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1. Distribution of serotypes and antibiotic resistance of invasive Pseudomonas aeruginosa in a multi-country collection

Author

Nasrin, Shamima, Hegerle, Nicolas, Sen, Shaichi, Nkeze, Joseph, Sen, Sunil, Permala-Booth, Jasnehta, Choi, Myeongjin, Sinclair, James, Tapia, Milagritos D., Johnson, J. Kristie, Sow, Samba O., Thaden, Joshua T., Fowler, Jr, Vance G., Krogfelt, Karen A., Brauner, Annelie, Protonotariou, Efthymia, Christaki, Eirini, Shindo, Yuichiro, Kwa, Andrea L., Shakoor, Sadia, Singh-Moodley, Ashika, Perovic, Olga, Jacobs, Jan, Lunguya, Octavie, Simon, Raphael, Cross, Alan S., and Tennant, Sharon M.

Published
2022
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3. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey

Author

Koraqi, Andi, Hoxha, Iris, Tafaj, Silva, Lacej, Denada, Hojman, Martin, Quiros, Rodolfo Ernesto, Ghazaryan, Lilit, Cairns, Kelly A, Cheng, Allen, Horne, Kylie C, Doukas, Fiona F, Gottlieb, Thomas, Alsalman, Jameela, Magerman, Koen, Marielle, Gounongbe YT, Ljubovic, Amela Dedeic, Coelho, André Afonso Machado, Gales, Ana Cristina, Keuleyan, Emma, Sabuda, Deana, Boswell, Jennifer Lee, Conly, John M, Rojas, Alvaro, Carvajal, Camila, Labarca, Jaime, Solano, Antonio, Valverde, Carlos Ramírez, Villalobos-Vindas, Juan M, Pristas, Irina, Plecko, Vanda, Paphitou, Niki, Shaqiri, Erjona, Rummukainen, Maija-Liisa, Pagava, Karaman, Korinteli, Irma, Brandt, Tobias, Messler, Sabine, Enimil, Anthony, Iosifidis, Elias, Roilides, Emmanuel, Sow, Mamadou Saliou, Sengupta, Sharmila, George, Joby V, Poojary, Aruna, Patil, Priyanka, Soltani, Jafar, Jafarpour, Zahra, Ameen, Hadi, Fitzgerald, David, Maor, Yasmin, Chowers, Michal, Temkin, Elizabeth, Esposito, Susanna, Arnoldo, Luca, Brusaferro, Silvio, Gu, Yoshiaki, El-Hajji, Feras Darwish, Kim, Nam Joong, Kambaralieva, Baktygul, Pavare, Jana, Zarakauska, Lelde, Usonis, Vytautas, Burokiene, Sigita, Ivaskeviciene, Inga, Mijovic, Gordana, Duborija-Kovacevic, Natasa, Bondesio, Kristen, Iregbu, Kenneth, Oduyebo, Oyinlola, Raka, Denis, Raka, Lul, Rachina, Svetlana, Enani, Mushira Abdulaziz, Al Shehri, Mohamed, Carevic, Biljana, Dragovac, Gorana, Obradovic, Dusanka, Stojadinovic, Aleksandra, Radulovic, Lili, Wu, Jia EN, Wei Teng Chung, Gladys, Chen, Hui Hiong, Tambyah, Paul Anantharajah, Lye, David, Tan, Sock Hoon, Ng, Tat Ming, Tay, Hui Lin, Ling, Moi Lin, Chlebicki, Maciej Piotr, Kwa, Andrea L, Lee, Winnie, Beović, Bojana, Dramowski, Angela, Finlayson, Heather, Taljaard, Jantjie, Ojeda-Burgos, Guillermo, Retamar, Pilar, Lucas, Johan, Pot, Wolter, Verduin, Cees, Kluytmans, Jan, Scott, Michael, Aldeyab, Mamoon A, McCullagh, Bernadette, Gormley, Cairine, Sharpe, David, Gilchrist, Mark, Whitney, Laura, Laundy, Matthew, Lockwood, Debbie, Drysdale, Simon B, Boudreaux, Jennifer, Septimus, Edward J, Greer, Nickie, Gawrys, Gerard, Rios, Edgar, May, Suzanne, Versporten, Ann, Zarb, Peter, Caniaux, Isabelle, Gros, Marie-Françoise, Drapier, Nico, Miller, Mark, Jarlier, Vincent, Nathwani, Dilip, and Goossens, Herman

