Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi

Publications in this journal

• Article: Medication-adherence predictors among patients with tuberculosis or human immunodeficiency virus infection in Burkina Faso.

  Ziemlé Clément Méda, Yu-Ting Lin, Issiaka Sombié, Daouda Maré, Donald E Morisky, Yi-Ming Arthur Chen
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  ABSTRACT: BACKGROUND: Adherence to treatment remains a key issue for tuberculosis (TB) and human immunodeficiency virus (HIV) programs. The study objective was to identify potential determinants of medication adherence (MA) among patients with TB, HIV, or both. METHODS: In this cross-sectional study, adult patients attending TB or HIV clinics were recruited in two main regions (Centre and Hauts-Bassins) of Burkina Faso from August to October 2010. Questionnaires were collected and simple and multiple step-wise linear regression models were used to identify predictors of MA. RESULTS: In total, 1043 patients (309 with TB, 553 with HIV, and 181 coinfected with both) participated in this study. For patients with TB, adjusted predictors of good MA were no alcohol use, ever been lost to follow-up, and awareness of disease transmission. For patients with HIV, adjusted predictors of good MA were less stigma, good knowledge about TB transmission, and awareness of disease transmission. For patients with dual infection, adjusted predictors of good MA was good attitude. Furthermore, adjusted predictors of poor MA for patients with TB or with dual infection were poor financial access to care and high number of persons sleeping in the household, respectively. CONCLUSION: This study provides information on MA in patients infected with TB, HIV, and those coinfected with TB and HIV. TB and HIV programs have to consider the environment of the patient and its characteristics, including stigma, attitude, status of loss to follow-up, TB knowledge, financial access to care, alcohol use, awareness of disease transmission, and number of persons sleeping in the household. These identified factors in this study need to be taken into account for a specific patient profile and during sensitization, project planning, and research stages.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections in Taiwan.

  Yao-Sheng Chen
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Clinical appliance of probiotics in the treatment of Helicobacter pylori infection-A brief review.

  Ami Patel, Nihir Shah, J B Prajapati
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  ABSTRACT: The role of probiotics in the treatment of gastrointestinal infections is increasingly being documented as an alternative or complement to antibiotics, with the potential to decrease the use of antibiotics or reduce their side effects. Although antibiotics-based Helicobacter pylori eradication treatment is 90% effective, it is expensive and causes antibiotic resistance associated with other adverse effects. Probiotics have an in vitro inhibitory effect on H. pylori. Animal studies demonstrated that probiotic treatment is effective in reducing H. pylori-associated gastric inflammation. About 12 human studies investigated the efficacy of combinations of antibiotics and probiotics, whereas 16 studies used probiotic alone as an alternative to antibiotics for the treatment of H. pylori infection. Most of the studies showed an improvement of H. pylori gastritis and decrease in H. pylori colonization after administration of probiotics. However, no study could demonstrate complete eradication of H. pylori infection by probiotic treatment. Probiotic combinations can reduce adverse effects induced by H. pylori eradication treatment and, thus, have beneficial effects in H. pylori-infected individuals. Long-term intakes of products containing probiotic strains may have a favorable effect on H. pylori infection in humans, particularly by reducing the risk of developing disorders associated with high degrees of gastric inflammation.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Candida lipolytica candidemia as a rare infectious complication of acute pancreatitis: A case report and literature review.

  Wen-Cheng Liu, Ming-Chin Chan, Te-Yu Lin, Chin-Hui Hsu, Sheng-Kang Chiu
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  ABSTRACT: Candida lipolytica candidemia is a rare but an emerging pathogenic yeast infection in humans. It can gain access to the bloodstream through intravascular catheterization, especially through central venous catheters in immunocompromised or critically ill patients during hospitalization. In this report, we present a noncatheter-related C. lipolytica candidemia infection in an 84-year-old man who was admitted due to acute pancreatitis. The possible pathogenesis and management of C. lipolytica candidemia are highlighted. It was an unusual infectious complication of acute pancreatitis. Clinicians should be aware that such an opportunistic pathogen can lead to invasive candidemia infection. In clinical practice, systemic antifungal therapy and the removal of the potentially infected central venous catheter might be recommended for the treatment of C. lipolytica candidemia.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Clinical manifestations and microbiology of acute otitis media with spontaneous otorrhea in children.

