18 results on '"Yen-Mu Wu"'
Search Results
2. A hospital cluster of COVID-19 associated with a SARS-CoV-2 superspreading event
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Po-Yen Huang, Ting-Shu Wu, Chun-Wen Cheng, Chih-Jung Chen, Chung-Guei Huang, Kuo-Chien Tsao, Chun-Sui Lin, Ting-Ying Chung, Chi-Chun Lai, Cheng - Ta Yang, Yi-Ching Chen, Cheng-Hsun Chiu, Li-Yueh Huang, Yueh-Pi Chiu, Kuei-Chu Hou, Mei-Lien Chen, Yu-Chuan Huang, Li-Mei Tsai, Yu-Hua Su, Hsiu-Ping Wu, Shu-Ling Liu, Hsiao-Ni Wang, Li-Fang Chang, Shu-Hui Shen, Yun-Chi Hung, En-Chi Liu, Yi-Chuan Chen, Chiu-Lan Yeh, Hsiao-Chi Chang, Yu-Ching Chen, Ya-Ting Wu, Ching-Yu Wang, Yi-Rong Lu, Mao-Cheng Ge, Jeng-How Yang, and Yen-Mu Wu
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SARS-CoV-2 ,COVID-19 ,Superspreading event ,Outbreak ,Hospital ,Microbiology ,QR1-502 - Abstract
Background/purpose: Superspreading events (SSEs) are pivotal in the spread of SARS-CoV-2. This study aimed to investigate an SSE of COVID-19 in a hospital and explore the transmission dynamics and heterogeneity of SSE. Methods: We performed contact tracing for all close contacts in a cluster. We did nasopharyngeal or throat swabbing for SARS-CoV-2 by real-time RT-PCR. Environmental survey was performed. The epidemiological and clinical characteristics of the SSE were studied. Results: Patient 1 with congestive heart failure and cellulitis, who had onset of COVID-19 two weeks after hospitalization, was the index case. Patient 1 led to 8 confirmed cases, including four health care workers (HCW). Persons tested positive for SARS-CoV-2 were HCW (n = 4), patient 1's family (n = 2), an accompanying person of an un-infected in-patient (n = 1), and an in-patient admitted before the SSE (n = 1). The attack rate among the HCW was 3.2 % (4/127). Environmental survey confirmed contamination at the bed rails, mattresses, and sink in the room patient 1 stayed, suggesting fomite transmission. The index case's sputum remained positive on illness day 35. Except one asymptomatic patient, at least three patients acquired the infection from the index case at the pre-symptomatic period. The effective reproduction number (Rt) was 0.9 (8/9). Conclusion: The host factor (heart failure, longer viral shedding), transmissibility of SARS-CoV-2 (Rt, pre-symptomatic transmission), and possible multiple modes of transmission altogether contributed to the SSE. Rapid response and advance deployment of multi-level protection in hospitals could mitigate COVID-19 transmission to one generation, thereby reducing its impact on the healthcare system.
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- 2022
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3. A Validated Composite Score Demonstrates Potential Superiority to MELD-Based Systems in Predicting Short-Term Survival in Patients with Liver Cirrhosis and Spontaneous Bacterial Peritonitis—A Preliminary Study
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Yan-Ting Lin, Wei-Ting Chen, Tsung-Han Wu, Yu Liu, Li-Tong Liu, Wei Teng, Yi-Chung Hsieh, Yen-Mu Wu, Chien-Hao Huang, Chao-Wei Hsu, and Rong-Nan Chien
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spontaneous bacterial peritonitis ,liver cirrhosis ,short-term mortality ,MELD-based prediction models ,sepsis ,hepatorenal syndrome ,Medicine (General) ,R5-920 - Abstract
Background: Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhosis patients with ascites, leading to high mortality rates if not promptly treated. However, specific prediction models for SBP are lacking. Aims: This study aimed to compare commonly used cirrhotic prediction models (CTP score, MELD, MELD-Na, iMELD, and MELD 3.0) for short-term mortality prediction and develop a novel model to improve mortality prediction. Methods: Patients with the first episode of SBP were included. Prognostic values for mortality were assessed using AUROC analysis. A novel prediction model was developed and validated. Results: In total, 327 SBP patients were analyzed, with HBV infection as the main etiologies. MELD 3.0 demonstrated the highest AUROC among the traditional models. The novel model, incorporating HRS, exhibited superior predictive accuracy for in-hospital in all patients and 3-month mortality in HBV-cirrhosis, with AUROC values of 0.827 and 0.813 respectively, surpassing 0.8. Conclusions: MELD 3.0 score outperformed the CTP score and showed a non-significant improvement compared to other MELD-based scores, while the novel SBP model demonstrated impressive accuracy. Internal validation and an HBV-related cirrhosis subgroup sensitivity analysis supported these findings, highlighting the need for a specific prognostic model for SBP and the importance of preventing HRS development to improve SBP prognosis.
