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author:("hsieh, Po-Ren")
1.  Cronobacter Infections Not from Infant Formula, Taiwan 
Emerging Infectious Diseases  2013;19(1):167-169.
doi:10.3201/eid1901.120774
PMCID: PMC3557994  PMID: 23260041
Cronobacter sakazakii; infection; Taiwan; bacteria; adults; immunocompromised; infant formula
2.  Brucellosis, Taiwan, 2011 
Emerging Infectious Diseases  2011;17(12):2374-2375.
doi:10.3201/eid1712.110739
PMCID: PMC3311202  PMID: 22172150
Brucellosis; Taiwan; zoonoses; bacteria
3.  Disseminated Mycobacterium abscessus Infection and Showerheads, Taiwan 
Emerging Infectious Diseases  2011;17(11):2077-2078.
doi:10.3201/eid1711.110050
PMCID: PMC3310555  PMID: 22099106
Mycobacterium abscessus; bacteremic lymphadenitis; Sjögren syndrome; showerheads; bacteria; Taiwan; letter
4.  Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry Can Accurately Differentiate between Mycobacterium masilliense (M. abscessus subspecies bolletti) and M. abscessus (Sensu Stricto) 
Journal of Clinical Microbiology  2013;51(9):3113-3116.
Among 36 Mycobacterium masilliense and 22 M. abscessus isolates identified by erm(41) PCR and sequencing analysis of rpoB and 23S rRNA genes, the rate of accurate differentiation between these two subspecies was 100% by cluster analysis of spectra generated by Bruker Biotyper matrix-assisted laser desorption ionization–time of flight mass spectrometry.
doi:10.1128/JCM.01239-13
PMCID: PMC3754645  PMID: 23824775
5.  Listeriosis, Taiwan, 1996–2008 
Emerging Infectious Diseases  2011;17(9):1731-1733.
During 1996–2008, a total of 48 patients with listeriosis were identified at a Taiwan hospital. Average annual incidence increased from 0.029 to 0.118 cases per 1,000 admissions before and after January 2005. Serotype 1/2b predominated; serotype 4b emerged since 2004. Food monitoring and disease surveillance systems could help control listeriosis in Taiwan.
doi:10.3201/eid1709.110093
PMCID: PMC3322081  PMID: 21888806
listeriosis; Listeria; bacteria; clustering; zoonoses; Taiwan; dispatch
6.  Decline in the incidence of invasive pneumococcal disease at a medical center in Taiwan, 2000–2012 
Background
It is essential to investigate the serotype distribution of pneumococcal diseases in each region and its associated clinical features. This study investigated the annual incidence of invasive pneumococcal disease (IPD) and the distribution of serotypes of isolates causing IPD at a medical center in northern Taiwan during the period 2000 to 2012.
Methods
Serotypes of all available Streptococcus pneumoniae isolates causing IPD were determined using the latex agglutination test.
Results
During the study period, the annual incidence (per 10,000 admissions) of IPD decreased significantly from 9.8 in 2000 to 2.1 in 2012 (P < 0.001). The annual incidence of all-cause bacteremia, primary pneumococcal bacteremia, bacteremic pneumonia, peritonitis, and meningitis also decreased significantly during the study period (P < 0.05). In contrast to the decrease in annual incidence of pneumococcal serotypes 14, 23F and 6B, the incidence and the proportion of serotype 19A significantly increased with time (P < 0.001). The coverage rate of 7-valent protein conjugated vaccine (PCV-7) and PCV-10 decreased significantly; however, the coverage rate of PCV-13 and pneumococcal polysaccharide vaccine (PPV-23) remained stable over time. Serotype 14 and 19A isolates were commonly isolated from blood and pleural effusion, respectively. Serotypes 14 and 23F were the two most common serotypes found in adult patients, and serotypes 14 and 19A were the two most common serotypes isolated from children.