  Yi-Jen Chen, Yu-Chia Hsieh, Yhu-Chering Huang, Cheng-Hsun Chiu
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  ABSTRACT: BACKGROUND: In Taiwan, clinical and microbiological data on acute otitis media (AOM) with spontaneous otorrhea in children are limited. MATERIALS AND METHODS: We retrospectively collected data on children with AOM and spontaneous otorrhea between January 2011 and June 2012. Otorrhea samples were collected using sterile swabs and sent for cultures. Pathogens found were Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, and Staphylococcus aureus. Pneumococcal isolates collected from October 2011 to June 2012 were serotyped. RESULTS: A total of 92 patients were enrolled in the study for demographic and microbiological analysis. Their median age was 2.5 years. After excluding those with lobar pneumonia, 84 patients were included for analysis of clinical manifestation. The mean febrile duration was 6 days. Leukocytosis and C-reactive protein (CRP) level >50 mg/L were noted in 29 (34.5%) patients and 38 (45.2%) patients, respectively. Patients with pneumococcal infection were older (p = 0.007) and had more severe symptoms [fever (p = 0.001), otalgia (p = 0.055), respiratory symptoms (p = 0.002-0.03), and higher CRP level (p = 0.015)] than children with other bacterial infection. Otorrhea cultures were obtained from 69 (75%) patients, of whom 52 had definitive AOM pathogens. The most common causative pathogen was S. pneumoniae (61.5%), followed by S. aureus (36.5%). Serotype 19A accounted for two-thirds of pneumococcal isolates and had a high rate of nonsusceptibility to penicillin (66.7%) and ceftriaxone (83.3%). CONCLUSION: S. pneumoniae was found to be the most important source of AOM with spontaneous otorrhea in children and caused more severe symptoms. Serotype 19A, which was usually nonsusceptible to antimicrobial agents, was the most prevalent serotype in these patients.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Early life exposure to antibiotics and the risk of childhood allergic diseases: An update from the perspective of the hygiene hypothesis.

  Chang-Hung Kuo, Hsuan-Fu Kuo, Ching-Hua Huang, San-Nan Yang, Min-Sheng Lee, Chih-Hsing Hung
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  ABSTRACT: The prevalence of allergic diseases has been growing rapidly in industrial countries during recent decades. It is postulated that growing up with less microbial exposure may render the immune system susceptible to a T helper type 2 (Th2)-predominant allergic response-also known as the hygiene hypothesis. This review delineates recent epidemiological and experimental evidence for the hygiene hypothesis, and integrates this hypothesis into the association between early life exposure to antibiotics and the development of allergic diseases and asthma. Several retrospective or prospective epidemiological studies reveal that early exposure to antibiotics may be positively associated with the development of allergic diseases and asthma. However, the conclusion is inconsistent. Experimental studies show that antibiotics may induce the Th2-skewed response by suppressing the T helper type 1 (Th1) response through inhibition of Th1 cytokines and disruption of the natural course of infection, or by disturbing the microflora of the gastrointestinal (GI) tract and therefore jeopardizing the establishment of oral tolerance and regulatory T cell immune responses. The hygiene hypothesis may not be the only explanation for the rapid increase in the prevalence of allergic diseases and asthma. Further epidemiological and experimental studies addressing the issue of the impact of environmental factors on the development of allergic diseases and the underlying mechanisms may unveil novel strategies for the prevention and treatment of allergic diseases in the future.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Tigecycline salvage therapy for necrotizing fasciitis caused by Vibrio vulnificus: Case report in a child.