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- 2023
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4. Bacteremia (Sepsis), Hepatorenal Syndrome, and Serum Creatinine Levels Rather than Types or Microbial Patterns Predicted the Short-Term Survival of Cirrhotic Patients Complicated with Spontaneous Bacterial Peritonitis
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Chien-Hao Huang, Sheng-Fu Wang, Chen-Hung Lee, Yen-Mu Wu, Ching Chang, Bo-Huan Chen, Yu-Tung Huang, and Yu-Pin Ho
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spontaneous bacterial peritonitis and types ,liver cirrhosis ,extended-spectrum beta-lactamases resistant (ESBL) ,Gram-positive bacteria (GPC) ,bacteremia or sepsis ,hepatorenal syndrome (HRS) ,Medicine (General) ,R5-920 - Abstract
(1) Background: Spontaneous bacterial peritonitis (SBP) is a major and severe complication in cirrhosis patients with ascites. Over the years, advance in antibiotic treatment has led to changes in microbial patterns in some regions, including the emergence of extended-spectrum beta-lactamases resistant (ESBL)-producing bacteria and an increase in Gram-positive bacteria (GPC). In addition, three SBP types (classic SBP, culture-negative neutrophilic ascites (CNNA), and monomicrobial non-neutrocytic bacterascites (MNB)), may also have different prognoses. Therefore, the study aimed to investigate the microbial pattern and the predictors of short-term outcomes in patients with SBP. (2) Methods: Patients discharged with a diagnosis of the first episode of SBP between January 2006 and July 2017 were enrolled. Patients’ clinical, demographic, hematological, and biochemical data were obtained at diagnosis, and the model for end-stage liver disease (MELD)-based scores were calculated accordingly. Patients were followed up until February 2018 or until death. (3) Results: A total of 327 patients were analyzed. The prevalence of classic SBP was nearly equivalent to CNNA. As for the microbial pattern, Gram-negative bacillus (GNB) remained more prevalent than GPC (75 vs. 25%), with E. coli being the most common bacterial species, followed by K. Pneumoniae and then Staphylococcus. The percentage of ESBL strain in culture-positive patients was 10.9%. By univariable and multivariable logistic regression survival analysis, there was no significant difference in predicting short-term mortality among the three SBP types, neither between GNB vs. GPC nor between ESBL- and non-ESBL-producing bacteria. Only bacteremia (sepsis), hepatorenal syndrome (HRS), and serum creatinine (Cr) were independent predictors of in-hospital and 3-month mortality, whereas HRS and Cr were independent predictors of 6-month mortality. (4) Conclusions: SBP types, Gram stain result, and ESBL strain did not affect survival. Only bacteremia (sepsis), HRS, and serum Cr independently predicted the short-term mortality in patients with SBP.
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- 2022
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5. Enhanced Virulence of Candida albicans by Staphylococcus aureus: Evidence in Clinical Bloodstream Infections and Infected Zebrafish Embryos
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Yen-Mu Wu, Po-Yen Huang, Yi-Chuan Cheng, Chih-Hua Lee, Meng-Chieh Hsu, Jang-Jih Lu, and Shao-Hung Wang
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mixed BSI ,virulence ,co-biofilm ,Candida albicans ,Staphylococcus aureus ,hyphal morphogenesis ,Biology (General) ,QH301-705.5 - Abstract
Coinfection with Candida and Staphylococcus results in higher mortality in animal studies. However, the pathogenesis and interplay between C. albicans and S. aureus in bloodstream infections (BSIs) is unclear. This study determines the clinical features and outcomes of mixed C. albicans/S. aureus (CA/SA) BSIs and biofilm formation on pathogenesis during coinfection. Demographics and outcomes for mixed BSIs and monomicrobial candidemia were compared. Compared to 115 monomicrobial C. albicans BSIs, 22 patients with mixed CA/SA BSIs exhibited a significantly higher mortality rate and shorter survival time. In vitro and in vivo biofilm analysis showed that C. albicans accounted for the main biofilm architecture, and S. aureus increased its amount. Antibiotic tolerance in S. aureus, which adhered to Candida hyphae observed by scanning electron microscope, was demonstrated by the presence of wild-type C. albicans co-biofilm. Upregulation in exotoxin genes of S. aureus was evidenced by quantitative RT-PCR when a co-biofilm was formed with C. albicans. Mixed CA/SA BSIs result in a higher mortality rate in patients and in vivo surrogate models experiments. This study demonstrates that the virulence enhancement of C. albicans and S. aureus during co-biofilm formation contributes to the high mortality rate.
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- 2021
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6. Prognostic implication of EGFR gene mutations and histological classification in patients with resected stage I lung adenocarcinoma.
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Chun-Yu Lin, Yen-Mu Wu, Meng-Heng Hsieh, Chih-Wei Wang, Ching-Yang Wu, Ying-Jen Chen, and Yueh-Fu Fang
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Medicine ,Science - Abstract
The prognostic value of epidermal growth factor receptor (EGFR) mutations and the correlation between EGFR mutations and the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histological classification remain controversial. The current study aimed to investigate the pure prognostic role of EGFR mutations in treatment-naïve patients with resected stage I lung adenocarcinoma.We retrospectively reviewed 373 patients with stage I pulmonary non-small-cell lung cancer who underwent complete surgical resection between January 2010 and May 2014. The tumors were classified according to IASLC/ATS/ERS criteria. EGFR mutation status was determined by established methods.A total of 120 patients were included for analysis; 87 had tumors with EGFR mutations and 33 had wild-type tumors. More low- and intermediate-grade tumors had EGFR mutations, and nearly half of the high-grade tumors were wild-type (75.7% versus 46.2%, p = 0.041). Patients with low-grade tumors had significantly greater median disease-free survival (DFS) (76.8 versus 13 months, p < 0.0001) and better overall survival (OS) (median OS not reached, p = 0.0003) than those with intermediate- and high-grade tumors. Tumor recurrence was 41.4% and 30.3% in mutant and wild-type patients. The 5-years survival rate was 54% and 71.2%. Multivariate analysis revealed that the new histological classification and the pathologic stage were independent predictors of both DFS and OS. EGFR mutation status had no prognostic implications.Low grade tumors according to IASLC/ATS/ERS histological classification and the pathologic stage IA tumors of resected stage I lung adenocarcinomas independently predict better DFS and OS. EGFR mutations were frequently seen in histologically low- and intermediate-grade tumors but not a prognostic factor.
