Sing-On Teng

Taipei Medical University, T’ai-pei, Taipei, Taiwan

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Publications (14)14.68 Total impact

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    ABSTRACT: Objective Acinetobacter baumannii (AB) bacteremia has increasingly emerged as a nosocomial pathogen in healthcare settings, associated with high patient morbidity and mortality. The objective of this study was to compare clinical features, risk factors, treatment outcome, and antibiotic resistance in patients with pneumonia- and non–pneumonia-related AB bacteremia. Methods We conducted a retrospective study in a tertiary teaching hospital in northern Taiwan. The medical records of the 141 episodes of hospital-acquired AB bacteremia between July 1, 2006 and June 30, 2012 were reviewed, and sorted into groups of AB bacteremia with (n = 59) and without pneumonia (n = 82). Results The hospital-acquired pneumonia-related AB bacteremia group were found to be significantly more frequently treated in intensive care units (49.2%, p < 0.001), but the AB bacteremia without pneumonia group were significantly more frequently treated on general wards (85.4%, p < 0.001). Patients with pneumonia tended to be older than the nonpneumonia group (72.8 years vs. 65.2 years in mean age, p < 0.01), and more likely to use mechanical ventilators (62.7% vs. 15.9 %, p < 0.001). Pneumonia patients were found to receive broad-spectrum antibiotics significantly earlier than nonpneumonia patients (p < 0.001). Compared to those without pneumonia, the patients with pneumonia had significantly higher incidence of antibiotic-resistance (p < 0.05), longer hospital stay (p < 0.01), and higher mortality rate (p < 0.001). The incidence of multidrug-resistant AB was significantly higher in patients with pneumonia (p < 0.05), and only colistin (p < 0.01) and tigecycline (p < 0.01) were significantly active against multidrug-resistant AB isolates. Conclusion Pneumonia-related AB bacteremia has a worse outcome, more antibiotic resistance, and more comorbidity than the nonpneumonia group.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 08/2014; · 1.63 Impact Factor
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    ABSTRACT: Objective Urinary tract infection (UTI) is the most common hospital-acquired infection. Foley catheter-related UTI is associated with increased mortality, morbidity, length of hospital stay, and costs. Few studies have compared the pathogens by bacterial strains, resistance to antibiotics, comorbidities, and related risk factors in hospital-acquired UTI patients with or without diabetes and with or without a Foley catheter. The objective of this study was to compare the variables of hospital-acquired UTI between these two groups. Methods In this retrospective chart review study, we included hospital-acquired UTI patients (hospitalization time > 48 hours) with either diabetes or a Foley catheter from a medical center in Taipei (Taiwan) between January 1, 2011 and December 31, 2012. We excluded patients with positive urine culture for bacteria within 48 hours of admission. Clinically related information was collected using case data sheets. Results We analyzed 595 patients with hospital-acquired UTI; the infection rate of hospital-acquired UTI in our study was significantly higher in patients with a urinary catheter (n = 497) than in those without (p < 0.05). Regardless of the status of diabetes, all hospital-acquired UTI patients with a urinary catheter had higher mortality (27% vs. 19%) and bloodstream infection rates (14% vs. 9%) than those without a urinary catheter. Predictably, both groups (i.e., groups with and without a urinary catheter) had more Gram-negative strains, with Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae being the most commonly isolated pathogens. The fungal infection rate was significantly higher in the urinary catheter group than in the nonurinary catheter group (37% vs. 25%; p < 0.05). Among the 78 pathogenic strains isolated from patients who died, the microorganisms found were fungi (39%), Gram-negative bacteria (31%), and Gram-positive bacteria (8%). Of the patients with a urinary catheter, age, length of hospital stay, number of comorbidities, and duration of infection after admission were all significantly higher in the diabetic group than in the nondiabetic group (p < 0.05). Conclusion Unlike having diabetes, having a urinary catheter was a significant risk factor for hospital-acquired UTI (p < 0.001). However, diabetic patients with a urinary catheter had a longer length of hospital stay than those without a urinary catheter. The resistance rate of E. coli to first-generation cephalosporins was higher in diabetic patients with a urinary catheter. Fungal infections, renal insufficiency, and cerebral vascular accident were significantly (p < 0.01) related risk factors for mortality. Candida deaths outnumbered other bacterial infections, and fungal UTI was the most prominent infection in nosocomial urinary catheterized patients.
    Journal of Experimental and Clinical Medicine 06/2014;
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    ABSTRACT: Echinocandins are not active against basidiomycetous yeasts, such as Cryptococcus neoformans, Trichosporon, and Rhodotorula species, and zygomycosis. We present a patient with renal failure and candidemia, who developed a breakthrough fungal infection with cryptococcemia and cryptococcuria while receiving micafungin therapy.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 04/2013; · 1.63 Impact Factor
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    Journal of Experimental & Clinical Medicine. 04/2013; 5(2):86–87.
