RESUMO
INTRODUCTION: The surveillance of antibiotic resistance is critical for the establishment of effective control strategies. The antibiotic resistance situations in private hospitals in Hong Kong have not been systematically described. The objective of the study was to analyse antibiogram data from private hospitals and describe the temporal trends of non-susceptibility percentages in this setting. METHODS: This retrospective descriptive study used antibiogram data from all private hospitals in Hong Kong that had been collected annually for 6 years (2014-2019). Data on six targeted bacteria and their corresponding multidrug-resistant organisms were included. RESULTS: The non-susceptibility percentages of isolates remained stable or decreased during the study period: methicillin-resistant Staphylococcus aureus had a stable prevalence of approximately 20%; extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species had stable prevalences of 20% to 30% and 10% to 20%, respectively; multidrug-resistant Acinetobacter species had prevalences of approximately 2% to 8%, which decreased over time; multidrug-resistant Pseudomonas aeruginosa had prevalences of 0.0% to 0.3%; Streptococcus pneumoniae penicillin and macrolide non-susceptibility percentages were 2% to 9% and 71% to 79%, respectively. These values generally were comparable with findings from public hospitals and Residential Care Homes for the Elderly in Hong Kong. However, the prevalences of carbapenem-resistant Enterobacteriaceae, which are increasing in Hong Kong and other nations, were also increasing in our dataset despite their currently low values (<1% for Escherichia coli and <2% for Klebsiella species). CONCLUSION: The antibiotic resistance landscape among private hospitals in Hong Kong is satisfactory overall; there remains a need for surveillance, antibiotic stewardship, and other infection control measures.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Escherichia coli , Hong Kong/epidemiologia , Hospitais Privados , Humanos , Testes de Sensibilidade Microbiana , Estudos RetrospectivosRESUMO
INTRODUCTION: In response to two nosocomial clusters of coronavirus disease 2019 (COVID-19) in our hospital, we adopted a series of strict infection control measures, including regular rapid antigen test (RAT) screening for high-risk patients, visitors, and healthcare workers. We evaluated the diagnostic performance of a locally developed RAT, the INDICAID COVID-19 Rapid Antigen Test (Phase Scientific, Hong Kong), using respiratory samples from both symptomatic and asymptomatic individuals. METHODS: Real-time reverse-transcription polymerase chain reaction (rRT-PCR)-confirmed deep throat saliva (DTS) and pooled nasopharyngeal swab and throat swab (NPS/TS) samples collected from 1 November to 30 November 2020 were tested by INDICAID. Screening RATs were performed on asymptomatic healthcare workers during a 16-week period (1 December 2020 to 22 March 2021). RESULTS: In total, 20 rRT-PCR-confirmed samples (16 DTS, four pooled NPS/TS) were available for RAT. Using the original sample, RAT results were positive in 17/20 samples, indicating 85% sensitivity (95% confidence interval [CI]=62.11%-96.79%). Negative RAT results were associated with higher cycle threshold (Ct) values. For samples with Ct values <25, the sensitivity was 100%. Of the 49 801 RATs collected from healthcare workers, 33 false positives and one rRT-PCR-confirmed case were detected. The overall specificity was 99.93% (95% CI=99.91%-99.95%). The positive and negative predictive values were 2.94% (95% CI=2.11%-4.09%) and 100%, respectively. CONCLUSION: The INDICAID COVID-19 RAT demonstrated good sensitivity for specimens with high viral loads and satisfactory specificity for low-risk, asymptomatic healthcare workers.
Assuntos
COVID-19 , COVID-19/diagnóstico , COVID-19/epidemiologia , Surtos de Doenças , Hong Kong/epidemiologia , Hospitais Privados , Humanos , SARS-CoV-2 , Sensibilidade e EspecificidadeRESUMO
The Centre for Health Protection of the Department of Health has convened the Advisory Group on Antibiotic Stewardship Programme in Primary Care (the Advisory Group) to formulate guidance notes and strategies for optimising judicious use of antibiotics and enhancing the Antibiotic Stewardship Programme in Primary Care. Acute pharyngitis is one of the most common conditions among out-patients in primary care in Hong Kong. Practical recommendations on the diagnosis and antibiotic treatment of acute streptococcal pharyngitis are made by the Advisory Group based on the best available clinical evidence, local prevalence of pathogens and associated antibiotic susceptibility profiles, and common local practice.
