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Chew KL, Octavia S, Jureen R, Ng OT, Marimuthu K, Lin RTP, Teo JWP. Molecular epidemiology and phylogenomic analysis of Mycobacterium abscessus clinical isolates in an Asian population. Microb Genom 2021; 7. [PMID: 34845980 PMCID: PMC8743566 DOI: 10.1099/mgen.0.000708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Mycobacterium abscessus comprises three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. bolletii, and M. abscessus subsp. massiliense. These closely related strains are typically multi-drug-resistant and can cause difficult-to-treat infections. Dominant clusters of isolates with increased pathogenic potential have been demonstrated in pulmonary infections in the global cystic fibrosis (CF) population. An investigation was performed on isolates cultured from an Asian, predominantly non-CF population to explore the phylogenomic relationships within our population and compare it to global M. abscessus isolates. Whole-genome-sequencing was performed on M. abscessus isolates between 2017 and 2019. Bioinformatic analysis was performed to determine multi-locus-sequence-type, to establish the phylogenetic relationships between isolates, and to identify virulence and resistance determinants in these isolates. A total of 210 isolates were included, of which 68.5 % (144/210) were respiratory samples. These isolates consisted of 140 (66.6 %) M. abscessus subsp. massiliense, 67 (31.9 %) M. abscessus subsp. abscessus, and three (1.4 %) M. abscessus subsp. bolletii. Dominant sequence-types in our population were similar to those of global CF isolates, but SNP differences in our population were comparatively wider despite the isolates being from the same geographical region. ESX (ESAT-6 secretory) cluster three appeared to occur most commonly in ST4 and ST6 M. abscessus subsp. massiliense, but other virulence factors did not demonstrate an association with isolate subspecies or sample source. We demonstrate that although similar predominant sequence-types are seen in our patient population, cross-transmission is absent. The risk of patient-to-patient transmission appears to be largely limited to the vulnerable CF population, indicating infection from environmental sources remains more common than human-to-human transmission. Resistance and virulence factors are largely consistent across the subspecies with the exception of clarithromycin susceptibility and ESX-3.
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Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sophie Octavia
- Environmental Health Institute, National Environment Agency, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raymond Tzer Pin Lin
- Department of Laboratory Medicine, National University Hospital, Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
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2
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Chew KL, Low C, Achik R, Jureen R, Chew KL. Sensititre broth microdilution plates variation in colistin quality control minimum inhibitory concentration results. Pathology 2021; 54:662-664. [PMID: 34823859 DOI: 10.1016/j.pathol.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Clayton Low
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Rosemini Achik
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Kean Lee Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
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Chew KL, Octavia S, Go J, Ng S, Tang YE, Soh P, Yong J, Jureen R, Lin RTP, Yeoh SF, Teo J. In vitro susceptibility of Mycobacterium abscessus complex and feasibility of standardizing treatment regimens. J Antimicrob Chemother 2021; 76:973-978. [PMID: 33338230 DOI: 10.1093/jac/dkaa520] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the in vitro susceptibility of members of the Mycobacterium abscessus complex to routinely tested antibiotics and to an extended antibiotic panel. METHODS Non-duplicate isolates for which susceptibility testing results were available were included in this study. Retrospective laboratory records were reviewed, including tigecycline susceptibility results, and testing was performed with additional drugs, including vancomycin, dalbavancin, telavancin, oritavancin, rifabutin, delafloxacin, eravacycline, clofazimine and bedaquiline using broth microdilution (Sensititre, Thermo Fisher). RESULTS A total of 218 M. abscessus complex isolates were included for retrospective review, of which 151 were respiratory isolates. Of these 218 isolates, 211 were available for additional testing with the extended antibiotic panel. Of these, 146 were respiratory isolates. One isolate had a vancomycin MIC of 2 mg/L and MICs of all other isolates were >8 mg/L. All isolates had MICs of >8 mg/L for oritavancin, dalbavancin and telavancin. One isolate had a delafloxacin MIC of 4 mg/L and MICs of all other isolates were >8 mg/L. The MIC50/MIC90s of rifabutin, tigecycline, eravacycline, clofazimine and bedaquiline were 16/32, 0.5/1, 0.12/0.25, 0.12/0.25 and 0.06/0.12 mg/L, respectively. CONCLUSIONS In vitro activity was demonstrated for clofazimine, bedaquiline and eravacycline, indicating potential for inclusion as standardized therapy for M. abscessus complex infections.
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Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Sophie Octavia
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Joelle Go
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Sally Ng
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Yit Er Tang
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Patsy Soh
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Joy Yong
- Department of Pharmacy, National University Hospital, Singapore, Republic of Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
| | - Raymond Tzer Pin Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - Siang Fei Yeoh
- Department of Pharmacy, National University Hospital, Singapore, Republic of Singapore
| | - Jeanette Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Republic of Singapore
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Chew KL, Octavia S, Jureen R, Lin RTP, Teo JWP. Targeted amplification and MinION nanopore sequencing of key azole and echinocandin resistance determinants of clinically relevant Candida spp. from blood culture bottles. Lett Appl Microbiol 2021; 73:286-293. [PMID: 34060660 DOI: 10.1111/lam.13516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/29/2021] [Accepted: 05/21/2021] [Indexed: 12/19/2022]
Abstract
The objective of the study was to evaluate the use of targeted multiplex Nanopore MinION amplicon re-sequencing of key Candida spp. from blood culture bottles to identify azole and echinocandin resistance associated SNPs. Targeted PCR amplification of azole (ERG11 and ERG3) and echinocandin (FKS) resistance-associated loci was performed on positive blood culture media. Sequencing was performed using MinION nanopore device with R9.4.1 Flow Cells. Twenty-eight spiked blood cultures (ATCC strains and clinical isolates) and 12 prospectively collected positive blood cultures with candidaemia were included. Isolate species included Candida albicans, Candida glabrata, Candida krusei, Candida parapsilosis, Candida tropicalis and Candida auris. SNPs that were identified on ERG and FKS genes using Snippy tool and CLC Genomic Workbench were correlated with phenotypic testing by broth microdilution (YeastOne™ Sensititre). Illumina whole-genome-sequencing and Sanger-sequencing were also performed as confirmatory testing of the mutations identified from nanopore sequencing data. There was a perfect agreement of the resistance-associated mutations detected by MinION-nanopore-sequencing compared to phenotypic testing for acquired resistance (16 with azole resistance; 3 with echinocandin resistance), and perfect concordance of the nanopore sequence mutations to Illumina and Sanger data. Mutations with no known association with phenotypic drug resistance and novel mutations were also detected.
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Affiliation(s)
- K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - S Octavia
- National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - R Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - R T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore.,National Public Health Laboratory, National Centre for Infectious Diseases, Singapore
| | - J W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore
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Tan SS, Saw S, Chew KL, Wang C, Pajarillaga A, Khoo C, Wang W, Ali ZM, Yang Z, Chan YH, Tambyah P, Jureen R, Sethi SK. Comparative Clinical Evaluation of the Roche Elecsys and Abbott Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Serology Assays for Coronavirus Disease 2019 (COVID-19). Arch Pathol Lab Med 2021; 145:32-38. [PMID: 33367664 DOI: 10.5858/arpa.2020-0499-sa] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic tests detects antibodies in the host, contributing to the identification of individuals who have been exposed to coronavirus disease 2019 (COVID-19). OBJECTIVE.— To critically evaluate 2 commercially available SARS-CoV-2 serology tests. DESIGN.— A total of 333 unique, nonduplicated serum samples obtained from COVID-19 patients (n = 170) and negative controls (n = 163) obtained before December 2019 were used in the study. Samples were tested on the Roche E411 and Abbott Architect i4000SR platforms, and results were correlated to reverse transcription polymerase chain reaction (PCR) results and clinical symptoms. RESULTS.— There was a strong level of agreement in the qualitative results between both assays, with a Cohen κ value of .840, P < .001. The specificity for both Roche and Abbott were excellent at 100%. Roche exhibited marginally better performance in the 21 days or more group with a sensitivity of 90.6% (95% CI, 75.8%-96.8%) versus an Abbott sensitivity of 84.4% (95% CI, 68.3%-93.1%), as well as in the 14- to 20-day group with a sensitivity of 85.7% (95% CI, 65.4%-95.0%) versus an Abbott sensitivity of 81.0% (95% CI, 60.0%-92.3%). Less than 14 days of symptoms groups exhibited poor sensitivity at less than 50% for both assays. The areas under curve (± standard error) for Roche (0.894 ± 0.025, P < .001) and Abbott (0.884 ± 0.026, P < .001) were very similar. Potential confounders for negative serologic results include antiretroviral medication use and pauci-symptomatic patients. CONCLUSIONS.— Specificities for high-throughput Roche and Abbott immunoassays are excellent, but users need to be cautious to interpret serologic test results after 14 days of symptoms to avoid false negatives.
