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Coronavirus disease-19 (COVID-19) is an emerging infectious disease caused by SARS-CoV-2 that has rapidly evolved into a pandemic to cause over 600 million infections and more than 6.6 million deaths up to Nov 25, 2022. COVID-19 carries a high mortality rate in severe cases. Co-infections and secondary infections with other micro-organisms, such as bacterial and fungus, further increases the mortality and complicates the diagnosis and management of COVID-19. The current guideline provides guidance to physicians for the management and treatment of patients with COVID-19 associated bacterial and fungal infections, including COVID-19 associated bacterial infections (CABI), pulmonary aspergillosis (CAPA), candidiasis (CAC) and mucormycosis (CAM). Recommendations were drafted by the 7th Guidelines Recommendations for Evidence-based Antimicrobial agents use Taiwan (GREAT) working group after review of the current evidence, using the grading of recommendations assessment, development, and evaluation (GRADE) methodology. A nationwide expert panel reviewed the recommendations in March 2022, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes the epidemiology, diagnostic methods and treatment recommendations for COVID-19 associated infections. The aim of this guideline is to provide guidance to physicians who are involved in the medical care for patients with COVID-19 during the ongoing COVID-19 pandemic.

Background Proteus mirabilis is the second most common pathogen that causes urinary tract infections after Escherichia coli. In rare cases, it is associated with vertebral osteomyelitis. The underlying mechanism of this relationship may be related to the retrograde dissemination of bacteria through the paravertebral venous plexus. Case presentation We report a case of an 80-year-old Taiwanese woman who had recurrent episodes of fever and chronic back pain for 1 year. All blood cultures were positive for P. mirabilis. Inflammation scans and magnetic resonance imaging revealed a previously undetected vertebral lesion between the seventh and eighth thoracic vertebra. She responded well to treatment with antibiotics, reporting considerable relief of back pain and no fever recurrence at the 4-month follow-up. Conclusions Chronic back pain is a common but often dismissed symptom among the older population; osteomyelitis should be considered in patients with recurrent fever or neurological symptoms. Old age, chronic renal failure, and diabetes mellitus are possible predisposing factors for osteomyelitis. Our findings suggest that long-term treatment with antibiotics is effective for osteomyelitis caused by P. mirabilis,, although surgery is required for abscess formation or serious vertebral destruction.

The study explored the differences in visual search tasks for people with different cognitive styles of field independence and field dependence when browsing the different sequence of application layout on computer desktops. This experiment is a 2 (Cognitive styles: field independence vs. field dependence) * 2 (Familiarity: familiar vs. un-familiar) * 2 (Sequence of application layout: name vs type) design of mixed factors. The response time and fixation times of searching computer application were the dependent variables. The experiment meth-od is: All participants took the test with the Group Embedded Figures Test (GEFT), the top 25% and bottom 25% of the test scores are divided into styles of field-independent and field-dependent. They per-formed visual search tasks in different sequence of application layout on computer desktops with eye tracking devices. Each participant per-formed a total of 4 search tasks.

The study uses different types of music to induce different emotions of the subjects, then checks if the emotions affect driving behavior in different road environments. 30 subjects used the STISIM driving simulator to con-duct the experiments. A mixed factor design of 3 music types (positive vs negative vs no music) * 2 road environments (urban vs rural). After filling out an emotion scale, subjects listened to positive or negative music, recalled relevant memories that matched the emotion, and then filled out the emotion scale again. After reaching the conforming emotion, they listened to the mu-sic and followed a car while completing the driving task. The data collected driving behavior and the duration of TTC < 2.5(time to collision). The results show that an existing interaction between the environment and the music type: in the urban environment, the lane departure offset in non-music sce-narios is greater than that of positive and negative music—same goes for the rural environment. The total time of TTC < 2.5 s in the urban environment is longer than the rural environment; the longitudinal acceleration variation in the urban is higher than the rural environment.

