168 results on '"Shu-Chen Kuo"'
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2. Letter to the Editor: Appropriate timing for the removal of urinary catheter after laparoscopic surgery for benign gynecologic diseases may still be uncertain
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Shu‐Fen Chen, Shu‐Chen Kuo, and Peng‐Hui Wang
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Gynecologic Surgical Procedures ,Humans ,Obstetrics and Gynecology ,Female ,Laparoscopy ,General Medicine ,Urinary Catheters ,Urinary Catheterization ,Genital Diseases, Female ,Device Removal - Published
- 2022
3. In vitro and in vivo comparison of eravacycline- and tigecycline-based combination therapies for tigecycline-resistant Acinetobacter baumannii
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Ti Yin, Tsung-Ta Chiang, Shu-Chen Kuo, Jiun-Ji Lai, Ya-Sung Yang, and Wei-Cheng Huang
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Pharmacology ,Imipenem ,biology ,business.industry ,medicine.drug_class ,Antibiotics ,Tigecycline ,Drug resistance ,biochemical phenomena, metabolism, and nutrition ,Acinetobacter ,bacterial infections and mycoses ,biology.organism_classification ,Eravacycline ,Acinetobacter baumannii ,chemistry.chemical_compound ,Infectious Diseases ,Oncology ,chemistry ,medicine ,Colistin ,Pharmacology (medical) ,business ,medicine.drug - Abstract
Several antimicrobial combination therapies are used to treat multiple drug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii infections. A novel antibiotic, eravacycline, shows a higher potency than tigecycline. The efficacies of eravacycline-based therapies have not yet been evaluated. We demonstrated the effectiveness of eravacycline- and tigecycline-based combination therapies in XDR and especially tigecycline resistant A. baumannii. Thirteen eligible isolates were selected from 642 non-duplicate Acinetobacter blood isolates from four medical centres in 2010-2014. Tigecycline/imipenem and eravacycline/imipenem combinations were simultaneously effective against some isolates in vitro with fractional inhibitory concentration index of 0.5. In contrast, eravacycline- and tigecycline-based combination therapies provided no additional benefits in mouse survival compared to those for monotherapy. In summary, colistin is still the final resort for XDR-A. baumannii treatment according to the sensitivities. Owning to rapid development of resistance in A. baumannii, novel antibiotics are urgently needed.
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- 2021
4. Is antibiotic exposure associated with an increased risk of developing necrotizing enterocolitis and bronchopulmonary dysplasia in very low birth weight infants?
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Shu-Chen Kuo, Shu-Fen Chen, and Peng-Hui Wang
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General Medicine - Published
- 2022
5. Ser253Leu substitution in PmrB contributes to colistin resistance in clinical Acinetobacter nosocomialis
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Jun-Ren Sun, Cheng-Cheung Chen, Chi-Ju Hsu, Hsing-Yu Chen, Yi-Tzu Lee, Shu-Chen Kuo, Yu-Ching Chou, Wen Yih Jeng, Ya-Sung Yang, and Wei-Jane Hsu
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Epidemiology ,Immunology ,Colistin resistance ,Microbiology ,pmrB ,Bacterial Proteins ,Virology ,Drug Resistance, Multiple, Bacterial ,Drug Discovery ,medicine ,polycyclic compounds ,Humans ,biology ,Acinetobacter ,business.industry ,Colistin ,pmrCAB operon ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Frequent use ,Anti-Bacterial Agents ,Infectious Diseases ,Amino Acid Substitution ,Multilocus sequence typing ,bacteria ,Acinetobacter nosocomialis ,Parasitology ,lipids (amino acids, peptides, and proteins) ,business ,Bacteria ,medicine.drug ,Research Article ,MLST ,Acinetobacter Infections ,Transcription Factors - Abstract
Infections caused by extensively drug-resistant (XDR) Acinetobacter nosocomialis have become a challenging problem. The frequent use of colistin as the last resort drug for XDR bacteria has led to the emergence of colistin-resistant A. nosocomialis (ColRAN) in hospitals. The mechanism of colistin resistance in A. nosocomialis remains unclear. This study aimed to investigate the mechanisms underlying colistin resistance in clinical ColRAN isolates. We collected 36 A. nosocomialis isolates from clinical blood cultures, including 24 ColRAN and 12 colistin-susceptible A. nosocomialis (ColSAN). The 24 ColRAN isolates clustered with ST1272 (13), ST433 (eight), ST1275 (two), and ST410 (one) by multilocus sequence typing. There was a positive relationship between pmrCAB operon expression and colistin resistance. Further analysis showed that colistin resistance was related to an amino acid substitution, Ser253Leu in PmrB. By introducing a series of recombinant PmrB constructs into a PmrB knockout strain and protein structural model analyses, we demonstrated that the association between Ser253Leu and Leu244 in PmrB was coupled with colistin resistance in ColRAN. To the best of our knowledge, this is the first study demonstrating that the key amino acid Ser253Leu in PmrB is associated with overexpression of the pmrCAB operon and hence colistin resistance. This study provides insight into the mechanism of colistin resistance in A. nosocomialis.
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- 2021
6. Biofilm formation is not an independent risk factor for mortality in patients with Acinetobacter baumannii bacteremia
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Tsung-Ta Chiang, Tzu-Wen Huang, Jun-Ren Sun, Shu-Chen Kuo, Aristine Cheng, Chang-Pan Liu, Yuag-Meng Liu, Ya-Sung Yang, Te-Li Chen, Yi-Tzu Lee, and Yung-Chih Wang
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Microbiology (medical) ,Infectious Diseases ,Immunology ,Microbiology - Abstract
In the past decades, due to the high prevalence of the antibiotic-resistant isolates of Acinetobacter baumannii, it has emerged as one of the most troublesome pathogens threatening the global healthcare system. Furthermore, this pathogen has the ability to form biofilms, which is another effective mechanism by which it survives in the presence of antibiotics. However, the clinical impact of biofilm-forming A. baumannii isolates on patients with bacteremia is largely unknown. This retrospective study was conducted at five medical centers in Taiwan over a 9-year period. A total of 252 and 459 patients with bacteremia caused by biofilm- and non-biofilm-forming isolates of A. baumannii, respectively, were enrolled. The clinical demographics, antimicrobial susceptibility, biofilm-forming ability, and patient clinical outcomes were analyzed. The biofilm-forming ability of the isolates was assessed using a microtiter plate assay. Multivariate analysis revealed the higher APACHE II score, shock status, lack of appropriate antimicrobial therapy, and carbapenem resistance of the infected strain were independent risk factors of 28-day mortality in the patients with A. baumannii bacteremia. However, there was no significant difference between the 28-day survival and non-survival groups, in terms of the biofilm forming ability. Compared to the patients infected with non-biofilm-forming isolates, those infected with biofilm-forming isolates had a lower in-hospital mortality rate. Patients with either congestive heart failure, underlying hematological malignancy, or chemotherapy recipients were more likely to become infected with the biofilm-forming isolates. Multivariate analysis showed congestive heart failure was an independent risk factor of infection with biofilm-forming isolates, while those with arterial lines tended to be infected with non-biofilm-forming isolates. There were no significant differences in the sources of infection between the biofilm-forming and non-biofilm-forming isolate groups. Carbapenem susceptibility was also similar between these groups. In conclusion, the patients infected with the biofilm-forming isolates of the A. baumannii exhibited different clinical features than those infected with non-biofilm-forming isolates. The biofilm-forming ability of A. baumannii may also influence the antibiotic susceptibility of its isolates. However, it was not an independent risk factor for a 28-day mortality in the patients with bacteremia.
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- 2022
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7. In vitroactivity of imipenem/relebactam, meropenem/vaborbactam, ceftazidime/avibactam, cefepime/zidebactam and other novel antibiotics against imipenem-non-susceptible Gram-negative bacilli from Taiwan
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Mei-Chen Tan, Wei-Cheng Huang, Tsai-Ling Lauderdale, Yung-Chih Wang, Shu-Chen Kuo, Hui-Ying Wang, Yih-Ru Shiau, Jui-Fen Lai, and I-Wen Huang
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Microbiology (medical) ,Imipenem ,Klebsiella pneumoniae ,Avibactam ,Cefepime ,Taiwan ,Ceftazidime ,Microbial Sensitivity Tests ,Biology ,Meropenem ,beta-Lactamases ,Microbiology ,Cyclooctanes ,chemistry.chemical_compound ,Bacterial Proteins ,Piperidines ,polycyclic compounds ,medicine ,Humans ,Pharmacology (medical) ,Original Research ,Pharmacology ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,Eravacycline ,Ceftazidime/avibactam ,Boronic Acids ,Anti-Bacterial Agents ,Drug Combinations ,Infectious Diseases ,chemistry ,Azabicyclo Compounds ,medicine.drug - Abstract
ObjectivesTo investigate the susceptibility of imipenem-non-susceptible Escherichia coli (INS-EC), Klebsiella pneumoniae (INS-KP), Acinetobacter baumannii (INS-AB) and Pseudomonas aeruginosa (INS-PA) to novel antibiotics.MethodsMICs were determined using the broth microdilution method. Carbapenemase and ESBL phenotypic testing and PCR for genes encoding ESBLs, AmpCs and carbapenemases were performed.ResultsZidebactam, avibactam and relebactam increased the respective susceptibility rates to cefepime, ceftazidime and imipenem of 17 INS-EC by 58.8%, 58.8% and 70.6%, of 163 INS-KP by 77.9%, 88.3% and 76.1% and of 81 INS-PA by 45.7%, 38.3% and 85.2%, respectively. Vaborbactam increased the meropenem susceptibility of INS-EC by 41.2% and of INS-KP by 54%. Combinations of β-lactams and novel β-lactamase inhibitors or β-lactam enhancers (BLI-BLE) were inactive against 136 INS-AB. In 58 INS-EC and INS-KP with exclusively blaKPC-like genes, zidebactam, avibactam, relebactam and vaborbactam increased the susceptibility of the partner β-lactams by 100%, 96.6%, 84.5% and 75.9%, respectively. In the presence of avibactam, ceftazidime was active in an additional 85% of 20 INS-EC and INS-KP with exclusively blaOXA-48-like genes while with zidebactam, cefepime was active in an additional 75%. INS-EC and INS-KP with MBL genes were susceptible only to cefepime/zidebactam. The β-lactam/BLI-BLE combinations were active against INS-EC and INS-KP without detectable carbapenemases. For INS-EC, INS-KP and INS-AB, tigecycline was more active than omadacycline and eravacycline but eravacycline had a lower MIC distribution. Lascufloxacin and delafloxacin were active in Conclusionsβ-Lactam/BLI-BLE combinations were active in a higher proportion of INS-EC, INS-KP and INS-PA. The susceptibility of novel fluoroquinolones and tetracyclines was not superior to that of old ones.
