Influenza is a highly contagious viral illness characterized by fever, cough, headache and myalgia. The influenza virus is a segmented ribonucleic acid (RNA) virus that can infect both humans and animals, and the capacity for reassortment when multiple viruses infect the same cell has led – and will continue to lead – to the development of novel pandemic influenza A viruses. The disease is generally self-limiting, although complications and deaths can occur, particularly in children < two years of age, adults >65 years of age, pregnant women, and immunosuppressed individuals. Specific antiviral therapy is available, including oseltamivir in Singapore, and is recommended for severe disease as well as those with higher likelihood for developing complications from influenza. In addition to hand hygiene and respiratory etiquette, antiviral prophylaxis may reduce the impact and burden of influenza in household and institutional settings. However, the primary means for preventing influenza is via annual vaccination in those above the age of two years. The influenza vaccine, while having variable efficacy depending on antigenic matching with circulating viruses each year, is safe and cost-effective at the population level.

Disclosure ; Health Care Costs ; trends ; Hospital Charges ; trends ; Hospitalization ; economics ; Humans ; Severe Acute Respiratory Syndrome ; economics ; Singapore

Anti-Bacterial Agents ; therapeutic use ; Drug Resistance, Microbial ; Humans ; Singapore

Health Surveys ; Hospitalization ; Humans ; Incidence ; International Classification of Diseases ; Pneumococcal Infections ; epidemiology ; Singapore ; epidemiology

Disease Outbreaks ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; Singapore ; epidemiology ; World Health Organization

Antimicrobial resistance (AMR) increases the morbidity, mortality and costs of treating infectious diseases. (Hawkey and Jones, 2009)1. The threat from resistant organisms is now a global problem, both in the hospital and to some extent in the community. The key drivers are: medical care complexity; widespread antimicrobial use in animal husbandry; antimicrobial contaminated food distribution; international travel, and food distribution of food contaminated with multidrug resistant organism. Strategies for infection control are: good understanding of what needs to be done, consistent application of infection control measures, use of “search and destroy” techniques; and effective antimicrobial stewardship. This paper reviews the current issues and potential solutions.

INTRODUCTIONCeftaroline is a fifth-generation cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA) that was recently launched in Singapore. It received approval from the United States (US) Food Drug Administration (FDA) and European Commission for the treatment of adult patients with community-acquired pneumonia (CAP) and complicated skin and soft tissue infections (cSSTI). This study aimed to review current published data and determine its clinical role, particularly in the local setting.

MATERIALS AND METHODSA literature review on published articles in English on ceftaroline, focusing in particular on clinical trials and other clinical reports. Susceptibility testing was also performed on a limited sample of local MRSA and Streptococcus pneumoniae isolates.

RESULTSCeftaroline has an extensive spectrum of activity, including coverage of MRSA and multidrug-resistant S. pneumoniae. However, it has limited activity against non-fermenting Gram-negative bacteria and is susceptible to hydrolysis by extended spectrum beta-lactamases. It is only available for intravenous delivery, with a reconstituted stability of just 6 hours, rendering it unavailable for use for outpatient antibiotic therapy. Clinical trials demonstrate non-inferiority compared to first-line comparators in the treatment of CAP and cSSTI. Published case reports/series suggest a potential greater role in the treatment of MRSA bacteremia and endocarditis. No resistance was found among local archived MRSA and S. pneumoniae isolates.

CONCLUSIONWe believe ceftaroline will occupy primarily niche roles for culture-directed treatment of various infections--in particular those caused by MRSA--until further clinical trial data become available. A variety of factors render it less useful or appealing for empirical treatment of CAP or healthcare-associated infections.

Cephalosporins ; pharmacology ; therapeutic use ; Humans ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; Singapore ; Staphylococcal Infections ; drug therapy

Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; Personnel, Hospital ; Singapore

INTRODUCTIONCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged worldwide. In contrast to healthcare-associated MRSA (HA-MRSA), CA-MRSA isolates are usually susceptible to multiple non-beta-lactam antibiotics and cause a distinct spectrum of infections in epidemiologically disparate populations - in particular, cutaneous abscesses, necrotising fasciitis and necrotising pneumonia. They arise from a broader genetic background, and possess differing virulence genes. We aim to describe the distribution of different molecular subtypes of CA-MRSA among various regions and discuss briefly the implications of CA-MRSA from a local perspective.

METHODSLiterature review of articles on CA-MRSA, focusing mainly on reports where the genetic background of isolates had been analysed using multi-locus sequence typing (MLST). Singapore data were obtained from the local CA-MRSA database.

RESULTSMLST analysis demonstrated the presence of epidemic subtypes of CA-MRSA within most geographic areas. In parts of the United States, community MRSA infections currently exceed those caused by their methicillin-susceptible counterparts. In Singapore, CA-MRSA infections are increasing, predominantly as a result of the spread of ST30 clones.

CONCLUSIONAvailable evidence suggests that the emergence of MRSA from the community is not going to be a transient phenomenon. Local guidelines for dealing with this phenomenon at both therapeutic and preventive levels are needed prior to the potential development of a situation mirroring that of meso-endemic HA-MRSA in local hospitals or CA-MRSA epidemics in parts of USA.

Bacterial Typing Techniques ; Community-Acquired Infections ; epidemiology ; microbiology ; Cross Infection ; diagnosis ; microbiology ; Humans ; Methicillin Resistance ; Risk Factors ; Singapore ; epidemiology ; Staphylococcal Infections ; epidemiology ; microbiology ; Staphylococcus aureus ; classification ; drug effects