1.Arrival of Fungus in Singapore: Report of the First 3 Cases.
Annals of the Academy of Medicine, Singapore 2018;47(7):260-262
Adult
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Aged
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Antifungal Agents
;
administration & dosage
;
adverse effects
;
classification
;
Candida
;
drug effects
;
isolation & purification
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Carcinoma
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pathology
;
therapy
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Cross Infection
;
microbiology
;
therapy
;
Drug Resistance, Multiple, Fungal
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Female
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Fractures, Bone
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surgery
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Humans
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Male
;
Middle Aged
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Mycoses
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microbiology
;
therapy
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Patient Care Management
;
methods
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Pulmonary Disease, Chronic Obstructive
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complications
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therapy
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Surgical Wound Infection
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microbiology
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therapy
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Symptom Flare Up
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Treatment Outcome
2.Susceptibility of multi-resistant Gram-negative bacilli in Singapore to tigecycline as tested by agar dilution.
Annals of the Academy of Medicine, Singapore 2007;36(10):807-810
INTRODUCTIONTigecycline is an antibiotic belonging to the glycylcycline class with in vitro activity against most Gram-negative bacteria, other than Pseudomonas aeruginosa. This study investigated the in vitro activity of tigecycline against multi-resistant isolates of Enterobacteriaceae and Acinetobacter spp. isolated from clinical specimens in Singapore.
MATERIALS AND METHODSMinimum inhibitory concentrations (MICs) to tigecycline were determined for 173 isolates of multi-resistant Escherichia coli, Klebsiella spp., Enterobacter spp. and Acinetobacter spp. using agar dilution.
RESULTSThe MIC required to inhibit the growth of 90% of organisms varied from 0.5 to 4 mg/L for the study isolates. Based on a resistance breakpoint of >or=8 mg/L, resistance rates varied from 0% to 9%.
CONCLUSIONSTigecycline demonstrates good in vitro activity against multi-resistant strains of Enterobacteriaceae, with more variable activity against multi-resistant strains of Acinetobacter spp.
Acinetobacter ; drug effects ; Anti-Bacterial Agents ; pharmacology ; Drug Resistance, Multiple, Bacterial ; Enterobacteriaceae ; drug effects ; Escherichia coli ; drug effects ; Klebsiella ; drug effects ; Minocycline ; analogs & derivatives ; pharmacology ; Singapore
3.Late-onset Nipah virus encephalitis 11 years after the initial outbreak: A case report
Suhailah Abdullah ; Li-Yen Chang ; Kartini Rahmat ; Khean Jin Goh ; Chong Tin Tan
Neurology Asia 2012;17(1):71-74
Nipah virus infection is known to cause late-onset and relapsed encephalitis, in addition to an acute
encephalitic illness. This is a report of a 35 years old woman, who had exposure to the Nipah virus
infection during the 1999 Malaysian outbreak, was positive for Nipah IgG by immunofl uorescence, and
had multiple small hyperintense lesions in brain MRI typically seen in acute Nipah encephalitis patients,
indicating asymptomatic Nipah virus infection. She subsequently developed acute encephalitis after
11 years, manifesting as diplopia, internuclear opthalmoplegia and epileptic seizures with pleocytosis
in cerebrospinal fl uid examination. She had another episode of relapsed encephalitis a year later, with
seizures, memory impairment, chorea and new lesions in MRI brain. This patient is unusual in the
long incubation of 11 years before manifesting with late-onset Nipah encephalitis.
4.Klebsiella Pneumoniae Visceral Organ Abscesses - Clinical Characteristics.
Shuwei ZHENG ; Seow Yen TAN ; Helen Ml OH
Annals of the Academy of Medicine, Singapore 2019;48(2):48-54
INTRODUCTION:
In recent years, () has emerged as the predominant cause of pyogenic liver abscess in Asia. - as the causative microorganism in other visceral organ abscesses-is less described. In this study, we seeked to describe the clinical characteristics of visceral organ abscesses in our institution and evaluated the prescription practices of physicians with regard to antibiotic therapy.
MATERIALS AND METHODS:
A retrospective analysis of patients with culture positive (blood or abscess aspirate) visceral organ abscesses from May 2014 to April 2016 requiring hospitalisation in Changi General Hospital was conducted.
RESULTS:
A total of 140 adult patients with visceral organ abscesses were identified. The commonest site of involvement was the liver (77.9%), followed by genitourinary tract (20.7%). Diabetic patients were more likely to have liver abscesses, genitourinary abscesses, abscesses in 2 or more organs, genitourinary disease with abscess formation outside of the genitourinary tract, and endovascular infection. Patients with extended spectrum beta-lactamase producing , were more likely to have an obstructive lesion related to the site of the abscess. Overall mortality rate was 7.1%. Amongst survivors, the mean total duration of parenteral antimicrobial therapy was 2.5 weeks before switching to oral antimicrobial agents.
