This multinational study from Asia revealed that reduced susceptibility to ciprofloxacin (MIC, 0.125 to 1 microg/ml) in nontyphoid Salmonella isolates was common in Taiwan (48.1%) and Thailand (46.2%) and in S. enterica serotype Choleraesuis (68.8%) and S. Virchow (75.0%) from all countries. Reduced susceptibility to ceftriaxone (MIC, 2 to 8 microg/ml) remained uncommon in Asia, except in Taiwan (38.0%) or in S. Typhimurium (25.0%) from all countries.

BACKGROUND AND PURPOSE:Shigellosis is a major health problem in developing countries, causing 91 million episodes and 414,000 deaths in Asia annually. Because of increasing trends towards drug resistance, this study was undertaken to monitor local resistance patterns of Shigella isolates from 8 Asian countries.METHODS:Ninety eight Shigella isolates collected from 8 centers in 8 Asian countries from July 2001 to July 2004 were analyzed in terms of serogroup distribution and antimicrobial susceptibility.RESULTS:The most common serogroup of Shigella isolates was Shigella flexneri (49/98, 50%), followed by Shigella sonnei (44/98, 45%). The highest resistance rate was found for trimethoprim-sulfamethoxazole (81%), followed by tetracycline (74%) and ampicillin (53%). Overall, 76 Shigella isolates (78%) were multidrug-resistant strains; S. flexneri had a higher multidrug resistance rate than S. sonnei (74% vs 23%). Increasing ciprofloxacin and ceftriaxone resistance was observed; approximately 10% and 5% of isolates were resistant to ciprofloxacin and ceftriaxone, respectively. Five ceftriaxone-non-susceptible strains (from Taiwan [3], Hong Kong [1] and The Philippines [1]) and 10 ciprofloxacin-non-susceptible strains (from Hong Kong [2], The Philippines [1], Korea [2], Vietnam [4] and Sri Lanka [1]) were isolated.CONCLUSIONS:High rates of multidrug resistance and steady increases in ceftriaxone and ciprofloxacin resistance of Shigella are serious pubic health concerns in Asian countries. Continuous monitoring of resistance patterns among Shigella isolates is necessary.

Singapore has a sophisticated healthcare system and is an important referral centre for Asia. Like much of the world, methicillin-resistant Staphylococcus aureus (MRSA) is now endemic across its health system. MRSA infection has been associated with considerable attributable mortality, morbidity plus personal and public cost. Nosocomial infections are potentially preventable and need to be considered an unacceptable complication rather than a tolerable byproduct of healthcare. Failure to introduce long-term sustainable infection control initiatives is not an option for responsible clinical leaders and managers. Control of MRSA transmission in Singapore is achievable but we need to accept the challenge and acknowledge that it will take perhaps a decade. It requires implementation of many varied infection control measures to be rolled out sequentially and across all health services. Our ambition, in Singapore, should be for hospitals to achieve an inpatient prevalence of <1% MRSA colonised patients. Identified transmission of MRSA should be regarded as a serious breech. Successful control will require extraordinary collaboration, support, resources, accountability and consistency of effort. Currently, efforts are evolving significantly and today, we have a good opportunity to embark on this difficult journey. Implementing infection control initiatives successfully over the next few years will save lives in the future. Key words: Colonisation, Infection, Infection control