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Affiliation(s)
- Shaun S Tan
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Sharon Saw
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Ka Lip Chew
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Cindy Wang
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Anastacia Pajarillaga
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Candy Khoo
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Weixuan Wang
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Zahidah Mohamed Ali
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Zhixin Yang
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Yiong Huak Chan
- The Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (Chan)
| | - Paul Tambyah
- The Division of Infectious Diseases (Tambyah), Department of Medicine, National University Hospital, Singapore
| | - Roland Jureen
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
| | - Sunil K Sethi
- From the Department of Laboratory Medicine (Tan, Saw, Chew, C. Wang, Pajarillaga, Khoo, W. Wang, Ali, Yang, Jureen, Sethi), National University Hospital, Singapore
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Tham JWM, Ng SC, Chai CN, Png S, Tan EJM, Ng LJ, Chua RP, Sani M, Chiang D, Tan KX, Tee NWS, Jureen R, Tan SS, Yan G, Yan B, Lee CK. Parallel testing of 241 clinical nasopharyngeal swabs for the detection of SARS-CoV-2 virus on the Cepheid Xpert Xpress SARS-CoV-2 and the Roche cobas SARS-CoV-2 assays. Clin Chem Lab Med 2020; 59:e45-e48. [PMID: 33554503 DOI: 10.1515/cclm-2020-1338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/08/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Wei Ming Tham
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Shu Chi Ng
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Chean Nee Chai
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Siyu Png
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Eunice Jia Min Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Li Jie Ng
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Rui Ping Chua
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Musa Sani
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Donald Chiang
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Ker Xin Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Nancy Wen Sim Tee
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Shaun S Tan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
| | - Gabriel Yan
- Department of Medicine, National University Health System, Singapore, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore.,Stronghold Diagnostic Lab, Agency for Science, Technology and Research, Singapore, Singapore
| | - Chun Kiat Lee
- Department of Laboratory Medicine, National University Health System, Singapore, Singapore
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7
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Tan SS, Chew KL, Saw S, Jureen R, Sethi S. Cross-reactivity of SARS-CoV-2 with HIV chemiluminescent assay leading to false-positive results. J Clin Pathol 2020; 74:614. [PMID: 32907911 PMCID: PMC8380903 DOI: 10.1136/jclinpath-2020-206942] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 07/14/2020] [Accepted: 08/25/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Shaun S Tan
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sharon Saw
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sunil Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore
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8
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Chew KL, Tan SS, Saw S, Pajarillaga A, Zaine S, Khoo C, Wang W, Tambyah P, Jureen R, Sethi SK. Clinical evaluation of serological IgG antibody response on the Abbott Architect for established SARS-CoV-2 infection. Clin Microbiol Infect 2020; 26:1256.e9-1256.e11. [PMID: 32531475 PMCID: PMC7282795 DOI: 10.1016/j.cmi.2020.05.036] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/30/2020] [Accepted: 05/31/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic performance of the Abbott Architect SARS-CoV-2 IgG assay in COVID-19 patients. METHODS Residual sera from 177 symptomatic SARS-CoV-2-positive patients and 163 non-COVID-19 patients were tested for antibody with the Abbott SARS-CoV-2 IgG assay (Abbott Diagnostics, Chicago, USA). Clinical records for COVID-19 patients were reviewed to determine the time from onset of clinical illness to testing. RESULTS Specificity of the assay was 100.0% (95%CI: 97.1-100.0%). The clinical sensitivity of the assay varied depending on time from onset of symptoms, increasing with longer periods from the onset of clinical illness. The clinical sensitivity at ≤6 days was 8.6% (7/81; 95%CI: 3.8-17.5%), at 7-13 days 43.6% (17/39; 95%CI: 28.2-60.2%), at 14-20 days 84.0% (21/25; 95%CI: 63.1-94.7%), and at ≥21 days 84.4% (27/32; 95%CI: 66.5-94.1%). Clinical sensitivity was higher in the ≥14-day group compared to <14 days. There were no differences between the 14-20-day and ≥21-days groups; the combined clinical sensitivity for these groups (≥14 days) was 84.2% (49/57; 71.6-92.1%). CONCLUSION The Abbott SARS-CoV-2 IgG test has high specificity. Clinical sensitivity was limited in the early stages of disease but improved from 14 days after the onset of clinical symptoms.
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Affiliation(s)
- K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - S S Tan
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - S Saw
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - A Pajarillaga
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - S Zaine
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - C Khoo
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - W Wang
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - P Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - R Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - S K Sethi
- Department of Laboratory Medicine, National University Hospital, Singapore
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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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10
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Tan SS, Yan B, Saw S, Lee CK, Chong AT, Jureen R, Sethi S. Practical laboratory considerations amidst the COVID-19 outbreak: early experience from Singapore. J Clin Pathol 2020; 74:257-260. [PMID: 32198190 DOI: 10.1136/jclinpath-2020-206563] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) is a zoonotic viral infection originating from Wuhan, China in December 2019. The World Health Organization has classified this pandemic as a global health emergency due to its virulent nature of transmission, which may lead to acute respiratory distress syndrome. Singapore's health ministry has responded with enhanced surveillance of COVID-19 for all suspected pneumonia cases, further increasing the volume of testing via real-time reverse transcription PCR, as well as samples necessitating stringent infectious control. Collectively, this has implications on the total testing process, laboratory operations and its personnel due to biosafety concerns. Turnaround time for routine testing may also be affected. The aim of this article is to present our tertiary institution's early experience with managing this emerging crisis and offer practical considerations for the preanalytical, analytical and postanalytical phases of laboratory testing in this cohort of patients.
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11
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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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12
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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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13
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Lee CK, Chai CN, Capinpin SM, Ang A, Ng SY, Lee PL, Ng CWS, Yan G, Lee HK, Chiu LL, Jureen R, Yan B, Loh TP. Evaluation of the Luminex ARIES HSV 1&2 Assay and Comparison with the FTD Neuro 9 and In-house Real-Time PCR Assays for Detecting Herpes Simplex Viruses. Ann Lab Med 2018; 38:440-445. [PMID: 29797814 PMCID: PMC5973918 DOI: 10.3343/alm.2018.38.5.440] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/15/2017] [Accepted: 05/03/2018] [Indexed: 11/20/2022] Open
Abstract
Background Human herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are responsible for a plethora of human diseases, of which cutaneous and mucocutaneous infections are the most prevalent. In its most severe form, HSV infection can cause meningitis/encephalitis. We compared the Luminex ARIES HSV 1&2 assay (Luminex Corp., Austin, TX, USA), an automated sample-to-result molecular solution, to two non-automated HSV DNA assays. Methods A total of 116 artificial controls were used to determine the analytical performance of the ARIES assay. Controls were prepared by spiking universal transport medium (UTM) and cerebrospinal fluid (CSF) samples from patients who tested negative for HSV by an in-house HSV-1 and -2 DNA assay with reference materials (SeraCare Life Sciences, MA, USA; ZeptoMetrix Corp., MA, USA). Another 117 clinical samples were then used to compare the clinical performance of the ARIES assay with those of an in-house assay and the FTD Neuro 9 assay (Fast Track Diagnostics, Junglinster, Luxembourg). Results The analytical sensitivity (95% limit of detection) of the ARIES assay was 318 copies/mL (UTM samples) and 935 copies/mL (CSF samples) for HSV-1 strain 96 and 253 copies/mL (UTM samples) and 821 copies/mL (CSF samples) for HSV-2 strain 09. No cross-reactivity was observed in samples spiked with 14 non-HSV microorganisms. Compared with the reference result (agreement between the in-house and FTD Neuro 9 results), the ARIES assay had overall concordance rates of 98.2% (111/113) and 100% (113/113) for HSV-1 and HSV-2, respectively. Conclusions The ARIES assay appears to be an excellent alternative for rapid detection and differentiation of HSV in skin and genital infections, meningitis, and encephalitis.
