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COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.

BACKGROUND Antimicrobial resistance (AMR) has emerged as a major global public health challenge due to the overuse and misuse of antibiotics for humans and animals. Hospitals are among the major users of antibiotics, thereby having a large contribution to AMR. OBJECTIVE The aim of this study is to determine the prevalence of antibiotic-resistant pathogenic bacteria and the level of antibiotic residues in the hospital effluents in Selangor, Malaysia. METHODS A cross-sectional study will be performed in the state of Selangor, Malaysia. Tertiary hospitals will be identified based on the inclusion and exclusion criteria. The methods are divided into three phases: sample collection, microbiological analysis, and chemical analysis. Microbiological analyses will include the isolation of bacteria from hospital effluents by culturing on selective media. Antibiotic sensitivity testing will be performed on the isolated bacteria against ceftriaxone, ciprofloxacin, meropenem, vancomycin, colistin, and piperacillin/tazobactam. The identification of bacteria will be confirmed using 16S RNA polymerase chain reaction (PCR) and multiplex PCR will be performed to detect resistance genes (ermB, mecA, blaNDM-L, blaCTX-M, blaOXA-48, blaSHV, VanA, VanB, VanC1, mcr-1, mcr-2, mcr-3, Intl1, Intl2, and qnrA). Finally, the level of antibiotic residues will be measured using ultrahigh-performance liquid chromatography. RESULTS The expected outcomes will be the prevalence of antibiotic-resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter (ESKAPE) bacterial species from the hospital effluents, the occurrence of antibiotic resistance genes (ARGs) from the isolated ESKAPE bacteria, and the level of antibiotic residues that may be detected from the effluent. Sampling has been conducted in three hospitals. Data analysis from one hospital showed that as of July 2022, 80% (8/10) of E. faecium isolates were resistant to vancomycin and 10% (1/10) were resistant to ciprofloxacin. Further analysis will be conducted to determine if the isolates harbor any ARGs and effluent samples are being analyzed to detect antibiotic residues. Sampling activities will be resumed after being suspended due to the COVID-19 pandemic and are scheduled to end by December 2022. CONCLUSIONS This study will provide the first baseline information to elucidate the current status of AMR of highly pathogenic bacteria present in hospital effluents in Malaysia. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/39022

This study was performed to investigate the serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae in Asian countries. A prospective surveillance study on S. pneumoniae collected from adult patients (≥50 years old) with invasive pneumococcal disease or community-acquired pneumonia was performed at 66 hospitals in Asian countries (Korea, China, Malaysia, Singapore, the Philippines, and Thailand) in 2012-2017. Serotyping and antimicrobial susceptibility tests of 850 pneumococcal isolates were performed. The proportions of isolates with serotypes covered by 13-valent pneumococcal conjugate vaccine (PCV13) were 37.0% in Korea, 53.4% in China, 77.2% in Malaysia, 35.9% in the Philippines, 68.7% in Singapore, and 60.2% in Thailand. Major serotypes were 19F (10.4%), 19A (10.1%), and 3 (8.5%) in 2012-2017, with different serotype distributions in each country. Macrolide resistance in pneumococci was high (66.8%) and prevalence of multidrug resistance (MDR) also remained high (50.8%). MDR non-PCV13 serotypes such as 11A, 15A, 35B, and 23A have emerged in Asian countries. This study showed the persistent prevalence of 19F and 19A with a noteworthy increase of certain non-PCV13 serotypes in Asian countries. High prevalence of macrolide resistance and MDR was also found in pneumococcal isolates. These data emphasize the need for continued surveillance of pneumococcal epidemiology in Asia in the post-pneumococcal vaccine era.

