Delivery of Health Care ; Humans ; Office Visits ; Physician-Patient Relations ; Quality Assurance, Health Care ; Residence Characteristics ; Singapore ; Time Factors

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

Diagnostic Errors ; prevention & control ; Emergency Service, Hospital ; Humans ; Severe Acute Respiratory Syndrome ; diagnosis ; World Health Organization

Antitubercular Agents ; economics ; therapeutic use ; Directly Observed Therapy ; Drug Resistance, Multiple, Bacterial ; Humans ; Singapore ; epidemiology ; Tuberculosis, Multidrug-Resistant ; drug therapy ; economics

Animals ; Birds ; Communicable Disease Control ; methods ; Disease Outbreaks ; prevention & control ; statistics & numerical data ; Health Planning ; Humans ; Influenza A Virus, H5N1 Subtype ; Influenza in Birds ; epidemiology ; virology ; Risk Factors ; Singapore ; epidemiology

Coronavirus Infections ; epidemiology ; Humans ; Middle East ; epidemiology ; Respiratory Tract Infections ; epidemiology ; virology ; Singapore ; epidemiology ; Syndrome

Adolescent ; Adult ; Anticoagulants ; therapeutic use ; Aortic Valve Stenosis ; congenital ; surgery ; Dengue ; complications ; Heart Valve Prosthesis ; Humans ; Male ; Thrombocytopenia ; etiology ; Warfarin ; therapeutic use

With our rapidly ageing population and advancing treatments for patients with haematological, oncologic and rheumatological diseases, there are increasing numbers of immunocompromised patients presenting to primary care and general hospitals with opportunistic infections. This review considers the trends of these infections across four representative subgroups: fungal infections following haematopoietic stem cell transplant; viral infections post solid organ transplant; mycobacterial infections during treatment with targeted biological agents; and bacterial infections as a cause of fever in neutropenia. We also consider the impact of host, pathogens, environments and treatments on the epidemiology and outcomes of these infections.
Adult ; Bacterial Infections ; complications ; Communicable Diseases ; etiology ; Female ; Fever ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Immunocompromised Host ; Immunosuppressive Agents ; adverse effects ; Male ; Middle Aged ; Mycoses ; etiology ; Neutropenia ; etiology ; Opportunistic Infections ; epidemiology ; etiology ; Organ Transplantation ; adverse effects ; Virus Diseases ; etiology

INTRODUCTIONThe National University Hospital (NUH) was the first restructured public hospital in Singapore. As the most recently established hospital in Singapore, it has a unique record of alert organisms including methicillin-resistant Staphylococcus aureus (MRSA).

MATERIALS AND METHODSWe performed a critical review of multiple data sources including surveillance reports, task force reports, published abstracts and manuscripts concerning MRSA in NUH.

RESULTSThree themes emerged: 1) the MRSA rates have remained relatively stable through the life of the hospital despite the increased complexity of patients and intermittent intensified control efforts; 2) the major MRSA task forces were driven by surgeons and 3) a scientific approach to epidemiology has a critical role in understanding and planning interventions.

CONCLUSIONAlthough containment of MRSA can be accomplished to a certain degree through mobilisation of existing resources, higher goals such as eradication would require massive infusions of infrastructural, scientific and human resources to have a chance of success.

History, 20th Century ; History, 21st Century ; Hospitals, University ; history ; Humans ; Incidence ; Infection Control ; history ; methods ; Methicillin-Resistant Staphylococcus aureus ; drug effects ; Population Surveillance ; Singapore ; Staphylococcal Infections ; epidemiology ; microbiology ; prevention & control

Cause of Death ; Child Mortality ; trends ; Female ; Hospital Mortality ; trends ; Humans ; Male