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  1. 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
  2. Fulltext The presence of heterogeneous vancomycin-lntermediate Staphylococcus aureus (heteroVISA) in a major Malaysian hospital
    Norazah A, Law NL, Abd Ghani MK, Salbiah N
    Med J Malaysia, 2012 Jun;67(3):269-73.
    PMID: 23082415
    This study was conducted to detect the presence of heterogenous vancomycin-intermediate Staphylococcus aureus (heteroVISA) among MRSA isolates in a major hospital. Forty-three MRSA isolates with vancomycin MIC 2 microg/ml collected in 2009 was screened for heteroVISA using Etest Glycopeptide Resistance Detection (GRD) and confirmed by population analysis profile-area under curve method. The genetic relatedness of heteroVISA strains with other MRSA was examined by pulsed-field gel electrophoresis (PFGE) method. Two isolates were shown to be heteroVISA and derived from the same clone. This showed that heteroVISA strains were already present among our local strains since 2009 and were genetically related to other susceptible strains.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  3. Comparison of antimicrobial resistance in neonatal and adult intensive care units in a tertiary teaching hospital
    Ariffin N, Hasan H, Ramli N, Ibrahim NR, Taib F, Rahman AA, et al.
    Am J Infect Control, 2012 Aug;40(6):572-5.
    PMID: 22854380 DOI: 10.1016/j.ajic.2012.02.032
    Intrahospital variations in antimicrobial profiles may be related to many factors. This study compared causative agents of nosocomial bloodstream infections between a neonatal intensive care unit (NICU) that adopted a ward-tailored antibiotic policy and adult intensive care units (ICUs). Data on organisms from blood cultures obtained from the respective wards between 2005 and 2009 were analyzed. Compared with the adult ICUs, the NICU had a higher frequency of Enterobacteriacae and lower frequencies of typical hospital-acquired pathogens (eg, Klebsiella pneumoniae, 17.4% vs 10.0% [P < .001]; Acinetobacter baumannii, 3.9% vs 11.6% [P < .001]). Antibiotic resistance of gram-negative organisms was also significantly lower in the NICU, including resistance to imipenem (5.7% vs 32.1%; P < .001), amikacin (8.8% vs 30.3%), and ceftriaxone (36.1% vs 74.6%; P < .001). This could possibly be due to the ward-tailored antibiotic policy adopted by the NICU but not by the other ICUs.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  4. In vitro activity of tigecycline against Acinetobacter baumannii isolates from a teaching hospital in Malaysia
    Dhabaan GN, AbuBakar S, Shorman MA, Hassan H
    J Chemother, 2012 Apr;24(2):87-92.
    PMID: 22546763 DOI: 10.1179/1120009X12Z.00000000017
    The In vitro susceptibility of clinical and environmental isolates of Acinetobacter baumannii to tigecycline and other antibiotics was determined by disk diffusion method. The E-test was used to determine the minimum inhibitory concentration (MIC). The growth curves of tigecycline treated environmental and clinical strains were established. Fifty-seven percent and 75% of the clinical and environmental isolates were MDR strains, respectively. Ninety-five percent of the clinical isolates were susceptible to tigecycline and 5% showed intermediate resistance with MIC ranging between 0.032 and 3 mg/l. Tigecycline susceptible and intermediate resistance among the environmental isolates were 40% and 60%, respectively, with a significantly lower MIC range of 0.5-4 mg/l. The bacterial growth curves demonstrated the higher ability of the environmental strains to tolerate the antibiotic effects than the clinical strains. The relatively high resistance profile among the environmental isolate suggests an insidious emergence of tigecycline resistance amongst A. baumannii. Strict infection control procedures are imperative to prevent the dissemination of tigecycline-resistant A. baumannii strains in the hospital environment.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  5. 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
  6. Prevalence, antibiotic resistance and RAPD typing of Campylobacter species isolated from ducks, their rearing and processing environments in Penang, Malaysia
    Adzitey F, Rusul G, Huda N, Cogan T, Corry J
    Int J Food Microbiol, 2012 Mar 15;154(3):197-205.
