119 results on '"Shu-Chen Kuo"'
Search Results
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
- Published
- 2019
11. 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
12. 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
13. 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
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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
14. [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
15. 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
16. 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
17. 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
18. 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
19. 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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20. 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
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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.
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- 2020
21. 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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22. 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
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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
23. 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
24. Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study
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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
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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.
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- 2018
25. 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
26. Association between influenza vaccination and reduced risks of major adverse cardiovascular events in elderly patients
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Hau-Hsin Wu, Chia-Jen Shih, Yung Tai Chen, Ming-Hsien Chiang, Te-Li Chen, and Shu-Chen Kuo
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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.
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- 2017
27. Effects of a Multifaceted Intervention Program on the Eating Ability of Nursing Home Residents
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Yueh-Juen Hwu, Chia-Hui Chiu, Shu-Chen Kuo, and Mei-Ling Chen
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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.
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- 2021
28. Verapamil Use Is Associated With Reduction of Newly Diagnosed Diabetes Mellitus
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Yung Tai Chen, Ti Yin, Kai-Wei Katherine Wang, Shu-Chen Kuo, and Yea-Yuan Chang
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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.
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- 2017
29. An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution
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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
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- 2017
30. A Supramolecular Trap to Increase the Antibacterial Activity of Colistin
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Chun-Jen Su, Shu-Chen Kuo, Te-Haw Wu, U-Ser Jeng, Fang-Hsuean Liao, Chun-Nien Yao, and Shu-Yi Lin
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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.
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- 2019
31. Molecular Epidemiology of Emerging Carbapenem Resistance in Acinetobacter nosocomialis and Acinetobacter pittii in Taiwan, 2010 to 2014
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Jui-Fen Lai, Huey-Kang Sytwu, Yu-Chieh Liao, Wei-Cheng Huang, Tsai-Ling Lauderdale, Hui-Ying Wang, Feng-Jui Chen, and Shu-Chen Kuo
- Subjects
Acinetobacter baumannii ,medicine.drug_class ,Antibiotics ,carbapenem resistance ,Taiwan ,mechanism ,Microbial Sensitivity Tests ,Integron ,beta-Lactamases ,Epidemiology and Surveillance ,Microbiology ,03 medical and health sciences ,Plasmid ,Antibiotic resistance ,Bacterial Proteins ,Drug Resistance, Bacterial ,polycyclic compounds ,medicine ,Humans ,Pharmacology (medical) ,Longitudinal Studies ,030304 developmental biology ,Pharmacology ,Molecular Epidemiology ,0303 health sciences ,Acinetobacter pittii ,Acinetobacter ,Whole Genome Sequencing ,biology ,Molecular epidemiology ,030306 microbiology ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,Carbapenems ,biology.protein ,Acinetobacter nosocomialis ,Genome, Bacterial ,Acinetobacter Infections ,Plasmids - Abstract
This study investigated the molecular epidemiology of carbapenem-resistant Acinetobacter nosocomialis and Acinetobacter pittii (ANAP). Clinical isolates of Acinetobacter spp., This study investigated the molecular epidemiology of carbapenem-resistant Acinetobacter nosocomialis and Acinetobacter pittii (ANAP). Clinical isolates of Acinetobacter spp. collected by the biennial nationwide Taiwan Surveillance of Antimicrobial Resistance program from 2010 to 2014 were subjected to species identification, antimicrobial susceptibility testing, and PCR for detection of carbapenemase genes. Whole-genome sequencing or PCR mapping was performed to study the genetic surroundings of the carbapenemase genes. Among 1,041 Acinetobacter isolates, the proportion of ANAP increased from 11% in 2010 to 22% in 2014. The rate of carbapenem resistance in these isolates increased from 7.5% (3/40) to 22% (14/64), with a concomitant increase in their resistance to other antibiotics. The blaOXA-72 and blaOXA-58 genes were highly prevalent in carbapenem-resistant ANAP. Various genetic structures were found upstream of blaOXA-58 in different plasmids. Among the plasmids found to contain blaOXA-72 flanked by XerC/XerD, pAB-NCGM253-like was identified in 8 of 10 isolates. Conjugations of plasmids carrying blaOXA-72 or blaOXA-58 to A. baumannii were successful. In addition, three isolates with chromosome-located blaOXA-23 embedded in AbGRI1-type structure with disruption of genes other than comM were detected. Two highly similar plasmids carrying class I integron containing blaIMP-1 and aminoglycoside resistance genes were also found. The universal presence of blaOXA-272/213-like on A. pittii chromosomes and their lack of contribution to carbapenem resistance indicate its potential to be a marker for species identification. The increase of ANAP, along with their diverse mechanisms of carbapenem resistance, may herald their further spread and warrants close monitoring.
- Published
- 2019
32. Use of lipid-lowering agents is not associated with improved outcomes for tuberculosis patients on standard-course therapy: A population-based cohort study
- Author
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Yea Yuan Chang, Shu-Chen Kuo, Pei Wen Chao, and Yung Tai Chen
- Subjects
0301 basic medicine ,Male ,Bacterial Diseases ,Antitubercular Agents ,Fibrate ,Biochemistry ,Geographical Locations ,Cohort Studies ,Outcome Assessment, Health Care ,Medicine and Health Sciences ,Hypolipidemic Agents ,education.field_of_study ,Multidisciplinary ,Pharmaceutics ,Incidence (epidemiology) ,Incidence ,Fibric Acids ,Drugs ,Middle Aged ,Lipids ,Actinobacteria ,Infectious Diseases ,Research Design ,Cohort ,Tuberculosis Diagnosis and Management ,Medicine ,Drug Therapy, Combination ,Female ,Cohort study ,Research Article ,medicine.medical_specialty ,Tuberculosis ,Statin ,Asia ,medicine.drug_class ,Science ,030106 microbiology ,Population ,Taiwan ,Research and Analysis Methods ,03 medical and health sciences ,Drug Therapy ,Diagnostic Medicine ,Internal medicine ,medicine ,Humans ,education ,Tuberculosis, Pulmonary ,Aged ,Retrospective Studies ,Pharmacology ,Bacteria ,business.industry ,Statins ,Organisms ,Biology and Life Sciences ,medicine.disease ,Tropical Diseases ,Clinical trial ,030104 developmental biology ,People and Places ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Mycobacterium Tuberculosis - Abstract
ObjectivesAnimal and ex vitro studies suggested lipid-lowering agents (LLAs) may be used as an adjunct to standard anti- tuberculosis (TB) treatment. No human study has been conducted to date. Using the Taiwan National Health Insurance Research Database (NHIRD), the current population-based cohort study sought to examine the association between use of LLAs and outcomes of patients with pulmonary TB receiving anti-TB treatment.MethodsUsing a NHIRD from 2003 to 2010, this population-based cohort study retrospectively examined the association between LLAs (statins or fibrates) and the outcomes of patients with pulmonary TB receiving anti-TB treatment.ResultsA total of 1452 adult patients newly diagnosed with pulmonary TB during the study period were identified and compared with 5808 matched patients. In the LAA cohort, 1258 received statin, and 295 received fibrate. Compared with patients who did not take LLA, patients who took oral LLAs had similar incidence of treatment completion at 9, 12, and 24 months.ConclusionsNeither statins nor fibrates provide clinical benefit superior to that achieved with standard anti-tuberculosis treatment. Future clinical trials should investigate the effects of statins and fibrates on short-course standard anti-TB therapy.