Assuntos
Antibacterianos/administração & dosagem , Faringite/tratamento farmacológico , Infecções Estreptocócicas/diagnóstico , Streptococcus/isolamento & purificação , Doença Aguda , Gestão de Antimicrobianos/organização & administração , Hong Kong , Humanos , Faringite/microbiologia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Índice de Gravidade de DoençaRESUMO
Aims: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterized by ventricular arrhythmia during exertion or stress. Mutations in RYR2-coded Ryanodine Receptor-2 (RyR2) and CASQ2-coded Calsequestrin-2 (CASQ2) genes underlie CPVT1 and CPVT2, respectively. However, prognostic markers are scarce. We sought to better characterize the phenotypic and genotypic spectrum of CPVT, and utilize molecular modelling to help account for clinical phenotypes. Methods and results: This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at <19 years of age and their first-degree relatives. Genetic testing was undertaken in 194 of 236 subjects (82%) during 3.5 (1.4-5.3) years of follow-up. The majority (60%) had RyR2-associated CPVT1. Variant locations were predicted based on a 3D structural model of RyR2. Specific residues appear to have key structural importance, supported by an association between cardiac arrest and mutations in the intersubunit interface of the N-terminus, and the S4-S5 linker and helices S5 and S6 of the RyR2 C-terminus. In approximately one quarter of symptomatic patients, cardiac events were precipitated by only normal wakeful activities. Conclusion: This large, multicentre study identifies contemporary challenges related to the diagnosis and prognostication of CPVT patients. Structural modelling of RyR2 can improve our understanding severe CPVT phenotypes. Wakeful rest, rather than exertion, often precipitated life-threatening cardiac events.
Assuntos
Calsequestrina/genética , Mutação , Canal de Liberação de Cálcio do Receptor de Rianodina/genética , Taquicardia Ventricular/genética , Adolescente , Criança , Análise Mutacional de DNA , Morte Súbita Cardíaca/epidemiologia , Feminino , Marcadores Genéticos , Predisposição Genética para Doença , Hereditariedade , Humanos , Masculino , Modelos Moleculares , Linhagem , Fenótipo , Prognóstico , Conformação Proteica , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Canal de Liberação de Cálcio do Receptor de Rianodina/química , Canal de Liberação de Cálcio do Receptor de Rianodina/metabolismo , Relação Estrutura-Atividade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/mortalidade , Taquicardia Ventricular/fisiopatologiaRESUMO
The exploratory study reported here was intended to examine: how strongly subjectively reported driving avoidance behaviors (commonly referred to as self-regulation) and exposure were related to their objectively measured counterparts and whether it depended on the specific behavior; the extent to which gender and age play a role in the association between subjectively reported driving avoidance behaviors and exposure and their objectively measured counterparts; and the extent to which demographics, health and functioning, driving-related perceptions, and cognition influence the association between subjective and objective driving avoidance behaviors overall. The study used data from the Longitudinal Research on Aging Drivers (LongROAD) study, a multisite, prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental, and technological factors in driving safety during the process of aging. Objective driving measures were derived from GPS/datalogger data from 2131 LongROAD participants' vehicles. The corresponding subjective measures came from a comprehensive questionnaire administered to participants at baseline that asked them to report on their driving exposure, patterns, and other aspects of driving. Several other variables used in the analyses came from the comprehensive questionnaire and an inperson clinical assessment administered to participants at baseline. A series of simple linear and logistic models were fitted to examine the relationship between the subjective and objective driving measures of interest, and a multivariable analysis was conducted to examine the potential role of selected factors in the relationship between objective and subjective driving avoidance behaviors. Results of the models are presented and overall findings are discussed within the context of the existing research literature.
