275 results on '"Yin Ching Chuang"'
Search Results
252. Corrigendum to 'Combating antimicrobial resistance: Antimicrobial stewardship program in Taiwan'
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Hsieh-Shong Leu, Kao-Pin Hwang, Shan-Chwen Chang, Yin Ching Chuang, Feng-Yee Chang, Shu Hui Tseng, Muh Yong Yen, Che Chieh Yen, Chun Ming Lee, and Tzou Yien Lin
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Microbiology (medical) ,medicine.medical_specialty ,General Immunology and Microbiology ,business.industry ,General Medicine ,University hospital ,Disease control ,humanities ,Occupational safety and health ,City hospital ,Infectious Diseases ,Immunology and Microbiology(all) ,Family medicine ,Pediatric Infectious Disease ,Immunology and Allergy ,Medicine ,Antimicrobial stewardship ,book.journal ,business ,China ,book - Abstract
Centers for Disease Control, Department of Health, Taiwan, ROC Occupational Safety and Health, Chung Shan Medical University, Taiwan, ROC Division of Infectious Diseases, Department of Internal Medicine, Mackay Memorial Hospital, Taiwan, ROC Mackay Medicine, Nursing and Management College, Taiwan, ROC Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taiwan, ROC Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taiwan, ROC g Superintendent Office, Chi Mei Hospital, Liouying, Taiwan, ROC Division of Infectious Diseases, Department of Internal Medicine, Taipei City Hospital, National Yang-Ming University, Taipei, Taiwan, ROC Division of Pediatric Infectious Diseases, Department of Pediatrics, China Medical University Hospital and China Medical University School of Medicine, Taichung, Taiwan, ROC Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC k School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC Department of Internal Medicine, National Defense Medical Center, Taiwan, ROC
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253. First description of lung abscess caused by ST23 clone capsule genotype K1 Klebsiella pneumoniae
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Mei Feng Lee, Yin Ching Chuang, Kuo Chen Cheng, and Wen Liang Yu
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Medicine(all) ,lcsh:R5-920 ,biology ,business.industry ,Klebsiella pneumoniae ,Clone (cell biology) ,Capsule ,Lung abscess ,General Medicine ,medicine.disease ,biology.organism_classification ,Microbiology ,Genotype ,medicine ,business ,lcsh:Medicine (General) - Full Text
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254. Post-craniotomy meningitis caused by Klebsiella pneumoniae in adult patients: Virulence characteristics and antibiotic resistance
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Wen-Liang Yu, Mei-Feng Lee, Yin Ching Chuang, and Yee-Huang Ku
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Microbiology (medical) ,General Immunology and Microbiology ,Adult patients ,biology ,Klebsiella pneumoniae ,business.industry ,medicine.medical_treatment ,Virulence ,General Medicine ,medicine.disease ,biology.organism_classification ,Microbiology ,Antibiotic resistance ,Infectious Diseases ,Immunology and Microbiology(all) ,medicine ,Immunology and Allergy ,business ,Meningitis ,Craniotomy - Full Text
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255. What do we learn from antimicrobial photodynamic therapy?
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I-Hsiu Huang, Chun Keung Yu, Tak Wah Wong, Yin-Ching Chuang, and Wen Chien Ko
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Microbiology (medical) ,Infectious Diseases ,General Immunology and Microbiology ,business.industry ,medicine.medical_treatment ,Immunology and Microbiology(all) ,medicine ,Immunology and Allergy ,Photodynamic therapy ,General Medicine ,Pharmacology ,Antimicrobial ,business - Full Text
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256. Polymerase Chain Reaction Analysis for Detecting Capsule Serotypes K1 and K2 of Klebsiella pneumoniae Causing Abscesses of the Liver and Other Sites.
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Wen-Liang Yu, Chang-Phone Fung, Wen-Chien Ko, Kuo-Chen Cheng, Ching-Chien Lee, and Yin-Ching Chuang
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LETTERS to the editor ,POLYMERASE chain reaction - Abstract
A letter to the editor is presented in response to an article related to the application of polymerase chain reaction analysis to detect capsular serotype K2 of Klebsiella pneumoniae in the March 1, 2006 issue.