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Affiliation(s)
- Chun Kiat Lee
- Department of Laboratory Medicine, National University Hospital, Singapore.
| | - Chean Nee Chai
- Department of Laboratory Medicine, National University Hospital, Singapore
| | | | - Alynn Ang
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Sau Yoke Ng
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Peak Ling Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | | | - Gabriel Yan
- Department of Medicine, National University Health System, Singapore
| | - Hong Kai Lee
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Lily Lily Chiu
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore.,Biomedical Institute for Global Health Research and Technology, National University of Singapore, Singapore
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14
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Chew K, Lee C, Cross G, Lum L, Yan B, Jureen R. Culture-confirmed cryptococcal meningitis not detected by Cryptococcus PCR on the Biofire meningitis/encephalitis panel®. Clin Microbiol Infect 2018; 24:791-792. [DOI: 10.1016/j.cmi.2018.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/14/2018] [Accepted: 02/16/2018] [Indexed: 10/17/2022]
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15
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Wong RSL, Yeo F, Chia WT, Lee CK, Leong MH, Ng CWS, Poon KS, Yan GZ, Chiu LL, Yan BJ, Jureen R, Koay ESC, Lee HK. Performance evaluation of Cepheid Xpert Norovirus kit with a user-modified protocol. J Med Virol 2017; 90:485-489. [PMID: 29073731 DOI: 10.1002/jmv.24981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/24/2017] [Indexed: 01/21/2023]
Abstract
The Cepheid Xpert® Norovirus kit automates sample processing, nucleic acid extraction, and real-time reverse transcription polymerase chain reactions (RT-PCRs) to detect norovirus genogroups I (GI) and II (GII). Eighty-five stool samples collected between February 2015 and May 2017 were used to compare the performance of a user-modified Xpert assay against a clinically validated laboratory-developed test (LDT). Of the 85 samples, 54 were previously archived in -80°C freezer. The remaining 31 were fresh samples tested concurrently with the LDT. The results of all samples tested using the Xpert kit and LDT were found to be concordant, including 12 GI- and 42 GII-positive samples, 1 GI and GII coinfection, and 30 negative samples. Comparison of the assays showed perfect concordance with a kappa coefficient score of 1.00 (95%CI from 1.00 to 1.00). Of the 30 negative stool samples tested, three samples were positive for rotavirus detected using an immunochromatographic assay, with no cross-reactivity shown in both LDT and Xpert assays. In-run sample processing control of the Xpert assay for all negative samples tested showed no/minor inhibition. Compared to the LDT, the Xpert assay produced similar or better Ct values for detection. It also showed better mitigation of PCR inhibition in stool sample testing.
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Affiliation(s)
- Rachel Shi-Lei Wong
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore
| | - Fion Yeo
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore
| | - Wai Theng Chia
- School of Life Sciences and Chemical Technology, Ngee Ann Polytechnic, Singapore
| | - Chun Kiat Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Mun Han Leong
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Christopher Wai-Siong Ng
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Kok Siong Poon
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Gabriel Zherong Yan
- Department of Medicine, National University Hospital, National University Health System, Singapore
| | - Lily-Lily Chiu
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Benedict Junrong Yan
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore.,Translational Centre for Development and Research, National University Health System, Singapore
| | - Roland Jureen
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
| | - Evelyn Siew-Chuan Koay
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hong Kai Lee
- Molecular Diagnosis Centre, Department of Laboratory Medicine, National University Hospital, National University Health System, Singapore
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16
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Chee C, KhinMar KW, Sng LH, Jureen R, Cutter J, Lee V, Wang YT. Eligibility for WHO shorter MDR treatment regimen among foreign-born MDR PTB patients in Singapore. Tuberculosis (Edinb) 2017. [DOI: 10.1183/1393003.congress-2017.oa4854] [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: 11/05/2022]
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17
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Chee CB, KhinMar KW, Sng LH, Jureen R, Cutter J, Lee VJ, Wang YT. The shorter multidrug-resistant tuberculosis treatment regimen in Singapore: are patients from South-East Asia eligible? Eur Respir J 2017; 50:50/2/1700753. [DOI: 10.1183/13993003.00753-2017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/06/2017] [Indexed: 11/05/2022]
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18
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Lee CK, Chiu L, Yan G, Chew KL, Yan B, Jureen R, Loh TP. False negative results caused by erroneous automated result interpretation algorithm on the FilmArray 2.0 instrument. ACTA ACUST UNITED AC 2017; 56:e43-e45. [DOI: 10.1515/cclm-2017-0518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 07/01/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Chun Kiat Lee
- Department of Laboratory Medicine , Molecular Diagnosis Centre, National University Health System , 5, Lower Kent Ridge Road , 119074, Singapore , Singapore , Phone: +65-6772-4175, Fax: +65-6772-4407, E-mail:
| | - Lily Chiu
- Department of Laboratory Medicine , National University Health System , Singapore , Singapore
| | - Gabriel Yan
- Department of Medicine , National University Health System , Singapore , Singapore
| | - Ka Lip Chew
- Department of Laboratory Medicine , National University Health System , Singapore , Singapore
| | - Benedict Yan
- Department of Laboratory Medicine , National University Health System , Singapore , Singapore
| | - Roland Jureen
- Department of Laboratory Medicine , National University Health System , Singapore , Singapore
| | - Tze Ping Loh
- Department of Laboratory Medicine , National University Health System , Singapore , Singapore
- Biomedical Institute for Global Health Research and Technology, National University of Singapore , Singapore , Singapore
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19
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Ng SMS, Teo SW, Yong YE, Ng FM, Lau QY, Jureen R, Hill J, Chia CSB. Preliminary investigations into developing all-D Omiganan for treating Mupirocin-resistant MRSA skin infections. Chem Biol Drug Des 2017; 90:1155-1160. [PMID: 28581672 DOI: 10.1111/cbdd.13035] [Citation(s) in RCA: 14] [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: 03/05/2017] [Revised: 05/14/2017] [Accepted: 05/15/2017] [Indexed: 01/22/2023]
Abstract
Staphylococcus aureus is the primary pathogen responsible for the majority of human skin infections, and meticillin-resistant S. aureus (MRSA) currently presents a major clinical concern. The overuse of Mupirocin, the first-line topical antibacterial drug over 30 years, has led to the emergence of Mupirocin-resistant MRSA, creating a clinical concern. The antimicrobial peptide Omiganan was touted to be a promising antibacterial drug candidate due to its rapid membrane-disrupting bactericidal mode of action, entering clinical trials in 2005 as a topical gel to prevent catheter site infections. However, drug development ceased in 2009 due to a lack of efficacy. We postulate this to be due to proteolytic degradation caused by endogenous human skin proteases. Herein, we tested our hypothesis using Omiganan and its all-D enantiomer in a human skin protease stability assay, followed by anti-MRSA activity assay against of a panel of clinical MRSA isolates, a bactericidal/static determination and a time-kill assay to gauge all-D Omiganan's potential for further topical antibacterial drug development.
