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Search Results: 1 - 10 of 20265 matches for " Chang-Phone Fung "
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Long-Term Mortality of Patients with Septic Ocular or Central Nervous System Complications from Pyogenic Liver Abscess: A Population-Based Study
Yi-Tsung Lin, Chia-Jen Liu, Tzeng-Ji Chen, Chang-Phone Fung
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0033978
Abstract: Background Taiwan is endemic for pyogenic liver abscess (PLA). Septic ocular or central nervous system (CNS) complications derived from PLA can result in catastrophic disability. We investigated the epidemiology and long-term prognosis of PLA patients with septic ocular or CNS complications over an 8-year period. Methodology/Principal Findings We extracted 21,307 patients with newly diagnosed PLA from a nationwide health registry in Taiwan between 2000 and 2007. The frequency of and risk factors for PLA with septic ocular or CNS complications were determined. The 2-year survival of these patients was compared between those with and without septic ocular or CNS complications. Septic ocular or CNS complications accounted for 2.1% of all PLA patients. Age and the Charlson comorbidity index were significantly lower in PLA patients with ocular or CNS complications than those without. Diabetes and age <65 years were independent predictors of septic ocular or CNS complications. The 2-year mortality of patients with septic ocular or CNS complications was similar to those without complications (24.8% vs. 27.5%, p = 0.502). However, among patients <65 years old and a Charlson index ≤1, the 2-year mortality was significantly higher in those with than without complications (18.6% vs. 11.8%, p = 0.001). Conclusions/Significance Physicians should recognize that catastrophic disability due to ocular or neurological complications from PLA could lead to a poor long-term prognosis, and should follow-up these patients more closely.
Bacteremic community-acquired pneumonia due to Klebsiella pneumoniae: Clinical and microbiological characteristics in Taiwan, 2001-2008
Yi-Tsung Lin, Yuan-Yu Jeng, Te-Li Chen, Chang-Phone Fung
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-307
Abstract: The clinical characteristics of bacteremic community-acquired pneumonia (CAP) in adults due to K. pneumoniae were compared to those of adults with bacteremic CAP due to Streptococcus pneumoniae at a tertiary medical center in Taiwan from 2001-2008. Risk factors for mortality of bacteremic CAP due to K. pneumoniae were analyzed. All clinical isolates of K. pneumoniae were examined for capsular serotypes, hypermucoviscosity phenotype, aerobactin and rmpA gene.K. pneumoniae was the dominant cause of bacteremic CAP and was associated with a more fulminant course and a worse prognosis than bacteremic CAP due to Streptococcus pneumoniae. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality. Serotype K1 and K2 comprised around half of all isolates. There were no significant differences in the clinical characteristics of patients with bacteremic CAP due to K1/K2 and non-K1/K2 isolates. Hypermucoviscosity phenotype as well as the aerobactin and rmpA genes were highly prevalent in the K. pneumoniae isolates.K. pneumoniae continued to be the dominant cause of bacteremic CAP in Taiwanese adults during 2001-2008. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality from K. pneumoniae bacteremic CAP. Serotypes K1/K2 comprised around half of all isolates, but did not predispose patients to a poor clinical outcome. Physicians should be aware of the poor prognosis of any patient with bacteremic K. pneumoniae CAP and monitor these patients more closely.Klebsiella pneumoniae is the major cause of liver abscess, Gram-negative bacillary meningitis, brain abscess, lung abscess, thoracic empyema, prostatic abscess, deep neck infection and complicated skin and soft tissue infections in Taiwan [1], and comprised 4.8% of the common causative pathogens of community-acquired pneumonia (CAP) in a multi-center survey [2]. Although K. pneumoniae is
Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics
Lin Yi-Tsung,Wang Fu-Der,Wu Ping-Feng,Fung Chang-Phone
BMC Infectious Diseases , 2013, DOI: 10.1186/1471-2334-13-56
Abstract: Background Klebsiella pneumoniae liver abscess (KPLA) has been reported with increasing frequency in East Asian countries in the past 3 decades, especially in Taiwan and Korea. Diabetes is a well-known risk factor for KPLA and highly associated with septic metastatic complications from KPLA. We investigated the association of glycemic control in diabetic patients with the clinical characteristics of KPLA in Taiwan. Methods Adult diabetic patients with KPLA were identified retrospectively in a medical center from January 2007 to January 2012. Clinical characteristics were compared among patients with different levels of current hemoglobin A1c (HbA1c). Risk factors for metastatic infection from KPLA were analyzed. Results Patients with uncontrolled glycemia (HbA1c ≥ 7%) were significantly younger than those with controlled glycemia (HbA1c < 7%). Patients with uncontrolled glycemia had the trend to have a higher rate of gas-forming liver abscess, cryptogenic liver abscess, and metastatic infection than those with controlled glycemia. Cryptogenic liver abscess and metastatic infection were more common in the poor glycemic control group (HbA1c value >; 10%) after adjustment with age. HbA1c level and abscess < 5 cm were independent risk factors for metastatic complications from KPLA. Conclusions Glycemic control in diabetic patients played an essential role in the clinical characteristics of KPLA, especially in metastatic complications from KPLA.
