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ABSTRACT: Raltegravir is the first integrase inhibitor antiretroviral agent that has been demonstrated to have antiviral efficacy and safety. However, the US Food and Drug Administration has recommended use with caution in patients with risk factors for rhabdomyolysis, based on four case reports of rhabdomyolysis in patients with identifiable risk factors. We present a 32-year-old Asian man with human immunodeficiency virus (HIV), but without other underlying diseases, who developed rapid-onset, raltegravir-associated rhabdomyolysis and hyperlactatemia. Our patient lacked predisposing factors for rhabdomyolysis, and the rapid onset time of 4 days was the shortest reported. Therefore, clinicians should exercise caution when using raltegravir and closely monitor all patients for the symptoms of muscle pain and weakness. This case has been reported to the National Adverse Drug Reactions Reporting System of the Department of Health in Taiwan.
Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 04/2013; · 0.99 Impact Factor
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Kuan-Sheng Wu,
Susan Shin-Jung Lee, Jui-Kuang Chen,
Hung-Chin Tsai,
Ching-Hsien Li,
Hsueh-Lan Chao,
Hsueh-Chih Chou,
Yueh-Ju Chen,
Chin-Mei Ke,
Yu-Hsiu Huang,
Cheng Len Sy,
Yu-Ting Tseng,
Yao-Shen Chen
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ABSTRACT: BACKGROUND: Patient participation has been proven to increase hand hygiene compliance of health care workers. The objective of the study is to better understand patients' attitudes and perceptions toward hand hygiene, and to identify patients with the highest motivation to participate in hand hygiene. DESIGN: A 2-week, cross-sectional survey of hospitalized patients and their family members was conducted using an anonymous, self-reporting questionnaire in a large teaching hospital in Taiwan. RESULTS: Of the 859 respondents, 89.8% considered hand hygiene important, and 75.9% would take hand hygiene practices into consideration when they choose a hospital. Most respondents (78.4%) would like more information on hand hygiene, particularly persons who have had experience with health care-associated infection (odds ratio, 2.48; 95% confidence interval, 1.57-3.89; P < .001). Respondents would be more willing to ask a doctor or nurse to wash his or her hands if they knew that the doctor or nurse would appreciate the reminder (doctor: from 48.9% to 74.6% [P < .001]; nurse: from 50.8% to 76.3% [P < .001]). CONCLUSIONS: Hand hygiene is considered important by most patients and family members and plays an influential role in their choice of a hospital or doctor. Persons with experience with health care-associated infections have the greatest motivation to participate in hand hygiene.
American journal of infection control 10/2012; · 3.01 Impact Factor
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ABSTRACT: Non-nosocomial healthcare-associated infective endocarditis (NNHCA-IE) is a new category of IE of increasing importance. This study described the clinical and microbiological characteristics and outcome of NNHCA-IE in Taiwan.
A retrospective study was conducted of all patients with IE admitted to the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan over a five-year period from July 2004 to July 2009. The clinical and microbiological features of NNHCA-IE were compared to those of community-acquired and nosocomial IE. Predictors for in-hospital death were determined.
Two-hundred episodes of confirmed IE occurred during the study period. These included 148 (74%) community-acquired, 30 (15%) non-nosocomial healthcare-associated, and 22 (11%) nosocomial healthcare-associated IE. Staphylococcus aureus was the most frequent pathogen. Patients with NNHCA-IE compared to community-acquired IE, were older (median age, 67 vs. 44, years, p < 0.001), had more MRSA (43.3% vs. 9.5%, p < 0.001), more comorbidity conditions (median Charlson comorbidity index [interquartile range], 4[2-6] vs. 0[0-1], p < 0.001), a higher in-hospital mortality (50.0% vs. 17.6%, p < 0.001) and were less frequently recognized by clinicians on admission (16.7% vs. 47.7%, p = 0.002). The overall in-hospital mortality rate for all patients with IE was 25%. Shock was the strongest risk factor for in-hospital death (odds ratio 7.8, 95% confidence interval 2.4-25.2, p < 0.001).
NNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.
BMC Infectious Diseases 08/2011; 11:221. · 3.12 Impact Factor
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Susan Shin-Jung Lee,
Kang-Ju Chou,
Horng-Yunn Dou,
Tsi-Shu Huang,
Yen-Yun Ni,
Hua-Chang Fang,
Hung-Chin Tsai,
Cheng-Len Sy, Jui-Kuang Chen,
Kuang-Sheng Wu,
Yung-Hsin Wang,
Hsi-Hsun Lin,
Yao-Shen Chen
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ABSTRACT: Patients in ESRD on hemodialysis with latent tuberculosis (TB) infection have 10 to 25 times the risk of reactivation into active disease compared with healthy adults. This study investigates the prevalence of latent TB infection in dialysis patients from a country with an intermediate burden of TB and its associated risk factors using the QuantiFERON-TB Gold in-tube test (QGIT) and the tuberculin skin test (TST).
This was a prospective, cross-sectional study performed at a medical center in Taiwan on dialysis patients. Each patient underwent QGIT, two-step TST using 2 tuberculin units (TU) of PPD RT-23, a chest x-ray to exclude active TB, and an interview to determine TB risk factors.
Ninety-three of 190 eligible patients were enrolled: 35 men and 58 women. 64.8% were vaccinated with the Bacille-Calmette-Guérin (BCG) vaccination. Overall, 34.4% were positive by QGIT and 10.8% were indeterminate. Using a 10-mm TST cutoff, 53.9% were positive. There was poor correlation between TST and QGIT at any TST cutoff criteria. There was a significant increasing trend of QGIT positivity with age in those younger than 70 years, and, conversely, a decreasing trend of TST reactivity with age. Significant risk factors for QGIT positivity included age and past TB disease.
This study shows a high prevalence of latent TB infection in dialysis patients in a country with an intermediate burden of TB. QGIT in dialysis patients correlated better than TST with the risk of TB infection and past TB disease.
Clinical Journal of the American Society of Nephrology 08/2010; 5(8):1451-7. · 5.23 Impact Factor
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Susan Shin-Jung Lee,
Chin-Mei Ke,
Ming-Fang Cheng,
Ju-Hsin Chen,
Li-Jen Lin,
Min-Nan Hung,
Hsueh-Lan Chao,
Ching-Hsien Li,
Hui-Hua Lu,
Yu Hsiu Huang,
Yueh-Ju Chen,
Cheng-Len Sy,
Kuan-Sheng Wu, Jui-Kuang Chen,
Hung-Chin Tsai,
Yao-Shen Chen
Infection Control and Hospital Epidemiology 11/2009; 30(10):1026-8. · 3.67 Impact Factor