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Affiliation(s)
- Siew Mei Samantha Ng
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Shu Wei Teo
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Yaqing Elena Yong
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Fui Mee Ng
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Qiu Ying Lau
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Jeffrey Hill
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
| | - C S Brian Chia
- Experimental Therapeutics Centre, Agency for Science, Technology and Research (A*STAR), Singapore
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20
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Chew KL, Cheng JW, Jureen R, Lin RT, Teo JW. ERG11 mutations are associated with high-level azole resistance in clinical Candida tropicalis isolates, a Singapore study. MYCOSCIENCE 2017. [DOI: 10.1016/j.myc.2016.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Teo JWP, La MV, Jureen R, Lin RTP. Emergence of a New Delhi metallo-β-lactamase-1-producing Pseudomonas aeruginosa in Singapore. Emerg Microbes Infect 2015; 4:e72. [PMID: 26632659 PMCID: PMC4661430 DOI: 10.1038/emi.2015.72] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 09/21/2015] [Accepted: 09/25/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jeanette W P Teo
- Department of Laboratory Medicine, Division of Microbiology, National University Hospital, Singapore 119074, Republic of Singapore
| | - My-Van La
- National Public Health Laboratory, Ministry of Health, Synapse, Singapore 138623, Republic of Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, Division of Microbiology, National University Hospital, Singapore 119074, Republic of Singapore
| | - Raymond T P Lin
- Department of Laboratory Medicine, Division of Microbiology, National University Hospital, Singapore 119074, Republic of Singapore.,National Public Health Laboratory, Ministry of Health, Synapse, Singapore 138623, Republic of Singapore
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22
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Harris PNA, Yin M, Jureen R, Chew J, Ali J, Paynter S, Paterson DL, Tambyah PA. Comparable outcomes for β-lactam/β-lactamase inhibitor combinations and carbapenems in definitive treatment of bloodstream infections caused by cefotaxime-resistant Escherichia coli or Klebsiella pneumoniae. Antimicrob Resist Infect Control 2015; 4:14. [PMID: 25932324 PMCID: PMC4414382 DOI: 10.1186/s13756-015-0055-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 04/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae are often susceptible in vitro to β-lactam/β-lactamase inhibitor (BLBLI) combination antibiotics, but their use has been limited by concerns of clinical inefficacy. We aimed to compare outcomes between patients treated with BLBLIs and carbapenems for bloodstream infection (BSI) caused by cefotaxime non-susceptible (likely ESBL- or AmpC β-lactamase-producing) Escherichia coli and Klebsiella pneumoniae. METHODS All adult patients with a BSI caused by cefotaxime non-susceptible E. coli or K. pneumoniae were included from May 2012-May 2013. We compared outcomes between patients who had definitive monotherapy with a carbapenem to those who had definitive monotherapy with a BLBLI. RESULTS There were 92 BSIs that fulfilled the microbiological inclusion criteria. 79 (85.9%) were caused by E. coli and 13 (14.1%) by K. pneumoniae. Four out of 23 (17.4%) patients treated with carbapenem monotherapy and 2 out of 24 (8.3%) patients treated with BLBLI monotherapy died (adjusted HR for survival 0.91, 95% CI 0.13 to 6.28; p = 0.92). The time to resolution of systemic inflammatory response syndrome (SIRS) criteria did not vary between the treatment groups (adjusted HR 0.91, 95% CI 0.32 to 2.59; p = 0.97). The length of hospital admission post-positive blood culture was slightly longer in patients treated with BLBLIs (median duration 15 vs. 11 days), although this was not significant (adjusted HR 0.62; 95% CI 0.27 to 1.42; p = 0.26). There were no significant differences in subsequent isolation of carbapenem resistant organisms (4.3% vs. 4.2%, p = 1.0), C. difficile infection (13.0% vs. 8.3%, p = 0.67) or relapsed BSI (0% vs. 2%, p = 0.23). CONCLUSIONS BLBLIs appear to have a similar efficacy to carbapenems in the treatment of cefotaxime-resistant E. coli and K. pneumoniae bloodstream infections. Directed therapy with a BLBLI, when susceptibility is proven, may represent an appropriate carbapenem-sparing option.
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Affiliation(s)
- Patrick N A Harris
- University of Queensland Centre for Clinical Research, Brisbane, Queensland Australia ; Department of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mo Yin
- Department of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roland Jureen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Jonathan Chew
- International Medical University, Kuala Lumpur, Malaysia
| | - Jaminah Ali
- Department of Infectious Diseases, National University Hospital, Singapore, Singapore
| | - Stuart Paynter
- School of Population Health, University of Queensland, Brisbane, QLD Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Brisbane, Queensland Australia
| | - Paul A Tambyah
- Department of Infectious Diseases, National University Hospital, Singapore, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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23
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Aamodt H, Mohn SC, Maselle S, Manji KP, Willems R, Jureen R, Langeland N, Blomberg B. Genetic relatedness and risk factor analysis of ampicillin-resistant and high-level gentamicin-resistant enterococci causing bloodstream infections in Tanzanian children. BMC Infect Dis 2015; 15:107. [PMID: 25884316 PMCID: PMC4350950 DOI: 10.1186/s12879-015-0845-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 09/30/2014] [Accepted: 02/19/2015] [Indexed: 01/11/2023] Open
Abstract
Background While enterococci resistant to multiple antimicrobials are spreading in hospitals worldwide, causing urinary tract, wound and bloodstream infections, there is little published data on these infections from Africa. Methods We assessed the prevalence, susceptibility patterns, clinical outcome and genetic relatedness of enterococcal isolates causing bloodstream infections in children in a tertiary hospital in Tanzania, as part of a prospective cohort study of bloodstream infections among 1828 febrile children admitted consecutively from August 2001 to August 2002. Results Enterococcal bacteraemia was identified in 2.1% (39/1828) of admissions, and in 15.3% (39/255) of cases of culture-confirmed bloodstream infections. The case-fatality rate in children with Enterococcus faecalis septicaemia (28.6%, 4/14) was not significantly different from those with Enterococcus faecium septicaemia (6.7%, 1/15, p = 0.12). E. faecium isolates commonly had combined ampicillin-resistance and high-level gentamicin resistance (HLGR), (9/17), while E. faecalis frequently displayed HLGR (6/15), but were ampicillin susceptible. None of the tested enterococcal isolates displayed vancomycin resistance by Etest or PCR for vanA and vanB genes. Multi-locus sequence-typing (MLST) showed that the majority of E. faecium (7/12) belonged to the hospital associated Bayesian Analysis of Population Structure (BAPS) group 3–3. Pulsed-field gel electrophoresis (PFGE) indicated close genetic relationship particularly among E. faecium isolates, but also among E. faecalis isolates. There was also correlation between BAPS group and PFGE results. Risk factors for enterococcal bloodstream infection in univariate analysis were hospital-acquired infection and clinical diagnosis of sepsis with unknown focus. In multivariate analysis, neonates in general were relatively protected from enterococcal infection, while both prematurity and clinical sepsis were risk factors. Malnutrition was a risk factor for enterococcal bloodstream infection among HIV negative children. Conclusion This is the first study to describe bloodstream infections caused by ampicillin-resistant HLGR E. faecium and HLGR E. faecalis in Tanzania. The isolates of E. faecium and E. faecalis, respectively, showed high degrees of relatedness by genotyping using PFGE. The commonly used treatment regimens at the hospital are insufficient for infections caused by these microbes. The study results call for increased access to microbiological diagnostics to guide rational antibiotic use in Tanzania.
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Affiliation(s)
- Håvard Aamodt
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Center for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Stein Christian Mohn
- Center for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Samuel Maselle
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Rob Willems
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Roland Jureen
- National University Health System, Singapore City, Singapore.
| | - Nina Langeland
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Center for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Center for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway.