Published
2018
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4. Prevalence of Healthcare-Associated Infections and Antimicrobial Use Among Adult Inpatients in Singapore Acute-Care Hospitals: Results From the First National Point Prevalence Survey

Author

Cai, Yiying, Venkatachalam, Indumathi, Tee, Nancy W., Tan, Thean Yen, Kurup, Asok, Wong, Sin Yew, Low, Chian Yong, Wang, Yang, Lee, Winnie, Liew, Yi Xin, Ang, Brenda, Lye, David C., Chow, Angela, Ling, Moi Lin, Oh, Helen M., Cuvin, Cassandra A., Ooi, Say Tat, Pada, Surinder K., Lim, Chong Hee, Tan, Jack Wei Chieh, Chew, Kean Lee, Nguyen, Van Hai, Fisher, Dale A., Goossens, Herman, Kwa, Andrea L., Tambyah, Paul A., Hsu, Li Yang, and Marimuthu, Kalisvar

Published
2017

5. Impact of the COVID-19 pandemic on a tertiary care public hospital in Singapore: resources and economic costs

Author

Cai, Yiying, Kwek, Samuel, Tang, Sarah SL., Saffari, Seyed Ehsan, Lum, Elaine, Yoon, Sungwon, Ansah, John P., Matchar, David B., Kwa, Andrea L., Ang, Kwok Ann, Thumboo, Julian, Ong, Marcus EH., and Graves, Nicholas

Subjects
disease outbreak, Microbiology (medical), Singapore, Hospitals, Public, SARS-CoV-2, Tertiary Healthcare, hospital costs, COVID-19, Bayes Theorem, General Medicine, Article, Infectious Diseases, Communicable Disease Control, Humans, Pandemics, Retrospective Studies
Abstract

Background The COVID-19 pandemic has prompted hospitals to respond with stringent measures. Accurate estimates of costs and resources used in outbreaks can guide evaluations of responses. We report the financial expenditure associated with COVID-19, the bed-days used for COVID-19 patients and hospital services displaced due to COVID-19 in a Singapore tertiary hospital. Methods We conducted a retrospective cost analysis from January to December 2020 in the largest public hospital in Singapore. Costs were estimated from the hospital perspective. We examined financial expenditures made in direct response to COVID-19; hospital admissions data related to COVID-19 inpatients; and the number of outpatient and emergency department visits, non-emergency surgeries, inpatient days in 2020, compared to preceding years of 2018 and 2019. Bayesian time-series was used to estimate the magnitude of displaced services. Results USD$41.96 million was incurred in the hospital for COVID-19 related expenses. Facilities setup and capital assets counted for 51.6% of the expenditure; patient-care supplies comprised 35.1%. Out of the 19,611 inpatients tested for COVID-19 in 2020, 727 (3.7%) had COVID-19. The total inpatient- and ICU-days for COVID-19 patients in 2020 were 8,009 and 8 days respectively. A decline in all hospital services were observed from February following a raised disease outbreak alert level; most services quickly resumed when the lockdown was lifted in June. Conclusion COVID-19 has led to increase in healthcare expenses and displacement in hospital services. Our findings are useful for informing economic evaluations of COVID-19 response and provide some information about the expected costs of future outbreaks.

Published
2022
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7. Gaps in antimicrobial stewardship programmes in Asia: a survey of 10 countries

Author

Chang, Feng-Yee, primary, Chuang, Yin Ching, additional, Veeraraghavan, Balaji, additional, Apisarnthanarak, Anucha, additional, Tayzon, Maria Fe, additional, Kwa, Andrea L, additional, Chiu, Cheng-Hsun, additional, Deris, Zakuan Zainy, additional, Amir Husin, Suraya, additional, Hashim, Hazimah, additional, Karuniawati, Anis, additional, Ahmed, Altaf, additional, Matsumoto, Tetsuya, additional, Nguyen, Van Kinh, additional, and Dinh, Thi Thu Huong, additional

Published
2022
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10. Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic

Author

Lim, Shena Y. C., primary, Zhou, Yvonne P., additional, Yii, Daphne, additional, Chin, De Zhi, additional, Hung, Kai Chee, additional, Lee, Lai Wei, additional, Lim, Jia Le, additional, Loo, Li Wen, additional, Koomanan, Narendran, additional, Chua, Nathalie Grace, additional, Liew, Yixin, additional, Cherng, Benjamin P. Z., additional, Thien, Siew Yee, additional, Lee, Winnie H. L., additional, Kwa, Andrea L. H., additional, and Chung, Shimin J., additional

Published
2022
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15. Additional file 1 of Distribution of serotypes and antibiotic resistance of invasive Pseudomonas aeruginosa in a multi-country collection

Author

Nasrin, Shamima, Hegerle, Nicolas, Sen, Shaichi, Nkeze, Joseph, Sen, Sunil, Permala-Booth, Jasnehta, Choi, Myeongjin, Sinclair, James, Tapia, Milagritos D., Johnson, J. Kristie, Sow, Samba O., Thaden, Joshua T., Fowler, Vance G., Krogfelt, Karen A., Brauner, Annelie, Protonotariou, Efthymia, Christaki, Eirini, Shindo, Yuichiro, Kwa, Andrea L., Shakoor, Sadia, Singh-Moodley, Ashika, Perovic, Olga, Jacobs, Jan, Lunguya, Octavie, Simon, Raphael, Cross, Alan S., and Tennant, Sharon M.

Abstract

Additional file 1: Table S1. Primers used for O antigen serotyping. Figure S1. The number of P. aeruginosa isolates tested by each method. *Flagellin typing was not performed on 27 isolates from Duke University due to logistic constraints. Figure S2. Antibiotic resistance of isolates from Greece. Figure S3. The O-antigen profiles of representative non-typable P. aeruginosa isolates determined by SDS-PAGE. LPS from eight non-typable P.aeruginosa strains were extracted and separated on a 4���12% Bis-Tris SDS-polyacrylamide gel and stained with Pro-Q Emerald 300 according to manufacturer���s instructions. CandyCane glycoprotein molecular weight standard (ladder), P. aeruginosa strain PAK (+ve control).

Published
2022
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16. Assessing the predictive performance of population pharmacokinetic models for intravenous polymyxin B in critically ill patients

Author

Hanafin, Patrick O., primary, Nation, Roger L., additional, Scheetz, Marc H., additional, Zavascki, Alexandre P., additional, Sandri, Ana M., additional, Kwa, Andrea L., additional, Cherng, Benjamin P. Z., additional, Kubin, Christine J., additional, Yin, Michael T., additional, Wang, Jiping, additional, Li, Jian, additional, Kaye, Keith S., additional, and Rao, Gauri G., additional

Published
2021
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21. Elimination of Extracellular Adenosine Triphosphate for the Rapid Prediction of Quantitative Plate Counts in 24 h Time-Kill Studies against Carbapenem-Resistant Gram-Negative Bacteria

Author

Cai, Yiying, primary, Ng, Jonathan J., additional, Leck, Hui, additional, Teo, Jocelyn Q., additional, Goh, Jia-Xuan, additional, Lee, Winnie, additional, Koh, Tse-Hsien, additional, Tan, Thuan-Tong, additional, Lim, Tze-Peng, additional, and Kwa, Andrea L., additional

Published
2020
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24. The Diversity of Lipopolysaccharide (O) and Capsular Polysaccharide (K) Antigens of Invasive Klebsiella pneumoniae in a Multi-Country Collection

Author

Choi, Myeongjin, primary, Hegerle, Nicolas, additional, Nkeze, Joseph, additional, Sen, Shaichi, additional, Jamindar, Sanchita, additional, Nasrin, Shamima, additional, Sen, Sunil, additional, Permala-Booth, Jasnehta, additional, Sinclair, James, additional, Tapia, Milagritos D., additional, Johnson, J. Kristie, additional, Mamadou, Sylla, additional, Thaden, Joshua T., additional, Fowler, Vance G., additional, Aguilar, Ana, additional, Terán, Enrique, additional, Decre, Dominique, additional, Morel, Florence, additional, Krogfelt, Karen Angeliki, additional, Brauner, Annelie, additional, Protonotariou, Efthymia, additional, Christaki, Eirini, additional, Shindo, Yuichiro, additional, Lin, Yi-Tsung, additional, Kwa, Andrea L., additional, Shakoor, Sadia, additional, Singh-Moodley, Ashika, additional, Perovic, Olga, additional, Jacobs, Jan, additional, Lunguya, Octavie, additional, Simon, Raphael, additional, Cross, Alan S., additional, and Tennant, Sharon M., additional