- Published
- 2019
33. 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 Tai Chen, Shu-Chen Kuo, Chao A. Hsiung, Yung-Chih Wang, and Shu-Man Shih
- Subjects
medicine.medical_specialty ,Population ,Taiwan ,bloodstream infection ,intensive care unit ,healthcare costs ,law.invention ,Cohort Studies ,law ,Sepsis ,Intensive care ,Health care ,medicine ,Humans ,education ,Retrospective Studies ,Cross Infection ,education.field_of_study ,business.industry ,Mortality rate ,Retrospective cohort study ,General Medicine ,Length of Stay ,mortality ,Intensive care unit ,hospital stay ,Intensive Care Units ,Infectious Diseases ,Emergency medicine ,Cohort ,Medicine ,business ,Hospital stay - Abstract
ObjectivesTo estimate the clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan.DesignRetrospective cohort study.SettingNationwide Taiwanese population in the National Health Insurance Research Database and the Taiwan Nosocomial Infections Surveillance (2007–2015) dataset.ParticipantsThe first episodes of intensive care unit-acquired bloodstream infections in patients ≥20 years of age in the datasets. 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.Primary and secondary outcome measuresThe mortality rate, length of hospitalisation and healthcare cost.ResultsAfter matching, the in-hospital mortality of 14 234 patients with intensive care unit-acquired bloodstream infections was 44.23%, compared with 33.48% for 28 468 intensive care unit patients without infections. The 14-day mortality rate was also higher in the bloodstream infections cohort (4323, 30.37% vs 6766 deaths, 23.77%, respectively; pCandida spp.ConclusionsIntensive care unit-acquired bloodstream infections in critically ill patients were associated with increased mortality, longer hospital stays and higher healthcare costs.
- Published
- 2020
34. Dipeptidyl peptidase-4 inhibitors and cardiovascular risks in patients with pre-existing heart failure
- Author
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Hung Ta Chen, Shu-Chen Kuo, Yung Tai Chen, Tzeng Ji Chen, Chia Jen Shih, and Shuo Ming Ou
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Dipeptidyl Peptidase 4 ,Population ,Myocardial Infarction ,Taiwan ,030204 cardiovascular system & hematology ,Risk Assessment ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Propensity Score ,education ,Stroke ,Aged ,Proportional Hazards Models ,Cause of death ,Heart Failure ,Dipeptidyl-Peptidase IV Inhibitors ,education.field_of_study ,business.industry ,Incidence ,Middle Aged ,Protective Factors ,medicine.disease ,Hospitalization ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Heart failure ,Cohort ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
Background Although recent clinical trials raised concerns about the risk for heart failure (HF) in dipeptidyl peptidase-4 (DPP-4) inhibitor use, data on the cardiovascular risks in the patients with pre-existing HF are still lacking. Methods We used Taiwan9s National Health Insurance Research Database to identify 196 986 patients diagnosed with type 2 diabetes mellitus (T2DM) who had previous history of HF between 2009 and 2013. This population included 30 204 DPP-4 inhibitor users and 166 782 propensity score-matched DPP-4 inhibitor non-users. The outcomes of interest were all-cause mortality, combination of myocardial infarction (MI) and ischaemic stroke, and hospitalisation for HF. Results The incidence in DPP-4 users compared with non-users was 67.02 vs 102.85 per 1000 person-years for all-cause mortality, 37.89 vs 47.54 per 1000 person-years for the combination of MI and ischaemic stroke, 12.70 vs 16.18 per 1000 person-years for MI and 26.37 vs 32.46 per 1000 person-years for ischaemic stroke. The risk of all-cause mortality was lower in DPP-4 inhibitor users (HR 0.67, 95% CI 0.64 to 0.70), combination of MI and stroke (HR 0.81, 95% CI 0.76 to 0.87), MI (HR 0.80, 95% CI 0.71 to 0.89) and ischaemic stroke (HR 0.83, 95% CI 0.76 to 0.89) than in non-users. Notably, the risk of hospitalisation for HF did not differ significantly between groups. The results were similar after accounting for death as a competing risk. Conclusions In this nationwide T2DM cohort, the risks of mortality and the combination of MI and ischaemic stroke were lower for patients receiving DPP-4 inhibitors than for those who did not receive such treatment. DPP-4 inhibitor use was not associated with a higher risk of hospitalisation for HF even in patients with pre-existing HF.
