7 results on '"Jocelyn Qi Min Teo"'
Search Results
2. Candida auris in Singapore: Genomic epidemiology, antifungal drug resistance, and identification using the updated 8.01 VITEKⓇ2 system
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Nurdyana Binte Abdul Rahman, Ai Ling Tan, Marimuthu Kalisvar, Yen Ee Tan, Oon Tek Ng, Rick Twee-Hee Ong, Jocelyn Qi-Min Teo, and Tse Hsien Koh
- Subjects
0301 basic medicine ,Microbiology (medical) ,Genetics ,medicine.medical_specialty ,Strain (biology) ,030106 microbiology ,Antifungal drug ,General Medicine ,Biology ,Southeast asian ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Candida auris ,Epidemiology ,medicine ,Pharmacology (medical) ,Identification (biology) ,030212 general & internal medicine ,Clade ,Fluconazole ,medicine.drug - Abstract
Objectives Candida auris (C. auris) has globally emerged as a multidrug-resistant pathogen. While it is known that there are four geographic clades, little is known about its genomic epidemiology in the Southeast Asian region. Laboratory identification can be challenging but the VITEKⓇ2 system (version 8.01 software) has recently updated its database to include C. auris. This study aimed to investigate the genomic epidemiology of C. auris isolated in Singapore and the susceptibility profiles in relation to ERG11 and FKS1 mutations. Methods Seven C. auris isolates from 2012–2018 were analysed using whole-genome sequencing, and antifungal susceptibility testing was performed. The performance of the updated VITEKⓇ2 system in identifying C. auris was also evaluated using these C. auris strains together with five closely related Candida species. Results Three clades were identified: South Asian (71.4%), South American (14.3%) and East Asian (14.3%). Local transmission was unlikely as there was no obviously identified cluster and most cases were likely to be imported at different time points following overseas hospitalisation exposure. Three isolates (42.9%) were multidrug-resistant. All South Asian strains were resistant to fluconazole and harboured ERG11 mutations, which were clade-specific. No FKS1 mutation was detected. The VITEKⓇ2 system was able to correctly identify most of the South Asian C. auris strains but misidentified the East Asian strain and gave a low discrimination result for the South American clade. Conclusion This study showed that the introduction of C. auris into Singapore was possibly over multiple episodes and from different sources. The VITEKⓇ2 System version 8.01 software has limited abilities in identifying C .auris.
- Published
- 2019
3. Do antimicrobial stewardship programme interventions reduce the rate of and protect against Clostridium difficile infection?
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Maciej Piotr Chlebicki, Yi Xin Liew, Lynette Oon, Bih Yee Chia, Jocelyn Qi-Min Teo, Rachel Pui-Lai Ee, Andrea L. Kwa, and Winnie Lee
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Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,genetic structures ,medicine.drug_class ,030106 microbiology ,Immunology ,Antibiotics ,Psychological intervention ,Microbiology ,Tazobactam ,Tertiary Care Centers ,Antimicrobial Stewardship ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic therapy ,medicine ,Humans ,Immunology and Allergy ,Antimicrobial stewardship ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Cross Infection ,Singapore ,Clostridioides difficile ,business.industry ,Incidence ,Incidence (epidemiology) ,Middle Aged ,Clostridium difficile ,Drug Utilization ,Anti-Bacterial Agents ,Carbapenems ,Emergency medicine ,Clostridium Infections ,Female ,business ,medicine.drug ,Piperacillin - Abstract
Antimicrobial stewardship programmes (ASPs) have often been recommended as a viable solution to minimise the incidence of Clostridium difficile infection (CDI), which can be life-threatening. This study aimed to evaluate whether ASP interventions have contributed to reducing CDI rates.A retrospective review of ASP interventions issued from January 2013 to April 2014 was performed using data from the ASP database of Singapore General Hospital, a 1600-bed tertiary-care hospital in Singapore. A total of 283 interventions satisfied the inclusion criteria, of which commonly audited antibiotics were piperacillin/tazobactam (41.3%) and carbapenems (54.8%). Comparisons were made at 30days post-intervention between those with accepted or rejected interventions. The primary outcome was CDI incidence; secondary outcomes included length of hospitalisation post-intervention, 30-day mortality and CDI recurrence rate.Whilst the median duration of antibiotic therapy was reduced by 2days (6days vs. 4 days; P0.001), acceptance of ASP interventions did not alter primary CDI incidence at 30days (P=0.644) post-intervention. However, reduced CDI recurrence rates were observed for patients positive for CDI in the accepted patient group compared with the rejected group (0% vs. 37.5%; P=0.03), with no difference in CDI 30-day mortality between the two groups.Intervention acceptance did not contribute to a significant reduction in CDI incidence but may be associated with lower recurrence rates, although further studies are required.
