MyMedR

Fulltext Impact of an Antimicrobial Stewardship Intervention on the Appropriateness of Carbapenem Use at a Tertiary Hospital in Malaysia

Chang CY, Devi Nath N, Lam K, Zaid M

Cureus, 2022 Nov;14(11):e31660.

PMID: 36540495 DOI: 10.7759/cureus.31660

Introduction Carbapenems are broad-spectrum antibiotics used to treat infections caused by multidrug-resistant organisms. The inappropriate use of carbapenem results in the development of antimicrobial resistance. The aim of this study was to determine the impact of an antimicrobial stewardship intervention on the appropriateness of carbapenem use. Method The study includes a baseline/pre-intervention audit, an intervention, and a post-intervention study to examine the impact of antimicrobial stewardship activities on carbapenem use. Audit and data collection were carried out by filling up an audit form. The indicator for this study will be the appropriateness of carbapenem use (appropriate, suboptimal, or inappropriate) pre- and post-intervention. Results The overall appropriateness of carbapenem prescription in the medical wards increased from 65% to 83.3% following the implementation of antimicrobial stewardship intervention. The most common indication of carbapenem usage in our study was hospital-acquired pneumonia/ventilator-associated pneumonia. Conclusion Antimicrobial stewardship intervention is effective in improving the appropriateness of carbapenem use. Tailored stewardship programs are required to better control carbapenem use and combat antimicrobial resistance.

Fulltext Bacteroides fragilis Causing Liver Abscess and Pyelonephritis

Teo PS, Chong XY, Chang CY, Deen AN, Zaid M

J Glob Infect Dis, 2024;16(1):39-40.

PMID: 38680751 DOI: 10.4103/jgid.jgid_184_23

Fulltext Transcriptome analysis of Pseudomonas aeruginosa PAO1 grown at both body and elevated temperatures

Chan KG, Priya K, Chang CY, Abdul Rahman AY, Tee KK, Yin WF

PeerJ, 2016;4:e2223.

PMID: 27547539 DOI: 10.7717/peerj.2223

Functional genomics research can give us valuable insights into bacterial gene function. RNA Sequencing (RNA-seq) can generate information on transcript abundance in bacteria following abiotic stress treatments. In this study, we used the RNA-seq technique to study the transcriptomes of the opportunistic nosocomial pathogen Pseudomonas aeruginosa PAO1 following heat shock. Samples were grown at both the human body temperature (37 °C) and an arbitrarily-selected temperature of 46 °C. In this work using RNA-seq, we identified 133 genes that are differentially expressed at 46 °C compared to the human body temperature. Our work identifies some key P. aeruginosa PAO1 genes whose products have importance in both environmental adaptation as well as in vivo infection in febrile hosts. More importantly, our transcriptomic results show that many genes are only expressed when subjected to heat shock. Because the RNA-seq can generate high throughput gene expression profiles, our work reveals many unanticipated genes with further work to be done exploring such genes products.

Chromobacterium violaceum infection in Taiwan: a case report and literature review

Chang CY, Lee YT, Liu KS, Wang YL, Tsao SM

J Microbiol Immunol Infect, 2007 Jun;40(3):272-5.

PMID: 17639170

Chromobacterium violaceum is a facultative anaerobic, Gram-negative bacillus which inhabits stagnant water in tropical and subtropical regions. We describe the case of an 80-year-old female patient with C. violaceum bacteremia due to traumatic wound infected by contaminated water and soil. She had persistent fever, hypotension and neutrophilic leukocytosis on admission. Two sets of blood cultures yielded C. violaceum. The patient was successfully treated with levofloxacin. Since the first case from Malaysia in 1927, about 150 cases have been reported in the world literature. To our knowledge, six other cases have been reported previously from Taiwan, including two children and four adults. Of the total of seven patients from Taiwan, four had a fatal outcome within several days, while the three survivors were apparently free of vital organ involvement. Although human infections caused by C. violaceum are rare, clinicians should be aware of this potentially fatal infection as part of the differential diagnosis of sepsis associated with a history of exposure to stagnant water.

Fulltext Primary iliopsoas abscess due to Staphylococcus aureus bacteremia

Chang CY, Teoh SC

Rev Soc Bras Med Trop, 2020;54:e20200264.