  Yu-San Lin, Min-Hsiang Hung, Chi-Chung Chen, Kuo-Feng Huang, Wen-Chien Ko, Hung-Jen Tang
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  ABSTRACT: Necrotizing fasciitis caused by Vibrio vulnificus is rarely reported in children. We describe a 12-year-old immunocompetent boy with necrotizing fasciitis caused by V. vulnificus. He was cured by radical and serial debridement and salvage therapy with intravenous cefpirome plus tigecycline. The in vitro antibacterial activity of combination regimens and a literature review of pediatric V. vulnificus infection are described.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Lower initial central venous pressure in septic patients from long-term care facilities than those from the community.

  Chun-Yu Lin, Tun-Chieh Chen, Po-Liang Lu, Hui-Juan Chen, Kebba S Bojang, Yen-Hsu Chen
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  ABSTRACT: BACKGROUND/PURPOSE: The cornerstone of emergency management of severe sepsis and septic shock is early (within 6 hours) goal-directed therapy, including maintenance of central venous pressure (CVP) at 8-12 mmHg. It is unclear whether there is a difference in initial (baseline) CVP between septic patients who are referred from the community and those who come from long-term care facilities (LTCFs) in Taiwan. We designed this study to investigate the difference in hemodynamic parameters between these two groups. MATERIALS AND METHODS: Every patient with severe sepsis or septic shock who had a central venous catheter inserted via the internal jugular or subclavian vein at Kaohsiung Medical University Hospital between April 2007 and October 2007 was enrolled. CVP was measured immediately at the emergency department. Patient demographics, including residence, were retrospectively recorded and analyzed. RESULTS: There were 166 evaluable patients; 125 (75.3%) came from the community and 41 (24.7%) from LTCFs. There were no significant differences in age, sex, initial body temperature, heart rate, blood pressure, or leukocyte count between the two groups. However, patients who were referred from LTCFs had a significantly lower initial CVP than those from the community (5.0 ± 4.5 mmHg vs. 7.0 ± 4.8 mmHg, p = 0.023). The difference was more significant between mechanically ventilated patients from LTCFs and those from the community (5.0 ± 3.0 mmHg vs. 8.1 ± 5.6 mmHg, p = 0.006). CONCLUSION: Severely septic patients referred from LTCFs may require more aggressive fluid resuscitation within the first 6 hours of the diagnostic criteria met at the emergency department to achieve the CVP target of early goal-directed therapy.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: CD209 promoter -336 A/G (rs4804803) polymorphism is associated with susceptibility to pulmonary tuberculosis in Zahedan, southeast Iran.

  Mohammad Naderi, Mohammad Hashemi, Mohsen Taheri, Hossein Pesarakli, Ebrahim Eskandari-Nasab, Gholamreza Bahari
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  ABSTRACT: INTRODUCTION: The association between -336 A/G polymorphism of CD209 and susceptibility to/protection from tuberculosis is inconsistent. AIM: The present study aimed at evaluating the possible association between CD209 rs4804803 (-336 A/G) gene polymorphism and pulmonary tuberculosis (PTB) in a sample of Iranian population. MATERIALS AND METHODS: This case-control study was performed on 156 PTB patients and 154 healthy individuals. Tetra-amplification refractory mutation system-polymerase chain reaction was used to detect the polymorphisms. RESULTS: Our findings revealed that the CD209 rs4804803 increased the risk of PTB in codominant [odds ratio (OR) = 5.16, 95% confidence interval (CI) = 1.60-16.59, p = 0.006, GG vs. AA], dominant (OR = 1.69, 95% CI = 1.07-2.66, p = 0.024, AG + GG vs. AA), and recessive (OR = 4.20, 95% CI = 1.34-13.16, p = 0.014, GG vs. AA + AG) tested inheritance models. Furthermore, the rs4804803 G allele increased the risk of PTB (OR = 1.58, 95% CI = 1.12-2.23, p = 0.011) as compared to the A allele. CONCLUSION: Our data suggest that CD209 rs4804803 polymorphism increased the risk of PTB in a sample of Iranian population.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Simultaneous cryptococcal and tuberculous meningitis in a patient with systemic lupus erythematosus.