    PMID: 22285201 DOI: 10.1016/j.ijfoodmicro.2012.01.006
    We report for the first time on the prevalence, antibiotic resistance and RAPD types of Campylobacter species in ducks and duck related environmental samples in Malaysia. Samples were examined by enrichment in Bolton Broth followed by plating onto modified Charcoal Cefoperazone Deoxycholate agar (mCCDA) and/or plating directly onto mCCDA. A total of 643 samples were screened, and the prevalence of Campylobacter spp. in samples from different sources ranged from 0% to 85%. The method of isolation had a significant (P<0.05) effect on the isolation rate. One hundred and sixteen Campylobacter isolates, comprising of 94 Campylobacter jejuni, 19 Campylobacter coli and three Campylobacter lari, were examined for their sensitivity to 13 antibiotics. Majority of the C. jejuni isolates were resistant to cephalothin (99%), tetracycline (96%), suphamethoxazole/trimethoprim (96%), and very few were resistant to gentamicin (5%), chloramphenicol (7%) and erythromycin (1%). All C. coli isolates were resistant to cephalothin, nalidixic acid, norfloxacin and tetracycline but susceptible to chloramphenicol, erythromycin and gentamicin. The three C. lari isolates were resistant to all the antibiotics tested except chloramphenicol and gentamicin (1/3 and 2/3 susceptible, respectively). Genetic diversity of Campylobacter isolates were determined using random amplification of polymorphic DNA (RAPD). C. jejuni and C. coli isolates belong to fifty-eight and twelve RAPD types, respectively.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  7. A survey on the management of acute rhinosinusitis among Asian physicians
    Wang DY, Wardani RS, Singh K, Thanaviratananich S, Vicente G, Xu G, et al.
    Rhinology, 2011 Aug;49(3):264-71.
    PMID: 21866280 DOI: 10.4193/Rhino10.169
    BACKGROUND: Based on the `European Position Paper on Rhinosinusitis and Nasal polyps (EP3OS 2007)`, this study aimed to investigate general practitioners (GPs) and other specialists` understanding when managing patients with acute rhinosinusitis (ARS) in Asia.
    METHODOLOGY: Among a total of 2662 questionnaires completed, 2524 (94.8%) were valid for analysis. There were 1308 GPs (51.8%), 989 otolaryngologists (39.2%) and 227 paediatricians (9%) from Mainland China, Hong Kong, Indonesia, India, Malaysia, Pakistan, Philippines, Singapore, Thailand and Taiwan.
    RESULTS: ARS is affecting an estimated 6 - 10% of patients seen in a daily out-patient practice. The EP3OS criteria are well supported by Asian physicians (94.1%). Most physicians (62.7%) agreed that radiological investigation is not needed to diagnose ARS. However, even for mild ARS (common cold), medical treatments were still recommended by 87% of GPs, 83.9% of otolaryngologists, and 70% of paediatricians. The top three first-line treatments prescribed were antihistamines (39.2%), nasal decongestants (33.6%), and antibiotics (29.5%). Antibiotics usage increased as the first line treatment of moderate (45.9%) and severe (60.3%) ARS.
    CONCLUSION: ARS is commonly managed by GPs, otolaryngologists, and paediatricians in Asia. However, understanding of the management of ARS needs further improvement to minimize unnecessary use of radiological investigations, overuse of antibiotics, and under use of nasal corticosteroids.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
  8. Antimicrobial susceptibility and pulsed: field Gel Electrophoretic analysis of Salmonella in a tertiary hospital in northern Malaysia
    Thong KL, Lai WL, Dhanoa A
    J Infect Public Health, 2011 Jun;4(2):65-72.
    PMID: 21663875 DOI: 10.1016/j.jiph.2011.03.003
    Salmonella infections remain a major public health problem in developing countries. The occurrence of infections caused by antimicrobial-resistant Salmonella has been on the rise complicating the available therapeutic options. The study aimed to determine the antibiograms and genotypes of prevalent Salmonella serotypes.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  9. Fulltext Public knowledge and attitudes towards antibiotic usage: a cross-sectional study among the general public in the state of Penang, Malaysia
    Oh AL, Hassali MA, Al-Haddad MS, Syed Sulaiman SA, Shafie AA, Awaisu A
    J Infect Dev Ctries, 2011 May;5(5):338-47.
    PMID: 21628809
    INTRODUCTION: Public knowledge and attitudes towards antibiotics play a vital role in the success of the treatment process. This study aimed to assess public knowledge and attitudes toward antibiotic usage which could serve as baseline data for future studies within a government hospital setting in Malaysia.
    METHODOLOGY: A self-administered cross-sectional survey involving 408 respondents was conducted using a validated questionnaire at an outpatient pharmacy department in Penang Hospital, Malaysia, from February to March 2009.
