exudates and Pneumonia--Bacterial

Topics: Community-Acquired Infections; Humans; Incidence; Malaysia; Pneumonia, Bacterial; Survival Rate

Melioidosis, an important diagnosis in the severely ill traveler Melioidosis is a common tropical infection in Southeast Asia and is caused by the highly pathogenic soil bacterium Burkholderia pseudomallei. Diagnosis and treatment is often challenging due to variations in clinical presentation, limited antibiotic susceptibility and high risk of recurring infection. In this report, three cases with different clinical presentations are described.

Topics: Aged; Anti-Bacterial Agents; Burkholderia pseudomallei; Humans; Malaysia; Male; Melioidosis; Middle Aged; Pneumonia, Bacterial; Sweden; Thailand; Travel-Related Illness

To evaluate the yield of blood cultures and the impact of blood culture results on the adjustment of empiric antibiotic treatment in children hospitalised with community acquired pneumonia (CAP).. This was a prospective study conducted at a tertiary hospital in Malaysia, from 1st August 2010 until 31st July 2011. Children aged between 1 mo and 12 y who were admitted for CAP and had blood cultures performed before starting intravenous antibiotics were recruited. Children with congenital pneumonia, immunodeficiency, chronic cardiac or respiratory disorders, nosocomial pneumonia or those on corticosteroids, were excluded. Decision for admission was made by the attending Accident and Emergency physician.. One hundred and seventy-one children were enrolled. The median age was 13 mo (range: 38 d-10 y 3 mo) and 59 % were males. Blood cultures were positive in 1.2 % (2/171) of patients while the contamination rate was 1.8 % (3/171). Doctors altered antibiotics based on blood culture results in only one patient.. Both the yield and the impact of blood culture results on the adjustment of empiric antibiotic treatment were very small. There was a high contamination rate. The recommended practice of performing blood cultures in all children admitted with CAP should be reviewed.

Topics: Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Community-Acquired Infections; Female; Hospitalization; Humans; Infant; Malaysia; Male; Pneumonia, Bacterial; Prospective Studies

Prior to the implementation of Haemophilus influenzae type b vaccination worldwide, H. influenzae has been one of the main causative agents of community acquired pneumonia and meningitis in children. Due to the lack of information on the characteristics of the H. influenzae isolates that have previously been collected in Malaysia, the H. influenzae were assessed of their microbial susceptibility to commonly used antibiotics. Emphasis was made on strains that were resistance to co-trimoxazole (SXT) and their mode of transfer of the antibiotic resistance determinants were examined. A collection of 34 H. influenzae isolates was serotyped and antimicrobial susceptibility tests were performed to 11 antibiotics. To the isolates that were found to be resistant to co-trimoxazole, minimum inhibition concentration (MIC) to SXT was performed using Etest while agar dilution method was used to measure the individual MICs of trimethoprim (TMP) and sulfamethoxazole (SUL). These isolates were also examined for presence of plasmid by PCR and isolation method. Conjugal transfers of SXT-resistant genes to SXT-susceptible hosts were performed to determine their rate of transfer. Result showed that 20.6% of the total number of isolates was serotype B while the remaining was non-typeable. Antimicrobial susceptibility profile of all the isolates revealed that 58.8% was resistant to at least one antibiotic. Majority of these isolates were equally resistant to ampicillin and tetracycline (29.4% each), followed by resistance to SXT (26.5%). From nine isolates that were found to be SXT-resistant, five contained plasmid/s. Conjugal transfer experiment showed that these five isolates with plasmid transferred SXT-resistance determinants at a higher frequency than those without. From these observations, it is postulated that plasmid is not involved in the transfer of SXT-resistance genes but presence of plasmid facilitates their transfer. The information obtained from this study provides some basic knowledge on the antimicrobial susceptibility pattern of the H. influenzae isolates and their mode of transfer of SXT-resistance genes.

Topics: Ampicillin; Anti-Bacterial Agents; Child; Community-Acquired Infections; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Malaysia; Microbial Sensitivity Tests; Phenotype; Plasmids; Pneumonia, Bacterial; Serotyping; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Community-acquired pneumonia (CAP) is still a major cause of morbidity and mortality especially to children and compromised hosts, such as the old and those with underlying chronic diseases. Knowledge of pathogens causing CAP constitutes the basis for selection of antimicrobial treatment. Previous data have shown that etiological agents can be identified in only up to 50% of patients, but this figure can be improved by using polymerase chain reaction (PCR). This study was designed to evaluate multiplex real-time PCR as a method for rapid differential detection of five bacterial causes of CAP (Streptococcus pneumoniae, Burkholderia pseudomallei and atypical bacterial pathogens namely Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila) in CAP patients attending Hospital Tengku Ampuan Afzan (HTAA)/ Kuantan, Pahang, Malaysia. Two previously developed multiplex real-time PCR assays, duplex for the differential detection of S. pneumoniae and B. pseudomallei and triplex for the atypical bacterial pathogens, were used to detect a bacterial cause of CAP in blood and respiratory samples. Thus, 46 blood and 45 respiratory samples collected from 46 adult CAP patients admitted to HTAA were analysed by multiplex real-time PCR assays and conventional methods. The microbial etiology of CAP could be established for 39.1% (18/46) of CAP patients by conventional methods and this was increased to 65.2% (30/46) with the additional use of real-time PCR. The most frequently detected pathogens were S. pneumoniae (21.7% - all by PCR alone), Klebsiella pneumoniae (17.3%), B. pseudomallei (13% - 83% of them positive by PCR alone and 17% by both culture and PCR), Pseudomonas aeruginosa (6.5%), M. pneumoniae (6.5% - all by serology), C. pneumoniae (4.3% - all positive by both PCR and serology), L. pneumophila (2.1% - all by PCR alone), Escherichia coli (4.3%). Haemophilus infuenzae, Acinetobacter lwoffii and Acinetobacter baumannii were detected by conventional methods (2.1% for each).

