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3. SG-APSIC1159: Control of hospital-acquired carbapenemase-producing carbapenem-resistant Enterobacteriaceae colonization: A descriptive study

Author

Tuodi Wu, Li Jie, Maria Theresa Mapalo Muyot Cabahug, Philomena Liew, Chai Hairu, Suhailah Binte Nasir, Harminder Kaur, An Rongyan, Foo Shi Yun, Tan Seow Yen, Tan Thean Yen, and Tan Si Huei

Subjects
Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Objectives: Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are nosocomial pathogens, and control of CP-CRE transmission is one of the most important infection control issues healthcare organizations face today. Increasing colonization acquisition and clinical infections of CP-CRE occurred in our institution in 2019. In this observational study, we monitored CP-CRE acquisition following implementation of multimodal control measures, and we describe the impact of this intervention on clinical infections. Methods: Increased hospital-acquired CP-CRE colonization and clinical infections were observed in early 2019. Increased CP-CRE surveillance was implemented to include CP-CRE contacts, patients with lengths of stay >7 days, patients with a recent history of hospitalization in other hospitals, and renal dialysis patients. The following interventions were also implemented: (1) isolation or placing CP-CRE patients in cohorts in a designated multidrug-resistant organism (MDRO) ward; (2) emphasis on hand hygiene and contact precautions; (3) mandatory use of gown and gloves for predefined ‘high-risk’ nursing activities, including diaper changing, toilet assistance, wound dressing, and handling urine or stool; (4) enhanced environmental and equipment cleaning; (5) regular audit and feedback regarding compliance; and (6) weekly feedback on ward-level CP-CRE acquisition. CP-CRE colonization cases and clinical infections were tracked by infection prevention and control nurses. Results: The hospital-acquired CP-CRE colonization rate was 4.39 per 10,000 patient days in 2019; it decreased slightly to 3.61 in 2020 and remained steady at 3.77 in 2021. The predominant CP-CRE genes were NDM, OXA-48–like, and KPC. There were 12 hospital-acquired CP-CRE infections in 2019, a rate of 0.37 per 10,000 patient days. This incidence decreased to 6 infections in 2020 and 3 infections in 2021, with corresponding infection rates of 0.19 and 0.09 per 10,000 patient days, respectively. Conclusions: Control of CP-CRE remains extremely challenging in hospitals with multibed open wards. A bundle approach to infection control showed a gradual reduction in CP-CRE cases, with a significant impact on the prevention of clinical infections.

Published
2023
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4. Whole genome sequencing reveals hidden transmission of carbapenemase-producing Enterobacterales

Author

Marimuthu, Kalisvar, Venkatachalam, Indumathi, Koh, Vanessa, Harbarth, Stephan, Perencevich, Eli, Cherng, Benjamin Pei Zhi, Fong, Raymond Kok Choon, Pada, Surinder Kaur, Ooi, Say Tat, Smitasin, Nares, Thoon, Koh Cheng, Tambyah, Paul Anantharajah, Hsu, Li Yang, Koh, Tse Hsien, De, Partha Pratim, Tan, Thean Yen, Chan, Douglas, Deepak, Rama Narayana, Tee, Nancy Wen Sim, Kwa, Andrea, Cai, Yiying, Teo, Yik-Ying, Thevasagayam, Natascha May, Prakki, Sai Rama Sridatta, Xu, Weizhen, Khong, Wei Xin, Henderson, David, Stoesser, Nicole, Eyre, David W., Crook, Derrick, Ang, Michelle, Lin, Raymond Tzer Pin, Chow, Angela, Cook, Alex R., Teo, Jeanette, and Ng, Oon Tek

Published
2022
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5. Multicenter Evaluation of the Xpert MRSA NxG Assay for Detection of Methicillin-Resistant Staphylococcus aureus in Nasal Swabs

Author

Yarbrough, Melanie L, Warren, David K, Allen, Karen, Burkholder, Dennis, Daum, Robert, Donskey, Curtis, Knaack, Dennis, LaMarca, Anthony, May, Larissa, Miller, Loren G, Parenti, David M, Peterson, Lance, Tan, Thean Yen, Widen, Raymond, Hernandez, Diana R, Wolk, Donna M, and Burnham, Carey-Ann D