  Bilgul Mete, Nese Saltoglu, Ersin Vanli, Cigdem Ozkara, Ferhat Arslan, Ali Mert, Resat Ozaras, Fehmi Tabak, Recep Ozturk
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  ABSTRACT: Simultaneous central nervous system (CNS) infection with Cryptococcus and tuberculosis (TB) is very rare. Despite improved therapeutic options, treatment of CNS cryptococcosis is still difficult and needs invasive treatment modalities, such as intrathecal or intraventricular amphotericin B, in refractory cases. We describe a patient with systemic lupus erythematosus diagnosed with simultaneous cryptococcal and TB meningitis who had a poor response to intravenous liposomal amphotericin B and fluconazole, but was successfully treated with intraventricular amphotericin B, in addition to anti-TB therapy.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: High prevalence of Chlamydia pneumoniae infection in an asymptomatic Jordanian population.

  Hesham M Al-Younes
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  ABSTRACT: BACKGROUND/PURPOSE: The bacterium Chlamydia pneumoniae is associated with respiratory diseases and nonrespiratory illnesses like atherosclerosis. This study aims to investigate the seroprevalence of immunoglobulin G (IgG) against C. pneumoniae in an asymptomatic population in Jordan and to analyze the immunity state in relation to age and gender. METHODS: Serum samples were collected from 588 apparently healthy individuals aged 2-86 years. Using the microimmunofluorescence (MIF) test, seropositivity was defined as an anti-C. pneumoniae IgG titer ≥1:16. Titers from 1:16 to 1:256 were considered indicative for a past infection, whereas 1:512 was considered diagnostic of an acute infection. RESULTS: The overall prevalence of C. pneumoniae was 54.9%. The mean seropositivity in males was slightly higher than females. The seroprevalence of infection was relatively low in children aged 2-9 years, and steadily increased to reach a plateau of 66.7% at around 30-39 years of age, which remained stable in later years. Recent infection was indicated in 14.3% of study subjects. The seropositivity was highest in males, and more frequent in adults than in children and teenagers. CONCLUSION: A high seroprevalence of C. pneumoniae in the asymptomatic population suggests that infection with this pathogen is common in Jordan. Higher seropositivity in males compared to females was observed. The primary infection is acquired during the first four decades of life, and in older ages high antibody levels are likely maintained by reinfection or persistent infection.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Burkholderia pseudomallei infection induces the expression of apoptosis-related genes and proteins in mouse macrophages.

  You-Cheng Hseu, Jia-Chuen Sung, Bao-Sen Shieh, Ssu Ching Chen
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  ABSTRACT: BACKGROUND/PURPOSE: In this study, we addressed whether the production of apoptosis-related genes and proteins is induced in mouse macrophages infected with Burkholderia pseudomallei cells. METHODS: Mouse macrophages were infected with B. pseudomallei cells at 0.5 hours, 1 hour, 2 hours, 4 hours, and 6 hours, respectively, followed by real-time polymerase chain reaction (PCR) array analysis. The amount of apoptosis-related proteins (caspase-3, caspase -8, caspase -9, Bax, and Bcl-2) was confirmed by Western blot. RESULTS: After infection, an increase of these proteins was observed. The expression levels of other apoptosis-related genes were also determined by PCR array. Experimental results revealed that the messenger RNA levels of tumor necrosis factor ligand (e.g., tnfsf10 and tnfrs10b) and fas were increased, whereas the expression levels of some antiapoptosis genes such as Birc5, Hells, and Bnip3 were decreased. CONCLUSION: Our study results demonstrate that the apoptosis-related genes and proteins in mouse macrophages were modulated by B. pseudomallei.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 06/2013;
• Article: Incidence of human herpesvirus 6 in clinical samples from Swedish patients with demyelinating diseases.

