B-cell modules relative to placebo. The effects persisted for 6 weeks after doxycycline discontinuation, concurrent with suppressed plasma MMP-1. Doxycycline significantly reduced sputum MMP-1, -8, -9, -12 and -13, suppressed type I collagen and elastin destruction, reduced pulmonary cavity volume without altering sputum mycobacterial loads, and was safe.CONCLUSIONAdjunctive doxycycline with standard anti-TB treatment suppressed pathological MMPs in PTB patients. Larger studies on adjunctive doxycycline to limit TB immunopathology are merited.TRIAL REGISTRATIONClinicalTrials.gov NCT02774993.FUNDINGSingapore National Medical Research Council (NMRC/CNIG/1120/2014, NMRC/Seedfunding/0010/2014, NMRC/CISSP/2015/009a); the Singapore Infectious Diseases Initiative (SIDI/2013/013); National University Health System (PFFR-28 January 14, NUHSRO/2014/039/BSL3-SeedFunding/Jul/01); the Singapore Immunology Network Immunomonitoring platform (BMRC/IAF/311006, H16/99/b0/011, NRF2017_SISFP09); an ExxonMobil Research Fellowship, NUHS Clinician Scientist Program (NMRC/TA/0042/2015, CSAINV17nov014); the UK Medical Research Council (MR/P023754/1, MR/N006631/1); a NUS Postdoctoral Fellowship (NUHSRO/2017/073/PDF/03); The Royal Society Challenge Grant (CHG\R1\170084); the Sir Henry Dale Fellowship, Wellcome Trust (109377/Z/15/Z); and A*STAR.
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Affiliation(s)
- Qing Hao Miow
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andres F Vallejo
- Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Yu Wang
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Mei Hong
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chen Bai
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Felicia Sw Teo
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, National University Health System, Singapore
| | - Alvin Dy Wang
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Hong Rong Loh
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tuan Zea Tan
- Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Ying Ding
- National Centre for Infectious Diseases, Singapore
| | - Hoi Wah She
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | - Suay Hong Gan
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | - Nicholas I Paton
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Alicia Tay
- Singapore Immunology Network, A*STAR, Singapore
| | - Cynthia Be Chee
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | - Paul A Tambyah
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Marta E Polak
- Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Yee Tang Wang
- Tuberculosis Control Unit, Tan Tock Seng Hospital, Singapore
| | | | - Paul T Elkington
- NIHR Respiratory Biomedical Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | | | - Catherine Wm Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Institute for Health Innovation and Technology, National University of Singapore, Singapore
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16
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Petersen E, Lee SS, Blumberg L, Kramer LD, Obiero C, Al-Abri S, Abubakar A, Pinto TCA, Yapi BR, Tambyah PA, Holmes AH. International Journal of Infectious Diseases: from the past quarter-century to the next. Int J Infect Dis 2021; 109:36-37. [PMID: 34217873 PMCID: PMC7613580 DOI: 10.1016/j.ijid.2021.06.064] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- E Petersen
- International Society for Infectious Diseases, Boston, United States.; Institute for Clinical Medicine, Aarhus University, Denmark..
| | - S S Lee
- International Society for Infectious Diseases, Boston, United States.; Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - L Blumberg
- International Society for Infectious Diseases, Boston, United States.; Centre for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, Johannesburg 2195, South Africa
| | - L D Kramer
- International Society for Infectious Diseases, Boston, United States.; School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - C Obiero
- International Society for Infectious Diseases, Boston, United States.; Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Global Health, University of Amsterdam, Faculty of Medicine, Amsterdam, Noord-Holland, The Netherlands
| | - S Al-Abri
- International Society for Infectious Diseases, Boston, United States.; Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - A Abubakar
- International Society for Infectious Diseases, Boston, United States.; Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - T C A Pinto
- International Society for Infectious Diseases, Boston, United States.; Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Brazil
| | - B R Yapi
- International Society for Infectious Diseases, Boston, United States.; Centre d'Entomologie Médicale et Vétérinaire, CEMV - Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - P A Tambyah
- International Society for Infectious Diseases, Boston, United States.; Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A H Holmes
- International Society for Infectious Diseases, Boston, United States.; Department of Infectious Disease, Faculty of Medicine, Imperial College London, United Kingdom
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17
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Chan YH, Young BE, Fong SW, Ding Y, Goh YS, Chee RSL, Tan SY, Kalimuddin S, Tambyah PA, Leo YS, Ng LFP, Lye DC, Renia L. Differential Cytokine Responses in Hospitalized COVID-19 Patients Limit Efficacy of Remdesivir. Front Immunol 2021; 12:680188. [PMID: 34262564 PMCID: PMC8275132 DOI: 10.3389/fimmu.2021.680188] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022] Open
Abstract
A significant proportion of COVID-19 patients will progress to critical illness requiring invasive mechanical ventilation. This accentuates the need for a therapy that can reduce the severity of COVID-19. Clinical trials have shown the effectiveness of remdesivir in shortening recovery time and decreasing progression to respiratory failure and mechanical ventilation. However, some studies have highlighted its lack of efficacy in patients on high-flow oxygen and mechanical ventilation. This study uncovers some underlying immune response differences between responders and non-responders to remdesivir treatment. Immunological analyses revealed an upregulation of tissue repair factors BDNF, PDGF-BB and PIGF-1, as well as an increase in ratio of Th2-associated cytokine IL-4 to Th1-associated cytokine IFN-γ. Serological profiling of IgG subclasses corroborated this observation, with significantly higher magnitude of increase in Th2-associated IgG2 and IgG4 responses. These findings help to identify the mechanisms of immune regulation accompanying successful remdesivir treatment in severe COVID-19 patients.
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Affiliation(s)
- Yi-Hao Chan
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Barnaby E Young
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siew-Wai Fong
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Ying Ding
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Yun Shan Goh
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Rhonda Sin-Ling Chee
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Seow-Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.,Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore, Singapore
| | - Paul A Tambyah
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Lisa F P Ng
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Laurent Renia
- ASTAR Infectious Diseases Labs (A*STAR ID Labs), Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
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18
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Lu L, Koh CT, Lim YH, Sng A, Poon KS, Tan SSY, Kao PT, Tee N, Yap HK, Lee BW, Tambyah PA. Role of Asymptomatic Children in Community Severe Acute Respiratory Syndrome Coronavirus 2 Transmission. J Infect Dis 2021; 223:1834-1836. [PMID: 33728456 PMCID: PMC7989340 DOI: 10.1093/infdis/jiab138] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/13/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Liangjian Lu
- Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore
| | - Chee Teck Koh
- Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore
| | - Yi Herng Lim
- Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore
| | - Andrew Sng
- Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok Siong Poon
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Shaun S Y Tan
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Pao Tang Kao
- Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nancy Tee
- Department of Laboratory Medicine, National University Health System, Singapore
| | - Hui Kim Yap
- Department of Paediatrics, Khoo Teck Puat- National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bee Wah Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul A Tambyah
- Division of Infectious Diseases, National University Health System and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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19
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Young BE, Wei WE, Fong SW, Mak TM, Anderson DE, Chan YH, Pung R, Heng CS, Ang LW, Zheng AKE, Lee B, Kalimuddin S, Pada S, Tambyah PA, Parthasarathy P, Tan SY, Sun L, Smith GJ, Lin RTP, Leo YS, Renia L, Wang LF, Ng LF, Maurer-Stroh S, Lye DC, Lee VJ. Association of SARS-CoV-2 clades with clinical, inflammatory and virologic outcomes: An observational study. EBioMedicine 2021; 66:103319. [PMID: 33840632 PMCID: PMC8027908 DOI: 10.1016/j.ebiom.2021.103319] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/11/2021] [Accepted: 03/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Host determinants of severe coronavirus disease 2019 include advanced age, comorbidities and male sex. Virologic factors may also be important in determining clinical outcome and transmission rates, but limited patient-level data is available. METHODS We conducted an observational cohort study at seven public hospitals in Singapore. Clinical and laboratory data were collected and compared between individuals infected with different SARS-CoV-2 clades. Firth's logistic regression was used to examine the association between SARS-CoV-2 clade and development of hypoxia, and quasi-Poisson regression to compare transmission rates. Plasma samples were tested for immune mediator levels and the kinetics of viral replication in cell culture were compared. FINDINGS 319 patients with PCR-confirmed SARS-CoV-2 infection had clinical and virologic data available for analysis. 29 (9%) were infected with clade S, 90 (28%) with clade L/V, 96 (30%) with clade G (containing D614G variant), and 104 (33%) with other clades 'O' were assigned to lineage B.6. After adjusting for age and other covariates, infections with clade S (adjusted odds ratio (aOR) 0·030 (95% confidence intervals (CI): 0·0002-0·29)) or clade O (B·6) (aOR 0·26 (95% CI 0·064-0·93)) were associated with lower odds of developing hypoxia requiring supplemental oxygen compared with clade L/V. Patients infected with clade L/V had more pronounced systemic inflammation with higher concentrations of pro-inflammatory cytokines, chemokines and growth factors. No significant difference in the severity of clade G infections was observed (aOR 0·95 (95% CI: 0·35-2·52). Though viral loads were significantly higher, there was no evidence of increased transmissibility of clade G, and replicative fitness in cell culture was similar for all clades. INTERPRETATION Infection with clades L/V was associated with increased severity and more systemic release of pro-inflammatory cytokines. Infection with clade G was not associated with changes in severity, and despite higher viral loads there was no evidence of increased transmissibility.