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Vaccine Related, Prevention, Emerging Infectious Diseases, Clinical Research, Antimicrobial Resistance, Infectious Diseases, Infection, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, Bacteriological Techniques, Child, Child, Preschool, DNA, Bacterial, Female, Humans, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Nasal Cavity, Polymerase Chain Reaction, Reagent Kits, Diagnostic, Sensitivity and Specificity, Staphylococcal Infections, Young Adult, methicillin-resistant Staphylococcus aureus, bacterial colonization, nasal swab, Biological Sciences, Agricultural and Veterinary Sciences, Medical and Health Sciences, Microbiology, Clinical sciences, Medical microbiology
Abstract

Health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a burden on the health care system. Clinical laboratories play a key role in reducing this burden, as the timely identification of MRSA colonization or infection facilitates infection control practices that are effective at limiting invasive MRSA infections. The Xpert MRSA NxG assay recently received FDA clearance for the direct detection of MRSA from nasal swabs. This multicenter study evaluated the clinical performance characteristics of the Xpert MRSA NxG assay with prospectively collected rayon nasal swabs (n = 1,103) and flocked swab (ESwab) nasal specimens (n = 846). Culture-based identification methods and antimicrobial susceptibility testing were used as the reference standards for comparison. According to the reference method, the positivity rates for MRSA in the population evaluated were 11.1% (122/1,103) for rayon swabs and 11.6% (98/846) for flocked swabs. The overall sensitivity and specificity of the rayon swabs were 91.0% (95% confidence interval [CI], 84.6 to 94.9%) and 96.9% (95% CI, 95.7 to 97.8%), respectively, across eight testing sites. The flocked swab specimens were 92.9% sensitive (95% CI, 86.0 to 96.5%) and 97.6% specific (95% CI, 96.2 to 98.5%) for MRSA detection across six testing sites. The sensitivity and specificity of the combined flocked and rayon swab data were 91.8% (95% CI, 87.4 to 94.8%) and 97.2% (95% CI, 96.3 to 97.9%), respectively. The positive predictive value (PPV) for rayon swabs was 78.7%, versus 83.5% for ESwabs. The negative predictive values (NPVs) for rayon swabs and ESwab specimens were 98.9% and 99.1%, respectively. In conclusion, the Xpert MRSA NxG assay is a sensitive and specific assay for the direct detection of MRSA from nasal swab specimens.

Published
2018

12. 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

13. Clinical and Molecular Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Adult Inpatients in Singapore

Author

Carbapenemase-Producing Enterobacteriaceae in Singapore (CaPES) Study Group, Marimuthu, Kalisvar, Venkatachalam, Indumathi, Khong, Wei Xin, Koh, Tse Hsien, Cherng, Benjamin Pei Zhi, Van La, My, De, Partha Pratim, Krishnan, Prabha Unny, Tan, Thean Yen, Choon, Raymond Fong Kok, Pada, Surinder Kaur, Lam, Choong Weng, Ooi, Say Tat, Deepak, Rama Narayana, Smitasin, Nares, Tan, Eng Lee, Lee, Jia Jun, Kurup, Asok, Young, Barnaby, Sim, Nancy Tee Wen, Thoon, Koh Cheng, Fisher, Dale, Ling, Moi Lin, Peng, Brenda Ang Sze, Teo, Yik-Ying, Hsu, Li Yang, Lin, Raymond Tzer Pin, Ong, Rick Twee-Hee, Teo, Jeanette, and Ng, Oon Tek

Published
2017

14. 2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data

Author

Singapore Group B Streptococcus Consortium, Kalimuddin, Shirin, Chen, Swaine L., Lim, Cindy T. K., Koh, Tse Hsien, Tan, Thean Yen, Kam, Michelle, Wong, Christopher W., Mehershahi, Kurosh S., Chau, Man Ling, Ng, Lee Ching, Tang, Wen Ying, Badaruddin, Hishamuddin, Teo, Jeanette, Apisarnthanarak, Anucha, Suwantarat, Nuntra, Ip, Margaret, Holden, Matthew T. G., Hsu, Li Yang, and Barkham, Timothy