Pneumococcal disease is a potentially fatal bacterial infection that is vaccine-preventable. Malaysia has yet to adopt a pneumococcal conjugate vaccine (PCV) into its national immunization program (NIP). In 2016, pneumonia was the 3rd leading cause of death in children under five in Malaysia, accounting for 3.8% of under-five deaths. Introducing a pneumococcal conjugate vaccine (PCV) is an effective strategy to reduce the disease burden. This study used a decision-analytic model to assess the potential impacts of introducing the available PCVs (13-valent and 10-valent) in Malaysia. Epidemiological and costs inputs were sourced from published literature. For each vaccination program, health outcomes and associated healthcare costs were estimated. The scenarios of initiating PCV13 vs. PCV10 and the status quo (no pneumococcal vaccine) were compared. Serotype trends of Finland and the U.K. were used to model the clinical impacts of PCV10 and PCV13 respectively. The base-case analysis used a societal perspective over a 5-year time horizon. Compared with PCV10, PCV13 was projected to avert an additional 190,628 cases of pneumococcal disease and 1126 cases of death. The acquisition of PCV13 was estimated to cost an incremental US$89,904,777, offset by a cost reduction of -US$250,219,914 on pneumococcal disease-related medical care and lost productivity. PCV13 demonstrated a higher cost-saving potential over PCV10. Compared with no vaccination, PCV13 was estimated as cost-saving. Results were robust across a series of sensitivity analyses. The introduction of PCV13 in a NIP was estimated to reduce a significant burden of disease and to be a cost-saving for the Malaysian health system.

The emergence of non-vaccine multidrug-resistant Streptococcus pneumoniae serotypes is on rise. This study was performed to investigate a highly resistant serotype 15A S. pneumoniae isolated from the blood specimen of a 20-month-old patient who died of her infection. The SS40_16 isolate was resistant to erythromycin, co-trimoxazole, tetracycline, and chloramphenicol, as well as to penicillin, ceftriaxone, and cefotaxime (using meningitis cut-off points, Clinical and Laboratory Standards Institute). The isolate belonged to sequence type 1591 (ST1591) and was related to CC81 clonal complex, suggesting the possibility of horizontal gene transfer. Scanning electron microscopy comparison between resistant and sensitive pneumococcal isolates also indicated similar phenotypic characteristics that confer high resistance. The emergence of highly resistant non-vaccine pneumococci is of great concern to public health and in the clinical setting. Pneumococcal surveillance programs represent a crucial tool, not only for determining the impact of pneumococcal conjugate vaccines, but also for monitoring the selective pressure of serotype replacement with regard to the treatment of invasive pneumococcal disease. Keywords: Emerging non-vaccine serotype, Multidrug resistant, Serotype 15A

BACKGROUND Antimicrobial resistance (AMR) is a known global public health threat. In addition to this, it brings serious economic consequences to agriculture. Antibiotic resistance is an interconnection of humans, animals and the environment as proposed in tricycle surveillance by the WHO. In Malaysia, research and surveillance of AMR are mainly derived from clinical samples, agricultural settings, and surface water, but no surveillance of the drinking water system is currently performed. Hence, this policy-driven study is a combined effort of microbiologists and engineers to provide baseline data on the magnitude of AMR as a possible pollutant in the drinking water system which is not being monitored at present. OBJECTIVE To study the baseline level of antibiotic resistance in drinking water distribution from pre-and post- drinking water treatment plants in a selected state in Malaysia. METHODS This is a lab-based, cross-sectional study in a selected state, Malaysia. Water samples from six drinking water treatment plants (DWTPs) were collected. Samples were collected at three sampling points consisting of the intake sampling station, service reservoir outlet station, and distribution system sampling station. These were tested against seven types of antibiotics in triplicates. Samples were screened for antibiotic-resistant bacteria (ARBs) and antibiotic-resistant genes (ARGs) and quantified for the level of antibiotics present in the DWTPs. RESULTS Results include descriptive statistics of the number of bacterial colonies harvested from water samples grown on Reasoner’s (R2A) agar with or without antibiotics, the occurrence of antibiotic-resistant genes, and the level of antibiotics detected in water samples. CONCLUSIONS This study provides baseline information on the status of antimicrobial-resistant bacteria, the presence of resistance genes as contaminants, and the level of antibiotics present in drinking water systems, with the aim of demonstrating to policymakers the need to consider AMR as a parameter in drinking water surveillance. CLINICALTRIAL This study is not a clinical trial