Published
2020
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26. Estimating the excess bed days and economic burden of healthcare-associated infections in Singapore public acute-care hospitals

Author

Cai, Yiying, Venkatachalam, Indumathi, Kwa, Andrea L., Tambyah, Paul A., Hsu, Li Yang, Marimuthu, Kalisvar, and Graves, Nicholas

Abstract

AbstractWe estimated the annual bed days lost and economic burden of healthcare-associated infections to Singapore hospitals using Monte Carlo simulation. The mean (standard deviation) cost of a single healthcare-associated infection was S$1,809 (S$440) [or US$1,362 (US$331)]. This translated to annual lost bed days and economic burden of 55,978 (20,506) days and S$152.0 million (S$37.1 million) [or US$114.4 million (US$27.9 million)], respectively.

Published
2022
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27. The impact of healthcare associated infections on mortality and length of stay in Singapore - A time-varying analysis

Author

Cai, Yiying, Lo, Jamie Jay May, Venkatachalam, Indumathi, Kwa, Andrea L., Tambyah, Paul A., Hsu, Li Yang, Barnett, Adrian, Marimuthu, Kalisvar, Graves, Nicholas, Cai, Yiying, Lo, Jamie Jay May, Venkatachalam, Indumathi, Kwa, Andrea L., Tambyah, Paul A., Hsu, Li Yang, Barnett, Adrian, Marimuthu, Kalisvar, and Graves, Nicholas

Abstract

Objective: Methods that include the time-varying nature of healthcare-associated infections (HAIs) avoid biases when estimating increased risk of death and excess length of stay. We determined the excess mortality risk and length of stay associated with HAIs among inpatients in Singapore using a multistate model that accommodates the timing of key events. Design: Analysis of existing prospective cohort study data. Setting: Seven public acute-care hospitals in Singapore. Patients: Inpatients reviewed in a HAI point-prevalence survey (PPS) conducted between June 2015 and February 2016. Methods: We modeled each patient's admission over time using 4 states: susceptible with no HAI, infected, died, and discharged alive. We estimated the excess mortality risk and length of stay associated with HAIs, with adjustment for the baseline characteristics between the groups for mortality risk. Results: We included 4,428 patients, of whom 469 had ≥1 HAI. Using a multistate model, the expected excess length of stay due to any HAI was 1.68 days (95% confidence interval [CI], 1.15-2.21 days). Surgical site infections were associated with the longest excess length of stay of 4.68 days (95% CI, 2.60-6.76 days). After adjusting for baseline differences, HAIs were associated with increased hazards of in-hospital mortality (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.09-1.65) and decreased hazards in being discharged (aHR, 0.75; 95% CI, 0.67-0.84). Conclusions: HAIs are associated with increased length of hospital stay and mortality in hospitalized patients. Avoiding nosocomial infections can improve patient outcomes and free valuable bed days.

Published
2020

32. Decline in Clostridium difficile-associated disease rates in Singapore public hospitals, 2006 to 2008

Author

Krishnan Prabha, Kwa Andrea L, Koh Tse, Tan Thean, Hsu Li-Yang, Tee Nancy W, and Jureen Roland

Subjects
Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract

Abstract Background Clostridium difficile is the major cause of pseudomembranous colitis associated with antibiotic use, and the spread of the hypervirulent epidemic ribotype 027/NAP-1 strain across hospitals worldwide has re-focused attention on this nosocomial pathogen. The overall incidence and trend of C. difficile-associated disease (CDAD) in Singapore is unknown, and a surveillance program to determine these via formal laboratory-based reporting was established. Findings Laboratory and pharmacy data were collated from one tertiary and two secondary hospitals on a quarterly basis between 2006 and 2008. All hospitals tested for C. difficile using Immunocard Toxins A&B (Meridian Bioscience Inc., Cincinnati, OH) during this period. Duplicate positive C. difficile results within a 14-day period were removed. The CDAD results were compared with trends in hospital-based prescription of major classes of antibiotics. Overall CDAD incidence-density decreased from 5.16 (95%CI: 4.73 - 5.62) cases per 10,000 inpatient-days in 2006 to 2.99 (95%CI: 2.67 to 3.33) cases per 10,000 inpatient-days in 2008 (p < 0.001), while overall rates for C. difficile testing increased significantly (p < 0.001) within the same period. These trends were mirrored at the individual hospital level. Evaluation of antibiotic prescription data at all hospitals showed increasing use of carbapenems and fluoroquinolones, while cephalosporin and clindamycin prescription remained stable. Conclusions Our results demonstrate a real decline of CDAD rates in three large local hospitals. The cause is unclear and is not associated with improved infection control measures or reduction in antibiotic prescription. Lack of C. difficile stool cultures as part of routine testing precluded determination of the decline of a major clone as a potential explanation. For more accurate epidemiological trending of CDAD and early detection of epidemic clones, data collection will have to be expanded and resources set in place for reference laboratory culture and typing.