Conclusions
Although the incidence of IPD has decreased, serotype 19A is an emerging problem in Taiwan. The distribution of serotypes of pneumococci varied with clinical symptoms and age. As the changing distribution of pneumococcal serotype with time, the coverage rate of pneumococcal vaccines would be different.
doi:10.1186/1471-2334-14-76
PMCID: PMC3927834  PMID: 24512501
Invasive pneumococcal disease; Incidence; Streptococcus pneumoniae; Serotypes
7.  Risk Factors for Healthcare-Associated Extensively Drug-Resistant Acinetobacter baumannii Infections: A Case-Control Study 
PLoS ONE  2014;9(1):e85973.
The emergence of extensively drug-resistant Acinetobacter baumannii (XDRAB) is a serious threat to hospitalized patients. From 2008 to 2010, surveillance detected 25 hospital-acquired infection (HAI) cases caused by XDRAB at a medical center in Taipei. The site of XDRAB infection was bloodstream (n = 8), urinary tract (n = 12), lower respiratory tract (n = 3), surgical site (n = 1), and cardiovascular (n = 1). The isolates were resistant to all currently available antibiotics except for colistin. The XDRAB isolates are genetically diverse, shown by pulsed-field gel electrophoresis, but 23 of 25 harbored class 1 integron with a 2.3-kb gene cassette. Most of these isolates carry OXA-23 (n = 21) and OXA-51-like carbapenemase genes (n = 25). To identify the risk factors, a case-control study was conducted. The 25 cases were compared with 100 controls randomly selected from hospitalized patients without XDRAB-HAIs, matched by the onset date, ward, and age, at a ratio of 1∶4. Prior use of imipenem, meropenem, piperacillin/tazobactam or fourth-generation cephalosporins (adjusted OR: 3.2, 95% CI: 1.03–10.2, P = 0.04) and >30 days bed-ridden (adjusted OR: 6.0, 95% CI: 1.3–27.6, P = 0.02) were found to be the independent risk factors for XDRAB-HAIs. These findings highlight that, even in the absence of clonal dissemination, XDRAB can emerge under the selective pressure of broad-spectrum antibiotics and causes subsequent HAIs in compromised hosts. An appropriate response to the XDRAB threat therefore should include a component of prudent use of broad-spectrum antibiotics active against gram-negative bacteria.
doi:10.1371/journal.pone.0085973
PMCID: PMC3897568  PMID: 24465819
8.  Distribution of Extended-Spectrum β-Lactamases, AmpC β-Lactamases, and Carbapenemases among Enterobacteriaceae Isolates Causing Intra-Abdominal Infections in the Asia-Pacific Region: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) 
The increasing trend of β-lactam resistance among Enterobacteriaceae is a worldwide threat. Enterobacteriaceae isolates causing intra-abdominal infections (IAI) from the Study for Monitoring Antimicrobial Resistance Trends (SMART) collected in 2008 and 2009 from the Asia-Pacific region were investigated. Detection of extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases, and carbapenemases was performed by multiplex PCR. A total of 699 Enterobacteriaceae isolates with positive genotypic results, included Escherichia coli (n = 443), Klebsiella pneumoniae (n = 187), Enterobacter cloacae (n = 45), Klebsiella oxytoca (n = 9), Citrobacter freundii (n = 5), Proteus mirabilis (n = 3), Enterobacter aerogenes (n = 2), Morganella morganii (n = 2), and one each of Enterobacter asburiae, Proteus vulgaris, and Providencia rettgeri were analyzed. Nearly 20% of these β-lactamase-producing Enterobacteriaceae isolates were from community-associated IAI. CTX-M (588 isolates, including 428 [72.8%] with CTX-M-15) was the most common ESBL, followed by SHV (n = 59) and TEM (n = 4). CMY (n = 110, including 102 [92.7%] with CMY-2) was the most common AmpC β-lactamase, followed by DHA (n = 46) and ACT/MIR (n = 40). NDM (n = 65, including 62 [95.4%] with NDM-1) was the most common carbapenemase, followed by IMP (n = 7) and OXA (n = 7). Isolates from hospital-associated IAI had more complicated β-lactamase combinations than isolates from the community. Carbapenemases were all exclusively detected in Enterobacteriaceae isolates from India, except that IMP β-lactamases were also detected in Philippines and Australia. CTX-M β-lactamases were the predominant ESBLs produced by Enterobacteriaceae causing IAI in the Asia-Pacific region. Emergence of CTX-M-15-, CMY-2-, and NDM-1-producing Enterobacteriaceae isolates is of major concern and highlights the need for further surveillance in this area.