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- 2021
8. Biofilm formation is not an independent risk factor for mortality in patients with
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Tsung-Ta, Chiang, Tzu-Wen, Huang, Jun-Ren, Sun, Shu-Chen, Kuo, Aristine, Cheng, Chang-Pan, Liu, Yuag-Meng, Liu, Ya-Sung, Yang, Te-Li, Chen, Yi-Tzu, Lee, and Yung-Chih, Wang
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Acinetobacter baumannii ,Heart Failure ,Carbapenems ,Risk Factors ,Biofilms ,Humans ,Bacteremia ,Microbial Sensitivity Tests ,Acinetobacter Infections ,Anti-Bacterial Agents ,Retrospective Studies - Abstract
In the past decades, due to the high prevalence of the antibiotic-resistant isolates of
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- 2022
9. In vitro and in vivo efficacy of minocycline-based therapy for Elizabethkingia anophelis and the impact of reduced minocycline susceptibility
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Ya-Sung Yang, Tzu-Wen Huang, Ying-Chi Huang, Wei-Cheng Huang, Shu-Yuan Hsu, Han-Chieh Wu, Feng-Jui Chen, Hung-Sheng Shang, Huey-Kang Sytwu, and Shu-Chen Kuo
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Microbiology (medical) ,Mice ,Infectious Diseases ,Animals ,Pharmacology (medical) ,Minocycline ,General Medicine ,Microbial Sensitivity Tests ,Flavobacteriaceae ,Anti-Bacterial Agents - Abstract
Elizabethkingia anophelis is inherently resistant to multiple antibiotics, except minocycline. This study aimed to determine the in vitro and in vivo efficacy of minocycline monotherapy and combination therapy against susceptible strains and the impact of reduced minocycline susceptibility.Three clinical isolates and one laboratory-induced mutant with reduced minocycline susceptibility were included. Time-kill and checkerboard assays were used to assess in vitro efficacy and synergy, respectively. Galleria mellonella infection and mouse pneumonia models were used to assess in vivo efficacy, and a mouse thigh infection model was used to determine the bacterial load.Minocycline monotherapy exerted a modest inhibitory effect on three clinical minocycline-susceptible E. anophelis isolates in vitro, but delayed G. mellonella death and improved infected mouse survival; it also significantly reduced the in vivo bacterial load. Minocycline had decreased efficacy on G. mellonella and mice infected by the mutant with reduced minocycline susceptibility. Genome comparison revealed several spontaneous mutations associated with reduced minocycline susceptibility. Among eight antibiotics tested in combination with minocycline, rifampin consistently showed in vitro synergy. The addition of rifampin (1 mg/L) reduced the mutant prevention concentration of minocycline from 2-4 mg/L to0.5 mg/L. However, compared with monotherapy, the combination of rifampin and minocycline did not further reduce the bacterial load or improve the survival of G. mellonella or mice.Minocycline monotherapy was in vivo effective against susceptible E. anophelis. Reduced minocycline susceptibility due to spontaneous mutation decreased its therapeutic efficacy. In combination with rifampin, it prevented the in vitro emergence of reduced susceptibility but did not provide additional in vivo survival benefit.
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- 2022
10. Mobile resistomes of human pathogens in swine wastewater treatment plants
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Shu-Man Shih, Feng-Jui Chen, Shu-Chen Kuo, Hung-Wei Cheng, Hung-Chih Kuo, and Yu-Chieh Liao
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Microbiology (medical) ,General Immunology and Microbiology ,Bacteria ,business.industry ,Swine ,Human pathogen ,General Medicine ,Biology ,Mobile element ,Microbiology ,Resistome ,QR1-502 ,Biotechnology ,Water Purification ,Interspersed Repetitive Sequences ,Infectious Diseases ,Swine wastewater ,Wastewater treatment plants ,Immunology and Allergy ,Animals ,Humans ,Human pathogens ,business - Published
- 2021
11. Susceptibility of Elizabethkingia spp. to commonly tested and novel antibiotics and concordance between broth microdilution and automated testing methods
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Hui-Ying Wang, Wei-Cheng Huang, Yih-Ru Shiau, Mei-Chen Tan, Yu-Chieh Liao, Tsai-Ling Lauderdale, Shu-Chen Kuo, Feng-Jui Chen, and Han Chieh Wu
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Microbiology (medical) ,Imipenem ,food.ingredient ,Elizabethkingia ,Taiwan ,Elizabethkingia miricola ,Microbial Sensitivity Tests ,medicine.disease_cause ,Tazobactam ,Microbiology ,food ,Flavobacteriaceae Infections ,RNA, Ribosomal, 16S ,medicine ,Humans ,Pharmacology (medical) ,Elizabethkingia meningoseptica ,Aged ,Original Research ,Pharmacology ,biology ,business.industry ,Broth microdilution ,biology.organism_classification ,Trimethoprim ,Anti-Bacterial Agents ,Infectious Diseases ,Elizabethkingia anophelis ,business ,Flavobacteriaceae ,medicine.drug - Abstract
Objectives We aimed to determine susceptibilities of Elizabethkingia spp. to 25 commonly tested and 8 novel antibiotics, and to compare the performance of different susceptibility testing methods. Methods Clinical isolates of Elizabethkingia spp., Chryseobacterium spp. and Flavobacterium spp. collected during 2002–18 (n = 210) in a nationwide surveillance programme in Taiwan were speciated by 16S rRNA sequencing. MICs were determined by broth microdilution. The broth microdilution results of 18 common antibiotics were compared with those obtained by the VITEK 2 automated system. Results Among the Elizabethkingia spp. identified (n = 108), Elizabethkingia anophelis was the most prevalent (n = 90), followed by Elizabethkingia meningoseptica (n = 7) and Elizabethkingia miricola cluster [E. miricola (n = 6), Elizabethkingia bruuniana (n = 3) and Elizabethkingia ursingii (n = 2)]. Most isolates were recovered from respiratory or blood specimens from hospitalized, elderly patients. PFGE showed two major and several minor E. anophelis clones. All isolates were resistant to nearly all the tested β-lactams. Doxycycline, minocycline and trimethoprim/sulfamethoxazole inhibited >90% of Elizabethkingia spp. Rifampin inhibited E. meningoseptica (100%) and E. anophelis (81.1%). Fluoroquinolones and tigecycline were active against E. meningoseptica and E. miricola cluster isolates. Novel antibiotics, including imipenem/relebactam, meropenem/vaborbactam, ceftazidime/avibactam, cefepime/zidebactam, delafloxacin, eravacycline and omadacycline were ineffective but lascufloxacin inhibited half of Elizabethkingia spp. The very major discrepancy rates of VITEK 2 were >1.5% for ciprofloxacin, moxifloxacin and vancomycin. Major discrepancy rates were >3% for amikacin, tigecycline, piperacillin/tazobactam and trimethoprim/sulfamethoxazole. Conclusions MDR, absence of standard interpretation criteria and poor intermethod concordance necessitate working guidelines to facilitate future research of emerging Elizabethkingia spp.
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- 2020
12. Clinical and molecular characterization of Acinetobacter seifertii in Taiwan
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Li-Hua Li, Jun-Ren Sun, Wei-Cheng Huang, Shu-Chen Kuo, Ya-Sung Yang, Yung-Chih Wang, Feng-Jui Chen, Tzu-Wen Huang, Yi-Tzu Lee, Te-Li Chen, and Ting-Hao Kuo
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Acinetobacter baumannii ,Adult ,Microbiology (medical) ,Carbapenem ,Taiwan ,Microbial Sensitivity Tests ,Acinetobacter seifertii ,medicine.disease_cause ,beta-Lactamases ,Microbiology ,Levofloxacin ,polycyclic compounds ,Humans ,Medicine ,Pharmacology (medical) ,Retrospective Studies ,Pharmacology ,Acinetobacter ,biology ,business.industry ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,rpoB ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,Colistin ,bacteria ,Multilocus sequence typing ,business ,Acinetobacter Infections ,Multilocus Sequence Typing ,medicine.drug ,Acinetobacter nosocomialis - Abstract
Objectives Acinetobacter seifertii, a new member of the Acinetobacter baumannii group, has emerged as a cause of severe infections in humans. We investigated the clinical and molecular characteristics of A. seifertii. Patients and methods This retrospective study enrolled 80 adults with A. seifertii bloodstream infection (BSI) at four medical centres over an 8 year period. Species identification was confirmed by MALDI-TOF MS, rpoB sequencing and WGS. Molecular typing was performed by MLST. Clinical information, antimicrobial susceptibility and the mechanisms of carbapenem and colistin resistance were analysed. Transmissibility of the carbapenem-resistance determinants was examined by conjugation experiments. Results The main source of A. seifertii BSI was the respiratory tract (46.3%). The 28 day and in-hospital mortality rates of A. seifertii BSI were 18.8% and 30.0%, respectively. High APACHE II scores and immunosuppressant therapy were independent risk factors for 28 day mortality. The most common MLST type was ST553 (58.8%). Most A. seifertii isolates were susceptible to levofloxacin (86.2%), and only 37.5% were susceptible to colistin. Carbapenem resistance was observed in 16.3% of isolates, mostly caused by the plasmid-borne ISAba1-blaOXA-51-like genetic structure. A. seifertii could transfer various carbapenem-resistance determinants to A. baumannii, Acinetobacter nosocomialis and other A. seifertii isolates. Variations of pmrCAB and lpxCAD genes were not associated with colistin resistance of A. seifertii. Conclusions Levofloxacin and carbapenems, but not colistin, have the potential to be the drug of choice for A. seifertii infections. A. seifertii can transfer carbapenem-resistance determinants to other species of the A. baumannii group and warrants close monitoring.
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- 2020
13. Influence of severity of infection on the effect of appropriate antimicrobial therapy for Acinetobacter baumannii bacteremic pneumonia
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Chorng-Kuang How, Ya-Sung Yang, Aristine Cheng, Te-Li Chen, Yung-Chih Wang, Chang-Pan Liu, Shu-Chen Kuo, Yuag-Meng Liu, Yi-Tzu Lee, and Fang-Yu Kang
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Microbiology (medical) ,Male ,Acinetobacter baumannii ,medicine.medical_specialty ,Bacteremia ,Drug resistance ,Severity of Illness Index ,Severity ,lcsh:Infectious and parasitic diseases ,Internal medicine ,Medicine ,Humans ,Pharmacology (medical) ,lcsh:RC109-216 ,Mortality ,Aged ,APACHE II ,biology ,Appropriate antimicrobial therapy ,business.industry ,Mortality rate ,Research ,Public Health, Environmental and Occupational Health ,Odds ratio ,Pneumonia ,Antimicrobial ,medicine.disease ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,Logistic Models ,Multivariate Analysis ,Female ,business ,Acinetobacter Infections - Abstract
Background The impact of appropriate antimicrobial therapy for A. baumannii bacteremic pneumonia has not been well established due to the inclusion of the three phenotypically indistinguishable Acinetobacter species and confounding factors including underlying diseases and severity of infection. This retrospective study aimed to evaluate the impact of appropriate antimicrobial therapy on 14-day mortality in A. baumannii bacteremic pneumonia patients after adjusting for risk factors. Methods This study was conducted at five medical centers in Taiwan between July 2012 and June 2016. A. baumannii species identification was performed using reference molecular methods. Risk factors for 14-day mortality were analyzed via logistic regression. The interaction between the Acute Physiology and Chronic Health Evaluation (APACHE) II score and appropriate antimicrobial therapy was assessed using the logistic model. Results A total of 336 patients with monomicrobial A. baumannii bacteremic pneumonia were included in this study. The overall 14-day mortality rate was 47.3%. The crude mortality of appropriate antimicrobial therapy was 35.9% (57 of 151 patients). Appropriate antimicrobial therapy was associated with a lower mortality after multivariate adjustment (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.34–0.97; p = 0.04), and the effect was influenced by APACHE II score (OR for interaction term, 0.0098; 95% CI, 0.0005–0.1885; p = 0.002). Further analysis demonstrated that appropriate antimicrobial therapy significantly reduced 14-day mortality among the patients with an APACHE II score > 35 (OR 0.0098; 95% CI 0.0005–0.1885). Conclusion Appropriate antimicrobial therapy decreases 14-day mortality of the most severely ill patients with A. baumannii bacteremic pneumonia.
