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1.
Clin Infect Dis ; 74(10): 1850-1854, 2022 05 30.
Artículo en Inglés | MEDLINE | ID: mdl-34554228

RESUMEN

We studied the performance of an algorithm combining multiplex polymerase chain reaction with phenotypic detection of extended-spectrum ß-lactamases and carbapenemases directly from positive blood culture bottles in patients with gram-negative bacteremia and found good concordance with routine cultures. Such an algorithm may be a tool to improve time to optimal therapy in patients with gram-negative bacteremia.


Asunto(s)
Bacteriemia , Reacción en Cadena de la Polimerasa Multiplex , Algoritmos , Bacteriemia/diagnóstico , Proteínas Bacterianas , Cultivo de Sangre , Bacterias Gramnegativas/genética , Humanos , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/genética
2.
J Hosp Infect ; 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39059770

RESUMEN

BACKGROUND: An increased incidence of P. aeruginosa in microbiological surveillance (MS) cultures from gastrointestinal endoscopes was detected between March 2020 to March 2023 in Tan Tock Seng Hospital Singapore. The aim of this report is to describe the use of whole-genome sequencing (WGS) in this investigation. METHODS: WGS was performed for all P. aeruginosa isolates with pairwise comparison of isolates to assess for genomic linkage. Comprehensive review of reprocessing practices and environmental sampling was performed. FINDINGS: Twenty-two P. aeruginosa isolates were detected from endoscopic MS cultures. Fifteen (68%) isolates were available for WGS. Eighteen pairwise comparisons of isolates were made, of which 10 were found to be genomically linked. One endoscope had P. aeruginosa repeatedly cultured from subsequent MS that were genomically linked and persistent despite repeat endoscopic reprocessing, establishing the persistence of biofilm that could not be eradicated with routine reprocessing. All P. aeruginosa isolates cultured from other different endoscopes were genetically distinct. Investigation into reprocessing practices revealed the use of air/water valves connected to endoscopes during clinical use. Inspection of these valves revealed the presences of cracks and tears. All other environmental samples were negative. CONCLUSIONS: The WGS findings helped to deprioritize common source contamination and supported the hypothesis of biofilm buildup within endoscopes leading to repeatedly positive MS cultures that were genomically linked. This was possibly related to incomplete reprocessing of the damaged air/water valves, resulting in biofilm build up. All faulty valves were changed and subsequently cleaned separately with ultrasonic cleaning followed by sterilization which resolved this incident.

3.
Front Med (Lausanne) ; 9: 964640, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35979220

RESUMEN

Shigella flexneri is a major diarrhoeal pathogen, and the emergence of multidrug-resistant S. flexneri is of public health concern. We report the detection of a clonal cluster of multidrug-resistant serotype 1c (7a) S. flexneri in Singapore in April 2022. Long-read whole-genome sequence analysis found five S. flexneri isolates to be clonal and harboring the extended-spectrum ß-lactamases bla CTX-M-15 and bla TEM-1. The isolates were phenotypically resistant to ceftriaxone and had intermediate susceptibility to ciprofloxacin. The S. flexneri clonal cluster was first detected in a tertiary hospital diagnostic laboratory (sentinel-site), to which the S. flexneri isolates were sent from other hospitals for routine serogrouping. Long-read whole-genome sequence analysis was performed in the sentinel-site near real-time in view of the unusually high number of S. flexneri isolates received within a short time frame. This study demonstrates that near real-time sentinel-site sequence-based surveillance of convenience samples can detect possible clonal outbreak clusters and may provide alerts useful for public health mitigations at the earliest possible opportunity.

4.
Case Rep Infect Dis ; 2020: 8887647, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33294239

RESUMEN

Neurocysticercosis is a common cause for brain lesions and adult-onset epilepsy in endemic countries. However, diagnosis is challenging in the absence of typical radiologic or histopathologic features. In this case report, we present a case of a 35-year-old male with a new-onset seizure and a rim-enhancing temporal lobe lesion. Radiologic features were nonspecific, and brain biopsy was performed. Histologic features showed only nonspecific granulomatous inflammation, and the diagnosis of neurocysticercosis was confirmed only with polymerase chain reaction (PCR) testing on brain biopsy tissue demonstrating PCR products consistent with Taenia solium. This case highlights the diagnostic role of PCR in such clinical situations whereby the diagnosis is unclear after initial routine evaluation.

5.
BMC Infect Dis ; 8: 14, 2008 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-18254979

RESUMEN

BACKGROUND: Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia remains a condition associated with considerable morbidity and mortality worldwide. It is a common but little-studied problem outside of Europe and North America. METHODS: A single-centre retrospective case series profiling all patients with community onset-MSSA bacteraemia presenting between March 2005 and February 2006 to a tertiary acute-care university hospital in Singapore. In addition to epidemiological and clinical data collection, risk factors for complicated bacteremia and attributable mortality were analysed. RESULTS: A total of 100 patients met the case definition. Patients were more likely to be male (65%) and below 65 years of age (69%). Seventeen patients were intravenous drug abusers, while 38 had diabetes mellitus. There were 18 cases of endocarditis, with 11 occurring in intravenous buprenorphine abusers. Attributable mortality was 11%, and 46% of patients developed complicated bacteremia. On multivariate analysis, age > 65 years and presence of chronic pulmonary disease were the only significant risk factors for the former, while valvular heart disease was a significant risk factor for the latter. CONCLUSION: MSSA bacteraemia is associated with a significant risk of serious complications in Singapore. Other Asian cities should be alert to the risk factors for adverse outcomes for this important cause of morbidity and mortality.


Asunto(s)
Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Meticilina/farmacología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Adulto , Distribución por Edad , Anciano , Análisis de Varianza , Antibacterianos/uso terapéutico , Bacteriemia/diagnóstico , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Hospitales Universitarios , Humanos , Incidencia , Modelos Logísticos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Singapur/epidemiología , Infecciones Estafilocócicas/diagnóstico , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Análisis de Supervivencia , Resultado del Tratamiento
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