Bacteremia caused by staphylococci with inducible vancomycin heteroresistance

The clinical significance of bacteremia due to vancomycin- heteroresistant staphylococci and a rapid laboratory screening method were examined; 203 strains of staphylococci isolated from patients with clinically significant bacteremia were screened by the disk-agar method with use of vancomycin-salt agar to demonstrate satellitism around an aztreonam disk as well as by conventional population screening. Eighteen isolates (three Staphylococcus aureus and 15 coagulase-negative staphylococci) were shown to be heteroresistant to vancomycin. A case-control clinical study showed that the interval between admission and bacteremia, admission to the intensive care unit, prior use of vancomycin and/or β-lactams, and isolation of methicillin-resistant staphylococci were significantly more common among patients with bacteremia due to staphylococci with heteroresistance to vancomycin; these patients had an overall mortality of 44.4%. The use of vancomycin and admission to the intensive care unit were independently significant risk factors on multivariate analysis. Vancomycin heteroresistance is inducible by salt and β-lactams. Indiscriminate sequential use of β-lactams and glycopeptides may facilitate the emergence of glycopeptide resistance.published_or_final_versio

Unilateral epistaxis after swimming in a stream

A 55-year-old Chinese woman presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction. She had swum in a freshwater stream 1 month prior to the onset of symptoms. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal. Magnetic resonance imaging performed following removal confirmed that no other leeches were present in the sinonasal area. The endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain. This form of leech infestation has not been previously reported.published_or_final_versio

Exploring undergraduate students’ usage pattern of mobile apps for education

In recent years, with the general adoption of smartphones with computing power comparable to desktop computers, mobile applications (apps) have experienced a surge in popularity. However, there are few studies conducted about their educational use, especially in Southeast Asia. To close this research gap, this study aims to provide a current overview of mobile apps usage in higher education. Besides exploring the actual use of apps, the technology acceptance model was applied to examine (1) undergraduate students’ perceptions, which involve perceived usefulness and perceived ease of use, towards adopting mobile apps for educational purposes, and (2) their overall attitude toward such adoption. Both quantitative and qualitative methods were used to collect data from 150 undergraduate students in Business, Education, and Engineering in Hong Kong. The results show undergraduate students use mobile apps frequently to engage in learning activities related to their academic studies, with a particularly focus on communication and collaborative working, accessing academic resources, and checking a dictionary. However, the discrepancies in using apps for academic purposes are not significant between the three faculties. Meanwhile, perceived usefulness has a more positive impact on overall attitude compared with the impact of perceived ease of use. The investigation will help tertiary institutions, library service providers, and educators develop and assess strategic planning for education collaborating with mobile apps. This paper could also give app developers some suggestions for app design based on actual usage and students’ information needs.preprin

Acinetobacter bacteremia in Hong Kong: Prospective study and review

The epidemiological characteristics of 18 patients with acinetobacter bacteremia were analyzed. Patients (mean age, 55.5 years) developed bacteremia after an average of 14.1 days of hospitalization. Fifteen of 16 patients survived bacteremia caused by Acinetobacter baumannii. Cultures of blood from the remaining two patients yielded Acinetobacter Iwoffii. Most patients (78%) resided in the general ward, while four patients (22%) were under intensive care. Genotyping by arbitrarily primed polymerase chain reaction analysis and the temporal sequence of isolation were more useful than phenotyping by antimicrobial susceptibility in the determination of the source of bacteremia, and the intravascular catheter was the leading infection source (39% of cases). The possibility of an association of glucose with the pathogenesis of acinetobacter infection was raised.published_or_final_versio

The role of clinical microbiologists in infectious disease management

All infectious disease consultations directed to the clinical microbiologists at the Queen Mary Hospital in February 1995 were analysed. A total of 95 written and 111 telephone consultations were received. Fifty three percent of the written consultations involved patients with persistent fever despite multiple antimicrobial therapy. Of all written consultations, gram positive bacteria, gram negative bacteria, and fungi were encountered in 39%, 31%, and 19%, respectively. The majority of written consultations (55%) were from surgical units. In contrast, 65% of telephone consultations came from medical and paediatric units. This study indicated that a wide spectrum of infectious disease problems - both diagnostic and therapeutic - were encountered by clinical microbiologists. The unique combination of laboratory skill and clinical infectious disease knowledge gives the microbiologist a distinctive advantage in assisting clinicians to provide optimal care to patients suffering from infection.published_or_final_versio

Immunorestitution diseases in patients not infected with HIV

The aim of this study was to assess the clinical spectrum of immunorestitution disease (IRD) in hospitalized patients over a 12-month period. In nine of 18 patients who presented with clinical deterioration during reduction or cessation of immunosuppressants (n = 6) or bone marrow engraftment (n = 3), IRD cases included the following infections: scabies infestation (n = 1); gastric strongyloidiasis (n = 1); hepatosplenic candidiasis (n = 1); methicillin-resistant Staphylococcus aureus abscess formation (n = 2); polyomavirus-related hemorrhagic cystitis (n = 3); and influenza A pneumonitis (n = 1). Immunopathological damage during withdrawal of immunosuppression is an incidental way to uncover an asymptomatic infectious disease. Serial monitoring of hematological and clinical profiles is essential in making a diagnosis of IRD.postprin

