Showing papers in "Journal of Microbiology Immunology and Infection in 2017"
TL;DR: The important mechanisms of action and potential of AMPs in the eradication of biofilm formation in multidrug-resistant pathogen, with the goal of designing novel antimicrobial therapeutics, are discussed.
Abstract: Bacterial resistance to commonly used drugs has become a global health problem, causing increased infection cases and mortality rate. One of the main virulence determinants in many bacterial infections is biofilm formation, which significantly increases bacterial resistance to antibiotics and innate host defence. In the search to address the chronic infections caused by biofilms, antimicrobial peptides (AMP) have been considered as potential alternative agents to conventional antibiotics. Although AMPs are commonly considered as the primitive mechanism of immunity and has been extensively studied in insects and non-vertebrate organisms, there is now increasing evidence that AMPs also play a crucial role in human immunity. AMPs have exhibited broad-spectrum activity against many strains of Gram-positive and Gram-negative bacteria, including drug-resistant strains, and fungi. In addition, AMPs also showed synergy with classical antibiotics, neutralize toxins and are active in animal models. In this review, the important mechanisms of action and potential of AMPs in the eradication of biofilm formation in multidrug-resistant pathogen, with the goal of designing novel antimicrobial therapeutics, are discussed.
210 citations
TL;DR: For patients with C. freundii bacteremia, carrying the blaTEM-1 resistance gene was an independent risk factor for 28-day mortality, indicating that Carbapenems, fourth-generation cephalosporins, amikacin, and quinolones are still reliable agents for drug-resistant strains.
Abstract: Background/purpose Multidrug-resistant strains of Citrobacter have emerged, which carry Amp-C β-lactamase (Amp-C), broad-spectrum β-lactamase, extended-spectrum β-lactamase (ESBL), and other resistance mechanisms. These strains are associated with a higher rate of in-hospital mortality. The object of this study is to determine the mortality risk factors, susceptibility pattern to antibiotics, and prevalence of resistance genes in patients with Citrobacter freundii bacteremia. Methods From January 2009 to December 2014, blood isolates of C . freundii were collected in MacKay Memorial Hospital, Taipei, Taiwan. PCR technique and sequencing were performed for resistance genes. Pulsed-field gel electrophoresis (PFGE) was done using Xba I restriction enzyme. The clinical characteristics and risk factors for mortality are demonstrated. Results The 36 blood isolates of C . freundii belonged to 32 different PFGE pulsotypes, and 15 isolates (41.7%) were polymicrobial. The most common source of infection was intra-abdominal origin (61.1%), followed by unknown sources (22.2%), the urinary tract (8.3%), intravascular catheter (5.6%), and soft tissue (2.8%). High degree of antibiotic resistance was noted for cefazolin (100%), cefoxitin (97.2%), and cefuroxime (66.7%). The bla TEM-1 resistance gene was present in 16.7% isolates. 72.2% isolates carried bla AmpC and 5.6% isolates carried ESBL genes ( bla SHV-12 or bla CTX-M-15 ). Multivariate analysis indicated that the independent risk factor for 28-day mortality was carrying the bla TEM-1 resistance gene. Conclusion For patients with C . freundii bacteremia, carrying the bla TEM-1 resistance gene was an independent risk factor for 28-day mortality. Carbapenems, fourth-generation cephalosporins, amikacin, and quinolones are still reliable agents for drug-resistant strains.
103 citations
TL;DR: When a patient (regardless of age) presents with neck mass or swelling, the DNI should always be included in the differential diagnosis, and performing Gram staining and acid-fast staining of pus, instead of culture alone, as early as possible before initiating the initial antimicrobial therapy are thus crucial.
Abstract: From December 1989 through 1998, a total of 68 children with deep neck infection were enrolled into this study. The mean age was 5.9 years (range, 1 month-15.8 years). Infections in the retropharyngeal space (36.7%) were most common, followed by parapharyngeal space (30.8%), peritonsillar space (20.6%), and submandibular space (11.9%). Fever, neck pain, and swelling were the most frequent symptoms. The most common pathogens were viridans streptococci (41%, 16/39) and Staphylococcus aureus (26%, 10/39). Other isolates included Prevotella spp., Veillonella spp., Klebsiella pneumoniae, Escherichia coli, Morganella spp., and Enterobacter spp. Mixed infection was found in 46% (18/39) of patients. The mean duration of hospitalization was 12.4 days (range, 2-45 days). Complete resolution was achieved in 61 (89.7%) children. Complications occurred in 7 patients, including recurrence, mediastinal spread, bacteremia, and suppurative thyroiditis; the patient with mediastinal spread plus bacteremia died. Five patients had congenital cyst and 4 of them had complications or recurrence/relapse. In conclusion, infections in the retropharyngeal space and polymicrobial infections were most common in deep neck infection of Taiwan children.
93 citations
TL;DR: UV-C disinfection system was effective in killing MDR pathogens and further study is warranted to confirm its effectiveness as an adjunctive method in disinfecting hospital environment.