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Affiliation(s)
- Barnaby E Young
- National Centre for Infectious Diseases, Singapore; Deaprtment of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Wycliffe E Wei
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore; Singapore Ministry of Health, Singapore
| | - Siew-Wai Fong
- A*STAR ID Labs, Agency for Science, Technology and Research (A*STAR), Singapore; Singapore Immunology Network, A*STAR, Singapore; Department of Biological Science, National University of Singapore, Singapore
| | - Tze-Minn Mak
- National Centre for Infectious Diseases, Singapore
| | | | - Yi-Hao Chan
- Singapore Immunology Network, A*STAR, Singapore; Singapore Immunology Network, A*STAR, Singapore
| | - Rachael Pung
- Singapore Ministry of Health, Singapore; London School of Hygiene and Tropical Medicine, London, UK
| | | | - Li Wei Ang
- National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore
| | | | - Bernett Lee
- Singapore Immunology Network, A*STAR, Singapore
| | - Shirin Kalimuddin
- Duke NUS Medical School, Singapore; Singapore General Hospital of Singapore, Singapore
| | | | - Paul A Tambyah
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore; Deaprtment of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Laurent Renia
- Singapore Immunology Network, A*STAR, Singapore; Singapore Immunology Network, A*STAR, Singapore
| | | | - Lisa Fp Ng
- Singapore Immunology Network, A*STAR, Singapore; Singapore Immunology Network, A*STAR, Singapore
| | | | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Deaprtment of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vernon J Lee
- Singapore Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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20
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Chioh FW, Fong SW, Young BE, Wu KX, Siau A, Krishnan S, Chan YH, Carissimo G, Teo LL, Gao F, Tan RS, Zhong L, Koh AS, Tan SY, Tambyah PA, Renia L, Ng LF, Lye DC, Cheung C. Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation. eLife 2021; 10:64909. [PMID: 33752798 PMCID: PMC7987341 DOI: 10.7554/elife.64909] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
Numerous reports of vascular events after an initial recovery from COVID-19 form our impetus to investigate the impact of COVID-19 on vascular health of recovered patients. We found elevated levels of circulating endothelial cells (CECs), a biomarker of vascular injury, in COVID-19 convalescents compared to healthy controls. In particular, those with pre-existing conditions (e.g., hypertension, diabetes) had more pronounced endothelial activation hallmarks than non-COVID-19 patients with matched cardiovascular risk. Several proinflammatory and activated T lymphocyte-associated cytokines sustained from acute infection to recovery phase, which correlated positively with CEC measures, implicating cytokine-driven endothelial dysfunction. Notably, we found higher frequency of effector T cells in our COVID-19 convalescents compared to healthy controls. The activation markers detected on CECs mapped to counter receptors found primarily on cytotoxic CD8+ T cells, raising the possibility of cytotoxic effector cells targeting activated endothelial cells. Clinical trials in preventive therapy for post-COVID-19 vascular complications may be needed.
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Affiliation(s)
- Florence Wj Chioh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Siew-Wai Fong
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore, Singapore
| | - Barnaby E Young
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kan-Xing Wu
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Anthony Siau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shuba Krishnan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, ANA Futura, Campus Flemingsberg, Stockholm, Sweden
| | - Yi-Hao Chan
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Guillaume Carissimo
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Louis Ly Teo
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Fei Gao
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Seow-Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Paul A Tambyah
- Department of Medicine, National University Hospital, Singapore, Singapore
| | - Laurent Renia
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Lisa Fp Ng
- A*STAR ID Labs, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - David C Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christine Cheung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
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21
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Archuleta S, Chia PY, Wei Y, Syed-Omar SF, Low JG, Oh HM, Fisher D, Ponnampalavanar SSL, Wijaya L, Kamarulzaman A, Lum LCS, Tambyah PA, Leo YS, Lye DC. Predictors and Clinical Outcomes of Poor Platelet Recovery in Adult Dengue With Thrombocytopenia: A Multicenter, Prospective Study. Clin Infect Dis 2021; 71:383-389. [PMID: 31626692 DOI: 10.1093/cid/ciz850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/15/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Platelet transfusion is common in dengue patients with thrombocytopenia. We previously showed in a randomized clinical trial that prophylactic platelet transfusion did not reduce clinical bleeding. In this study, we aimed to characterize the predictors and clinical outcomes of poor platelet recovery in transfused and nontransfused participants. METHODS We analyzed patients from the Adult Dengue Platelet Study with laboratory-confirmed dengue with ≤20 000 platelets/μL and without persistent mild bleeding or any severe bleeding in a post hoc analysis. Poor platelet recovery was defined as a platelet count of ≤20 000/μL on Day 2. We recruited 372 participants from 5 acute care hospitals located in Singapore and Malaysia between 29 April 2010 and 9 December 2014. Of these, 188 were randomly assigned to the transfusion group and 184 to the control group. RESULTS Of 360 patients, 158 had poor platelet recovery. Age, white cell count, and day of illness at study enrollment were significant predictors of poor platelet recovery after adjustment for baseline characteristics and platelet transfusion. Patients with poor platelet recovery had longer hospitalizations but no significant difference in other clinical outcomes, regardless of transfusion. We found a significant interaction between platelet recovery and transfusion; patients with poor platelet recovery were more likely to bleed if given a prophylactic platelet transfusion (odds ratio 2.34, 95% confidence interval 1.18-4.63). CONCLUSIONS Dengue patients with thrombocytopenia who were older or presented earlier and with lower white cell counts were more likely to have poor platelet recovery. In patients with poor platelet recovery, platelet transfusion does not improve outcomes and may actually increase the risk of bleeding. The mechanisms of poor platelet recovery need to be determined. CLINICAL TRIALS REGISTRATION NCT01030211.
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Affiliation(s)
- Sophia Archuleta
- Division of Infectious Diseases, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Po Ying Chia
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Yuan Wei
- Singapore Clinical Research Institute, Singapore
| | | | - Jenny G Low
- Singapore General Hospital, Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Helen M Oh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Changi General Hospital, Singapore; and
| | - Dale Fisher
- Division of Infectious Diseases, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Lucy C S Lum
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Paul A Tambyah
- Division of Infectious Diseases, National University Hospital, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yee-Sin Leo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - David C Lye
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Singapore
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22
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Tan YK, Goh C, Leow AS, Tambyah PA, Ang A, Yap ES, Tu TM, Sharma V, Yeo LL, Chan BP, Tan BY. Abstract P89: Covid-19 and Ischemic Stroke: A Systematic Review and Meta-Summary of the Literature. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain.
Objectives:
We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients.
Methods:
A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included.
Results:
A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean D-dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129).
Conclusion:
We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated D-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis.
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Affiliation(s)
| | - Claire Goh
- National Univ of Singapore, Singapore, Singapore
| | - Aloysius S Leow
- Div of Neurology, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | - Paul A Tambyah
- Div of Infectious Diseases, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | - Alicia Ang
- Div of Infectious Diseases, Dept of Medicine, National Univ Health System, Singapore, Singapore, Singapore
| | - Eng Soo Yap
- Dept of Haematology-Oncology,, National Univ Cancer Institute, Singapore, Singapore, Singapore
| | | | | | | | | | - Benjamin Y Tan
- Dept of Medicine, National Univ of Singapore, Singapore, Singapore
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23
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Sundah NR, Natalia A, Liu Y, Ho NRY, Zhao H, Chen Y, Miow QH, Wang Y, Beh DLL, Chew KL, Chan D, Tambyah PA, Ong CWM, Shao H. Catalytic amplification by transition-state molecular switches for direct and sensitive detection of SARS-CoV-2. Sci Adv 2021; 7:7/12/eabe5940. [PMID: 33731349 PMCID: PMC7968834 DOI: 10.1126/sciadv.abe5940] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
Despite the importance of nucleic acid testing in managing the COVID-19 pandemic, current detection approaches remain limited due to their high complexity and extensive processing. Here, we describe a molecular nanotechnology that enables direct and sensitive detection of viral RNA targets in native clinical samples. The technology, termed catalytic amplification by transition-state molecular switch (CATCH), leverages DNA-enzyme hybrid complexes to form a molecular switch. By ratiometric tuning of its constituents, the multicomponent molecular switch is prepared in a hyperresponsive state-the transition state-that can be readily activated upon the binding of sparse RNA targets to turn on substantial enzymatic activity. CATCH thus achieves superior performance (~8 RNA copies/μl), direct fluorescence detection that bypasses all steps of PCR (<1 hour at room temperature), and versatile implementation (high-throughput 96-well format and portable microfluidic assay). When applied for clinical COVID-19 diagnostics, CATCH demonstrated direct and accurate detection in minimally processed patient swab samples.