Published
2017

17. Epidemiology and trends in the antibiotic susceptibilities of Gram-negative bacilli isolated from patients with intra-abdominal infections in the Asia-Pacific region, 2010–2013

Author

Chang, Ya-Ting, Coombs, Geoffrey, Ling, Thomas, Balaji, V., Rodrigues, Camilla, Mikamo, Hiroshige, Kim, Min-Ja, Rajasekaram, Datin Ganeswrie, Mendoza, Myrna, Tan, Thean Yen, Kiratisin, Pattarachai, Ni, Yuxing, Barry, Weinman, Xu, Yingchun, Chen, Yen-Hsu, and Hsueh, Po-Ren

Published
2017
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19. SG-APSIC1095: Acquisition rate of carbapenemase-producing organisms (CPOs) among hospital contacts of CPO patients: An interim subgroup analysis of a cohort study

Author

Husen, Sharifah Farhanah Syed, primary, Linn, Kyaw Zaw, additional, Ong, Clara Chong Hui, additional, Huan, Xiaowei, additional, Loo, Liang Hui, additional, Sazali, Ismail Bin, additional, Vasoo, Shawn, additional, Foo, Meow Ling, additional, Ooi, Say Tat, additional, Tan, Thean Yen, additional, Smitasin, Nares, additional, Ling, Moi Lin, additional, Tambyah, Paul Anantharajah, additional, Tan, Seow Yen, additional, Ng, Oon Tek, additional, and Marimuthu, Kalisvar, additional

Published
2023
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20. Impact of COVID-19 pandemic on carbapenem-resistant Enterobacterales incidence in the South-East Asia region: an observational study

Author

Linn, Kyaw Zaw, primary, Sutjipto, Stephanie, additional, Ng, Oon Tek, additional, Teo, Jeanette, additional, Cherng, Benjamin Pei Zhi, additional, Tan, Thean Yen, additional, Pada, Surinder Kaur, additional, Ooi, Say Tat, additional, Smitasin, Nares, additional, Thoon, Koh Cheng, additional, Huan, Xiaowei, additional, De, Partha Pratim, additional, Chan, Douglas, additional, Tee, Nancy Wen Sim, additional, Ang, Michelle, additional, Hsu, Li Yang, additional, Lin, Raymond Tzer Pin, additional, Ng, Tong Yong, additional, Deepak, Rama Narayana, additional, Koh, Tse Hsien, additional, Apisarnthanarak, Anucha, additional, Ponnampalavanar, Sasheela, additional, Venkatachalam, Indumathi, additional, and Marimuthu, Kalisvar, additional

Published
2023
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27. Clinical trial: seven‐day vonoprazan‐ versus 14‐day proton pump inhibitor‐based triple therapy for first‐line Helicobacter pylori eradication

Author

Ang, Daphne, primary, Koo, Seok Hwee, additional, Chan, Yiong Huak, additional, Tan, Thean Yen, additional, Soon, Gaik Hong, additional, Tan, Chin Kimg, additional, Lin, Kenneth Weicong, additional, Krishnasamy‐Balasubramanian, Jaydeesh‐Khanna, additional, Wong, Yu Jun, additional, Kumar, Rahul, additional, R, Rajesh, additional, Tan, Yiyuan, additional, Ong, Peng‐Lan Jeannie, additional, Tan, Yi‐Lyn Jessica, additional, Li, James Weiquan, additional, Kwek, Andrew Boon‐Eu, additional, and Ang, Tiing Leong, additional

Published
2022
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28. Viral Dynamics and Immune Correlates of Coronavirus Disease 2019 (COVID-19) Severity