  Rasmus Gustafsson, Renate Reitsma, Annelie Strålfors, Andreas Lindholm, Rayomand Press, Anna Fogdell-Hahn
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  ABSTRACT: BACKGROUND: Human herpesvirus 6 (HHV-6) has been reported to be associated with multiple sclerosis (MS) and Guillain-Barré syndrome (GBS). METHODS: We analyzed cell-free HHV-6 DNA as an indication of active infection in the peripheral blood and cerebrospinal fluid (CSF) of Swedish patients with GBS, patients with chronic inflammatory demyelinating polyradiculoneuropathy, treatment-naïve patients with possible MS, interferon-β treated MS patients [with or without neutralizing antibodies (NAbs)], and control patients with headache. RESULTS: One of 14 GBS patients and one of eight patients with chronic inflammatory demyelinating polyradiculoneuropathy were positive for HHV-6 DNA in serum. Of the 27 treatment-naïve possible MS patients, two were positive in plasma and one in CSF. HHV-6 DNA was detected in the serum of three of 79 NAb+ patients and one of 102 NAb-interferon-β treated MS patients. HHV-6 DNA could not be detected in the plasma or CSF of any of the 33 controls, although the differences were not statistically significant. CONCLUSION: Our results do not suggest active HHV-6 infection to be a common phenomenon in any of the patient groups studied.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013;
• Article: Risk of tuberculosis infection in anti-TNF-α biological therapy: From bench to bedside.

  Xi Xie, Fen Li, Jin-Wei Chen, Jia Wang
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  ABSTRACT: Anti-tumor necrosis factor-α (TNF-α) biological agents, including soluble TNF-α receptors and anti-TNF-α monoclonal antibodies, bring new hope for treating rheumatic diseases such as rheumatoid arthritis, but also increase the risk of infection, especially tuberculosis (TB) infection. Recent findings have shown that the physiological TNF-mediated signaling was somehow impaired by TNF antagonists, leading to the exacerbation of chronic infection associated with aberrant granuloma formation and maintenance. Although both receptor and antibody agents appear to pose an equally high risk in causing development of new TB infections, monoclonal anti-TNF-α antibody seems more inclined to reactivate latent TB infection. This review is focused on the underlying mechanisms that cause the TB risk in the anti-TNF-α therapy and also the strategies to deal with it, with the aim of reducing the TB incidence during anti-TNF-α biological therapies.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013;
• Article: Comparison of real-time polymerase chain reaction and serological tests for the confirmation of Mycoplasma pneumoniae infection in children with clinical diagnosis of atypical pneumonia.

  Hsin-Yu Chang, Luan-Yin Chang, Pei-Lan Shao, Ping-Ing Lee, Jong-Min Chen, Chin-Yun Lee, Chun-Yi Lu, Li-Min Huang
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  ABSTRACT: BACKGROUND: Mycoplasma pneumoniae is a common pathogen of respiratory tract infection in children, and its correct and rapid diagnosis is a clinical challenge. Real-time polymerase chain reaction (RT-PCR) has been used frequently for the detection of this pathogen. MATERIALS AND METHODS: Medical records from all children with a clinical diagnosis of mycoplasma pneumonia and whose respiratory samples were tested for M. pneumoniae (using RT-PCR) during 2011 were reviewed retrospectively. We compared the sensitivity and specificity of serological assays versus those of RT-PCR for diagnosis of M. pneumoniae infections. We also reviewed retrospectively clinical characteristics, and laboratory and imaging findings of children with laboratory evidence of M. pneumoniae infection. RESULTS: In 2011, 290 children were diagnosed to have mycoplasma pneumonia clinically and had their respiratory samples tested for M. pneumoniae by RT-PCR. Fifty-four children (19%) had a positive result. Meanwhile, 63% (182/290) of these children also underwent serological tests, out of whom 44 (24%) were found to be positive for immunoglobulin M (IgM). Using PCR as a gold standard, M. pneumoniae IgM assay was found to show a sensitivity of 62.2% and a specificity of 85.5%. Positive and negative predictive values of IgM were 52.3% and 89.9%, respectively. In M. pneumoniae IgM-positive children, a negative PCR result was associated with more coinfection by other pathogens and longer duration of prehospitalization fever. Bacterial loads of M. pneumoniae were not correlated with clinical outcomes. CONCLUSION: The majority of clinically diagnosed mycoplasma pneumonia was unconfirmed. Mycoplasma pneumoniae IgM has poor sensitivity and a positive predictive value. Interpretation of Mycoplasma pneumoniae IgM should be done with caution.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013;
• Article: Identification and epidemiological relatedness of clinical Elizabethkingia meningoseptica isolates from central Taiwan.