Simple Summary We investigated the pathogenicity, antimicrobial resistance and multilocus sequence types of Salmonella enterica subspecies enterica serovar Enteritidis isolated from fresh chicken meat, ready-to-eat chicken meat as well as from cloacal swabs of live chickens in some selected locations within the central region of peninsular Malaysia. After culture and serotype confirmation of the Salmonella isolates, the genomic DNA was extracted and whole-genome sequencing was conducted using the NextSeq 550 System (Illumina, San Diego, CA, USA). In silico serotypes were determined with the aid of SeqSero WGS in silico software version 2, while multilocus sequence types, as well as virulence and antimicrobial resistance determinants, were all determined using the BioEasy Epinod pipeline. The S. Enteritidis isolates were found to harbour several virulence genes, with multidrug-resistance characteristics. The results of this investigation indicate the potential risks both humans and livestock are exposed to due to this foodborne pathogen. Abstract This study was undertaken to determine the virulence, antimicrobial resistance and molecular subtypes of Salmonella in the Central Region of Peninsular Malaysia. A total of 45 Salmonella Enteritidis were detected from live chicken (cloacal swab), and chicken products (fresh and ready-to-eat meat) samples upon cultural isolation and serotyping. Similarly, an antimicrobial susceptibility test based on the Kirby Bauer disk diffusion method as well as antimicrobial resistance AMR genes, virulence determinants and multilocus sequence typing (MLST) typing were conducted after the Whole Genome Sequencing and analysis of the isolates. The results indicate that sequence types ST1925 (63.7%), and ST11 (26.5%) were the predominant out of the seven sequence types identified (ST292, ST329, ST365, ST423 and ST2132). The phenotypic antimicrobial profile corresponds to the genotypic characterization in that the majority of the isolates that exhibited tetracycline, gentamycin and aminoglycoside resistance; they also possessed the tetC and blaTEM β-Lactam resistance genes. However, isolates from cloacal swabs showed the highest number of resistance genes compared to the chicken products (fresh and ready-to-eat meat) samples. Furthermore, most of the virulence genes were found to cluster in the Salmonella pathogenicity island (SPI). In this study, all the isolates were found to possess SPI-1, which codes for the type III secretion system, which functions as actin-binding proteins (SptP and SopE). The virulence plasmid (VP) genes (spvB, spvC) were present in all genotypes except ST365. The findings of this study, particularly with regard to the molecular subtypes and AMR profiles of the Salmonella Enteritidis serotype shows multidrug-resistance features as well as genetic characteristics indicative of high pathogenicity.

Sporadic diphtheria cases in Malaysia have remained low in number since the 1990s. However, in 2016 a total of 31 cases were reported nationwide and to investigate this we performed molecular characterization of 30 Corynebacterium diphtheriae isolates collected from 1981 to 2016 using multilocus sequence typing (MLST). C. diphtheriae isolates were identified and biotyped using the API Coryne kit, while the toxigenicity was determined by PCR and the Elek test. All of the 2016 isolates belonged to biotype mitis, caused respiratory diphtheria and were toxigenic strains. MLST analysis identified 17 sequence types (STs), including 11 new ones. ST453 was the most common clone (7/30, 23.3 %), followed by ST141 (5/30, 16.7 %), ST451 (3/30, 10.0 %) and ST248 (2/30, 6.7 %). The clones identified in 2016 had not been detected in previous isolations and they were phylogenetically distinct. Our results suggest that the diphtheria cases in 2016 were caused by the emergence and spread of new clones in Malaysia.