    RESULTS: Nearly 55% of the respondents had a moderate level of knowledge. Three quarters of the respondents (76.7%) could correctly identify that antibiotics are indicated for the treatment of bacterial infections. However, 67.2% incorrectly thought that antibiotics are also used to treat viral infections. About 59.1% of the respondents were aware of antibiotic resistance phenomena in relation to overuse of antibiotics. With regard to attitudes, 38% believed that taking antibiotics when having cold symptoms could help them to recover faster, while 47.3% expected antibiotics to be prescribed for common cold symptoms. Age, race and educational level were among the demographic characteristics significantly associated with knowledge and attitudes toward antibiotic use. Poor level of knowledge was found in less than one-third of the respondents whereas more than one-third of the respondents wrongly self-medicate themselves with antibiotics once they have a cold.
    CONCLUSION: Educational interventions are needed to promote prudent use of antibiotics among the public.
    Study site: outpatient pharmacy, Hospital Pulau Pinang, Malaysia
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  10. Current trend of pneumococcal serotypes distribution and antibiotic susceptibility pattern in Malaysian hospitals
    Yasin RM, Zin NM, Hussin A, Nawi SH, Hanapiah SM, Wahab ZA, et al.
    Vaccine, 2011 Aug 5;29(34):5688-93.
    PMID: 21723357 DOI: 10.1016/j.vaccine.2011.06.004
    From January 2008 to December 2009, 433 Streptococcus pneumoniae strains were examined to determine the serotype distribution and susceptibility to selected antibiotics. About 50% of them were invasive isolates. The strains were isolated from patients of all age groups and 33.55% were isolated from children below 5 years. The majority was isolated from blood (48.53%) and other sterile specimens (6.30%). Community acquired pneumonia (41.70%) is the most common diagnosis followed by sepsis (9.54%). Serotyping was done using Pneumotest Plus-Kit and antibiotic susceptibility pattern was determined by modified Kirby-Bauer disk diffusion method and measurement of minimum inhibitory concentration (MIC) using E-test strip. Ten most common serotypes were 19F (15.02%), 6B (10.62%), 19A (6.93%), 14 (6.70%), 1 (5.08%), 6A (5.08%), 23F (4.85%), 18C (3.93%), 3 (2.08%) and 5 (1.85%). Penicillin MIC ranged between ≤ 0.012-4 μg/ml with MIC₉₀ of 1 μg/ml. Penicillin resistant rate is 31.78%. The majority of penicillin less-susceptible strains belonged to serotype 19F followed by 19A and 6B. Based on the serotypes distribution 22 (44.00%), 28 (56.00%) and 39 (78.00%) of the invasive isolates from children ≤ 2 years were belonged to serotypes included in the PCV7, PCV10 and PCV13, respectively.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology
  11. High Helicobacter pylori resistance to metronidazole but zero or low resistance to clarithromycin, levofloxacin, and other antibiotics in Malaysia
    Goh KL, Navaratnam P
    Helicobacter, 2011 Jun;16(3):241-5.
    PMID: 21585611 DOI: 10.1111/j.1523-5378.2011.00841.x
    OBJECTIVE: Bacterial resistance to antibiotics is the single most important determinant of treatment success. The objective of this study was to determine the prevalence of Helicobacter pylori resistance to clarithromycin, amoxicillin, metronidazole, tetracycline, levofloxacin, rifabutin, and furazolidone in our local bacterial strains.
    METHODS: Samples from consecutive ninety patients were obtained for culture and sensitivity testing. Resistance to individual antibiotics were tested using the E-test and MIC(90) read from the strips. Resistance to rifampicin and nitrofurantoin were used as a surrogate for rifabutin and furazolidine.
    RESULTS: There was a high prevalence of resistance to metronidazole 68/90 (75.5%). No male (34/45 (75.5%) versus female (35/45 (77.7%) difference in frequency of metronidazole resistance was noted (p = 1.000). There was zero resistance (0) to clarithromycin, levofloxacin, amoxicillin, and nitrofurantoin/furazolidone. Resistance to rifampicin/rifabutin was for breakpoints of 1 and 4 μg/mL of 14.4 and 2.2% respectively.
    CONCLUSIONS: Although there was high bacterial resistance to metronidazole, the absence of resistance particularly to the key antibiotics used in H. pylori eradication therapy: clarithromycin and levofloxacin is reassuring to note. Continued monitoring of antibiotic resistance should be carried out.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  12. Antibacterial activity and morphological changes of Pseudomonas aeruginosa cells after exposure to Vernonia cinerea extract
    Latha LY, Darah I, Kassim MJ, Sasidharan S
    Ultrastruct Pathol, 2010 Aug;34(4):219-25.