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- 2007
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257. Integrated safety summary of phase II and III studies comparing oral nemonoxacin and levofloxacin in community-acquired pneumonia
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Shih-Lung Cheng, Ren-Guang Wu, Yin-Ching Chuang, Wann-Cherng Perng, Shih-Ming Tsao, Yu-Ting Chang, Li-Wen Chang, and Ming-Chu Hsu
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Microbiology ,QR1-502 - Abstract
Background: Nemonoxacin, a novel nonfluorinated quinolone, has broad-spectrum antibacterial activity, including activity against antibiotic-resistant strains, and was developed for treating community-acquired pneumonia (CAP). This report provides an integrated safety summary of oral nemonoxacin from two phase II and one phase III clinical studies. Methods: Patients with mild CAP were randomized for treatment with nemonoxacin 500 mg (NEMO-500MG), nemonoxacin 750 mg (NEMO-750MG), or levofloxacin 500 mg (LEVO), orally, once daily, for 7–10 days. Hematological, gastrointestinal, and hepatic disorders; electrocardiography abnormalities; and reported quinolone-associated clinical concerns were included in this analysis. Results: A total of 520, 155, and 320 subjects were assigned to receive NEMO-500MG, NEMO-750MG, and LEVO, respectively. The incidence of adverse events (AEs) was the highest (54.8%) in the NEMO-750MG group (NEMO-500MG, 36.9%; NEMO-750MG, 54.8%; LEVO, 39.7%) and that of drug-related AEs was comparable between the three groups (NEMO-500MG, 22.9%; NEMO-750MG, 31.0%; LEVO, 22.5%). The majority (>80%) of the patients showed mild drug-related AEs and the distribution based on severity was similar between the groups. The most commonly reported drug-related AEs included neutropenia (NEMO-500MG, 2.5%; NEMO-750MG, 8.4%; LEVO, 4.4%), nausea (NEMO-500MG, 2.5%; NEMO-750MG, 7.1%; LEVO, 2.5%), leukopenia (NEMO-500MG, 2.3%; NEMO-750MG, 4.5%; LEVO, 3.1%), and increased alanine aminotransferase level (NEMO-500MG, 4.4%; NEMO-750MG, 0%; LEVO, 2.5%). Conclusion: Nemonoxacin was well tolerated and no clinically significant safety concerns were identified, suggesting that it possesses a desirable safety and tolerability profile similar to that of levofloxacin, and may be a suitable alternative to fluoroquinolones for treating patients with CAP. Keywords: Community-acquired pneumonia, Fluoroquinolone, Levofloxacin, Nemonoxacin, Safety
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- 2019
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258. National bundle care program implementation to reduce ventilator-associated pneumonia in intensive care units in Taiwan
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Chin-Chuan Kao, Hsiu-Tzy Chiang, Chih-Yu Chen, Ching-Tzu Hung, Ying-Chun Chen, Li-Hsiang Su, Zhi-Yuan Shi, Jein-Wei Liu, Chang-Pan Liu, Yin-Ching Chuang, Wen-Chien Ko, Yen-Hsu Chen, Shu-Hui Tseng, Chun-Ming Lee, Min-Chi Lu, and Po-Ren Hsueh
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Microbiology ,QR1-502 - Abstract
Background/purpose: This study investigated the impact of implementing ventilator-associated pneumonia (VAP) bundle care on the rates of VAP in intensive care units (ICUs) in Taiwan. Methods: A total of 10 ICUs (bed number, 170), including surgical (SICUs) (n = 7), cardiovascular/surgical (CV/S-ICUs) (n = 1), and medical ICUs (MICUs) (n = 2) from 10 hospitals (7 medical center hospitals and 3 regional hospitals) were enrolled in this quality-improvement project. This study was divided into the pre-intervention phase (1st January, 2012–31st July, 2013) and the intervention phase (1st August, 2013–31st October, 2014). Results: Among the 10 hospitals, the overall rates (cases per 1000 ventilator-days) of VAP declined significantly (p = 0.005; rate ratio, 0.71) from 1.9 in the pre-intervention period to 1.5 in the intervention period. Significant difference in VAP rates between these periods was found in the regional hospitals (from 1.6 to 0.7; p
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- 2019
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259. Colistin-sparing regimens against Klebsiella pneumoniae carbapenemase-producing K. pneumoniae isolates: Combination of tigecycline or doxycycline and gentamicin or amikacin
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Hung-Jen Tang, Chih-Cheng Lai, Chi-Chung Chen, Chun-Cheng Zhang, Tzu-Chieh Weng, Yu-Hsin Chiu, Han-Siong Toh, Shyh-Ren Chiang, Wen-Liang Yu, Wen-Chien Ko, and Yin-Ching Chuang