Abstract: Background Healthcare-associated infections caused by multidrug-resistant (MDR) pathogens are significantly associated with increased mortality and morbidity. Environmental cleaning can reduce transmission of these pathogens but is often inadequate. Adjunctive methods are warranted to enhance the effectiveness of disinfection particularly in hospital settings where healthcare-associated infections are of major concern. Methods We conducted a study to examine the effectiveness of a mobile, automatic device, Hyper Light Disinfection Robot (model: Hyper Light P3), which utilized ultraviolet-C (UV-C) to kill MDR- Pseudomonas aeruginosa , MDR- Acinetobacter baumannii , methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium ( VRE), Mycobacterium abscessus and Aspergillus fumigatus . The performance of this device in disinfecting hospital rooms previously admitted by patients harboring MRSA and VRE was also assessed. Results Except for VRE and M. abscessus , more than 3 log 10 reduction of vegetative bacteria colonies was observed after UV-C irradiation of 5 min at a distance of 3 m from the device. At the distance of 1 m, substantial and comparable reduction of colonies was observed across all tested microorganisms regardless of exposure time. The killing effect was less pronounced for A. fumigatus particularly at the distance of 2–3 m. In uncleaned hospital rooms, there was significant reduction in the number of bacteria colonies sampled from different surfaces after UV-C irradiation for 15 min. Conclusions UV-C disinfection system was effective in killing MDR pathogens. Further study is warranted to confirm its effectiveness as an adjunctive method in disinfecting hospital environment.
79 citations
TL;DR: Component of LGG exerted immunomodulatory effects on porcine IECs, especially immunostimulatory CpG oligodeoxynucleotides, by modulating TLR expressions and inhibiting MAPK and NF-κB signaling to decrease inflammatory cytokine expressions.
Abstract: Background/purpose This study aimed to evaluate the immunomodulatory effects and signaling mechanisms of Lactobacillus rhamnosus GG (LGG) and its components [surface-layer protein (SLP), DNA, exopolysaccharides, and CpG oligodeoxynucleotides] on lipopolysaccharide (LPS)-stimulated porcine intestinal epithelial cell (IEC) IPEC-J2. Methods The mRNA expressions of inflammatory cytokines and Toll-like receptors (TLRs) were measured by quantitative real-time polymerase chain reaction. Activation of mitogen-activated protein kinase (MAPK) and nuclear factor kappa B (NF-κB) signaling was detected by western blot and immunofluorescence. Results Pretreatment of IPEC-J2 cells with LGG, SLP, or exopolysaccharides significantly alleviated LPS-induced inflammatory cytokines and TLR activation at mRNA level. LGG, SLP, and exopolysaccharides also attenuated LPS-induced MAPK and NF-κB signaling activations. CpG oligodeoxynucleotides significantly increased the interleukin 12, tumor necrosis factor α, and TLR9 mRNA levels and enhanced NF-κB signaling activation in LPS-stimulated cells. Conclusion LGG had immunomodulatory effects on LPS-induced porcine IECs by modulating TLR expressions and inhibiting MAPK and NF-κB signaling to decrease inflammatory cytokine expressions. Components of LGG exerted immunomodulatory effects on porcine IECs, especially immunostimulatory CpG oligodeoxynucleotides.
78 citations
TL;DR: Efflux pump genes are universally present in the collected clinical MDRAB isolates and the upregulation of the adeB, adeJ, macB and abeS genes is more related with antibiotic resistance.
Abstract: Background/purpose Efflux pumps are one of the major mechanisms of antimicrobial resistance in Acinetobacter baumannii This study aimed to understand the distribution of different types of pump genes in clinical isolates of multidrug-resistant A baumannii (MDRAB) and to reveal the relationship between their presence and expression with antimicrobial resistance Methods MDRAB isolates were collected from five hospitals in Taiwan Different categories of pump genes, including adeB , adeJ , macB , abeM , abeS , emrA -like, emrB -like, and craA , were chosen, and their presence in the collected isolates was determined Three induced resistant strains of A baumannii ATCC 17978 to tigecycline, imipenem, and amikacin were also included The expressions of the selected pump genes were determined using quantitative reverse transcription-polymerase chain reaction Results Twenty-one MDRAB clinical isolates were obtained from five hospitals All of the studied pump genes were present in the collected MDRAB isolates except one isolate that lacked the emrA -like gene The gene expression of these efflux pumps was variable among the strains The upregulation of the adeB , adeJ , and macB genes was responsible for tigecycline resistance, and the increased abeS expression was strongly related to amikacin resistance Of all the antibiotics studied, tigecycline was the strongest inducer of gene expression for many efflux pumps in A baumannii Conclusion Efflux pump genes are universally present in the collected clinical MDRAB isolates The upregulation of the adeB , adeJ , macB and abeS genes is more related with antibiotic resistance
69 citations
TL;DR: MALDI-TOF MS is a rapid, reliable, economical, and environmentally friendly method for routine microbial identification and may contribute to early appropriate antibiotic treatment in clinical settings.
Abstract: Background Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been widely used in microbial identification. This study evaluated the performance of MALDI-TOF MS and investigated the economic and medical impact of MALDI-TOF MS implementation. Methods A total of 12,202 clinical isolates collected from April to September 2013 were identified using MALDI-TOF MS, and the success rates in identifying isolates were analyzed. The differences in the processing time, cost of consumables, weight of waste, and clinical impact between MALDI-TOF MS and biochemical reaction were compared. Results MALDI-TOF MS successfully identified 96% of 12,202 isolates, including 96.8% of 10,502 aerobes, 90.5% of 1481 anaerobes, 93.8% of 81 yeasts, and 90.6% of 138 nontuberculous mycobacteria at the genus level. By using MALDI-TOF MS, the processing time for aerobes decreased from 32.5 hours to 4.1 hours, and that for anaerobes decreased from 71.5 hours to 46 hours. For detection of aerobes and anaerobes, the cost of consumables was estimated to decrease by US$0.9 per isolate, thus saving US$94,500 in total annual isolation. Furthermore, the weight of waste decreased six-fold, resulting in a reduction of 350 kg/month or 4.2 tons/year. MALDI-TOF MS also increased the percentage of correct antibiotics treatment for Escherichia coli and Klebsiella pneumonia from 56.1% to 75% and shortened the initiation time of the correct antibiotic action from 3.3 hours to 2.5 hours. Conclusions MALDI-TOF MS is a rapid, reliable, economical, and environmentally friendly method for routine microbial identification and may contribute to early appropriate antibiotic treatment in clinical settings.