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Affiliation(s)
- Noah R Sundah
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Auginia Natalia
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Yu Liu
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Nicholas R Y Ho
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
| | - Haitao Zhao
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
| | - Yuan Chen
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Qing Hao Miow
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yu Wang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darius L L Beh
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Douglas Chan
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Catherine W M Ong
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Huilin Shao
- Institute for Health Innovation&Technology, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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24
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Goh YS, Chavatte JM, Lim Jieling A, Lee B, Hor PX, Amrun SN, Lee CYP, Chee RSL, Wang B, Lee CY, Ngoh EZX, Wang CI, Young BE, Tambyah PA, Kalimuddin S, Pada S, Tan SY, Sun LJ, Chen MIC, Leo YS, Lye DC, Ng LFP, Lin RTP, Renia L. Sensitive detection of total anti-Spike antibodies and isotype switching in asymptomatic and symptomatic individuals with COVID-19. Cell Rep Med 2021; 2:100193. [PMID: 33495757 PMCID: PMC7816583 DOI: 10.1016/j.xcrm.2021.100193] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/06/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
Early detection of infection is crucial to limit the spread of coronavirus disease 2019 (COVID-19). Here we develop a flow cytometry-based assay to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) protein antibodies in individuals with COVID-19. The assay detects specific immunoglobulin M (IgM), IgA, and IgG in individuals with COVID-19 and also acquisition of all IgG subclasses, with IgG1 being the most dominant. The antibody response is significantly higher at a later stage of infection. Furthermore, asymptomatic individuals with COVID-19 also develop specific IgM, IgA, and IgG, with IgG1 being the most dominant subclass. Although the antibody levels are lower in asymptomatic infection, the assay is highly sensitive and detects 97% of asymptomatic infections. These findings demonstrate that the assay can be used for serological analysis of symptomatic and asymptomatic infections, which may otherwise remain undetected. Flow cytometry assay detects specific antibodies in symptomatic individuals with COVID-19 Asymptomatic individuals with COVID-19 also develop specific antibodies IgG1 is the dominant IgG subclass in symptomatic and asymptomatic individuals The assay is highly sensitive and detects 97% of asymptomatic infections
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Affiliation(s)
- Yun Shan Goh
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Jean-Marc Chavatte
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore
| | - Alicia Lim Jieling
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore
| | - Bernett Lee
- Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Pei Xiang Hor
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Siti Naqiah Amrun
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Cheryl Yi-Pin Lee
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Rhonda Sin-Ling Chee
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Bei Wang
- Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Chia Yin Lee
- Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Eve Zhi Xian Ngoh
- Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Cheng-I Wang
- Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore
| | - Barnaby Edward Young
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore
| | - Paul A Tambyah
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore.,Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753, Singapore.,Emerging Infectious Disease Program, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Surinder Pada
- Division of Infectious Diseases, Ng Teng Fong Hospital, 1 Jurong East Street 21, Singapore 609606, Singapore
| | - Seow-Yen Tan
- Department of Infectious Diseases, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Louisa Jin Sun
- Alexandra Hospital, 378 Alexandra Road, Singapore 159964, Singapore
| | - Mark I-Cheng Chen
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore 117549, Singapore
| | - Yee-Sin Leo
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Drive, Singapore 117597, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Drive, Singapore 117597, Singapore
| | - Lisa F P Ng
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117596, Singapore.,National Institute of Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.,Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Raymond Tzer Pin Lin
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 10 Medical Drive, Singapore 117597, Singapore
| | - Laurent Renia
- Infectious Diseases Laboratories (ID Labs), Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Singapore Immunology Network, Agency for Science, Technology and Research (A∗STAR), Immunos, Biopolis, Singapore 138648, Singapore.,Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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25
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Henderson A, Paterson DL, Chatfield MD, Tambyah PA, Lye DC, De PP, Lin RTP, Chew KL, Yin M, Lee TH, Yilmaz M, Cakmak R, Alenazi TH, Arabi YM, Falcone M, Bassetti M, Righi E, Ba R, Kanj SS, Bhally H, Iredell J, Mendelson M, Boyles TH, Looke DFM, Runnegar NJ, Miyakis S, Walls G, Ai Khamis M, Zikri A, Crowe A, Ingram PR, Daneman NN, Griffin P, Athan E, Roberts L, Beatson SA, Peleg AY, Cottrell KK, Bauer MJ, Tan E, Chaw K, Nimmo GR, Harris-Brown T, Harris PNA. Association between minimum inhibitory concentration, beta-lactamase genes and mortality for patients treated with piperacillin/tazobactam or meropenem from the MERINO study. Clin Infect Dis 2020; 73:e3842-e3850. [PMID: 33106863 DOI: 10.1093/cid/ciaa1479] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 12/08/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This study aims to assess the association of piperacillin/tazobactam and meropenem minimum inhibitory concentration (MIC) and beta-lactam resistance genes with mortality in the MERINO trial. METHODS Blood culture isolates from enrolled patients were tested by broth microdilution and whole genome sequencing at a central laboratory. Multivariate logistic regression was performed to account for confounders. Absolute risk increase for 30-day mortality between treatment groups was calculated for the primary analysis (PA) and the microbiologic assessable (MA) populations. RESULTS 320 isolates from 379 enrolled patients were available with susceptibility to piperacillin/tazobactam 94% and meropenem 100%. The piperacillin/tazobactam non-susceptible breakpoint (MIC > 16 mg/L) best predicted 30-day mortality after accounting for confounders (odds ratio 14.9, 95% CI 2.8 - 87.2). The absolute risk increase for 30-day mortality for patients treated with piperacillin/tazobactam compared with meropenem was 9% (95% CI 3% - 15%) and 8% (95% CI 2% - 15%) for the original PA population and the post-hoc MA populations, which reduced to 5% (95% CI -1% - 10%) after excluding strains with piperacillin/tazobactam MIC values > 16 mg/L. Isolates co-harboring ESBL and OXA-1 genes were associated with elevated piperacillin/tazobactam MICs and the highest risk increase in 30-mortality of 14% (95% CI 2% - 28%). CONCLUSION After excluding non-susceptible strains, the 30-day mortality difference was from the MERINO trial was less pronounced for piperacillin/tazobactam. Poor reliability in susceptibility testing performance for piperacillin/tazobactam and the high prevalence of OXA co-harboring ESBLs suggests meropenem remains the preferred choice for definitive treatment of ceftriaxone non-susceptible E. coli and Klebsiella.