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Microbiology ,QR1-502 - Abstract
Background/Purpose: In vitro studies of the combination of an aminoglycoside with tigecycline or doxycycline against Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates are rarely published. The goal of this study was to evaluate the antibacterial activity of the combination regimens. Methods: Thirteen genetically different KPC-producing K. pneumoniae isolates were randomly selected. Drug concentrations of amikacin, gentamicin, tigecycline, and doxycycline were adjusted to 1-, 1/2-, and 1/4-fold of respective minimum inhibitory concentrations (MICs). Each drug alone or the combinations of amikacin or gentamicin with tigecycline or doxycycline were tested by combination studies. Results: Treatment with the 1× MIC concentration in combinations of amikacin or gentamicin and tigecycline or doxycycline for 24 hours resulted in bactericidal activity of 84–100% in the isolates. Treatment with 1/2× MIC combinations resulted in synergism of 69–100% in the isolates. Notably, doxycycline plus gentamicin or amikacin was synergistic for all tested isolates. However, bactericidal or synergistic effect was barely evident following 1/4× MIC combinations. There was no antagonism in any of the combination regimens. Conclusion: Enhanced activity was noted following treatment with doxycycline combined with gentamicin or amikacin against KPC-producing K. pneumoniae isolates, warranting further in vitro and animal investigations before clinical application. Keywords: aminoglycoside, doxycycline, KPC, synergism, tigecycline
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- 2019
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260. Recommendations and guidelines for the treatment of pneumonia in Taiwan
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Chih-Chen Chou, Ching-Fen Shen, Su-Jung Chen, Hsien-Meng Chen, Yung-Chih Wang, Wei-Shuo Chang, Ya-Ting Chang, Wei-Yu Chen, Ching-Ying Huang, Ching-Chia Kuo, Ming-Chi Li, Jung-Fu Lin, Shih-Ping Lin, Shih-Wen Ting, Tzu-Chieh Weng, Ping-Sheng Wu, Un-In Wu, Pei-Chin Lin, Susan Shin-Jung Lee, Yao-Shen Chen, Yung-Ching Liu, Yin-Ching Chuang, Chong-Jen Yu, Li-Ming Huang, and Meng-Chih Lin
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Microbiology ,QR1-502 - Abstract
Executive Summary: Pneumonia is a leading cause of death worldwide, ranking third both globally and in Taiwan. This guideline was prepared by the 2017 Guidelines Recommendations for Evidence-based Antimicrobial agents use in Taiwan (GREAT) working group, formed under the auspices of the Infectious Diseases Society of Taiwan (IDST). A consensus meeting was held jointly by the IDST, Taiwan Society of Pulmonary and Critical Care Medicine (TSPCCM), the Medical Foundation in Memory of Dr. Deh-Lin Cheng, the Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines. The final guideline was endorsed by the IDST and TSPCCM. The major differences between this guideline and the 2007 version include the following: the use of GRADE methodology for the evaluation of available evidence whenever applicable, the specific inclusion of healthcare-associated pneumonia as a category due to the unique medical system in Taiwan and inclusion of recommendations for treatment of pediatric pneumonia. This guideline includes the epidemiology and recommendations of antimicrobial treatment of community-acquired pneumonia, hospital-acquired pneumonia, ventilator-associated pneumonia, healthcare-associated pneumonia in adults and pediatric pneumonia. Keywords: Pneumonia, Guidelines, Treatment, Taiwan
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- 2019
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261. Implementation of a national bundle care program to reduce central line-associated bloodstream infections in intensive care units in Taiwan
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Chih-Cheng Lai, Cong-Tat Cia, Hsiu-Tzy Chiang, Yung-Chung Kung, Zhi-Yuan Shi, Yin-Ching Chuang, Chun-Ming Lee, Wen-Chien Ko, and Po-Ren Hsueh
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Microbiology ,QR1-502 - Abstract