68 citations
TL;DR: The isolated UPEC strains predominantly belonged to three serogroups (O25, O15, and O8), harboured numerous virulence genes, and are multiresistant to antibiotics.
Abstract: Background/Purpose Uropathogenic Escherichia coli (UPEC) strains isolated from patients with community-acquired urinary tract infections (UTIs) were assessed to determine the prevalence of virulence genes, antibiotic resistance, and the O-serogroup of the strains. Methods Consenting patients with community-acquired UTI were enrolled at Unidad Medica Familiar Number 64 (Instituto Mexicano del Seguro Social, Estado de Mexico, Mexico) and 321 urine samples were collected. Polymerase chain reaction (PCR) was used to assess 24 virulence genes and 14 O-serogroups. The Kirby-Bauer method was used to evaluate the antibiotic susceptibility of the isolated strains to 12 commonly used antibiotics. Results A total of 194 strains were identified as E. coli using standard biochemical tests, followed by PCR amplification of 16S ribosomal RNA gene. Only 58.2% of the strains belonged to the assessed 14 O-serogroups. The serogroups O25, O15, O8, and O75 were present in 20.6%, 17%, 6.1%, and 4.6% of strains, respectively. The most frequently occurring virulence genes among UPEC strains included kpsMT (92.2% strains), usp (87.1%), irp2 (79.3%), iha (64.9%), fim (61.3%), set (36%), astA (33.5%), pap (24.7%), and papGII (21.1%). In addition, 97% of the strains were multi-drug resistant (coresistance to 3–11 antibiotics). Conclusion The isolated UPEC strains predominantly belonged to three serogroups (O25, O15, and O8), harboured numerous virulence genes, and are multiresistant to antibiotics. The findings of this study could be used to orient UTI treatment strategies and in epidemiological studies in Mexico.
63 citations
TL;DR: Evaluating the prevalence of mycoplasmas in a population of childbearing age women by means of multiplex RT-PCR can be a valuable tool to evaluate the real epidemiology of cervicalMycoplasma colonization.
Abstract: Background Mycoplasmas are frequently isolated from the genital tract. New molecular PCR-based methods for the detection of mycoplasmas can better define the real epidemiology of these microorganisms. The aim of this study was to evaluate the prevalence of mycoplasmas in a population of childbearing age women by means of PCR. Methods This 21-month multicentre observational study was conducted at four Italian clinical microbiology laboratories. Women reporting symptoms of vaginitis/cervicitis, or with history of infertility, pregnancy, miscarriage or preterm birth were included. Detection of Ureaplasma parvum, Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium was performed from cervical swabs by means of a commercially available multiplex real-time PCR. Results a total of 1761 women fulfilled the inclusion criteria and were included in the study. The overall prevalence was: U. parvum 38.3%, U. urealyticum 9%, M. hominis 8.6% and M. genitalium 0.6%. The proportion of foreign patients positive for U. parvum was significantly higher compared to Italian patients (37% vs 30.1%, p = 0.007) and also for overall mycoplasma colonization (53.4% vs 45.8%, p = 0.011). The number of symptomatic patients positive for M. hominis was significantly higher than that of negative controls (2.9% vs 1%, p = 0.036). A significant positive trend in mycoplasma colonization was found in relation to the pregnancy week for U. urealyticum ( p = 0.015), M. hominis ( p = 0.044) and for overall mycoplasma colonization ( p = 0.002). Conclusion multiplex RT-PCR can be a valuable tool to evaluate the real epidemiology of cervical mycoplasma colonization.
60 citations
TL;DR: A higher IgG2a/IgG1 ratio is associated with protective immune response in L. tropica infection, which can help to approach the complex profile of immunity against L. Tropica infection.
Abstract: Background/Purpose Leishmania (L.) tropica is the causative agent of different forms of human leishmaniasis. There is little information about the role of Leishmania -specific antibodies in the immune response against L. tropica infection. The aim of this study is to evaluate the role of Leishmania -specific antibodies and their immunoglobulin G (IgG) isotypes in L. tropica infection. Methods L. tropica at two different doses (high dose, 10 6 parasites/mouse and low dose, 10 3 parasites/mouse) were used for infection of BALB/c mice. BALB/c mice infected with Leishmania major were used for comparison. Anti- Leishmania antibodies of the IgG1 and IgG2a isotypes were assayed by enzyme-linked immunosorbent assay. Results Our data showed that (1) a higher parasite dose results in higher levels of antibody. (2) L. tropica infection results in a lower IgG1 antibody response, compared with L. major infection. (3) The IgG2a/IgG1 antibody response in L. tropica infection is higher than that in L. major infection. Conclusion A higher IgG2a/IgG1 ratio is associated with protective immune response in L. tropica infection. These data can help to approach the complex profile of immunity against L. tropica infection.
59 citations
TL;DR: It is demonstrated that polymorphisms in the IL-8 gene was significantly associated with H. pylori infection and was associated with an enhanced risk of peptic ulcer disease in H.pylori-positive patients.