Visual perception is an exceedingly critical concern in the daily lives of older people, particularly for determining traffic behaviors. In this study, two simulation experiments were conducted to determine the difference in visual perception judgement ability between healthy older individuals and patients with Parkinson’s disease (PD) in simulated environments. The first experiment conducted in this study manipulated the sizes of different depth cues, reference objects, and vehicle size, and also requested participants to determine the distances between objects in different images to determine differences in depth perception between different groups. The second experiment simulates the participant in predicting the time to reach the front target in the driving state. In the experiment, different distances and different speeds are used to understand whether the participants of different groups will have differences in the time prediction. The results of the first experiment demonstrated that patients with PD exhibited significant depth perception degeneration in judging object distances. The second experiment revealed that when vehicles were traveling at high speeds, participants considerably underestimated vehicle speed. The results of this study demonstrate that patients with PD experience a degree of degeneration in terms of depth perception and perception of dynamic distance prediction. This result can assist patients with PD in understanding their visual perception degeneration and improving traffic awareness.

This study aims to evaluate the usability of the forward collision warning (FCW) system as adopted by the statistical quality control (SQC) chart design concepts on drivers’ car following behaviors and task performance. A total of 48 highly aggressive and 48 less aggressive drivers participated in a two (aggressive driving: high vs. low; between-subjects) by two (driving workload: high vs. low; within-subjects) by three (the FCW system: five-stages vs. X-bar vs. X-bar plus exponentially weighted moving-average (EWMA) control charts; between-subjects) mixed-factorial simulation experiment. The drivers’ behaviors, response time to divided attention (DA) tasks, as well as subjective workload and trust ratings were collected. Findings showed that drivers with the FCW’s assistance improved their car-following behaviors and that the FCWs with the SQC chart design concepts showed better results than the five-stage system. Drivers who used both SQC FCWs performed correspondingly in their car-following behaviors. However, the X-bar FCW aided drivers in responding to DA tasks much faster, and drivers felt less stressed and had more trust in using the X-bar FCW system than those who used the X-bar + EWMA FCW system.

Interferon (IFN)-γ is crucial for normal immune surveillance and exhibits immunomodulatory, antimicrobial, and anticancer activity. Patients with nontuberculous mycobacteria (NTM) infection commonly express high levels of anti-IFN-γ autoantibodies (autoAbs) and suffer from recurrent infections due to adult-onset immunodeficiency with defects in IFN-γ immune surveillance. In this study, we developed the methods for determination of anti-IFN-γ autoAbs and then characterized their neutralizing activity in patients with NTM infection. A modified sandwich ELISA-based colorimetric assay followed by immunoblot analysis detected the presence of autoAbs in three out of five serum samples. Serum levels of IFN-γ were decreased. Synthetic peptide binding assay showed variable patterns of epitope recognition in patients positive for anti-IFN-γ autoAbs. Functional tests confirmed that patient serum blocked IFN-γ-activated STAT1 activation and IRF1 transactivation. Furthermore, IFN-γ-regulated inflammation, chemokine production and cytokine production were also blocked. These results provide potentially useful methods to assay anti-IFN-γ autoAbs and to characterize the effects of neutralizing autoAbs on IFN-γ signaling and bioactivity.

The interferon- (IFN-) γ expression is elicited in response to microbial infections and activates immune surveillance by antimicrobial immune elements to induce microbial killing. Patients with adult-onset immunodeficiency who suffer from recurrent infections with microbes, particularly nontuberculous mycobacteria (NTM), commonly display genetic defects in IFN-γ signaling as well as the generation of anti-IFN-γ autoantibodies (autoAbs). Because IFN-γ is an activator of macrophage differentiation and a proinflammatory activator of innate immunity, the blockade effects of the autoAbs present in NTM patient serum on IFN-γ are hypothesized to regulate the antimicrobial function of macrophages. In the presence of patient serum, IFN-γ-induced type 1 macrophage (M1) differentiation was inhibited in PMA-stimulated human monocytic THP-1 cells. Treatment with patient serum significantly blocked the production of proinflammatory factors, including cytokines/chemokines and reactive oxygen/nitrogen species, by M1 macrophages. Importantly, IFN-γ-facilitated phagocytosis and degradation of heat-killed mycobacterium were decreased by cotreatment with patient serum. These results show the blockade activity of anti-IFN-γ autoAbs on IFN-γ-mediated antimicrobial immunity in macrophages.

