The emergence of azole-resistant Candida tropicalis poses a significant threat in healthcare settings. It contributed to high morbidity and mortality, particularly in those undergoing chemotherapy for haematological diseases. In this study, we investigated a suspected outbreak in the haematology ward of Hospital Sultanah Bahiyah involving three patients, using whole genome sequencing. Azole-resistant C. tropicalis was isolated from all patients during episodes of neutropenic sepsis following chemotherapy. The index patient developed breakthrough candidemia while receiving fluconazole prophylaxis. Subsequently, the second and third patients developed candidemia occurring four days apart. Consequently, phylogenetic analysis confirmed that these isolates formed a clade closely related to other C. tropicalis strains, indicating a clonal nosocomial transmission. Further analysis demonstrated that, among key azole resistance genes, mutations were specifically identified in ERG11. Our findings underscore the critical role of genomic surveillance in uncovering transmission chains of multidrug-resistant fungal pathogens and highlight an urgent need for reinforced infection control measures to contain the spread of this clone.
Saccular cysts are extremely rare, but they can pose a significant risk to the airway of a newborn. We describe a case of saccular cyst in a term infant born via emergency Caesarean section for fetal distress, who immediately presented with respiratory difficulties. Multiple provisional diagnoses were made before the definite diagnosis of saccular cyst was confirmed using direct laryngoscopy and surgically treated with marsupialisation. Postoperatively, the infant's condition steadily improved, and was discharged home well. This case highlights the importance of quick recognition and timely intervention in newborns with airway obstruction.
BackgroundPharmacoeconomics (PE) is essential in optimizing healthcare resource allocation and ensuring cost-effective treatment decisions. Despite its recognized importance, limited evidence exists regarding healthcare professionals' understanding and application of PE in Malaysia. This study assessed the knowledge, perception, and application of PE among healthcare professionals within the Ministry of Health (MOH) Malaysia.MethodsA cross-sectional online survey was conducted among MOH healthcare professionals. The survey captured demographic characteristics, familiarity with PE, self-reported knowledge, perception of its importance, and its application in clinical and formulary decision-making. Descriptive statistics were used to summarize the findings.ResultsA total of 754 respondents completed the survey, comprising pharmacists (71.5%), doctors (24.3%) and other healthcare professionals (4.2%). While 63.7% reported familiarity with PE, substantial knowledge gaps were observed, particularly in cost-utility and cost-effectiveness analyses. PE application was most prevalent in budget impact assessments for formulary decisions. Notably, 94.8% of Drug and Therapeutics Committee members recognized the importance of PE in decision-making, and 96.9% supported the need for dedicated personnel with PE competency.ConclusionPE knowledge and application varied across MOH healthcare professionals, underscoring the need for targeted training and capacity building to strengthen PE competency, ultimately supporting evidence-informed, cost-effective healthcare decision-making in Malaysia.