doi:10.1128/AAC.00971-12
PMCID: PMC3697370  PMID: 23587958
9.  Bacteremia Caused by Group G Streptococci, Taiwan 
Emerging Infectious Diseases  2008;14(5):837-840.
A retrospective observational study in Taiwan, 1998–2004, identified 92 patients with group G streptococcal bacteremia; 86 had Streptococcus dysgalactiae subspecies equisimilis. The most common diagnosis was cellulitis (48 cases), followed by primary bacteremia (34 cases). Infection recurred in 9 patients. Mortality rate was low (3.3%); resistance to quinupristin-dalfopristin was high.
doi:10.3201/eid1405.070130
PMCID: PMC2600252  PMID: 18439377
Group G streptococcus; bacteremia; Taiwan; dispatch
11.  Diagnosis of Tuberculosis by an Enzyme-Linked Immunospot Assay for Interferon-γ 
Emerging Infectious Diseases  2007;13(4):553-558.
*National Taiwan University Hospital, Taipei, Taiwan,
This assay for interferon-γ can rapidly and accurately diagnose active tuberculosis in a disease-endemic area.
We evaluated an enzyme-linked immunospot assay for interferon-γ (T SPOT-TB) for rapid diagnosis of active tuberculosis (TB) in a disease-endemic area. From January to June 2005, patients whose clinical symptoms and radiographic findings were compatible with TB were recruited, and a blood sample was obtained for T SPOT-TB assay within 7 days of microbiologic studies. Sixty-five patients were studied, including 39 (60%) with active TB. Thirty-five (53.8%) patients had underlying medical conditions. Thirty-seven patients had positive cultures for Mycobacterium tuberculosis, and 11 patients had positive cultures for nontuberculous mycobacteria. The sensitivity, specificity, positive predictive value, and negative predictive value of the T SPOT-TB assay were 87.2%, 88.5%, 91.9%, and 82.1%, respectively. The accuracy of this test in diagnosing active TB is >80%, even in an area with a high incidence of nontuberculous mycobacteria disease.
doi:10.3201/eid1304.051195
PMCID: PMC2725949  PMID: 17553269
Tuberculosis; ELISPOT; latent infection; interferon-γ; research
12.  Serotype Competence and Penicillin Resistance in Streptococcus pneumoniae 
Emerging Infectious Diseases  2006;12(11):1709-1714.
Enhanced molecular surveillance of virulent clones with higher competence can detect serotype switching.
From 2003 to 2005, we prospectively collected 118 isolates of pneumococci belonging to 7 serotypes to investigate their competence under the influence of the synthetic competence-stimulating peptides. The degree of competence of the various serotypes differed significantly. Serotype 6B had the highest competence, followed by serotypes 14, 19F, 9V, 23F, 3, and 18C. Isolates belonging to serotype 6B had greater genetic diversity than isolates belonging to serotype 3, which has high genetic clustering. Isolates belonging to serotypes 3 and 18C that were 100% sensitive to penicillin were significantly less competent than isolates belonging to serotypes 6B, 14, 19F, 9V, and 23F, which were frequently resistant to penicillin. Under the 7-valent pneumococcal conjugate vaccine program, enhanced molecular surveillance of virulent clones with higher competence to detect serotype switching will become more important.
doi:10.3201/eid1211.060414
PMCID: PMC3372340  PMID: 17283621
Streptococcus pneumoniae; competence; serotype; antimicrobial resistance; research
13.  Empyema Thoracis from Salmonella Choleraesuis 
Emerging Infectious Diseases  2005;11(9):1493-1494.