Modified disk diffusion (MDD) and checkerboard tests were employed to assess the synergy of combinations of vancomycin and β-lactam antibiotics for 59 clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) and Mu50 (ATCC 700699). Bacterial inocula equivalent to 0.5 and 2.0 McFarland standard were inoculated on agar plates containing 0, 0.5, 1, and 2 μg/ml of vancomycin. Oxacillin-, cefazolin-, and cefoxitin-impregnated disks were applied to the surface, and the zones of inhibition were measured at 24 h. The CLSI-recommended checkerboard method was used as a reference to detect synergy. The MICs for vancomycin were determined using the Etest method, broth microdilution, and the Vitek 2 automated system. Synergy was observed with the checkerboard method in 51% to 60% of the isolates when vancomycin was combined with any β-lactam. The fractional inhibitory concentration indices were significantly lower in MRSA isolates with higher vancomycin MIC combinations ( P < 0.05). The overall agreement between the MDD and checkerboard methods to detect synergy in MRSA isolates with bacterial inocula equivalent to McFarland standard 0.5 were 33.0% and 62.5% for oxacillin, 45.1% and 52.4% for cefazolin, and 43.1% and 52.4% for cefoxitin when combined with 0.5 and 2 μg/ml of vancomycin, respectively. Based on our study, the simple MDD method is not recommended as a replacement for the checkerboard method to detect synergy. However, it may serve as an initial screening method for the detection of potential synergy when it is not feasible to perform other labor-intensive synergy tests.

This case report describes a methicillin-resistant Staphylococcus aureus isolated repeatedly from the blood of a patient with community-acquired endocarditis who developed a four-fold increase in the minimal inhibitory concentration of vancomycin and daptomycin 7 months after his last exposure to glycopeptide antibiotics. This is contrary to the expected situation in which antimicrobial resistance tends to decrease after a patient is no longer exposed to vancomycin.

End-stage renal disease (ESRD) has a major impact on health and affects more than 600,000 people in the USA. The current mainstay treatments include dialysis and kidney transplantation (KT), and patients who have received KT have a higher quality of life and a lower mortality risk than those on chronic dialysis. Therefore, KT is considered the more preferred treatment modality for patients with ESRD. However, even though KT results in a higher long-term survival rate, the use of immunosuppressants is associated with various complications, including opportunistic infections and malignancies, which may lead to a higher risk of death in the first year after transplantation. Progressive multifocal leukoencephalopathy (PML) is a rare complication following KT, with an incidence of 0.027% in KT recipients. We present a case of PML following immunosuppressant therapy in a patient who received KT.

This study investigated the visual search ability and number of collisions of subjects in different age group when encountering dangerous situations in a traffic environment. A total of 32 subjects were recruited in this study, which included the 12 young group (18–25 years old) and 12 elderly group (65–75 years old) respectively. Subjects wore the eye tracker to drive inside the driving simulator. There were 5 possible real road risky driving scenarios designed for the experiment. The result demonstrated that elderly group had a longer fixation duration than young group, and more fixation counts as well. However, the result found that the elderly group had no significantly higher than young group in the number of collisions. The results of the study were expected to assist in understanding the visual search behavior of elderly group in the road risk situation.

Resume Introduction Une tumefaction cervicale aigue avec signes pharynges est un motif classique de consultation en urgence. Le traitement et le diagnostic sont generalement multidisciplinaires. L’incapacite a trouver une eventuelle etiologie peut conduire a une erreur de diagnostic. Presentation du cas Un jeune homme s’est presente aux urgences en se plaignant d’une toux, d’un gonflement du cou et d’une douleur pharyngee depuis 4 jours. Le bilan biologique a permis de retrouver une numeration leucocytaire de 9200. Une CRP legerement elevee a 1,7 a ete observee et le scanner a montre une collection liquidienne dans l’espace retropharynge associee a un œdeme du cou jusqu’a la region thyroidienne. Un antibiotique a ete prescrit et le patient a ete admis en service d’infectiologie pour suspicion d’infection profonde du cou. Une ponction a ete realisee pendant l’hospitalisation et a ramene un liquide non purulent. Le bilan biologique a montre une proteinurie, une hypoalbuminemie et une hypercholesterolemie massives. Une biopsie renale a montre une glomerulosclerose segmentaire focale precoce. Apres administration de 60 mg de prednisolone par jour et d’un supplement en albumine, la tumefaction cervicale, les douleurs a la deglutition et l’œdeme general ont totalement disparu. Discussion Le but de ce cas est de montrer que le syndrome nephrotique peut etre une cause inhabituelle mais possible d’œdeme retropharynge. Nous mettons en lumiere les elements diagnostiques qui permettront aux medecins de poser le bon diagnostic, d’eviter une incision et un drainage inutiles, et de commencer un traitement efficace precoce.