Published
2011
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33. Prevalence of invasive fungal disease in hematological patients at a tertiary university hospital in Singapore

Author

Koh Liang-Piu, Kwa Andrea L, Lee Winnie H, Yeo Chay-Leng, Lee Siok-Ying, and Hsu Li-Yang

Subjects
Medicine, Biology (General), QH301-705.5, Science (General), Q1-390
Abstract

Abstract Background The use of newer azoles as prophylaxis in hematological patients undergoing stem cell transplantation or immunosuppressive chemotherapy has been shown to decrease the risk of developing invasive fungal disease (IFD). However, the cost-effectiveness of such a strategy is dependent on the local epidemiology of IFD. We conducted an audit of hematological patients with IFD in our institution in order to derive the prevalence and types of IFD that occur locally. Findings We conducted a retrospective chart review of all hematological patients who developed possible, probable or definite IFD according to EORTC/MSG criteria in the period from Oct 2007 to Apr 2010. The prevalence of IFD was determined via correlation with institutional database records of all hematological patients treated at our institution over the same time period. There were 39 cases of IFD diagnosed during the study period, with 8 (20.5%) possible, 19 (48.7%) probable and 12 (30.8%) definite cases of IFD. Aspergillus spp. accounted for 83.9% of all probable and definite infections. There was 1 case each of Rhinocladelia spp., Coprinopsis cinerea, Exserohilum spp. sinusitis and Rhizopus spp. sinusitis. IFD occurred in 12 of 124 (9.7%) AML and 4 of 103 (3.9%) ALL patients treated at our institution respectively. There were 10 (16.1%) infections among 62 allogeneic HSCT recipients, six of whom were having concurrent graft-versus-host disease (GVHD). Five other cases occurred after allogeneic HSCT failure, following salvage chemotherapy for disease relapse. The prevalence of IFD during induction chemotherapy was 8.9% (11 of 124 cases) for AML and 1.0% (1 of 103 cases) for ALL. Fluconazole prophylaxis had been provided for 28 out of the 39 (71.8%) cases, while 4 (10.3%) were on itraconazole prophylaxis. The in-hospital mortality was 28.2% (11 of 39 cases), of which 5 (12.8%) deaths were attributed to IFD. Conclusions The burden of IFD is high in our institution, especially in allogeneic HSCT recipients and patients on induction chemotherapy for AML. A prophylactic strategy directed against invasive mould infections for local high-risk patients may be considered as the comparative costs of treatment, prolonged hospitalisation and subsequent delayed chemotherapy favours such an approach.

Published
2011
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40. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey

