19 results on '"Shu-Chen Kuo"'
Search Results
2. 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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Yi-Tzu Lee, Tzu-Wen Huang, I-Fan Liu, Shu-Chen Kuo, Ya-Sung Yang, Pei-Ying Lin, Chang-Pan Liu, Yuag-Meng Liu, Te-Li Chen, Fu-Der Wang, and Yung-Chih Wang
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Acinetobacter ,CarbaAcineto NP test ,Carba NP test ,Modified carbapenem inactivation method ,Modified Hodge test ,Microbiology ,QR1-502 - 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.
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- 2022
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3. Mobile resistomes of human pathogens in swine wastewater treatment plants
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Hung-Chih Kuo, Yu-Chieh Liao, Hung-Wei Cheng, Shu-Man Shih, Feng-Jui Chen, and Shu-Chen Kuo
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Resistome ,Wastewater treatment plants ,Human pathogens ,Mobile element ,Microbiology ,QR1-502 - Published
- 2021
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4. Increased mcr-1 in pathogenic Escherichia coli from diseased swine, Taiwan
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Jing-Yi Liu, Tsai-Lien Liao, Wei-Cheng Huang, Yen-Ming Liu, Keh-Ming Wu, Tsai-Ling Lauderdale, Shih-Feng Tsai, Shu-Chen Kuo, and Hung-Chih Kuo
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Colistin resistance ,mcr-1 ,Escherichia coli ,Swine ,Microbiology ,QR1-502 - Abstract
Purpose: To investigate the increasing prevalence of colistin resistance in animal Escherichia coli isolates and their mcr-1-carrying plasmids, especially those shared by isolates from human and retail meats. Methods: E. coli from diseased swine and poultry recovered between 2012 and 2016 were studied. Susceptibility was determined using broth microdilution method or Vitek II system. Fifty-eight mcr-1-positive isolates were randomly selected for further testing, including pulsed-field gel electrophoresis (PFGE) for clonality determination, S1- or I-CeuI-PFGE and Southern blotting for localization of mcr-1, and conjugation for transmissibility. Whole genome sequencing (WGS) was performed for the genetic structure of plasmids. Results: Among the 1234 E. coli isolates from diseased swine, colistin resistance increased from 14.6% (14/96) in 2012 to 43.8% (63/144) in 2016 with a paralleled increase in mcr-1-positivity from 12.5% (12/96) to 33.3% (48/144) in 2016 (P
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- 2020
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5. Policy-driven revolution of prescription record in outpatient use of fluoroquinolones
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Shu-Chen Kuo, Shu-Man Shih, Tsai-Ling Yang Lauderdale, I-Shou Chang, Yee-Chun Chen, Chao A. Hsiung, and Shang-Chwen Chang
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Microbiology ,QR1-502 - 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
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6. 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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Microbiology ,QR1-502 - 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
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7. 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, Fang-Huy Shih, Te-Li Chen, Chorng-Kuang How, Ya-Sung Yang, and Yi-Tzu Lee
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Microbiology ,QR1-502 - 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
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8. Impact of reduced tigecycline susceptibility on clinical outcomes of Acinetobacter bacteremia
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Yea-Yuan Chang, Yuag-Meng Liu, Chang-Pan Liu, Shu-Chen Kuo, Te-Li Chen, Yi-Tzu Lee, and Ya-Sung Yang
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Tigecycline ,Acinetobacter bacteremia ,Minimum inhibitory concentration ,Appropriate antibiotics ,Microbiology ,QR1-502 - Abstract
The higher 14-day mortality rate for patients with Acinetobacter bacteremia receiving tigecycline appropriately compared to other appropriate antibiotics (36.4% versus 14.2%, P = 0.028) was due to the poor effect of tigecycline for isolates with a minimum inhibitory concentration of 2 μg/mL (63.6% of 11 versus 14.2% of 127, P = 0.001).