Background/purpose: This study assessed the effect of the central line bundle on the rate of central line-associated bloodstream infections (CLABSI) in intensive care units (ICUs) in Taiwan. Methods: This national study was conducted in 27 ICUs with 404 beds total, including 15 medical ICUs, 11 surgical ICUs, and one mixed ICU. The study period was divided into two phases: a pre-intervention (between June 1, 2011 and October 31, 2011) and intervention phase (between December 1, 2011 and October 31, 2012). Outcome variables, including CLABSI rates (per 1000 catheter-days) and catheter utilization rates, were measured. Results: The overall rate of CLABSI significantly decreased by 12.2% (p
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- 2018
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262. 2016 guideline strategies for the use of antifungal agents in patients with hematological malignancies or hematopoietic stem cell transplantation recipients in Taiwan
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Bor-Sheng Ko, Wei-Ting Chen, Hsiang-Chi Kung, Un-In Wu, Jih-Luh Tang, Ming Yao, Yee-Chun Chen, Hwei-Fang Tien, Shan-Chwen Chang, Yin-Ching Chuang, and Dong-Tsamn Lin
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Antifungal strategy ,Risk assessment ,Health economic ,Antifungal stewardship ,De-escalation ,Therapeutic algorithm ,Prophylaxis ,Empirical therapy ,Preemptive therapy ,Symptom-driven strategy ,Diagnosis-driven strategy ,Definitive therapy ,Microbiology ,QR1-502 - Abstract
The Infectious Diseases Society of Taiwan (IDST), the Hematology Society of Taiwan, the Taiwan Society of Blood and Marrow Transplantation, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines cooperatively published this guideline for the use of antifungal agents in hematological patients with invasive fungal diseases (IFDs) in Taiwan. The guideline is the first one endorsed by IDST focusing on selection of antifungal strategies, including prophylaxis, empirical (or symptom-driven) and pre-emptive (or diagnostic-driven) strategy. We suggest a risk-adapted dynamic strategy and provide an algorithm to facilitate decision making in population level as well as for individual patient. Risk assessment and management accordingly is explicitly emphasized. In addition, we highlight the importance of diagnosis in each antifungal strategy among five elements of the antimicrobial stewardship (diagnosis, drug, dose, de-escalation and duration). The rationale, purpose, and key recommendations for the choice of antifungal strategy are summarized, with concise review of international guidelines or recommendation, key original articles and local epidemiology reports. We point out the interaction and influence between elements of recommendations and limitation of and gap between evidences and daily practice. The guideline balances the quality of evidence and feasibility of recommendation in clinical practice. Finally, this version introduces the concept of health economics and provides data translated from local disease burdens. All these contents hopefully facilitate transparency and accountability in medical decision-making, improvements in clinical care and health outcomes, and appropriateness of medical resource allocation.
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- 2018
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263. The impact of inoculum size on the activity of cefoperazone-sulbactam against multidrug resistant organisms
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Ping-Chin Chang, Chi-Chung Chen, Ying Chen Lu, Chih-Cheng Lai, Hui-Ling Huang, Yin-Ching Chuang, and Hung-Jen Tang
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Microbiology ,QR1-502 - Abstract
Objectives: This study aims to assess the in vitro activity of cefoperazone alone and different cefoperazone-sulbactam ratios against different inoculum sizes of multidrug resistant organisms. Methods: Minimum inhibitory concentrations (MICs) of cefoperazone, cefoperazone-sulbactam at fixed ratio of 1:1 and 2:1 against a normal inoculum size of 5 × 105 CFU/ml and a high inoculum size of 5 × 107 CFU/ml were measured. Results: Each 33 isolates of extended-spectrum β-lactamases (ESBL)-producing Escherichia coli, ESBL-producing Klebsiella pneumoniae, carbapenem-resistant E. coli, and carbapenem-resistant Pseudomonas aeruginosa and a total of 122 isolates of carbapenem-resistant Acinetobacter baumannii were collected. After the addition of sulbactam at a 1:1 ratio, most MIC50 and MIC90 values decreased. Cefoperazone-sulbactam at a 1:1 ratio had a higher susceptibility rate against ESBL-producing E. coli, carbapenem-resistant E. coli, and carbapenem-resistant A. baumannii than cefoperazone-sulbactam at a 2:1 ratio (all P