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Affiliation(s)
- A Henderson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD
| | - D L Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - M D Chatfield
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - P A Tambyah
- Department of Infectious Diseases, National University Hospital, Singapore
| | - D C Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Hospital, Singapore
| | - P P De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - R T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - K L Chew
- Division of Microbiology, National University Hospital, Singapore
| | - M Yin
- Department of Infectious Diseases, National University Hospital, Singapore
| | - T H Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,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
| | - M Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - R Cakmak
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - T H Alenazi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Y M Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - M Falcone
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - M Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino Genoa, Italy
| | - E Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Udine, Italy.,Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Rogers Ba
- Monash University, Centre for Inflammatory Diseases, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Victoria, Australia
| | - S S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Bhally
- Department of Medicine and Infectious Diseases, North Shore Hospital, Auckland
| | - J Iredell
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, Australia.,Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - T H Boyles
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - D F M Looke
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, Australia
| | - N J Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, QLD.,University of Queensland, Brisbane, Australia
| | - S Miyakis
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia.,Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - G Walls
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | - M Ai Khamis
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - A Zikri
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - A Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia.,Department of Microbiology, St Vincent's Hospital, Melbourne, Australia
| | - P R Ingram
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Australia.,Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch , Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia
| | - N N Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - P Griffin
- University of Queensland, Brisbane, Australia.,Department of Medicine and Infectious Diseases, Mater Hospital and Mater Medical Research Institute, Brisbane, Australia.,QIMR Berghofer, Brisbane, Queensland, Australia
| | - E Athan
- Department of Infectious Diseases, Barwon Health and Deakin University, Geelong, Victoria, Australia
| | - L Roberts
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - S A Beatson
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - A Y Peleg
- Infection & Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia.,Department of Microbiology, Monash University, Clayton, Australia
| | - K K Cottrell
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - M J Bauer
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - E Tan
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - K Chaw
- Department of Microbiology, Pathology Queensland, Toowoomba Laboratory, Australia.,Department of Microbiology, Mater Pathology, Australia.,Infectious Diseases Department, Redcliffe Hospital, Australia
| | - G R Nimmo
- Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - T Harris-Brown
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - P N A Harris
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.,Department of Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
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26
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Pollack M, Madoff LC, Tambyah PA, Mendelson M, Holmes A. International Society for Infectious Diseases – Sustained and continuous funding for WHO. Int J Infect Dis 2020; 96:458. [PMID: 32425640 PMCID: PMC7233212 DOI: 10.1016/j.ijid.2020.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/04/2022] Open
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27
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Abstract
BACKGROUND The global coronavirus disease 2019 pandemic has highlighted the importance of understanding the cardiovascular implications of coronavirus infections, with more severe disease in those with cardiovascular co-morbidities, and resulting cardiac manifestations such as myocardial injury, arrhythmias, and heart failure. DESIGN A systematic review of the current knowledge on the effects of coronavirus infection on the cardiovascular system in humans was performed and results were summarized. METHODS Databases such as MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, ClinicalTrials.gov, Chinese Knowledge Resource Integrated Database and Chinese Clinical Trial Registry were searched on 20 March 2020. RESULTS In total, 135 studies were included, involving severe acute respiratory syndrome, Middle East respiratory syndrome, coronavirus disease 2019 and other coronaviruses. Most were case reports, case series and cohort studies of poor to fair quality. In post-mortem examinations of subjects who died from infection, around half had virus identified in heart tissues in severe acute respiratory syndrome, but none in Middle East respiratory syndrome and coronavirus disease 2019. Cardiac manifestations reported include tachycardia, bradycardia, arrhythmias, and myocardial injury, secondary to both systemic infection and treatment. Cardiac injury and arrhythmias are more prevalent in coronavirus disease 2019, and elevated cardiac markers are associated with intensive care unit admission and death. In severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019, comorbidities such as hypertension, diabetes mellitus, and heart disease are associated with intensive care unit admission, mechanical ventilation, and mortality. There were cases of misdiagnosis due to overlapping presentations of cardiovascular diseases and coronavirus infections, leading to hospital spread and delayed management of life-threatening conditions. CONCLUSION This review highlighted the ways in which coronaviruses affect cardiovascular function and interacts with pre-existing cardiovascular diseases.
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Affiliation(s)
- Jamie SY Ho
- />School of Clinical Medicine, University of Cambridge, UK
| | - Paul A Tambyah
- />Division of Infectious Diseases, National University Hospital, Singapore
- />Department of Medicine, National University of Singapore, Singapore
| | - Andrew FW Ho
- />SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore
- />Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore
- />National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Mark YY Chan
- />Department of Medicine, National University of Singapore, Singapore
- />Department of Cardiology, National University Heart Centre, Singapore
| | - Ching-Hui Sia
- />Department of Medicine, National University of Singapore, Singapore
- />Department of Cardiology, National University Heart Centre, Singapore
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28
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Chaung J, Chan D, Pada S, Tambyah PA. Coinfection with COVID-19 and coronavirus HKU1-The critical need for repeat testing if clinically indicated. J Med Virol 2020; 92:1785-1786. [PMID: 32293743 PMCID: PMC7262189 DOI: 10.1002/jmv.25890] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Jenna Chaung
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Douglas Chan
- Department of Laboratory Medicine, Ng Teng Fong General Hospital, Singapore
| | - Surinder Pada
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Paul A Tambyah
- Department of Medicine, National University Hospital, Singapore
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29
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Archuleta S, Cross G, Somani J, Lum L, Santosa A, Alagha RA, Allen DM, Ang A, Beh D, Chai L, Chan SM, Lim SM, Olszyna DP, Ong C, Oon J, Salada BMA, Smitasin N, Sun L, Tambyah PA, Tham SM, Yan G, Yee CH, Dan YY, Jureen R, Tee N, Mahadevan M, Yau YW, Quek SC, Liu EH, Sin C, Bagdasarian N, Fisher DA. Responding to COVID-19: how an academic infectious diseases division mobilized in Singapore. BMC Med 2020; 18:179. [PMID: 32507112 PMCID: PMC7276279 DOI: 10.1186/s12916-020-01641-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND On January 30, COVID-19 was declared a Public Health Emergency of International Concern-a week after Singapore's first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore's third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching. MAIN BODY With memories of SARS still vivid, there was an urgent requirement for the NUH Division of Infectious Diseases to adapt-undergoing major reorganization to face rapidly changing priorities while ensuring usual essential services and standards. Leveraging on individual strengths, our division mobilized to meet the demands of COVID-19 while engaging in high-level coordination, strategy, and advocacy. We present our experience of the 60 days since the nation's first case. During this time, our hospital has managed 3030 suspect cases, including 1300 inpatients, 37 confirmed cases, and overseen 4384 samples tested for COVID-19. CONCLUSION Complex hospital adaptations were supported by an unprecedented number of workflows and coordination channels essential to safe and effective operations. The actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other divisions and institutions facing the spread of COVID-19 globally.
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Affiliation(s)
- Sophia Archuleta
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Gail Cross
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Jyoti Somani
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lionel Lum
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amelia Santosa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Rheumatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Rawan A Alagha
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - David M Allen
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alicia Ang
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Darius Beh
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Louis Chai
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Si Min Chan
- Department of Pediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - See Ming Lim
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Dariusz P Olszyna
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Catherine Ong
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jolene Oon
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Brenda M A Salada
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Nares Smitasin
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Louisa Sun
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Paul A Tambyah
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sai Meng Tham
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Gabriel Yan
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Chen Hui Yee
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
| | - Yock Young Dan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Nancy Tee
- Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Department of Pathology, National University of Singapore, Singapore, Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Singapore
| | - Malcolm Mahadevan
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
| | - Ying Wei Yau
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore
| | - Swee Chye Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Pediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Eugene H Liu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Anesthesia, National University Hospital, National University Health System, Singapore, Singapore
| | - Clara Sin
- Group Operations, National University Hospital, National University Health System, Singapore, Singapore
| | - Natasha Bagdasarian
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dale A Fisher
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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30
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Tartari E, Saris K, Kenters N, Marimuthu K, Widmer A, Collignon P, Cheng VCC, Wong SC, Gottlieb T, Tambyah PA, Perencevich E, Allegranzi B, Dramowski A, Edmond MB, Voss A. Not sick enough to worry? "Influenza-like" symptoms and work-related behavior among healthcare workers and other professionals: Results of a global survey. PLoS One 2020; 15:e0232168. [PMID: 32401751 PMCID: PMC7219706 DOI: 10.1371/journal.pone.0232168] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/09/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Healthcare workers (HCWs) and non-HCWs may contribute to the transmission of influenza-like illness (ILI) to colleagues and susceptible patients by working while sick (presenteeism). The present study aimed to explore the views and behavior of HCWs and non-HCWs towards the phenomenon of working while experiencing ILI. METHODS The study was a cross-sectional online survey conducted between October 2018 and January 2019 to explore sickness presenteeism and the behaviour of HCWs and non-HCWs when experiencing ILI. The survey questionnaire was distributed to the members and international networks of the International Society of Antimicrobial Chemotherapy (ISAC) Infection Prevention and Control (IPC) Working Group, as well as via social media platforms, including LinkedIn, Twitter and IPC Blog. RESULTS In total, 533 respondents from 49 countries participated (Europe 69.2%, Asia-Pacific 19.1%, the Americas 10.9%, and Africa 0.8%) representing 249 HCWs (46.7%) and 284 non-HCWs (53.2%). Overall, 312 (58.5%; 95% confidence interval [CI], 56.2-64.6) would continue to work when sick with ILI, with no variation between the two categories. Sixty-seven (26.9%) HCWs and forty-six (16.2%) non-HCWs would work with fever alone (p<0 .01) Most HCWs (89.2-99.2%) and non-HCWs (80%-96.5%) would work with "minor" ILI symptoms, such as sore throat, sinus cold, fatigue, sneezing, runny nose, mild cough and reduced appetite. CONCLUSION A future strategy to successfully prevent the transmission of ILI in healthcare settings should address sick-leave policy management, in addition to encouraging the uptake of influenza vaccine.