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Ranjan S, Zeming KK, Jureen R, Fisher D, Zhang Y. DLD pillar shape design for efficient separation of spherical and non-spherical bioparticles. Lab Chip 2014; 14:4250-62. [PMID: 25209150 DOI: 10.1039/c4lc00578c] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Particle sorting methods in microfluidic platforms are gaining momentum for various biomedical applications. Bioparticles are found in different shapes and sizes. However, conventional separation techniques are mainly designed for separation of spherical particles. Thus, there is a need to develop new methods for effective separation of spherical and non-spherical bioparticles for various applications. Deterministic lateral displacement (DLD) microfluidic methods have become popular for high separation resolution, simplicity, and predictability. However, shape sorting in the DLD separation methods is not well researched. Recently, we explored this area and found that pillar shapes in DLD significantly affect bioparticle separation. In this work, we designed a group of different pillar shapes with protrusions and groove structures with the hypothesis that pillar protrusions will induce particle rotation while pillar grooves will confine the particle rotational movement in a directed path for effective separation in a DLD pillar array. Using combinations of protrusions and grooves, 3-dimensional spherical particles, 2-dimensional planar disc-shaped red blood cells and 1-dimensional rod-shaped bacteria were separated and two interesting phenomena were observed. Firstly, the arrangement of pillar protrusions and grooves induces inertial movements, enhancing the separation of spherical particles. Secondly, non-spherical particles experience dominant rotational movements due to the protrusions and grooves which help in changing their orientations. This gives an opportunity to perform efficient separation based on the desired orientation (the longest dimension of the particles) by restricting or containing their movement within a specific DLD path.
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Affiliation(s)
- Shashi Ranjan
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576.
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Tang SS, Lye DC, Jureen R, Sng LH, Hsu LY. Rapidly growing mycobacteria in Singapore, 2006-2011. Clin Microbiol Infect 2014; 21:236-41. [PMID: 25658536 DOI: 10.1016/j.cmi.2014.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 07/21/2014] [Revised: 09/25/2014] [Accepted: 10/27/2014] [Indexed: 01/15/2023]
Abstract
Nontuberculous mycobacteria infection is a growing global concern, but data from Asia are limited. This study aimed to describe the distribution and antibiotic susceptibility profiles of rapidly growing mycobacterium (RGM) isolates in Singapore. Clinical RGM isolates with antibiotic susceptibility tests performed between 2006 and 2011 were identified using microbiology laboratory databases and minimum inhibitory concentrations of amikacin, cefoxitin, clarithromycin, ciprofloxacin, doxycycline, imipenem, linezolid, moxifloxacin, sulfamethoxazole or trimethoprim-sulfamethoxazole, tigecycline and tobramycin were recorded. Regression analysis was performed to detect changes in antibiotic susceptibility patterns over time. A total of 427 isolates were included. Of these, 277 (65%) were from respiratory specimens, 42 (10%) were related to skin and soft tissue infections and 36 (8%) were recovered from blood specimens. The two most common species identified were Mycobacterium abscessus (73%) and Mycobacterium fortuitum group (22%), with amikacin and clarithromycin being most active against the former, and quinolones and trimethoprim-sulfamethoxazole against the latter. Decreases in susceptibility of M. abscessus to linezolid by 8.8% per year (p 0.001), M. fortuitum group to imipenem by 9.5% per year (p 0.023) and clarithromycin by 4.7% per year (p 0.033) were observed. M. abscessus in respiratory specimens is the most common RGM identified in Singapore. Antibiotic options for treatment of RGM infections are increasingly limited.
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Affiliation(s)
- S S Tang
- Singapore General Hospital, Singapore.
| | - D C Lye
- Tan Tock Seng Hospital, Singapore
| | - R Jureen
- National University Health System, Singapore, Singapore
| | - L-H Sng
- Singapore General Hospital, Singapore
| | - L Y Hsu
- National University Health System, Singapore, Singapore
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Teo JW, Tan P, La MV, Krishnan P, Tee N, KOH TH, Deepak RN, TAN TY, Jureen R, Lin RT. Surveillance trends of carbapenem-resistant Enterobacteriaceae from Singapore, 2010–2013. J Glob Antimicrob Resist 2014; 2:99-102. [DOI: 10.1016/j.jgar.2013.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 01/09/2023] Open
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Tan X, Verrall A, Jureen R, Riley T, Collins D, Lin R, Balm M, Chan D, Tambyah P. The emergence of community-onset Clostridium difficile infection in a tertiary hospital in Singapore: A cause for concern. Int J Antimicrob Agents 2014; 43:47-51. [DOI: 10.1016/j.ijantimicag.2013.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/15/2013] [Accepted: 09/17/2013] [Indexed: 01/05/2023]
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Hon PY, Koh TH, Tan TY, Krishnan P, Leong JWY, Jureen R, Chan J, Tee NWS, Murugesh J, Chan KS, Hsu LY. Changing molecular epidemiology and high rates of mupirocin resistance among meticillin-resistant Staphylococcus aureus in Singaporean hospitals. J Glob Antimicrob Resist 2013; 2:53-55. [PMID: 27873639 DOI: 10.1016/j.jgar.2013.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/02/2013] [Accepted: 10/05/2013] [Indexed: 11/25/2022] Open
Abstract
A prospective cross-sectional study was performed to determine the continuing shift in the molecular epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in Singapore. In total, 666 MRSA isolates from screening cultures performed between 7 and 20 January 2013 were obtained from all seven public sector hospitals in Singapore and were subjected to molecular typing using multilocus variable-number tandem-repeat fingerprinting with confirmatory multilocus sequencing typing for clustered isolates. Isolates were also tested for the presence of the orfX-ACME insert and the high-level mupirocin resistance gene ileS-2. The major circulating clones in Singaporean hospitals were ST22 (63.2%), ST45 (18.9%) and ST239 (10.7%). The orfX-ACME insert was only found in ST239 isolates (31/71, 43.7%), but ileS-2 was found in 207 (31.1%) of the MRSA isolates, varying between 10.0% and 47.8% among the hospitals. In conclusion, the molecular epidemiology of MRSA in Singaporean hospitals has continued to change, with ST45 now replacing ST239 in addition to the ongoing replacement of the latter by ST22. Although a greater proportion of ST239 isolates carry the orfX-ACME insert, the actual clinical impact may be marginal as ST239 MRSA continues to decline. Finally, high-level mupirocin resistance rates are remarkably high in local healthcare-associated MRSA, with implications for MRSA decolonisation and infection prevention. Further surveillance is required to monitor the changing epidemiological trends.
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Affiliation(s)
- Pei Yun Hon
- Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore
| | - Tse Hsien Koh
- Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore; Department of Pathology, Singapore General Hospital, The Academia, 20 College Road, Singapore 169856, Singapore
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Prabha Krishnan
- Department of Laboratory Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Janice Wai-Yeng Leong
- Department of Laboratory Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore
| | - Joey Chan
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Nancy Wen-Sim Tee
- Department of Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - Jagadeesan Murugesh
- Department of Laboratory Medicine, Jurong General Hospital, 378 Alexandra Road, Singapore 159964, Singapore
| | - Kian Sing Chan
- Department of Pathology, Singapore General Hospital, The Academia, 20 College Road, Singapore 169856, Singapore
| | - Li Yang Hsu
- Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore.
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Teo JWP, Cheng JWS, Jureen R, Lin RTP. Clinical utility of RD1, RD9 and hsp65 based PCR assay for the identification of BCG in vaccinated children. BMC Res Notes 2013; 6:434. [PMID: 24168785 PMCID: PMC4228461 DOI: 10.1186/1756-0500-6-434] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycobacterium bovis Bacille Calmette-Guérin (BCG) vaccine is widely administered to prevent tuberculosis. Vaccine complications are rare. However, when BCG-related adverse reactions arise there is a need to rapidly and reliably identify BCG from other members of the Mycobacterium tuberculosis complex (TBC). PCR assays based on the detection of the regions of difference (RD), in particular RD1 and RD9, have been invaluable in the identification of BCG. Prior to this study, specimens were identified through HPLC analysis at a local reference laboratory taking up to 2 weeks for a result. We sought to expedite the identification process by validating a RD1, RD9 and hsp65 PCR assay for the identification and differentiation of BCG from TBC. FINDINGS In last past 3 years, we validated the RD1, RD9 and hsp65 PCR assay for 16 mycobacterial isolates obtained from children who had experienced adverse reactions to BCG vaccination. In these cases, the clinician required a definitive identification of the isolate. The RD1 and RD9 PCR profiles indicated that all 16 isolates were BCG whilst amplification of the hsp65 target functioned as a PCR positive control. When tested against clinical M. tuberculosis (MTB), reference and non-tuberculous mycobacteria the PCR assay demonstrated 100% sensitivity and specificity. CONCLUSIONS The RD1, RD9 and hsp65 PCR assay is a useful tool for the rapid and reliable identification of BCG. Its ease of use has allowed it to be implemented in our clinical microbiology laboratory.