- Published
- 2016
35. Individual or Combined Effects of Meropenem, Imipenem, Sulbactam, Colistin, and Tigecycline on Biofilm-Embedded Acinetobacter baumannii and Biofilm Architecture
- Author
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Ya-Sung Yang, Ming-Fen Chuang, Shu-Chen Kuo, Chun-Hsiang Chiu, Yi-Tzu Lee, Te-Li Chen, Jung-Chung Lin, Yung-Chih Wang, and Feng-Yee Chang
- Subjects
Acinetobacter baumannii ,0301 basic medicine ,Imipenem ,030106 microbiology ,Minocycline ,Microbial Sensitivity Tests ,Tigecycline ,Clinical Therapeutics ,Meropenem ,Microbiology ,03 medical and health sciences ,Drug Resistance, Bacterial ,polycyclic compounds ,medicine ,Humans ,Pharmacology (medical) ,Pharmacology ,biology ,Colistin ,Chemistry ,Biofilm ,Drug Synergism ,Sulbactam ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,Antimicrobial ,biology.organism_classification ,Anti-Bacterial Agents ,Drug Combinations ,Infectious Diseases ,Carbapenems ,Biofilms ,bacteria ,Thienamycins ,Acinetobacter Infections ,medicine.drug - Abstract
Acinetobacter baumannii biofilms are difficult to eradicate. We investigated the effects of meropenem (2 mg/liter), imipenem (2 mg/liter), sulbactam (4 mg/liter), colistin (2 mg/liter), and tigecycline (2 mg/liter), alone or in combination, on biofilm-embedded carbapenem-resistant and carbapenem-susceptible A. baumannii (CRAb and CSAb, respectively) cells, as well as on the architecture of the biofilms. A. baumannii ATCC 15151 (Ab15151) and its OXA-82-overproducing transformant, along with two clinical CSAb and two clinical CRAb isolates of differing clonalities, were used. The minimal bactericidal concentrations for biofilm-embedded cells of the six tested isolates were >50-fold those of their planktonic cells. When used individually, meropenem exhibited a higher killing effect than the other four antimicrobials on biofilm-embedded CSAb cells in the colony biofilm assay. For two clinical CRAb isolates, meropenem plus sulbactam or sulbactam plus tigecycline showed >100-fold the bactericidal effect exhibited by these agents used alone after 48 h of treatment. The effect of antimicrobials on the architecture of Ab15151 biofilm emitting green fluorescence was determined by confocal laser scanning microscopy using COMSTAT software. Significant decreases in the maximum biofilm thickness were observed after exposure to meropenem and imipenem. Meropenem plus sulbactam significantly decreased the biomass and mean thickness and increased the roughness coefficient of biofilms, but sulbactam plus tigecycline only decreased the maximum and mean biofilm thickness compared to any of these agents used alone. Meropenem was active against biofilm-embedded CSAb, whereas meropenem plus sulbactam exhibited synergism against biofilm-embedded CRAb and caused significantly more damage to the biofilm architecture than did any of the agents used alone.
- Published
- 2016
36. Association Between Use of Dipeptidyl Peptidase-4 Inhibitors and the Risk of Acute Kidney Injury: A Nested Case-Control Study
- Author
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Shuo-Ming Ou, Yuan-Hao Lo, Chia-Jen Shih, Shu-Chen Kuo, Yi-Jung Lee, and Yung Tai Chen
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Taiwan ,Administration, Oral ,Comorbidity ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Hypoglycemic Agents ,Longitudinal Studies ,030212 general & internal medicine ,Intensive care medicine ,Aged ,Dipeptidyl-Peptidase IV Inhibitors ,business.industry ,Acute kidney injury ,Case-control study ,General Medicine ,Odds ratio ,Acute Kidney Injury ,medicine.disease ,Diabetes Mellitus, Type 2 ,Case-Control Studies ,Nested case-control study ,Cohort ,Female ,Risk assessment ,business - Abstract
Objective To examine the risk of acute kidney injury (AKI) in a nationwide cohort of patients with type 2 diabetes initiating dipeptidyl peptidase-4 (DPP-4) inhibitors. Patients and Methods This nested case-control study of a cohort of adult DPP-4 inhibitor users with type 2 diabetes who were hospitalized for AKI between January 1, 2010, and December 31, 2013, was conducted using Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, urbanization level, monthly income, comorbidity severity, and well-known predisposing factors for AKI. Odds ratios (ORs) for AKI were calculated according to current, recent, or past use of DPP-4 inhibitors. Results A total of 6752 cases with AKI and 6752 matched controls were analyzed. The exposure prevalence of DPP-4 inhibitor use in the previous year was higher among patients with AKI (adjusted OR, 1.20; 95% CI, 1.05-1.36; P =.006). In a stratified analysis, the association was significant for current DPP-4 inhibitor use (adjusted OR, 1.26; 95% CI, 1.08-1.48; P =.004), but not for recent or past use. Conclusion In this large contemporary cohort, DPP-4 inhibitor users had an increased risk of AKI development compared with nonusers. Further research is warranted to investigate the mechanism underlying this association.
- Published
- 2016
37. Long-Term Outcomes in Critically Ill Septic Patients Who Survived Cardiopulmonary Resuscitation*
- Author
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Yu Ning Shih, Chia Jen Shih, Shu-Chen Kuo, Hsi Ning Chu, Shuo Ming Ou, Szu Yuan Li, Yung Tai Chen, and Pei Wen Chao
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Critical Illness ,medicine.medical_treatment ,Taiwan ,Comorbidity ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Sepsis ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Long term outcomes ,medicine ,Humans ,Hospital Mortality ,Cardiopulmonary resuscitation ,Intensive care medicine ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Critically ill ,Age Factors ,030208 emergency & critical care medicine ,Middle Aged ,Prognosis ,medicine.disease ,Cardiopulmonary Resuscitation ,Heart Arrest ,Survival Rate ,Cohort ,Female ,Observational study ,business - Abstract
To evaluate the long-term survival rate of critically ill sepsis survivors following cardiopulmonary resuscitation on a national scale.Retrospective and observational cohort study.Data were extracted from Taiwan's National Health Insurance Research Database.A total of 272,897 ICU patients with sepsis were identified during 2000-2010. Patients who survived to hospital discharge were enrolled. Post-discharge survival outcomes of ICU sepsis survivors who received cardiopulmonary resuscitation were compared with those of patients who did not experience cardiopulmonary arrest using propensity score matching with a 1:1 ratio.None.Only 7% (n = 3,207) of sepsis patients who received cardiopulmonary resuscitation survived to discharge. The overall 1-, 2-, and 5-year postdischarge survival rates following cardiopulmonary resuscitation were 28%, 23%, and 14%, respectively. Compared with sepsis survivors without cardiopulmonary arrest, sepsis survivors who received cardiopulmonary resuscitation had a greater risk of all-cause mortality after discharge (hazard ratio, 1.38; 95% CI, 1.34-1.46). This difference in mortality risk diminished after 2 years (hazard ratio, 1.11; 95% CI, 0.96-1.28). Multivariable analysis showed that independent risk factors for long-term mortality following cardiopulmonary resuscitation were male sex, older age, receipt of care in a nonmedical center, higher Charlson Comorbidity Index score, chronic kidney disease, cancer, respiratory infection, vasoactive agent use, and receipt of renal replacement therapy during ICU stay.The long-term outcome was worse in ICU survivors of sepsis who received in-hospital cardiopulmonary resuscitation than in those who did not, but this increased risk of mortality diminished at 2 years after discharge.