BackgroundDespite high childhood immunization coverage, sporadic cases of diphtheria have been reported in Malaysia in recent years. This study aims to evaluate the seroprevalence of diphtheria among the Malaysian population.MethodsA total of 3317 respondents age 2 years old to 60 years old were recruited in this study from August to November 2017. Enzyme-linked immunosorbent assay (ELISA) was used to measure the level of IgG antibody against the toxoid of C. diphtheriae in the blood samples of respondents. We classified respondent antibody levels based on WHO definition, as protective (≥0.1 IU/mL) and susceptible (ResultsAmong the 3317 respondents, 57% were susceptible (38.1% of children and 65.4% of adults) and 43% (61.9% of children and 34.6% of adults) had protective antibody levels against diphtheria. The mean antibody level peaked among individuals aged 1–2 years old (0.59 IU/mL) and 6–7 years old (0.64 IU/mL) but generally decreased with age, falling below 0.1 IU/mL at around 4–6 years old and after age 20 years old. There was a significant association between age [Children: χ2 = 43.22(df = 2),p 2 = 5.58(df = 1),p = 0.018] and ethnicity [Adults: χ2 = 21.49(df = 5),p = 0.001] with diphtheria toxoid IgG antibody level.ConclusionsAbout 57% of the Malaysian population have inadequate immunity against diphtheria infection. This is apparently due to waning immunity following childhood vaccination without repeated booster vaccination in adults. Children at age 5–6 years old are particularly vulnerable to diphtheria infection. The booster vaccination dose normally given at 7 years should be given earlier, and an additional booster dose is recommended for high-risk adults.

An optimal clinical specimen for accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) by minimizing the usage of consumables and reduce hazard exposure to healthcare workers is an urgent priority. The diagnostic performance of SARS‐CoV‐2 detection between healthcare worker‐collected nasopharyngeal and oropharyngeal (NP + OP) swabs and patient performed self‐collected random saliva was assessed. Paired NP + OP swabs and random saliva were collected and processed within 48 h of specimen collection from two cohort studies which recruited 562 asymptomatic adult candidates. Real‐time reverse‐transcription polymerase chain reaction targeting Open reading frame 1a (ORF1a) and nucleocapsid (N) genes was performed and the results were compared. Overall, 65 of 562 (28.1%) candidates tested positive for COVID‐19 based on random saliva, NP + OP swabs, or both testing techniques. The detection rate of SARS‐CoV‐2 was higher in random saliva compared to NP + OP testing (92.3%; 60/65 vs. 73.8%; 48/65; p

Previous diversity studies on local Mycobacterium tuberculosis (MTB) isolates, with or without antibiotic resistance, showed predominance of Indo-Oceanic East African-Indian (EAI) strains. This study focused specifically on a drug-resistant MTB population from Central Malaysia and aimed to investigate the genotypes and resistance patterns involved.Whole-genome sequencing was performed on 56 local MTB isolates with known rifampicin resistance or multidrug resistance towards 13 anti-TB agents. Analysis of each genome sequence was performed using the widely recognized online MTB genotyping platforms, TBProfiler and Mykrobe, to determine lineage and genotypic drug resistance profiles.Forty (71.4%) isolates were identified as East-Asian Beijing strains. Phenotypic to genotypic antibiotic resistance patterns differed in 33 isolates (58.9%), with one isolate showing extensive drug-resistance (XDR) previously not detected by conventional drug-susceptibility testing.This drug resistance population study demonstrated predominance of the East-Asian Beijing strains and a newly detected extensively drug-resistant MTB (XDR-TB) isolate in Malaysia. Information regarding the association between lineage and drug-resistant TB in Malaysia is scarce, and more studies are needed to determine the significance of such association, if any, in our local settings.