Author

Young, Barnaby E, Ong, Sean W X, Ng, Lisa F P, Anderson, Danielle E, Chia, Wan Ni, Chia, Po Ying, Ang, Li Wei, Mak, Tze-Minn, Kalimuddin, Shirin, Chai, Louis Yi Ann, Pada, Surinder, Tan, Seow Yen, Sun, Louisa, Parthasarathy, Purnima, Fong, Siew-Wai, Chan, Yi-Hao, Tan, Chee Wah, Lee, Bernett, Rötzschke, Olaf, Ding, Ying, Tambyah, Paul, Low, Jenny G H, Cui, Lin, Barkham, Timothy, Lin, Raymond Tzer Pin, Leo, Yee-Sin, Renia, Laurent, Wang, Lin-Fa, Lye, David Chien, Lim, Poh Lian, Peng Ang, Brenda Sze, Lee, Cheng Chuan, U Lee, Lawrence Soon, Ling, Li Min, Ng, Oon Tek, Chan, Monica, Marimuthu, Kalisvar, Vasoo, Shawn, Wong, Chen Seong, Lee, Tau Hong, Sadarangani, Sapna, Lin, Ray Junhao, Sadasiv, Mucheli Sharavan, Ling Ng, Deborah Hee, Choy, Chiaw Yee, En Tan, Glorijoy Shi, Tan, Yu Kit, Sutjipto, Stephanie, Lee, Pei Hua, Tay, Jun Yang, Yeo, Tsin Wen, Khoo, Bo Yan, Tay, Woo Chiao, Ng, Gabrielle, Mah, Yun Yuan, Tan, Wilnard, De, Partha Pratim, Pooja, Rao, Chia, Jonathan W Z, Constance Chen, Yuan Yi, Mendis, Shehara, Toh, Boon Kiat, Choon Fong, Raymond Kok, Lin Oh, Helen May, Fong Chien, Jaime Mei, Shafi, Humaira, Cheong, Hau Yiang, Tan, Thean Yen, Tan, Thuan Tong, Tan, Ban Hock, Wijaya, Limin, Venkatachalam, Indumathi, Chua, Ying Ying, Zhi Cherng, Benjamin Pei, Zi Chan, Yvonne Fu, Wong, Hei Man, Thien, Siew Yee, Meng Goh, Kenneth Choon, Ling Tan, Shireen Yan, Ean Oon, Lynette Lin, Chan, Kian Sing, Lin, Li, Gin Chan, Douglas Su, Ooi, Say Tat, Narayana, Deepak Rama, Somani, Jyoti, Ling Oon, Jolene Ee, Yan, Gabriel Zherong, Allen, David Michael, Jureen, Roland, Yan, Benedict, Foo, Randy, Kang, Adrian, Sivalingam, Velraj, How, Wilson, Fernandez, Norman Leo, Yeo, Nicholas Kim-Wah, Chee, Rhonda Sin-Ling, Amrun, Siti Naqiah, Lee Kong Chian School of Medicine (LKCMedicine), National Centre for Infectious Diseases, Tan Tock Seng Hospital, Yong Loo Lin School of Medicine, NUS, and Saw Swee Hock School of Public Health, NUS

Subjects
0301 basic medicine, Microbiology (medical), biology, Viral culture, business.industry, 030106 microbiology, COVID-19, medicine.disease, 03 medical and health sciences, Pneumonia, 0302 clinical medicine, Infectious Diseases, Immune system, Immunoglobulin M, Viral pneumonia, Immunology, Severity of illness, medicine, biology.protein, Cytokines, Medicine [Science], 030212 general & internal medicine, Seroconversion, Antibody, business
Abstract

Background Key knowledge gaps remain in the understanding of viral dynamics and immune response of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Methods We evaluated these characteristics and established their association with clinical severity in a prospective observational cohort study of 100 patients with PCR-confirmed SARS-CoV-2 infection (mean age, 46 years; 56% male; 38% with comorbidities). Respiratory samples (n = 74) were collected for viral culture, serum samples for measurement of IgM/IgG levels (n = 30), and plasma samples for levels of inflammatory cytokines and chemokines (n = 81). Disease severity was correlated with results from viral culture, serologic testing, and immune markers. Results Fifty-seven (57%) patients developed viral pneumonia, of whom 20 (20%) required supplemental oxygen, including 12 (12%) with invasive mechanical ventilation. Viral culture from respiratory samples was positive for 19 of 74 patients (26%). No virus was isolated when the PCR cycle threshold (Ct) value was >30 or >14 days after symptom onset. Seroconversion occurred at a median (IQR) of 12.5 (9–18) days for IgM and 15.0 (12–20) days for IgG; 54/62 patients (87.1%) sampled at day 14 or later seroconverted. Severe infections were associated with earlier seroconversion and higher peak IgM and IgG levels. Levels of IP-10, HGF, IL-6, MCP-1, MIP-1α, IL-12p70, IL-18, VEGF-A, PDGF-BB, and IL-1RA significantly correlated with disease severity. Conclusions We found virus viability was associated with lower PCR Ct value in early illness. A stronger antibody response was associated with disease severity. The overactive proinflammatory immune signatures offer targets for host-directed immunotherapy, which should be evaluated in randomized controlled trials.