Single or in Combination Antimicrobial Resistance Mechanisms of Klebsiella pneumoniae Contribute to Varied Susceptibility to Different Carbapenems
Yu-Kuo Tsai, Ci-Hong Liou, Chang-Phone Fung, Jung-Chung Lin, L. Kristopher Siu
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079640
Abstract: Resistance to carbapenems has been documented by the production of carbapenemase or the loss of porins combined with extended-spectrum β-lactamases or AmpC β-lactamases. However, no complete comparisons have been made regarding the contributions of each resistance mechanism towards carbapenem resistance. In this study, we genetically engineered mutants of Klebsiella pneumoniae with individual and combined resistance mechanisms, and then compared each resistance mechanism in response to ertapenem, imipenem, meropenem, doripenem and other antibiotics. Among the four studied carbapenems, ertapenem was the least active against the loss of porins, cephalosporinases and carbapenemases. In addition to the production of KPC-2 or NDM-1 alone, resistance to all four carbapenems could also be conferred by the loss of two major porins, OmpK35 and OmpK36, combined with CTX-M-15 or DHA-1 with its regulator AmpR. Because the loss of OmpK35/36 alone or the loss of a single porin combined with blaCTX-M-15 or blaDHA-1-ampR expression was only sufficient for ertapenem resistance, our results suggest that carbapenems other than ertapenem should still be effective against these strains and laboratory testing for non-susceptibility to other carbapenems should improve the accurate identification of these isolates.
Do Neutrophils Play a Role in Establishing Liver Abscesses and Distant Metastases Caused by Klebsiella pneumoniae?
Jung-Chung Lin,Feng-Yee Chang,Chang-Phone Fung,Kuo-Ming Yeh,Chiung-Tong Chen,Yu-Kuo Tsai,L. Kristopher Siu
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0015005
Abstract: Serotype K1 Klebsiella pneumoniae is a major cause of liver abscesses and endophthalmitis. This study was designed to identify the role of neutrophils in the development of distant metastatic complications that were caused by serotype K1 K. pneumoniae. An in vitro cellular model was used to assess serum resistance and neutrophil-mediated killing. BALB/c mice were injected with neutrophils containing phagocytosed K. pneumoniae. Serotype K1 K. pneumoniae was significantly more resistant to serum killing, neutrophil-mediated phagocytosis and intra-cellular killing than non-K1 isolates (p<0.01). Electron microscopic examination had similar findings as in the bioassay findings. Intraperitoneal injection of neutrophils containing phagocytosed serotype K1 K. pneumoniae led to abscess formation in multiple sites including the subcutaneous tissue, lung, and liver, whereas no abscess formation was observed in mice injected with non-K1 isolates. The resistance of serotype K1 K. pneumoniae to complement- and neutrophil-mediated intracellular killing results in the dissemination of K. pneumoniae via the bloodstream. Escape from neutrophil intracellular killing may contribute to the dissemination and establishment of distant metastases. Thus, neutrophils play a role as a vehicle for helping K. pneumoniae and contributing to the establishment of liver abscess and distant metastatic complications.