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- 2018
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9. Genetic diversity of the Mycobacterium tuberculosis East AfricanâIndian family in three tropical Asian countries
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Yih-Yuan Chen, Jia-Ru Chang, Wei-Feng Huang, Chih-Hao Hsu, Han-Yin Cheng, Jun-Ren Sun, Shu-Chen Kuo, Ih-Jen Su, Ming-Shian Lin, Wei Chen, and Horng-Yunn Dou
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Microbiology ,QR1-502 - 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
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- 2017
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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. 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
12. Genetic diversity of the Mycobacterium tuberculosis East AfricanâIndian family in three tropical Asian countries
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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
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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
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- 2017
13. Risk factors and clinical outcome of sulbactam nonsusceptibility in monomicrobial Acinetobacter nosocomialis bacteremia
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Yea-Yuan Chang, Hsin-Hao Lai, Shu-Chen Kuo, Bo-Huang Liou, Yi-Tzu Lee, Te-Li Chen, and Chang-Phone Fung
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Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Taiwan ,Bacteremia ,Microbial Sensitivity Tests ,law.invention ,03 medical and health sciences ,law ,Immunology and Microbiology(all) ,Drug Resistance, Multiple, Bacterial ,Internal medicine ,medicine ,Humans ,Immunology and Allergy ,APACHE ,Aged ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,Acinetobacter ,General Immunology and Microbiology ,biology ,business.industry ,Retrospective cohort study ,General Medicine ,Sulbactam ,Odds ratio ,Middle Aged ,medicine.disease ,biology.organism_classification ,Intensive care unit ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,Surgery ,Treatment Outcome ,Infectious Diseases ,Female ,beta-Lactamase Inhibitors ,business ,Acinetobacter Infections ,medicine.drug ,Acinetobacter nosocomialis - Abstract
Background Sulbactam is an effective antimicrobial agent against multidrug-resistant Acinetobacter spp. This retrospective study evaluated the risk factors of sulbactam nonsusceptibility (SNS) in monomicrobial Acinetobacter nosocomialis bacteremia and its related outcome. Methods This 9-year retrospective study included 267 patients who were admitted to a large teaching hospital in Taiwan with monomicrobial A. nosocomialis bacteremia. A. nosocomialis was identified to the species level using molecular methods. Antimicrobial susceptibilities were determined by the agar dilution method. To identify the risk factors of acquiring resistant strains, significant clinical variables derived from univariate analysis were entered into multivariate analysis. Polymerase chain reaction was used to identify bla TEM . Clonality was determined by pulsed-field gel electrophoresis. Results A total of 41 of the 267 patients (15.4%) had SNS A. nosocomialis bacteremia. Compared to those with susceptible strains, these patients had higher 14-day mortality (17.1% vs. 7.5%, p = 0.049), were more likely to have higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, were more frequently admitted to the intensive care unit, and had previously received broad-spectrum antibiotics and underwent invasive procedures. In multivariate analysis, the independent risk factors were high APACHE II score and prior use of arterial line [odds ratio (OR), 1.048; 95% confidence interval (CI), 1.007–1.091; p = 0.022 and OR, 2.936; 95% CI, 1.339–6.441; p = 0.007, respectively]. No outbreak was identified and SNS isolates did not harbor bla TEM . Conclusion For monomicrobial A. nosocomialis bacteremia, the mortality of patients with SNS strains was higher. The SNS strains are more commonly recovered from patients with higher APACHE score and receiving more invasive procedures, especially arterial line.
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- 2016
14. Epidemiology and risk factors of community-onset urinary tract infection caused by extended-spectrum β-lactamase-producing Enterobacteriaceae in a medical center in Taiwan: A prospective cohort study
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Shu-Chen Kuo, Chi-Hung Lee, Yi-Tzu Lee, Chang-Phone Fung, Wen-Wei Ku, Che-Hsuan Kung, and Te-Li Chen
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Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,Klebsiella pneumoniae ,Cephalosporin ,Taiwan ,Microbial Sensitivity Tests ,Urine ,Polymerase Chain Reaction ,beta-Lactamases ,Microbiology ,Cohort Studies ,Antibiotic resistance ,Extended-spectrum β-lactamase ,Enterobacteriaceae ,Risk Factors ,Immunology and Microbiology(all) ,Internal medicine ,Genotype ,Epidemiology ,Escherichia coli ,polycyclic compounds ,Humans ,Immunology and Allergy ,Medicine ,Prospective Studies ,Prospective cohort study ,Urinary tract infection ,Academic Medical Centers ,General Immunology and Microbiology ,biology ,business.industry ,Enterobacteriaceae Infections ,General Medicine ,Odds ratio ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Community-Acquired Infections ,Infectious Diseases ,Urinary Tract Infections ,Community-onset ,Female ,business - Abstract