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- 2018
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264. 2016 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan
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Hsiang-Chi Kung, Po-Yen Huang, Wei-Ting Chen, Bor-Sheng Ko, Yee-Chun Chen, Shan-Chwen Chang, and Yin-Ching Chuang
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Antifungal therapy ,Aspergillosis ,Candidiasis ,Cryptococcosis ,Mucormycosis ,Definitive therapy ,Microbiology ,QR1-502 - Abstract
The Infectious Diseases Society of Taiwan, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines have updated the guidelines for the use of antifungal agents in adult patients with invasive fungal diseases in Taiwan. This guideline replaces the 2009 version. Recommendations are provided for Candida, Cryptococcus, Aspergillus and Mucormycetes. The focus is based on up-to-date evidence on indications for treatment or prophylaxis of the most common clinical problems. To support the recommendations in this guideline, the committee considered the rationale, purpose, local epidemiology, and key clinical features of invasive fungal diseases to select the primary and alternative antifungal agents. This is the first guideline that explicitly describes the quality and strength of the evidence to support these recommendations. The strengths of the recommendations are the quality of the evidence, the balance between benefits and harms, resource and cost. The guidelines are not intended nor recommended as a substitute for bedside judgment in the management of individual patients, the advice of qualified health care professionals, and more recent evidence concerning therapeutic efficacy and emergence of resistance. Practical considerations for individualized selection of antifungal agents include patient factors, pathogen, site of infection and drug-related factors, such as drug–drug interaction, drug-food intervention, cost and convenience. The guidelines are published in the Journal of Microbiology, Immunology and Infection and are also available on the Society website.
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- 2018
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265. In vitro and in vivo antibacterial activity of tigecycline against Vibrio vulnificus
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Hung-Jen Tang, Chi-Chung Chen, Chih-Cheng Lai, Chun-Cheng Zhang, Tzu-Chieh Weng, Yu-Hsin Chiu, Han-Siong Toh, Shyh-Ren Chiang, Wen-Liang Yu, Wen-Chien Ko, and Yin-Ching Chuang
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killing effects ,tigecycline ,Vibrio vulnificus ,Microbiology ,QR1-502 - Abstract
Background/purpose: The aim of this study is to investigate the role of tigecycline in Vibrio vulnificus infection. Methods: Eight randomly selected clinical V. vulnificus isolates were studied to obtain the minimal inhibitory concentrations (MICs) of minocycline, cefotaxime, and tigecycline, and the time–kill curves of tigecycline alone or in combination with other drugs. A peritonitis mouse model was used for the evaluation of the therapeutic efficacy of tigecycline alone or cefotaxime in combination with minocycline or tigecycline. Results: The MIC of minocycline, cefotaxime, and tigecycline for eight clinical V. vulnificus isolates was 0.06–0.12 μg/mL, 0.03–0.06 μg/mL, and 0.03–0.06 μg/mL, respectively. In time–killing studies, at the concentration of 1 × MIC, the inhibitory effect of tigecycline persisted for 24 hours in five of eight isolates. With 2 × MIC and trough level, the inhibitory effect was noted in all isolates for 24 hours. With the combination of minocycline plus cefotaxime and tigecycline plus cefotaxime at 1/2 × MIC, the bactericidal effect was noted in 25% and 62.5% of eight isolates and synergism in 50% and 75% of isolates. With a low (1.25 × 105 CFU/mL) inoculum, all infected mice survived with tigecycline alone, tigecycline plus cefotaxime, or minocycline plus cefotaxime on the 14th day. At the inoculum of 1.25 × 106 CFU, the survival rate was 33.3% on the 14th day in the tigecycline plus cefotaxime-treated group, but none of the mice treated by tigecycline alone or minocycline plus cefotaxime survived (33.3% vs. 0%, p = 0.01 by Fisher's exact test). Conclusion: Our in vitro combination and animal studies indicate that tigecycline could be an option for the treatment of invasive V. vulnificus infections.