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- 2017
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7. GPR97-mediated PAR2 transactivation via a mPR3-associated macromolecular complex induces inflammatory activation of human neutrophils
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Hsi-Hsien Lin, Tai-Ying Chu, Céline Zheng-Gérard, Kuan-Yeh Huang, Yu-Chi Chang, Ying-Wen Chen, Kuan-Yu I, Yu-Ling Lo, Nien-Yi Chiang, Hsin-Yi Chen, Martin Stacey, Siamon Gordon, Wen-Yi Tseng, Chiao-Yin Sun, Yen-Mu Wu, Yi-Shin Pan, Chien-Hao Huang, Chun-Yen Lin, Tse-Ching Chen, Marilina Antonelou, Scott Henderson, Alan salama, and Elena Seiradake
- Abstract
Neutrophils play essential anti-microbial and inflammatory roles in host defense, however their activities are tightly regulated as neutrophil dysfunction often leads to detrimental inflammatory and autoimmune diseases. Here, we identified a novel PR3/CD177/GPR97/PAR2/CD16b interactome as a critical modulator of neutrophil activation. Using multiple approaches, we deorphanized GPR97, a human neutrophil-restricted adhesion G protein-coupled receptor (aGPCR), as the interacting protein and allosteric activator of CD177-associated membrane proteinase 3 (mPR3). Structural and deletion analysis of the GPR97 extracellular region disclosed two independent mPR3-binding domains. The efficient binding and activation of mPR3 by GPR97 required a macromolecular CD177/GPR97/PAR2/CD16b interactome and resulted in the transactivation of PAR2, another GPCR. GPR97-mediated PAR2 transactivation in neutrophils elicited strong inflammatory activation, triggering anti-microbial activities and endothelial dysfunction. Altogether, we identify a novel aGPCR-GPCR transactivation mechanism that directs neutrophil activation and inflammation. The PR3/CD177/GPR97/PAR2/CD16b interactome represents a potential therapeutic target for neutrophil-mediated inflammatory diseases.
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- 2022
8. Deep Cutaneous Neoscytalidium dimidiatum Infection: Successful Outcome with Amphotericin B Therapy
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Pei-Lun Sun, Chau-Yee Ng, Ting-Shu Wu, Po-Yen Huang, Yen-Mu Wu, and Shih-Jyun Yang
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Male ,Microbiological Techniques ,0301 basic medicine ,medicine.medical_specialty ,Antifungal Agents ,Itraconazole ,Veterinary (miscellaneous) ,030106 microbiology ,Applied Microbiology and Biotechnology ,Microbiology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Medical microbiology ,Pharmacotherapy ,Ascomycota ,Amphotericin B ,DNA, Ribosomal Spacer ,medicine ,Dermatomycoses ,Humans ,DNA, Fungal ,Abscess ,Aged, 80 and over ,Voriconazole ,Foot ,business.industry ,Cellulitis ,Sequence Analysis, DNA ,Middle Aged ,medicine.disease ,Dermatology ,Phaeohyphomycosis ,Treatment Outcome ,Molecular Diagnostic Techniques ,Female ,business ,Agronomy and Crop Science ,medicine.drug - Abstract
Phaeohyphomycosis is a term used to describe a heterogenous group of cutaneous and systemic mycotic infections caused by melanized fungi. Many fungi have been reported as pathogens of this disease. The disease spectrum ranges from superficial cutaneous infections, deep cutaneous infections, to systemic infections with internal organ involvement. We report two cases of deep cutaneous phaeohyphomycosis on the foot clinically presenting as cellulitis with abscess formation. The pathogens were isolated from the lesion and both were identified as Neoscytalidium dimidiatum by their colony morphology, microscopic features, and sequences of internal transcribed spacers of ribosomal DNA. Both patients did not respond to the therapy with voriconazole and itraconazole, but improved after intravenous amphotericin B.