Background Salmonella is a very important foodborne pathogen causing illness in humans. The emergence of drug-resistant strains also constitutes a serious worry to global health and livestock productivity. This study investigated Salmonella isolates from chicken and chicken meat products using the phenotypic antimicrobial screening as well as the molecular characteristics of Salmonella isolates. Upon serotyping of the isolates, the antimicrobial susceptibility profiling using a panel of 9 commonly used antimicrobials was done. Subsequently, the molecular profiles of all the isolates were further determined using Pulsed Field Gel Electrophoresis (PFGE) and the Whole Genome Multi-Locus Sequence Type (wgMLST) analysis in order to obtain the sequence types. Results The PFGE data was input into FPQuest software, and the dendrogram generated was studied for possible genetic relatedness among the isolates. All the isolates were found to belong to the Salmonella Enteritidis serotype with notable resistance to tetracycline, gentamycin, streptomycin, and sulfadimidine. The S. Enteritidis isolates tested predominantly subtyped into the ST11 and ST1925, which was found to be a single cell variant of ST11. The STs were found to occur in chicken meats, foods, and live chicken cloacal swabs, which may indicate the persistence of the bacteria in multiple foci. Conclusion The data demonstrate the presence of S. Enteritidis among chickens, indicating its preference and reservoir status for enteric Salmonella pathogens.

Background: Since December 2019, the outbreak of COVID-19 has raised a great public health concern globally. Here, we report the whole genome sequencing analysis of SARS-CoV-2 strains in Malaysia isolated from six patients diagnosed with COVID-19.Methods: The SARS-CoV-2 viral RNA extracted from clinical specimens and isolates were subjected to whole genome sequencing using NextSeq 500 platform. The sequencing data were assembled to full genome sequences using Megahit and phylogenetic tree was constructed using Mega X software.Results: Six full genome sequences of SARS-CoV-2 comprising of strains from 1st wave (25th January 2020) and 2nd wave (27th February 2020) infection were obtained. Downstream analysis demonstrated diversity among the Malaysian strains with several synonymous and non-synonymous mutations in four of the six cases, affecting the genes M, orf1ab, and S of the SARS-CoV-2 virus. The phylogenetic analysis revealed viral genome sequences of Malaysian SARS-CoV-2 strains clustered under the ancestral Type B.Conclusion: This study comprehended the SARS-CoV-2 virus evolution during its circulation in Malaysia. Continuous monitoring and analysis of the whole genome sequences of confirmed cases would be crucial to further understand the genetic evolution of the virus.

Background The occurrence and spread of antibiotic-resistant bacteria (ARB) due to the high demand in poultry industries are of great public health concern. Indiscriminate and abusive use of various antibiotics on a large scale causes antibiotic resistance (AMR) in animal-associated bacteria that may be pathogenic to humans. These bacteria are widely disseminated in the environment via animal waste. This study was therefore designed to assess the prevalence of multiple antibiotic resistance (MAR) among the environmental bacteria in poultry farms and to determine the risk contamination category of poultry by calculating the multiple antibiotic resistance index (MARI). Results More than half (58.2%) of the 511 total bacteria had MAR, and a number of bacteria were resistant to cefazolin (86.8%), fusidic acid (84.6%), ampicillin (79.3%), clindamycin (65.5%) and erythromycin (63.7%). These antibiotics are listed under the WHO’s criteria of critically and highly important antibiotics in human medicine. In this study, 39.53% of the MARI values, which indicate the contamination level in the environment, indicated a high risk, while 14.48% were ambiguous. Conclusion These results therefore have shown that MAR is present not only among humans and animals but also in environmental bacteria. The high prevalence of MAR and the MARI values, together with the resistance patterns of each bacterium, indicate various effects, including possible occupational risks among workers. This study provides an introduction to the AMR of bacteria in the environment. Further studies are needed to observe the horizontal transfer of the resistance gene and the overall mobile genetic elements in environmental bacteria.