CONCLUSION
Genitourinary tract is the commonest extra-hepatic site for visceral organ abscess in infections. Parenteral to oral switch of antimicrobial agents appears to be a safe and effective treatment option.
Abscess
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classification
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microbiology
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mortality
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therapy
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Anti-Bacterial Agents
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therapeutic use
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Diabetes Mellitus
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epidemiology
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Female
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Humans
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Klebsiella pneumoniae
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isolation & purification
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Liver
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pathology
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Male
;
Middle Aged
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Retrospective Studies
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Risk Factors
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Singapore
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epidemiology
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Survival Analysis
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Urogenital System
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pathology
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Viscera
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pathology
5.Anaerobic culture of diabetic foot infections: organisms and antimicrobial susceptibilities.
Lily S Y NG ; Lee Ling KWANG ; Susan C S YEOW ; Thean Yen TAN
Annals of the Academy of Medicine, Singapore 2008;37(11):936-939
INTRODUCTIONThe prevalence of diabetes mellitus is high in Singapore. Infections of the lower limb are significant causes of morbidity in this population. Although the aerobic bacteriology of these infections is well-documented, there is less data available on the anaerobic pathogens involved. This study sets out to describe the anaerobic bacteria associated with diabetic foot infections, and evaluates the susceptibility to 3 antimicrobials with anaerobic activity.
MATERIALS AND METHODSAnaerobic culture was performed on operative samples taken from diabetic foot infections. Organisms were identified through standard microbiological methods and commercial identification kits. Antimicrobial susceptibility testing to clindamycin, metronidazole and imipenem was performed by agar dilution.
RESULTSOne hundred and two strains of strict anaerobic bacteria were isolated from 30 unique specimens. The predominant anaerobic isolates were Peptostreptococcus spp. (46%) and Bacteroides fragilis group (19%). Antibiotic resistance was detected for clindamycin (18%), metronidazole (1%) and imipenem (2%).
CONCLUSIONMultiple anaerobic species can be isolated from diabetic foot infections. A significant proportion of isolates are resistant to clindamycin, while resistance to imipenem and metronidazole remains low.
Anti-Bacterial Agents ; therapeutic use ; Bacteria, Aerobic ; drug effects ; genetics ; isolation & purification ; DNA, Bacterial ; analysis ; Diabetic Foot ; surgery ; Drug Resistance, Multiple, Bacterial ; Drug Therapy, Combination ; Humans ; Nucleic Acid Amplification Techniques ; Retrospective Studies ; Surgical Wound Infection ; drug therapy ; microbiology
6.Rehabilitation for traumatic brain injury in children and adolescents.
Hwee-Ling YEN ; Janice T Y WONG
Annals of the Academy of Medicine, Singapore 2007;36(1):62-66
Children and adolescents who have sustained a traumatic brain injury (TBI) may be left with multiple deficits and impairments that can impact adversely their abilities to return to premorbid functioning in the home, school and community. Early rehabilitation has been shown to improve functional outcome; the rehabilitation programme itself has to be based on real-world demands and experiences. Rehabilitation has to be continued beyond the post-acute stage in order to promote neuronal re-organisation, monitor the child's development as well as identify and manage new issues that may appear with growth, development and maturation. The availability of relevant research data and findings for children is much less than those for adults. It is not always appropriate to apply data for adults to the younger persons due to important differences in the 2 groups and these are discussed in more detail in the article. Multiple factors have been found to affect recovery and functional outcome. Apart from age and developmental stage at injury, other variables can be grouped as injury-related, patient-related and treatment-related factors. The goals and components of the rehabilitation process are examined for the various stages of recovery and the last section of the article describes the paediatric rehabilitation scene in Singapore.
Adolescent
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Brain
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physiopathology
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Brain Injuries
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epidemiology
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physiopathology
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rehabilitation
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Child
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Humans
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Neuronal Plasticity
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Recovery of Function
7.Anaerobic bacteraemia revisited: species and susceptibilities.
Lily S Y NG ; Lee Ling KWANG ; Suma RAO ; Thean Yen TAN
Annals of the Academy of Medicine, Singapore 2015;44(1):13-18
INTRODUCTIONThis retrospective study was performed to evaluate the frequency of anaerobic bacteraemia over a 10-year period, and to provide updated antibiotic susceptibilities for the more clinically relevant anaerobes causing blood stream infection.