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- 2020
14. Bacterial membrane vesicles from Acinetobacter baumannii induced by ceftazidime are more virulent than those induced by imipenem
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Yu-Han Liu, Ya-Sung Yang, Yi-Tzu Lee, Shu-Chen Kuo, Yung-Chih Wang, Chun-Hsiang Chiu, Feng-Yee Chang, Jung-Chung Lin, Te-Li Chen, and Yu-Chun Lin
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Microbiology (medical) ,Carbapenem ,Imipenem ,Lipopolysaccharide ,medicine.drug_class ,Immunology ,Cephalosporin ,Ceftazidime ,Virulence ,Infectious and parasitic diseases ,RC109-216 ,Microbiology ,Minimum inhibitory concentration ,chemistry.chemical_compound ,polycyclic compounds ,medicine ,ceftazidime ,biology ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Acinetobacter baumannii ,virulence ,Infectious Diseases ,chemistry ,Parasitology ,acinetobacter baumannii ,bacterial membrane vesicles ,imipenem ,medicine.drug - Abstract
Patients with Acinetobacter baumannii bacteremia treated with antipseudomonal cephalosporins showed higher 14-day mortality than patients treated with antipseudomonal carbapenems. We hypothesized that the bacterial membrane vesicles (BMVs) induced by antipseudomonal cephalosporins are more virulent than BMVs induced by antipseudomonal carbapenems. To simulate the clinical condition with inadequate antimicrobial treatment, carbapenem-resistant A. baumannii was treated with ceftazidime (an antipseudomonal cephalosporin) or imipenem (an antipseudomonal carbapenem) at 1/2 the minimum inhibitory concentration. BMVs and BMV-carried lipopolysaccharide were measured by nanoparticle tracking analysis and western blotting, respectively. Cytokine expression in RAW264.7 macrophages or mice serum induced by the BMVs was determined by ELISA, fluorescent bead-based immunoassay or western blotting. The virulence of the BMVs was assessed in mice. Liquid chromatography tandem-mass spectrometry was used to determine the protein contents of the BMVs. We found that ceftazidime induced a higher number of BMVs (CAZ-BMV), which carried more LPS, and induced higher expression levels of iNOS, IL-1β, and IL-6 in macrophages, higher expression of many cytokines in mice, more neutrophil infiltration in lung interstitium, and higher mortality in mice than imipenem-induced BMVs (IMP-BMV). When adjusted to same amount of LPS, CAZ-BMV still led to higher mortality than IMP-BMV. Proteomic analysis revealed different protein contents in CAZ-BMV and IMP-BMV. In conclusion, A. baumannii BMVs induced by ceftazidime are more virulent than BMVs induced by imipenem.
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- 2020
15. Policy-driven revolution of prescription record in outpatient use of fluoroquinolones
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Shang-Chwen Chang, Shu-Man Shih, Yee-Chun Chen, Tsai-Ling Lauderdale, Shu-Chen Kuo, I-Shou Chang, and Chao A. Hsiung
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0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,030106 microbiology ,Population ,Taiwan ,lcsh:QR1-502 ,Drug Prescriptions ,lcsh:Microbiology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Outpatients ,Immunology and Allergy ,Medicine ,Humans ,030212 general & internal medicine ,Medical prescription ,Formulary ,Practice Patterns, Physicians' ,education ,Sinusitis ,Respiratory Tract Infections ,Aged ,education.field_of_study ,General Immunology and Microbiology ,business.industry ,Prescription record ,Differential regulation ,General Medicine ,Middle Aged ,medicine.disease ,Anti-Bacterial Agents ,Infectious Diseases ,National health insurance ,Health Care Surveys ,Emergency medicine ,Etiology ,Female ,business ,Fluoroquinolones - Abstract
Objective: A policy initiated in 2001 by Taiwan's National Health Insurance (NHI) Administration has effectively reduced outpatient antibiotic use except fluoroquinolones (FQs). The influence of differential regulation policy of narrow-spectrum versus broad-spectrum FQs on the prescriptions is unknown. Methods: This study analyzed the claim records of oral FQs prescription at outpatient visits during 2000–2010 using the NHI Research Database and compared prescriptions for narrow-spectrum FQs, which are inactive against Streptococcus pneumoniae and lack formulary restriction, with those for broad-spectrum FQs. Results: Oral antibiotics were prescribed in 13.3% of visits and FQs accounted for 2.2% of them. During the study period the population-based rates of FQ prescription visits to children decreased, which was offset by increased use in the adult and geriatric populations (all p
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- 2020
16. A multicenter study on clinical characteristics of Acinetobacter bacteremia in patients with liver cirrhosis
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Chang-Pan Liu, Tsung-Ta Chiang, Yuag-Meng Liu, Shu-Chen Kuo, Ya-Sung Yang, Yi-Tzu Lee, Te-Li Chen, Shou-Chuan Shih, and YeaYuan Chang
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0301 basic medicine ,Microbiology (medical) ,Acinetobacter baumannii ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Cirrhosis ,030106 microbiology ,Taiwan ,lcsh:QR1-502 ,Bacteremia ,Logistic regression ,lcsh:Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,In patient ,030212 general & internal medicine ,Hospital Mortality ,APACHE ,Aged ,Retrospective Studies ,Aged, 80 and over ,General Immunology and Microbiology ,APACHE II ,biology ,business.industry ,Mortality rate ,General Medicine ,Acinetobacter ,Middle Aged ,medicine.disease ,biology.organism_classification ,Infectious Diseases ,Multicenter study ,Female ,business ,Acinetobacter Infections - Abstract
Background: Clinical characteristics and risk factors for mortality of Acinetobacter bacteremia in cirrhotic patients have not been investigated. Methods: Acinetobacter bacteremia cases from four medical centers were collected from 2009 to 2014, to compare between patients with and without liver cirrhosis. Risk factors for mortality of Acinetobacter bacteremia among cirrhotic patients were identified using multivariate logistic regression. Results: Among the patients with Acinetobacter bacteremia, 72 had liver cirrhosis and 816 had not. Patients with cirrhosis were younger (57.5 [50–71] vs. 72 [50.25–71], p
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- 2019
17. Contribution of Testing Strategies and Contact Tracing towards COVID-19 Outbreaks Control: A Mathematical Modeling Study
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Shu-Chen Kuo, Byron Fan, Hongye Zhu, Meng-Hsuan Wu, Fang-Jing Lee, Yu-Chieh Cheng, Hsiao-Yu Wu, Ya-Ting Hsu, Chao A. Hsiung, Shiow-Ing Wu, Wei J. Chen, Hung-Yi Chiou, Huey-Kang Sytwu, and Hsiao-Hui Tsou
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Infectious Diseases ,General Immunology and Microbiology ,Public Health, Environmental and Occupational Health ,COVID-19 ,SARS-CoV-2 ,universal testing ,contact tracing ,symptomatic screening - Abstract
This modeling study considers different screening strategies, contact tracing, and the severity of novel epidemic outbreaks for various population sizes, providing insight into multinational containment effectiveness of emerging infectious diseases, prior to vaccines development. During the period of the ancestral SARS-Cov-2 virus, contact tracing alone is insufficient to achieve outbreak control. Although universal testing is proposed in multiple nations, its effectiveness accompanied by other measures is rarely examined. Our research investigates the necessity of universal testing when contact tracing and symptomatic screening measures are implemented. We used a stochastic transmission model to simulate COVID-19 transmission, evaluating containment strategies via contact tracing, one-time high risk symptomatic testing, and universal testing. Despite universal testing having the potential to identify subclinical cases, which is crucial for non-pharmaceutical interventions, our model suggests that universal testing only reduces the total number of cases by 0.0009% for countries with low COVID-19 prevalence and 0.025% for countries with high COVID-19 prevalence when rigorous contact tracing and symptomatic screening are also implemented. These findings highlight the effectiveness of testing strategies and contact tracing in reducing COVID-19 cases by identifying subclinical cases.
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- 2022
18. The effects of maternal body weight and gestational diabetes mellitus on the risk of the delivery of large-for-gestational age babies: Synergistic or additive?
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Shu-Chen, Kuo, Wen-Ling, Lee, and Peng-Hui, Wang
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Diabetes, Gestational ,Pregnancy ,Body Weight ,Birth Weight ,Humans ,Obstetrics and Gynecology ,Female ,Gestational Age ,Weight Gain ,Body Mass Index - Published
- 2022
19. Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020
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Wei J. Chen, Ya Ting Hsu, Hsiao Yu Wu, Hsiao-Hui Tsou, Shu Man Shih, Shu-Chen Kuo, Fang Jing Lee, and Chao A. Hsiung
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Microbiology (medical) ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Adolescent ,Epidemiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,viruses ,030231 tropical medicine ,Taiwan ,lcsh:Medicine ,Disease ,medicine.disease_cause ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,respiratory infections ,0302 clinical medicine ,nonpharmaceutical ,Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020 ,Pandemic ,Research Letter ,Enterovirus Infections ,Medicine ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,Child ,interventions ,Coronavirus ,Enterovirus ,nonpolio enterovirus ,business.industry ,SARS-CoV-2 ,lcsh:R ,virus diseases ,COVID-19 ,Infant ,Virology ,zoonoses ,Infectious Diseases ,coronavirus disease ,Child, Preschool ,preventable fraction ,business ,Coronavirus Infections ,severe acute respiratory syndrome coronavirus 2 - Abstract
In Taiwan, lower nonpolio enterovirus activity during the coronavirus disease pandemic in 2020 compared with 2014–2019 might be attributable to adherence to nonpharmaceutical interventions. The preventable fraction among unexposed persons indicated that 90% of nonpolio enterovirus activity might have been prevented during 2014–2019 by adopting the same measures enforced in 2020.
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- 2021
20. Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study
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Pei-Hsuan Lee, Jia-Hwa Yang, Yin-Chen Chen, Shu-Chen Kuo, Peng-Hui Wang, Senyeong Kao, Shu Fen Chen, and Huei-Jhen Sia
- Subjects
medicine.medical_specialty ,Foley ,business.industry ,medicine.medical_treatment ,Urinary system ,Foley catheter ,Urinary Catheters ,Surgery ,Catheters, Indwelling ,Gynecologic Surgical Procedures ,Quasi experimental study ,Urinary Tract Infections ,medicine ,Humans ,Female ,business ,Adverse effect ,Urinary Catheterization ,Urinary catheter ,General Nursing ,Gynecological surgery ,Device Removal - Abstract
Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery ( n = 38) or standard catheter removal, within 12 to 24 hours of surgery ( n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.