Background The ideal severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) testing method would be accurate and also be patient-performed to reduce exposure to healthcare workers. The aim of this study was to compare patient-performed testing based on a morning saliva sample with the current standard testing method, healthcare worker-collected sampling via a nasopharyngeal swab (NPS). Methods This was a prospective single center study which recruited 217 asymptomatic adult male participants in a coronavirus disease 2019 (COVID-19) quarantine center who had tested positive for SARS-CoV-2 8–10 days prior to isolation. Paired NPS and saliva specimens were collected and processed within 5 hours of sample collection. Real time reverse transcription polymerase chain reaction (RT-PCR) targeting Envelope (E) and RNA-dependent RNA polymerase (RdRp) genes was performed and the results were compared. Results Overall, 160 of the 217 (74%) participants tested positive for COVID-19 based on saliva, NPS, or both testing methods. The detection rate for SARS-CoV-2 was higher in saliva compared to NPS testing (93.1%, 149/160 vs 52.5%, 84/160, P < .001). The concordance between the 2 tests was 45.6% (virus was detected in both saliva and NPS in 73/160), whereas 47.5% were discordant (87/160 tested positive for 1 whereas negative for the other). The cycle threshold (Ct) values for E and RdRp genes were significantly lower in saliva specimens compared to NP swab specimens. Conclusions Our findings demonstrate that saliva is a better alternative specimen for detection of SARS-CoV-2. Taking into consideration, the simplicity of specimen collection, shortage of PPE and the transmissibility of the virus, saliva could enable self-collection for an accurate SARS-CoV-2 surveillance testing.

BackgroundSalmonella is a very important food-borne pathogen causing illness in humans. The emergence of drug-resistant strains also constitutes a serious worry to global health and livestock productivity. This study investigated Salmonella isolates from poultry and poultry products using the phenotypic antimicrobial screening as well as the molecular characteristics of Salmonella isolates. Upon serotyping of the isolates, the antimicrobial susceptibility profiling using a panel of 9 commonly used antimicrobials was done. Subsequently, the molecular profiles of all the isolates were further determined using Pulsed Field Gel Electrophoresis (PFGE) and the Whole Genome Multi-Locus Sequence Type (wgMLST) analysis in order to obtain the sequence types. ResultsThe PFGE data was input into FPQuest software, and the dendrogram generated was studied for possible genetic relatedness among the isolates. All the isolates were found to belong to the S. Enteritidis serotype with notable resistance to tetracycline, gentamycin, streptomycin, and sulfadimidine. The S. Enteritidis isolates tested predominantly subtyped into the ST11 and ST1925, which was found to be a single cell variant of ST11. The STs were found to occur in chicken meat, food, and live chicken cloacal swab, which may indicate the persistence of the bacteria in multiple foci. ConclusionThe data demonstrate the presence of S. Enteritidis among chicken, indicating its preference and reservoir status for enteric salmonella pathogens.

Background. The spread of carbapenem-resistantA. baumannii(CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility toβ-lactams. The aim of this study was to analyzeβ-lactamase genetic compositions of CrAb in Malaysia.Methods. Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016.Results. Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multipleβ-lactamase genes.blaOXA-23(n = 13) andblaOXA-66(n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harborblaADC,blaOXA-51-like, andblaOXA-23-likegenes.blaTEM(n = 7),blaNDM-1(n = 3),blaCARB-8(n = 1), andblaPER-3(n = 1) are amongst otherβ-lactamase genes found in this study. ISAba1was found upstream toblaOXA-23(n = 13),blaOXA-66(n = 1), andblaADC(n = 11). AllblaNDM-1isolates had ISAba125(mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008and Tn2009but were negative for Tn2007.Conclusion. Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings.