Background Extended-spectrum β-lactamase (ESBL)-producing pathogens have been increasingly identified in community-onset urinary tract infection (UTI). This study was conducted to determine the epidemiology and risk factors of community-onset UTI caused by ESBL-producing pathogens, and to determine the correlation of antimicrobial resistance with ESBL detected by phenotypic and genotypic methods. Methods The study was conducted from December 2010 to January 2012. Patients with community-onset UTI caused by Enterobacteriaceae were enrolled from the emergency department. The production of ESBL was determined by the phenotypic method (using the combined disk test) or by the genotypic method (using polymerase chain reaction detection). The patients' medical records were reviewed and risk factors were analyzed by multivariate analysis. Results A total of 376 patients were enrolled and 393 isolates from urine culture were analyzed. Escherichia coli was the most commonly isolated species (259/393 isolates; 65.9%), followed by Klebsiella pneumoniae (42/393 isolates; 10.7%). Fifty-three (13.5%) isolates were phenotypically positive for ESBL production. Nine (2.3%) isolates were phenotypically positive for both ESBL and AmpC β-lactamase (AmpC) production. Nasogastric tube placement [odds ratio (OR) 2.230; 95% confidence interval (CI) 1.244–3.997; p = 0.007] and hospitalization within the previous 3 months (OR 2.567, 95% CI 1.448–4.551, p = 0.001) were independently associated with the acquisition of ESBL-producing pathogens in community-onset UTI. The ESBL phenotype had a better correlation with resistance to third-generation cephalosporins, compared to the ESBL-positive genotype. Conclusion In our study, nasogastric tube placement and hospitalization within the previous 3 months were significantly associated with the acquisition of ESBL-producing pathogens in community-onset UTI.
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- 2015
15. Evolution of carbapenem resistance in Acinetobacter baumannii: An 18-year longitudinal study from a medical center in northern Taiwan
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Wen-Wei Ku, Ping-Feng Wu, Chi-Hung Lee, Shu-Chen Kuo, Chang-Phone Fung, Te-Li Chen, Fu-Der Wang, Yi-Tzu Lee, Chih-Peng Tseng, and Che-Hsuang Kung
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Acinetobacter baumannii ,Carbapenem ,ISAba1-blaOXA-51-like ,law.invention ,law ,Prevalence ,polycyclic compounds ,Cluster Analysis ,Immunology and Allergy ,Longitudinal Studies ,Polymerase chain reaction ,Carbapenem resistance ,Academic Medical Centers ,Cross Infection ,Molecular Epidemiology ,biology ,General Medicine ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,Infectious Diseases ,Acinetobacter Infections ,medicine.drug ,Microbiology (medical) ,ISAba1-blaOXA-23-like ,Genotype ,Taiwan ,Microbial Sensitivity Tests ,beta-Lactam Resistance ,beta-Lactamases ,Microbiology ,Immunology and Microbiology(all) ,Pulsed-field gel electrophoresis ,medicine ,Humans ,Allele ,General Immunology and Microbiology ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Virology ,Molecular Typing ,Carriage ,Carbapenems ,Tn2006 ,Genes, Bacterial ,DNA Transposable Elements ,Colistin ,bacteria ,Tn2008 - Abstract
BackgroundCarbapenem-resistant Acinetobacter baumannii has emerged as an important cause of nosocomial infections with high morbidity and mortality. The carbapenemases, especially class D carbapenem-hydrolyzing oxacillinases (CHDLs), play an important role, but the relationship between their prevalence trend and carbapenem resistance remains unclear.Materials and methodsBetween 1995 and 2012, we collected 667 isolates of A. baumannii from a single medical center in northern Taiwan. Pulsed-field gel electrophoresis (PFGE) was used to determine clonality. Antimicrobial susceptibility was determined. Carbapenemase genes and associated genetic structures were detected by polymerase chain reaction.ResultsIsolates were heterogeneous on PFGE. Susceptibility to carbapenem decreased steadily over the study period from 88.1% (2001–2003) to
- Published
- 2015
16. Risk factors for imipenem-nonsusceptible Acinetobacter nosocomialis bloodstream infection
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Mei-Hui Lee, Lei Huang, Chang-Phone Fung, Shu-Chen Kuo, Horng-Yunn Dou, Yi-Tzu Lee, Te-Li Chen, and Kwok-Woon Yu
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Male ,Microbiology (medical) ,Carbapenem ,medicine.medical_specialty ,Imipenem ,Imipenem resistance ,Bacteremia ,Microbial Sensitivity Tests ,beta-Lactam Resistance ,Immunology and Microbiology(all) ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Immunology and Allergy ,Infection control ,Intensive care medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Academic Medical Centers ,Cross Infection ,Acinetobacter ,General Immunology and Microbiology ,biology ,business.industry ,General Medicine ,Sulbactam ,Odds ratio ,Middle Aged ,biology.organism_classification ,medicine.disease ,Acinetobacter baumannii ,Infectious Diseases ,Risk factors ,Acinetobacter nosocomialis ,Female ,business ,Acinetobacter Infections ,medicine.drug - Abstract