Abstract: Background/Purpose Helicobacter pylori -induced gastric mucosal inflammation is mediated by proinflammatory and anti-inflammatory cytokines. Polymorphisms in genes that code cytokines influence cytokine secretion levels and appear to contribute to the risk of gastric diseases. In this sense, we performed this study to identify the polymorphisms in the IL-6, IL-8, and IL-10 genes and their associations with H. pylori infection and gastric pathologies. Methods Gastric biopsy samples of 151 patients infected with H. pylori and 76 uninfected individuals were used. Helicobacter pylori infection was diagnosed by histological examination and the detection of the ureA and glmM genes. The polymorphisms in the IL-6 (at position −174) , IL-8 (at position −251), and IL-10 (at position −819) were detected by polymerase chain reaction–restriction fragment length polymorphism. Results Among the genetic polymorphisms studied, we observed that only the presence of the A allele at position −251 of the IL-8 gene was significantly associated with H. pylori infection. In addition, patient carriers of the A/A genotype at position −251 of the IL-8 gene and carriers of the T allele at position −819 of the IL-10 gene had an increased risk of peptic ulcer disease in the presence of H. pylori infection. We did not find a correlation between polymorphisms in the IL-6, IL-8 , and IL-10 genes and a higher risk of gastric carcinoma. Conclusion We demonstrated that polymorphisms in the IL-8 gene was significantly associated with H. pylori infection. Furthermore, polymorphisms in the IL-8 and IL-10 genes were associated with an enhanced risk of peptic ulcer disease in H. pylori- positive patients.
TL;DR: Enhanced cooperation between state, local government and non-state institutions, particularly neighborhood committees, has resulted in a strengthened, holistic epidemic preparedness and response infrastructure in Taiwan, and governments beyond Taiwan's borders seriously consider adopting this approach.
Abstract: Background Over time, as newly emerging infectious diseases have become increasingly common and more easily spread, it has become clear that traditional response mechanisms have proven inadequate to the task of prevention and control. Purpose To explore whether enhanced cooperation with local government and community institutions can effectively supplement traditional state-centric public health epidemic responses. Methods Drawing on Taiwan as a case study, we assess the role of the whole-of-society approach to epidemic response as arises from the collaborative governance literature. The approach calls for enhanced cooperation, trust building, resource sharing and consensus-oriented decision making among multiple levels of government, business, non-profits, and the public in general. Results The Taiwan case illustrates the benefits of the whole-of-society approach. Enhanced cooperation between state, local government and non-state institutions, particularly neighborhood committees, has resulted in a strengthened, holistic epidemic preparedness and response infrastructure. Conclusion The Taiwan case provides evidence that by implementing the whole-of-society approach to pandemic preparedness and response governments can enhance their ability to manage future outbreaks. We recommend that governments beyond Taiwan's borders seriously consider adopting this approach.
TL;DR: The proposed antimicrobial substance, LBP102 was found to be effective against V. parahaemolyticus BCRC 12864 and Cronobacter sakazakii BCRC 13988, indicating its potential as a natural preservative/food additive.
Abstract: Background/Purpose Lactic acid bacteria (LAB) are used in a variety of bio-industrial processes, including milk fermentation, and have been reported to have bactericidal activities. We previously isolated Lactobacillus plantarum NTU 102 from homemade Korean-style cabbage pickles. The aims of this work were to perform a screen of the antimicrobial substances produced by L. plantarum NTU 102 and to characterize it. Methods In this study, we investigated the bactericidal activity of this LAB strain and demonstrated that the cell-free supernatant of L. plantarum NTU 102 had antimicrobial activity. Results The antibacterial activity was significantly decreased by proteolytic enzymes, including pepsin, proteinase K, and trypsin, suggesting that the antimicrobial substance had proteinaceous properties. Additionally, this activity was heat stable and not affected by alterations in the pH from 1.0 to 4.0. The antibacterial substance produced by L. plantarum NTU 102, which we named LBP102, exhibited a broad inhibitory spectrum. The active compound was identified by nuclear magnetic resonance (NMR) techniques ( 1 H NMR and 13 C NMR). The IUPAC name was 2-(2-1 mino-1-hydroxyethoxy) ethyl 2-methylpropanoate. The substance showed antibacterial activity against Vibrio parahaemolyticus , and completely inhibited the growth of V. parahaemolyticus on agar plates at a concentration of 75 μg/mL. Conclusion The proposed antimicrobial substance, LBP102 was found to be effective against V. parahaemolyticus BCRC 12864 and Cronobacter sakazakii BCRC 13988. The remarkable effects of LBP102 against this and other pathogens indicated its potential as a natural preservative/food additive.
TL;DR: The genus Helicobacter contains more than 35 species and discovery of these helicobacters gives opportunity to understand the relationship between these bacteria which colonise the animal and human gut and their effect on the host.
Abstract: The genus Helicobacter contains more than 35 species. Helicobacter pylori is the most important in terms of human health. Discovery of these helicobacters gives opportunity to understand the relationship between these bacteria which colonise the animal and human gut and their effect on the host. Infection with Helicobacter spp. and the associated diseases in their hosts allow us to study the pathogenic mechanisms. The potential zoonotic pathway for the transmission of Helicobacter spp. and epidemiology of this genus, deserve more attention to these emerging pathogens.
TL;DR: The efficacy of fosfomycin against multidrug-resistant Enterobacteriaceae infections is assessed and a clear need for additional in-vivo investigations involving pharmacokinetics is assessed.