INTRODUCTION This study investigated the differences in road-crossing behavior among healthy older adults and patients with Alzheimer's disease (AD). METHOD Twelve pedestrians with mild AD and 24 age-, gender-, and education-matched controls were examined with a battery of cognitive, visual, and motor tests. Using a simulated two-lane, one-way road-crossing situation, we determined the remaining time and safety margin for each participant in traffic situations involving different vehicle speeds (40 km/h vs. 60 km/h vs. 80 km/h), time gaps (5 s vs. 7 s vs. 9 s), and time of day (dusk vs. midday). RESULTS We found that patients with AD were more vulnerable to traffic crash while crossing the road than healthy older adults (Odds Ratio = 2.50, P

Noise exposure is a common operating room (OR) phenomenon. Music is often regarded as a useful tool to relieve stress and energize lagging attention levels. Surgical teams, therefore, often listen to music when they conduct operations. However, these noises may impact surgical outcomes and patient safety. Focusing on nurses, this study aims to determine the association of sound volumes, state anxiety, mental workload and situation awareness when nurses assist in the operating room. A total of 40 circulating nurses and 40 anesthesia nurses participated in the study. The experiment was designed by 4 between subjects (without music, songs with Chinese lyrics, FM pop music broadcasting and Mozart’s music) and 2 within subjects (55–60 dB and 75–80 dB), and adopted a subjective rating technique to investigate the participants’ state anxiety, mental workload and situation awareness during the surgical process. The results showed that the participants maintained a high level of situation awareness. The degrees of mental workload revealed statistically significant differences when specific tasks, especially surgical time-out, needed to be carried out. Sound volume was reported as a major factor that caused great state anxiety among circulating nurses. By listening to Mozart music, the participants significantly decreased their mental workload, increased situation awareness and relieved stress to achieve positive reaction. In addition, mental workload was positively correlated to state anxiety among circulating nurses. Finally, some implications and further suggestions are provided. Music volume should be controlled since it significantly affects mental workload and state anxiety. Noises produced from medical equipment and instruments need to be decreased; maintaining sound volume less than 60 dB is recommended. Moreover, developing a low volume music environment during an operation will be beneficial to both occupational health and patient care outcomes.

The age distribution is rapidly aging in Taiwan, which also leads the proportion of elderly driver increases. According to the past studies, the elderly driver caused a much more serious damage than others when there is a traffic accident. Therefore, this study explores the relationship between situation awareness (SA) and driving performance when there are driving emergencies at different driving road workload on elderly drivers. A total number of 44 subjects were recruited to perform driving simulation, which includes 22 senior citizens and 22 young people. This experiment evaluates driver's situation awareness statues by their verbal answer situation to Situation Awareness Global Assessment Technique (SAGAT) questions. The study showed that the age had an effect on situation awareness. The elderly driver had a poor situation awareness ability than young people.

Summary Objectives Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survivalof patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis. Methods An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed. Results Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty. Conclusions Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.

This simulation study was conducted to examine how age (elder vs. young) and road events (in-vehicle information, vehicles, traffic signs, traffic lights, pedestrians, and bicyclists) affect driver performance levels in terms of situation awareness (SA). The participants comprised 46 age-balanced volunteers who executed a simulated driving task and verbally completed the Situation Awareness Global Assessment Technique questionnaire with the researcher. The results indicate that age affects SA during driving. Elder drivers demonstrated less situation comprehension than young drivers, and all participants demonstrated significantly poorer SA performance levels toward vehicles and traffic signs compared with other road events.