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- 2018
9. A hospital cluster of COVID-19 associated with a SARS-CoV-2 superspreading event
- Author
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Po-Yen Huang, Ting-Shu Wu, Chun-Wen Cheng, Chih-Jung Chen, Chung-Guei Huang, Kuo-Chien Tsao, Chun-Sui Lin, Ting-Ying Chung, Chi-Chun Lai, Cheng - Ta Yang, Yi-Ching Chen, Cheng-Hsun Chiu, Li-Yueh Huang, Yueh-Pi Chiu, Kuei-Chu Hou, Mei-Lien Chen, Yu-Chuan Huang, Li-Mei Tsai, Yu-Hua Su, Hsiu-Ping Wu, Shu-Ling Liu, Hsiao-Ni Wang, Li-Fang Chang, Shu-Hui Shen, Yun-Chi Hung, En-Chi Liu, Yi-Chuan Chen, Chiu-Lan Yeh, Hsiao-Chi Chang, Yu-Ching Chen, Ya-Ting Wu, Ching-Yu Wang, Yi-Rong Lu, Mao-Cheng Ge, Jeng-How Yang, and Yen-Mu Wu
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Microbiology (medical) ,medicine.medical_specialty ,Attack rate ,Disease cluster ,Asymptomatic ,Hospital ,Throat ,Epidemiology ,Immunology and Allergy ,Medicine ,Humans ,Index case ,Superspreading event ,General Immunology and Microbiology ,business.industry ,SARS-CoV-2 ,COVID-19 ,Outbreak ,General Medicine ,Hospitals ,Virus Shedding ,Infectious Diseases ,medicine.anatomical_structure ,Emergency medicine ,Sputum ,Original Article ,medicine.symptom ,Contact Tracing ,business ,Contact tracing - Abstract
Background/purpose Superspreading events (SSEs) are pivotal in the spread of SARS-CoV-2. This study aimed to investigate an SSE of COVID-19 in a hospital and explore the transmission dynamics and heterogeneity of SSE. Methods We performed contact tracing for all close contacts in a cluster. We did nasopharyngeal or throat swabbing for SARS-CoV-2 by real-time RT-PCR. Environmental survey was performed. The epidemiological and clinical characteristics of the SSE were studied. Results Patient 1 with congestive heart failure and cellulitis, who had onset of COVID-19 two weeks after hospitalization, was the index case. Patient 1 led to 8 confirmed cases, including four health care workers (HCW). Persons tested positive for SARS-CoV-2 were HCW (n = 4), patient 1's family (n = 2), an accompanying person of an un-infected in-patient (n = 1), and an in-patient admitted before the SSE (n = 1). The attack rate among the HCW was 3.2 % (4/127). Environmental survey confirmed contamination at the bed rails, mattresses, and sink in the room patient 1 stayed, suggesting fomite transmission. The index case's sputum remained positive on illness day 35. Except one asymptomatic patient, at least three patients acquired the infection from the index case at the pre-symptomatic period. The effective reproduction number (Rt) was 0.9 (8/9). Conclusion The host factor (heart failure, longer viral shedding), transmissibility of SARS-CoV-2 (Rt, pre-symptomatic transmission), and possible multiple modes of transmission altogether contributed to the SSE. Rapid response and advance deployment of multi-level protection in hospitals could mitigate COVID-19 transmission to one generation, thereby reducing its impact on the healthcare system.
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- 2021
10. Prevalence of drug resistance mutations in HIV-infected individuals with low-level viraemia under combination antiretroviral therapy: an observational study in a tertiary hospital in Northern Taiwan, 2017-19
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Yu-Hsiang Hsiao, Shian-Sen Shie, Nan-Yu Chen, Chia-Lung Tsai, Po-Yen Huang, Zhuo-Hao Liu, Ting-Shu Wu, Shu-Wei Kao, Stephane Wen-Wei Ku, and Yen-Mu Wu
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Microbiology (medical) ,medicine.medical_specialty ,Anti-HIV Agents ,Human immunodeficiency virus (HIV) ,Taiwan ,Viremia ,HIV Infections ,Drug resistance ,medicine.disease_cause ,Tertiary Care Centers ,Internal medicine ,Pandemic ,Drug Resistance, Viral ,medicine ,Prevalence ,Humans ,Pharmacology (medical) ,Risk factor ,Genotyping ,Pharmacology ,business.industry ,Viral Load ,medicine.disease ,Infectious Diseases ,Mutation ,HIV-1 ,Observational study ,business ,Viral load - Abstract
Background Effective ART is crucial for combating the HIV pandemic. Clinically, plasma viral load monitoring to achieve virological suppression is the guide for an optimal ART. The presence of low-level viraemia (LLV) below the definition level of virological failure is a risk factor for ART failure. However, there is no treatment consensus over LLV yet, mainly due to the limitation of standard HIV-RNA genotyping and the resultant insufficient understanding of LLV characteristics. Objectives To better profile drug resistance mutations (DRMs) and the associated factors in cases experiencing LLV. Methods A prospective observational study was conducted from 2017 to 2019. HIV-DNA was used as an alternative to HIV-RNA for HIV genotyping coupled with deep sequencing for ART-naive and ART-failure cases, as well as those with LLV. Results Eighty-one ART-naive, 18 ART-failure and 16 LLV cases received HIV genotyping in the study. Three-quarters (12/16) of cases experiencing LLV harboured DRMs. Cases with LLV had higher prevalence of DRMs to NNRTIs than the ART-naive group (69% versus 20%, P Conclusions HIV DRM profiles in LLV cases were significantly different to those in ART-naive and ART-failure cases. Approaches to consolidate ART compliance and early exploration of potential ART resistance may be needed for cases experiencing LLV episodes.