Abstract: The long-used antibiotic fosfomycin has recently been re-evaluated as a potential regimen for treating extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant Enterobacteriaceae (CRE). Fosfomycin is known for its robust bactericidal effect against ESBL-producing Enterobacteriaceae and CRE. However, fosfomycin-modified genes have been reported in transposon elements and conjugative plasmids, resulting in fosfomycin resistance in parts of East Asia. Here we review reports of fosfomycin-modified ( fos ) genes in Enterobacteriaceae and assess the efficacy of fosfomycin against multidrug-resistant Enterobacteriaceae infections. At least 10 kinds of fos genes have been identified in the past decade; of these, fosA (and fosA subtypes) and fosC2 are primarily found in Enterobacteriaceae . All fosA subtypes except fosA2 are found in plasmids and transposons, nearby insertion sequence elements, or integrons, indicating that mobilizing elements also play an important role in plasmid-mediated fos genes in Enterobacteriaceae . fosA3 , which is prevalent in East Asia, has been transmitted (mostly by animals) within and across continents via IS 26 mobile elements. The acquisition of multiple antibiotic resistance genes via plasmids and mobile elements has resulted in a need for combined treatments for Enterobacteriaceae cases. The combination of fosfomycin and carbapenem has been the focus of many in vitro studies, but there is a clear need for additional in vivo investigations involving pharmacokinetics.
TL;DR: The distribution and persistence of MDROs varied among the different LTCFs and time periods.
Abstract: Objectives This study investigated the prevalence of multidrug-resistant organisms (MDROs) in the residents and environments of long-term care facilities (LTCFs) in Taiwan. Methods We prospectively investigated the distribution of MDROs in residents of six LTCFs and their environments from January 2015 to December 2015 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples every 3 months for the residents: 63, 79, and 73 in the first, second, and third surveillance investigations, respectively. If MDROs, including methicillin-resistant Staphylococcus aureus , carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa , and MDR Acinetobacter baumannii were identified, then swab specimens from environmental sources were also collected and cultured. During the study period, several infection control measures were also implemented. Results The overall infection density decreased significantly from 2.69 per 1000 patient–days in the preintervention (January 2014 to December 2014) to 2.39 per 1000 patient–days during the intervention period ( p S. aureus ( n = 83, 53.9%) was the predominant organism, followed by carbapenem-resistant Enterobacteriaceae ( n = 35, 22.7%), MDR A. baumannii ( n = 30, 19.5%), and carbapenem-resistant P. aeruginosa ( n = 6, 3.9%). The rates of detection of MDROs were 27.9% (60/215) in nasal swabs, 15.8% (34/215) in rectal swabs, and 11.1% (60/542) in the environmental sources. Conclusions The distribution and persistence of MDROs varied among the different LTCFs and time periods.
TL;DR: Elderly had lower frequency of classical dengue symptoms, yet were at higher risk of development of severe dengingue during their early denge course, and a small number of patients developed severe d Dengue at the WHO-proposed recovery phase.
Abstract: Background/Purpose Dengue clinically dynamically changes over time; the World Health Organization (WHO) dengue classification framework proposed 3 dengue clinical phases—febrile (days 1–3), critical (days 4–6) and recovery (days ≥7) phases. This study aimed to better understand clinical and laboratory characteristics in adults (≥18 years) suffering dengue in different clinical phases at their hospital presentations. Methods A retrospective analysis of adults suffering dengue between 2008 and 2014. Results Of the 669 included dengue adults, 146 (21.8%) were elderly (≥65 years), and 27 (4%) suffered severe dengue. When compared with those in febrile phase, significantly higher incidence of ascites, mucosal bleeding, and/or gastrointestinal bleeding; lower white blood cell (WBC) and platelet counts; higher hematocrit, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values were found in critical phase. When compared with their younger counterparts, elderly at febrile phase had significantly lower frequencies of bone pain, myalgia, headache and rash; higher frequencies of vomiting, pleural effusion and mucosal bleeding; higher WBC count, AST and ALT levels, and lower platelet count; in critical phase, elderly had significantly higher frequencies of pleural effusion, mucosal bleeding and gum bleeding. Four (0.6%) patients experienced severe dengue in recovery phase. Significantly higher proportions of elderly developed severe dengue in both febrile and critical phases as compared with younger adults. Conclusions Elderly had lower frequency of classical dengue symptoms, yet were at higher risk of development of severe dengue during their early dengue course. A small number of patients developed severe dengue at the WHO-proposed recovery phase.
TL;DR: The worldwide CRPA prevalence has been on the raise and Taiwan has been also keeping up with the trend, and antimicrobials usage should be monitored carefully, especially with carbapenems and aminoglycoside.
Abstract: Background/purpose The incidence of carbapenem-resistant Pseudomonas aeruginosa (CRPA) related healthcare-associated infection (HAI) has increased in recent year worldwide. This study is to investigate the risk factors associated with CRPA infections in a university hospital setting in Taiwan to provide more information for clinician and infection control system. Methods A retrospective cross-sectional study was conducted from January 1st, 2009 to June 30th, 2014. Patients with P. aeruginosa related HAI were included and divided into the CRPA case group and carbapenem-susceptible Pseudomonas aeruginosa (CSPA) control group. The medical records were reviewed to identify risk factors for CRPA HAI and mortality. Patients with prior use of any anti-pseudomonal carbapenems were included in subgroup analysis. Results 395 cases of P. aeruginosa infection were enrolled from total of 3263 HAI events; 63 were CRPA and 332 were CSPA. The prevalence of CRPA was 15.9% (63/395). Significant risk factors related to CRPA infection were longer time at risk, prior use of anti-pseudomonal carbapenems, and prior use of aminoglycoside ( p Conclusion The worldwide CRPA prevalence has been on the raise and Taiwan has been also keeping up with the trend. Antimicrobials usage should be monitored carefully, especially with carbapenems and aminoglycoside. Clinicians should be award of and understand about the risk of CRPA infection, which increases by 1% with each hospitalization day.