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- 2021
21. [Legal Liability for Negligence: Nurse Aides Working in Hospitals]
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Shu-Chen, Kuo and Huey-Jen, Lay
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Nursing Assistants ,Malpractice ,Humans ,Liability, Legal ,Hospitals - Abstract
Nurse aides are the most important direct-care providers and are indispensable in caring for hospitalized patients. Most of the hospitalized patients who need care in their daily lives hire nurse aides as regular caregivers. Care work involves numerous risks, and negligent care that results in patient injury may put a nurse aid caregiver at risk of litigation. To help nurse aides better understand their care duties, the concept of risk and prevention in care and three civil lawsuit cases involving negligence in care are presented in this paper. In the legal cases, the nurse aides were found guilty of causing death or injury due to negligence, highlighting that these caregivers did not meet their duty of care in providing care to their patients. These cases are used to analyze the causes of care negligence and the types of negligence and to propose preventive strategies for hospitals, care providers, and nurse aides to implement preventive measures and enforce self-autonomy. In addition, regular government programs focused on inspection, supervision, and accreditation can strengthen the supervision and responsibilities of hospitals. Nurse aides are expected to fulfill their care duties and develop ethical norms as well as internalize these into their personal beliefs as the framework for providing care. It is hoped that nurse aides will understand and fulfill their care duties to prevent patient injury or death due to negligence as part of their duty to protect patient rights.醫院照顧服務員照顧過失之法律責任.照顧服務員(照服員)是最重要的直接照顧人力,亦是不可或缺的照顧人力,住院病人須日常生活照顧者,大都聘請照服員協助照顧,照顧工作有一定的風險存在,一旦照顧疏失造成病人傷害,甚至危及生命,就可能出現法律訴訟風險。為協助照服員了解照顧上之注意義務,本文淺介照顧風險與預防概念,並分析三例因照顧疏失之民事訴訟,說明照服員於照顧病人過程欠缺注意義務。藉由案例分析照顧疏忽原因、過失樣態,針對醫院、照顧管理公司及照服員提出預防策略,以落實事前預防管理,與實踐自律。再者,藉由政府部門外部他律機制(例如查核、督導、評鑑),強化醫院監督責任、健全管理公司的制度、照服員善盡照顧責任與道德倫理規範的養成,並內化為個人信念,作為照顧信條和行為準則,希冀照服員掌握及克盡照顧上之注意義務,避免因過失而致人於死或傷害之憾事發生,以保障病人之權益。.
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- 2021
22. Pregnant women with COVID-19
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Wen-Ling, Lee, Shu-Chen, Kuo, and Peng-Hui, Wang
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Pregnancy ,COVID-19 ,Humans ,Obstetrics and Gynecology ,Female ,Pregnant Women - Published
- 2022
23. Antimicrobial Resistance Mechanisms and Virulence of Colistin- and Carbapenem-Resistant Acinetobacter baumannii Isolated from a Teaching Hospital in Taiwan
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I-Hui Lee, Tzu-Wen Huang, Yuarn-Jang Lee, Noor Andryan Ilsan, and Shu-Chen Kuo
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0301 basic medicine ,Microbiology (medical) ,medicine.drug_class ,phosphoethanolamine transferase ,QH301-705.5 ,030106 microbiology ,Antibiotics ,Virulence ,Microbiology ,Article ,biofilm ,03 medical and health sciences ,Antibiotic resistance ,Virology ,medicine ,polycyclic compounds ,Galleria mellonella ,heteroresistance ,Biology (General) ,biology ,lipopolysaccharide ,Biofilm ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,nosocomial pathogen ,Acinetobacter baumannii ,030104 developmental biology ,whole-genome sequencing ,two-component system ,Colistin ,bacteria ,lipids (amino acids, peptides, and proteins) ,Bacteria ,medicine.drug - Abstract
Acinetobacter baumannii, a Gram-negative bacterium, is an important nosocomial pathogen. Colistin-resistant A. baumannii is becoming a new concern, since colistin is one of the last-line antibiotics for infections by carbapenem-resistant A. baumannii. From 452 carbapenem-resistant isolates collected in a teaching hospital in Taipei, Taiwan, we identified seven that were resistant to colistin. Carbapenem resistance in these isolates is attributed to the presence of carbapenemase gene blaOXA-23 in their genomes. Colistin resistance is presumably conferred by mutations in the sensor kinase domain of PmrB found in these isolates, which are known to result in modification of colistin target lipid A via the PmrB–PmrA–PmrC signal transduction pathway. Overexpression of pmrC, eptA, and naxD was observed in all seven isolates. Colistin resistance mediated by pmrB mutations has never been reported in Taiwan. One of the seven isolates contained three mutations in lpxD and exhibited an altered lipopolysaccharide profile, which may contribute to its colistin resistance. No significant difference in growth rates was observed between the isolates and the reference strain, suggesting no fitness cost of colistin resistance. Biofilm formation abilities of the isolates were lower than that of the reference. Interestingly, one of the isolates was heteroresistant to colistin. Four of the isolates were significantly more virulent to wax moth larvae than the reference.
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- 2021
24. Collateral Benefit of COVID-19 Control Measures on Influenza Activity, Taiwan
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Chao A. Hsiung, Shu-Chen Kuo, Li Hsin Chien, and Shu Man Shih
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Office Visits ,Epidemiology ,lcsh:Medicine ,Disease ,medicine.disease_cause ,Disease Outbreaks ,COVID-19 Testing ,Hygiene ,Outpatients ,Pandemic ,Influenza A virus ,Infection control ,Coronavirus ,media_common ,Coinfection ,Incidence ,Incidence (epidemiology) ,Masks ,Infectious Diseases ,coronavirus disease ,Quarantine ,influenza ,Coronavirus Infections ,severe acute respiratory syndrome coronavirus 2 ,Microbiology (medical) ,medicine.medical_specialty ,media_common.quotation_subject ,Physical Distancing ,Pneumonia, Viral ,Taiwan ,lcsh:Infectious and parasitic diseases ,Betacoronavirus ,respiratory infections ,Internal medicine ,Influenza, Human ,Research Letter ,medicine ,Humans ,viruses ,lcsh:RC109-216 ,Pandemics ,Clinical Laboratory Techniques ,SARS-CoV-2 ,business.industry ,lcsh:R ,COVID-19 ,medicine.disease ,zoonoses ,Influenza B virus ,Communicable Disease Control ,infection control measures ,business ,Collateral Benefit of COVID-19 Control Measures on Influenza Activity, Taiwan - Abstract
Taiwan has strictly followed infection control measures to prevent spread of coronavirus disease. Meanwhile, nationwide surveillance data revealed drastic decreases in influenza diagnoses in outpatient departments, positivity rates of clinical specimens, and confirmed severe cases during the first 12 weeks of 2020 compared with the same period of 2019.
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- 2020
25. Discrimination of Methicillin-resistant Staphylococcus aureus by MALDI-TOF Mass Spectrometry with Machine Learning Techniques in Patients with Staphylococcus aureus Bacteremia
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Po-Hsin Kong, Cheng-Hsiung Chiang, Ting-Chia Lin, Shu-Chen Kuo, Chien-Feng Li, Chao A. Hsiung, Yow-Ling Shiue, Hung-Yi Chiou, Li-Ching Wu, and Hsiao-Hui Tsou
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Microbiology (medical) ,Infectious Diseases ,General Immunology and Microbiology ,Immunology and Allergy ,methicillin-resistant Staphylococcus aureus ,Staphylococcus aureus bacteremia ,antimicrobial susceptibility testing ,MALDI-TOF MS ,machine learning ,binning method ,Molecular Biology - Abstract
Early administration of proper antibiotics is considered to improve the clinical outcomes of Staphylococcus aureus bacteremia (SAB), but routine clinical antimicrobial susceptibility testing takes an additional 24 h after species identification. Recent studies elucidated matrix-assisted laser desorption/ionization time-of-flight mass spectra to discriminate methicillin-resistant strains (MRSA) or even incorporated with machine learning (ML) techniques. However, no universally applicable mass peaks were revealed, which means that the discrimination model might need to be established or calibrated by local strains’ data. Here, a clinically feasible workflow was provided. We collected mass spectra from SAB patients over an 8-month duration and preprocessed by binning with reference peaks. Machine learning models were trained and tested by samples independently of the first six months and the following two months, respectively. The ML models were optimized by genetic algorithm (GA). The accuracy, sensitivity, specificity, and AUC of the independent testing of the best model, i.e., SVM, under the optimal parameters were 87%, 75%, 95%, and 87%, respectively. In summary, almost all resistant results were truly resistant, implying that physicians might escalate antibiotics for MRSA 24 h earlier. This report presents an attainable method for clinical laboratories to build an MRSA model and boost the performance using their local data.
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- 2022
26. Effectiveness of coffee for postoperative ileus in patients following abdominal surgery: a systematic review protocol
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Li Yin Chang, Mei Yin Lee, Shin Shang Chou, Marianne Curia, Pei Fan Mu, Shu Chen Kuo, Chiung Fen Shih, and Jui Yuan Su
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Research design ,medicine.medical_specialty ,Time Factors ,Postoperative ileus ,MEDLINE ,Decaffeinated coffee ,Coffee ,Ileus ,Postoperative Complications ,Caffeine ,Abdomen ,medicine ,Humans ,In patient ,Postoperative Period ,Defecation ,Digestive System Surgical Procedures ,General Nursing ,business.industry ,General surgery ,General Medicine ,Length of Stay ,Research Design ,Gastrointestinal function ,business ,Systematic Reviews as Topic ,Abdominal surgery - Abstract
REVIEW QUESTION/OBJECTIVE The purpose of this systematic review is to critically appraise, synthesize and present the best available evidence concerning the effects of coffee on postoperative ileus following abdominal surgery. The review will consider the effect of coffee and decaffeinated coffee on recovering gastrointestinal function, time to first bowel movement, time to first flatus, time to tolerance of solid food, postoperative complications and length of hospital stay.