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Affiliation(s)
- Jeanette WP Teo
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore 119074, Republic of Singapore
| | - Janet WS Cheng
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore 119074, Republic of Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore 119074, Republic of Singapore
| | - Raymond TP Lin
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore 119074, Republic of Singapore
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Fisher D, Tambyah PA, Lin RTP, Jureen R, Cook AR, Lim A, Ong B, Balm M, Ng TM, Hsu LY. Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore. J Hosp Infect 2013; 85:141-8. [PMID: 24011440 PMCID: PMC7114850 DOI: 10.1016/j.jhin.2013.07.005] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/22/2013] [Indexed: 11/25/2022]
Abstract
Background Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities. Aim To study the impact of an MRSA control bundle that was implemented via gradual geographic extension across hospital wards. Methods The bundle included active surveillance on admission and transfer/discharge to identify ward-based acquisition of MRSA, isolation and cohorting of MRSA-infected patients, enhanced hand hygiene initiatives, and publicly displayed feedback of MRSA acquisition and hand hygiene compliance rates. Implementation was between October 2006 and June 2010 in order to provide lead-time for the incremental development of infrastructural capacity, and to develop an ethic of infection prevention among staff. Results were analysed via interrupted time-series analysis. Findings MRSA infections fell midway through the implementation, with MRSA bacteraemia declining from 0.26 [95% confidence interval (CI): 0.18–0.34] cases per 1000 inpatient-days in the first quarter of 2004 to 0.11 (95% CI: 0.07–0.19) cases per 1000 inpatient-days in the first quarter of 2012. MRSA acquisition rates fell a year after the programme had been fully implemented, whereas hand hygiene compliance rose significantly from 47% (95% CI: 44–49) in the first quarter of 2009 to 69% (95% CI: 68–71) in the first quarter of 2012. Conclusion Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings.
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Affiliation(s)
- D Fisher
- Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Infection Control Team, National University Health System, Singapore.
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Balm MND, Salmon S, Jureen R, Teo C, Mahdi R, Seetoh T, Teo JTW, Lin RTP, Fisher DA. Bad design, bad practices, bad bugs: frustrations in controlling an outbreak of Elizabethkingia meningoseptica in intensive care units. J Hosp Infect 2013; 85:134-40. [PMID: 23958153 DOI: 10.1016/j.jhin.2013.05.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elizabethkingia meningoseptica is a nosocomial-adapted Gram-negative bacillus intrinsically resistant to antibiotics commonly used in the intensive care setting. An outbreak investigation commenced when five patients developed E. meningoseptica infection in two intensive care units (ICUs). METHODS Analysis of laboratory data, case reviews, ICU workflows and extensive environmental sampling were undertaken. Molecular typing was performed using repetitive element palindromic polymerase chain reaction. Follow-up studies after interventions included environmental monitoring and a survey of staff compliance with interventions. FINDINGS Laboratory data revealed increasing incidence of E. meningoseptica colonization or infection in ICU patients compared with preceding years. E. meningoseptica was cultured from 44% (35/79) of taps, but not from other sources. Hand hygiene sinks were used for disposal of patient secretions and rinsing re-usable patient care items. Sinks misused in this way were contaminated more often than sinks that were not misused (odds ratio 4.38, 95% confidence interval 1.68-11.39; P = 0.004). Molecular typing revealed that patient isolates had identical patterns to several isolates from hand hygiene taps. An urgent education programme was instituted to change these practices. Taps were cleaned systematically and aerators were changed. A temporary reduction in case numbers was achieved. Recolonization of taps was demonstrated on follow-up environmental screening, and cases recurred after two months. A survey revealed that 77.3% (163/213) of nursing staff still misused sinks due to time constraints or other problems adhering to the interventions. CONCLUSION Introduction of non-sanctioned practices due to suboptimal unit design may have unintentional consequences for ICU patients. Room design and staff workflows must be optimized for patient safety as lapses in procedure can inadvertently put patients at risk.
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Affiliation(s)
- M N D Balm
- Infection Control Team, National University Hospital, Singapore; Microbiology, Department of Laboratory Medicine, National University Hospital, Singapore
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Teo JWP, La MV, Krishnan P, Ang B, Jureen R, Lin RTP. Enterobacter cloacae producing an uncommon class A carbapenemase, IMI-1, from Singapore. J Med Microbiol 2013; 62:1086-1088. [DOI: 10.1099/jmm.0.053363-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In this study, we describe the characterization of an infrequently encountered class A carbapenemase, IMI-1, from a clinical Enterobacter cloacae isolate. The isolate had high levels of resistance to carbapenems but retained susceptibility to expanded-spectrum cephalosporins. The bla
IMI-1 gene was chromosomally encoded. Detection of the IMI-1 producer highlights the diversity of carbapenemases in a local clinical setting.
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Affiliation(s)
- Jeanette W. P. Teo
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Republic of Singapore
| | - My-Van La
- National Public Health Laboratory, Singapore 169612, Republic of Singapore
| | - Prabha Krishnan
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore 308433, Republic of Singapore
| | - Brenda Ang
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore 308433, Republic of Singapore
| | - Roland Jureen
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Republic of Singapore
| | - Raymond T. P. Lin
- Department of Laboratory Medicine, National University Hospital, Singapore 119074, Republic of Singapore
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Balm MND, La MV, Krishnan P, Jureen R, Lin RTP, Teo JWP. Emergence of Klebsiella pneumoniae co-producing NDM-type and OXA-181 carbapenemases. Clin Microbiol Infect 2013; 19:E421-3. [PMID: 23668475 DOI: 10.1111/1469-0691.12247] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [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: 01/12/2013] [Revised: 04/01/2013] [Accepted: 04/07/2013] [Indexed: 11/28/2022]
Abstract
The emergence of carbapenemase-producing Enterobacteriaceae is a rapidly evolving threat worldwide. Here, we report the molecular characterization of two Klebsiella pneumoniae isolates carrying both bla(OXA -181) and bla(NDM -1) or bla(NDM -5) isolated from epidemiologically unrelated patients in Singapore. The bla(OXA -181) genes were found existing in different genetic environments.
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Affiliation(s)
- M N D Balm
- Department of Laboratory Medicine, National University Hospital, Singapore City, Singapore.
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Balm MND, Ngan G, Jureen R, Lin RTP, Teo JWP. OXA-181-producing Klebsiella pneumoniae establishing in Singapore. BMC Infect Dis 2013; 13:58. [PMID: 23374756 PMCID: PMC3570352 DOI: 10.1186/1471-2334-13-58] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 01/28/2013] [Indexed: 11/15/2022] Open
Abstract
Background Carbapenemase producing Enterobacteriaceae are becoming a major public health concern globally, however, relatively little is known about the molecular and clinical epidemiology of these organisms in many parts of the world. Methods As part of a laboratory surveillance programme, 96 carbapenem non-susceptible Enterobacteriaceae isolates from clinical samples from patients in seven hospitals were referred for investigation for carbapenemases. Using polymerase chain reaction (PCR) to screen for a collection of genes encoding carbapenemases, 33 of 96 (34.5%) isolates were confirmed as carbapenemase producers. NDM-1 producers were the most prevalent at 64% (21/33) whilst OXA-181 was the second most common carbapenemase constituting 24.5% (8/33) of the carbapenemase producing isolates. Seven of these eight OXA-181 positive isolates underwent further characterisation with screening for other transmissible antimicrobial resistance determinants using PCR. Clonal relatedness was explored using Multilocus sequence typing (MLST) and Pulsed Field Gel Electrophoresis (PFGE). Plasmid characterisation was performed including restriction analysis and transfer by conjugation or transformation. Results In addition to the OXA-181 gene, all contained other transmissible resistance determinants including extended spectrum β-lactamases, oxacillinases or 16S rRNA methylase genes, but none contained metallo-β-lactamases or serine carbapenemases. All isolates had a multidrug resistant phenotype with two isolates being resistant to every antibiotic tested including colistin. Multilocus sequence typing confirmed five isolates belonged to ST17 and two to ST14, with those belonging to the same sequence type having identical PFGE profiles. The OXA-181 gene was typically carried on large plasmids which were mostly non-conjugative. Conclusions OXA-181 carbapenemase appears to be an important and probably under-recognised cause of carbapenem resistance in Enterobacteriaceae in Singapore. Further coordinated research into clinical and molecular epidemiology of carbapenemases is urgently required in Singapore and throughout Asia.