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- 2020
11. Association between CAI microsatellite, multilocus sequence typing, and clinical significance within Candida albicans isolates
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Yi-Chuan Cheng, Shao-Hung Wang, Chih-Hua Lee, Yen-Mu Wu, and Jang-Jih Lu
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Male ,Genotype ,Taiwan ,03 medical and health sciences ,Risk Factors ,Sepsis ,Candida albicans ,Cluster Analysis ,Humans ,Clinical significance ,Clade ,Mycological Typing Techniques ,Genotyping ,Alleles ,Phylogeny ,030304 developmental biology ,Aged ,Genetics ,Aged, 80 and over ,0303 health sciences ,Molecular Epidemiology ,biology ,030306 microbiology ,Candidiasis ,General Medicine ,Middle Aged ,biology.organism_classification ,Corpus albicans ,Infectious Diseases ,Multilocus sequence typing ,Microsatellite ,Female ,Microsatellite Repeats ,Multilocus Sequence Typing - Abstract
Candida albicans bloodstream infection (BSI) is epidemiologically important because of its increasing frequency and serious outcome. Strain typing and delineation of the species are essential for understanding the phylogenetic relationship and clinical significance. Microsatellite CAI genotyping and multilocus sequence typing (MLST) were performed on 285 C. albicans bloodstream isolates from patients in Chang Gung Memorial Hospital at Linkou (CGMHL), Taiwan from 2003 to 2011. Data regarding demographics, comorbidities, risk factors, and clinical outcomes were recorded within adult patients with C. albicans BSI. Both CAI genotyping and MLST yielded comparable discriminatory power for C. albicans characterization. Besides, the distribution of CAI repetition showed a satisfactory phylogenetic association, which could be a good alternative method in the molecular phylogenetics of C. albicans and epidemiological studies. As for the clinical scenario, clade 17 isolates with CAI alleles either possessing 29 or more repetitions were related to higher 14-day and 30-day mortality, and shorter median survival days.
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- 2020
12. DST659 genotype of Candida albicans showing positive association between biofilm formation and dominance in Taiwan
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Jang-Jih Lu, Yin-Zhi Chen, Hsiu-Jung Lo, Yen-Mu Wu, Shao-Hung Wang, and Jia-Yuan Chang
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Male ,0301 basic medicine ,Genotype ,Zygote ,030106 microbiology ,Taiwan ,Virulence ,Biology ,Microbiology ,03 medical and health sciences ,Candida albicans ,Animals ,Humans ,Typing ,Zebrafish ,Retrospective Studies ,Dominance (genetics) ,Incidence ,Biofilm ,Candidemia ,General Medicine ,biology.organism_classification ,Survival Analysis ,Corpus albicans ,Disease Models, Animal ,030104 developmental biology ,Infectious Diseases ,Biofilms ,Multilocus sequence typing ,Female ,Multilocus Sequence Typing - Abstract
Based on multiple locus sequence typing, we previously found that DST659 and DST693 were dominant genotypes of Candida albicans among the bloodstream isolates at Chang-Gung Memorial Hospital at Linkou. Biofilm-forming activity, which is critical for C. albicans virulence, probably contributed to the dominance of antifungal sensitive isolates in hospital. Both in vitro membrane weighting and in vivo zebrafish egg infection assays were used to evaluate the biofilm-forming activity of DST659 and DST693 genotypes. Medical records of the patients infected by these two genotypes were retrospectively reviewed. High biofilm-forming activity of DST659 isolates was demonstrated in vitro and further proved with the zebrafish egg infection model, which showed a positive correlation between the biofilm-forming extent on chorion and the in vitro biofilm activity. Moreover, significantly less embryos survived when infected with DST659 isolates than those with DST693 (1.25% vs. 11.43%), and the high-biofilm subset of DST659 showed a greater reduction in survival of embryos at 48 h post-infection than the low-biofilm subset (0 vs. 1.92%). Patients infected with DST659 seemed to survive slightly worse than those infected with DST693, although the difference was insignificant. It is noteworthy that DST659-infected patients were associated with a higher incidence in renal insufficiency as compared to those with DST693, the low biofilm genotype. We suggest that a strong biofilm activity of DST659 contributed to a high mortality rate in zebrafish hosts and poor renal function in patients, as well as gaining the dominance in the northern Taiwan.