TL;DR: In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality.
Abstract: Background/Purpose Patients admitted to intensive care units (ICUs) are at high risk for central line-associated bloodstream infections (CLABSIs). Bundle care has been documented to reduce CLABSI rates in Western countries, however, few reports were from Asian countries and the differences in the epidemiology or outcomes of critically-ill patients with CLABSIs after implementation of bundle care remain unknown. We aimed to evaluate the incidence, microbiological characteristics, and factors associated with mortality in critically-ill patients after implementation of bundle care. Methods Prospective surveillance was performed on patients admitted to ICUs at the National Taiwan University Hospital, Taipei, Taiwan from January 2012 to June 2013. The demographic, microbiological, and clinical data of patients who developed CLABSI according to the National Healthcare Safety Network definition were reviewed. A total of 181 episodes of CLABSI were assessed in 156 patients over 46,020 central-catheter days. Results The incidence of CLABSI was 3.93 per 1000 central-catheter days. The predominant causative microorganisms isolated from CLABSI episodes were Gram-negative bacteria (39.2%), followed by Gram-positive bacteria (33.2%) and Candida spp. (27.6%). Median time from insertion of a central catheter to occurrence of CLABSI was 8 days. In multivariate analysis, the independent factors associated with mortality were higher Pitt bacteremia score [odds ratio (OR) 1.41; 95% confidence interval (CI) 1.18–1.68] and longer interval between onset of CLABSIs and catheter removal (OR 1.10; 95% CI 1.02–1.20), respectively. Conclusion In institutions with a high proportion of CLABSI caused by Gram-negative bacteria, severity of bacteremia and delay in catheter removal were significant factors associated with mortality.
TL;DR: Intestinal parasitic infections are very severe among school aged children in the urban slums, thus regular mass de-worming programs, health education, and the provision of safe drinking water is recommended to combat IPIs among the school agedChildren.
Abstract: Background/purpose Intestinal parasitic infections (IPIs) among school aged children (SAC) in Nigeria remains endemic, hence the need for regular surveillance to attract the attention of policy makers. This cross-sectional study investigated the current prevalence and factors associated with intestinal parasitic infections among school aged children in an urban slum of Lagos City, Nigeria. Methods Single stool samples from 384 school aged children (188 boys and 196 girls) were examined by employing Merthiolate-iodine-formaldehyde concentration (MIFC) and Kato-Katz methods. Demographic characteristics and risk factors were obtained by questionnaires investigation. Results The overall prevalence was 86.2% in school children, out of them 39.1% had polyparasitism. IPIs showed the highest to the lowest prevalence of 62% (238/384), 25% (97/384), 12.3% (47/384), 11.8% (45/384), 9.9% (38/384), 8.4% (32/384), 3.4% (13/384), and 0.5% (2/384) found in Ascaris lumbricoides , Entamoeba histolytica/dispar , Giardia duodenalis , Endolimax nana , Entamoeba coli , Trichuris trichiura , Blastocystis hominis , and hookworm infections, respectively. MIFC technique showed superiority to Kato-Katz technique in the detection of IPIs ( p p = 0.02). Conclusion Intestinal parasitic infections are very severe among school aged children in the urban slums, thus regular mass de-worming programs, health education, and the provision of safe drinking water is recommended to combat IPIs among the school aged children.
TL;DR: The Infectious Diseases Society of Taiwan, Medical Foundation in Memory of Dr. Deh-Lin Cheng, Foundation of Professor Wei-Chuan Hsieh forinfectious Diseases Research and Education, and CY Lee's Research Foundation for Pediatric infections have updated the guidelines for the use of antifungal agents in adult patients with invasive fungal diseases in Taiwan.
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.
TL;DR: It is shown that mice immunized with OprF/OprI or OPRF/ OprI and flagellin B are significantly protected from infection caused by mucoid and nonmucoid strains of P. aeruginosa.
Abstract: Background Pseudomonas aeruginosa is a Gram-negative opportunistic bacterium, which considered as a common cause of nosocomial infection and life-threatening complications in immunocompromized and cystic fibrosis patients. Here, we evaluate the protective effect of recombinant vaccines composed of outer membrane proteins OprF and OprI alone or in combination with flagellin B against mucoid and nonmucoid pseudomonas infection. Methods BALB/C mice were immunized subcutaneous using OprF and OprI with or without flagellin B and antibody titers were determined. Serum bactericidal and opsonophagocytosis activities of immunized and control sera were estimated against mucoid and nonmucoid pseudomonas strains. Lung tissue sections from immunized and nonimmunized mice were analyzed and the levels of peripheral neutrophils infiltration into the lung and tissue inflammation were scored. Results Subcutaneous immunization using OprF and OprI with or without flagellin B elicited higher antibody titers against OprF, OprI, and flagellin B. The produced antibodies successfully opsonized both mucoid and nonmucoid strains with subsequent activation of the terminal pathway of complement that enhances killing of nonmucoid strains via complement-mediated lysis. Furthermore, opsonized mucoid and nonmucoid strains showed enhanced opsonophagocytosis via human peripheral neutrophils, a mechanism that kills P. aeruginosa when complement mediated lysis is not effective especially with mucoid strains. Immunized mice also showed a significant prolonged survival time, lower bacteremia, and reduced lung damage when compared with control nonimmunized mice. Conclusion Our data showed that mice immunized with OprF/OprI or OprF/OprI and flagellin B are significantly protected from infection caused by mucoid and nonmucoid strains of P. aeruginosa .