The current study investigated the effects of age, time gap, time of day, and speed of approaching vehicle on the decision of pedestrians to cross a road. Sixteen young and sixteen elderly participants were asked to watch pre-recorded videos in which a vehicle was approaching from the left and then decide the last moment at which they could safely cross. Data on pedestrians’ walking speed, road-crossing decision performance, subjective confidence ratings and walking strategies, as well as responses given in post-experiment interviews were collected as dependent variables. A logistic regression model was constructed to analyse the risk of above mentioned variables yielding the odds that the road would be crossed safely. This study found that pedestrians’ decisions on whether or not they would cross the road safely were made based on the distance between them and the oncoming vehicle; and thus the faster the vehicular approach, the higher the risk. Young pedestrians demonstrated a higher safe road-crossing ratio than their elderly counterparts. Elderly pedestrians might not have taken their decline in walking ability into consideration when they made the same road-crossing decisions as young pedestrians, resulting in a relatively higher risk of road crossing. In addition, the most significant determinant of risk was the time gap. The time gap, which is affected by the distance from the oncoming vehicle and its speed, could be easily misjudged.

We explored the effect and the difference between types of navigation maps (north-up map versus track-up map), landmarks, and the map complexity on the wayfinding abilities of Alzheimer’s disease (AD) patients. Our study included 48 participants (12 patients with AD, 12 patients with mild cognitive impairment (MCI), and 24 normal elderly subjects). We developed a virtual maze with 3Dmax and an interface with Virtools. Our results showed that the wayfinding abilities were worse in the AD group compared with the MCI group and the normal elderly. However, with the support of track-up maps, the AD group and the MCI group had similar performance as the normal elderly. The time spent on wayfinding decreased when using less complex maps and maps with no landmarks. All cognitive tests which we performed were significantly correlated with wayfinding abilities. Our study helped to establish future electric navigation maps built for patients with cognition impairment.

This study aims to develop a risk prediction model for in-vehicle tasks performed by drivers by using two methods: task analysis (TA) and back-propagation neural networks (BPNNs). Sixty-six participants volunteered to participate and were divided in two groups with different in-vehicle secondary tasks (traditional vs. in-vehicle information system/IVIS) and participated in a driving experiment simulating low/high driving load road conditions. We assessed driving performance (i.e. longitudinal velocity and lateral acceleration variance), hand movements (i.e. number of movements and movement durations), visual judgment behaviors (i.e. glance duration and glance frequency) and response time. Task analysis results allowed us to generate input and output variables for further BPNN modeling. The overall risk prediction accuracy rate of our model was as high as 60%. In addition, an analysis of variable importance demonstrated that the longitudinal velocity was the most important variable in predicting traditional in-vehicle tasks, whereas the number of glances was the most important variable for predicting IVIS in-vehicle tasks. This study may help researchers better understand safety considerations related to in-vehicle secondary tasks and in-vehicle interface design.

This study is to investigate the difference of depth perception between normal elder and Parkinson's disease (PD) patients. This study manipulate different clues (overlapping and perspective), reference material (with and without), and size of the vehicle (motorcycles, vehicles and trucks). Subject is required to judge the difference in the distance of the objects of the picture. This is in order to analyze the spatial depth perception difference between two groups. Twenty-four PD patients and twenty-four control participants were recruited to participate in this study. The results showed that perspective accuracy of Parkinson's disease patient was significantly weaker than the normal group, but no significant difference in the accuracy of overlapping reaction. This study also found an interesting result, where in a situation with difference in vehicle size frontal and rear, for example, an vehicle in the front and a motorcycle in the rear, the judgment was worsened by such scenario, which was true for both the Parkinson's patient and the normal control group, but with the former bearing higher degree of severity. In daily life, different size vehicles are mixed on public road, it is not possible to have just a single vehicle on the road. Hence, the Parkinson's patient should pay more attention to the approaching vehicle.