Comparative antimicrobial susceptibility of aerobic and facultative bacteria from community-acquired bacteremia to ertapenem in Taiwan
Sai-Cheong Lee, Shie-Shian Huang, Chao-Wei Lee, Chang-Phone Fung, Ning Lee, Wen-Bin Shieh, LK Siu
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-79
Abstract: Aerobic and facultative bacteria isolated from blood obtained from hospitalized patients with community-acquired bacteremia within 48 hours of admission between August 1, 2004 and September 30, 2004 in Chang Gung Memorial Hospital at Keelung, Taiwan, were identified using standard procedures. Antimicrobial susceptibility was evaluated by Etest according to the standard guidelines provided by the manufacturer and document M100-S16 Performance Standards of the Clinical Laboratory of Standard Institute. Antimicrobial agents including cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin were used against the bacterial isolates to test their MICs as determined by Etest. For Staphylococcus aureus isolates, MICs of oxacillin were also tested by Etest to differentiate oxacillin-sensitive and oxacillin-resistant S. aureus.Ertapenem was highly active in vitro against many aerobic and facultative bacterial pathogens commonly recovered from patients with community-acquired bacteremia (128/159, 80.5 %). Ertapenem had more potent activity than ceftriaxone, piperacillin-tazobactam, or ciprofloxacin against oxacillin-susceptible S. aureus (17/17, 100%)and was more active than any of these agents against enterobacteriaceae (82/82, 100%).Based on the microbiology pattern of community-acquired bacteremia, initial empiric treatment that requires coverage of a broad spectrum of both gram-negative and gram-positive aerobic bacteria, such as ertapenem, may be justified in moderately severe cases of community-acquired bacteremia in non-immunocompromised hosts.Ertapenem is a once-a-day parenteral β-lactam antimicrobial agent [1-6]. Preclinical in vitro studies have shown that this structurally unique carbapenem has excellent activity against many gram-positive and gram-negative aerobic, facultative, and anaerobic bacteria that, in general, are associated with community-acquired infections [1-6]. However, it h
High-dose daptomycin and fosfomycin treatment of a patient with endocarditis caused by daptomycin-nonsusceptible Staphylococcus aureus: Case report
Liang-Yu Chen, Cheng-Hsiung Huang, Shu-Chen Kuo, Chen-Yuan Hsiao, Mei-Lin Lin, Fu-Der Wang, Chang-Phone Fung
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-152
Abstract: We describe the emergence of DNS S. aureus. in a patient with implantable cardioverter-defibrillator (ICD) device -related endocarditis who was priorily treated with daptomycin. Metastatic dissemination as osteomyelitis further complicated the management of endocarditis. The dilemma was successfully managed by surgical removal of the ICD device and combination antimicrobial therapy with high-dose daptomycin and fosfomycin.Surgical removal of intracardiac devices remains an important adjunctive measure in the treatment of endocarditis. Our case suggests that combination therapy is more favorable than single-agent therapy for infections caused by DNS S. aureus.Infective endocarditis is a clinically significant disease with mortality ranging from 16% to 25% [1,2], and Staphylococcus aureus is reported as the most common pathogen, accounting for 31.4% of cases in developing countries [3]. In addition to methicillin-resistant S. aureus (MRSA), the emergence of vancomycin-resistant S. aureus also became a major problem after the first report in Japan in 1997 [4].Daptomycin is a 13-aminoacid compound derived from fermentation of Streptomyces roseosporus and is a new treatment option for S. aureus endocarditis, including vancomycin-resistant S. aureus [5,6]. The once daily dosing of daptomycin 6 mg/kg approved by the USA Food and Drug administration showed non-inferiority to the standard therapy for treating S. aureus bacteremia and endocarditis [7]. However, increased incidence of daptomycin-nonsusceptible (DNS) S. aureus was reported recently. Mutations in the mprF and yycFG genes, related to membrane fluidity changes or fatty acid biosynthesis, were identified recently as possible contributors to daptomycin nonsusceptibility [5,8]. Effective management in case of DNS S. aureus infections is an important issue nowadays.Fosfomycin, a phosphonic acid derivative (cis-1,2-epoxypropyl phosphonic acid), was initially described and isolated in 1969 from cultures of Streptomyces
Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy chinese and overseas chinese adults in Asian countries
Yi-Tsung Lin, L Kristopher Siu, Jung-Chung Lin, Te-Li Chen, Chih-Peng Tseng, Kuo-Ming Yeh, Feng-Yee Chang, Chang-Phone Fung
BMC Microbiology , 2012, DOI: 10.1186/1471-2180-12-13