  Yi-Cheng Chang, Hsueh-Hsia Lo, Hsiu-Ying Hsieh, Shan-Min Chang
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  ABSTRACT: BACKGROUND: Elizabethkingia meningoseptica is an opportunistic pathogen. Identification of E. meningoseptica based on conventional methods is rather labor- and time-consuming. The information on epidemiological relatedness and microbiological characteristics of E. meningoseptica isolates from central Taiwan was limited. METHODS: Forty E. meningoseptica isolates identified by conventional methods were collected by the Central Laboratory of Central Region Hospital Alliance between 2007 and 2011. The amplification of 16S rDNA gene by polymerase chain reaction with species-specific or universal primers following DNA sequencing was used as a standard identification method. The feasibility of Vitek 2 GN card was also evaluated. Some clinical information of the patients and the drug susceptibilities and epidemiological relatedness of the isolates were analyzed. RESULTS: For the 40 isolates, 39 E. meningoseptica and one Chryseobacterium indologenes were identified using 16S rDNA sequencing. Among the 39 isolates, all could be identified using species-specific primers, whereas only 84.6% could be identified by Vitek 2 GN card with excellent discrimination. All E. meningoseptica isolates were susceptible to minocycline but resistant to many drugs examined including ceftazidime, amikacin, colistin, and imipenem. The pulsed field gel electrophoresis (PFGE) patterns demonstrated that most isolates were quite genetic diversity. The patients had average age of 72.2 ± 14.5 years old (excluded one child patient of 1 year old) and 79.5% of patients were male. Twenty-three patients (59.0%) had underlying diseases. CONCLUSIONS: The designed species-specific primers could be used to identify E. meningoseptica with 100% of specificity and sensitivity, whereas the Vitek 2 GN card showed considerable ability in E. meningoseptica identification. The PFGE patterns showed that most isolates were genetic diversity enough to exclude the possibility of intrahospital spread.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013;
• Article: Molecular epidemiology, antimicrobial susceptibility and carbapenemase resistance determinants among Acinetobacter baumannii clinical isolates in Taiwan.