ABSTRACT Klebsiella pneumoniae causes common and severe hospital- and community-acquired infections with a high incidence of multidrug resistance. The emergence and spread of β-lactamase-producing K. pneumoniae strains highlight the need to develop new therapeutic strategies. In this study, we developed antisense peptide nucleic acids (PNAs) conjugated to the (KFF) 3 K peptide and investigated whether they could mediate gene-specific antisense effects in K. pneumoniae . No outer membrane permeabilization was observed with antisense PNAs when used alone. Antisense peptide-PNAs targeted at two essential genes, gyrA and ompA , were found to be growth inhibitory at concentrations of 20 μM and 40 μM, respectively. Mismatched antisense peptide-PNAs with sequence variations of the gyrA and ompA genes when used as controls were not growth inhibitory. Bactericidal effects exerted by peptide-anti- gyrA PNA and peptide-anti- ompA PNA on cells were observed within 6 h of treatment. The antisense peptide-PNAs specifically inhibited expression of DNA gyrase subunit A and OmpA from the respective targeted genes in a dose-dependent manner. Both antisense peptide-PNAs cured IMR90 cell cultures that were infected with K. pneumoniae (10 4 CFU) in a dose-dependent manner without any noticeable toxicity to the human cells.

INTRODUCTIONTo assess the efficacy of screening stools sent for Clostridium difficile cytotoxin assay (CDTA) for surveillance of vancomycin-resistant enterococci (VRE).MATERIALS AND METHODSFrom April to May 2005, all stools submitted for CDTA were also cultured for VRE using vancomycin containing culture media. Isolates were identified to species level and vancomycin resistance confirmed, followed by polymerase chain reaction (PCR) for detection of vancomycin resistance genes and DNA fingerprinting. Over 2 consecutive days during that period, stool specimens or rectal swabs were also obtained from all patients in high-risk units (haematology, oncology, renal and intensive care). Fifty-one patients in each group were compared in terms of VRE risk factors previously identified.RESULTS AND DISCUSSIONThe prevalence of VRE in both groups was similar [3/204 (1.5%) in the CDTA arm and 1/97 (1.0%) in the high-risk arm; P = 1.0, Fisher's exact test]. Prevalence of risk factors for VRE colonisation, including age, duration of hospitalisation, exposure to antibiotics, exposure to surgical procedures, presence of malignancy and diabetes mellitus was similar in both groups (P > 0.05). Only renal failure (P < 0.05) was more common in the high-risk group. All 4 isolates of VRE identified were genetically distinct by variable number tandem repeat (VNTR) typing; 3 were Enterococcus faecium (2 with the vanB gene, 1 with vanA) and one E. faecalis.CONCLUSIONLess than 2% of our high-risk patients are VRE carriers. In-hospital VRE screening using stools sent for CDTA is a simple, reasonable surrogate for screening individual high-risk patients as the patient risk profile is similar and the yield comparable in a low-prevalence setting.

An 18-month epidemiologic investigation of Candida bloodstream infections in a Singapore hospital identified 52 candidemic patients: 36% of whose infections were caused by C. tropicalis, 29% were due to C. albicans, 10% with C. parapsilosis and 21% involved C. glabrata. A predominant clonal C. tropicalis strain was demonstrated. No association with ICU stay, prior exposure to fluconazole/broad-spectrum antibiotics or increased mortality was found in this apparent shift towards non-C. albicans Candida species as the primary agents of candidemia.

OBJECTIVE: To assess the frequency of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.SETTING: A teaching hospital in Singapore.METHODS: Prospectively collected surveillance data were reviewed during a 1-year period to determine the extent and origin of community-acquired MRSA infections.RESULTS: Whereas 32% of 383 MRSA infections were detected less than 48 hours after hospital admission and would, by convention, be classified as "community acquired," all but one of these were among patients who had been exposed to outpatient centers including dialysis or chemotherapy clinics, visiting nurses, community hospitals, or all three.CONCLUSIONS: With health. care increasingly being delivered in an outpatient setting, community-acquired MRSA infections are often acquired in hospital-related sites and most may be more accurately described as "healthcare acquired." Infection control measures need to move beyond the traditional paradigm of acute care hospitals to effectively control the spread of resistant pathogens.