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- 2018
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266. High-level ambient particulate matter before influenza attack with increased incidence of Aspergillus antigenemia in Southern Taiwan, 2016
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Wen-Liang Yu, Wei-Lun Liu, Khee-Siang Chan, Chun-Chieh Yang, Che-Kim Tan, Chi-Lun Tsai, Chin-Ming Chen, and Yin-Ching Chuang
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aspergillosis ,epidemic ,galactomannan ,influenza ,particulate matter ,Microbiology ,QR1-502 - Abstract
We found significant correlation between the incidence of severe influenza and Aspergillus antigenemia among medical intensive care unit patients for 7-month observation (coefficient γ=0.976, p
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- 2018
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267. Comparison of synergism between colistin, fosfomycin and tigecycline against extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolates or with carbapenem resistance
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Yee-Huang Ku, Chi-Chung Chen, Mei-Feng Lee, Yin-Ching Chuang, Hung-Jen Tang, and Wen-Liang Yu
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Microbiology ,QR1-502 - Abstract
Purpose: To investigate the synergistic and bactericidal effects of antimicrobial combinations of any two of colistin, fosfomycin and tigecycline against the nine extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (KP) clinical isolates, including 4 carbapenem-susceptible strains and five imipenem and/or meropenem-resistant strains. Methods: In vitro synergism and bactericidal activity of combination of colistin, fosfomycin and tigecycline were evaluated by time-kill studies in standard inoculum of bacterial densities of a suspension containing 5 Ã 105 CFU/mL by using 1/2à MIC for each alone, and both 1/2à and 1/4à MIC for any two drugs. The settings of low MIC dosing were allowed to rapidly survey the most active drug combination. Results: The most active combination group was colistin plus tigecycline, showing synergy in 8 isolates and bactericidal activities in 6 isolates by using concentrations of 1/2à MIC and 1/4à MIC, respectively. The least active combination was tigecycline plus fosfomycin, which showed synergy in only 4 isolates and no bactericidal activities by using concentrations of 1/2à MIC and 1/4à MIC, respectively. Conclusions: The combination of tigecycline and colistin may be considered as a last-resort approach to the ESBL-producing KP infections, especially those isolates with carbapenem resistance. Keywords: Carbapenem resistance, Colistin, ESBL, Fosfomycin, Tigecycline
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- 2017
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268. The plasmid-mediated fosfomycin resistance determinants and synergy of fosfomycin and meropenem in carbapenem-resistant Klebsiella pneumoniae isolates in Taiwan
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Sung-Pin Tseng, Sheng-Fan Wang, Ling Ma, Ting-Yin Wang, Tsung-Ying Yang, L. Kristopher Siu, Yin-Ching Chuang, Pei-Shan Lee, Jann-Tay Wang, Tsu-Lan Wu, Jung-Chung Lin, and Po-Liang Lu
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Fosfomycin ,Carbapenem resistance ,fosA3 ,foskp96 ,blaKPC-2 ,Microbiology ,QR1-502 - Abstract
Background: Epidemiology of fosfomycin susceptibility and the plasmid-mediated fosfomycinase genes of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates in Taiwan remain unclear. Methods: 642 CRKP clinical isolates were collected from a nation-wide surveillance study (16 hospitals) in Taiwan in 2012–2013. Antimicrobial susceptibilities were determined. PFGE and MLST determined the clonal relatedness. Carbapenemases and fosfomycinases genes were detected by PCR, and their flanking regions were determined by PCR and sequencing. Synergistic activity of meropenem with fosfomycin was examined by the checkerboard method. Results: In total, 36.4% (234/642) of CRKP isolates in Taiwan were resistant to fosfomycin. Among 234 fosfomycin-resistant CRKP isolates, PFGE analysis revealed 81 pulsotypes. Pulsotype XXIII (n = 63) was predominant and belonged to ST11. 71 had carbapnemases (65 blaKPC-2-positive, 1 blaVIM-1-positive and 5 blaIMP-8-positive) and 62 had fosfomycinases (35 fosA3-positive and 27 foskp96-positive). Only 18.5% (5/27) of foskp96-positive isolates carried foskp96 and blaKPC-2, while 71.4% (25/35) of fosA3-positive isolates contained fosA3 and blaKPC-2. There were five types of flanking sequences for fosA3, and 85.7% (30/35) of fosA3 genes were flanked by IS26, suggesting possible horizontal gene transfer. Synergistic effect of fosfomycin and meropenem was observed in all 25 randomly selected pulsotype XXIII strains (100%; 25/25), even those containing fosfomycinase (48%, 12/25) or carbapnemase (96%, 24/25). Conclusions: A clone (pulsotype XXIII, ST11) has been found to be prevailing among fosfomycin-resistant CRKP in Taiwan. According to the in vitro data, the combination of fosfomycin and meropenem is a potentially alternative choice.