  • Journal of Experimental & Clinical Medicine. 10/2012; 4(5):290–291.
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    ABSTRACT: PURPOSE: This study investigates the clinical and epidemiological features of Chryseobacterium indologenes infections and antimicrobial susceptibilities of C indologenes. METHODS: With 215 C indologenes isolates between January 1, 2004 and September 30, 2011, at a medical center, we analyzed the relationship between the prevalence of C indologenes infections and total prescription of colistin and tigecycline, clinical manifestation, antibiotic susceptibility, and outcomes. RESULTS: Colistin and tigecycline were introduced into clinical use at this medical center since August 2006. The increasing numbers of patients with C indologenes pneumonia and bacteremia correlated to increased consumption of colistin (p = 0.018) or tigecycline (p = 0.049). Among patients with bacteremia and pneumonia, the in-hospital mortality rate was 63.6% and 35.2% (p = 0.015), respectively. Administration of appropriate antibiotics showed significant benefit in 14-day survival in patients with C indologenes bloodstream infection (p = 0.040). In bacteremic patients, old cardiovascular accident (p = 0.036) and cancer (p = 0.014) were the most common comorbidity. The most common co-infection pathogen in patients with C indologenes pneumonia was Acinetobacter baumannii (36/91, 39.6%), followed by Pseudomonas aeruginosa (23/91, 25.3%), carbapenem-resistant A baumannii (22/91, 24.2%), and Klebseilla pneumoniae (13/91, 14.3%). Antimicrobial susceptibility testing of the 215 isolates showed that trimethoprim-sulfamethoxazole was the most active agent (susceptibility rate: 87.4%), followed by cefoperazone-sulbactam (48.0%). CONCLUSION: The present study showed a trend of increasing prevalence of C indologenes infection after introduction of colistin and tigecycline usage. The bacteremia group had higher mortality rate than the pneumonia group. Increasing resistance to piperacillin-tazobactam, ceftazidime, cefepime, and newer fluoroquinolone were noticed in our analysis. Trimethoprim-sulfamethoxazole was a potential antimicrobial agent in vitro for C indologenes. To avoid collateral damage, we emphasize the importance of antibiotic stewardship program.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 09/2012; · 1.63 Impact Factor
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    ABSTRACT: Background/Purpose: Blood culture specimens collected from patients in the emergency department (ED) can subsequently give the clinical physicians useful information and references for diagnosis and medication selection. If the isolates are found to be contaminants, the consequences are increased antibiotic use and inpatient hospital fees. The purpose of this research is to reduce blood culture contamination (BCC) rates in the ED. Methods: The effectiveness of educational intervention and one-on-one feedback to reduce BCC rates in the ED was assessed in a busy medical center in which blood cultures were obtained by nurses rather than trained phlebotomists. The study comprised two phases. The first phase was to ensure understanding of the correct methods for performing blood culture, and to measure the effectiveness of the educational intervention. The second phase was to continue the educational intervention plus to give one-on-one feedback of the BCC rates to the ED and individuals weekly. Results: The baseline BCC rate was 3.4% in the pre-intervention period. The BCC rate fell to 2.67% in Phase 1 (i.e., educational intervention only). The BCC rate fell to 2% in Phase 2 (i.e., educational intervention plus one-on-one feedback). Among the contaminants, coagulase-negative staphylococci (CoNS) fell from 62% before the intervention to 48% post-intervention. Conclusion: Educational intervention plus one-on-one feedback for decreasing BCC rates was more effective than an educational intervention alone in our study.
    Journal of Experimental and Clinical Medicine 06/2012; 4(3).
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    ABSTRACT: A 93-year-old male was hospitalized due to complicated urinary tract infection. Delftia acidovorans was isolated from patient's blood and urine culture. The blood and urine strains were identical and confirmed by pulse field gel electrophoresis. Symptoms resolved after specific antibiotic therapy with intravenous administration with imipenem 500 mg every 6 hours. D acidovorans is an environment microorganism and rarely caused human infections. So far as we know, this is the first report of ascending urinary tract infection associated with D acidovorans bacteremia in Taiwan.
    Journal of Experimental & Clinical Medicine. 06/2012; 4(3):180–182.