doi:10.3201/eid1109.050030
PMCID: PMC3310618  PMID: 16673520
nontyphoid Salmonella; Salmonella enterica serotype Choleraesuis; empyema thoracis; letter
14.  Disseminated Coccidioidomycosis 
Emerging Infectious Diseases  2005;2(1):192-9.
doi:10.3201/eid1101.040613
PMCID: PMC3294337  PMID: 15714666
letter; coccidioidomycosis; disseminated; Taiwan
15.  Vancomycin Heteroresistance in Methicillin-resistant Staphylococcus aureus, Taiwan 
Emerging Infectious Diseases  2004;10(9):1702-1704.
doi:10.3201/eid1009.040239
PMCID: PMC3320303  PMID: 15503416
Vancomycin; Heteroresistance; Staphylococcus aureus; Taiwan; letter
16.  SARS Outbreak in Taiwan 
Emerging Infectious Diseases  2004;10(8):201-6.
doi:10.3201/eid1008.040115
PMCID: PMC3320396  PMID: 15503404
SARS; Taiwan; reply
17.  Vibrio vulnificus in Taiwan 
Emerging Infectious Diseases  2004;10(8):1363-1368.
Clinical features of 84 patients with V. vulnificus infection are analyzed and molecular features of isolates are described.
Residents in Taiwan are often exposed to marine microorganisms through seafood and occupational exposure. The number of reported cases of infection attributable to this organism has increased since the first case was reported in 1985. The increasing number of cases may be caused by greater disease activity or improved recognition by clinicians or laboratory workers. We analyze a clinical-case series of 84 patients with Vibrio vulnificus infection from 1995 to 2000 and describe the molecular epidemiologic features of pathogens isolated from these patients. The spectrum of clinical manifestations and outcomes, options of antimicrobial therapy, and virulence mechanisms were investigated. Results of molecular typing of isolates from humans and marine environment in this country had a high genetic divergence among these isolates. Education and measures are needed to prevent this emerging disease.
doi:10.3201/eid1008.040047
PMCID: PMC3320410  PMID: 15496235
Vibrio vulnificus; Taiwan; emerging; research
18.  SARS Exposure and Emergency Department Workers 
Emerging Infectious Diseases  2004;10(6):1117-1119.
Of 193 emergency department workers exposed to severe acute respiratory syndrome (SARS), 9 (4.7%) were infected. Pneumonia developed in six workers, and assays showed anti-SARS immunoglobulin (Ig) M and IgG. The other three workers were IgM-positive and had lower IgG titers; in two, mild illness developed, and one remained asymptomatic.
doi:10.3201/eid1006.030972
PMCID: PMC3323160  PMID: 15207066
SARS; serologic responses; emergency department workers
19.  Comparison of the Accuracy of Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry with That of Other Commercial Identification Systems for Identifying Staphylococcus saprophyticus in Urine 
Journal of Clinical Microbiology  2013;51(5):1563-1566.
Among 30 urinary isolates of Staphylococcus saprophyticus identified by sequencing methods, the rate of accurate identification was 100% for Bruker Biotyper matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS), 86.7% for the Phoenix PID and Vitek 2 GP systems, 93.3% for the MicroScan GP33 system, and 46.7% for the BBL CHROMagar Orientation system.
doi:10.1128/JCM.00261-13
PMCID: PMC3647924  PMID: 23390286
20.  Antimicrobial Resistance in Streptococcus pneumoniae, Taiwan 
Emerging Infectious Diseases  2002;8(12):1487-1491.