Author

Versporten, Ann, primary, Zarb, Peter, additional, Caniaux, Isabelle, additional, Gros, Marie-Françoise, additional, Drapier, Nico, additional, Miller, Mark, additional, Jarlier, Vincent, additional, Nathwani, Dilip, additional, Goossens, Herman, additional, Koraqi, Andi, additional, Hoxha, Iris, additional, Tafaj, Silva, additional, Lacej, Denada, additional, Hojman, Martin, additional, Quiros, Rodolfo Ernesto, additional, Ghazaryan, Lilit, additional, Cairns, Kelly A, additional, Cheng, Allen, additional, Horne, Kylie C, additional, Doukas, Fiona F, additional, Gottlieb, Thomas, additional, Alsalman, Jameela, additional, Magerman, Koen, additional, Marielle, Gounongbe YT, additional, Ljubovic, Amela Dedeic, additional, Coelho, André Afonso Machado, additional, Gales, Ana Cristina, additional, Keuleyan, Emma, additional, Sabuda, Deana, additional, Boswell, Jennifer Lee, additional, Conly, John M, additional, Rojas, Alvaro, additional, Carvajal, Camila, additional, Labarca, Jaime, additional, Solano, Antonio, additional, Valverde, Carlos Ramírez, additional, Villalobos-Vindas, Juan M, additional, Pristas, Irina, additional, Plecko, Vanda, additional, Paphitou, Niki, additional, Shaqiri, Erjona, additional, Rummukainen, Maija-Liisa, additional, Pagava, Karaman, additional, Korinteli, Irma, additional, Brandt, Tobias, additional, Messler, Sabine, additional, Enimil, Anthony, additional, Iosifidis, Elias, additional, Roilides, Emmanuel, additional, Sow, Mamadou Saliou, additional, Sengupta, Sharmila, additional, George, Joby V, additional, Poojary, Aruna, additional, Patil, Priyanka, additional, Soltani, Jafar, additional, Jafarpour, Zahra, additional, Ameen, Hadi, additional, Fitzgerald, David, additional, Maor, Yasmin, additional, Chowers, Michal, additional, Temkin, Elizabeth, additional, Esposito, Susanna, additional, Arnoldo, Luca, additional, Brusaferro, Silvio, additional, Gu, Yoshiaki, additional, El-Hajji, Feras Darwish, additional, Kim, Nam Joong, additional, Kambaralieva, Baktygul, additional, Pavare, Jana, additional, Zarakauska, Lelde, additional, Usonis, Vytautas, additional, Burokiene, Sigita, additional, Ivaskeviciene, Inga, additional, Mijovic, Gordana, additional, Duborija-Kovacevic, Natasa, additional, Bondesio, Kristen, additional, Iregbu, Kenneth, additional, Oduyebo, Oyinlola, additional, Raka, Denis, additional, Raka, Lul, additional, Rachina, Svetlana, additional, Enani, Mushira Abdulaziz, additional, Al Shehri, Mohamed, additional, Carevic, Biljana, additional, Dragovac, Gorana, additional, Obradovic, Dusanka, additional, Stojadinovic, Aleksandra, additional, Radulovic, Lili, additional, Wu, Jia EN, additional, Wei Teng Chung, Gladys, additional, Chen, Hui Hiong, additional, Tambyah, Paul Anantharajah, additional, Lye, David, additional, Tan, Sock Hoon, additional, Ng, Tat Ming, additional, Tay, Hui Lin, additional, Ling, Moi Lin, additional, Chlebicki, Maciej Piotr, additional, Kwa, Andrea L, additional, Lee, Winnie, additional, Beović, Bojana, additional, Dramowski, Angela, additional, Finlayson, Heather, additional, Taljaard, Jantjie, additional, Ojeda-Burgos, Guillermo, additional, Retamar, Pilar, additional, Lucas, Johan, additional, Pot, Wolter, additional, Verduin, Cees, additional, Kluytmans, Jan, additional, Scott, Michael, additional, Aldeyab, Mamoon A, additional, McCullagh, Bernadette, additional, Gormley, Cairine, additional, Sharpe, David, additional, Gilchrist, Mark, additional, Whitney, Laura, additional, Laundy, Matthew, additional, Lockwood, Debbie, additional, Drysdale, Simon B, additional, Boudreaux, Jennifer, additional, Septimus, Edward J, additional, Greer, Nickie, additional, Gawrys, Gerard, additional, Rios, Edgar, additional, and May, Suzanne, additional

Published
2018
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42. Integrated pharmacokinetic–pharmacodynamic modeling to evaluate empiric carbapenem therapy in bloodstream infections

Author

Lim,Tze-Peng, Wang,Reyna, Poh,Gang Quan, Koh,Tse-Hsien, Tan,Thean-Yen, Lee,Winnie, Teo,Jocelyn Qi-Min, Cai,Yiying, Tan,Thuan-Tong, Ee,Pui Lai Rachel, Kwa,Andrea L, Lim,Tze-Peng, Wang,Reyna, Poh,Gang Quan, Koh,Tse-Hsien, Tan,Thean-Yen, Lee,Winnie, Teo,Jocelyn Qi-Min, Cai,Yiying, Tan,Thuan-Tong, Ee,Pui Lai Rachel, and Kwa,Andrea L