TL;DR: In the study population, pneumonia and PLA were the most common sources of community-acquired bacteremia and hypermucoviscosity, rmpA, aerobactin, and serotype K1 could be useful laboratory markers to alert clinicians to arrange abdominal imaging to detect liver abscess.
Abstract: Introduction This retrospective study investigated the clinical etiology of community-acquired bacteremic K lebsiella pneumoniae infections, and characterized laboratory and genetic markers which may be associated with primary liver abscess (PLA). Methods Community-onset K. pneumoniae bacteremic episodes from 2010 to 2011 were identified from the laboratory information system. Isolates were retrieved for susceptibility testing, hypermucoviscosity testing, PCR-based serotyping (K1, K2 and K5) and PCR detection of virulence genes ( rmpA , alls , kfu and aerobactin). Clinical data collected from electronic medical records included primary and secondary diagnoses, co-existing morbidities, antibiotic therapy, and in-patient mortality. Results 129 bacteremic episodes were identified. The most common primary infections were pneumonia (n = 24, 18.6%), primary liver abscess (n = 21, 16.3%) and urinary tract infections (n = 21, 16.3%). Hypermucoviscosity was present in 55 isolates (42.6%). The most commonly detected virulence genes were aerobactin (n = 63, 48.8%) and rmpA (n = 59, 45.7%). Isolates causing liver abscess were significantly associated with a positive string test, rmpA , aerobactin gene, and capsular serotype K1 (all p kfu , or allS genes. The absence of a positive string test, rmpA , or aerobactin genes had a 97.3%–100% negative predictive value for PLA. The positive predictive values of the string test, rmpA , aerobactin genes, and serotype K1 for PLA ranged from 31.7% to 35.6%. Conclusion In our study population, pneumonia and PLA were the most common sources of community-acquired bacteremia. Hypermucoviscosity, rmpA , aerobactin, and serotype K1 could be useful laboratory markers to alert clinicians to arrange abdominal imaging to detect liver abscess.
TL;DR: Seasonal prevalence of HCoV-NL63 infection was late winter, overlapping the highest peak of the influenza A/H1N1 epidemic during December 2010 to March 2011 in Taiwan.
Abstract: Background/Purpose Human coronavirus (HCoV) NL63 is recognized in association with upper or lower respiratory tract illnesses in children. This study surveyed the prevalence of HCoV-NL63 and influenza viruses in patients with influenza-like illness in Taiwan during 2010–2011. Methods Throat samples from 107 hospitalized patients with pneumonia and 175 outpatients with influenza-like illness were examined using real-time polymerase chain reaction assays with virus-specific primers, and then virus-positive specimens were confirmed by sequencing the polymerase chain reaction products. Results HCoV-NL63 infection was identified in 8.4% (9/107) of hospitalized patients with pneumonia, but not found in outpatients with influenza-like illness. Age distribution of HCoV-NL63 infection in hospitalized patients with pneumonia indicated that the group aged 16–25 years (20%) had the highest positive rate compared with the other groups, and exhibited a similar age-specific pattern to influenza A/H1N1 infection, but not influenza A/H3N2 and B infections in hospitalized patients. Seasonal prevalence of HCoV-NL63 infection was late winter, overlapping the highest peak of the influenza A/H1N1 epidemic during December 2010 to March 2011 in Taiwan. Co-infection of HCoV-NL63 and influenza A/H1N1 was detected in three hospitalized patients. Clinical manifestation analysis indicated that the main symptoms for HCoV-NL63 infection included fever (88.9%), cough (77.8%), and pneumonia (100%). Co-infection caused significantly higher rates of breathing difficulties, cough, and sore throat than those of single infection with HCoV-NL63 and influenza A/H1N1. Phylogenetic analysis indicated a low level of heterogeneity between Taiwan and global HCoV-NL63 strains. Conclusion Understanding epidemiology of HCoV-NL63 in Taiwan provides an insight for worldwide surveillance of HCoV-NL63 infection.
TL;DR: Repeated carbapenem use in such patients might increase rates of inappropriate initial empirical treatment and mortality, and it is important to reduce the emergence of CROPA.
Abstract: Background/purpose Carbapenem-resistant Pseudomonas aeruginosa infections have been a challenge and issue in hospital settings. However, the clinical impact of P. aeruginosa blood isolates resistant only to carbapenems has never been discussed previously. Methods To assess the risk factors and clinical significance of bacteremia caused by carbapenem resistance only P. aeruginosa (CROPA), a 6-year retrospective case–control study was conducted. The CROPA strains were defined as isolates susceptible to ciprofloxacin, antipseudomonal penicillins and cephalosporins, and aminoglycosides but resistant to one antipseudomonal carbapenem (imipenem or meropenem) or both. The controls were selected among patients with bacteremia due to P. aeruginosa susceptible to all above classes of antipseudomonal antibiotics, which was defined as all-susceptible P . aeruginosa . Results Twenty-five patients had at least one blood culture positive for CROPA, and 50 controls had all-susceptible P . aeruginosa bacteremia. CROPA bacteremia had a high 30-day mortality rate (72.0%), as compared to 26.0% for the controls ( p p = 0.002). A comparison between the surviving and deceased patients with CROPA bacteremia showed that nine (50%) of those who died, but none of the survivors, received carbapenems as the initial empirical therapy ( p = 0.027). Conclusion Carbapenem exposure was associated with emergence of CROPA infections. Repeated carbapenem use in such patients might increase rates of inappropriate initial empirical treatment and mortality. Prudent carbapenem use is important to reduce the emergence of CROPA.