From June to September 2011, a total of 305 ertapenem-nonsusceptible Enterobacteriaceae isolates (MICs of ertapenem ≥ 1 μg/ml) were collected from 11 hospitals in different parts of Taiwan. The MICs of 12 antimicrobial agents against these isolates were determined using the broth microdilution method, and genes for carbapenemases were detected using PCR. Genotypes of isolates possessing carbapenemase genes were identified by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. The ertapenem-nonsusceptible Enterobacteriaceae isolates included Klebsiella pneumoniae ( n = 219), Escherichia coli ( n = 64), Enterobacter cloacae ( n = 15), and other species ( n = 7). Seven (2.3%) of the ertapenem-nonsusceptible Enterobacteriaceae isolates exhibited colistin MICs of >4 μg/ml, and 24 (7.9%) were not susceptible to tigecycline (MICs > 2 μg/ml). A total of 29 (9.5%) isolates carried genes encoding carbapenemases, namely, K. pneumoniae carbapenemase-2 (KPC-2) in 16 (7.3%) isolates of K. pneumoniae (KPC-2-KP) and IMP-8 in 5 (2.3%) isolates of K. pneumoniae , 5 (33.3%) isolates of E. cloacae , 1 isolate of E. coli , 1 isolate of Klebsiella oxytoca , and one isolate of Citrobacter freundii . The 16 KPC-2-KP isolates were isolated from patients at four different hospitals in northern Taiwan. All 16 of the KPC-2-KP isolates were susceptible to amikacin and colistin and had a similar pulsotype (pulsotype 1) and the same sequence type (sequence type 11). Infections due to KPC-2-KP mainly occurred in severely ill patients in the intensive care unit ( n = 14, 88%). Four patients with infections due to KPC-2-KP died within 14 days of hospitalization. The findings are the first to demonstrate intrahospital and interhospital dissemination of KPC-2-KP in northern Taiwan.

Summary We investigated the trends in antimicrobial resistance among species of Gram-negative bacilli isolated from patients with hepatobiliary tract infections in Taiwan during the period 2006–2010 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART). During the study period, 1032 isolates of Gram-negative bacilli that had been collected from patients with hepatobiliary infections were tested for susceptibility to 12 antimicrobial agents in accordance with the Clinical and Laboratory Standards Institute guidelines. Enterobacteriaceae accounted for the majority ( n = 874, 84.7%) of isolates and Escherichia coli was the most common pathogen ( n = 323, 31.3%). There were significantly more E. coli ( P = 0.001) and Proteus mirabilis ( P = 0.031) isolates collected from patients who had been hospitalized for less than 48 h and significantly more Serratia marcescens ( P = 0.035) and Pseudomonas aeruginosa ( P = 0.008) isolates collected from patients who had been hospitalized for 48 h or longer. The prevalence of extended–spectrum β–lactamase (ESBL)-producing pathogens was low. The decline in susceptibility rates with time was remarkable for ceftazidime ( P = 0.036), ciprofloxacin ( P = 0.029), and levofloxacin ( P = 0.018). The most effective antibiotics, i.e., those that were active against more than 90% of Enterobacteriaceae, were amikacin, cefepime, imipenem, ertapenem, and piperacillin–tazobactam. Susceptibility of P. aeruginosa to anti-pseudomonal agents was greater than 80%. In this study, we found an overall increase in resistance to antimicrobial agents among Gram-negative bacilli isolated from patients with hepatobiliary tract infections in Taiwan. Surveillance of antimicrobial susceptibility and updates of treatment guidelines are recommended to help achieve optimal therapy for patients with hepatobiliary infections.