Taiwan has one of the highest levels of antibiotic-resistant pneumococcus in the world. Pneumococcal isolates not susceptible to penicillin first appeared in Taiwan in 1986; in 1995 an increase in the prevalence of nonsusceptibility to penicillins, extended-spectrum cephalosporins, trimethoprim-sulfamethoxazole, and macrolides as well as multidrug resistance began to be recognized. With the persistence of antibiotic selective pressure, resistance in some antibiotics reached a high plateau (β-lactam antibiotics) or continued to increase (macrolides), while novel resistance (fluoroquinolones) emerged in the last 3 years. Widespread distribution of some novel resistant 23F and 19F clones (and the international epidemic of 23F clones) contributes further to the rapid increase of resistance. Because Streptococcus pneumoniae is a major pathogen that causes community-acquired lower respiratory tract infections and meningitis in adults and children, antibiotic-resistance in this organism is a serious problem.
doi:10.3201/eid0812.020178
PMCID: PMC2738523  PMID: 12498668
antimicrobial resistance; Streptococcus pneumoniae; Taiwan
21.  Intravenous anidulafungin followed optionally by oral voriconazole for the treatment of candidemia in Asian patients: results from an open-label Phase III trial 
BMC Infectious Diseases  2013;13:219.
Background
Candidemia is a significant cause of morbidity and mortality in hospitalized patients, particularly in Asia. Anidulafungin has been reported to be an effective treatment for candidemia in Western populations, but little is known about its efficacy in Asian patients, where the clinical presentation and epidemiology may be different.
Methods
An open-label study of anidulafungin for the treatment of candidemia was recently conducted in several Asian countries. Treatment was initiated with intravenous anidulafungin, given for at least 5 days, with the option to complete treatment with oral voriconazole. The primary endpoint was global (clinical and microbiological) response, and the primary analysis was the proportion of patients in the modified intent-to-treat population with successful global response at the end of therapy. Secondary analyses included proportion with successful global response in clinically relevant patient subgroups. The safety and tolerability profile of anidulafungin and voriconazole in this population was also investigated.
Results
Forty-three patients were studied, including 42 in the modified intent-to-treat population. Eighteen patients were > 65 years, the largest age subgroup, and 21 had central venous catheters. The most common Candida species causing infection were C. tropicalis (n = 18) and C. albicans (n = 10). In the primary analysis, 73.8% had a successful global response at end of therapy. Success rates in subgroups were: 72.2% for C. tropicalis and 71.4% for C. albicans infection, 58.8% for patients > 65 years, and 81.0% for patients with central venous catheters. Safety and tolerability were comparable with the known profiles for anidulafungin (and voriconazole).
Conclusions
Although the epidemiology of Candida infections was different in this open-label study, the efficacy of anidulafungin in Asian patients with documented candidemia was consistent with previous studies in Western populations. No new safety concerns were identified.
Trial registration
http://www.clinicaltrials.gov identifier NCT00537329
doi:10.1186/1471-2334-13-219
PMCID: PMC3659089  PMID: 23676114
Anidulafungin; Candidemia; Asia
22.  Otitis Media and Otomastoiditis Caused by Mycobacterium massiliense (Mycobacterium abscessus subsp. bolletii) 
Journal of Clinical Microbiology  2012;50(11):3754-3756.
We describe two patients with otologic infections caused by Mycobacterium massiliense (M. abscessus subsp. bolletti) which were identified using erm(41) PCR, 23S rRNA, and rpoB gene sequence analysis. They were middle-aged adults with underlying otologic diseases and were treated successfully with clarithromycin-based combination regimens for 3 and 9 months, respectively.
doi:10.1128/JCM.01049-12
PMCID: PMC3486222  PMID: 22933592
23.  Outbreak of Klebsiella pneumoniae Carbapenemase-2-Producing K. pneumoniae Sequence Type 11 in Taiwan in 2011 
Antimicrobial Agents and Chemotherapy  2012;56(10):5016-5022.