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Affiliation(s)
- Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and University of Geneva Faculty of Medicine, Geneva, Switzerland
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Katja Saris
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
- REshape Center for Innovation, Radboudumc, Nijmegen, The Netherlands
| | - Nikki Kenters
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Kalisvar Marimuthu
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
- National Centre for Infectious Diseases, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andreas Widmer
- University of Basel Hospitals and Clinics, Basel, Switzerland
| | - Peter Collignon
- Medical School, The Australian National University, Canberra, ACT, Australia
| | - Vincent C. C. Cheng
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | - Shuk C. Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hospital Authority, Hong Kong SAR, China
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Paul A. Tambyah
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Eli Perencevich
- Divisions of General Internal Medicine and Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA, United States of Amrerica
| | - Benedetta Allegranzi
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Division of Paediatric Infectious Diseases, Stellenbosch University, Cape Town, South Africa
| | - Michael B. Edmond
- University of Iowa Hospitals and Clinics, Iowa City, IA, United States of America
| | - Andreas Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
- REshape Center for Innovation, Radboudumc, Nijmegen, The Netherlands
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31
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Lum LHW, Tambyah PA. Authors’ reply. Singapore Med J 2020; 61:223. [DOI: 10.11622/smedj.2020057] [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: 11/18/2022]
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Abstract
Peritonitis- and catheter-related infections due to nontuberculous mycobacteria (NTM) including Mycobacterium abscessus have been reported among adults on peritoneal dialysis (PD). There is no recommended antimicrobial regimen for the treatment of M. abscessus peritonitis. Clofazimine has emerged as an important adjuvant antimicrobial treatment of M. abscessus lung infection. We report, to our knowledge, the first case of M. abscessus PD peritonitis in a child treated successfully using clofazimine as a novel adjuvant therapy to amikacin and clarithromycin. Her clinical features were similar to those of bacterial peritonitis, but she had persistence of symptoms and high inflammatory markers despite empirical therapy for peritonitis. Bacterial culture of PD effluent became positive for M. abscessus after 5 days. There was complete symptom resolution after 6 days of multidrug therapy. Due to ototoxicity, amikacin was discontinued after 6 weeks, while clarithromycin and clofazimine were continued for 9 months to ensure complete pathogen eradication before a planned renal transplant. A high index of suspicion in refractory or culture-negative cases is important for the diagnosis of NTM peritonitis. Multidrug therapy is recommended for M. abscessus infections. Clofazimine was chosen as a novel adjunct antimicrobial because of its pharmacokinetics, ease of administration, cost-effectiveness, and lack of serious adverse events.
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Affiliation(s)
- Archana Pinapala
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
| | - Lee Jin Koh
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
| | - Kar-Hui Ng
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
| | - Paul A Tambyah
- Division of Infectious Disease, 150744National University Health System, University Medicine Cluster, Singapore
| | - Hui-Kim Yap
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
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33
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Yan G, Tan KB, Chandran NS, Chai L, Chew KL, Somani J, Tambyah PA. Histoplasmosis presenting with Sweet's syndrome. Clin Microbiol Infect 2020; 26:795-796. [PMID: 32035234 DOI: 10.1016/j.cmi.2020.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/02/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Affiliation(s)
- G Yan
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore.
| | - K B Tan
- Department of Pathology, National University Health System, Singapore
| | - N S Chandran
- Division of Dermatology, University Medicine Cluster, National University Health System, Singapore
| | - L Chai
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore
| | - K L Chew
- Division of Microbiology, Department of Laboratory Medicine, National University Health System, Singapore
| | - J Somani
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore
| | - P A Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore
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Sim MY, Sia CH, Chew KL, Lum LHW, Loh PH, Tambyah PA. Group B streptococcus bacteraemia and purulent pericarditis in an immunocompetent adult. QJM 2019; 112:801-802. [PMID: 31385591 DOI: 10.1093/qjmed/hcz201] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- M-Y Sim
- Internal Medicine Residency, National University Health System, 5 Lower Kent Ridge Road, Singapore
| | - C-H Sia
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore
| | - K-L Chew
- Department of Laboratory Medicine
| | - L H-W Lum
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore
| | - P-H Loh
- Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Road, Singapore
| | - P A Tambyah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore
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35
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Marimuthu K, Ng OT, Bagdasarian N, Tambyah PA. The global challenge of carbapenemases and the critical need for more data. Int J Infect Dis 2019; 84:141-142. [DOI: 10.1016/j.ijid.2019.05.018] [Citation(s) in RCA: 2] [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: 11/29/2022] Open
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Tambyah PA, Oon J, Asli R, Kristanto W, Hwa SH, Vang F, Karwal L, Fuchs J, Santangelo JD, Gordon GS, Thomson C, Rao R, Dean H, Das SC, Stinchcomb DT. An inactivated enterovirus 71 vaccine is safe and immunogenic in healthy adults: A phase I, double blind, randomized, placebo-controlled, study of two dosages. Vaccine 2019; 37:4344-4353. [PMID: 31230881 DOI: 10.1016/j.vaccine.2019.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/31/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD), especially that caused by enterovirus 71 (EV71) infection, is a public health concern in the Asia-Pacific region. We report a phase I clinical trial of an EV71 candidate vaccine (INV21) based on a binary ethylenimine inactivated B2 sub-genotype formulated with aluminum hydroxide. METHODS In this double-blind, placebo-controlled, randomized, dose escalation study adult volunteers received two vaccinations 28 days apart of low or high dose formulations of the candidate vaccine and were then monitored for safety and reactogenicity for four weeks after each dose, and for their immune responses up to 28 weeks. RESULTS Of 36 adults enrolled, 35 completed the study as planned. Either no or mild adverse events were observed, mainly injection site pain and tiredness. Seroconversion was 100% after two vaccinations. High geometric mean neutralizing antibody titers (GMT) were observed 14 days post first dose, peaking 14 days post second dose (at Day 42) in both high and low dose groups; GMTs on days 14, 28, 42, and 56 were 128, 81, 323, 203 and 144, 100, 451, 351 in low- and high-dose groups, respectively. Titers for both doses declined gradually to Day 196 but remained higher than baseline and the placebo groups, which had low GMTs throughout the duration of the study. Cross-neutralizing antibody activity against heterologous sub-genotypes was demonstrated. CONCLUSION These data show that the EV71 candidate vaccine is safe and immunogenic in adults and supports further clinical development as a potential pediatric vaccine by initiating a dose-escalation study for determining the dose-dependent safety and immunogenicity of the vaccine in young naïve children.
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Affiliation(s)
- Paul A Tambyah
- Department of Medicine, NUH Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - Jolene Oon
- Department of Medicine, NUH Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - Rosmonaliza Asli
- Department of Medicine, NUH Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - William Kristanto
- Department of Medicine, NUH Investigational Medicine Unit, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore 119228, Singapore
| | - Shi-Hsia Hwa
- Vaccine Business Unit, Takeda Pharmaceuticals Asia Pacific Pte Ltd, 21 Biopolis Road, Nucleos South Tower Level 4, Singapore 138567, Singapore
| | - Fue Vang
- Vaccine Business Unit, Takeda Pharmaceuticals USA, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Lovkesh Karwal
- Vaccine Business Unit, Takeda Pharmaceuticals USA, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Jeremy Fuchs
- Vaccine Business Unit, Takeda Pharmaceuticals USA, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Joseph D Santangelo
- Vaccine Business Unit, Takeda Pharmaceuticals USA, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Gilad S Gordon
- Takeda Vaccines, Inc., Takeda Pharmaceuticals USA, Fort Collins, CO, USA
| | - Cynthia Thomson
- Vaccine Business Unit, Takeda Pharmaceuticals Asia Pacific Pte Ltd, 21 Biopolis Road, Nucleos South Tower Level 4, Singapore 138567, Singapore
| | - Raman Rao
- Vaccine Business Unit, Takeda Pharmaceuticals Asia Pacific Pte Ltd, 21 Biopolis Road, Nucleos South Tower Level 4, Singapore 138567, Singapore
| | - Hansi Dean
- Vaccine Business Unit, Takeda Pharmaceuticals USA, 40 Landsdowne Street, Cambridge, MA 02139, USA
| | - Subash C Das
- Vaccine Business Unit, Takeda Pharmaceuticals USA, 40 Landsdowne Street, Cambridge, MA 02139, USA.