Acanthamoeba spp. boleh menyebabkan keratitis kepada manusia, khasnya kepada pemakai kanta sentuh yang tidak menitikberatkan aspek higen kanta sentuh. Kajian ini bertujuan untuk mengkaji keberkesanan antibiotik titisan mata Gentamicin terhadap sista Acanthamoeba isolat klinikal iaitu HKL 5, HKL 11, HKL 32, dan HKL 51. Kajian dimulakan dengan melakukan suspensi sista terhadap keempat-empat isolat klinikal tersebut. Mikropencairan terhadap antimikrob dilakukan dan kemudiannya suspensi sista ditambah, seterusnya dieramkan selama 24 jam pada 30oC sebelum dipindahkan ke atas plat agar bukan nutrien (NNA) yang dilapisi E. coli matian haba. Plat agar diperhatikan setiap hari sehingga hari yang ke-14 untuk mengesan sebarang kehadiran trofozoit di bawah mikroskop inverted. Kehadiran trofozoit Acanthamoeba menunjukkan bahawa antibiotik ujian tidak berkesan terhadap sista Acanthamoeba. Gentamicin berkesan terhadap sista Acanthamoeba, dengan nilai purata sistisidal minimum (MCC) 1453.1 μg/ml. Gentamicin merupakan antibiotik yang boleh digunakan dalam rawatan keratitis Acanthamoeba memandangkan kepada keberkesanannya terhadap sista Acanthamoeba isolat klinikal dalam kajian ini. __________________________________________________________________________ Acanthamoeba spp. may cause keratitis in humans especially amongst the contact lens wearers who do not practice good hygienic care of contact lenses. This study aims to evaluate the effectiveness of Gentamicin on four clinical isolates of Acanthamoeba cysts from Kuala Lumpur Hospital consisting HKL 5, HKL 11, HKL 32, and HKL 51. Cysts suspensions of all 4 clinical isolates of Acanthamoeba were prepared. Microdilution of antimicrobial was prepared and cyst suspension was added and later incubated at 30oC for 24 hours before being transferred onto non-nutrient agar (NNA) plates seeded with heat-killed E.coli. The plates were observed daily until day 14 to detect the presence of trophozoites under inverted microscope. The presence of trophozoite stage indicates ineffectiveness of the tested antibiotic towards Acanthamoeba cysts. Gentamicin was found to be effective against Acanthamoeba cysts with MCC mean value of 1453.1 μg/ml. Gentamicin could be used for the treatment of Acanthamoeba keratitis as it exhibited cysticidal effect on all isolates of Acanthamoeba cysts in this study. Keywords: Topical antibiotic eyedrop, Gentamicin, Acanthamoeba, Malaysia

Acanthamoeba spp. merupakan ameba hidup bebas yang tersebar luas di persekitaran. Ameba ini menyebabkan penyakit keratitis terutamanya kepada individu yang memakai kanta sentuh terkontaminasi atau mempunyai sejarah trauma pada mata. Tujuh puluh empat sampel kikisan kornea pesakit keratitis daripada 4 buah hospital di sekitar Lembah Kelang telah dikultur untuk menemukan Acanthamoeba spp. Keputusan kajian mendapati Acanthamoeba spp. berjaya dipencilkan daripada 14.87% sampel kikisan kornea pesakit keratitis. Berdasarkan kajian ini, kesemua pesakit keratitis Acanthamoeba adalah merupakan pemakai kanta sentuh yang majoritinya (90.9%) terdiri daripada kaum wanita. Kanta sentuh lembut terlibat dalam 90.9% kes manakala jenis kanta separa keras cuma satu kes 9.1%. Kesemua 11 pencilan Acanthamoeba yang dipencilkan adalah daripada kumpulan polyphagids yang biasanya patogenik kepada manusia dan menyebabkan jangkitan ini. Kegagalan pengguna kanta sentuh mengamalkan tahap kebersihan kanta sentuh yang baik merupakan faktor risiko yang penting dalam kejadian keratitis Acanthamoeba di Malaysia.

We report a fatal case of Candida auris that was involved in mixed candidemia with Candida tropicalis, isolated from the blood of a neutropenic patient. Identification of both isolates was confirmed by amplification and sequencing of internal transcribed spacer and D1/D2 domain of large subunit in rRNA gene. Antifungal susceptibility test by E-test method revealed that C. auris was resistant to amphotericin B, anidulafungin, caspofungin, fluconazole, itraconazole and voriconazole. On the other hand, C. tropicalis was sensitive to all antifungal tested. The use of chromogenic agar as isolation media is vital in detecting mixed candidemia.