Assuntos
Potenciais de Ação , Displasia Arritmogênica Ventricular Direita/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Taquicardia Ventricular/diagnóstico , Adolescente , Displasia Arritmogênica Ventricular Direita/fisiopatologia , Displasia Arritmogênica Ventricular Direita/cirurgia , Diagnóstico Diferencial , Transplante de Coração , Humanos , Masculino , Valor Preditivo dos Testes , Recidiva , Taquicardia Ventricular/fisiopatologia , Taquicardia Ventricular/cirurgia , Fatores de Tempo , Resultado do Tratamento , Função Ventricular DireitaAssuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Imunogenicidade da Vacina , Adulto , Anticorpos Neutralizantes/sangue , Vacina BNT162 , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologia , Feminino , Hong Kong/epidemiologia , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Testes Sorológicos/métodos , Testes Sorológicos/estatística & dados numéricos , Glicoproteína da Espícula de Coronavírus/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Vacinas de Produtos Inativados/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/imunologia , Vacinas de mRNAAssuntos
Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Imunogenicidade da Vacina , Vacinas Sintéticas/imunologia , Adulto , Anticorpos Neutralizantes/sangue , Vacina BNT162 , COVID-19/epidemiologia , Vacinas contra COVID-19/administração & dosagem , Feminino , Hong Kong/epidemiologia , Humanos , Imunoglobulina G/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Testes Sorológicos/métodos , Testes Sorológicos/estatística & dados numéricos , Glicoproteína da Espícula de Coronavírus/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Vacinas de Produtos Inativados/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas de mRNAAssuntos
Eletrocardiografia , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia Supraventricular/diagnóstico , Potenciais de Ação , Ablação por Cateter , Criança , Diagnóstico Diferencial , Técnicas Eletrofisiológicas Cardíacas , Feminino , Frequência Cardíaca , Humanos , Valor Preditivo dos Testes , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoAssuntos
Ablação por Cateter/métodos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Veia Cava Inferior/cirurgia , Veia Cava Superior/cirurgia , Veia Ázigos , Técnicas Eletrofisiológicas Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Veia Cava Inferior/anormalidadesRESUMO
Kawasaki disease (KD) is a multisystem inflammatory illness of infants and young children that can result in acute vasculitis. The mechanism of coronary artery aneurysms (CAA) in KD despite intravenous gamma globulin (IVIG) treatment is not known. We performed a Whole Genome Sequencing (WGS) association analysis in a racially diverse cohort of KD patients treated with IVIG, both using AHA guidelines. We defined coronary aneurysm (CAA) (N = 234) as coronary z ≥ 2.5 and large coronary aneurysm (CAA/L) (N = 92) as z ≥ 5.0. We conducted logistic regression models to examine the association of genetic variants with CAA/L during acute KD and with persistence >6 weeks using an additive model between cases and 238 controls with no CAA. We adjusted for age, gender and three principal components of genetic ancestry. The top significant variants associated with CAA/L were in the intergenic regions (rs62154092 p < 6.32E-08 most significant). Variants in SMAT4, LOC100127, PTPRD, TCAF2 and KLRC2 were the most significant non-intergenic SNPs. Functional mapping and annotation (FUMA) analysis identified 12 genomic risk loci with eQTL or chromatin interactions mapped to 48 genes. Of these NDUFA5 has been implicated in KD CAA and MICU and ZMAT4 has potential functional implications. Genetic risk score using these 12 genomic risk loci yielded an area under the receiver operating characteristic curve (AUC) of 0.86. This pharmacogenomics study provides insights into the pathogenesis of CAA/L in IVIG-treated KD and shows that genomics can help define the cause of CAA/L to guide management and improve risk stratification of KD patients.