- Published
- 2016
38. Risk factors and clinical outcome of sulbactam nonsusceptibility in monomicrobial Acinetobacter nosocomialis bacteremia
- Author
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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
- Subjects
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.
- Published
- 2016
39. Angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and the risk of major adverse cardiac events in patients with diabetes and prior stroke
- Author
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Shu-Chen Kuo, Chia Jen Shih, Der Cherng Tarng, Chih Yu Yang, Szu Yuan Li, Yung Tai Chen, Shuo Ming Ou, Hung Ta Chen, and Pei Wen Chao
- Subjects
Male ,Risk ,medicine.medical_specialty ,Databases, Factual ,Hyperkalemia ,Physiology ,Myocardial Infarction ,Taiwan ,Angiotensin-Converting Enzyme Inhibitors ,Comorbidity ,030204 cardiovascular system & hematology ,Cohort Studies ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aged ,Proportional Hazards Models ,biology ,business.industry ,Acute kidney injury ,Angiotensin-converting enzyme ,Acute Kidney Injury ,Middle Aged ,medicine.disease ,Intention to Treat Analysis ,Hospitalization ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Hypertension ,biology.protein ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Renin-angiotensin-aldosterone system blockers are the preferred antihypertensive medications in patients with diabetes and prior stroke. This study aimed to compare the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in terms of major adverse cardiac events (MACEs) in patients with diabetes who survived ischemic stroke.We conducted an observational, nationwide, propensity score-matched cohort study using Taiwan's National Health Insurance Research Database. Patients aged at least 20 years with type 2 diabetes who initiated ACEI (n = 15,959) or ARB (n = 23,929) use within 90 days after discharge for first ischemic stroke between January 2000 and December 2011 were allocated to ACEI and ARB groups, respectively. The primary outcomes were MACEs (myocardial infarction, ischemic stroke, and cardiovascular mortality). The secondary outcomes were hospitalization for acute kidney injury and hyperkalemia. Intention-to-treat and as-treated models were used.Intention-to-treat analysis showed no significant difference between the ACEI and ARB groups in the outcomes of MACEs [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.95-1.04], including ischemic stroke (HR, 1.01; 95% CI, 0.97-1.06), myocardial infarction (HR, 1.06; 95% CI, 0.95-1.18), and cardiovascular mortality (HR, 0.98; 95% CI, 0.91-1.06). As-treated analysis produced similar results. Additionally, the groups showed no difference in the risk of hospitalization for acute kidney injury or hyperkalemia.Our study supports the hypothesis that the risks of MACEs and two additional secondary outcomes in patients with diabetes who survived ischemic stroke did not differ according to ACEI versus ARB use.
- Published
- 2016
40. Risks of Death and Stroke in Patients Undergoing Hemodialysis With New-Onset Atrial Fibrillation
- Author
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Shuo Ming Ou, Der Cherng Tarng, Chia Jen Shih, Szu Yuan Li, Yi Jung Lee, Chih Ching Lin, Shu-Chen Kuo, Pei Wen Chao, Chih Yu Yang, Po Hsun Huang, and Yung Tai Chen
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Statistics as Topic ,Taiwan ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Competing risks ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Risk Factors ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,In patient ,Hospital Mortality ,Intensive care medicine ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Middle Aged ,medicine.disease ,New onset atrial fibrillation ,Population Surveillance ,Cohort ,Oral anticoagulant ,Female ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— Whether oral anticoagulant use should be considered in patients undergoing hemodialysis with atrial fibrillation (AF) remains controversial because of the uncertainty regarding risk-benefit assessments. The purpose of this study was to investigate the risk of ischemic stroke in patients undergoing hemodialysis with new-onset AF, in comparison with those without arrhythmia. Methods and Results— This nationwide, population-based, propensity score–matched cohort study used data from Taiwan’s National Health Insurance Research Database during 1998 to 2011 for patients on hemodialysis with new-onset nonvalvular AF and matched subjects without arrhythmia. The clinical end points were ischemic stroke (fatal or nonfatal), all-cause death, and other serious adverse cardiovascular events. In comparison with the matched cohort, patients with AF (n=6772) had higher risks of ischemic stroke (adjusted hazard ratio [aHR], 1.27; 95% confidence interval [CI], 1.13–1.43), all-cause death (aHR, 1.59; 95% CI, 1.52–1.67), in-hospital cardiovascular death (aHR, 1.83; 95% CI, 1.71–1.94), myocardial infarction (aHR, 1.33; 95% CI, 1.17–1.51), and hospitalization for heart failure (aHR, 1.90; 95% CI, 1.76–2.05). After considering in-hospital death as a competing risk, AF significantly increased the risk of heart failure (HR, 1.56; 95% CI, 1.45–1.68), but not those of ischemic stroke and myocardial infarction. Additionally, the predictive value of the CHA 2 DS 2 –VASc score for ischemic stroke was diminished in the competing-risk model. Conclusions— The risk of stroke was only modestly higher in patients undergoing hemodialysis with new-onset AF than in those without AF, and it became insignificant when accounting for the competing risk of in-hospital death.