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- 2017
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269. Higher mortality of severe influenza patients with probable aspergillosis than those with and without other coinfections
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Yee-Huang Ku, Khee-Siang Chan, Chun-Chieh Yang, Che-Kim Tan, Yin-Ching Chuang, and Wen-Liang Yu
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Aspergillosis ,Coinfection ,Galactomannan ,Influenza ,Mortality ,Medicine (General) ,R5-920 - Abstract
Aspergillus-associated infection might comprise up to 23–29% of severe influenza patients from the community throughout stay in an intensive care unit (ICU). In Taiwan, cases of severe influenza with aspergillosis are increasingly reported. Therefore, we describe the relative risk of mortality among severe influenza patients with aspergillosis and other coinfections compared to severe influenza patients without Aspergillus coinfections. Methods: We retrospectively reviewed 124 adult patients with severe influenza in a tertiary medical center in southern Taiwan from January 2015 through March 2016. The definition of probable aspergillosis required abnormal radiological findings and positive Aspergillus galactomannan (GM) antigen and/or Aspergillus isolation. Results: Probable aspergillosis (detected throughout the whole course) and other coinfections (only community-acquired) were diagnosed in 21 (17%) and 38 (31%) of all patients respectively. Klebsiella pneumoniae (36.8%), Pseudomonas aeruginosa (31.6%) and Staphylococcus aureus (31.6%) were the most frequent isolates of other coinfections. In-ICU mortality of Aspergillus group (66.7%) was significantly higher than other coinfections (23.7%, p = 0.001) or control group without coinfections (15.4%, p
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- 2017
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270. Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan
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Chih-Cheng Lai, Chun-Ming Lee, Hsiu-Tzy Chiang, Ching-Tzu Hung, Ying-Chun Chen, Li-Hsiang Su, Zhi-Yuan Shi, Jein-Wei Liu, Chang-Pan Liu, Min-Chi Lu, Yin-Ching Chuang, Wen-Chien Ko, Shu-Hui Tseng, Yen-Hsu Chen, and Po-Ren Hsueh
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Bundle care ,Catheter-associated urinary tract infection ,Surveillance ,Microbiology ,QR1-502 - Abstract
Background/purpose: This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. Methods: Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. Results: The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65–0.82; p
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- 2017
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271. The Potential Role of Sulbactam and Cephalosporins Plus Daptomycin Against Daptomycin-Nonsusceptible VISA and H-VISA Isolates: An In Vitro Study
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Chih-Cheng Lai, Chi-Chung Chen, Ying-Chen Lu, Tsuey-Pin Lin, Hung-Jui Chen, Bo-An Su, Chien-Ming Chao, Yin-Ching Chuang, and Hung-Jen Tang
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vancomycin-intermediate resistant s. aureus ,heterogeneous vancomycin-intermediate s. aureus ,daptomycin ,cephalosporin ,sulbactam ,synergism test ,Therapeutics. Pharmacology ,RM1-950 - Abstract
This study assesses the synergistic effect of the combination of cephalosporins and sulbactam with daptomycin against daptomycin-nonsusceptible, vancomycin-intermediate resistant Staphylococcus aureus (VISA) or heterogeneous vancomycin-intermediate S. aureus (h-VISA) isolates. The in vitro activity of daptomycin against daptomycin-nonsusceptible VISA/h-VISA isolates after adding cephalosporins with or without sulbactam was evaluated. The MIC of daptomycin against the VISA/h-VISA isolates was reduced after adding cephalosporins to daptomycin. Except for one VISA and two h-VISA isolates, the other VISA/h-VISA isolates became daptomycin-susceptible (MICs ≤ 1 mg/L). After adding sulbactam to each daptomycin/cephalosporin combination, the MIC of daptomycin against the VISA/h-VISA isolates decreased for 5 (33.3%), 6 (40.0%), 6 (40.0%), and 6 (40.0%) isolates with the cefazolin, cefmetazole, cefotaxime, and cefepime combinations, respectively. Synergism using the checkerboard method was noted in 100% of cefazolin and cefotaxime combinations and 87% and 80% of cefmetazole and cefepime combinations for all the VISA and h-VISA isolates. With the addition of sulbactam, synergism was noted in 100% of cefazolin, cefmetazole, and cefotaxime combinations and 93% of the cefepime combinations for all the VISA and h-VISA isolates. Almost all the FICs for the three-drug combinations were lower than those for the two-drug combinations. Using time-killing methods, a synergistic effect against five h-VISA isolates was observed. A synergistic effect of daptomycin, sulbactam, and each cephalosporin was observed for all VISA isolates. In conclusion, the activity of daptomycin against daptomycin-nonsusceptible VISA/h-VISA isolates can be enhanced by adding cephalosporins, and partially further promoted by sulbactam.