Assuntos
Ablação por Cateter , Seio Coronário/cirurgia , Dextrocardia , Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Taquicardia Supraventricular/cirurgia , Potenciais de Ação , Adulto , Seio Coronário/fisiopatologia , Dextrocardia/diagnóstico por imagem , Técnicas Eletrofisiológicas Cardíacas , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Frequência Cardíaca , Humanos , Masculino , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/fisiopatologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Fascículo Atrioventricular/fisiopatologia , Seio Coronário/fisiopatologia , Frequência Cardíaca , Defeitos dos Septos Cardíacos/complicações , Taquicardia por Reentrada no Nó Atrioventricular/complicações , Taquicardia Supraventricular/complicações , Potenciais de Ação , Adulto , Ablação por Cateter , Seio Coronário/cirurgia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Defeitos dos Septos Cardíacos/diagnóstico , Defeitos dos Septos Cardíacos/fisiopatologia , Defeitos dos Septos Cardíacos/cirurgia , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/diagnóstico , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Taquicardia Supraventricular/cirurgia , Resultado do TratamentoRESUMO
Cystic fibrosis (CF) is one of the most common life-shortening genetic disorders, and the CF transmembrane conductance regulator (CFTR) is the major causal gene. However, a substantial clinical variability among patients with identical CFTR genotypes suggests the presence of modifier genes. We tested the effect of four genes involved in Pseudomonas aeruginosa infection. Analysis of a primary cohort detected eight candidate polymorphisms that were genotyped in the secondary cohort of 1579 patients; lung function and age at first infection with P. aeruginosa were considered as the phenotypes. Both additive and codominant models were considered, adjusting for confounding variables but not for multiple comparisons. In the secondary cohort, heme oxygenase-1 (HMOX1) rs2071749 had the most significant effect on lung function in the pediatric group (P=0.01; P(corrected)=0.03), and complement factor 3 (C3) rs11569393 and HMOX1 rs2071746 in the adult groups (P=0.03 for both variants; P(corrected)=0.16, 0.09). No polymorphism of complement factor B (CFB) or toll-like receptor 4 (TLR4) had a significant modifying effect on lung function in either group. We have identified two genes that showed nominal association with disease severity among CF patients. However, because of the multiple comparisons made, further studies are required to confirm the interaction between these modifying genes and CFTR.
Assuntos
Fibrose Cística/genética , Genes Modificadores , Infecções por Pseudomonas/genética , Adolescente , Adulto , Fatores Etários , Alelos , Criança , Pré-Escolar , Fibrose Cística/complicações , Fibrose Cística/microbiologia , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Metanálise como Assunto , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/fisiologia , Adulto JovemAssuntos
Flutter Atrial/terapia , Ablação por Cateter/métodos , Valva Tricúspide/cirurgia , Veia Cava Inferior/anormalidades , Veia Cava Superior/anormalidades , Flutter Atrial/diagnóstico , Flutter Atrial/fisiopatologia , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagemAssuntos
Antibacterianos/uso terapêutico , Emigrantes e Imigrantes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Fatores Etários , Idoso , Escolaridade , Feminino , Grupos Focais , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Adulto JovemRESUMO
1. Community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains with diverse genetic backgrounds are emerging in Hong Kong. 2. Intra-familial spread of community-associated MRSA is common.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Bacterianas/genética , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/transmissão , Exotoxinas/genética , Características da Família , Saúde da Família , Hong Kong/epidemiologia , Humanos , Lactente , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/genética , Pessoa de Meia-Idade , Epidemiologia Molecular , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/transmissão , Adulto JovemRESUMO
Community-associated methicillin resistant Staphylococcus aureus is an emerging cause of skin and soft tissue infections in Hong Kong, especially among certain ethnic minorities.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções dos Tecidos Moles/epidemiologia , Infecções Cutâneas Estafilocócicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Bacterianas/genética , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/microbiologia , Eletroforese em Gel de Campo Pulsado , Exotoxinas/genética , Feminino , Hong Kong/epidemiologia , Humanos , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Pessoa de Meia-Idade , Fatores de Risco , Infecções dos Tecidos Moles/microbiologia , Infecções Cutâneas Estafilocócicas/microbiologia , Adulto JovemRESUMO
Norovirus outbreaks occur worldwide every year and have become more frequent over the last few years. There were extensive outbreaks in Hong Kong from May to July 2006 and our aim was to describe nosocomial outbreaks from 1 May 2006 to 31 July 2006 in this retrospective observational study. A total of 38 confirmed norovirus outbreaks involving 218 patients were identified. Most of these patients were elderly with a mean age of 74.5 years (range: 3 months to 97 years); 62% of them were either totally or partially dependent for help with daily activities, 83.9% had underlying chronic medical problems and 56% had limited mobility. In all, 97.2% of individuals presented with diarrhoea and only 46.3% of them had vomiting. The median duration for diarrhoea was 3 days and the longest 24 days. The median duration of vomiting was one day and the longest 15 days. Fever occurred in one-third of all cases. Reverse transcriptase-polymerase chain reaction was positive for norovirus in 72.6% cases. We conclude that nosocomial norovirus infection often involves frail elderly patients with limited mobility and that these patients may have more prolonged symptoms.