- Published
- 2016
41. Association between comorbidities and dementia in diabetes mellitus patients: population-based retrospective cohort study
- Author
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Chih-Hsin Muo, Shieh-Liang Chen, Fung-Chung Sung, Yueh-Juen Hwu, Shih-Wei Lai, Chia-Wei Chang, Ling-Ling Liu, Shih-Chang Hung, Shu-Chen Kuo, and Hung-Chang Hung
- Subjects
Male ,medicine.medical_specialty ,National Health Programs ,Endocrinology, Diabetes and Metabolism ,Taiwan ,Comorbidity ,Kaplan-Meier Estimate ,Cohort Studies ,Diabetes Complications ,Coronary artery disease ,Endocrinology ,Risk Factors ,Internal medicine ,Diabetes mellitus ,mental disorders ,Prevalence ,Internal Medicine ,Electronic Health Records ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,Dementia ,Longitudinal Studies ,Stroke ,Proportional Hazards Models ,Retrospective Studies ,business.industry ,Incidence ,Age Factors ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Cohort ,Physical therapy ,Female ,business ,Kidney disease - Abstract
Aims Most diabetes mellitus (DM) patients have several comorbidities; the correlation of these comorbidities with dementia in DM requires clarification. Methods Using claims data from Taiwan National Health Insurance, we identified 33,709 DM adults before the year 2000 and randomly selected 67,066 non-DM patients matched by sex and age. Subjects were followed until diagnosis with dementia, excluded due to death/withdrawal from the insurance program, or followed until 2011. We compared the incidence and hazard ratio (HR) for dementia in both cohorts. Results Comorbidities were more prevalent in DM patients, including hypertension, hyperlipidemia, stroke, coronary artery and/or kidney disease. The HR was higher for the DM cohort with comorbidities than those without: 1.88 vs. 1.46 with hypertension; 1.56 vs. 1.39 with hyperlipidemia; 1.73 vs. 1.37 with coronary artery disease; 2.36 vs. 2.29 with stroke and 1.88 vs. 1.50 with kidney disease. The HR for dementia in diabetics rose from 1.41 in those without comorbidities to 2.49 in those with ≥ 4 comorbidities. In the DM cohort, HR was 1.22 for non-insulin-users and 1.41 for insulin-users, and 1.49 for type 1 DM and 1.23 for type 2 DM. Conclusion Diabetic patients have an elevated risk of dementia, and comorbidity increases this risk.
- Published
- 2015
42. Sensitivity and specificity of Matrix-Associated Laser Desorption/Ionization – Time of Flight Mass Spectrometry (MALDI-TOF MS) in discrimination at species level for Acinetobacter bacteremia
- Author
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Shu-Chen Kuo, Sophie Collier, Ya-Sung Yang, Po-Yu Liu, Te-Li Chen, Chin-Fu Lin, Zi-Yuan Shi, Yi-Tzu Lee, and Meng-San Wu
- Subjects
Acinetobacter baumannii ,0301 basic medicine ,Microbiology (medical) ,030106 microbiology ,Bacteremia ,Sensitivity and Specificity ,Microbiology ,Matrix (chemical analysis) ,03 medical and health sciences ,parasitic diseases ,Multiplex polymerase chain reaction ,Humans ,Molecular Biology ,Acinetobacter pittii ,Chromatography ,biology ,Chemistry ,biochemical phenomena, metabolism, and nutrition ,Acinetobacter ,bacterial infections and mycoses ,biology.organism_classification ,Matrix-assisted laser desorption/ionization ,Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ,Time-of-flight mass spectrometry ,Acinetobacter Infections ,Acinetobacter nosocomialis - Abstract
We aimed to establish the role of MALDI-TOF MS on species discrimination of phenotypically indistinguishable A. baumannii, A. pittii and A. nosocomialis. Compared to multiplex PCR, the gold standard, MALDI-TOF MS yielded a high sensitivity for A. baumannii (97.9%) and specificity for A. pittii (98.9%) and A. nosocomialis (100%).
- Published
- 2017
43. Multicentre study of risk factors for mortality in patients with Acinetobacter bacteraemia receiving colistin treatment
- Author
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Te-Li Chen, Ya-Sung Yang, Shu-Chen Kuo, Yi-Tzu Lee, Yung-Chih Wang, Jun-Ren Sun, and Chun-Hsiang Chiu
- Subjects
Acinetobacter baumannii ,Male ,0301 basic medicine ,Antibiotics ,Bacteremia ,Comorbidity ,0302 clinical medicine ,Risk Factors ,polycyclic compounds ,Pharmacology (medical) ,030212 general & internal medicine ,Aged, 80 and over ,Acinetobacter ,biology ,Mortality rate ,General Medicine ,Middle Aged ,Prognosis ,Antimicrobial ,Anti-Bacterial Agents ,Treatment Outcome ,Infectious Diseases ,Female ,lipids (amino acids, peptides, and proteins) ,Acinetobacter Infections ,medicine.drug ,Acinetobacter nosocomialis ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,030106 microbiology ,Microbial Sensitivity Tests ,03 medical and health sciences ,Internal medicine ,Drug Resistance, Bacterial ,Operon ,medicine ,Humans ,Aged ,Retrospective Studies ,Colistin ,business.industry ,biochemical phenomena, metabolism, and nutrition ,equipment and supplies ,bacterial infections and mycoses ,biology.organism_classification ,Action study ,business ,Genome, Bacterial - Abstract
Colistin remains a last-line antibiotic for the treatment of infections by multidrug-resistant Acinetobacter species. However, mortality rates are high in patients with Acinetobacter infection receiving colistin treatment. This multicentre study evaluated whether colistin susceptibility, additional antimicrobial agents or other prognostic factors influenced the clinical outcomes of patients receiving colistin treatment for Acinetobacter bacteraemia. This retrospective study enrolled 122 adults receiving colistin for monomicrobial Acinetobacter bacteraemia at six medical centres in the ACTION Study Group over an 8-year period. Clinical information, antimicrobial susceptibility and colistin resistance determinants were analysed. The primary outcome measure was 14-day mortality. Among 122 patients, 18 and 104 were infected with colistin-resistant (ColR) isolates [minimum inhibitory concentration (MIC) ≥4 mg/L] and colistin-susceptible (ColS) isolates (MIC ≤2 mg/L), respectively. Patients infected with ColR and ColS isolates did not differ significantly with regard to Charlson comorbidity index, invasive procedures, sources of bacteraemia, disease severity and 14-day mortality rate (44.4% vs. 34.6%; P = 0.592). No specific additional antimicrobial agent was independently associated with higher or lower mortality. Coronary artery disease, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and bacteraemia caused Acinetobacter baumannii were independent risk factors associated with 14-day mortality. Mechanisms of colistin resistance were associated with amino acid variants in the pmrCAB operon. Finally, previously unreported Acinetobacter nosocomialis amino acid variants related to colistin resistance were identified. In conclusion, colistin susceptibility and colistin combination antimicrobial treatment were not associated with decreased 14-day mortality in patients with Acinetobacter bacteraemia receiving colistin treatment.