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- 2018
27. Community-acquired bloodstream infections caused by Acinetobacter baumannii: A matched case–control study
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Chung-Ting Chen, Yung-Chih Wang, Shu-Chen Kuo, Chorng-Kuang How, Fang-Huy Shih, Yi-Tzu Lee, Te-Li Chen, and Ya-Sung Yang
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Acinetobacter baumannii ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,lcsh:QR1-502 ,Taiwan ,Bacteremia ,lcsh:Microbiology ,Tertiary Care Centers ,03 medical and health sciences ,Risk Factors ,Cause of Death ,Drug Resistance, Multiple, Bacterial ,Internal medicine ,Humans ,Immunology and Allergy ,Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Cross Infection ,General Immunology and Microbiology ,APACHE II ,biology ,business.industry ,Case-control study ,General Medicine ,Odds ratio ,Middle Aged ,biology.organism_classification ,medicine.disease ,Confidence interval ,Anti-Bacterial Agents ,Community-Acquired Infections ,Multiple drug resistance ,Treatment Outcome ,Infectious Diseases ,Case-Control Studies ,Cohort ,Female ,business ,Acinetobacter Infections - Abstract
Background: Acinetobacter baumannii is an important nosocomial pathogen worldwide. Its role in community-acquired infection remains controversial and has rarely been reported. Methods: Patients with monobacterial bloodstream infections caused by genomic species identified A. baumannii, admitted to Taipei Veterans General Hospital between 1999 and 2010, were selected as cases. Controls were defined as patients acquiring infection in a healthcare setting and were matched for age and sex. The clinical, epidemiologic, and microbiological characteristics of cases and controls were compared. Results: Cases presented with shock more frequently and had higher APACHE II scores (25 vs 19, p = 0.005). No significant differences between the two groups were noted in the sources of bloodstream infection and underlying diseases. Multidrug resistance rates were higher in nosocomial A. baumannii isolates then in those acquired in the community (81.5% vs 38.9%, p = 0.002). Patients infected in the community were more likely to receive appropriate antimicrobial therapy than those with hospital-acquired A. baumannii (10/18; 55.6% vs 11/54; 20.4%, p = 0.011). Acquisition in the community (odds ratio [OR] 5.716, 95% confidence interval [CI] 1.021–32.003, p = 0.047), respiratory tract as the infection source (OR 9.514, 95% CI 2.370–38.189, p = 0.001), and immunosuppressive therapy (OR 4.331, 95% CI 1.052–17.832, p = 0.042) were independently associated with increased 14-day mortality among patients with A. baumannii bacteremia in this cohort. Conclusion: Community-acquired bacteremia caused by A. baumannii was rare but associated with a severe outcome. Further investigation of potential virulence factors of community-acquired A. baumannii is required. Keywords: Acinetobacter baumannii, Community-acquired infection, Healthcare-associated infection, Bloodstream infection
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- 2018
28. Visiting in disguise: Analysis of inpatient companions in the time of COVID-19
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Jun-Jeng Fen, Kuan-Jui Tseng, Shu-Chen Kuo, Shih-Hsin Hung, Jin-Lain Ming, and Ying-Chou Sun
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Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,MEDLINE ,Taiwan ,030204 cardiovascular system & hematology ,Disease cluster ,Differential analysis ,03 medical and health sciences ,Interpersonal relationship ,0302 clinical medicine ,medicine ,Humans ,Statistical software ,Inpatients ,business.industry ,SARS-CoV-2 ,Microsoft excel ,COVID-19 ,Visitors to Patients ,General Medicine ,Spouse ,030220 oncology & carcinogenesis ,Family medicine ,Female ,business - Abstract
Background As outbreak of COVID-19 infection, on April 3, 2020, it is stipulated that the number of inpatient companions is limited to one in Taiwan. All companions are required to register their real personal data with 14 days of travel history, occupation, contact history, and cluster history. We would like to evaluate the impact of the new regulations to the accompanying and visiting culture in Taiwan, via analyzing the appearance and characteristics of inpatient companions in this period. Methods Using intelligent technology, we designed a novel system in managing the inpatient companions (InPatients Companions Management System [IPCMS]), and the IPCMS was used to collect data about characteristics of inpatients and companions between April 27 and May 3, 2020. The database is built using MySQL software. Microsoft Excel 2016 and SPSS version 20.0 statistical software were used for data analysis, including the basic data of the companions, differential analysis of companions' gender, person-days and cumulative time, differential analysis of accompaniment-patient relationship, and frequency of accompaniment and cumulative hours. Results During study period, daily inpatient admissions ranged from 2242 to 2514, the number of companions per day ranged from 2048 to 2293, and the number of companions for one inpatient is 1 to 9 per day, with an average of 1.20 to 1.26. The companions were mostly family members, and most of them were the inpatients' children (32.9%), and spouse (26.13%). More females than males were noted in all categories of companionship with statistical significance. Conclusion The data obtained in this study could be an important basis for the transformation and reform of the companions culture in Taiwan's hospitals and will also provide a glimpse into the attitudes and culture of companions who have long been ignorant and neglected. The experience gained in our IPCMS could also serve as a reference for other hospitals in Taiwan and worldwide.
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- 2020
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29. The prediction values of carbapenemase detection methods and carbapenem susceptibility testing for clinical outcomes of patients with Acinetobacter bacteremia under carbapenem treatment
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Chang-Pan Liu, Fu-Der Wang, Ya-Sung Yang, Yuag-Meng Liu, I-Fan Liu, Te-Li Chen, Yi-Tzu Lee, Tzu-Wen Huang, Pei-Ying Lin, Shu-Chen Kuo, and Yung-Chih Wang
- Subjects
0301 basic medicine ,Microbiology (medical) ,Susceptibility testing ,Carbapenem ,Imipenem ,medicine.medical_specialty ,030106 microbiology ,Bacteremia ,Microbial Sensitivity Tests ,beta-Lactamases ,03 medical and health sciences ,0302 clinical medicine ,Bacterial Proteins ,Internal medicine ,medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Agar diffusion test ,Retrospective Studies ,General Immunology and Microbiology ,biology ,Acinetobacter ,business.industry ,Retrospective cohort study ,General Medicine ,bacterial infections and mycoses ,biology.organism_classification ,medicine.disease ,Enterobacteriaceae ,Anti-Bacterial Agents ,Infectious Diseases ,Carbapenems ,business ,medicine.drug - Abstract
Background Carbapenem-resistant Acinetobacter species have emerged as notorious pathogens causing nosocomial infections. Several phenotypic methods have been developed for detecting carbapenemase production in Enterobacteriaceae. The accuracy of these methods in the prediction of carbapenemase production in Acinetobacter species has not been studied well. Methods This retrospective study enrolled adult patients with Acinetobacter bacteremia from four medical centers in Taiwan between 2012 and 2016. Their demographics and clinical outcomes were recorded. The carbapenem susceptibility of the Acinetobacter species was determined using the agar diffusion method. The carbapenemase genes were detected by PCR. Four phenotypic methods, including the modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test, and CarbAcineto NP test were carried out to determine the production of carbapenemase. Results We analyzed 257 adults who received initial carbapenem monotherapy for the treatment of Acinetobacter bacteremia. Shock within three days of bacteremia and acquisition of carbapenem non-susceptible isolates were independently associated with a higher 14-day and 30-day mortality in patients with Acinetobacter bacteremia. Among the four phenotypic tests for carbapenemase detection, MHT using the imipenem disc displayed the greatest sensitivity (94%; 95% confidence interval [CI], 89–97%) and specificity (81%; 95% CI, 73–88%) for predicting imipenem non-susceptibility. Conclusion Carbapenem non-susceptibility and shock were independent risk factors for mortality in patients with Acinetobacter bacteremia. The MHT could predict the carbapenem susceptibility of Acinetobacter isolates. It is a cheap and quick assay, which could be applied in clinical practice.
- Published
- 2020
30. Evaluation of an Oral Hygiene Education Program for Staff Providing Long-Term Care Services: A Mixed Methods Study
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Yueh-Juen Hwu, Shu-Chen Kuo, Chun-Chieh Wang, Shang-Jung Wu, and Shwn-Huey Shieh
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medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Health, Toxicology and Mutagenesis ,media_common.quotation_subject ,Teaching method ,Health Personnel ,lcsh:Medicine ,Qualitative property ,Oral hygiene ,Article ,03 medical and health sciences ,Presentation ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Dental Care ,media_common ,concurrent triangulation ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,oral hygiene ,030206 dentistry ,Long-term care ,Telephone interview ,Care workers ,Family medicine ,oral health ,long-term care ,business ,Care staff ,Program Evaluation - Abstract
Background: Oral hygiene is often neglected in clients receiving long-term care, suggesting that long-term care workers require formal oral hygiene education. Thus, the aim of this study was to investigate the effects of oral hygiene education on long-term care workers. Methods: This study utilized a mixed methods design. Eighty long-term care workers were recruited for participation in the oral hygiene education program, which employed three teaching methods: narration with multimedia presentation, demonstration, and teach-back. The effect of the education program on the participants&rsquo, level of oral hygiene knowledge, attitudes, and skills was measured using a structured questionnaire that was administered both pre- and post-delivery of the education program. Three months later, all participants submitted a self-report of their oral hygiene skills, and six participants completed a telephone interview. Quantitative data were analyzed using paired t-tests, and qualitative data were manually analyzed and coded. Results: Scores of oral hygiene knowledge (p <, 0.001), attitudes (p = 0.001), and oral cleaning daily frequency for clients (p <, 0.001), were significantly higher three months after undertaking the educational program. Conclusions: This preliminary study suggests that oral hygiene education may be effective in improving oral hygiene knowledge, attitudes, and skills among long-term care staff.
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- 2020
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31. In vitro and in vivo activities of imipenem combined with BLI-489 against class D β-lactamase-producing Acinetobacter baumannii
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Yi-Tzu Lee, I-Ming Lee, Ming-Hsien Chiang, Shu-Chen Kuo, Fu-Der Wang, Ya-Sung Yang, Chun-Hsiang Chiu, Shu-Wei Huang, Te-Li Chen, Ying-Shih Su, and Yung-Chih Wang
- Subjects
Microbiology (medical) ,Acinetobacter baumannii ,Imipenem ,Lactams ,Microbial Sensitivity Tests ,beta-Lactamases ,Microbiology ,In silico docking ,Mice ,Gentamicin protection assay ,Bacterial Proteins ,In vivo ,polycyclic compounds ,medicine ,Animals ,Pharmacology (medical) ,Caenorhabditis elegans ,Gene ,Pharmacology ,biology ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,In vitro ,Anti-Bacterial Agents ,Infectious Diseases ,medicine.drug - Abstract
Background According to our preliminary study, BLI-489 has the potential to inhibit the hydrolysing activity of OXA-51-like β-lactamase produced by carbapenem-resistant Acinetobacter baumannii (CRAb). Objectives In the present study, the in vitro and in vivo activities of imipenem combined with BLI-489 against CRAb producing carbapenem-hydrolysing class D β-lactamases (CHDLs), namely OXA-23, OXA-24, OXA-51 and OXA-58, were determined. Methods A chequerboard analysis of imipenem and BLI-489 was performed using 57 and 7 clinical CRAb isolates producing different CHDLs and MBLs, respectively. Four representative strains harbouring different CHDL genes were subjected to a time–kill assay to evaluate the synergistic effects. An in silico docking analysis was conducted to simulate the interactions between BLI-489 and the different families of CHDLs. The in vivo activities of this combination were assessed using a Caenorhabditis elegans survival assay and a mouse pneumonia model. Results Chequerboard analysis showed that imipenem and BLI-489 had a synergistic effect on 14.3, 92.9, 100, 16.7 and 100% of MBL-, OXA-23-, OXA-24-like-, OXA-51-like- and OXA-58-producing CRAb isolates, respectively. In the time–kill assay, imipenem and BLI-489 showed synergy against OXA-24-like-, OXA-51-like- and OXA-58-, but not OXA-23-producing CRAb isolates after 24 h. The in silico docking analysis showed that BLI-489 could bind to the active sites of OXA-24 and OXA-58 to confer strong inhibition activity. The combination of imipenem and BLI-489 exhibited synergistic effects for the rescue of CRAb-infected C. elegans and mice. Conclusions Imipenem combined with BLI-489 has synergistic effects against CHDL-producing CRAb isolates.