| | - Dan T Stinchcomb
- Takeda Vaccines, Inc., Takeda Pharmaceuticals USA, Fort Collins, CO, USA
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37
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Harris PNA, Ben Zakour NL, Roberts LW, Wailan AM, Zowawi HM, Tambyah PA, Lye DC, Jureen R, Lee TH, Yin M, Izharuddin E, Looke D, Runnegar N, Rogers B, Bhally H, Crowe A, Schembri MA, Beatson SA, Paterson DL. Whole genome analysis of cephalosporin-resistant Escherichia coli from bloodstream infections in Australia, New Zealand and Singapore: high prevalence of CMY-2 producers and ST131 carrying blaCTX-M-15 and blaCTX-M-27. J Antimicrob Chemother 2019; 73:634-642. [PMID: 29253152 DOI: 10.1093/jac/dkx466] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Accepted: 11/09/2017] [Indexed: 12/11/2022] Open
Abstract
Objectives To characterize MDR Escherichia coli from bloodstream infections (BSIs) in Australia, New Zealand and Singapore. Methods We collected third-generation cephalosporin-resistant (3GC-R) E. coli from blood cultures in patients enrolled in a randomized controlled trial from February 2014 to August 2015. WGS was used to characterize antibiotic resistance genes, MLST, plasmids and phylogenetic relationships. Antibiotic susceptibility was determined using disc diffusion and Etest. Results A total of 70 3GC-R E. coli were included, of which the majority were ST131 (61.4%). BSI was most frequently from a urinary source (69.6%), community associated (62.9%) and in older patients (median age 71 years). The median Pitt score was 1 and ICU admission was infrequent (3.1%). ST131 possessed more acquired resistance genes than non-ST131 (P = 0.003). Clade C1/C2 ST131 predominated (30.2% and 53.5% of ST131, respectively) and these were all ciprofloxacin resistant. All clade A ST131 (n = 6) were community associated. The predominant ESBL types were blaCTX-M (80.0%) and were strongly associated with ST131 (95% carried blaCTX-M), with the majority blaCTX-M-15. Clade C1 was associated with blaCTX-M-14 and blaCTX-M-27, whereas blaCTX-M-15 predominated in clade C2. Plasmid-mediated AmpC genes (mainly blaCMY-2) were frequent (17.1%) but were more common in non-ST131 (P < 0.001) isolates from Singapore and Brisbane. Two strains carried both blaCMY-2 and blaCTX-M. The majority of plasmid replicon types were IncF. Conclusions In a prospective collection of 3GC-R E. coli causing BSI, community-associated Clade C1/C2 ST131 predominate in association with blaCTX-M ESBLs, although a significant proportion of non-ST131 strains carried blaCMY-2.
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Affiliation(s)
- Patrick N A Harris
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,Microbiology Department, Central Laboratory, Pathology Queensland, Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Nouri L Ben Zakour
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Leah W Roberts
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Alexander M Wailan
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,Infection Genomics, Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Hosam M Zowawi
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,WHO Collaborating Centre for Infection Prevention and Control, and GCC Centre for Infection Control, Riyadh, Saudi Arabia
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - David C Lye
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, Division of Microbiology, National University Hospital, Singapore
| | - Tau H Lee
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Mo Yin
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Ezlyn Izharuddin
- Communicable Disease Centre, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore
| | - David Looke
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Naomi Runnegar
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,The University of Queensland, School of Medicine, Brisbane, Queensland, Australia
| | - Benjamin Rogers
- Centre for Inflammatory Disease, Monash University, Clayton, Victoria, Australia.,Monash Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Hasan Bhally
- Department of Medicine, North Shore Hospital, Milford, Auckland, New Zealand
| | - Amy Crowe
- Department of Infectious Diseases, St Vincent's Hospital, Melbourne, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - David L Paterson
- University of Queensland, UQ Centre for Clinical Research, Royal Brisbane & Women's Hospital, Queensland, Australia.,Wesley Medical Research, Wesley Hospital, Toowong, Queensland, Australia
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38
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Yan G, Pang L, Cook AR, Ho HJ, Win MS, Khoo AL, Wong JG, Lee CK, Yan B, Jureen R, Ho SS, Lye DC, Tambyah PA, Leo YS, Fisher D, Oon J, Bagdasarian N, Chow A, Smitasin N, Chai LYA. Distinguishing Zika and Dengue Viruses through Simple Clinical Assessment, Singapore. Emerg Infect Dis 2019; 24:1565-1568. [PMID: 30016242 PMCID: PMC6056111 DOI: 10.3201/eid2408.171883] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/27/2023] Open
Abstract
Dengue virus and Zika virus coexist in tropical regions in Asia where healthcare resources are limited; differentiating the 2 viruses is challenging. We showed in a case–control discovery cohort, and replicated in a validation cohort, that the diagnostic indices of conjunctivitis, platelet count, and monocyte count reliably distinguished between these viruses.
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Mo Y, Seah I, Lye PSP, Kee XLJ, Wong KYM, Ko KKK, Ong RTH, Tambyah PA, Cook AR. Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey. BMJ Open 2019; 9:e023859. [PMID: 30842108 PMCID: PMC6429736 DOI: 10.1136/bmjopen-2018-023859] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors and public health interventions to reduce prevalence of multidrug-resistant organism colonisation in the community. DESIGN Cross-sectional questionnaire of KAP towards antibiotic use and collection of stool samples or rectal swabs. ESBL-PE isolates obtained underwent whole genome sequencing to identify resistance genes. SETTING A densely populated community in Singapore. PARTICIPANTS There were 693 healthy community-dwelling questionnaire respondents. Out of which, 305 provided stool samples or rectal swabs. RESULTS The overall knowledge of antibiotic use was poor (mean score 4.6/10, IQR 3.0-6.0). 80 participants (80/305, 26.2%) carried at least one ESBL-PE isolate. The most common ESBL-PE was Escherichia coli sequence type 131 carrying CTX-M type beta-lactamases (11/71, 15.5%). Living overseas for >1 year (OR 3.3, 95% CI 1.6 to 6.9) but not short-term travel, recent hospitalisation or antibiotic intake was associated with ESBL-PE carriage. Interestingly, higher knowledge scores (OR 2.0, 95% CI 1.03 to 3.9) and having no leftover antibiotics (OR 2.4, 95% CI 1.2 to 4.9) were independent factors associated with ESBL-PE carriage in the multivariate logistic regression model. CONCLUSIONS While the role of trans-border transmission of antimicrobial resistance is well known, we may have to examine the current recommendation that all antibiotics courses have to be completed. Clinical trials to determine the optimum duration of treatment for common infections are critically important.
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Affiliation(s)
- Yin Mo
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - Ivan Seah
- National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Xiang Lee Jamie Kee
- National University Singapore Yong Loo Lin School of Medicine, Singapore, Singapore
| | | | - Kwan Ki Karrie Ko
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Rick Twee-Hee Ong
- National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Paul A Tambyah
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex R Cook
- National University Singapore Saw Swee Hock School of Public Health, Singapore, Singapore
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Harris PNA, Tambyah PA, Lye DC, Mo Y, Lee TH, Yilmaz M, Alenazi TH, Arabi Y, Falcone M, Bassetti M, Righi E, Rogers BA, Kanj S, Bhally H, Iredell J, Mendelson M, Boyles TH, Looke D, Miyakis S, Walls G, Al Khamis M, Zikri A, Crowe A, Ingram P, Daneman N, Griffin P, Athan E, Lorenc P, Baker P, Roberts L, Beatson SA, Peleg AY, Harris-Brown T, Paterson DL. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance: A Randomized Clinical Trial. JAMA 2018; 320:984-994. [PMID: 30208454 PMCID: PMC6143100 DOI: 10.1001/jama.2018.12163] [Citation(s) in RCA: 458] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Extended-spectrum β-lactamases mediate resistance to third-generation cephalosporins (eg, ceftriaxone) in Escherichia coli and Klebsiella pneumoniae. Significant infections caused by these strains are usually treated with carbapenems, potentially selecting for carbapenem resistance. Piperacillin-tazobactam may be an effective "carbapenem-sparing" option to treat extended-spectrum β-lactamase producers. OBJECTIVES To determine whether definitive therapy with piperacillin-tazobactam is noninferior to meropenem (a carbapenem) in patients with bloodstream infection caused by ceftriaxone-nonsusceptible E coli or K pneumoniae. DESIGN, SETTING, AND PARTICIPANTS Noninferiority, parallel group, randomized clinical trial included hospitalized patients enrolled from 26 sites in 9 countries from February 2014 to July 2017. Adult patients were eligible if they had at least 1 positive blood culture with E coli or Klebsiella spp testing nonsusceptible to ceftriaxone but susceptible to piperacillin-tazobactam. Of 1646 patients screened, 391 were included in the study. INTERVENTIONS Patients were randomly assigned 1:1 to intravenous piperacillin-tazobactam, 4.5 g, every 6 hours (n = 188 participants) or meropenem, 1 g, every 8 hours (n = 191 participants) for a minimum of 4 days, up to a maximum of 14 days, with the total duration determined by the treating clinician. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality at 30 days after randomization. A noninferiority margin of 5% was used. RESULTS Among 379 patients (mean age, 66.5 years; 47.8% women) who were randomized appropriately, received at least 1 dose of study drug, and were included in the primary analysis population, 378 (99.7%) completed the trial and were assessed for the primary outcome. A total of 23 of 187 patients (12.3%) randomized to piperacillin-tazobactam met the primary outcome of mortality at 30 days compared with 7 of 191 (3.7%) randomized to meropenem (risk difference, 8.6% [1-sided 97.5% CI, -∞ to 14.5%]; P = .90 for noninferiority). Effects were consistent in an analysis of the per-protocol population. Nonfatal serious adverse events occurred in 5 of 188 patients (2.7%) in the piperacillin-tazobactam group and 3 of 191 (1.6%) in the meropenem group. CONCLUSIONS AND RELEVANCE Among patients with E coli or K pneumoniae bloodstream infection and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a noninferior 30-day mortality. These findings do not support use of piperacillin-tazobactam in this setting. TRIAL REGISTRATION anzctr.org.au Identifiers: ACTRN12613000532707 and ACTRN12615000403538 and ClinicalTrials.gov Identifier: NCT02176122.