PMID: 33206883 DOI: 10.1590/0037-8682-0264-2020

Fulltext ROS-generating alginate-coated gold nanorods as biocompatible nanosonosensitisers for effective sonodynamic therapy of cancer

Loke YL, Beishenaliev A, Wang PW, Lin CY, Chang CY, Foo YY, et al.

Ultrason Sonochem, 2023 Jun;96:106437.

PMID: 37187119 DOI: 10.1016/j.ultsonch.2023.106437

Sonodynamic therapy (SDT) emerges as a promising non-invasive alternative for eradicating malignant tumours. However, its therapeutic efficacy remains limited due to the lack of sonosensitisers with high potency and biosafety. Previously, gold nanorods (AuNRs) have been extensively studied for their applications in photodynamic or photothermal cancer therapy, but their sonosensitising properties are largely unexplored. Here, we reported the applicability of alginate-coated AuNRs (AuNRsALG) with improved biocompatibility profiles as promising nanosonosensitisers for SDT for the first time. AuNRsALG were found stable under ultrasound irradiation (1.0 W/cm2, 5 min) and maintained structural integrity for 3 cycles of irradiation. The exposure of the AuNRsALG to ultrasound irradiation (1.0 W/cm2, 5 min) was shown to enhance the cavitation effect significantly and generate a 3 to 8-fold higher amount of singlet oxygen (1O2) than other reported commercial titanium dioxide nanosonosensitisers. AuNRsALG exerted dose-dependent sonotoxicity on human MDA-MB-231 breast cancer cells in vitro, with ∼ 81% cancer cell killing efficacy at a sub-nanomolar level (IC50 was 0.68 nM) predominantly through apoptosis. The protein expression analysis showed significant DNA damage and downregulation of anti-apoptotic Bcl-2, suggesting AuNRsALG induced cell death through the mitochondrial pathway. The addition of mannitol, a reactive oxygen species (ROS) scavenger, inhibited cancer-killing effect of AuNRsALG-mediated SDT, further verifying that the sonotoxicity of AuNRsALG is driven by the production of ROS. Overall, these results highlight the potential application of AuNRsALG as an effective nanosonosensitising agent in clinical settings.

The amount and types of fatty acids acutely affect insulin, glycemic and gastrointestinal peptide responses but not satiety in metabolic syndrome subjects

Chang CY, Kanthimathi MS, Tan AT, Nesaretnam K, Teng KT

Eur J Nutr, 2018 Feb;57(1):179-190.

PMID: 27632019 DOI: 10.1007/s00394-016-1307-9

PURPOSE: Limited clinical evidence is available on the effects of amount and types of dietary fats on postprandial insulinemic and gastrointestinal peptide responses in metabolic syndrome subjects. We hypothesized that meals enriched with designated: (1) amount of fats (50 vs 20 g), (2) fats with differing fatty acid composition (saturated, SFA; monounsaturated, MUFA or n-6 polyunsaturated fatty acids, PUFA) would affect insulinemic and gastrointestinal peptide releases in metabolic syndrome subjects.

METHODS: Using a randomized, crossover and double-blinded design, 15 men and 15 women with metabolic syndrome consumed high-fat meals enriched with SFA, MUFA or n-6 PUFA, or a low-fat/high-sucrose (SUCR) meal. C-peptide, insulin, glucose, gastrointestinal peptides and satiety were measured up to 6 h.

RESULTS: As expected, SUCR meal induced higher C-peptide (45 %), insulin (45 %) and glucose (49 %) responses compared with high-fat meals regardless of types of fatty acids (P < 0.001). Interestingly, incremental area under the curve (AUC0-120min) for glucagon-like peptide-1 was higher after SUCR meal compared with MUFA (27 %) and n-6 PUFA meals (23 %) (P = 0.01). AUC0-120min for glucose-dependent insulinotropic polypeptide was higher after SFA meal compared with MUFA (23 %) and n-6 PUFA meals (20 %) (P = 0.004). Significant meal x time interaction (P = 0.007) was observed for ghrelin, but not cholecystokinin and satiety.

CONCLUSIONS: The amount of fat regardless of the types of fatty acids affects insulin and glycemic responses. Both the amount and types of fatty acids acutely affect the gastrointestinal peptide release in metabolic syndrome subjects, but not satiety.

Fulltext Analysis of Pectate Lyase Genes in Dickeya chrysanthemi Strain L11, Isolated from a Recreational Lake in Malaysia: a Draft Genome Sequence Perspective

Chan KG, Kher HL, Chang CY, Yin WF, Tan KH

Genome Announc, 2015;3(2).