Published
2020
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29. Antimicrobial susceptibility of bacterial pathogens associated with community-acquired respiratory tract infections in Asia: report from the Community-Acquired Respiratory Tract Infection Pathogen Surveillance (CARTIPS) study, 2009–2010

Author

Wang, Hui, Chen, Minjun, Xu, Yingchun, Sun, Hongli, Yang, Qiwen, Hu, Yunjian, Cao, Bin, Chu, Yunzhuo, Liu, Yong, Zhang, Rong, Yu, Yunsong, Sun, Ziyong, Zhuo, Chao, Ni, Yuxing, Hu, Bijie, Tan, Thean Yen, Hsueh, Po-Ren, Wang, Jen-Hsien, Ko, Wen-Chien, Chen, Yen-Hsu, and Wahjono, Hendro

Published
2011
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31. Distribution of ESBLs, AmpC β-lactamases and carbapenemases among Enterobacteriaceae isolates causing intra-abdominal and urinary tract infections in the Asia-Pacific region during 2008–14: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART)

Author

Jean, Shio-Shin, Hsueh, Po-Ren, Korman, Tony, Ellem, Justin, George, Narelle, Coombs, Geoffrey, Ling, Thomas, Tsang, Owen, Balaji, V., Mikamo, Hiroshige, Kusachi, Shinya, Mizutani, Tetsu, Kim, Min-Ja, Bae, In-Gyu, Umur, Nurulhuda Binti, Rajasekaram, Datin Ganeswrie, Taylor, Susan, Roberts, Sally, van der Werff, Koen, Drinkovic, Dragana, Lagamayo, Evelina, Mendoza, Myrna, Tan, Thean Yen, Krishnan, Prabha, Wang, Ellie, Lu, Po-Liang, Liu, Chun-Eng, Chuang, Kenneth Yin-Ching, Yu, Kwok-Woon, Chen, Yao-Shen, Lu, Min-Chi, Panthuwong, Siripen, Kiratisin, Pattarachai, My Phoung, Nguyen Tran, Phuong, Doan Mai, Van, Nguyen Thi, and Thanh Nga, Tran Thi

Published
2017
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37. Antimicrobial drug resistance in Singapore hospitals

Author

Hsu, Li-Yang, Tan, Thean-Yen, Jureen, Roland, Koh, Tse-Hsien, Krishnan, Prabha, Lin, Raymond Tzer-Pin, Tee, Nancy Wen-Sin, and Tambyah, Paul Ananth

Subjects
Hospital patients -- Health aspects, Hospital patients -- Surveys, Drug resistance in microorganisms -- Surveys, Drug resistance in microorganisms -- Research
Abstract

A new national antimicrobial resistance surveillance program in Singapore public hospitals that uses WHONET detected high levels of methicillin resistance among Staphylococcus aureus (35.3%), carbapenem resistance among Acinetobacter spp. (49.6%), [...]

Published
2007

44. The accuracy of healthcare worker versus self collected (2-in-1) Oropharyngeal and Bilateral Mid-Turbinate (OPMT) swabs and saliva samples for SARS-CoV-2

Author

Tan, Seow Yen, primary, Tey, Hong Liang, additional, Lim, Ernest Tian Hong, additional, Toh, Song Tar, additional, Chan, Yiong Huak, additional, Tan, Pei Ting, additional, Lee, Sing Ai, additional, Tan, Cheryl Xiaotong, additional, Koh, Gerald Choon Huat, additional, Tan, Thean Yen, additional, and Siau, Chuin, additional

Published
2020
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