Inpatient emergencies encountered by an infectious disease consultative service

The spectrum of infections disease (ID) emergencies in hospitalized patients was assessed in a prospective study of 3,626 inpatient ID consultations in a 1,350-bed teaching hospital. ID emergencies, defined by a need or anticipated need for advanced life support or by irreversible organ damage leading to permanent functional loss, were encountered in 175 patients. Infections of the central nervous system (26.3%), cardiovascular system (14.9%), alimentary system (13.1%), and lower respiratory tract (7.4%) and adverse reactions to antimicrobial agents (7.4%) were most common. In 18.9% of the cases, the referring clinicians were unaware of the emergency at the time of referral. Drug reactions (46.1%), severe alimentary and peritoneal infections (32.0%), upper respiratory tract infections (28.6%), and skin and soft-tissue infections (27.3%) were most frequently missed. The emergency ID conditions were not recognized because they had an atypical presentation (51.5%), were not commonly seen in the referring specialty (24.2%), were due to rare organisms (15.2%), or had unusual anatomical sites of involvement (9.1%). A close liaison between clinicians and the ID team is crucial for recognition of ID emergencies at their early stages so that appropriate investigations and management can be instituted expediently, before the occurrence of irreversible damage.published_or_final_versio

Proceedings of The First Current Topic in Infectious Diseases: Consensus Meeting on Conjugate Vaccines of the Center of Infection

Titles include: 1. Invasive Haemophilus Influenzae b Disease: Overview and Disease Burden in Hong Kong (YL LAU) ; 2. Overview and Disease Burden of Haemophilus Influenzae Type b in China (YH YANG) ; 3. Factors to Consider in the Routine Use of Hib in Hong Kong (THF TSANG) ; 4. Burden of Pneumococcal Disease in Hong Kong (CB CHOW) ; 5. Overview and Disease Burden of Streptococcus Pneumoniae in China (YH YANG) ; 6. Resistance in Pediatric Isolates of Pneumococci. Results from a Territorywide Carriage Study (SSS CHIU) ; 7. Serotype Distribution of Invasive and Noninvasive Strains of Pneumococci in Hong Kong (PL HO) ; 8. Overview of Conjugate Pneumococcal Vaccine: Serotype Coverage, Efficacy and Status of Usage in other Countries (SSY WONG)Conference Theme: The First Current Topic in Infectious Diseasespublished_or_final_versio

Assessing the health and hygiene performance of apartment buildings

The recent global outbreak of Severe Acute Respiratory Syndrome has aroused public concern on environmental health and hygiene. Develops a practical assessment scheme for assessing the health and hygiene performance of apartment buildings in Hong Kong. The scheme involves assessing a hierarchy of building factors that have a bearing on environmental qualities, and thus occupants' health. Proposes an index method to integrate the assessment outcomes into a simple and user- friendly performance indicator for public consumption. The index can inform the public of the health and hygiene risk of different buildings and facilitate building owners, developers, and government bodies to make more informed and socially responsible decisions on environmental health and hygiene improvement. Although the assessment scheme is tailored for the institutional and cultural settings of Hong Kong, the assessment framework for the development of the scheme is also applicable to other cities.published_or_final_versio

Delayed clearance of viral load and marked cytokine activation in severe cases of pandemic H1N1 2009 influenza virus infection

Background: Infections caused by the pandemic H1N1 2009 influenza virus range from mild upper respiratory tract syndromes to fatal diseases. However, studies comparing virological and immunological profile of different clinical severity are lacking. Methods: We conducted a retrospective cohort study of 74 patients with pandemic H1N1 infection, including 23 patients who either developed acute respiratory distress syndrome (ARDS) or died (ARDS-death group), 14 patients with desaturation requiring oxygen supplementation and who survived without ARDS (survived-withoutARDS group), and 37 patients with mild disease without desaturation (mild-disease group). We compared their pattern of clinical disease, viral load, and immunological profile. Results: Patients with severe disease were older, more likely to be obese or having underlying diseases, and had lower respiratory tract symptoms, especially dyspnea at presentation. The ARDS-death group had a slower decline in nasopharyngeal viral loads, had higher plasma levels of proinflammatory cytokines and chemokines, and were more likely to have bacterial coinfections (30.4%), myocarditis (21.7%), or viremia (13.0%) than patients in the survived-without-ARDS or the mild-disease groups. Reactive hemophagocytosis, thrombotic phenomena, lymphoid atrophy, diffuse alveolar damage, and multiorgan dysfunction similar to fatal avian influenza A H5N1 infection were found at postmortem examinations. Conclusions: The slower control of viral load and immunodysregulation in severe cases mandate the search for more effective antiviral and immunomodulatory regimens to stop the excessive cytokine activation resulting in ARDS and death. © 2010 by the Infectious Diseases Society of America. All rights reserved.published_or_final_versio