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Affiliation(s)
- Patrick N. A. Harris
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Department of Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul A. Tambyah
- Department of Infectious Diseases, National University Hospital, Singapore
| | - David C. Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 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
| | - Yin Mo
- Department of Infectious Diseases, National University Hospital, Singapore
| | - Tau H. Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 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
| | - Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Thamer H. Alenazi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Marco Falcone
- Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Udine, Italy
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Santa Maria Misericordia Hospital, Udine, Italy
| | - Benjamin A. Rogers
- Monash University, Centre for Inflammatory Diseases, Melbourne, Victoria, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | - Souha Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hasan Bhally
- Department of Medicine and Infectious Diseases, North Shore Hospital, Auckland, New Zealand
| | - Jon Iredell
- Marie Bashir Institute for Infectious Disease and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Tom H. Boyles
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - David Looke
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Spiros Miyakis
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
- Department of Infectious Diseases, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Genevieve Walls
- Department of Infectious Diseases, Middlemore Hospital, Auckland, New Zealand
| | | | - Ahmed Zikri
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amy Crowe
- Department of Infectious Diseases, St Vincent’s Hospital, Melbourne, Victoria, Australia
- Department of Microbiology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Paul Ingram
- School of Pathology and Laboratory Medicine, The University of Western Australia, Crawley, Australia
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia
| | - Nick Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Paul Griffin
- University of Queensland, Brisbane, Queensland, Australia
- Department of Medicine and Infectious Diseases, Mater Hospital and Mater Medical Research Institute, Brisbane, Queensland, Australia
- QIMR Berghofer, Brisbane, Queensland, Australia
| | - Eugene Athan
- Department of Infectious Diseases, Barwon Health and Deakin University, Geelong, Victoria, Australia
| | - Penelope Lorenc
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Peter Baker
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Leah Roberts
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - Scott A. Beatson
- Australian Centre for Ecogenomics, School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
| | - Anton Y. Peleg
- Infection & Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia
- Department of Microbiology, Monash University, Clayton, Australia
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Tiffany Harris-Brown
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
| | - David L. Paterson
- University of Queensland, UQ Centre for Clinical Research, Brisbane, Queensland, Australia
- Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
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Mo Y, Low I, Tambyah SK, Tambyah PA. The socio-economic impact of multidrug-resistant nosocomial infections: a qualitative study. J Hosp Infect 2018; 102:454-460. [PMID: 30171886 DOI: 10.1016/j.jhin.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/23/2018] [Indexed: 11/24/2022]
Abstract
The burden of healthcare-associated infections (HCAIs) has traditionally been measured using clinical and economic outcomes. We conducted semi-structured interviews with 18 patients or their caregivers affected by HCAI caused by multidrug-resistant organisms to better understand the human impact of HCAI. Most patients had misconceptions about HCAI and antimicrobial resistance, leading to strong negative feelings towards HCAIs despite positive views of their healthcare providers. Communication issues across power imbalances need to be addressed to help deal with trauma of HCAIs. A holistic approach to HCAIs incorporating patient perspectives will likely help guide policymakers developing solutions to improve patient outcomes.
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Affiliation(s)
- Y Mo
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - I Low
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore
| | - S K Tambyah
- Department of Marketing, NUS Business School, National University of Singapore, Singapore
| | - P A Tambyah
- Division of Infectious Disease, University Medicine Cluster, National University Hospital, Singapore; Department of Medicine, National University of Singapore, Singapore
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Mandakhalikar KD, Wang R, Rahmat JN, Chiong E, Neoh KG, Tambyah PA. Restriction of in vivo infection by antifouling coating on urinary catheter with controllable and sustained silver release: a proof of concept study. BMC Infect Dis 2018; 18:370. [PMID: 30081836 PMCID: PMC6090839 DOI: 10.1186/s12879-018-3296-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Received: 02/04/2018] [Accepted: 08/01/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Catheter Associated Urinary Tract Infections are among the most common urological infections world-wide. Bacterial biofilms and encrustation cause significant complications in patients with urinary catheters. The objective of the study is to demonstrate the efficacy and safety of an anti-microbial and anti-encrustation silver nanoparticle (AgNP) coating on silicone urinary catheter in two different animal models. METHODS Antifouling coating (P3) was prepared with alternate layers of polydopamine and AgNP and an outermost antifouling layer. Sixteen C57BL/6 female mice and two female PWG Micropigs® were used to perform the experiments. In mice, a 5 mm long silicone catheter with or without P3 was transurethrally placed into the urinary bladder. Micropigs were transurethrally implanted - one with P3 silicone catheter and the other with commercially available silver coated silicone catheter. Both models were challenged with E. coli. Bacteriuria was evaluated routinely and upon end of study (2 weeks for mice, 3 weeks for micropigs), blood, catheters and bladders were harvested and analysed for bacterial colonization and encrustation as well as for toxicity. RESULTS Lower bacterial colonization was seen on P3 catheters as well as in bladders of animals with P3 catheter. Bacteriuria was consistently less in mice with P3 catheter than with uncoated catheters. Encrustation was lower on P3 catheter and in bladder of micropig with P3 catheter. No significant toxicity of P3 was observed in mice or in micropig as compared to controls. The numbers were small in this proof of concept study and technical issues were noted especially with the porcine model. CONCLUSIONS Antifouling P3 coating reduces bacterial colonization on catheter and in animal bladders without causing any considerable toxicity for 2 to 3 weeks. This novel coating could potentially reduce the complications of indwelling urethral catheters.
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Affiliation(s)
- Kedar Diwakar Mandakhalikar
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore.
| | - Rong Wang
- ACI Medical Pte Ltd, Singapore, 069534, Singapore
| | - Juwita N Rahmat
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Edmund Chiong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
| | - Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore, 117585, Singapore
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, 119228, Singapore
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Chai LY, Tambyah PA. The Threat of Multiresistant Nosocomial Fungi. Ann Acad Med Singap 2018; 47:241-242. [PMID: 30135964] [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: 06/08/2023]
Affiliation(s)
- Louis Ya Chai
- Division of Infectious Diseases, National University Health System, Singapore
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Abstract
History A 99-year-old Chinese-Indonesian woman with a longstanding history of diabetes mellitus was admitted for chest infection and was incidentally found to have bilateral deformed feet. She was otherwise asymptomatic and could ambulate independently. Photographs and radiographs of the feet were obtained.
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Affiliation(s)
- Adeline Mei-Yen Yong
- From the National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Paul A Tambyah
- From the National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074
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Hey Hwee W, Ng Li W, Kumar N, Lau Tze-Chun E, Joseph T, Naresh K, Leok-Lim L, Liu Ka-Po G, Anupama V, Dale F, Hee-Kit W, Tambyah PA. Spinal Implants can be Retained in Patients with Deep Spine Infection: A Cohort Study. Journal of Orthopaedics, Trauma and Rehabilitation 2018. [DOI: 10.1016/j.jotr.2017.05.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background/Purpose It is unclear whether implant removal is necessary when deep spine infection of spinal instrumentation occurs. This study compares mortality, relapse, and reoperation rates between such patients with and without removal of spine implants. Methods A total of 20 patients were retrospectively reviewed. Baseline characteristics of the implant removal and nonremoval groups were compared. Outcome measures between groups were compared using multivariable logistic regression and predictors of each outcome identified. Results There were no significant differences in mortality, relapse, or reoperation rates between groups. Multiple vertebral level involvement was common (85%), and the L4 (30%) and L5 (35%) levels were most commonly involved. The majority of patients had osteomyelitis/spondylodiscitis (50%) and Staphylococcus aureus infections (60%). Thoracic spine infection was associated with relapse (odds ratio = 1.26) and reoperation (odds ratio = 1.101). Conclusion Implant removal is not always necessary in cases of deep spine infection as retention of implants is not associated with higher mortality, relapse, or reoperation rates.