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- 2020
32. The effect of preventing subclinical transmission on the containment of COVID-19: Mathematical modeling and experience in Taiwan
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Shu-Man Shih, Fang-Jing Lee, Shiow-Ing Wu, Ya-Ting Hsu, Tzai-Hung Wen, Hsiao-Yu Wu, Hsiang-Yu Yuan, Hsiao-Hui Tsou, Yu-Chieh Cheng, Huey-Kang Sytwu, Shu-Chen Kuo, Wei J. Chen, and Chao A. Hsiung
- Subjects
medicine.medical_specialty ,Isolation (health care) ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,Taiwan ,High coverage ,Article ,law.invention ,Infectious Disease Incubation Period ,Patient Isolation ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,law ,Epidemiology ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Symptom onset ,Asymptomatic Infections ,Pandemics ,Subclinical infection ,030505 public health ,business.industry ,SARS-CoV-2 ,Outbreak ,COVID-19 ,General Medicine ,Models, Theoretical ,Transmission (mechanics) ,Communicable Disease Control ,Quarantine ,0305 other medical science ,business ,Coronavirus Infections ,Outbreak control ,Demography - Abstract
The control strategies preventing subclinical transmission differed among countries. A stochastic transmission model was used to assess the potential effectiveness of control strategies at controlling the COVID-19 outbreak. Three strategies included lack of prevention of subclinical transmission (Strategy A), partial prevention using testing with different accuracy (Strategy B) and complete prevention by isolating all at-risk people (Strategy C, Taiwan policy). The high probability of containing COVID-19 in Strategy C is observed in different scenario, had varied in the number of initial cases (5, 20, and 40), the reproduction number (1.5, 2, 2.5, and 3.5), the proportion of at-risk people being investigated (40%, 60%, 80%, to 90%), the delay from symptom onset to isolation (long and short), and the proportion of transmission that occurred before symptom onset (
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- 2020
33. Confronting Tigecycline-Resistant Acinetobacter baumannii via Immunization Against Conserved Resistance Determinants
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Ming-Hsien Chiang, Ya-Sung Yang, Jun-Ren Sun, Yung-Chih Wang, Shu-Chen Kuo, Yi-Tzu Lee, Yi-Ping Chuang, and Te-Li Chen
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Microbiology (medical) ,Population ,lcsh:QR1-502 ,Tigecycline ,Biology ,Active immunization ,immunization ,Microbiology ,lcsh:Microbiology ,03 medical and health sciences ,Minimum inhibitory concentration ,Antigen ,medicine ,resistant determinant ,education ,030304 developmental biology ,Original Research ,0303 health sciences ,education.field_of_study ,Acinetobacter ,030306 microbiology ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,Acinetobacter baumannii ,bacteria ,efflux pump ,Efflux ,tigecycline ,medicine.drug - Abstract
Antimicrobial-resistant (AMR) bacterial infections, including those caused by Acinetobacter baumannii, have emerged as a clinical crisis worldwide. Immunization with AMR determinants has been suggested as a novel approach to combat AMR bacteria, but has not been validated. The present study targeted tigecycline (TGC) resistance determinants in A. baumannii to test the feasibility of this approach. Using bioinformatic tools, four candidates, AdeA, AdeI, AdeK, and TolC, belonging to the resistance-nodulation-division (RND) efflux pump were identified as highly conserved and exposed antigens from 15 A. baumannii genomes. Antisera generated from recombinant proteins showed the capability to reserve Hoechst 33342, a substrate of the efflux pump, in bacterial cells. The rTolC antisera had the highest complement-dependent killing and opsonophagocytosis effect compared to the sera from phosphate-buffered saline immunized mice. Among the antisera, anti-rAdeK-specific antisera decreased the minimal inhibitory concentration of TGC in 26.7% of the tested isolates. Immunization with rAdeK significantly potentiated TGC efficacy in treating TGC-resistant A. baumannii pneumonia in the murine model. The bacterial load (7.5 × 105 vs. 3.8 × 107, p < 0.01) and neutrophil infiltration in the peri-bronchial vasculature region of immunized mice was significantly lower compared to the PBS-immunized mice when TGC was administrated concomitantly. Collectively, these results suggest that active immunization against resistance determinants might be a feasible approach to combat multidrug-resistant pathogens in high risk population.
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- 2020
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34. Emergence of mcr-1, mcr-3 and mcr-8 in clinical Klebsiella pneumoniae isolates in Taiwan
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Yih-Ru Shiau, Wei-Cheng Huang, Shu-Chen Kuo, Feng-Jui Chen, Hui-Ying Wang, and Tsai-Ling Lauderdale
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Microbiology (medical) ,Adolescent ,Klebsiella pneumoniae ,Colistin ,Taiwan ,General Medicine ,Microbial Sensitivity Tests ,Biology ,Middle Aged ,biology.organism_classification ,Microbiology ,Anti-Bacterial Agents ,Klebsiella Infections ,Infectious Diseases ,Bacterial Proteins ,Drug Resistance, Bacterial ,Humans ,MCR-1 ,Child ,Aged - Published
- 2020
35. Bacterial membrane vesicles from
- Author
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Chun-Hsiang, Chiu, Yi-Tzu, Lee, Yu-Chun, Lin, Shu-Chen, Kuo, Ya-Sung, Yang, Yung-Chih, Wang, Yu-Han, Liu, Jung-Chung, Lin, Feng-Yee, Chang, and Te-Li, Chen
- Subjects
Acinetobacter baumannii ,Male ,Proteomics ,Membranes ,Bacteremia ,Microbial Sensitivity Tests ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,Ceftazidime ,Anti-Bacterial Agents ,Cephalosporins ,virulence ,Disease Models, Animal ,Imipenem ,Mice ,RAW 264.7 Cells ,Carbapenems ,polycyclic compounds ,Animals ,Cytokines ,Nitric Oxide Synthase ,Acinetobacter Infections ,Research Paper ,Bacterial membrane vesicles - Abstract
Patients with Acinetobacter baumannii bacteremia treated with antipseudomonal cephalosporins showed higher 14-day mortality than patients treated with antipseudomonal carbapenems. We hypothesized that the bacterial membrane vesicles (BMVs) induced by antipseudomonal cephalosporins are more virulent than BMVs induced by antipseudomonal carbapenems. To simulate the clinical condition with inadequate antimicrobial treatment, carbapenem-resistant A. baumannii was treated with ceftazidime (an antipseudomonal cephalosporin) or imipenem (an antipseudomonal carbapenem) at 1/2 the minimum inhibitory concentration. BMVs and BMV-carried lipopolysaccharide were measured by nanoparticle tracking analysis and western blotting, respectively. Cytokine expression in RAW264.7 macrophages or mice serum induced by the BMVs was determined by ELISA, fluorescent bead-based immunoassay or western blotting. The virulence of the BMVs was assessed in mice. Liquid chromatography tandem-mass spectrometry was used to determine the protein contents of the BMVs. We found that ceftazidime induced a higher number of BMVs (CAZ-BMV), which carried more LPS, and induced higher expression levels of iNOS, IL-1β, and IL-6 in macrophages, higher expression of many cytokines in mice, more neutrophil infiltration in lung interstitium, and higher mortality in mice than imipenem-induced BMVs (IMP-BMV). When adjusted to same amount of LPS, CAZ-BMV still led to higher mortality than IMP-BMV. Proteomic analysis revealed different protein contents in CAZ-BMV and IMP-BMV. In conclusion, A. baumannii BMVs induced by ceftazidime are more virulent than BMVs induced by imipenem.
- Published
- 2020
36. Frontispiece: A Supramolecular Trap to Increase the Antibacterial Activity of Colistin
- Author
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Fang‐Hsuean Liao, Te‐Haw Wu, Chun‐Nien Yao, Shu‐Chen Kuo, Chun‐Jen Su, U‐Ser Jeng, and Shu‐Yi Lin
- Subjects
General Chemistry ,Catalysis - Published
- 2020
37. Frontispiz: A Supramolecular Trap to Increase the Antibacterial Activity of Colistin
- Author
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Chun-Jen Su, Fang-Hsuean Liao, Te-Haw Wu, Shu-Yi Lin, U-Ser Jeng, Shu-Chen Kuo, and Chun-Nien Yao
- Subjects
Gram-negative bacteria ,biology ,medicine.drug_class ,Chemistry ,Antibiotics ,Supramolecular chemistry ,General Medicine ,biology.organism_classification ,Combinatorial chemistry ,Trap (computing) ,medicine ,Colistin ,Antibacterial activity ,medicine.drug - Published
- 2020
38. Is Polymicrobial Bacteremia an Independent Risk Factor for Mortality in Acinetobacter baumannii Bacteremia?
- Author
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And Yi-Tzu Lee, Yung-Chih Wang, Shu-Chen Kuo, Fu-Der Wang, Chih-Chun Kao, Chun-Hsiang Chiu, Wen-Wei Ku, Ya-Sung Yang, Fang-Yu Kang, and Te-Li Chen
- Subjects
Acinetobacter baumannii ,medicine.medical_specialty ,appropriate therapy ,polymicrobial infection ,lcsh:Medicine ,medicine.disease_cause ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,Risk factor ,bacteremia ,0303 health sciences ,biology ,030306 microbiology ,Pseudomonas aeruginosa ,business.industry ,Mortality rate ,lcsh:R ,Retrospective cohort study ,General Medicine ,biology.organism_classification ,medicine.disease ,Antimicrobial ,bacterial infections and mycoses ,mortality ,Bacteremia ,Concomitant ,business - Abstract
This retrospective observational study assessed the differences between monomicrobial and polymicrobial A. baumannii bacteremia and identified possible independent risk factors for 14-day mortality. There were 379 patients with A. baumannii bacteremia admitted to a tertiary care center in northern Taiwan between August 2008 and July 2015 enrolled for data analysis. Among them, 89 patients (23.5%) had polymicrobial bacteremia and 290 patients (76.5%) had monomicrobial bacteremia. No significant difference in 14-day mortality was observed between patients with monomicrobial and polymicrobial A. baumannii bacteremia (26.9% vs. 29.2%, p = 0.77). Logistic regression controlled for confounders demonstrated that polymicrobial bacteremia was not an independent predictor of mortality, whereas appropriate antimicrobial therapy was independently associated with reduced mortality. Higher 14-day mortality rates were observed in the polymicrobial bacteremic patients with concomitant isolation of Escherichia coli, Pseudomonas aeruginosa, and Enterobacter spp. from the bloodstream. Compared with patients with monomicrobial multidrug-resistant A. baumannii (MDRAb) bacteremia, those with MDRAb concomitant with Gram-negative bacilli bacteremia had a worse outcome. Polymicrobial A. baumannii bacteremia was not associated with a higher 14-day mortality rate than that of monomicrobial A. baumannii bacteremia, although more deaths were observed when certain Gram-negative bacteria were concomitantly isolated. Appropriate antimicrobial therapy remains an important life-saving measure for A. baumannii bacteremic patients.