PMID: 25792063 DOI: 10.1128/genomeA.00145-15

Dickeya chrysanthemi is well known as a plant pathogen that caused major blackleg in the European potato industry in the 1990s. D. chrysanthemi strain L11 was discovered in a recreational lake in Malaysia. Here, we present its draft genome sequence.

Fulltext Spontaneous splenic rupture in Plasmodium knowlesi malaria

Chang CY, Pui WC, Kadir KA, Singh B

Malar J, 2018 Dec 04;17(1):448.

PMID: 30509259 DOI: 10.1186/s12936-018-2600-2

BACKGROUND: Plasmodium knowlesi, a malaria parasite typically found in long-tailed and pig-tailed macaques, is the most common cause of human malaria in Malaysian Borneo. Infections in humans result in a spectrum of disease, including fatal outcomes. Spontaneous splenic rupture is a rare, but severe complication of malaria and has not been reported previously for knowlesi malaria.

CASE PRESENTATION: A 46-year-old man presented with fever and acute surgical abdomen with concomitant P. knowlesi malaria infection at Kapit Hospital. He was in compensated shock upon arrival to the hospital. He had generalized abdominal tenderness, maximal at the epigastric region. Bedside focused abdominal ultrasonography revealed free fluid in the abdomen. He underwent emergency exploratory laparotomy in view of haemodynamic instability and worsening peritonism. Intraoperatively, haemoperitoneum and bleeding from the spleen was noted. Splenectomy was performed. Histopathological examination findings were suggestive of splenic rupture and presence of malarial pigment. Analysis of his blood sample by nested PCR assays confirmed P. knowlesi infection. The patient completed a course of anti-malarial treatment and recovered well post-operation.

CONCLUSIONS: Spontaneous splenic rupture is a rare complication of malaria. This is the first reported case of splenic rupture in P. knowlesi malaria infection. Detection of such a complication requires high index of clinical suspicion and is extremely challenging in hospitals with limited resources.

Fulltext Draft Genome Sequence of Aeromonas caviae Strain L12, a Quorum-Sensing Strain Isolated from a Freshwater Lake in Malaysia

Chan KG, Chin PS, Tee KK, Chang CY, Yin WF, Sheng KY

Genome Announc, 2015;3(2).

PMID: 25745006 DOI: 10.1128/genomeA.00079-15

Here, we present the draft genome sequence of Aeromonas caviae strain L12, which shows quorum-sensing activity. The availability of this genome sequence is important to the research of the quorum-sensing regulatory system in this isolate.

Fulltext Cryptococcus gattii meningitis complicated by immune reconstitution inflammatory syndrome in an apparent immunocompetent host in Malaysia

Chang CY, Mohd Shah SH, Lio JY, Bahari N, Radhakrishnan AP

Med Mycol Case Rep, 2022 Mar;35:1-4.

PMID: 34984166 DOI: 10.1016/j.mmcr.2021.12.004

Cryptococcosis is a systemic fungal infection caused by Cryptococcus neoformans or Cryptococcus gattii. Cryptococcus causes a wide range of diseases, ranging from asymptomatic pulmonary lesions to disseminated disease involving the central nervous system, particularly meningoencephalitis. C. gattii infection has rarely been reported in Malaysia. We present a case of C. gattii meningitis with pulmonary cryptococcosis complicated by immune reconstitution inflammatory syndrome in an apparently immunocompetent person with no prior travel history.

Fulltext Invasive Aspergillus rhinosinusitis complicated with cerebral abscess

Wang VV, Chang CY, Radhakrishnan AP

Rev Soc Bras Med Trop, 2021;54:e02962021.

PMID: 34431947 DOI: 10.1590/0037-8682-0296-2021

Fulltext Necrotizing Pneumonia Due To Rhodococcus Hoagii In A Patient With Advanced Retroviral Disease

Gan YL, Chang CY, Yusoff YK, Radhakrishnan AP

J Ayub Med Coll Abbottabad, 2022;34(4):877-879.

