MyMedR

Primary antibiotic resistance in Helicobacter pylori in the Asia-Pacific region: a systematic review and meta-analysis

Kuo YT, Liou JM, El-Omar EM, Wu JY, Leow AHR, Goh KL, et al.

Lancet Gastroenterol Hepatol, 2017 10;2(10):707-715.

PMID: 28781119 DOI: 10.1016/S2468-1253(17)30219-4

BACKGROUND: So far, a comprehensive systematic review and meta-analysis has not been done of the prevalence of primary antibiotic resistance in Helicobacter pylori in the Asia-Pacific region. We aimed to assess the trends and regional differences in primary antibiotic resistance to H pylori in the Asia-Pacific region and to examine the relation between resistance and first-line eradication.

METHODS: We did a systematic review and meta-analysis of primary antibiotic resistance to H pylori and the efficacy of first-line regimens in the Asia-Pacific region. We searched PubMed, Embase, and the Cochrane Library for articles published between Jan 1, 1990, and Sept 30, 2016; we also searched abstracts from international conferences. Both observational studies and randomised controlled trials were eligible for inclusion in the analysis of primary antibiotic resistance, but only randomised controlled trials were eligible for inclusion in the analysis of efficacy of first-line therapies. Meta-analysis was by the random-effects model to account for the substantial variations in resistance across the region. We did subgroup analyses by country and study period (ie, before 2000, 2001-05, 2006-10, and 2011-15) to establish country-specific prevalences of primary antibiotic resistance and first-line eradication rates. This study is registered with PROSPERO, number CRD42017057905.

FINDINGS: 176 articles from 24 countries were included in our analysis of antibiotic resistance. The overall mean prevalences of primary H pylori resistance were 17% (95% CI 15-18) for clarithromycin, 44% (95% CI 39-48) for metronidazole, 18% (95% CI 15-22) for levofloxacin, 3% (95% CI 2-5) for amoxicillin, and 4% (95% CI 2-5) for tetracycline. Prevalence of resistance to clarithromycin and levofloxacin rose significantly over time during the period investigated, whereas resistance to other antibiotics remained stable. 170 articles from 16 countries were included in analysis of efficacy of first-line therapies. We noted unsatisfactory efficacy (ie, <80%) with clarithromycin-containing regimens in countries where the clarithromycin resistance rates were higher than 20%.

INTERPRETATION: The prevalence of primary antibiotic resistance varied greatly among countries in the Asia-Pacific region, and thus treatment strategy should be adapted relative to country-specific resistance patterns. Clarithromycin-containing regimens should be avoided in countries where the prevalence of clarithromycin resistance is higher than 20%.

FUNDING: Ministry of Health and Welfare of Taiwan, Ministry of Science and Technology of Taiwan, and Amity University.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Pantoea agglomerans as a rare cause of catheter-related infection in hemodialysis patients

Wong KW

J Vasc Access, 2013 Jul-Sep;14(3):306.

PMID: 23599132 DOI: 10.5301/jva.5000139

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Salmonella enteritidis ventriculitis

Johan AJ, Hung LC, Norlijah O

Southeast Asian J. Trop. Med. Public Health, 2013 May;44(3):456-9.

PMID: 24050077

Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Outcomes and appropriateness of management of nosocomial Acinetobacter bloodstream infections at a teaching hospital in northeastern Malaysia

Deris ZZ, Harun A, Shafei MN, Rahman RA, Johari MR

Southeast Asian J. Trop. Med. Public Health, 2009 Jan;40(1):140-7.

PMID: 19323046

Acinetobacter spp is a known nosocomial pathogen causing a wide range of clinical diseases such as pneumonia, wound infection and bloodstream infections (BSI). The clinical outcomes of acinetobacter BSI were determined by a 1:1 case control study involving 58 confirmed cases of acinetobacter BSI who were compared to other gram-negative infections. The crude mortality of acinetobacter BSI was 47.2%, which was significantly greater than other gram-negative BSI (OR 1.89, 95% CI 1.10-3.24) but there were no significant differences in attributed mortality between the two groups. We found that patients treated in intensive care units (ICU), who had longer ICU stays, who presented with shock or coagulopathy, had prior exposure to carbapenems, had mechanical ventilation, were on a ventilator for longer periods, had a nasogastric tube, had an arterial catheter or had parenteral nutrition at a significantly greater risk of mortality due to acinetobacter BSI. Patients presenting with septic shock (OR 17.95, 95% CI 3.36-95.84) or having a central venous catheter (OR 12.48, 95% CI 1.09-142.68) were independently at higher risk for mortality. Appropriateness of therapy reduced the mortality attributes of acinetobacter BSI (OR 0.197, 95% CI 0.040-0.967) but did not significantly reduce crude mortality in acinetobacter BSI patients. This study shows the importance of preventing acinetobacter BSI and the appropriate use of antimicrobial agents to reduce mortality.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext A case of auricular myiasis in Malaysia

Rohela M, Jamaiah I, Amir L, Nissapatorn V

Southeast Asian J. Trop. Med. Public Health, 2006;37 Suppl 3:91-4.