  Yu-Chung Chuang, Wang-Huei Sheng, Tsai-Ling Lauderdale, Shu-Yin Li, Jann-Tay Wang, Yee-Chun Chen, Shan-Chwen Chang
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  ABSTRACT: BACKGROUND: Emerging carbapenem resistance among Acinetobacter baumannii clinical isolates is a worldwide problem. Infections caused by A. baumannii are increasing and demonstrate high mortality rates. This study aimed to establish a nationwide surveillance of antimicrobial susceptibility, carbapenemase genes, and clonal relationships of A. baumannii clinical isolates in Taiwan. METHODS: Clinical isolates of Acinetobacter calcoaceticus-A. baumannii (ACB) complex collected by the Taiwan Surveillance of Antimicrobial Resistance-V program between July 2006 and September 2006 were used in this study. Genospecies identification was verified by 16S-23S rRNA intergenic-spacer sequences. Carbapenemase genes were detected by polymerase chain reaction. Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) was applied for identification of clonal relationships. RESULTS: Among the 151 ACB-complex isolates collected, 134 (88.7%) were A. baumannii, 12 (8.0%) were A. pittii, and five (3.3%) were A. nosocomialis. A. baumannii isolates showed higher resistance rates to ciprofloxacin, amikacin, and ampicillin/sulbactam than A. pittii or A. nosocomialis (all p < 0.001). The most commonly detected carbapenemase genes were blaOxA-51 (n = 135), followed by blaOxA-24 (n = 4), blaOxA-23 (n = 2), and blaOxA-58 (n = 1). Three major A. baumannii clones were found throughout Taiwan, and showed significantly higher resistance rates to ciprofloxacin, amikacin, and ampicillin/sulbactam than the other A. baumannii isolates (100% vs. 68.7%, p < 0.001; 98.4% vs. 61.5%, p < 0.001; and 66.7% vs. 39.8%, p = 0.004; respectively). MLST showed that these major clones were sequence type 2 and belonged to international clonal complex 2. CONCLUSIONS: Our results demonstrate clonal spreading of A. baumannii in Taiwan hospitals and that these clones were more resistant to many antimicrobial agents. Efforts to prevent and control A. baumannii colonization/infections and prudent use of antibiotics to reduce antimicrobial selective pressure should be emphasized.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013;
• Article: Bacteriology of septic arthritis at a regional hospital in southern Taiwan.

  Chien-Ming Chao, Chih-Cheng Lai, Po-Ren Hsueh
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2013;
• Article: Risk factors for imipenem-nonsusceptible Acinetobacter nosocomialis bloodstream infection.

  Lei Huang, Te-Li Chen, Yi-Tzu Lee, Mei-Hui Lee, Shu-Chen Kuo, Kwok-Woon Yu, Horng-Yunn Dou, Chang-Phone Fung
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  ABSTRACT: BACKGROUND: The emergence of imipenem-nonsusceptible (INS) Acinetobacter baumannii complex has had a great impact on healthcare systems worldwide. Understanding the risk factors related to INS infection is useful for infection control. The risk factors for INS A. baumannii have been well documented; however, the risk factors related to INS Acinetobacter nosocomialis infection lack documentation. The purpose of this study was to identify the risk factors associated with INS A. nosocomialis bacteremia. METHODS: This retrospective 9-year study included 329 adults with A. nosocomialis bacteremia in a tertiary medical center in Taiwan. Acinetobacter nosocomialis was identified using a multiplex polymerase chain reaction method and sequence analysis of a 16S-23S intergenic spacer. RESULTS: Among 329 patients with A. nosocomialis bacteremia, 67 had INS isolates (20.4%). Patients with INS isolates tended to have a more severe form of the diseases [with ICU admission and a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score], specific underlying diseases (associated with chronic lung diseases and end-stage renal diseases, but less commonly alcoholism and chemotherapy), multiple invasive procedures, pneumonia as a primary focus of infection, and prior antimicrobial use (sulbactam, antipseudomonal penicillins, aminoglycosides, and carbapenems). Multivariable analysis showed that ICU admission, chronic lung diseases, arterial line catheterization, total parenteral nutrition, and prior use of carbapenems were independent risk factors; prior use of carbapenems was found to be the most influential (odds ratio 6.36, 95% confidence interval 2.00-20.21; p = 0.002). CONCLUSION: To our knowledge, this is the first study describing the risk factors associated with INS A. nosocomialis bacteremia. Regulated antibiotic control policy, especially for carbapenem, and infection control measures targeting patients hospitalized in ICU, with chronic lung diseases and multiple invasive procedures, may be helpful in reducing INS A. nosocomialis infection.
  Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 04/2013;