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- 2018
13. Risk factors and outcomes of candidemia caused by Candida parapsilosis complex in a medical center in northern Taiwan
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Jang-Jih Lu, Ching-Tai Huang, Jung-Jr Ye, Shian-Sen Shie, Ting-Shu Wu, Yen-Mu Wu, and Po-Yen Huang
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0301 basic medicine ,Microbiology (medical) ,Azoles ,Male ,medicine.medical_specialty ,Antifungal Agents ,Candida parapsilosis ,030106 microbiology ,Taiwan ,Candida glabrata ,Microbial Sensitivity Tests ,Microbiology ,Tertiary Care Centers ,03 medical and health sciences ,Minimum inhibitory concentration ,Risk Factors ,Internal medicine ,Candida albicans ,medicine ,Humans ,Candida tropicalis ,Retrospective Studies ,biology ,Candidemia ,Retrospective cohort study ,General Medicine ,Odds ratio ,Middle Aged ,biology.organism_classification ,Corpus albicans ,Infectious Diseases ,Treatment Outcome ,Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ,SOFA score ,Candida parapsilosis complex ,Female ,Fluconazole ,medicine.drug - Abstract
To investigate the risk factors and outcomes associated with Candida parapsilosis candidemia, a retrospective study was conducted at a tertiary medical center in northern Taiwan. Patients with C. parapsilosis candidemia and corresponding controls with C. albicans candidemia were chosen and their demographics, comorbidities, risk factors, and clinical outcomes were reviewed. Antifungal susceptibility tests were performed using the Sensititre YeastOne colorimetric system. Matrix-assisted laser desorption ionization-time of flight mass spectrometry was used to classify the genomic species. Of the 270 candidemias found in 253 patients, C. albicans was the most common Candida species isolated (43.0%), followed by C. parapsilosis (22.6%), C. tropicalis (17.4%), and C. glabrata (10.0%). The 30-day mortality of C. parapsilosis candidemia was significantly lower than that of C. albicans candidemia (21.7% vs. 53.9%, P
- Published
- 2017
14. Prognostic implication of EGFR gene mutations and histological classification in patients with resected stage I lung adenocarcinoma
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Meng-Heng Hsieh, Ying-Jen Chen, Chih-Wei Wang, Yueh-Fu Fang, Chun-Yu Lin, Yen-Mu Wu, and Ching-Yang Wu
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0301 basic medicine ,Oncology ,Male ,Lung Neoplasms ,Cancer Treatment ,lcsh:Medicine ,Gene mutation ,Lung and Intrathoracic Tumors ,0302 clinical medicine ,Adenocarcinomas ,Medicine and Health Sciences ,Epidermal growth factor receptor ,lcsh:Science ,Multidisciplinary ,biology ,Adenocarcinoma of the Lung ,Middle Aged ,Prognosis ,ErbB Receptors ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Adenocarcinoma ,Female ,Anatomy ,Research Article ,medicine.medical_specialty ,Histology ,Surgical and Invasive Medical Procedures ,Carcinomas ,03 medical and health sciences ,Internal medicine ,medicine ,Adenocarcinoma of the lung ,Genetics ,Humans ,Point Mutation ,Lung cancer ,Survival rate ,Aged ,Lung ,business.industry ,lcsh:R ,Cancers and Neoplasms ,Biology and Life Sciences ,medicine.disease ,030104 developmental biology ,Mutation ,biology.protein ,lcsh:Q ,business - Abstract
Introduction The prognostic value of epidermal growth factor receptor (EGFR) mutations and the correlation between EGFR mutations and the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) histological classification remain controversial. The current study aimed to investigate the pure prognostic role of EGFR mutations in treatment-naive patients with resected stage I lung adenocarcinoma. Methods We retrospectively reviewed 373 patients with stage I pulmonary non-small-cell lung cancer who underwent complete surgical resection between January 2010 and May 2014. The tumors were classified according to IASLC/ATS/ERS criteria. EGFR mutation status was determined by established methods. Results A total of 120 patients were included for analysis; 87 had tumors with EGFR mutations and 33 had wild-type tumors. More low- and intermediate-grade tumors had EGFR mutations, and nearly half of the high-grade tumors were wild-type (75.7% versus 46.2%, p = 0.041). Patients with low-grade tumors had significantly greater median disease-free survival (DFS) (76.8 versus 13 months, p < 0.0001) and better overall survival (OS) (median OS not reached, p = 0.0003) than those with intermediate- and high-grade tumors. Tumor recurrence was 41.4% and 30.3% in mutant and wild-type patients. The 5-years survival rate was 54% and 71.2%. Multivariate analysis revealed that the new histological classification and the pathologic stage were independent predictors of both DFS and OS. EGFR mutation status had no prognostic implications. Conclusion Low grade tumors according to IASLC/ATS/ERS histological classification and the pathologic stage IA tumors of resected stage I lung adenocarcinomas independently predict better DFS and OS. EGFR mutations were frequently seen in histologically low- and intermediate-grade tumors but not a prognostic factor.
- Published
- 2017
15. [Factors influencing adherence to antibiotic therapy in patients with acute infections]
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Yi-Chun, Chen, Hsieh-Shong, Leu, Shu-Fang, Wu, Yen-Mu, Wu, and Tsae-Jyy, Wang
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Adult ,Male ,Logistic Models ,Patient Education as Topic ,Acute Disease ,Humans ,Female ,Bacterial Infections ,Middle Aged ,Aged ,Anti-Bacterial Agents ,Medication Adherence - Abstract