Background The emergence of imipenem-nonsusceptible (INS) Acinetobacter baumannii complex has had a great impact on healthcare systems worldwide. Understanding the risk factors related to INS infection is useful for infection control. The risk factors for INS A. baumannii have been well documented; however, the risk factors related to INS Acinetobacter nosocomialis infection lack documentation. The purpose of this study was to identify the risk factors associated with INS A. nosocomialis bacteremia. Methods This retrospective 9-year study included 329 adults with A. nosocomialis bacteremia in a tertiary medical center in Taiwan. Acinetobacter nosocomialis was identified using a multiplex polymerase chain reaction method and sequence analysis of a 16S–23S intergenic spacer. Results Among 329 patients with A. nosocomialis bacteremia, 67 had INS isolates (20.4%). Patients with INS isolates tended to have a more severe form of the diseases [with ICU admission and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score], specific underlying diseases (associated with chronic lung diseases and end-stage renal diseases, but less commonly alcoholism and chemotherapy), multiple invasive procedures, pneumonia as a primary focus of infection, and prior antimicrobial use (sulbactam, antipseudomonal penicillins, aminoglycosides, and carbapenems). Multivariable analysis showed that ICU admission, chronic lung diseases, arterial line catheterization, total parenteral nutrition, and prior use of carbapenems were independent risk factors; prior use of carbapenems was found to be the most influential (odds ratio 6.36, 95% confidence interval 2.00–20.21; p = 0.002). Conclusion To our knowledge, this is the first study describing the risk factors associated with INS A. nosocomialis bacteremia. Regulated antibiotic control policy, especially for carbapenem, and infection control measures targeting patients hospitalized in ICU, with chronic lung diseases and multiple invasive procedures, may be helpful in reducing INS A. nosocomialis infection.
- Published
- 2014
17. Polymerase chain reaction assay for the detection of Acinetobacter baumannii in endotracheal aspirates from patients in the intensive care unit
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Yu-Chih Chen, Yi-Tzu Lee, Shu-Chen Kuo, Chang-Phone Fung, Te-Li Chen, and Mei-Chun Chiang
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Adult ,DNA, Bacterial ,Male ,Acinetobacter baumannii ,Microbiology (medical) ,Adolescent ,Polymerase Chain Reaction ,Sensitivity and Specificity ,Polymerase chain reaction (PCR) ,law.invention ,Microbiology ,Young Adult ,Predictive Value of Tests ,law ,Immunology and Microbiology(all) ,Diagnosis ,Multiplex polymerase chain reaction ,Pneumonia, Bacterial ,Humans ,Immunology and Allergy ,Medicine ,Prospective Studies ,Polymerase chain reaction ,Aged ,Aged, 80 and over ,General Immunology and Microbiology ,biology ,business.industry ,General Medicine ,Gold standard (test) ,Middle Aged ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,medicine.disease ,Intensive care unit ,Intensive Care Units ,Detection ,Pneumonia ,Infectious Diseases ,Predictive value of tests ,bacteria ,Female ,Acinetobacter calcoaceticus ,business ,Acinetobacter Infections - Abstract
Background We aim to evaluate the efficacy of polymerase chain reaction (PCR) to detect Acinetobacter baumannii in endotracheal aspirates. Methods Endotracheal aspirates and clinical data were collected from patients who were admitted to the intensive care unit of Taipei Veterans General Hospital between April 1 and August 31 in 2006. Bacterial isolates from endotracheal aspirate cultures were phenotypically identified as Acinetobacter calcoaceticus – A baumannii complex using the API ID 32GN system. The presence of A baumannii in the aspirate was also directly detected by multiplex PCR. Results Ten of the 114 endotracheal aspirate cultures were positive for A calcoaceticus – A baumannii complex, and only nine of the isolates were confirmed as A baumannii by the multiplex PCR. Direct PCR detection showed that 40 (35.1%) of the endotracheal aspirates were positive for A baumannii . Using positive culture of A baumannii as the gold standard, the sensitivity of direct PCR detection was 100% (6 of 6), the specificity was 70.4% (38 of 54), the positive predictive value was 27.3% (6 of 22), and the negative predictive value (NPV) was 100% (38 of 38) among patients with A baumannii pneumonia. Among patients with A baumannii colonization, the sensitivity of direct PCR detection was 100% (3 of 3), the specificity was 70.6% (36 of 51), the positive predictive value was 16.7% (3 of 18), and the NPV was 100% (36 of 36). Conclusion Direct PCR detection of A baumannii in endotracheal aspirates has a high sensitivity and NPV as compared with culture-based methods. Further studies are needed to determine the clinical applicability of this rapid detection test.