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- 2019
4. Risk factors and outcomes associated with the isolation of polymyxin B and carbapenem-resistant Enterobacteriaceae spp.: A case–control study
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Tse Hsien Koh, Shannon Jing-Yi Lee, Andrea L. Kwa, Cheng-Yee Tang, Thuan Tong Tan, Rick Twee-Hee Ong, Jocelyn Qi-Min Teo, Yiying Cai, Cassandra Wee-Ting Chang, and Hui Leck
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Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Carbapenem ,Genotype ,medicine.drug_class ,Polymyxin ,030106 microbiology ,Carbapenem-resistant enterobacteriaceae ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Aged ,Polymyxin B ,Retrospective Studies ,Aged, 80 and over ,Singapore ,biology ,business.industry ,Enterobacteriaceae Infections ,Case-control study ,General Medicine ,Enterobacter ,Odds ratio ,Middle Aged ,biology.organism_classification ,Hospitals ,Anti-Bacterial Agents ,Carbapenem-Resistant Enterobacteriaceae ,Treatment Outcome ,Infectious Diseases ,Carbapenems ,Case-Control Studies ,Colistin ,Female ,business ,Multilocus Sequence Typing ,medicine.drug - Abstract
Increasing resistance to polymyxin, a last-line antibiotic, is a growing public health concern worldwide. The primary objective of this study was to identify predictors for the isolation of polymyxin-resistant (PR) carbapenem-resistant Enterobacteriaceae (CRE) among hospitalized patients. The secondary objective was to describe the clinical outcomes of patients with PR-CRE infections. A retrospective case–control study including patients admitted to Singapore General Hospital between June 2012 and June 2016 was conducted. Cases were defined as patients who had clinical cultures from which a PR-CRE was isolated. Controls were randomly selected from patients with polymyxin-susceptible (PS) CRE admitted during the same period, and frequency-matched to site of isolation. We included 37 PR cases and 111 PS controls. Polymyxin resistance was detected predominantly in Enterobacter spp. (54.1%) and Klebsiella pneumoniae (43.2%). Multilocus sequence typing showed little clonal relatedness among the isolates. mcr-1 was detected in two PR-CRE isolates. Multivariable analyses showed that PR-CRE isolation was associated with prior polymyxins (adjusted odds ratio (OR), 21.31; 95% confidence interval (CI), 3.04–150.96) and carbapenem exposures (OR 3.74; CI 1.13–12.44), when adjusted for time at risk and bacteria species. In PR-CRE patients with infections, the 30-day all-cause in-hospital mortality was 50.0% as compared to 38.1% in patients with PS-CRE (P = 0.346). Prior polymyxin and carbapenem exposures were independent risk factors for isolation of PR-CRE. Outcomes of PR-CRE and PS-CRE infections were similar in this study.
- Published
- 2019
5. Incidence of a subsequent carbapenem-resistant Enterobacteriaceae infection after previous colonisation or infection: a prospective cohort study
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Maciej Piotr Chlebicki, Enqing Chee, Jocelyn Qi-Min Teo, Sarah S.L. Tang, and Andrea L. Kwa
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Male ,0301 basic medicine ,medicine.medical_treatment ,Carbapenem-resistant enterobacteriaceae ,Urine ,Tertiary Care Centers ,0302 clinical medicine ,Recurrence ,Risk Factors ,Pharmacology (medical) ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Lung ,Skin ,Aged, 80 and over ,Singapore ,Incidence ,Medical record ,Incidence (epidemiology) ,Enterobacteriaceae Infections ,General Medicine ,Middle Aged ,Anti-Bacterial Agents ,Infectious Diseases ,medicine.anatomical_structure ,Carrier State ,Female ,Microbiology (medical) ,medicine.medical_specialty ,030106 microbiology ,Microbial Sensitivity Tests ,Sepsis ,03 medical and health sciences ,Internal medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,Dialysis ,Aged ,business.industry ,Rectum ,medicine.disease ,Colonisation ,Carbapenem-Resistant Enterobacteriaceae ,Carbapenems ,Intraabdominal Infections ,business ,Follow-Up Studies ,Respiratory tract - Abstract