PMID: 17547059

Many cases of myiasis have been reported in Malaysia. This is the second reported case of auricular myiasis caused by Chrysomya bezziana. The patient was a 41-year-old, mentally retarded, Orang Asli man. He was brought to the clinic by his mother with a complaint of pain and bleeding in his right ear for 3 days. On examination, blood and multiple maggots were seen packed in the external auditory canal of the right ear. A total of 39 live maggots were removed and maintained until they developed into 3rd instar larvae, which were later processed and identified as Chrysomya bezziana. The patient was discharged with amoxicillin 500 mg three times a day for 1 week.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Retrospective prevalence of snakebites from Hospital Kuala Lumpur (HKL) (1999-2003)

Jamaiah I, Rohela M, Ng TK, Ch'ng KB, Teh YS, Nurulhuda AL, et al.

Southeast Asian J. Trop. Med. Public Health, 2006 Jan;37(1):200-5.

PMID: 16771235

A hospital based retrospective study of the prevalence of snakebite cases at Hospital Kuala Lumpur was carried out over a five-year period from 1999 to 2003. A total of 126 snakebite cases were recorded. The highest admission for snakebites was recorded in 2001 (29 cases). The majority of cases were admitted for three days or less (79%). Most of the snakebite cases were reported in the 11-30 years age group (52%). The male:female ratio was 3:1. The majority of cases were Malaysians (80%, 101 cases). Of the non-Malaysians, Indonesians constituted the most (56%, 14 cases). Bites occurred most commonly on the lower limbs (49%), followed by upper limbs (45%) and on other parts of the body (6%). No fatal cases were detected and complications were scarce. In 60% (70 cases) the snake could not be identified. Of the four species of snakes that were identified, cobra (both suspected and confirmed) constituted the largest group (25%), followed by viper (10%), python (4%) and sea snake (1%). The most common clinical presentations were pain and swelling, 92% (116 cases). All patients were put on snakebite charts and their vital signs were monitored. Of the snakebite cases, 48% (61 cases) were treated with cloxacillin and 25% (32 cases) were given polyvalent snake antivenom.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Rhodococcus equi--an emerging human pathogen in immunocompromized hosts: a report of four cases from Malaysia

Puthucheary SD, Sangkar V, Hafeez A, Karunakaran R, Raja NS, Hassan HH

Southeast Asian J. Trop. Med. Public Health, 2006 Jan;37(1):157-61.

PMID: 16771229

Rhodococcus equi, a recognized pathogen in horses, is emerging as a human opportunistic pathogen, especially in immunocompromized hosts. We describe four immunocompromized patients who had serious R. equi infections with an overall mortality of 75%. The natural habitat of R. equi is soil, particularly soil contaminated with animal manure. Necrotizing pneumonia is the commonest form of infection but extrapulmonary infections, such as wound infections and subcutaneous abscess, have also been described in humans. R. equi is cultured easily in ordinary non-selective media. Large, smooth, irregular colonies appear within 48 hours. It is a facultative, intracellular, nonmotile, non-spore forming, gram-positive coccobacillus, which is weakly acid-fast staining and bears a similarity to diphtheroids. It forms a salmon-colored pigment usually after 48 hours incubation. A particular characteristic of this organism is that it undergoes synergistic hemolysis with some bacteria on sheep blood agar. R. equi may be misidentified as diphtheroids, Mycobacterium species, or Nocardia. In vitro R. equi is usually susceptible to erythromycin, ciprofloxacin, vancomycin, aminoglycosides, rifampin, imipenem and meropenem. The organism can be difficult to eradicate, making treatment challenging. Increased awareness of the infection may help with early diagnosis and timely treatment.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Analysis of pediatric subdural empyema outcome in relation to computerized tomography brain scan

Md Ralib AR, Ariff AR, Shuaib IL, Naing NN, George PJ, Abdullah JM

Southeast Asian J. Trop. Med. Public Health, 2004 Jun;35(2):434-44.