    PMID: 20594042 DOI: 10.3109/01913121003651513
    The antibacterial activity of Vernonia cinerea (L.) extract was investigated using the broth dilution method. The extract showed a favorable antimicrobial activity against Pseudomonas aeruginosa with a minimum inhibition concentration (MIC) value of 3.13 mg/mL. V. cinerea extract at (1/2), 1, or 2 times the MIC significantly inhibited bacterial growth with a noticeable drop in optical density (OD) of the bacterial culture, thus confirming the antibacterial activity of the extract on P. aeruginosa. Imaging using scanning (SEM) and transmission (TEM) electron microscopy was done to determine the major alterations in the microstructure of the extract-treated P. aeruginosa. The main abnormalities noted via SEM and TEM studies were the alteration in morphology of the bacterial cells. The main reason for this destruction was the severe alterations of the cell wall with the formation of holes, invaginations, and morphological disorganization caused by the extract. The authors conclude that the extract may be used as a candidate for the development of antimicrobial agents.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  13. Fulltext Cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia
    Ding WY, Lee CK, Choon SE
    Int J Dermatol, 2010 Jul;49(7):834-41.
    PMID: 20618508 DOI: 10.1111/j.1365-4632.2010.04481.x
    BACKGROUND: Adverse drug reactions are most commonly cutaneous in nature. Patterns of cutaneous adverse drug reactions (ADRs) and their causative drugs vary among the different populations previously studied.
    OBJECTIVE: Our aim is to determine the clinical pattern of drug eruptions and the common drugs implicated, particularly in severe cutaneous ADRs in our population.
    MATERIALS AND METHODS: This study was done by analyzing the database established for all adverse cutaneous drug reactions seen from January 2001 until December 2008.
    RESULTS: A total of 281 cutaneous ADRs were seen in 280 patients. The most common reaction pattern was maculopapular eruption (111 cases, 39.5%) followed by Stevens-Johnson Syndrome (SJS: 79 cases, 28.1%), drug reaction with eosinophilia and systemic symptoms (DRESS: 19 cases, 6.8%), toxic epidermal necrolysis (TEN: 16 cases, 5.7 %), urticaria/angioedema (15 cases, 5.3%) and fixed drug eruptions (15 cases, 5.3%). Antibiotics (38.8%) and anticonvulsants (23.8%) accounted for 62.6% of the 281 cutaneous ADRs seen. Allopurinol was implicated in 39 (13.9%), carbamazepine in 29 (10.3%), phenytoin in 27 (9.6%) and cotrimoxazole in 26 (9.3%) cases. Carbamazepine, allopurinol and cotrimoxazole were the three main causative drugs of SJS/TEN accounting for 24.0%, 18.8% and 12.5% respectively of the 96 cases seen whereas DRESS was mainly caused by allopurinol (10 cases, 52.6%) and phenytoin (3 cases, 15.8%).
    DISCUSSION: The reaction patterns and drugs causing cutaneous ADRs in our population are similar to those seen in other countries although we have a much higher proportion of severe cutaneous ADRs probably due to referral bias, different prescribing habit and a higher prevalence of HLA-B*1502 and HLA-B*5801 which are genetic markers for carbamazepine-induced SJS/TEN and allopurinol-induced SJS/TEN/DRESS respectively.
    CONCLUSION: The most common reaction pattern seen in our study population was maculopapular eruptions. Antibiotics, anticonvulsants and NSAIDs were the most frequently implicated drug groups. Carbamazepine and allopurinol were the two main causative drugs of severe ADRs in our population.
    Matched MeSH terms: Anti-Bacterial Agents/adverse effects*
  14. Fulltext Green synthesis and antibacterial effect of silver nanoparticles using Vitex negundo L
    Zargar M, Hamid AA, Bakar FA, Shamsudin MN, Shameli K, Jahanshiri F, et al.
    Molecules, 2011 Aug 08;16(8):6667-76.