- Published
- 2020
44. Activity of ceftolozane-tazobactam against Gram-negative pathogens isolated from lower respiratory tract infections in the Asia-Pacific region: SMART 2015-2016
- Author
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Fu-Der Wang, Po-Liang Lu, Chun-Eng Liu, Min-Chi Lu, Wen Chien Ko, Shu-Chen Kuo, Yin Ching Chuang, Po-Ren Hsueh, and Yao-Shen Chen
- Subjects
0301 basic medicine ,Microbiology (medical) ,Tazobactam ,Asia ,Klebsiella pneumoniae ,030106 microbiology ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Enterobacteriaceae ,Escherichia coli ,polycyclic compounds ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Respiratory Tract Infections ,biology ,Broth microdilution ,General Medicine ,biochemical phenomena, metabolism, and nutrition ,bacterial infections and mycoses ,biology.organism_classification ,Anti-Bacterial Agents ,Cephalosporins ,Acinetobacter baumannii ,Infectious Diseases ,Amikacin ,Pseudomonas aeruginosa ,Colistin ,bacteria ,Ceftolozane ,Gram-Negative Bacterial Infections ,Enterobacter cloacae ,medicine.drug - Abstract
The aim of this study was to investigate the susceptibility of respiratory Gram-negative bacteria to ceftolozane/tazobactam and other antibiotics in the Asia-Pacific region during 2015-2016. MICs were determined using the CLSI standard broth microdilution method and interpreted accordingly. Pseudomonas aeruginosa (1574 isolates), Klebsiella pneumoniae (1226), Acinetobacter baumannii (627) and Escherichia coli (476) accounted for 73.1% of 5342 Gram-negative respiratory pathogens. Susceptibility to ceftolozane/tazobactam of individual Enterobacteriaceae was >80%, except for Enterobacter cloacae (76.6%). Ceftolozane/tazobactam inhibited 81.9% of K. pneumoniae and 91.9% of E. coli, with respective MIC50/MIC90 values of 0.5/>32 and 0.25/2 mg/L. For carbapenem-susceptible, ESBL-producing K. pneumoniae and E. coli, susceptibility was 65.5% and 93.3%, respectively, and respective MIC50/MIC90 values were 2/>32 and 0.5/2 mg/L. BlaCTX-M-1 group was most prevalent in selected ESBL-producing K. pneumoniae (40 of 54 isolates) and E. coli (15 of 22 isolates), with ceftolozane/tazobactam susceptibility rates of 50% and 80%, respectively. BlaSHV-ESBL was the second most prevalent, and ceftolozane/tazobactam inhibited 20% of 20 K. pneumoniae isolates with blaSHV-ESBL. The only effective antibiotics for carbapenem-non-susceptible K. pneumoniae (111 isolates) and E. coli (24 isolates) were amikacin and colistin. Ceftolozane/tazobactam was effective against almost all tested P. aeruginosa and carbapenem-non-susceptible strains, with susceptibility of 92.3% and 72.8%, respectively; the respective MIC50/MIC90 values were 1/4 and 2/>32 mg/L. The high susceptibility of ceftolozane/tazobactam remained in different age groups, patient locations, recovery times and countries, except Vietnam. In conclusion, ceftolozane/tazobactam was effective against most respiratory Gram-negative pathogens in the Asia-Pacific region; however, the emergence of carbapenem resistance mandates ongoing surveillance.
- Published
- 2020
45. [Hyperbaric Oxygen Therapy and Acute Carbon Monoxide Poisoning]
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Shu-Chen, Kuo, Chien-Kang, Hsu, Chien-Tsung, Tsai, and Min-Jung, Chieh
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Carbon Monoxide Poisoning ,Hyperbaric Oxygenation ,Humans ,Emergency Nursing - Abstract
Carbon monoxide poisoning is the most commonly seen cause of poisoning in the emergency room (ER). The high affinity between carbon monoxide and hemoglobin and their complex biological characteristics greatly increase the risks of cardiac, nervous, muscular, and kidney diseases. In severe cases, patients may lose consciousness or die in just a few minutes. In recent years, hyperbaric oxygen therapy has been applied extensively in patients with severe conditions such as carbon monoxide poisoning and cerebral hypoxia. Hyperbaric oxygen accelerates the decomposition of carbon monoxide in hemoprotein. Therefore, treating patients with similar conditions in the ER with hyperbaric oxygen as soon as possible will improve their cognitive disorder and postpone their neuropsychological sequelae. ER nurses typically play a decisive role in saving patients with carbon monoxide poisoning. This research scrutinizes a case analysis of using hyperbaric oxygen to treat carbon monoxide poisoning and offers general rules for the use of hyperbaric oxygen. Further, the research elaborates from the perspective of ER nursing staffs the management and care of acute carbon monoxide poisoning and hyperbaric oxygen therapy nursing care. The aim of this research is to offer references for members of the ER nursing team and to enable this team to provide accurate and effective medical measures to patients during the "golden hours" of nursing care. Achieving this will help ensure that patients receive comprehensive nursing and care, thus reducing the harm suffered by patients and increasing the rate of survival.高壓氧治療與急性一氧化碳中毒.一氧化碳中毒是急診室最常見的中毒類型急症,因一氧化碳與血紅素具有高親和力與複雜的生物學特性,導致一氧化碳中毒會造成心臟、神經、肌肉、腎臟等組織病變,嚴重者數分鐘內失去知覺或死亡。近年來,高壓氧廣泛應用在急重症病人(如一氧化碳中毒、腦組織缺氧),因為高壓氧可以加速一氧化碳結合血紅素的分解,故這類病人送達急診室,若能盡早接受高壓氧治療,可以改善或降低認知障礙及延遲神經心理學後遺症。急診護理是影響一氧化碳中毒病人能否獲救的關鍵。本文探討高壓氧對一氧化碳中毒的實證分析,提出高壓氧的使用通則;繼而由護理人員角度闡述急性一氧化碳中毒的處置與照護,及高壓氧治療的護理,期能提供給急診照護團隊參考,在救護的黃金時刻給予正確有效的醫護措施,使病人得到完善的護理照顧,減低對病人的傷害,及提高存活率。.