- Published
- 2011
18. Dissemination of multidrug-resistant Acinetobacter baumannii carrying BlaOxA-23 from hospitals in central Taiwan
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Mei-Hui Lee, Chang-Phone Fung, Shu-Chen Kuo, Horng-Yunn Dou, Yi-Tzu Lee, Lei Huang, Te-Li Chen, Po-Ren Hsueh, Ih-Jen Su, and Kwok-Woon Yu
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DNA, Bacterial ,Microbiology (medical) ,Acinetobacter baumannii ,Imipenem ,Genotype ,Carbapenem resistance ,Taiwan ,Microbial Sensitivity Tests ,Polymerase Chain Reaction ,beta-Lactamases ,Microbiology ,law.invention ,Agar dilution ,Plasmid ,law ,Immunology and Microbiology(all) ,Drug Resistance, Multiple, Bacterial ,polycyclic compounds ,medicine ,Cluster Analysis ,Humans ,Immunology and Allergy ,Hospitals, Teaching ,Polymerase chain reaction ,Etest ,Cross Infection ,General Immunology and Microbiology ,Molecular epidemiology ,biology ,Sequence Analysis, DNA ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Virology ,blaOxA-23 ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,Molecular Typing ,Blotting, Southern ,Infectious Diseases ,DNA Transposable Elements ,Colistin ,Acinetobacter Infections ,Plasmids ,medicine.drug - Abstract
Background Imipenem-resistant Acinetobacter baumannii (IRAB) poses a great threat to healthcare systems. Production of carbapenem-hydrolyzing class D β-lactamases (CHDLs) is the major mechanism for imipenem resistance. In this study, we found a high prevalence of IRAB carrying a gene encoding CHDL, bla OxA-23 , in central Taiwan and elucidated the molecular characteristics and possible mechanisms of the spread of these isolates. Methods During 2007, we collected 291 nonrepetitive A baumannii isolates from 10 teaching hospitals in Taiwan. The antimicrobial susceptibility of the isolates was determined by agar dilution or Etest. The genes encoding carbapenemase and related structure were detected by polymerase chain reaction mapping and sequencing, and the clonal relationship of the isolates was analyzed by pulsed-field gel electrophoresis. Plasmid localization of bla OxA-23 was determined by extraction of plasmid with commercial kit and Southern blot analysis. Results Among 142 IRAB isolates, 30 harbored the bla OxA-23. The prevalence of IRAB with bla OxA-23 was highest in central Taiwan compared to other areas [24.8% (27/109) vs. 1.6% (3/182); p bla OxA-23 were also resistant to other antimicrobial agents, except colistin. The PCR methods showed the presence of bla OxA-51 in all isolates. We could exclude clonal spreading due to the diversity of the pulsotype. The bla OxA-23 gene was detected in the plasmids of 6 isolates. Tn 2006 was present in 22 (73.3%) isolates, and Tn 2008 , in 6 other isolates (26.7%). Two strains had bla oxa-23 –ΔATPase but lacked upstream IS Aba1 . Conclusion The high prevalence of bla OxA-23 -harboring IRAB in central Taiwan might be attributed to the transposition event of Tn 2006 .
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19. Fluoroquinolone prescribing in Taiwan, 2000 to 2010
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Shu-Man Shih, Chao A. Hsiung, Yee-Chun Chen, Shu-Chen Kuo, and Tsai-Ling Lauderdale
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Microbiology (medical) ,Infectious Diseases ,General Immunology and Microbiology ,business.industry ,Immunology and Microbiology(all) ,Immunology and Allergy ,Medicine ,General Medicine ,business - Full Text
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