Taking antibiotics in strict adherence to physician prescriptions is crucial for maintaining the stability of the drug concentration in the blood and for achieving the best therapeutic effects. The increasing antimicrobial resistance in recent decades has led the Ministry of Health and Welfare to promote the rational use of antibiotics and the use of a computer monitoring system to control the use of antibiotics in hospitals. Although non-adherence is considered as the major factor contributing to antimicrobial resistance, patient non-adherence to antibiotic prescriptions is an issue that has been largely overlooked. This paper explores this issue due to the serious threat from antimicrobial resistance and the few studies that have investigated patient adherence to antibiotic treatments for acute infections in Taiwan.The aims of the study include: (1) describe patient's adherence to antibiotic therapy for acute infections and (2) explore the potential factors of influence on antibiotic adherence such as demographics, disease characteristics, and knowledge of antibiotic treatment.The study used a descriptive correlational design. A convenience sample of 162 patients with acute infections was recruited from outpatient infectious disease clinics in Taoyuan City. Data were collected using the study questionnaire and analyzed using the chi-square test, Mann-Whitney U test, and logistic regression.The study results showed that only 40.1% of patients followed their prescription to take antibiotics completely. The remainder earned lower scores than their prescription-adhering counterparts for knowledge regarding the effects of antibiotics (U = 2654.5, p = .046). Results of logistic regression showed that knowledge regarding the effects of antibiotics was the most significant predictor (B = .481, p = .046) of adherence to antibiotic therapies.Non-adherence to prescriptions is prevalent in short-term antibiotic treatments prescribed for acute infections. This finding reminds healthcare providers to provide proper education to the recipients of antibiotic treatments, even those treated for a very short duration for acute infections in outpatient settings. Special attention should be pay to enhancing the understanding and appreciation of patients for the therapeutic effects of antibiotics.急性感染病人抗生素服藥遵從性及其影響因素之研究服用抗生素的時間和劑量要符合醫師處方才能維持穩定的藥物血中濃度,進而發揮最佳滅菌或抑菌的效果與減少產生細菌抗藥性的機會。有鑑於抗藥性菌種問題日益嚴重,衛生服利部在醫院中積極推動抗生素使用的合理性、電腦管制抗生素的使用量等,卻忽略了門診病人在抗生素的使用上是否正確,國外研究顯示抗生素服藥不遵從是導致抗藥性菌種問題的主因之一,然而台灣關於抗生素服藥遵從性的研究少,且抗藥性菌種問題嚴重,故引發作者探討感染科門診就診之急性感染病人服用抗生素的遵從性及其影響因素之動機,以作為日後改善抗生素服藥遵從性的參考。本研究目的為(1)描述急性感染門診病人服用抗生素的遵從情形,(2)探討影響服用抗生素遵從性的因素,包括人口學、疾病特性與抗生素服藥知識。採描述性相關研究設計,以因急性感染服用抗生素之門診病人為研究對象,採方便取樣,共招募162位符合收案條件之病人參與本研究,以結構式問卷進行資料收集,以Chi-square test、Mann-Whitney U test和logistic regression進行資料分析。研究結果顯示因急性感染接受抗生素短期治療之門診病人按醫囑服用抗生素的遵從度不高,在平均5天的抗生素療程中,僅有40.1%的病人完全遵從醫囑服用抗生素。不遵從者在抗生素效果面向的知識得分較遵從者低(U = 2654.5, p = .046)。邏輯式回歸結果顯示抗生素效果面向的知識為不遵從服藥的重要預測子(B = .481, p = .046)。不同於醫護人員的預期,因急性感染接受短期抗生素治療的病人,未遵從醫囑服藥的情形是很普遍的。此一發現提醒醫護人員即便是治療因急性感染短期接受抗生素治療之門診病人,亦應加強抗生素相關衛教,特別是抗生素效果面向有關的抗生素知識,進而增加病人之服藥遵從性。
- Published
- 2015
16. Tigecycline-based versus sulbactam-based treatment for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex.
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Jung-Jr Ye, Huang-Shen Lin, Chun-Fu Yeh, Yen-Mu Wu, Po-Yen Huang, Chien-Chang Yang, Ching-Tai Huang, Ming-Hsun Lee, Ye, Jung-Jr, Lin, Huang-Shen, Yeh, Chun-Fu, Wu, Yen-Mu, Huang, Po-Yen, Yang, Chien-Chang, Huang, Ching-Tai, and Lee, Ming-Hsun
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PNEUMONIA treatment ,ACINETOBACTER calcoaceticus ,ACINETOBACTER baumannii ,MULTIDRUG resistance ,CARBAPENEMS ,APACHE (Disease classification system) ,PNEUMONIA-related mortality ,ACINETOBACTER infections ,ANTIBIOTICS ,COMBINATION drug therapy ,DRUG resistance in microorganisms ,PENICILLIN ,PNEUMONIA ,TREATMENT effectiveness ,RETROSPECTIVE studies ,MINOCYCLINE ,GRAM-negative aerobic bacteria ,THERAPEUTICS - Abstract
Background: The treatment options for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (MDR Acb) complex are limited, and the optimal treatment has not been established.Methods: To compare the efficacy of tigecycline-based with sulbactam (or ampicillin/sulbactam)-based therapy for pneumonia involving MDR Acb complex, we conducted a retrospective study comparing 84 tigecycline-treated adult patients during the period August 2007 to March 2010 with 84 sulbactam or ampicillin/sulbactam-treated adult patients during the period September 2004 to July 2007. Both groups had the matched Acute Physiology and Chronic Health Evaluation (APACHE) II score and received treatment for at least 7 days.Results: The mean APACHE II score was 20.1 for both groups. More patients in sulbactam group had ventilator use (89.3 % versus 69.0 %), bilateral pneumonia (79.8 % versus 60.7 %) and combination therapy (84.5 % versus 53.6 %), particularly with carbapenems (71.4 % versus 6.0 %), while more patients in tigecycline group had delayed treatment (41.7 % versus 26.2 %) (P <0.05). At the end of treatment, more patients in sulbactam group had airway MDR Acb complex eradication (63.5 % versus 33.3 %, P <0.05). The clinical resolution rate was 66.7 % for both groups. The mortality rate during treatment was 17.9 % in sulbactam group, and 25.0 % in tigecycline group (P = 0.259). The multivariate analysis showed that bilateral pneumonia was the only independent predictor for mortality during treatment (adjusted odds ratio, 2.717; 95 % confidence interval, 1.015 to 7.272).Conclusions: Patients treated with either tigecycline-based or sulbactam-based therapy had a similar clinical outcome, but tigecycline group had a lower microbiological eradiation rate. [ABSTRACT FROM AUTHOR]- Published