PMID: 36566419 DOI: 10.55519/JAMC-04-10234

Rhodococcus hoagii is a well-known zoonotic disease, especially in foals. Its occurrence in humans is uncommon and usually occurs in immunocompromised patients. We present a case of Rhodococcus hoagii infection resulting in necrotizing pneumonia in a patient with advanced retroviral disease who had defaulted treatment. Effective treatment of Rhodococcus hoagii infection requires a combination of antibiotics. We also highlighted the importance of effective communication between clinicians and microbiologists so that prompt treatment can be initiated to improve patient outcomes.

Fulltext Pandoraea sp. Strain E26: Discovery of Its Quorum-Sensing Properties via Whole-Genome Sequence Analysis

Chan KG, Yin WF, Tee KK, Chang CY, Priya K

Genome Announc, 2015;3(3).

PMID: 26021935 DOI: 10.1128/genomeA.00565-15

We report the draft genome sequence of Pandoraea sp. strain E26 isolated from a former landfill site, sequenced by the Illumina MiSeq platform. This genome sequence will be useful to further understand the quorum-sensing system of this isolate.

Fulltext Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss

Chang CY, Lau NLJ, Currie BJ, Podin Y

BMC Infect Dis, 2020 Mar 06;20(1):201.

PMID: 32143598 DOI: 10.1186/s12879-020-4937-8

BACKGROUND: Melioidosis is a potentially life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei. Melioidosis is difficult to diagnose due to its diverse clinical manifestations, which often delays administration of appropriate antibiotic therapy.

CASE PRESENTATION: Melioidosis is uncommon in pregnancy but both spontaneous abortion and neonatal melioidosis have been reported. We report a case of bacteraemic melioidosis in a young woman with a subsequent spontaneous abortion, with B. pseudomallei cultured from a high vaginal swab as well as blood.

CONCLUSION: It remains unclear in this and previously reported cases as to whether the maternal melioidosis was sexually transmitted.

Fulltext Disseminated talaromycosis in an HIV-infected patient

Chang CY, Wahid AA, Ong ELC

Rev Soc Bras Med Trop, 2021 03 22;54:e0896-2020.

PMID: 33759937 DOI: 10.1590/0037-8682-0896-2020

Fulltext Acute abdomen revealed Streptococcus gordonii infective endocarditis with systemic embolism

Chang CY, Gan YL, Radhakrishnan AP, Ong ELC

Oxf Med Case Reports, 2022 Jan;2022(1):omab145.

PMID: 35083058 DOI: 10.1093/omcr/omab145

Infective endocarditis can result in potentially fatal complications such as heart failure, systemic embolization, mycotic aneurysm and neurological complications. Staphylococci and streptococci are the most common causative agents of infective endocarditis, with Streptococcus gordonii being a rare cause. We present a case of infective endocarditis in a young patient who presented with an acute abdomen 2 months after being diagnosed with cerebrovascular accident. An abdominal computed tomography revealed superior mesenteric artery thrombosis, and infarct in the right kidney and spleen as a result of systemic septic embolism. Echocardiography showed numerous vegetations at the aortic and mitral valves. Infective endocarditis was diagnosed based on echocardiographic findings and positive blood cultures for S. gordonii. He was treated with intravenous benzylpenicillin and was also referred for surgical intervention.

Fulltext Dengue fever complicated by hemophagocytic lymphohistiocytosis: Report of 2 cases and bone marrow findings

Chang CY, Rajappan M, Zaid M, Ong ELC

Clin Case Rep, 2020 Dec;8(12):3427-3431.

PMID: 33363946 DOI: 10.1002/ccr3.3422

Hemophagocytic lymphohistiocytosis is a rare but severe complication of dengue infection which carries a high mortality. This report highlights the importance of early recognition of this condition as prompt appropriate treatment improves outcomes.

Fulltext Streptococcus sanguis brain abscess as an initial manifestation of pulmonary arteriovenous malformation

Chang CY, Chai CSY, Ong ELC

Clin Case Rep, 2020 Dec;8(12):2685-2688.

PMID: 33363805 DOI: 10.1002/ccr3.3272

Pulmonary arteriovenous malformation is a vascular anomaly that predisposes to complications of paradoxical embolization including stroke and brain abscess. Here, we present a case of brain abscess associated with pulmonary arteriovenous malformation.

Neck Abscess Caused By Morganella Morganii

Chang CY, Rajappan M, Zaid M, Ong E

J Ayub Med Coll Abbottabad, 2021 3 29;33(1):172.

PMID: 33774979

Displaying publications 1 - 20 of 71 in total