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Affiliation(s)
- W.D. Hey Hwee
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - W.N. Ng Li
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Nishant Kumar
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - E. Lau Tze-Chun
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Thambiah Joseph
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Kumar Naresh
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Lau Leok-Lim
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - G. Liu Ka-Po
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Vasudevan Anupama
- Department of Medicine, National University Health System, Singapore
| | - Fisher Dale
- Department of Medicine, National University Health System, Singapore
| | - Wong Hee-Kit
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Paul A. Tambyah
- Department of Medicine, National University Health System, Singapore
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Ennis SS, Guo H, Raman L, Tambyah PA, Chen SL, Tiong HY. Premenopausal women with recurrent urinary tract infections have lower quality of life. Int J Urol 2018; 25:684-689. [PMID: 29788547 DOI: 10.1111/iju.13698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/30/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the impact on quality of life of recurrent acute uncomplicated urinary tract infection among premenopausal Singaporean women, and to determine the risk factors for lower quality of life among these patients. METHODS A total of 85 patients with recurrent acute uncomplicated urinary tract infection who were referred to the Urology Department at the National University Hospital, Singapore, were prospectively recruited over a 3-year period to complete the validated Short Form 36 Health Survey version 1. In addition, demographic and clinical details including symptomology and medical history were analyzed for factors impacting quality of life. Short Form 36 Health Survey version 1 results were compared with published population norms. RESULTS After adjusting for age, gender and race, recurrent acute uncomplicated urinary tract infection patients had significantly lower quality of life on seven out of eight Short Form 36 Health Survey version 1 domains when compared with age-, gender- and race-adjusted population norms for Singapore. Among those with recurrent acute uncomplicated urinary tract infection, those who also reported caffeine consumption had significantly lower Short Form 36 Health Survey version 1 scores than those who did not. Those who reported chronic constipation also had consistently lower Short Form 36 Health Survey version 1 scores across all domains. CONCLUSIONS Recurrent acute uncomplicated urinary tract infection has a negative impact on the quality of life of premenopausal, otherwise healthy women. Recurrent acute uncomplicated urinary tract infection patients who also have chronic constipation or consume caffeine have lower quality of life than those who do not. More studies are required to understand the relationships between these common problems and risk factors.
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Affiliation(s)
- Siobhan S Ennis
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore
| | - Huifang Guo
- Department of Urology, National University Health System, Singapore
| | - Lata Raman
- Department of Urology, National University Health System, Singapore
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Swaine L Chen
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Health System, Singapore
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Affiliation(s)
- Adeline Mei-Yen Yong
- From the National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Paul A. Tambyah
- From the National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074
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Cai Y, Venkatachalam I, Tee NW, Tan TY, Kurup A, Wong SY, Low CY, Wang Y, Lee W, Liew YX, Ang B, Lye DC, Chow A, Ling ML, Oh HM, Cuvin CA, Ooi ST, Pada SK, Lim CH, Tan JWC, Chew KL, Nguyen VH, Fisher DA, Goossens H, Kwa AL, Tambyah PA, Hsu LY, Marimuthu K. Prevalence of Healthcare-Associated Infections and Antimicrobial Use Among Adult Inpatients in Singapore Acute-Care Hospitals: Results From the First National Point Prevalence Survey. Clin Infect Dis 2018; 64:S61-S67. [PMID: 28475790 DOI: 10.1093/cid/cix103] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background We conducted a national point prevalence survey (PPS) to determine the prevalence of healthcare-associated infections (HAIs) and antimicrobial use (AMU) in Singapore acute-care hospitals. Methods Trained personnel collected HAI, AMU, and baseline hospital- and patient-level data of adult inpatients from 13 private and public acute-care hospitals between July 2015 and February 2016, using the PPS methodology developed by the European Centre for Disease Prevention and Control. Factors independently associated with HAIs were determined using multivariable regression. Results Of the 5415 patients surveyed, there were 646 patients (11.9%; 95% confidence interval [CI], 11.1%-12.8%) with 727 distinct HAIs, of which 331 (45.5%) were culture positive. The most common HAIs were unspecified clinical sepsis (25.5%) and pneumonia (24.8%). Staphylococcus aureus (12.9%) and Pseudomonas aeruginosa (11.5%) were the most common pathogens implicated in HAIs. Carbapenem nonsusceptibility rates were highest in Acinetobacter species (71.9%) and P. aeruginosa (23.6%). Male sex, increasing age, surgery during current hospitalization, and presence of central venous or urinary catheters were independently associated with HAIs. A total of 2762 (51.0%; 95% CI, 49.7%-52.3%) patients were on 3611 systemic antimicrobial agents; 462 (12.8%) were prescribed for surgical prophylaxis and 2997 (83.0%) were prescribed for treatment. Amoxicillin/clavulanate was the most frequently prescribed (24.6%) antimicrobial agent. Conclusions This survey suggested a high prevalence of HAIs and AMU in Singapore's acute-care hospitals. While further research is necessary to understand the causes and costs of HAIs and AMU in Singapore, repeated PPSs over the next decade will be useful to gauge progress at controlling HAIs and AMU.
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Affiliation(s)
- Yiying Cai
- Department of Pharmacy, Singapore General Hospital.,Department of Pharmacy, National University of Singapore
| | | | - Nancy W Tee
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital
| | - Asok Kurup
- Infectious Diseases Care, Mount Elizabeth (Orchard) Hospital
| | - Sin Yew Wong
- Infectious Disease Specialists, Gleneagles Hospital
| | - Chian Yong Low
- Novena Medical Specialists, Mount Elizabeth (Novena) Hospital
| | - Yang Wang
- Division of Nursing, Raffles Hospital, Departments of
| | - Winnie Lee
- Department of Pharmacy, Singapore General Hospital
| | - Yi Xin Liew
- Department of Pharmacy, Singapore General Hospital
| | | | | | - Angela Chow
- Clinical Epidemiology, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital.,Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital
| | | | - Helen M Oh
- Division of Infectious Diseases, Changi General Hospital
| | | | - Say Tat Ooi
- Department of General Medicine, Khoo Teck Puat Hospital
| | - Surinder K Pada
- Department of Infectious Diseases, Ng Teng Fong General Hospital
| | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Center
| | | | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Van Hai Nguyen
- School of Pharmacy, Memorial University, St John's, NL, Canada
| | - Dale A Fisher
- Division of Infectious Disease, National University Hospital, and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Belgium; and
| | - Andrea L Kwa
- Department of Pharmacy, Singapore General Hospital.,Department of Pharmacy, National University of Singapore.,Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Paul A Tambyah
- Division of Infectious Disease, National University Hospital, and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Li Yang Hsu
- Infectious Diseases and.,Saw Swee Hock School of Public Health, National University of Singapore, 13Infection Control, Singapore General Hospital
| | - Kalisvar Marimuthu
- Infectious Diseases and.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Mukhopadhyay A, Maliapen M, Ong V, Jakes RW, Mundy LM, Jialiang L, Tambyah PA. Community-Acquired Pneumonia Case Validation in an Anonymized Electronic Medical Record-Linked Expert System. Clin Infect Dis 2018; 64:S141-S144. [PMID: 28475780 DOI: 10.1093/cid/cix020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An electronic anonymized patient portal analysis using radiographic reports and admission and discharge diagnoses had sensitivity, specificity, positive predictive value, and negative predictive value of 84.7%, 78.2%, 75%, and 87%, respectively, for community-acquired pneumonia validated against a blinded expert medical review. This approach can help to track antimicrobial use and resistance.
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Affiliation(s)
| | - Mahendran Maliapen
- Academic Informatics Office, National University Hospital, National University Health System, and
| | | | | | - Linda M Mundy
- Worldwide Epidemiology, GlaxoSmithKline, Inc, Collegeville, PA
| | - Li Jialiang
- Department of Statistics and Applied Probability, National University of Singapore
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Molton JS, Low I, Choy MMJ, Aw PPK, Hibberd ML, Tambyah PA, Wilder-Smith A. Dengue virus not detected in human semen. J Travel Med 2018; 25:4965004. [PMID: 29672710 DOI: 10.1093/jtm/tay023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/12/2018] [Indexed: 11/14/2022]
Abstract
Zika and Ebola viruses can persist in semen and pose a risk for sexual transmission. To determine if dengue virus, another flavivirus, is similarly detectable in semen, we performed dengue PCR on semen in five patients with acute dengue virus infection. All five tested negative, suggesting that dengue does not pose a risk for sexual transmission.
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Affiliation(s)
- James S Molton
- University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Isaac Low
- University Medicine Cluster, National University Health System, Singapore
| | - Milly Ming Ju Choy
- GIS Efficient Rapid Microbial Sequencing Platform, A*STAR Genome Institute of Singapore, Singapore
| | - Pauline Poh Kim Aw
- GIS Efficient Rapid Microbial Sequencing Platform, A*STAR Genome Institute of Singapore, Singapore
| | - Martin L Hibberd
- GIS Efficient Rapid Microbial Sequencing Platform, A*STAR Genome Institute of Singapore, Singapore
| | - Paul A Tambyah
- University Medicine Cluster, National University Health System, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Annelies Wilder-Smith
- Travellers' Health & Vaccination Clinic, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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