MATERIALS AND METHODSData were retrieved from the laboratory information system for the period 2003 to 2012. During this time, blood cultures were inoculated in Bactec™ Plus vials (BD, USA) and continuously monitored in the Bactec™ 9000 blood culture system (BD, USA). Anaerobic organisms were identified using commercial identification kits, predominantly API 20 A (bioMérieux, France) supplemented with Vitek ANC cards (bioMérieux, France) and AN-Ident discs (Oxoid, United Kingdom). A representative subset of isolates were retrieved from 2009 to 2011 and antimicrobial susceptibilities to penicillin, amoxicillin-clavulanate, clindamycin, imipenem, moxifloxacin, piperacillin-tazobactam and metronidazole were determined using the Etest method.
RESULTSAnaerobes comprised 4.1% of all positive blood culture with 727 obligate anaerobes recovered over the 10-year period, representing a positivity rate of 0.35%. The only significant change in anaerobe positivity rates occurred between 2003 and 2004, with an increase of 0.2%. The Bacteroides fragilis group (45%) were the predominant anaerobic pathogens, followed by Clostridium species (12%), Propioniobacterium species (11%) and Fusobacterium species (6%). The most active in vitro antibiotics were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and metronidazole, with susceptibilities of 95.0%, 93.3%, 90.8% and 90.8% respectively. Resistance was high to penicillin, clindamycin and moxifl oxacin. However, there were apparent differences for antibiotic susceptibilities between species.
CONCLUSIONThis study indicates that the anaerobes comprise a small but constant proportion of bloodstream isolates. Antibiotic resistance was high to some antibiotics, but metronidazole, the beta-lactam/beta-lactamase inhibitors and carbapenems retained good in vitro activity.
Anti-Bacterial Agents ; pharmacology ; Bacteremia ; microbiology ; Bacteria, Anaerobic ; classification ; drug effects ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Time Factors
8.A woman with erythematous plaques.
Sai Yee CHUAH ; Yen Loo LIM ; Joyce S S LEE ; Hiok Hee TAN
Annals of the Academy of Medicine, Singapore 2013;42(8):419-421
9.A retrospective analysis of antifungal susceptibilities of Candida bloodstream isolates from Singapore hospitals.
Thean Yen TAN ; Ai Ling TAN ; Nancy W S TEE ; Lily S Y NG
Annals of the Academy of Medicine, Singapore 2008;37(10):835-840
INTRODUCTIONWorldwide, Candida albicans is the most common Candida species implicated in bloodstream infections. However, the proportion of non-albicans bloodstream infections is increasing. Fluconazole resistance is known to be more common in non-albicans species, but is also reported in C. albicans. This retrospective study was performed to determine the species epidemiology of Candida bloodstream infections in Singapore hospitals, and to perform susceptibility testing to a range of antifungal drugs.
MATERIALS AND METHODSCandida spp. isolated from bloodstream infections from October 2004 to December 2006 were collected from 3 participating hospitals: a tertiary referral hospital (Singapore General Hospital), a secondary referral hospital (Changi General Hospital) and an obstetrics/paediatric hospital [KK Women's and Children's Hospital (KKWCH)]. Isolate collection was also retrospectively extended to January 2000 for KKWCH because of the limited number of cases from this hospital. Isolates were identified by a common protocol, and antifungal susceptibility testing was performed by microbroth dilution (Sensititre One, Trek Diagnostics, United Kingdom).
RESULTSThe most common isolates were C. albicans (37%), C. tropicalis (27%) and C. glabrata (16%). There were differences in species distribution between institutions, with C. parapsilosis and C. albicans predominant in KKWCH, and C. albicans and C. tropicalis predominant in the other 2 institutions. Fluconazole resistance was detected in 3.2% of all Candida spp., and 85.3% were classified as susceptible. All C. albicans and C. parapsilosis were susceptible to fluconazole and voriconazole, while susceptibility to fluconazole was much more variable for C. glabrata and C. krusei.
CONCLUSIONThis study shows that C. albicans remains the predominant Candida species isolated from bloodstream infections in the 3 participating hospitals. However, non-albicans species accounted for nearly two-thirds of all cases of candidaemia. Resistance to fluconazole was uncommon, and was generally confined to C. krusei and C. glabrata.
Antifungal Agents ; pharmacology ; Candida ; classification ; drug effects ; isolation & purification ; Candidiasis ; drug therapy ; epidemiology ; microbiology ; Cross Infection ; epidemiology ; microbiology ; Drug Resistance, Fungal ; drug effects ; Female ; Fungemia ; epidemiology ; microbiology ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Retrospective Studies ; Singapore ; epidemiology