    PMID: 25134770 DOI: 10.3390/molecules16086667
    Different biological methods are gaining recognition for the production of silver nanoparticles (Ag-NPs) due to their multiple applications. One of the most important applications of Ag-NPs is their use as an anti-bacterial agent. The use of plants in the synthesis of nanoparticles emerges as a cost effective and eco-friendly approach. In this study the biosynthesis of silver nanoparticles using Vitex negundo L. extract and its antimicrobial properties has been reported. The resulting silver particles are characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD) and UV-Visible (UV-Vis) spectroscopic techniques. The TEM study showed the formation of silver nanoparticles in the 10-30 nm range and average 18.2 nm in size. The XRD study showed that the particles are crystalline in nature, with a face centered cubic (fcc) structure. The silver nanoparticles showed the antimicrobial activity against Gram positive and Gram negative bacteria. Vitex negundo L. was found to display strong potential for the synthesis of silver nanoparticles as antimicrobial agents by rapid reduction of silver ions (Ag+ to Ag0).
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  15. Subacute osteomyelitis masquerading as primary bone sarcoma: report of six cases
    Dhanoa A, Singh VA
    Surg Infect (Larchmt), 2010 Oct;11(5):475-8.
    PMID: 20858161 DOI: 10.1089/sur.2009.011
    We report a series of six immunocompetent patients who were believed initially to have primary bone sarcomas, but turned out to have subacute osteomyelitis.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
  16. Lactic acid as a potential decontaminant of selected foodborne pathogenic bacteria in shrimp (Penaeus merguiensis de Man)
    Shirazinejad A, Ismail N, Bhat R
    Foodborne Pathog Dis, 2010 Dec;7(12):1531-6.
    PMID: 21034165 DOI: 10.1089/fpd.2010.0616
    Fresh raw shrimps were dipped for 10, 20, and 30 min at room temperature (25°C ± 1°C) in lactic acid (LA; 1.5%, 3.0%, v/v) to evaluate their antipathogenic effects against Vibrio cholerae, Vibrio parahaemolyticus, Salmonella entreitidis, and Escherichia coli O157:H7 inoculated at a level of 10(5) CFU/g. Significant reductions in the population of all these pathogenic bacteria were recorded after dipping treatments, which were correlated to the corresponding LA concentrations and treatment time. With respect to the microbial quality, 3.0% LA treatment for 10 min was acceptable in reducing the pathogenic bacteria. Additionally, sensory evaluation results revealed a 10-min dip in 3.0% LA to be more acceptable organoleptically compared with 20 and 30 min of treatments. Results of the present study are envisaged to be useful for commercial applications for effective decontamination of shrimp.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  17. Pediatric subperiosteal orbital abscess secondary to acute sinusitis: a 5-year review
    Tan VES
    Am J Otolaryngol, 2011 Jan-Feb;32(1):62-8.
    PMID: 20031268 DOI: 10.1016/j.amjoto.2009.10.002
    Objective: Subperiosteal orbital abscesses (SPOAs) secondary to acute sinusitis are rare occurrences in the pediatric age group, more so in the neonatal period. Here, a rare case of SPOA in a 38-day-old newborn later drained via endoscopic sinus surgery is included also. This review describes the demographic data, clinical history, treatment, microbiology results, complications, and outcome.
    Methods: The admission records for all the patients who were admitted to the Pediatric Surgical Ward in Sarawak General Hospital, Kuching, Malaysia, between January 2004 and May 2009 were retrospectively reviewed. Records of patients who presented with preseptal cellulitis, orbital cellulitis, subperiosteal abscess (extraconal), orbital abscess (intraconal), and cavernous sinus thrombosis were closely studied. Ophthalmology consultations were obtained in all these cases. Ultimately, 3 patients having SPOA secondary to acute sinusitis were selected for this review.
    Results: All patients were male with rapid onset of periorbital signs, absence of purulent rhinorrhea, and presence of significant thrombocytosis (exceeding 500 × 109/L). The 38-day-old newborn had mixed infection of methicillin-resistant coagulase-negative Staphylococcus bacteremia and local Acinetobacter eye infection with Staphylococcus aureus in the SPOA. All had medially located SPOA that was adequately drained via endoscopic sinus surgery, resulting in full recovery.
    Conclusion: Newborns with preexisting risk factors and immature immunity are at risk of severe and rare infections. Contrast-enhanced paranasal sinus computed tomographic scan is mandatory and reliable to differentiate preseptal and postseptal orbital infection, as both conditions can present similarly and rapidly deteriorate. In the contrast-enhanced computed tomography–demonstrable SPOA, endoscopic sinus surgery drainage of the abscess proved to be safe and reliable as the main treatment modality. All patients recovered well without complications.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use
  18. Antibiograms and molecular subtypes of methicillin-resistant Staphylococcus aureus in local teaching hospital, Malaysia
    Thong KL, Junnie J, Liew FY, Yusof MY, Hanifah YA
    J Microbiol Biotechnol, 2009 Oct;19(10):1265-70.