In 2009, the Study for Monitoring Antimicrobial Resistance Trends (SMART) was expanded to include surveillance of Gram-negative pathogens causing urinary tract infections (UTIs) in the Asia-Pacific region. A total of 1762 isolates were collected from 38 centers in 11 countries from patients with UTIs in 2009 and 2010. In vitro susceptibilities were determined by the broth microdilution method and susceptibility profiles were determined using minimum inhibitory concentration (MIC) interpretive criteria, as recommended by the Clinical and Laboratory Standards Institute (CLSI) in 2010 (M100-S20), in 2011 (M100-S21), and in 2012 (M100-S22). Enterobacteriaceae comprised 86.0% of the isolates, of which Escherichia coli (56.5%) and Klebsiella pneumoniae (13.8%) were the two most common species. Amikacin was the most effective antibiotic (91.7%), followed by ertapenem (86.9%), imipenem (86.6%), and piperacillin-tazobactam (84.9%). Rates of susceptibility were 50.3% for cefoxitin and ranged from 50.3% to 74.2% for the third- and fourth-generation cephalosporins. For ciprofloxacin and levofloxacin, the susceptibility rates were 51.4% and 54.4%, respectively. Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae comprised 28.2% of all isolates. We also found a high rate of resistance to carbapenems among Acinetobacter baumannii and Pseudomonas aeruginosa causing UTI. Interestingly, according to 2012 CLSI breakpoints, approximately 33.4% of ESBL producers were still susceptible to ceftazidime. However, this in vitro efficacy of ceftazidime needs to be validated in vivo by clinical data. The lowered CLSI interpretive breakpoints for piperacillin-tazobactam, carbapenems, and some cephalosporins in 2011-2012 for Enterobacteriaceae resulted in an approximate 5% drop in susceptibility rates for each drug, with the exception of imipenem for which the susceptibility rate dropped from 99.4% according to 2010 criteria to 91.2% according to 2011 criteria. With the updated CLSI criteria, the antimicrobial resistance threat from UTI pathogens in the Asia Pacific area was revealed to be more prominent.

Among the 219 vancomycin-resistant Enterococcus faecium isolates collected in 20 Taiwanese hospitals from 2006 to 2010, all were susceptible to linezolid and daptomycin, and 98.6% were susceptible to tigecycline. There was a shift toward higher tigecycline MIC values (MIC 90 s) from 2006-2007 (0.06 μg/ml) to 2008–2010 (0.12 μg/ml). The MIC 90 s of daptomycin and linezolid remained stationary. Although pulsotypes among the isolates from the 20 hospitals varied, intrahospital spreading of several clones was identified in 13 hospitals.

The Tigecycline In Vitro Surveillance in Taiwan (TIST) study, initiated in 2006, is a nationwide surveillance program designed to longitudinally monitor the in vitro activity of tigecycline against commonly encountered drug-resistant bacteria. This study compared the in vitro activity of tigecycline against 3,014 isolates of clinically important drug-resistant bacteria using the standard broth microdilution and disk diffusion methods. Species studied included methicillin-resistant Staphylococcus aureus (MRSA; n = 759), vancomycin-resistant Enterococcus faecium (VRE; n = 191), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli ( n = 602), ESBL-producing Klebsiella pneumoniae ( n = 736), and Acinetobacter baumannii ( n = 726) that had been collected from patients treated between 2008 and 2010 at 20 hospitals in Taiwan. MICs and inhibition zone diameters were interpreted according to the currently recommended U.S. Food and Drug Administration (FDA) criteria and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The MIC 90 values of tigecycline against MRSA, VRE, ESBL-producing E. coli , ESBL-producing K. pneumoniae , and A. baumannii were 0.5, 0.125, 0.5, 2, and 8 μg/ml, respectively. The total error rates between the two methods using the FDA criteria were high: 38.4% for ESBL-producing K. pneumoniae and 33.8% for A. baumannii . Using the EUCAST criteria, the total error rate was also high (54.6%) for A. baumannii isolates. The total error rates between these two methods were E. coli . For routine susceptibility testing of ESBL-producing K. pneumoniae and A. baumannii against tigecycline, the broth microdilution method should be used because of the poor correlation of results between these two methods.