Objectives In patients with a history of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE), the need for CP-CRE targeted treatment in subsequent sepsis episodes is unclear. This study aimed to characterise the incidence of subsequent CP-CRE infective episodes in individuals with prior CP-CRE colonisation and/or infection, and identify predictors for these subsequent CP-CRE infections. Methods All adult inpatients with CP-CRE detected from any site between June 2012 and May 2014 at a tertiary-care hospital were prospectively followed for two years to assess for any subsequent CP-CRE infections. Potential factors to which patients were exposed during the follow-up period were collected from medical records and analysed. Results A total of 171 patients were enrolled. Of 151 patients who entered the follow-up period, 16 (10.6%) developed a subsequent CP-CRE infection. The median time to a subsequent infective episode was 24.5 days (12–105 days). The type of carbapenemase was highly conserved within index and subsequent paired episodes (16 of 17 pairs). Patients with first CP-CRE isolated from intra-abdominal or respiratory sources were ≥7 times more likely to develop a subsequent infection, while most rectal carriers remain colonised. For carriers (n = 133), Klebsiella spp. (OR 4.7) and OXA carbapenemase (OR 9.4) were significant predictors of subsequent infection. In patients with initial infection (n = 18), end-stage renal failure requiring dialysis (OR 22.0) was the only predisposing factor. Conclusion The incidence of subsequent infections in patients with prior colonisation was low. Consideration for CP-CRE targeted therapy is recommended in patients on dialysis and previous CP-CRE infections involving the bloodstream and/or respiratory tract.
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- 2021
6. Polymyxin B with dual carbapenem combination therapy against carbapenemase-producing Klebsiella pneumoniae
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Thuan Tong Tan, Nathalie Grace Chua, Pushpalatha Bangalore Lingegowda, Andrea L. Kwa, Winnie Lee, Tze-Peng Lim, Yiying Cai, Jocelyn Qi-Min Teo, and Yvonne Peijun Zhou
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Microbiology (medical) ,Carbapenem ,Combination therapy ,biology ,Colistin ,business.industry ,Klebsiella pneumoniae ,Bacteremia ,Carbapenemase producing ,biology.organism_classification ,Anti-Bacterial Agents ,Microbiology ,Infectious Diseases ,Drug Resistance, Multiple, Bacterial ,Pseudomonas aeruginosa ,medicine ,Humans ,Pseudomonas Infections ,business ,Polymyxin B ,medicine.drug - Published
- 2015
7. Impact of an antimicrobial stewardship programme on patient safety in Singapore General Hospital
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Joan Chain Zhu Loh, Maciej Piotr Chlebicki, Yi Xin Liew, Rachel Ong, Jocelyn Qi-Min Teo, Cheryl Li Ling Lim, Winnie Lee, Yiying Cai, Sarah Si Lin Tang, and Andrea L. Kwa
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Male ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Psychological intervention ,MEDLINE ,Hospitals, General ,Retrospective database ,Patient safety ,Humans ,Medicine ,Antimicrobial stewardship ,Pharmacology (medical) ,General hospital ,Aged ,Retrospective Studies ,Singapore ,business.industry ,Retrospective cohort study ,Bacterial Infections ,General Medicine ,Length of Stay ,Survival Analysis ,Drug Utilization ,Anti-Bacterial Agents ,Prescriptions ,Treatment Outcome ,Infectious Diseases ,Emergency medicine ,Female ,Patient Safety ,business ,Cost of care - Abstract
Whilst studies have shown that antimicrobial stewardship programmes (ASPs) can effectively reduce antibiotic utilisation, cost of care and even antimicrobial resistance rates, ASPs should avoid the perception that the goal is primarily to reduce antibiotic purchases and costs, instead of focusing on improving the quality of care. In addition, to address the concern of primary physicians who deemed that ASPs' choices of antibiotics were often inadequate, the impact of ASPs on patient safety should be monitored and evaluated. The aim of this study was to analyse the impact of ASP interventions on patient safety in Singapore General Hospital (SGH), a 1559-bed, large, acute, tertiary-care hospital in Singapore. A retrospective database review of data on ASP interventions issued between October 2008 and September 2010 was performed. The database maintained by the ASP team detailed patients' demographic data as well as outcomes of issued interventions. The ASP recommended 1256 interventions in a total of 1249 admissions in six departments. Shorter average length of stay (mean ± standard deviation 19.4 ± 19.9 days vs. 24.2 ± 24.2 days) was observed among patients of physicians who accepted ASP suggestions compared with patients of physicians who rejected ASP interventions (P
- Published
- 2012
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