PMID: 15691152

A cross-sectional study was conducted to predict the outcome in patients with subdural empyema, using initial and post-treatment CT scan brain parameters. Data collection was done on those children who were diagnosed to have subdural empyema by CT scan of the brain with contrast, who underwent burrhole evacuation, from February 2000 until April 2002. Numerous factors, such as coma or loss of unconsciousness at diagnosis, age, types of antibiotic, microbiology, extension of empyema, associated cerebral infarction and ventriculitis, were analyzed. Poor prognosis was associated with loss of consciousness, and hypodensity by CT scan at presentation (p < 0.005). Patients with an extensive subdural empyema will have a good outcome if they are treated early and aggressively with antibiotics and burrhole evacuation.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Late onset group b beta-hemolytic streptococcus infection in a neonate manifesting as a urinary tract infection: a rare clinical presentation

Zurina Z, Rohani A, Neela V, Norlijah O

Southeast Asian J. Trop. Med. Public Health, 2012 Nov;43(6):1470-3.

PMID: 23413711

Group B beta-hemolytic streptococcus (GBS) sepsis is a serious bacterial infection in neonates, with significant morbidity and mortality. We report here a neonate with late onset GBS infection manifesting as a urinary tract infection (UTI) in an infant presenting with prolonged neonatal jaundice. The pathogenesis of this late onset is postulated.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Emphysematous pyelonephritis caused by Candida infection

Kamaliah MD, Bhajan MA, Dzarr GA

Southeast Asian J. Trop. Med. Public Health, 2005 May;36(3):725-7.

PMID: 16124446

We present an interesting and rare case of a diabetic patient who developed extensive unilateral emphysematous pyelonephritis (EPN) which was caused by fungal infection. The diagnosis was confirmed on computed tomography (CT) scan of the abdomen. Repeated urine cultures grew Candida albicans but no other organisms were isolated. The patient remained febrile and unwell despite parenteral broad spectrum antibiotics and antifungal treatment. She underwent nephrectomy and then made a good clinical recovery.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Focal non-typhoidal Salmonella infections from a single center in Malaysia

Lee WS, Hafeez A, Hassan H, Raja NS, Puthucheary SD

Southeast Asian J. Trop. Med. Public Health, 2005 May;36(3):678-82.

PMID: 16124437

A retrospective review of patients with focal non-typhoidal Salmonella (NTS) infection was performed to determine its features and outcome. All patients with focal NTS infection admitted to the University of Malaya Medical Center, Malaysia, from 1993 to 2002 were studied. More than half (58%) of the 35 cases (54% male, median age 39 years, range 1.5 months to 79 years) were immunocompromized or had chronic medical conditions. One-third of the patients (34%) had superficial infections (lymphadenitis or subcutaneous tissue infection) and all recovered with antimicrobial therapy alone. Deep infections (66%) noted were: meningitis (9%), osteomyelitis or arthritis (26%), abscesses of the gastrointestinal tract or adjacent organs (20%), and others (11%). Deep infections were more likely to occur in the extremes of age (<6 months or >60 years, p< 0.04), associated with adverse outcomes with an overall mortality rate of 9%, or required major surgery (15%).

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext An imported case of acute melioidosis caused by ST881 Burkholderia pseudomallei

Zong Z, Wang X, Deng Y

Southeast Asian J. Trop. Med. Public Health, 2016 Mar;47(2):219-22.

PMID: 27244959

A previously healthy Chinese male working in Malaysia returned to China with high fever. A blood culture showed Burkholderia pseudomallei strain WCBP1. This isolate was sequenced, showing type, ST881, which appears to be present in Malaysia. WCP1 had unusual susceptibility to aminoglycosides and habored the Yersinia-like fimbrial gene cluster for virulence. The patient's condition deteriorated rapidly but he recovered after receiving meropenem and intensive care support. Melioidosis is a potential problem among Chinese imigrant workers with strains new to China being identified.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext The use of surgical antibiotic prophylaxis in seven Malaysian hospitals

Lim VK, Cheong YM, Suleiman AB

Southeast Asian J. Trop. Med. Public Health, 1994 Dec;25(4):698-701.

PMID: 7667716

A survey on the use of antibiotics in surgical prophylaxis was carried out in seven Malaysian hospitals. Details of antibiotic prescriptions were obtained through questionnaires completed by the prescriber. A total of 430 such prescriptions was analysed. A large number of different antibiotic regimens were used for a variety of surgical procedures. The majority of prescriptions (70%) were issued for procedures where such prophylaxis was probably not necessary. Antibiotics were also often prescribed for durations that were longer than necessary. There is an urgent need to educate surgeons and standardize surgical prophylactic regimens in order to reduce cost and combat the emergence of antibiotic resistance.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Melioidosis in a splenectomized boy with beta-thalassemia major

Hoe TS, Deng CT, Khuzaiah R

Southeast Asian J. Trop. Med. Public Health, 1993 Sep;24(3):601-2.