TL;DR: The clinical epidemiology of Invasive candidiasis is characterized and risk factors between Candida albicans and Candida non-albicans species are differentiated to help in the empirical therapeutic decision-making process.
Abstract: Background Invasive candidiasis (IC) is the most common cause of invasive fungal infections. Identification of risk factors for such infection may help in the empirical therapeutic decision-making process. We conducted this study to characterize the clinical epidemiology of such infection and to differentiate risk factors between Candida albicans and Candida non-albicans species. Methods We retrospectively evaluated patients with IC from 2011 to 2013. Clinical data, antibiotic therapy, underlying condition, and invasive procedures were analyzed and compared between C. albicans and C. non-albicans species. Results C. albicans was the most frequently isolated Candida species (48.6% of all IC patients), although C. non-albicans spp. were more commonly isolated overall. C. albicans , Candida tropicalis , and Candida parapsilosis have a high susceptibility rate to all antifungal agents (>90%), whereas Candida glabrata showed decreased susceptibility to fluconazole and itraconazole. Amphotericin B demonstrated excellent antifungal activity against all Candida species. Univariate analyses showed that IC patients with C. albicans had a higher ratio of older age ( p = 0.008), solid tumor ( p = 0.029), and hypoproteinemia ( p = 0.019), whereas those with C. non-albicans spp. had a higher ratio of hospital length of stay ( p = 0.005), usage of corticosteroids ( p = 0.011), duration on corticosteroids ( p = 0.005), chemotherapy ( p = 0.022), hematologic malignancy ( p = 0.039), neutropenia ( p = 0.030), and usage of glycopeptides ( p = 0.002). Multivariate analyses showed that a significant predictor of IC due to C. albicans was hypoproteinemia [odds ratio (95% confidence interval) = 2.133 (1.164–3.908), p = 0.014]. Conclusion C. albicans was the most frequently isolated Candida species. The risk factors between C. albicans and C. non-albicans species are different.
TL;DR: Risk factors for acquisition of CR GNB bacteremia identified in this study each may serve as a reminder alerting clinicians to hospitalized patients at risk for CR GNBs requiring appropriate antibiotic coverage, and in these circumstances, combined antibiotics may be used until antimicrobial de-escalation/adjustment is clearly indicated.
Abstract: Background/purpose A substantial number of carbapenem-resistant Gram-negative bacilli (CR GNB) have been identified among the etiologic multidrug-resistant GNB in healthcare-associated infections. For achieving a better therapeutic outcome by minimizing inappropriate empirical antibiotic treatment before blood culture and susceptibility testing results are available, it is very important to identify patients who are at risk for the development of CR GNB bacteremia. Methods Retrospective analysis of propensity-score matched (PSM) adult patients with CR GNB bacteremia (PSM-group 1 [n = 95]) and those with non-CR GNB bacteremia (PSM-group 2 [n = 190]). Results PSM-group 1 was found to a significantly longer length of hospital stay (27 vs. 18 days; p p Conclusion Risk factors for acquisition of CR GNB bacteremia identified in this study each may serve as a reminder alerting clinicians to hospitalized patients at risk for CR GNB bacteremia requiring appropriate antibiotic coverage, and in these circumstances, combined antibiotics may be used until antimicrobial de-escalation/adjustment is clearly indicated by the subsequently identified pathogenic GNB and its susceptibility profile.
TL;DR: The progressive motility and the NAG activity of infertile men infected with UPA and mixed species were significantly lower than those of UUR infected subgroup (P < 0.05), indicating that UPA has higher pathogenicity on the progressive motilities and the secretary function of epididymis than UUR.
Abstract: Objective We investigated the prevalence of Ureaplasma spp. in semen samples of infertile men in Shanghai, China and evaluated the correlation between the sperm parameters (seminal volume, sperm concentration, progressive motility and non-progressive) and the secretary function in these infectious populations. Methods Semens were collected from 540 infertile men and 260 fertile control group in shanghai, China and subjected to standard bacterial and Ureaplasma spp. culture. Positive Ureaplasma spp. isolates were further tested by PCR to detect the biovars and serotypes of Ureaplasma spp. Sperm seminological variabilities were analyzed by Computer-Assisted Semen Analysis according to the fifth edition of World Health Organization (WHO) laboratory manual for the examination and processing of human semen. Seminal markers were measured by the automatic analyzer. Results The prevalence of Ureaplasma spp. in semen specimens was 39.6% (214/540) and 19.2% (50/260) in infertile and control group, respectively. Significant difference was observed between the two groups ( P Ureaplasma parvum (UPA), 26.2% (n = 56) was Ureaplasma urealyticum (UUR), and 14.5% (n = 31) was mixed species. While those numbers in control group (n = 50) were 64.0% (n = 32), 20.0% (n = 10), 16.0% (n = 8), respectively. There was no significant difference between any two groups ( P > 0.05). The progressive motility and the NAG activity of infertile men infected with UPA and mixed species were significantly lower than those of UUR infected subgroup ( P Conclusions The infection of Ureaplasma spp. plays an important pathogenic role in male infertility. UPA has higher pathogenicity on the progressive motility and the secretary function of epididymis than UUR.
TL;DR: 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.
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 × 10 5 CFU/mL by using 1/2× MIC for each alone, and both 1/2× and 1/4× 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 1/2× MIC and 1/4× 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 1/2× MIC and 1/4× 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.