    PMID: 19884790
    The objectives of this study were to determine the antibiotypes, SCCmec subtypes, PVL carriage, and genetic diversity of MRSA strains from a tertiary hospital. Sixtysix MRSA strains were selected randomly (2003, 2004, and 2007) and tested for the Panton-Valentine leukocidin gene, mecA gene, and SCCmec type via a PCR. The antibiograms were determined using a standard disc diffusion method, and the genetic diversity of the isolates was determined by PFGE. Thirty-four antibiograms were obtained, with 55% of the 66 strains exhibiting resistance to more than 4 antimicrobials. All the isolates remained susceptible to vancomycin, and low resistance rates were noted for fusidic acid (11%), rifampicin (11%), and clindamycin acid (19%). The MRSA isolates that were multisensitive (n=12) were SCCmec type IV, whereas the rest (multiresistant) were SCCmec type III. Only two isolates (SCCmec type IV) tested positive for PVL, whereas all the isolates were mecA-positive. The PFGE was very discriminative and subtyped the 66 isolates into 55 pulsotypes (F=0.31-1.0). The multisensitive isolates were distinctly different from the multidrug-resistant MRSA. In conclusion, no vancomycin-resistant isolate was observed. The Malaysian MDR MRSA isolates were mostly SCCmec type III and negative for PVL. These strains were genetically distinct from the SCCmec type IV strains, which were sensitive to SXT, tetracycline, and erythromycin. Only two strains were SCCmec IV and PVL-positive. The infections in the hospital concerned were probably caused by multiple subtypes of MRSA.
    Matched MeSH terms: Anti-Bacterial Agents/pharmacology*
  19. Impact of a training intervention on use of antimicrobials in teaching hospitals
    Akter SF, Heller RD, Smith AJ, Milly AF
    J Infect Dev Ctries, 2009 Jul 01;3(6):447-51.
    PMID: 19762958
    BACKGROUND: Antimicrobials are often used inappropriately in paediatric wards of medical college hospitals in Bangladesh. Most of the antimicrobials are prescribed based on clinical grounds-signs and symptoms. This intervention study assessed the effectiveness of a training intervention on antimicrobials prescribing by physicians in paediatric wards of tertiary care level hospitals.

    METHODOLOGY: This study was conducted at medical college hospitals in Bangladesh during the period from 1998 through 2000. The pre-intervention survey of antimicrobial use was conducted during 1998 in five hospitals. The post-intervention survey was conducted after the interactive training during the succeeding year in three of the original five hospitals, of which one was the intervention hospital and two control hospitals. A total of 3,466 admitted paediatric patients' treatment charts (2,171 in the pre-intervention and 1,295 in the post-intervention surveys) were reviewed.

    RESULTS: The most commonly used antimicrobials were ampicillin, gentamicin, amoxicillin, cloxacillin and ceftriaxone. Appropriate antimicrobial therapy for the most common infectious diseases, pneumonia and diarrhoea, increased by 16.4% and 56.8% respectively in the intervention hospital compared with the two control hospitals and these improvements were significant (p = < 0.001 and p = 0.002, for pneumonia and diarrhoea respectively).

    CONCLUSIONS: An interactive, focussed educational intervention, targeted at physicians, appears to have been effective in improving appropriate antimicrobial prescribing for the most common paediatric infectious diseases in a medical college hospital in Bangladesh.

    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
  20. Fulltext First isolation of Burkholderia tropica from a neonatal patient successfully treated with imipenem
    Deris ZZ, Van Rostenberghe H, Habsah H, Noraida R, Tan GC, Chan YY, et al.
    Int J Infect Dis, 2010 Jan;14(1):e73-4.
    PMID: 19482535 DOI: 10.1016/j.ijid.2009.03.005
    We report the first case of a human Burkholderia tropica infection. The patient was a premature neonate who had necrotizing enterocolitis with bowel perforation requiring surgical intervention. The stoma care and difficulties in feeding were a chronic problem. At the age of almost 4 months he developed septicemia due to B. tropica. Three consecutive blood cultures grew this organism. The organism was cleared from the blood after a course of imipenem and resolution of post-operative ileus. Our case suggests that environmental and plant pathogens can cause human infection especially in those in an immunocompromised condition.
    Matched MeSH terms: Anti-Bacterial Agents/therapeutic use*
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