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Affiliation(s)
- Michelle N D Balm
- Department of Laboratory Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
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Venkatachalam I, Teo J, Balm MND, Fisher DA, Jureen R, Lin RTP. Klebsiella pneumoniae Carbapenemase-producing enterobacteria in hospital, Singapore. Emerg Infect Dis 2013; 18:1381-3. [PMID: 22840461 PMCID: PMC3414009 DOI: 10.3201/eid1808.110893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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La MV, Siti Zulaina M, Chua A, Jureen R, Tee N, Lin R. Pneumococcal serotyping for surveillance of invasive pneumococcal diseases in Singapore, 2011. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.303] [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: 10/28/2022] Open
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Balm M, Teo C, Jureen R, Lin R, Fisher D. Massive hospital-wide bacillus outbreak related to hospital linen and construction. BMC Proc 2011. [PMCID: PMC3239493 DOI: 10.1186/1753-6561-5-s6-o77] [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] [Indexed: 11/10/2022] Open
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Yeo CL, Chan DSG, Earnest A, Wu TS, Yeoh SF, Lim R, Jureen R, Fisher D, Hsu LY. Prospective audit and feedback on antibiotic prescription in an adult hematology-oncology unit in Singapore. Eur J Clin Microbiol Infect Dis 2011; 31:583-90. [PMID: 21845470 DOI: 10.1007/s10096-011-1351-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/02/2011] [Indexed: 11/28/2022]
Abstract
We evaluated the impact of a prospective audit and feedback antimicrobial stewardship program (ASP) on antibiotic prescription and resistance trends in a hematology-oncology unit in a university hospital (National University Cancer Institute, Singapore [NCIS]). A prospective interrupted time-series study comprising 11-month pre-intervention (PIP) and intervention evaluation phases (IEP) flanking a one-month implementation phase was carried out. Outcome measures included defined daily dose per 100 (DDD/100) inpatient-days of ASP-audited and all antibiotics (encompassing audited and non-audited antibiotics), and the incidence-density of antibiotic-resistant microorganisms at the NCIS. Internal and external controls were DDD/100 inpatient-days of paracetamol at the NCIS and DDD/100 inpatient-days of antibiotics prescribed in the rest of the hospital. There were 580 ASP recommendations from 1,276 audits, with a mean monthly compliance of 86.9%. Significant reversal of prescription trends towards reduced prescription of audited (coefficient = -2.621; 95% confidence interval [CI]: -4.923, -0.319; p = 0.026) and all evaluated antibiotics (coefficient = -4.069; 95% CI: -8.075, -0.063; p = 0.046) was observed. No changes were seen for both internal and external controls, except for the reversal of prescription trends for cephalosporins hospital-wide. Antimicrobial resistance did not change over the time period of the study. Adverse outcomes-the majority unavoidable-occurred following 5.5% of accepted ASP recommendations. Safe and effective ASPs can be implemented in the complex setting of hematology-oncology inpatients.
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Affiliation(s)
- C-L Yeo
- Department of Pharmacy, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
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Pada S, Ding Y, Ling M, Hsu LY, Earnest A, Lee TE, Yong HC, Jureen R, Fisher D. Economic and clinical impact of nosocomial meticillin-resistant Staphylococcus aureus infections in Singapore: a matched case–control study. J Hosp Infect 2011; 78:36-40. [DOI: 10.1016/j.jhin.2010.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Ngan G, Ng L, Jureen R, Lin R, Teo J. Development of multiplex PCR assays based on the 16S-23S rRNA internal transcribed spacer for the detection of clinically relevant nontuberculous mycobacteria. Lett Appl Microbiol 2011; 52:546-54. [DOI: 10.1111/j.1472-765x.2011.03045.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hsu LY, Tan TY, Koh TH, Kwa AL, Krishnan P, Tee NW, Jureen R. Decline in Clostridium difficile-associated disease rates in Singapore public hospitals, 2006 to 2008. BMC Res Notes 2011; 4:77. [PMID: 21429188 PMCID: PMC3068971 DOI: 10.1186/1756-0500-4-77] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [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: 09/18/2010] [Accepted: 03/23/2011] [Indexed: 01/25/2023] Open
Abstract
Background Clostridium difficile is the major cause of pseudomembranous colitis associated with antibiotic use, and the spread of the hypervirulent epidemic ribotype 027/NAP-1 strain across hospitals worldwide has re-focused attention on this nosocomial pathogen. The overall incidence and trend of C. difficile-associated disease (CDAD) in Singapore is unknown, and a surveillance program to determine these via formal laboratory-based reporting was established. Findings Laboratory and pharmacy data were collated from one tertiary and two secondary hospitals on a quarterly basis between 2006 and 2008. All hospitals tested for C. difficile using Immunocard Toxins A&B (Meridian Bioscience Inc., Cincinnati, OH) during this period. Duplicate positive C. difficile results within a 14-day period were removed. The CDAD results were compared with trends in hospital-based prescription of major classes of antibiotics. Overall CDAD incidence-density decreased from 5.16 (95%CI: 4.73 - 5.62) cases per 10,000 inpatient-days in 2006 to 2.99 (95%CI: 2.67 to 3.33) cases per 10,000 inpatient-days in 2008 (p < 0.001), while overall rates for C. difficile testing increased significantly (p < 0.001) within the same period. These trends were mirrored at the individual hospital level. Evaluation of antibiotic prescription data at all hospitals showed increasing use of carbapenems and fluoroquinolones, while cephalosporin and clindamycin prescription remained stable. Conclusions Our results demonstrate a real decline of CDAD rates in three large local hospitals. The cause is unclear and is not associated with improved infection control measures or reduction in antibiotic prescription. Lack of C. difficile stool cultures as part of routine testing precluded determination of the decline of a major clone as a potential explanation. For more accurate epidemiological trending of CDAD and early detection of epidemic clones, data collection will have to be expanded and resources set in place for reference laboratory culture and typing.
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Affiliation(s)
- Li-Yang Hsu
- Department of Medicine, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore.
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La MV, Zulaina S, Jureen R, Lin R. Laboratory investigation for clonality of a foodborne outbreak due to Vibrio parahaemolyticus in Singapore, 2009. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Søndenaa K, Høiby EA, Digranes A, Jureen R. Lactobacillus rhamnosus Septicaemia in a Patient with a Graft in the Inferior Vena Cava. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/inf.34.2.135.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Blomberg B, Olsen BE, Hinderaker SG, Langeland N, Gasheka P, Jureen R, Kvåle G, Midtvedt T. Antimicrobial resistance in urinary bacterial isolates from pregnant women in rural Tanzania: Implications for public health. ACTA ACUST UNITED AC 2009; 37:262-8. [PMID: 15871165 DOI: 10.1080/00365540410021045] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Common variable immunodeficiency with an associated broad immunoglobulin (0.7%) deficit affecting all subclasses, was revealed in a 27-y-old previously healthy female, upon development of a severe pneumococcal meningitis. We report the third case of purulent meningitis complicating this primary immunodeficiency, and the second due to Streptococcus pneumoniae. Clinicians should maintain an elevated suspicion for congenital immunodeficiency, especially when observing adult patients with a negligible prior history.
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Affiliation(s)
- Bjørn Blomberg
- Centre for International Health and, University of Bergen, Norway.