- Published
- 2020
39. Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study
- Author
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Pei Wen Chao, Shu-Chen Kuo, Shuo Ming Ou, Yi Jung Lee, Hung Meng Huang, Yung Tai Chen, and Chia Hsiang Shih
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Influenza vaccine ,Taiwan ,Comorbidity ,030204 cardiovascular system & hematology ,urologic and male genital diseases ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Influenza, Human ,Epidemiology ,Internal Medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,Vaccination ,Odds ratio ,Acute Kidney Injury ,Confidence interval ,Logistic Models ,Influenza Vaccines ,Case-Control Studies ,Nested case-control study ,Cohort ,Female ,business ,Risk Reduction Behavior - Abstract
Objective The objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years. Methods We investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis. Results Influenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63–0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64–0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57–2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69–1.18). Conclusions The risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality.
- Published
- 2018
40. Clinical and Economic Impact of Intensive Care Unit-Acquired Bloodstream Infections in Taiwan: A nationwide population-based retrospective cohort study
- Author
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Yung-Chih Wang, Shu-Man Shih, Yung-Tai Chen, Chao A. Hsiung, and Shu-Chen Kuo
- Abstract
Background: To estimate the clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan. Methods: The first episodes of intensive care unit-acquired bloodstream infections in patients ≥ 20 years of age in the Taiwanese population were identified in the National Health Insurance Research Database and in the Taiwan Nosocomial Infections Surveillance (2007-2015) dataset. Propensity score-matching (1:2) of demographic data, comorbidities, and disease severity was performed to select a comparison cohort from a pool of intensive care unit patients without intensive care unit-acquired infections from the same datasets. Results: After matching, the in-hospital mortality of 14,369 patients with intensive care unit-acquired bloodstream infections was 44.38%, compared to 33.50% for 28,738 intensive care unit patients without bloodstream infections. The 14-day mortality rate was also higher in the bloodstream infections cohort (4,367, 30.39% vs. 6,860 deaths, 23.87%, respectively; p < 0.001). Furthermore, the patients with intensive care unit-acquired bloodstream infections had a prolonged length of hospitalization after their index date (18 [IQR 7–39] vs. 10 days [IQR 4–21], respectively; p < 0.001) and a higher healthcare cost (16,086 [IQR 9,706–26,131] vs. 10,731 US dollars [IQR 6,375–16,910], respectively; p < 0.001). The excessive hospital stay and healthcare cost per case were 12.77 days and 7,646 US dollars, respectively. Similar results were observed in subgroup analyses of various World Health Organization’s priority pathogens and Candida spp. Conclusions: Intensive care unit-acquired bloodstream infections in critically ill patients were associated with increased mortality, longer hospital stays, and higher healthcare costs.
- Published
- 2019
41. Genetic diversity of the Mycobacterium tuberculosis East AfricanâIndian family in three tropical Asian countries
- Author
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Jun-Ren Sun, Jia-Ru Chang, Wei Chen, Horng-Yunn Dou, Ih-Jen Su, Wei-Feng Huang, Ming-Shian Lin, Chih-Hao Hsu, Han-Yin Cheng, Shu-Chen Kuo, and Yih-Yuan Chen
- Subjects
0301 basic medicine ,Microbiology (medical) ,DNA, Bacterial ,Genetic Markers ,Lineage (evolution) ,030106 microbiology ,Taiwan ,lcsh:QR1-502 ,Microbial Sensitivity Tests ,lcsh:Microbiology ,Mycobacterium tuberculosis ,03 medical and health sciences ,Spacer Oligonucleotide Typing ,Tandem repeat ,Asian People ,Immunology and Microbiology(all) ,Asian country ,Immunology and Allergy ,Humans ,Typing ,Tuberculosis, Pulmonary ,Genetics ,Genetic diversity ,Singapore ,General Immunology and Microbiology ,biology ,Traditional medicine ,Strain (biology) ,Genetic Variation ,General Medicine ,biology.organism_classification ,bacterial infections and mycoses ,Interspersed Repetitive Sequences ,Molecular Typing ,030104 developmental biology ,Infectious Diseases ,East African–Indian family ,DNA, Intergenic ,tropical Asian countries ,Cambodia - Abstract
Background: The Beijing lineage of Mycobacterium tuberculosis (MTB) is the most predominant MTB strain in Asian countries and is spreading worldwide, however, the East AfricanâIndian (EAI) lineage is also particularly prevalent in many tropical Asian countries. The evolutionary relationships among MTB EAI isolates from Taiwan and those of tropical Asian countries remain unknown. Methods: The EAI strains collected from patients in Taiwan were analyzed using spacer oligonucleotide typing and mycobacterial interspersed repetitive unitâvariable number of tandem repeats (MIRU-VNTR) typing, and compared with published profiles from Cambodia and Singapore to investigate potential epidemiological linkages. Results: Among the three countries, the EAI lineage was most prevalent in Cambodia (60%; Singapore, 25.62%; and Taiwan, 21.85%), having also the highest rates of multidrug resistance and lowest rates of clustering of MTB isolates. We describe a convenient method using seven selected MIRU-VNTR loci for first-line typing to discriminate Beijing and EAI lineages. A potential epidemiological linkage in these tropical Asian countries is also discussed based on a minimum-spanning tree constructed using 24 MIRU-VNTR loci of MTB EAI strains. Conclusion: This study identified evolutionary relationships among MTB EAI isolates from Taiwan and those of two other tropical Asian countries, Cambodia and Singapore. Keywords: East AfricanâIndian family, Mycobacterium tuberculosis, tropical Asian countries
- Published
- 2017
42. Association between influenza vaccination and reduced risks of major adverse cardiovascular events in elderly patients
- Author
-
Hau-Hsin Wu, Chia-Jen Shih, Yung Tai Chen, Ming-Hsien Chiang, Te-Li Chen, and Shu-Chen Kuo
- Subjects
Male ,medicine.medical_specialty ,Influenza vaccine ,Population ,Taiwan ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Influenza, Human ,Odds Ratio ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,education ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Vaccination ,Age Factors ,Case-control study ,Retrospective cohort study ,Odds ratio ,Surgery ,Cardiovascular Diseases ,Influenza Vaccines ,Case-Control Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Mace ,Follow-Up Studies - Abstract
This study was conducted to determine the protective effect of influenza vaccine against primary major adverse cardiovascular events (MACEs) in elderly patients, especially those with influenza-like illness (ILI).This retrospective, population-based case-control study of an elderly population (age≥65 years) was conducted using Taiwan's National Health Insurance Research Database (2000-2013). One control was selected for each MACE case (n=80,363 each), matched according to age, year of study entry, and predisposing factors for MACEs. ILI and MACEs (myocardial infarction [MI] and ischemic stroke) were defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Odds ratios (ORs) were calculated for the association between MACEs and vaccination.Influenza vaccination received in the previous year was associated with reduced risks of primary MACEs overall (adjusted OR [aOR] 0.80, 95% CI 0.78-0.82, P.001), MI (aOR 0.80, 95% CI 0.76-0.84, P.001), and ischemic stroke (aOR 0.80, 95% CI 0.77-0.82, P.001). ILI diagnosed in the previous year was associated with increased risks of MACEs (aOR 1.24, 95% CI 1.18-1.29, P.001), MI (aOR 1.46, 95% CI 1.34-1.59, P.001), and ischemic stroke (aOR 1.16, 95% CI 1.10-1.22, P.001). Vaccination attenuated the heightened risks associated with ILI (MACEs: aOR 0.99, 95% CI 0.92-1.07, P=.834; MI: aOR 1.05, 95% CI 0.92-1.21, P=.440; ischemic stroke: aOR 0.96, 95% CI 0.89-1.05, P=.398).Results of this study suggest that influenza vaccination is associated with reduced primary MACE risks in the elderly population, including those with ILI.
- Published
- 2017
43. Effects of a Multifaceted Intervention Program on the Eating Ability of Nursing Home Residents
- Author
-
Yueh-Juen Hwu, Chia-Hui Chiu, Shu-Chen Kuo, and Mei-Ling Chen
- Subjects
Research design ,medicine.medical_specialty ,Strength training ,Health, Toxicology and Mutagenesis ,Aspiration pneumonia ,Oral hygiene ,Article ,Eating ,Swallowing ,Intervention (counseling) ,medicine ,Humans ,nursing home residents ,business.industry ,Malnutrition ,Public Health, Environmental and Occupational Health ,tongue strength ,medicine.disease ,Dysphagia ,Deglutition ,Nursing Homes ,eating ability ,Physical therapy ,oral health ,Medicine ,medicine.symptom ,Deglutition Disorders ,business ,Oropharyngeal dysphagia - Abstract
Oropharyngeal dysphagia is a common problem for nursing home residents that leads to aspiration pneumonia and malnutrition. Musculature surrounding head and neck and tongue strength are crucial for safe and efficient oropharyngeal swallowing. Oral hygiene facilitates the smooth swallowing. The aim of this study was thus to investigate the effects of a multifaceted intervention program which combines the interactive oral activities, tongue strength training and oral cleaning procedure on the eating ability of nursing home residents. A sequential, multiple time series, single-group quasi-experimental research design was used, and 41 residents were recruited to participate in this study. The study was divided into three phases, each lasting two months. In phase 1, the participants were conducting their usual activities, except that the outcome variables were measured on five occasions to obtain baseline data. Phase 2 was a two-month washout period, and phase 3 was the intervention period. Thirty-six residents completed phase 1, and 34 residents completed the phase 3 intervention period. The eight-week phase 3 intervention program comprised three sessions per day, conducted seven days a week, with each session lasting 15–20 min. Outcome variables were measured at weeks 0, 2, 4, 6, and 8 in phases 1 and 3 to evaluate the feasibility of the program. Following the intervention program, controlling for baseline differences, the patients’ tongue strength, food consumption, mealtime duration, oral health, and dysphagia severity were significantly improved in phase 3 relative to phase 1. These improvements lasted through to at least 2 months posttest. The study illustrates that this multifaceted intervention program may be an effective approach for improving the eating ability of nursing home residents.