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- 2019
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272. Vibrio vulnificus in Taiwan
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Po-Ren Hsueh, Ching-Yih Lin, Hung-Jen Tang, Hsin-Chun Lee, Jien-Wei Liu, Yung-Ching Liu, and Yin-Ching Chuang
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Vibrio vulnificus ,Taiwan ,emerging ,research ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Residents in Taiwan are often exposed to marine microorganisms through seafood and occupational exposure. The number of reported cases of infection attributable to this organism has increased since the first case was reported in 1985. The increasing number of cases may be caused by greater disease activity or improved recognition by clinicians or laboratory workers. We analyze a clinical-case series of 84 patients with V. vulnificus infection from 1995 to 2000 and describe the molecular epidemiologic features of pathogens isolated from these patients. The spectrum of clinical manifestations and outcomes, options of antimicrobial therapy, and virulence mechanisms were investigated. Results of molecular typing of isolates from humans and marine environment in this country had a high genetic divergence among these isolates. Education and measures are needed to prevent this emerging disease.
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- 2004
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273. Virulence diversity among bacteremic Aeromonas isolates: ex vivo, animal, and clinical evidences.
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Po-Lin Chen, Chi-Jung Wu, Pei-Jane Tsai, Hung-Jen Tang, Yin-Ching Chuang, Nan-Yao Lee, Ching-Chi Lee, Chia-Wen Li, Ming-Chi Li, Chi-Chung Chen, Hung-Wen Tsai, Chun-Chun Ou, Chang-Shi Chen, and Wen-Chien Ko
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Medicine ,Science - Abstract
BACKGROUND: The objective of this study was to compare virulence among different Aeromonas species causing bloodstream infections. METHODOLOGY/PRINCIPAL FINDINGS: Nine of four species of Aeromonas blood isolates, including A. dhakensis, A. hydrophila, A. veronii and A. caviae were randomly selected for analysis. The species was identified by the DNA sequence matching of rpoD. Clinically, the patients with A. dhakensis bacteremia had a higher sepsis-related mortality rate than those with other species (37.5% vs. 0%, P = 0.028). Virulence of different Aeromonas species were tested in C. elegans, mouse fibroblast C2C12 cell line and BALB/c mice models. C. elegans fed with A. dhakensis and A. caviae had the lowest and highest survival rates compared with other species, respectively (all P values
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- 2014
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274. First description of lung abscess caused by ST23 clone capsule genotype K1 Klebsiella pneumoniae
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Kuo-Chen Cheng, Mei-Feng Lee, Yin-Ching Chuang, and Wen-Liang Yu
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Medicine (General) ,R5-920 - Published
- 2015
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275. National surveillance study on carbapenem non-susceptible Klebsiella pneumoniae in Taiwan: the emergence and rapid dissemination of KPC-2 carbapenemase.
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Sheng-Kang Chiu, Tsu-Lan Wu, Yin-Ching Chuang, Jung-Chung Lin, Chang-Phone Fung, Po-Liang Lu, Jann-Tay Wang, Lih-Shinn Wang, L Kristopher Siu, and Kuo-Ming Yeh
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Medicine ,Science - Abstract
OBJECTIVES: The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals. METHODS: We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type. RESULTS: The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 bla IMP-8 and 2 bla VIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 bla KPC-2, 7 bla VIM-1, 6 bla IMP-8, and 1 bla NDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype. CONCLUSIONS: In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.
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- 2013
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