From June to September 2011, a total of 305 ertapenem-nonsusceptible Enterobacteriaceae isolates (MICs of ertapenem ≥ 1 μg/ml) were collected from 11 hospitals in different parts of Taiwan. The MICs of 12 antimicrobial agents against these isolates were determined using the broth microdilution method, and genes for carbapenemases were detected using PCR. Genotypes of isolates possessing carbapenemase genes were identified by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. The ertapenem-nonsusceptible Enterobacteriaceae isolates included Klebsiella pneumoniae (n = 219), Escherichia coli (n = 64), Enterobacter cloacae (n = 15), and other species (n = 7). Seven (2.3%) of the ertapenem-nonsusceptible Enterobacteriaceae isolates exhibited colistin MICs of >4 μg/ml, and 24 (7.9%) were not susceptible to tigecycline (MICs > 2 μg/ml). A total of 29 (9.5%) isolates carried genes encoding carbapenemases, namely, K. pneumoniae carbapenemase-2 (KPC-2) in 16 (7.3%) isolates of K. pneumoniae (KPC-2-KP) and IMP-8 in 5 (2.3%) isolates of K. pneumoniae, 5 (33.3%) isolates of E. cloacae, 1 isolate of E. coli, 1 isolate of Klebsiella oxytoca, and one isolate of Citrobacter freundii. The 16 KPC-2-KP isolates were isolated from patients at four different hospitals in northern Taiwan. All 16 of the KPC-2-KP isolates were susceptible to amikacin and colistin and had a similar pulsotype (pulsotype 1) and the same sequence type (sequence type 11). Infections due to KPC-2-KP mainly occurred in severely ill patients in the intensive care unit (n = 14, 88%). Four patients with infections due to KPC-2-KP died within 14 days of hospitalization. The findings are the first to demonstrate intrahospital and interhospital dissemination of KPC-2-KP in northern Taiwan.
doi:10.1128/AAC.00878-12
PMCID: PMC3457369  PMID: 22802253
24.  Performance Assessment of the DR. TBDR/NTM IVD Kit for Direct Detection of Mycobacterium tuberculosis Isolates, Including Rifampin-Resistant Isolates, and Nontuberculous Mycobacteria 
Journal of Clinical Microbiology  2012;50(10):3398-3401.
We evaluated the performance of the DR. TBDR/NTM IVD kit, which was designed to detect Mycobacterium tuberculosis, rifampin-resistant M. tuberculosis, and nontuberculous mycobacteria, for detecting 110 positive and 50 negative cultures in Mycobacterium Growth Indicator Tubes. The accuracy rate of this kit for identification of Mycobacterium species was 95.5% (105/110).
doi:10.1128/JCM.01862-12
PMCID: PMC3457463  PMID: 22855520
25.  Recurrent Bacteremia Caused by the Acinetobacter calcoaceticus-Acinetobacter baumannii Complex 
Journal of Clinical Microbiology  2012;50(9):2982-2986.
This study investigated the clinical and microbiological characteristics of patients with recurrent bacteremia caused by the Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) complex at a medical center. All ACB complex isolates associated with recurrent bacteremia were identified to the genomic species level using a 16S-23S rRNA gene intergenic spacer sequence-based method. Genotypes were determined by the random amplified polymorphic DNA patterns generated by arbitrarily primed PCR and by pulsotypes generated by pulsed-field gel electrophoresis. Relapse of infection was defined as when the genotype of the recurrent isolate was identical to that of the original infecting strain. Reinfection was defined as when the genospecies or genotype of the recurrent isolate differed from that of the original isolate. From 2006 to 2008, 446 patients had ACB complex bacteremia and 25 (5.6%) had recurrent bacteremia caused by the ACB complex. Among the 25 patients, 12 (48%) had relapse of bacteremia caused by A. nosocomialis (n = 7) or A. baumannii (n = 5). Among the 13 patients with reinfection, 5 (38.5%) had reinfection caused by different genospecies of the ACB complex. Most of the patients were immunocompromised, and most of the infection foci were catheter-related bloodstream infections. The overall in-hospital mortality rate was 33.3%. A. baumannii isolates had lower antimicrobial susceptibility rates than A. nosocomialis and A. pittii isolates. In conclusion, relapse of ACB complex bacteremia can develop in immunocompromised patients, especially those with central venous catheters. Molecular methods to identify the ACB complex to the genospecies level are essential for differentiating between reinfection and relapse of bacteremia caused by the ACB complex.
doi:10.1128/JCM.01194-12
PMCID: PMC3421778  PMID: 22760035

Results 1-25 (123)