- Published
- 2021
44. Corrigendum to 'Multicentre study of risk factors for mortality in patients with Acinetobacter bacteraemia receiving colistin treatment' [International Journal of Antimicrobial Agents 55 (2020) 105956]
- Author
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Yung-Chih Wang, Jun-Ren Sun, Chun-Hsiang Chiu, Yi-Tzu Lee, Te-Li Chen, Ya-Sung Yang, and Shu-Chen Kuo
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,biology ,business.industry ,General Medicine ,Acinetobacter ,Antimicrobial ,biology.organism_classification ,Infectious Diseases ,Internal medicine ,Colistin ,medicine ,Pharmacology (medical) ,In patient ,business ,medicine.drug - Published
- 2021
45. Clinical Antibiotic-resistant Acinetobacter baumannii Strains with Higher Susceptibility to Environmental Phages than Antibiotic-sensitive Strains
- Author
-
Chun-Chieh Tseng, Kai-Chih Chang, Tren-Yi Chen, Chieh-Chen Cheng, Li-Kuang Chen, Shu-Chen Kuo, Pei-Ying Yu, and Chih-Hui Chang
- Subjects
Acinetobacter baumannii ,0301 basic medicine ,medicine.drug_class ,Science ,030106 microbiology ,Antibiotics ,Microbial Sensitivity Tests ,Drug resistance ,Article ,Microbiology ,03 medical and health sciences ,Antibiotic resistance ,Drug Resistance, Multiple, Bacterial ,medicine ,polycyclic compounds ,Bacteriophages ,Antibiotic use ,Bacteriophage Typing ,Phage typing ,Multidisciplinary ,biology ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Virology ,Anti-Bacterial Agents ,030104 developmental biology ,bacteria ,Medicine - Abstract
Antibiotic-resistant Acinetobacter baumannii is associated with nosocomial infections worldwide. Here, we used clinically isolated A. baumannii strains as models to demonstrate whether antibiotic resistance is correlated with an increased susceptibility to bacteriophages. In this study, 24 active phages capable of infecting A. baumannii were isolated from various environments, and the susceptibilities of both antibiotic-sensitive and antibiotic-resistant strains of A. baumannii to different phages were compared. In our study, a total of 403 clinically isolated A. baumannii strains were identified. On average, the phage infection percentage of the antibiotic-resistant A. baumannii strains was 84% (from 81–86%), whereas the infection percentage in the antibiotic-sensitive A. baumannii strains was only 56.5% (from 49–64%). In addition, the risk of phage infection for A. baumannii was significantly increased in the strains that were resistant to at least four antibiotics and exhibited a dose-dependent response (p-trend A. baumannii isolates, 75.6% were phage typeable. The results of phage typing might also reveal the antibiotic-resistant profiles of clinical A. baumannii strains. In conclusion, phage susceptibility represents an evolutionary trade-off in A. baumannii strains that show adaptations for antibiotic resistance, particularly in medical environments that have high antibiotic use.
- Published
- 2017
46. Innovation resistance and strategic implications of enterprise social media websites in Taiwan through knowledge sharing perspective
- Author
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Shu Chen Kuo and Peng Ting Chen
- Subjects
Value (ethics) ,Knowledge management ,Process (engineering) ,business.industry ,media_common.quotation_subject ,05 social sciences ,Perspective (graphical) ,Resistance (psychoanalysis) ,Public relations ,Knowledge sharing ,Management of Technology and Innovation ,0502 economics and business ,Key (cryptography) ,050211 marketing ,Social media ,Prosperity ,Business and International Management ,business ,050203 business & management ,Applied Psychology ,media_common - Abstract
Virtual communities consist of social media users whose relationships are strengthened through information and knowledge transfers, as well as interactions among members. A new connection between customer feedback and brand modeling has been formed through social media. Therefore, this research aims to enhance effective management of enterprise social media platforms, as the key to prosperity in social media is built on the knowledge sharing behavior of users. The study employs the theory of innovation resistance and summarizes 27 factors of barriers encountered by users during the knowledge sharing process in enterprise social media. These factors are further categorized into seven dimensions of resistance, such as usage barriers, value barriers, physical risks, trust risks, security belief barriers, mutual benefit belief barriers, and image barriers. The validity of the scales is confirmed by using the corroboration process of factor analysis. The strategic implications of the barriers are explored, and recommendations to overcome those barriers are proposed as part of management of enterprise social media sites.
- Published
- 2017
47. Verapamil Use Is Associated With Reduction of Newly Diagnosed Diabetes Mellitus
- Author
-
Yung Tai Chen, Ti Yin, Kai-Wei Katherine Wang, Shu-Chen Kuo, and Yea-Yuan Chang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Population ,Taiwan ,Administration, Oral ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Biochemistry ,Drug Administration Schedule ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Reference Values ,Risk Factors ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Propensity Score ,education ,Retrospective Studies ,education.field_of_study ,Dose-Response Relationship, Drug ,business.industry ,Incidence ,Incidence (epidemiology) ,Biochemistry (medical) ,Hazard ratio ,Type 2 Diabetes Mellitus ,Retrospective cohort study ,Middle Aged ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Verapamil ,Case-Control Studies ,Cohort ,Female ,business ,Follow-Up Studies ,medicine.drug ,Cohort study - Abstract
Objective: The mechanism of the beneficial effect of calcium-channel blockers (CCBs), especially verapamil, on the development of type 2 diabetes mellitus (T2DM) has been described. This study compared the incidence of T2DM in adults prescribed oral verapamil and propensity score–matched adults prescribed other oral CCBs. Methods: This retrospective population-based cohort study used Taiwan’s National Health Insurance Research Database from 2000 to 2011. T2DM was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Results: During follow-up periods of 41,958 and 42,118 person-years, 269 of 4930 patients in the verapamil cohort and 340 of 4930 patients in the matched cohort, respectively, developed T2DM. The incidence rates were 6.41 and 8.07 per 1000 population per year among verapamil and other CCB users, respectively. The adjusted hazard ratio (HR) for T2DM associated with use of verapamil (vs. other CCBs) was 0.80 [95% confidence interval (CI), 0.68 to 0.94; P = 0.006]. After exclusion of patients followed for Conclusions: In patients with no known history of diabetes mellitus, oral verapamil use was associated with a decreased incidence of T2DM compared with other CCBs.
- Published
- 2017
48. An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution
- Author
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Fu-Mei Kuo, Chia-Ping Chen, Shu-Chen Kuo, Wan-Tsuei Huang, Fu-Der Wang, Yu-Jiun Chan, Yin-Yin Chen, and Shu-Mei Sun
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Adolescent ,Epidemiology ,medicine.medical_treatment ,030106 microbiology ,Taiwan ,Bacteremia ,Sodium Chloride ,Disease Outbreaks ,Microbiology ,Tertiary Care Centers ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Bloodstream infection ,medicine ,Humans ,030212 general & internal medicine ,Child ,Saline ,Aged ,Aged, 80 and over ,Ralstonia pickettii ,biology ,business.industry ,Outbreak ,Emergency department ,Middle Aged ,Contamination ,biology.organism_classification ,Catheter ,Infectious Diseases ,Child, Preschool ,Female ,Gram-Negative Bacterial Infections ,business - Abstract
OBJECTIVERalstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI).METHODSThis study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection.RESULTSWe collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii.CONCLUSIONSR. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks.Infect Control Hosp Epidemiol 2017;38:444–448
- Published
- 2017
49. A Supramolecular Trap to Increase the Antibacterial Activity of Colistin
- Author
-
Chun-Jen Su, Shu-Chen Kuo, Te-Haw Wu, U-Ser Jeng, Fang-Hsuean Liao, Chun-Nien Yao, and Shu-Yi Lin
- Subjects
endotoxin ,Gram-negative bacteria ,Lipopolysaccharide ,Antibiotics | Very Important Paper ,medicine.drug_class ,Polymyxin ,Antibiotics ,Catalysis ,antibiotics ,supramolecular chemistry ,Microbiology ,Lipid A ,chemistry.chemical_compound ,Mice ,medicine ,polycyclic compounds ,Animals ,Humans ,Boosting (doping) ,biology ,gold nanosheets ,Chemistry ,Colistin ,Communication ,General Chemistry ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,medicine.disease ,bacterial infections and mycoses ,Communications ,Anti-Bacterial Agents ,Bacteremia ,bacteria ,lipids (amino acids, peptides, and proteins) ,Bacterial outer membrane ,Antibacterial activity ,medicine.drug - Abstract
A strong interaction between colistin, a last‐resort antibiotic of the polymyxin family, and free lipopolysaccharide (LPS, also referred to as endotoxin), released from the Gram‐negative bacterial (GNB) outer membrane (OM), has been identified that can decrease the antibacterial efficacy of colistin, potentially increasing the dose of this antibiotic required for treatment. The competition between LPS in the GNB OM and free LPS for the interaction with colistin was prevented by using a supramolecular trap to capture free LPS. The supramolecular trap, fabricated from a subnanometer gold nanosheet with methyl motifs (SAuM), blocks lipid A, preventing the interaction between lipid A and colistin. This can minimize endotoxemia and maximize the antibacterial efficacy of colistin, enabling colistin to be used at lower doses. Thus, the potential crisis of colistin resistance could be avoided., Caught in a trap: The antibiotic colistin targets lipopolysaccharide (LPS) in the Gram‐negative bacterial (GNB) membrane. This interaction is disrupted by free LPS released during infection (path a). A methylated gold nanosheet (SAuM) binds to free LPS, preventing free LPS from binding colistin and reducing endotoxemia (path b). This increases the antibacterial efficacy of colistin, decreasing both the required dose and the risk of resistance.
- Published
- 2019
50. Completing Circular Bacterial Genomes With Assembly Complexity by Using a Sampling Strategy From a Single MinION Run With Barcoding
- Author
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Feng-Jui Chen, Han Chieh Wu, Shu-Chen Kuo, Yu-Chieh Liao, Hung-Wei Cheng, and Tsai-Ling Lauderdale
- Subjects
Microbiology (medical) ,0303 health sciences ,Contig ,030306 microbiology ,Computer science ,lcsh:QR1-502 ,MinION sequencing ,Sequence assembly ,GC skew ,Bacterial genome size ,Computational biology ,de novo assembly ,Microbiology ,lcsh:Microbiology ,03 medical and health sciences ,DNA sequencer ,bacterial genome ,assembly complexity ,Minion ,Base calling ,Nanopore sequencing ,Original Research ,one-stop analysis ,030304 developmental biology - Abstract
The Oxford Nanopore MinION is an affordable and portable DNA sequencer that can produce very long reads (tens of kilobase pairs), which enable de novo bacterial genome assembly. Although many algorithms and tools have been developed for base calling, read mapping, de novo assembly, and polishing, an automated pipeline is not available for one-stop analysis for circular bacterial genome reconstruction. In this paper, we present the pipeline CCBGpipe for completing circular bacterial genomes. Raw current signals are demultiplexed and base called to generate sequencing data. Sequencing reads are de novo assembled several times by using a sampling strategy to produce circular contigs that have a sequence in common between their start and end. The circular contigs are polished by using raw signals and sequencing reads; then, duplicated sequences are removed to form a linear representation of circular sequences. The circularized contigs are finally rearranged to start at the start position of dnaA/repA or a replication origin based on the GC skew. CCBGpipe implemented in Python is available at https://github.com/jade-nhri/CCBGpipe. Using sequencing data produced from a single MinION run, we obtained 48 circular sequences, comprising 12 chromosomes and 36 plasmids of 12 bacteria, including Acinetobacter nosocomialis, Acinetobacter pittii, and Staphylococcus aureus. With adequate quantities of sequencing reads (80×), CCBGpipe can provide a complete and automated assembly of circular bacterial genomes.
- Published
- 2019
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