- 2016
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17. Serratia marcescens meningitis: Epidemiology, prognostic factors and treatment outcomes
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Po-Chang Hsu, Yen-Mu Wu, Jung-Jr Ye, Hong-Jyun Chang, Ching-Tai Huang, Ming-Hsun Lee, and Chien-Chang Yang
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Male ,law.invention ,Cerebrospinal fluid ,law ,Risk Factors ,Epidemiology ,Immunology and Allergy ,Child ,Serratia marcescens ,Outcome ,Aged, 80 and over ,biology ,Mortality rate ,General Medicine ,Middle Aged ,Prognosis ,Intensive care unit ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Child, Preschool ,Female ,Neurosurgery ,Meningitis ,Microbiology (medical) ,Adult ,medicine.medical_specialty ,Adolescent ,Meningitis, Bacterial ,Serratia Infections ,Young Adult ,Internal medicine ,Immunology and Microbiology(all) ,medicine ,Humans ,Aged ,Retrospective Studies ,General Immunology and Microbiology ,business.industry ,Infant ,Odds ratio ,medicine.disease ,biology.organism_classification ,Survival Analysis ,Surgery ,Cephalosporins ,Lactate ,business - Abstract
Background/Purpose Serratia marcescens is a rare pathogen of central nervous system infections. This study was to investigate the epidemiology, prognostic factors, and treatment outcomes of S. marcescens meningitis. Methods This retrospective analysis included 33 patients with culture-proven S. marcescens meningitis hospitalized between January 2000 and June 2011. Results Of the 33 patients enrolled, only one did not receive neurosurgery before the onset of S. marcescens meningitis. Patients with S. marcescens meningitis had higher ratios of brain solid tumors (54.5%) and neurosurgery (97.0%) with a mortality rate of 15.2%. The mean interval between the first neurosurgical procedure and the diagnosis of meningitis was 17.1 days (range, 4–51 days). Only one third-generation cephalosporin-resistant S. marcescens isolate was recovered from the patients' cerebrospinal fluid (CSF) specimens. Compared with the favorable outcome group ( n = 20), the unfavorable outcome group ( n = 13) had a higher percentage of brain solid tumors, more intensive care unit stays, and higher Sequential Organ Failure Assessment score, CSF lactate and serum C-reactive protein concentrations at diagnosis of meningitis. Under the multiple regression analysis, CSF lactate concentration ≥2-fold the upper limit of normal (ULN) was independently associated with unfavorable outcomes (odds ratio, 7.20; 95% confidence interval, 1.08–47.96; p = 0.041). Conclusion S. marcescens meningitis is highly associated with neurosurgical procedures for brain solid tumors. CSF lactate concentration ≥2x ULN may predict an unfavorable outcome. Its mortality is not high and empiric treatment with parenteral third-generation cephalosporins may have a satisfactory clinical response.
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18. Tigecycline-based versus sulbactam-based treatment for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex
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Jung-Jr Ye, Huang-Shen Lin, Ming-Hsun Lee, Chien-Chang Yang, Chun-Fu Yeh, Yen-Mu Wu, Ching-Tai Huang, and Po-Yen Huang
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0301 basic medicine ,Acinetobacter baumannii ,Adult ,Male ,medicine.medical_specialty ,030106 microbiology ,Taiwan ,Minocycline ,Tigecycline ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,Ampicillin ,Internal medicine ,Drug Resistance, Multiple, Bacterial ,medicine ,Pneumonia, Bacterial ,Humans ,030212 general & internal medicine ,Acinetobacter calcoaceticus ,Aged ,Retrospective Studies ,Aged, 80 and over ,biology ,business.industry ,Mortality rate ,Sulbactam ,Acinetobacter ,Middle Aged ,biology.organism_classification ,medicine.disease ,Surgery ,Anti-Bacterial Agents ,Pneumonia ,Treatment Outcome ,Infectious Diseases ,Carbapenems ,Drug Therapy, Combination ,Female ,business ,medicine.drug ,Research Article ,Acinetobacter Infections - Abstract
Background The treatment options for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (MDR Acb) complex are limited, and the optimal treatment has not been established. Methods To compare the efficacy of tigecycline-based with sulbactam (or ampicillin/sulbactam)-based therapy for pneumonia involving MDR Acb complex, we conducted a retrospective study comparing 84 tigecycline-treated adult patients during the period August 2007 to March 2010 with 84 sulbactam or ampicillin/sulbactam-treated adult patients during the period September 2004 to July 2007. Both groups had the matched Acute Physiology and Chronic Health Evaluation (APACHE) II score and received treatment for at least 7 days. Results The mean APACHE II score was 20.1 for both groups. More patients in sulbactam group had ventilator use (89.3 % versus 69.0 %), bilateral pneumonia (79.8 % versus 60.7 %) and combination therapy (84.5 % versus 53.6 %), particularly with carbapenems (71.4 % versus 6.0 %), while more patients in tigecycline group had delayed treatment (41.7 % versus 26.2 %) (P
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