Advances in Tissue BankingThe Scientific Basis of Tissue Transplantation, pp. 175-199 (2001) No AccessINTRODUCTION TO MEDICAL MICROBIOLOGYGAMINI KUMARASINGHEGAMINI KUMARASINGHEDivision of Microbiology, Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singaporehttps://doi.org/10.1142/9789812811400_0012Cited by:0 (Source: Crossref) PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail Abstract: Antonie van Leeuwenhoek, in 1674, first saw what he called "ammalcules" — bacteria and protozoa — in biological samples, including those taken from his own body. Many important developments related to clinical microbiology took place during the latter part of the 19th century. In 1875, F.J. Cohn published an early classification of bacteria, using the genus name Bacillus for the first time. Robert Koch described anthrax in 1876, the culture plate technique in 1881 and the aetiology of tuberculosis in 1884. He was awarded the Nobel Prize for his contributions to medicine in 1905. Joseph Lister demonstrated the isolation of bacteria in pure culture, Louis Pasteur introduced the concept of vaccination with attenuated microorganisms and Paul Ehrlich demonstrated the formation of antibodies, all during the 19th century. Since then, medical microbiology has evolved at an explosive rate (ASM, 1999). A wide variety of emerging pathogens continue to be described as various advances are made in medicine (CDC, webpage). During the last two decades, molecular diagnostic techniques have led to a revolution in our abilities to identify, classify and understand microorganisms. Increasing numbers of diagnostic tests, including those commercially available, are based on molecular techniques. Some enthusiasts predict that they may replace culture as the routine laboratory method of investigation. Microbiology is the science concerned with studying all microorganisms. Medical microbiology restricts this to the microbes that live on the human surface, and those there or elsewhere that may invade human tissues or otherwise cause infectious disease. In a nutshell, medical microbiology involves the diagnosis, treatment and control of human infection. Clinical microbiology has matured into a wide-ranging science, not just a service to process specimens and provide results but also to advise on the collection of specimens, the interpretation of results and management of patients, the selection of antimicrobial agents and in the control of hospital-acquired infections. Conventional pathogens are capable of causing infections in previously healthy people. The organisms isolated from clinical specimens may derive from bacteria and fungi that are permanently living on body surfaces (commensals) or from the environment. Opportunistic pathogens are those that usually do not cause disease in normal people, but may cause serious infections in immunocompromised patients. Hence, the significance of laboratory findings will depend on how the specimen was collected and needs to be assessed in the context of the clinical situation. Serious nosocomial infections are often caused by commensals and environmental organisms. A clear distinction between a primary pathogen, a commensal and a contaminant is not always clear-cut. This situation is frequently encountered in immunologically compromised patients. As a result, the liaison between the medical microbiologist and the clinician is of paramount importance to ensure a sensible interpretation of laboratory findings. FiguresReferencesRelatedDetails Recommended The Scientific Basis of Tissue Transplantation Metrics History PDF download

Advances in Tissue BankingThe Scientific Basis of Tissue Transplantation, pp. 212-231 (2001) No AccessTRANSMISSIBLE DISEASES OF PARTICULAR IMPORTANCE IN THE IMMUNOCOMPROMISED AND TRANSPLANT RECIPIENTSGAMINI KUMARASINGHEGAMINI KUMARASINGHEDivision of Microbiology, Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singaporehttps://doi.org/10.1142/9789812811400_0014Cited by:0 PreviousNext AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsRecommend to Library ShareShare onFacebookTwitterLinked InRedditEmail Abstract: Transmissible diseases are caused by microorganisms such as bacteria, viruses, fungi and parasites. They are caused by living microorganisms. Hence, with adequate measures, diseases may be prevented or even eradicated, e.g. smallpox. Infection is a common problem shared by all medical specialities. Although the incidence of many communicable diseases in developed countries has fallen to very low levels, in developing countries, infections continue to cause considerable morbidity and mortality. On the other hand, infections associated with recent advances in medicine cause new problems particularly in developed countries. The salient features of a few selected organisms that cause infections in immunocompromised and transplant recipients are discussed in this chapter. FiguresReferencesRelatedDetails The Scientific Basis of Tissue TransplantationMetrics History PDF download