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    ABSTRACT: A woman aged 56 years of age had a community-acquired left neck abscess and internal jugular vein thrombosis with septicemia due to extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae. Even though she was treated with intravenous meropenem, the bacteremia persisted. She was complicated with multiple brain abscesses, seizure, and leucopenia. After a combination of intravenous fosfomycin and meropenem, her clinical condition became stable. Combination treatment was continued for 2 months and she recovered. In individual cases of Lemierre syndrome with brain abscess caused by ESBL-producing Enterobacteriaceae, fosfomycin combination therapy may be the alternative choice.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2011; 45(1):72-4. · 1.63 Impact Factor
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    ABSTRACT: Corynebacterium striatum (C striatum) has been considered a contaminant of blood culture in past decades. Here we report the case of a patient with acute deterioration of chronic renal failure. She received hemodialysis and died from C striatum bacteremia. By using a randomly amplified polymorphic DNA (RAPD) method, we found that an association existed between C striatum from the bloodstream and that from the central venous catheter. We suggest that C striatum could be a pathogen of bloodstream infection in patients with such a catheter in place.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 12/2011; 45(3):255-8. · 1.63 Impact Factor
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    ABSTRACT: Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important nosocomial pathogen. Antibiotic resistance has been increasing during the past decade. A. xylosoxidans may be confused with Pseudomonas spp. but, unlike Pseudomonas spp., this organism has peritrichous flagella. Complicated intra-abdominal infection with A. xylosoxidans has rarely been reported in the literature. This report is of an immunocompetent patient with acute cholecystitis complicated by an intra-abdominal abscess after surgery. Culture of both blood and ascites yielded extended drug-resistant A. xylosoxidans, which was only sensitive to colistin. The clinical and laboratory characteristics of A. xylosoxidans are presented.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 05/2009; 42(2):176-80. · 1.63 Impact Factor
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    ABSTRACT: Bacterial endocarditis in pregnancy causes maternal and fetal mortality rates of 22.1% and 14.7%, respectively. The mortality rates differ according to the involved valves, and the size of vegetation has a prognostic correlation. This report is of a pregnant woman with an unrepaired ventricular septal defect and pulmonary valve endocarditis with a vegetation size of 3.29 cm. She and her baby were treated successfully. An emergency surgical plan would be appropriate for pregnant women in the third trimester with a large vegetation in the right side of the heart, and dental disease should be treated aggressively with appropriate prophylactic antibiotics.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2009; 42(1):92-5. · 1.63 Impact Factor
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    ABSTRACT: In 2007, an outbreak of vancomycin-resistant enterococci (VRE) occurred at Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan. The aim of this study was to characterize the mechanism of glycopeptide resistance and to investigate the genetic relatedness among isolates of VRE. Between May and October 2007, bacterial isolates from 16 patients identified as colonized or infected with VRE were collected. Polymerase chain reaction and pulsed-field gel electrophoresis (PFGE) were used to determine resistant genes and molecular typing. All 16 isolates of VRE presented with the VanA phenotype with the vanA gene except for 1 isolate of Enterococcus faecalis, which had the VanB phenotype with the vanA gene. PFGE analysis revealed a major clone containing 12 isolates, and 4 other distinct clones containing 1 to 2 isolates each. Five patients had VRE colonized in their gastrointestinal tract, the genotype of which was the same as the clinical isolates. Fourteen isolates (87.5%) had the esp gene. An outbreak of VRE was caused by the simultaneous existence of monoclonal and polyclonal spread. Rigorous infection control, active surveillance, and decreasing pressure of antibiotic use are important for controlling the emergence of VRE.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2009; 42(1):63-8. · 1.63 Impact Factor
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    ABSTRACT: The purpose of this study was to determine the degree of bacterial contamination of patients' files, and to compare the colonized bacteria between files from the surgical intensive care unit (ICU) and the surgical ward at the Wan Fang Hospital, Taipei, Taiwan. 180 medical charts were randomly selected from the surgical ICU (n = 90) and the surgical ward (n = 90). The charts were sampled using sterile swabs moistened with sterile normal saline. The swabs were immediately transferred to trypticase soy broth and incubated aerobically for 48 h, then subcultured to separated sheep blood and eosin-methylene blue agars. Microorganisms were identified by the standard methods used in the microbiological laboratory. Ninety percent of charts in the surgical ICU (n = 81) and 72.2% in the surgical ward (n = 65) were contaminated with pathogenic or potentially pathogenic bacteria (p = 0.0023). Coagulase-negative staphylococci (CoNS) were the most commonly isolated bacteria, both in the surgical ICU (n = 40, 44.44%) and in the surgical ward (n = 48, 53.33%). Several bacteria isolated from the charts, including multidrug-resistant Acinetobacter baumannii, Stenotrophomonas maltophilia, and Klebsiella pneumoniae, had the same antibiogram as the same bacteria isolated from patients. This study showed that the patients' charts in the ICU were usually contaminated with pathogenic and potentially pathogenic bacteria. Contaminated charts can serve as a source for cross-infection. Health care personnel should wash their hands before and after contact with the chart to reduce the nosocomial infection rate.
    Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi 03/2009; 42(1):86-91. · 1.63 Impact Factor