Abstract: Serotypes K1/K2 accounted for 9.8% of all K. pneumoniae isolates from stools in all countries. There was no significant difference in the prevalence of K1/K2 isolates among the countries excluding Thailand and Vietnam. The antimicrobial susceptibility pattern was nearly the same in K. pneumoniae isolates. The result of pulsed-field gel electrophoresis revealed no major clonal cluster of serotype K1 isolates.The result showed that Chinese ethnicity itself might be a major factor predisposing to intestinal colonization by serotype K1/K2 K. pneumoniae isolates. The prevalent serotype K1/K2 isolates may partially correspond to the prevalence of K. pneumoniae liver abscess in Asian countries.Klebsiella pneumoniae is responsible for a wide spectrum of clinical syndromes, including purulent infections, urinary tract infections, pneumonia, bacteremia, septicemia, and meningitis [1]. In the past three decades, K. pneumoniae has emerged as the single leading cause of pyogenic liver abscess in East Asian countries, especially in Taiwan [2-7]. An invasive syndrome of liver abscess complicated by meningitis, endophthalmitis or other metastatic suppurative foci has been reported, and capsular serotypes K1 and K2 of K. pneumoniae are thought to the major virulence determinants responsible for this syndrome [3,6,8]. In an analysis of K. pneumoniae liver abscess from two hospitals in New York by Rahimian et al. [9], 78.3% of patients were of Asian origin. These findings raise the possibility that genetic susceptibility to or geographic distribution patterns of virulent K. pneumoniae subtypes may play important roles [10].The intestine is one of the major reservoirs of K. pneumoniae, and epidemiological studies have suggested that the majority of K. pneumoniae infections are preceded by colonization of the gastrointestinal tract [11]. The possibility of fecal-oral transmission has been raised on the basis of molecular typing of isolates from siblings, family members, and the environm
National Surveillance Study on Carbapenem Non-Susceptible Klebsiella pneumoniae in Taiwan: The Emergence and Rapid Dissemination of KPC-2 Carbapenemase
Sheng-Kang Chiu, Tsu-Lan Wu, Yin-Ching Chuang, Jung-Chung Lin, Chang-Phone Fung, Po-Liang Lu, Jann-Tay Wang, Lih-Shinn Wang, L. Kristopher Siu, Kuo-Ming Yeh
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0069428
Abstract: Objectives The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals. Methods We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type. Results The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 blaIMP-8 and 2 blaVIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 blaKPC-2, 7 blaVIM-1, 6 blaIMP-8, and 1 blaNDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype. Conclusions In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.
Formalin-Inactivated EV71 Vaccine Candidate Induced Cross-Neutralizing Antibody against Subgenotypes B1, B4, B5 and C4A in Adult Volunteers
Ai-Hsiang Chou, Chia-Chyi Liu, Jui-Yuan Chang, Renee Jiang, Yi-Chin Hsieh, Amanda Tsao, Chien-Long Wu, Ju-Lan Huang, Chang-Phone Fung, Szu-Min Hsieh, Ya-Fang Wang, Jen-Ren Wang, Mei-Hua Hu, Jen-Ron Chiang, Ih-Jen Su, Pele Choi-Sing Chong
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079783
Abstract: Background Enterovirus 71 (EV71) has caused several epidemics of hand, foot and mouth diseases (HFMD) in Asia. No effective EV71 vaccine is available. A randomized and open-label phase I clinical study registered with ClinicalTrials.gov #NCT01268787, aims to evaluate the safety, reactogenicity and immunogenicity of a formalin-inactivated EV71 vaccine candidate (EV71vac) at 5- and 10-μg doses. In this study we report the cross-neutralizing antibody responses from each volunteer against different subgenotypes of EV71 and CVA16. Methods Sixty eligible healthy adults were recruited and vaccinated. Blood samples were obtained on day 0, 21 and 42 and tested against B1, B4, B5, C2, C4A, C4B and CVA16 for cross-neutralizing antibody responses. Results The immunogenicity of both 5- and 10- μg doses were found to be very similar. Approximately 45% of the participants had <8 pre-vaccination neutralization titers (Nt) against the B4 vaccine strain. After the first EV71vac immunization, 95% of vaccinees have >4-fold increase in Nt, but there was no further increase in Nt after the second dose. EV71vac induced very strong cross-neutralizing antibody responses in >85% of volunteers without pre-existing Nt against subgenotype B1, B5 and C4A. EV71vac elicited weak cross-neutralizing antibody responses (~20% of participants) against a C4B and Coxsackie virus A16. Over 90% of vaccinated volunteers did not develop cross-neutralizing antibody responses (Nt<8) against a C2 strain. EV71vac can boost and significantly enhance the neutralizing antibody responses in volunteers who already had pre-vaccination antibodies against EV71 and/or CVA16. Conclusion EV71vac is efficient in eliciting cross-neutralizing antibody responses against EV71 subgenotypes B1, B4, B5, and C4A, and provides the rationale for its evaluation in phase II clinical trials. Trial Registration ClinicalTrials.gov __NCT01268787
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