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Tew CW, Han FC, Jureen R, Tey BH. Aspergillus vertebral osteomyelitis and epidural abscess. Singapore Med J 2009; 50:e151-e154. [PMID: 19421672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We present the first reported case of Aspergillus vertebral osteomyelitis and epidural abscess in Singapore in a 50-year-old man with post-tuberculous bronchiectasis. The patient presented with acute urinary retention and flaccid paraplegia. Despite surgical debridement and treatment with voriconazole, the patient developed multiorgan failure and died two weeks after presentation. Early diagnosis and prompt initiation of treatment are emphasised in the hope of improving the outcome of this aggressive condition.
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Affiliation(s)
- C W Tew
- Department of General Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore.
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Tan TY, Hsu LY, Koh TH, Ng LSY, Tee NWS, Krishnan P, Lin RTP, Jureen R. Antibiotic Resistance in Gram-negative Bacilli: A Singapore Perspective. Ann Acad Med Singap 2008. [DOI: 10.47102/annals-acadmedsg.v37n10p819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Antibiotic resistance in gram-negative bacilli is an area of increasing importance. This prospective study was performed to survey antibiotic resistance in Escherichia coli (E. coli), Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. over a 1-year period.
Materials and Methods: Non-duplicate isolates of E. coli, Klebsiella spp., P. aeruginosa and Acinetobacter spp. were collected from participating Singapore hospitals during defined collection periods in 2006 and 2007. Confirmatory identification and antibiotic susceptibility testing were performed at Changi General Hospital. Minimum inhibitory concentrations (MIC) to a defined panel of antibiotics were determined using microbroth dilution methods. The presence of extended-spectrum beta lactamases and AmpC beta-lactamases in Enterobacteriaceae was determined by phenotypic methods, and susceptibility results were defined using current breakpoints from the Clinical Laboratory Standards Institute (CLSI).
Results: Seven hundred and forty-six gram-negative bacilli were received for testing. Resistance to extended-spectrum cephalosporins was present in a third of Enterobacteriaceae isolates, and extended-spectrum beta-lactamases (ESBL) carriage was present in 19.6% and 30.1% of E. coli and Klebsiella pneumoniae, respectively. AmpC enzymes were also detected in 8.5% and 5.6% of E. coli and K. pneumoniae isolates respectively. All Enterobacteriaceae were susceptible to imipenem and meropenem. The most active antibiotics against P. aeruginosa were amikacin, meropenem and piperacillin-tazobactam. A third of P. aeruginosa showed reduced susceptibility to polymyxin B. Carbapenem resistance was significantly higher in Acinetobacter baumannii (70.5%) than in other Acinetobacter species (25.0%). The most active antibiotic against A. baumannii was polymyxin B.
Conclusion: Antibiotic resistance is prevalent in gram-negative bacilli isolated from Singapore hospitals. The MIC testing surveillance programme complemented susceptibility data from wider laboratory-based surveillance, and has revealed emerging mechanisms of antibiotic resistance.
Keywords: Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, Microbial sensitivity tests
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Tan TY, Hsu LY, Koh TH, Ng LSY, Tee NWS, Krishnan P, Lin RTP, Jureen R. Antibiotic resistance in gram-negative bacilli: a Singapore perspective. Ann Acad Med Singap 2008; 37:819-825. [PMID: 19037514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Antibiotic resistance in gram-negative bacilli is an area of increasing importance. This prospective study was performed to survey antibiotic resistance in Escherichia coli (E. coli), Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. over a 1-year period. MATERIALS AND METHODS Non-duplicate isolates of E. coli, Klebsiella spp., P. aeruginosa and Acinetobacter spp. were collected from participating Singapore hospitals during defined collection periods in 2006 and 2007. Confirmatory identification and antibiotic susceptibility testing were performed at Changi General Hospital. Minimum inhibitory concentrations (MIC) to a defined panel of antibiotics were determined using microbroth dilution methods. The presence of extended-spectrum beta lactamases and AmpC beta-lactamases in Enterobacteriaceae was determined by phenotypic methods, and susceptibility results were defined using current breakpoints from the Clinical Laboratory Standards Institute (CLSI). RESULTS Seven hundred and forty-six gram-negative bacilli were received for testing. Resistance to extended-spectrum cephalosporins was present in a third of Enterobacteriaceae isolates, and extended-spectrum beta-lactamases (ESBL) carriage was present in 19.6% and 30.1% of E. coli and Klebsiella pneumoniae, respectively. AmpC enzymes were also detected in 8.5% and 5.6% of E. coli and K. pneumoniae isolates respectively. All Enterobacteriaceae were susceptible to imipenem and meropenem. The most active antibiotics against P. aeruginosa were amikacin, meropenem and piperacillin-tazobactam. A third of P. aeruginosa showed reduced susceptibility to polymyxin B. Carbapenem resistance was significantly higher in Acinetobacter baumannii (70.5%) than in other Acinetobacter species (25.0%). The most active antibiotic against A. baumannii was polymyxin B. CONCLUSION Antibiotic resistance is prevalent in gram-negative bacilli isolated from Singapore hospitals. The MIC testing surveillance programme complemented susceptibility data from wider laboratory-based surveillance, and has revealed emerging mechanisms of antibiotic resistance.
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Affiliation(s)
- Thean Yen Tan
- Division of Laboratory Medicine, Changi General Hospital, Singapore.
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Jureen R, Koh TH, Wang G, Chai LYA, Tan AL, Chai T, Wong YW, Wang Y, Tambyah PA, Beuerman R, Tan D. Use of multiple methods for genotyping Fusarium during an outbreak of contact lens associated fungal keratitis in Singapore. BMC Infect Dis 2008; 8:92. [PMID: 18627616 PMCID: PMC2483985 DOI: 10.1186/1471-2334-8-92] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 07/15/2008] [Indexed: 11/17/2022] Open
Abstract
Background In Singapore, an outbreak of fungal keratitis caused by members of the Fusarium solani species complex (FSSC) was identified in March 2005 to May 2006 involving 66 patients. Epidemiological investigations have indicated that improper contact lens wear and the use of specific contact lens solutions were risk factors. Methods We assessed the genetic diversity of the isolates using AFLP, Rep-PCR, and ERIC-PCR and compared the usefulness of these typing schemes to characterize the isolates. Results AFLP was the most discriminative typing scheme and appears to group FSSC from eye infections and from other infections differently. Conclusion There was a high genomic heterogeneity among the isolates confirming that this was not a point source outbreak.
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Affiliation(s)
- Roland Jureen
- Department of Laboratory Medicine, Alexandra Hospital, Singapore.
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Hsu LY, Tan TY, Jureen R, Koh TH, Krishnan P, Tzer-Pin Lin R, Wen-Sin Tee N, Tambyah PA. Antimicrobial drug resistance in Singapore hospitals. Emerg Infect Dis 2008; 13:1944-7. [PMID: 18258055 PMCID: PMC2876746 DOI: 10.3201/eid1312.070299] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A new national antimicrobial resistance surveillance program in Singapore public hospitals that uses WHONET detected high levels of methicillin resistance among Staphylococcus aureus (35.3%), carbapenem resistance among Acinetobacter spp. (49.6%), and third-generation cephalosporin resistance among Klebsiella pneumoniae (35.9%) hospital isolates in 2006. Antimicrobial drug resistance is a major problem in Singapore.
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Affiliation(s)
- Li-Yang Hsu
- Department of Medicine, National University of Singapore, Singapore.
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Tellevik MG, Sollid JE, Blomberg B, Jureen R, Urassa WK, Langeland N. Extended-spectrum beta-lactamase-type SHV-12-producing Enterobacteriaceae causing septicemia in Tanzanian children: vectors for horizontal transfer of antimicrobial resistance. Diagn Microbiol Infect Dis 2007; 59:351-4. [PMID: 17878065 DOI: 10.1016/j.diagmicrobio.2007.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 06/20/2007] [Accepted: 06/23/2007] [Indexed: 11/15/2022]
Abstract
Septicemia caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was associated with high mortality in Tanzanian children. Conjugation experiments on the SHV-12-producing Enterobacteriaceae isolates showed that ESBL-encoding genes were transferred on large plasmids together with genes encoding resistance to aminoglycosides, resistance to ceftazidime, gentamicin, doxycycline, trimethoprim-sulfamethoxazole, and chloramphenicol.
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