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- 2018
46. Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan
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Yee-Chun Chen, Ching-Hsiung Lin, Shu-Chen Kuo, Shang-Yun Ho, Chia-Yu Chi, Sheng-Hao Lin, Shang-Ren Hsu, Shih-Li Su, Fan-Chen Tseng, Chiung-Ying Liao, Shi-Dou Lin, Yen-Po Yeh, Shu-Yi Wang, Ih-Jen Su, Ming-Chia Hsieh, Yuan-Chun Huang, Jen-Shiou Lin, Horng Yunn Dou, and Shih-Te Tu
- Subjects
Adult ,Male ,latent infection ,medicine.medical_specialty ,Tuberculosis ,030231 tropical medicine ,Taiwan ,Interferon gamma release assay ,tuberculin skin test ,Tuberculin ,interferon-gamma release assay ,03 medical and health sciences ,0302 clinical medicine ,Latent Tuberculosis ,Risk Factors ,Internal medicine ,Diabetes mellitus ,Epidemiology ,Diabetes Mellitus ,Odds Ratio ,medicine ,Humans ,030212 general & internal medicine ,Renal Insufficiency, Chronic ,Original Research ,Aged ,Glycated Hemoglobin ,Latent tuberculosis ,Tuberculin Test ,business.industry ,Incidence ,Incidence (epidemiology) ,Smoking ,Bacillus Calmette–Guérin vaccination ,General Medicine ,Middle Aged ,bacterial infections and mycoses ,medicine.disease ,Infectious Diseases ,Case-Control Studies ,BCG Vaccine ,Female ,business ,Risk assessment ,Interferon-gamma Release Tests - Abstract
ObjectiveTo investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas.DesignCommunity-based comparison study.SettingOutpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants.ParticipantsA total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic participants from the community were enrolled.Primary and secondary outcome measuresThe interferon-gamma release assay (IGRA) and the tuberculin skin test were used to detect LTBI. The IGRA result was used as a surrogate of LTBI in logistic regression analysis.ResultsDiabetes was significantly associated with LTBI (adjusted OR (aOR)=1.59; 95% CI 1.11 to 2.28) and age correlated positively with LTBI. Many subjects with diabetes also had additional risk factors (current smokers (aOR=1.28; 95% CI 0.95 to 1.71), comorbid chronic kidney disease (aOR=1.26; 95% CI 1.03 to 1.55) and history of TB (aOR=2.08; 95% CI 1.19 to 3.63)). The presence of BCG scar was protective (aOR=0.66; 95% CI 0.51 to 0.85). Duration of diabetes and poor glycaemic control were unrelated to the risk of LTBI.ConclusionThere was a moderately increased risk of LTBI in patients with diabetes from this high TB incidence area. This finding suggests LTBI screening for the diabetics be combined with other risk factors and comorbidities of TB to better identify high-risk groups and improve the efficacy of targeted screening for LTBI.
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- 2019
47. Increased mcr-1 in pathogenic Escherichia coli from diseased swine, Taiwan
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Jing-Yi Liu, Tsai-Lien Liao, Hung-Chih Kuo, Shu-Chen Kuo, Keh-Ming Wu, Tsai-Ling Lauderdale, Wei-Cheng Huang, Yen-Ming Liu, and Shih-Feng Tsai
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0301 basic medicine ,Microbiology (medical) ,Estonia ,Swine ,030106 microbiology ,Colistin resistance ,lcsh:QR1-502 ,mcr-1 ,medicine.disease_cause ,lcsh:Microbiology ,Chromosomes ,beta-Lactamases ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Plasmid ,Bacterial Proteins ,Pathogenic Escherichia coli ,Drug Resistance, Bacterial ,Pulsed-field gel electrophoresis ,medicine ,Escherichia coli ,Prevalence ,Immunology and Allergy ,Animals ,Humans ,030212 general & internal medicine ,Southern blot ,Gel electrophoresis ,Swine Diseases ,General Immunology and Microbiology ,biology ,Whole Genome Sequencing ,Colistin ,Escherichia coli Proteins ,Broth microdilution ,General Medicine ,biology.organism_classification ,Anti-Bacterial Agents ,Infectious Diseases ,MCR-1 ,hormones, hormone substitutes, and hormone antagonists ,Plasmids - 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
- Published
- 2018
48. Overexpression of AdeABC efflux pump associated with tigecycline resistance in clinical Acinetobacter nosocomialis isolates
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Jun-Ren Sun, Ya-Sung Yang, H.-S. Shang, Yi Tzu Lee, Yu-Ching Chou, Cherng-Lih Perng, C.-P. Liu, Y.-Y. Chang, W.-J. Hsu, H.-Y. Chen, Y.-M. Liu, Y.-T. Hsiao, Shu-Chen Kuo, and Te-Li Chen
- Subjects
0301 basic medicine ,Microbiology (medical) ,030106 microbiology ,Taiwan ,Tigecycline ,Microbial Sensitivity Tests ,Transcript level ,Biology ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,Bloodstream infection ,Drug Resistance, Bacterial ,medicine ,Humans ,030212 general & internal medicine ,Typing ,Amino Acid Sequence ,Gene ,Acinetobacter ,Membrane Transport Proteins ,General Medicine ,biology.organism_classification ,Acinetobacter baumannii ,Anti-Bacterial Agents ,Infectious Diseases ,Efflux ,medicine.drug ,Acinetobacter nosocomialis ,Acinetobacter Infections ,Multilocus Sequence Typing - Abstract
Objectives Tigecycline non-susceptible Acinetobacter nosocomialis (TNAN) has been discovered in clinical isolates. The resistance-nodulation-cell division (RND)-type efflux system plays a major role in tigecycline non-susceptible Acinetobacter baumannii, but the mechanism in A. nosocomialis remains unknown. Our aim was to analyse the contribution of efflux-based tigecycline resistance in clinical A. nosocomialis isolates collected from multiple medical centres in Taiwan. Methods A total of 57 A. nosocomialis isolates, including 46 TNAN and 11 tigecycline-susceptible A. nosocomialis (TSAN) isolates, were analysed. Of these, 46 TNAN isolates were clustered to ST410 (43 isolates) and ST68 (three isolates) by multi-locus sequence typing. Results The relationship between the RND efflux pump and tigecycline resistance was indirectly verified by successfully reducing tigecycline resistance with NMP, an efflux pump inhibitor. The three RND efflux systems (AdeABC, AdeIJK and AdeFGH) were detected in all clinical isolates. The transcript level of adeB gene increased significantly and was correlated with tigecycline resistance. Moreover, the AdeRS two-component system was further classified into four different types of AdeRS patterns considering the amino acid sequence. Further analysis showed that tigecycline resistance was related to the transcript level of adeB gene and the AdeRS pattern. Conclusion This study showed that the dissemination of TNAN isolates in Taiwan is attributable mainly to the spread of ST410. The AdeABC efflux pump appeared to play an important role in the tigecycline resistance of A. nosocomialis.