This study examined the effects of sign design features and training on the comprehension of four types of Taiwanese traffic signs in Taiwanese and Vietnamese users. Thirty Taiwanese and thirty Vietnamese, each group gender-balanced, participated in this experiment, which involved 5 design features (familiarity, concreteness, simplicity, meaningfulness, and semantic closeness), 4 types of traffic signs (warning, prohibition, auxiliary, and indicatory), and 3 training conditions (before training, immediately following training, and one month after training). A total of sixty-five traffic signs were selected as the stimuli and each was presented on a 10 cm × 10 cm white cardboard in random order. Within each training condition participants were instructed to (1) verbally describe their comprehension of the meaning of the signs, which was then evaluated by the experimenter from 0 to 1, and (2) provide subjective ratings for each of the five design features, on a scale ranging from 0 to 100. The results reveal the training effect to be positive in both user groups. For Taiwanese, the average comprehension was 0.63 before training and it increased to 0.98 immediately after training. For Vietnamese, the average comprehension was 0.41 before training and it increased to 0.89 immediately after training. Even one month after the training had taken place, the comprehension scores of both groups were still higher than groups that did not receive training (Taiwanese group: 0.83; Vietnamese group: 0.66). For the two groups, the design features of concreteness and meaningfulness were highly correlated (Taiwanese group: r = 0.97; Vietnamese group: r = 0.95), and the feature of semantic closeness had the greatest positive correlation with comprehension (Taiwanese group: r = 0.88; Vietnamese group: r = 0.80). In addition, a drop correlated to comprehension was found to be significant (Taiwanese group: r = −0.92; Vietnamese group: r = −0.89), and semantic closeness was the most negatively correlated feature (Taiwanese group: r = −0.82; Vietnamese group: r = −0.60), meaning that, the closer the semantic meaning is to the sign design, the higher the comprehension and the less decline in sign comprehension. Relevance to industry Globalization means that a country must cater to a population with a diversity of cultural backgrounds. Designing signs that effectively convey safety information to all the different groups of users has thus become an important issue. This research attempts to investigate the relationship between sign design feature and training on traffic sign comprehension in Taiwanese and Vietnamese users. The results of this study can provide insight into designing public signs and can be extended to various instructional pictures provided with consumer products designed for world-wide use.

Background Approximately two-thirds of the patients with severe sepsis or septic shock are first encountered in the emergency departments (EDs) of western countries, in which bacteremia is present in about 50% of patients with severe sepsis. The situation of bacteremia presenting to the EDs in Taiwan is not well documented. The objective of this study was to examine the epidemiology and microbiology of bacteremia in adult patients who visited the ED of a medical center in southern Taiwan. Methods A retrospective observational study of the epidemiology and microbiology of bacteremia was conducted in the ED of a medical center involving 6,137 adult patients and 13,903 blood cultures. Results A total of 831 consecutive patients with 890 episodes of bacteremia were obtained from January 1 to December 31, 2004, indicating a positive culture rate of 13.5% (1,872/13,903). Among these episodes, 525 (59%) were defined as true community–acquired infections followed by 263 (29.5%) as health care–associated infections and 102 (11.5%) as nosocomial infections. Of the 972 isolates, 289 (29.7%) were gram-positive species and 683 (70.3%) were gram-negative species. Urinary tract infections (32.2%, 287/890) were most common in these patients, with Escherichia coli (30.8%, 299/972) being the most common pathogen. Bacteremia caused by Staphylococcus aureus was more common in nosocomial than true community–acquired infections (31.3% vs . 12%) and had significantly higher possibility of resistance to methicillin in infections not purely acquired from community (odds ratio = 24.92; 95% confidence interval, 9.88–62.87). The overall crude mortality rate was 21% and nearly half of the mortalities occurred within 3 days of visiting the ED. All patients discharged inadvertently were uneventful ( n = 65, two lost at follow-up). Conclusions Categories of bacteremia acquisition was associated with different distribution of pathogens, antimicrobial resistance, and clinical outcome. Traditional classification might overestimate the problem of drug resistance in community-acquired infections. The concept of health care–associated infection should be introduced to avoid overemphasis of drug-resistant problem in true community–acquired infection.

Accurately differentiating tuberculous pleurisy from lung cancer is important for disease management but difficult using conventional laboratory methods. This study assessed the value of adenosine deaminase (ADA) and interferon gamma (IFN-γ) for differentiating the two conditions in a region of Taiwan with a high prevalence of tuberculosis. The study population comprised patients with lymphocytic exudative pleural effusions: tuberculous (n=24) and malignant (n=42). Mean levels of ADA and IFN-γ in pleural fluid, measured with commercial standardized kits, were significantly higher for tuberculous than for malignant pleurisy (p