Abstract

Tze-Peng Lim,1,2 Reyna Wang,1 Gang Quan Poh,3 Tse-Hsien Koh,4 Thean-Yen Tan,5 Winnie Lee,1 Jocelyn Qi-Min Teo,1 Yiying Cai,1 Thuan-Tong Tan,6 Pui Lai Rachel Ee,3 Andrea L Kwa1,3,7 1Department of Pharmacy, Singapore General Hospital, Singapore, Singapore; 2SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore; 3Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore; 4Department of Microbiology, Singapore General Hospital, Singapore, Singapore; 5Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore; 6Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore; 7Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore Objectives: Treatment for nosocomial bloodstream infections (BSI) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) is challenging. Rising antimicrobial resistance, especially in extended spectrum beta-lactamase production, inadvertently increases empiric carbapenem consumption. Three antipseudomonal carbapenems (imipenem, meropenem [MER], and doripenem [DOR]) are available commercially against MDR GNB in Singapore. The study aims to determine the most optimal empiric carbapenem dosing regimens (CDR) and evaluate their cost-effectiveness for GNB-BSI in the face of increasing MDR GNB. Methods: Carbapenem minimum inhibitory concentrations (MICs) were generated for non-repeat GNB-BSI obtained in 2013–2014 from two hospitals. Monte Carlo simulations were used to assess the cumulative fraction of response (CFR) of various CDRs using the percentage of time above MIC for 40% (%T > MIC of 40%) as the pharmacokinetic (PK)–pharmacodynamic (PD) parameter for efficacy. Carbapenem costs were based on patient antibiotic costs. Antibiotic cost-effectiveness was calculated as total daily drug cost/CFR. Results: A total of 1,140 bloodstream isolates were collected. They compri

Published
2018

46. Evaluating Polymyxin B-Based Combinations against Carbapenem-Resistant Escherichia coli in Time-Kill Studies and in a Hollow-Fiber Infection Model

Author

Cai, Yiying, primary, Lim, Tze-Peng, additional, Teo, Jocelyn Qi-Min, additional, Sasikala, Suranthran, additional, Chan, Eric Chun Yong, additional, Hong, Yan Jun, additional, Lee, Winnie, additional, Tan, Thean Yen, additional, Tan, Thuan Tong, additional, Koh, Tse Hsien, additional, Hsu, Li Yang, additional, and Kwa, Andrea L., additional

Published
2017
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47. Utility of Serial β-d-Glucan Levels in Patients with High Risk for Invasive Candidiasis: A Potential Tool for Antifungal Stewardship

Author

Chua, Alvin Qijia, primary, Tang, Sarah Si Lin, additional, Ng, Shin Yi, additional, Lee, Winnie, additional, Cheong, Eleanor Jing Yi, additional, Loo, Liwen, additional, Zhou, Yvonne Peijun, additional, Chua, Nathalie Grace Sy, additional, Lim, Cheryl Li Ling, additional, Chlebicki, Maciej Piotr, additional, Tan, Ban Hock, additional, and Kwa, Andrea L, additional

Published
2017
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48. In Vitro Activity of Polymyxin B in Combination with Various Antibiotics against Extensively Drug-Resistant Enterobacter cloacae with Decreased Susceptibility to Polymyxin B

Author

Cai, Yiying, primary, Lim, Tze-Peng, additional, Teo, Jocelyn, additional, Sasikala, Suranthran, additional, Lee, Winnie, additional, Hong, Yanjun, additional, Chan, Eric Chun Yong, additional, Tan, Thean Yen, additional, Tan, Thuan-Tong, additional, Koh, Tse Hsien, additional, Hsu, Li Yang, additional, and Kwa, Andrea L., additional

Published
2016
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49. From Bench-Top to Bedside: A Prospective In Vitro Antibiotic Combination Testing (iACT) Service to Guide the Selection of Rationally Optimized Antimicrobial Combinations against Extensively Drug Resistant (XDR) Gram Negative Bacteria (GNB)

Author

Cai, Yiying, primary, Chua, Nathalie Grace, additional, Lim, Tze-Peng, additional, Teo, Jocelyn Qi-Min, additional, Lee, Winnie, additional, Kurup, Asok, additional, Koh, Tse-Hsien, additional, Tan, Thuan-Tong, additional, and Kwa, Andrea L., additional

Published
2016
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