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- 2018
49. Effective transfer of a 47 kb NDM-1-positive plasmid amongAcinetobacterspecies
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Wei Xin Khong, Ying-Tsong Chen, Jung Jung Mu, Tsai Ling Lauderdale, Shih-Feng Tsai, Shu-Chen Kuo, Te-Li Chen, Tzu Wen Huang, Ming Chia Hsu, Tsai Lien Liao, Oon Tek Ng, Shan-Chwen Chang, and Feng-Yee Chang
- Subjects
Microbiology (medical) ,Gene Transfer, Horizontal ,Operon ,Microbial Sensitivity Tests ,medicine.disease_cause ,beta-Lactam Resistance ,beta-Lactamases ,Microbiology ,Plasmid ,Gene Order ,medicine ,Humans ,Pharmacology (medical) ,Gene ,Escherichia coli ,Pharmacology ,Genetics ,Cross Infection ,Acinetobacter pittii ,Acinetobacter ,biology ,biology.organism_classification ,Enterobacteriaceae ,Anti-Bacterial Agents ,New Delhi metallo-beta-lactamase 1 ,Infectious Diseases ,Conjugation, Genetic ,DNA Transposable Elements ,biology.protein ,Genome, Bacterial ,Acinetobacter Infections ,Plasmids - Abstract
OBJECTIVES To investigate the link between two NDM-1-positive Acinetobacter isolates from the same hospital, the plasmid profiles of the isolates were examined. These two isolates were found from a surveillance programme within 3 months from two patients without obvious physical contact or hospitalization time overlap. METHODS Antimicrobial susceptibility tests, genome sequencing of both isolates and plasmid transfer experiments were performed. A comparative study of similar plasmids was performed using BLAST analysis. RESULTS The antimicrobial susceptibility of the isolates (Acinetobacter soli M131 and Acinetobacter pittii MS32) and their Escherichia coli transconjugants revealed a conjugative plasmid that carried the carbapenem resistance determinant. Eleven plasmids were observed in M131 and three in MS32. Each isolate shared an identical plasmid that carried the blaNDM-1 gene. This 47 271 bp plasmid harbours a conserved blaNDM-1-containing region that is flanked by ISAba125 and ISAba11 elements, and also contains a Ti-type conjugative operon. The plasmid is nearly identical in sequence to those of Acinetobacter isolates from China. In contrast to the mobilization of the blaNDM-1 sequence in Enterobacteriaceae, which is mainly by transposition, this plasmid moves as a whole among Acinetobacter species. Consistently, this plasmid was found to transfer effectively by in vitro conjugation to several Acinetobacter species. CONCLUSIONS The clinical and laboratory findings suggest that Acinetobacter species may serve as a reservoir of this blaNDM-1 plasmid. Our study demonstrates the potential of applying genome sequencing to the surveillance of antimicrobial-resistant bacteria.
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- 2015
50. Efficacy of Tigecycline for Secondary Acinetobacter Bacteremia and Factors Associated with Treatment Failure
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Po-Yu Liu, Shu-Chen Kuo, Bo-Huang Liou, Yi-Tzu Lee, and Chang-Phone Fung
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Acinetobacter baumannii ,Male ,medicine.medical_specialty ,Bacteremia ,Minocycline ,Drug resistance ,Tigecycline ,Clinical Therapeutics ,Drug Resistance, Multiple, Bacterial ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,Acinetobacter calcoaceticus ,Aged ,Retrospective Studies ,Aged, 80 and over ,Pharmacology ,biology ,business.industry ,Mortality rate ,Retrospective cohort study ,Middle Aged ,Acinetobacter ,biology.organism_classification ,Antimicrobial ,medicine.disease ,Anti-Bacterial Agents ,Surgery ,Infectious Diseases ,Cohort ,Female ,business ,Acinetobacter Infections ,medicine.drug - Abstract
We describe the clinical outcome of 17 patients with secondary Acinetobacter bacteremia whose isolates had a tigecycline MIC of ≤2 mg/liter and who received tigecycline within 2 days of bacteremia onset. The 14-day mortality rate of the tigecycline cohort was 41.2% (7/17), which was significantly higher than that of those receiving other appropriate antimicrobial agents (13.8%, 9/65; P = 0.018). However, the percentages of end-stage renal disease and congestive heart failure were higher in the tigecycline cohort. The efficacy of tigecycline was contingent upon the illness severity and bacterial species. Tigecycline should be applied cautiously for treatment of Acinetobacter bacteremia.
- Published
- 2015
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