PMID: 8160075

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Antibiotic prescribing for upper respiratory tract infections in Sarawak district hospitals

Kho BP, Ong CMY, Tan FTY, Wee CY

Med J Malaysia, 2013 Apr;68(2):136-40.

PMID: 23629559 MyJurnal

Upper respiratory tract infection (URTI) is mostly viral in aetiology, but patients presenting with such complaints are frequently prescribed antibiotics. This may result in increased development of antimicrobial resistance. The objectives of this study are to determine the choice and proportion of oral antibiotics prescribed in patients with URTI, in a Sarawak district hospital setting. All outpatient prescriptions received in July 2011 in 10 hospitals with relevant diagnoses were analysed. A total of 6747 URTI prescriptions met the inclusion criteria, and 64.8% (95% CI 63.7%, 65.9%) had antibiotic prescribed. Medical Assistants (MAs) were significantly more likely to prescribe antibiotics compared to Medical Officers (MOs) (p < 0.001). Prescribers were significantly influenced by the patient's age and specific diagnosis when prescribing antibiotics for URTI (p < 0.001). Antibiotic choices differed between MOs and MAs, where some of the antibiotic choices were inappropriate. There is a need for multi-faceted interventions to improve antibiotic prescribing rate and choice.
Study site: 10 district hospitals, Sarawak, Malaysia

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Concern about the efficacy of clarithromycin containing standard triple therapy in the eradication of Helicobacter pylori infection in Malaysia

Raj JM, Raj SM

Med J Malaysia, 2012 Oct;67(5):547.

PMID: 23770883

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Lemierre syndrome

Lim AL, Pua KC

Med J Malaysia, 2012 Jun;67(3):340-1.

PMID: 23082433 MyJurnal

Lemierre syndrome is an uncommon disease which commonly arise from acute bacterial oropharyngeal infection. This disease was first described in 1900 by Courmont and Cade Lemierre. It is commonly caused by Fusobacterium necrophorum. Lemierre syndrome has been reported to be serious and potentially fatal in the preantibiotic era. It is characterized by an oropharyngeal infection leading to secondary septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. The incidence has become relatively rare at present and is usually only diagnosed when unsuspected culture results are available. We report a case of Lemierre syndrome which was recently diagnosed in our centre.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

Fulltext Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis--a case report

Shaharuddin NR, Leong CL, Chidambaram SK, Lee C

Med J Malaysia, 2012 Jun;67(3):337-9.

PMID: 23082432

Paraspinal abscess and spondylodiscitis due to Citrobacter koseri is a very rare condition. We report a remarkable case of Citrobacter koseri bacteraemia complicated by paraspinal abscess and spondylodiscitis in a patient who has successfully been treated in our hospital. Our patient demonstrates one of the common challenges in the practice of infectious disease medicine, wherein an innocuous presentation may and often underlie a serious infection. This case report elucidates to us that the diagnosis of a paraspinal abscess and spondylodiscitis requires a high index of suspicion in at risk patient presenting with compatible signs and symptoms.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext An atypical case of retropharyngeal abscess with long blind tract treated with Ryle's tube drainage

Tang ML, Lee SC, Phoon MP

Med J Malaysia, 2011 Dec;66(5):501-3.

PMID: 22390112

A 10 year-old Iban girl presented with severe odynophagia for 4 days and subcutaneous emphysema. Clinically, her neck was tender with crepitus. Lateral neck radiograph showed multiple linear radiolucent shadows at retropharyngeal space. Flexible nasopharyngolaryngoscope revealed a tunnel behind upper oesophagus with slough and there was pooling of saliva at pyriform sinus. Feeding via nasogastric tube was started and empirical treatment for fungal and bacterial infection was commenced. Subsequent computed tomography of neck and thorax showed a 15-long blind tract at subglottic region posterior to oesophagus (prevertebral region), extending to superior mediastinum just before carina at T3/T4 level, represent abscess. Hourly suctioning of the remaining abscess in the blind tract with 10ml-syringe was done.

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use

Fulltext Increasing rate of detection of fusidic acid resistance in methicillin-resistant Staphylococcus aureus isolated from clinical samples in Malaysia

Alreshidi MA, Mariana NS

Med J Malaysia, 2011 Aug;66(3):276.

PMID: 22111461

Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*

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