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteria; Bacteriological Techniques; Blood; Community-Acquired Infections; Female; Humans; Malaysia; Male; Middle Aged; Molecular Diagnostic Techniques; Multiplex Polymerase Chain Reaction; Pneumonia, Bacterial; Prevalence; Real-Time Polymerase Chain Reaction; Sensitivity and Specificity; Sputum; Young Adult

Melioidosis is an important public health problem causing community acquired sepsis in the northeastern part of Malaysia.. From January 2001 to December 2005, we reviewed case reports of all bacteraemic melioidosis admitted to a tertiary teaching hospital, Hospital Universiti Sains Malaysia.. Thirty-five patients had positive blood culture for meliodosis and 27 case reports were traceable for further analysis. The mean age was 46.8 + 20.0 years. Twenty patients (74.1%) were male. The main clinical presentation was fever that occurred in 23 (85.2%) patients. Eighteen patients (66.7%) had lung involvement and three patients had liver abscess. Two patients presented with scrotal swelling, one of whom further developed Fournier's Gangrene. Nineteen (70.4%) patients had underlying diabetes, five of whom were newly diagnosed during the admission. Thirteen (48.1%) patients were treated with high-dose ceftazidime and six (22.2%) patients were treated with imipenem. Eight (29.6%) patients were not given anti-melioidosis therapy because the causative agents were not identified until after the patients died. The patients were admitted 16.8 days + 18.1. Seventeen patients (63.0%) died in this series, 13 patients of whom died within four days of admission.. The wide range of clinical presentations and the fatal outcomes of melioidosis require a high level of suspicion among physicians to develop an early appropriate therapy and reduce the mortality rate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Burkholderia pseudomallei; Ceftazidime; Female; Hospitals, Teaching; Humans; Imipenem; Liver Abscess; Malaysia; Male; Melioidosis; Middle Aged; Pneumonia, Bacterial; Testicular Hydrocele; Treatment Outcome; Young Adult

The outcome indicator of nosocomial infection (NI) in the intensive care unit (ICU) is used to benchmark the quality of patient care in Malaysia. We conducted a three-year prospective study on the incidences of ventilator-associated pneumonia (VAP), risk factors, and patterns of the microorganisms isolated in three ICUs.. A follow-up in prospective cohort surveillance was conducted on patients admitted to an adult medical-surgical ICU of a university hospital and two governmental hospitals in Malaysia from October 2003 to December 2006. VAP was detected using CDC criteria which included clinical manifestation and confirmed endotracheal secretion culture results.. In total, 215 patients (2,306 patient-days) were enrolled into the study. The incidence of ICU-acquired device-related NI was 29.3 % (n = 63). The device-related VAP infection rate was 27.0 % (n = 58), with a mechanical ventilator utilization rate of 88.7%. The death rate due to all ICU-acquired NI including sepsis was 6.5%. The most common causative pathogen was Klebsiella pneumoniae (n = 27). Multivariate analysis using Cox regression showed that the risk factors identified were aspiration pneumonia (HR = 4.09; 95% CI = 1.24, 13.51; P = 0.021), cancer (HR = 2.51; 95% CI = 1.27, 4.97; P = 0.008), leucocytosis (HR=3.43; 95% CI= 1.60, 7.37; P=0.002) and duration of mechanical ventilation (HR=1.04; 95% CI = 1.00, 1.08; P = 0.030). Age, gender and race were not identified as risk factors in the multivariable analysis performed.. The incidence of VAP was comparable to that found in the National Nosocomial Infection Surveillance (NNIS) System report of June 1998. The incidence of VAP was considered high for the three hospitals studied.

Topics: Adult; Cross Infection; Female; Humans; Incidence; Intensive Care Units; Malaysia; Male; Middle Aged; Pneumonia, Bacterial; Pneumonia, Ventilator-Associated; Prospective Studies; Risk Factors

Acinetobacter spp. is a known nosocomial pathogen causing a wide range of clinical diseases mainly pneumonia, wound infections and blood stream infections (BSI). A cross sectional descriptive study was performed to determine the prevalence of Acinetobacter infection in Hospital Universiti Sains Malaysia, Kelantan (HUSM). The risk factors of Acinetobacter BSI were determined by 1:1 case control analytical study, involving fifty-eight confirmed cases of Acinetobacter BSI patients compared to the cases caused by Gram-negative bacteria. The prevalence of Acinetobacter BSI in the HUSM was 6.11% (95% CI 4.88-7.53%). The attack rate of Acinetobacter BSI was 2.77 episodes per 1000 hospital admissions. Acinetobacter BSI patients were mostly located in intensive care unit and had a longer intensive care unit stay. In univariate analysis, the risk factors for Acinetobacter BSI include prior exposure to antimicrobial agents such as penicillins, aminoglycosides and cephalosporins, mechanical ventilation, presence of nasogastric tube, arterial catheter and urinary catheter. In multivariate analysis, the independent risk factors for Acinetobacter BSI were prior treatment with cephalosporins (OR 3.836 95% CI 1.657-8.881 p=0.002) and mechanical ventilation (OR 3.164 95% CI 1.353-7.397 p=0.008). This study revealed that rational use of antimicrobial agents is of paramount importance to control Acinetobacter BSI.

Topics: Acinetobacter Infections; Adult; Anti-Bacterial Agents; Bacteremia; Cross Infection; Cross-Sectional Studies; Female; Gram-Negative Bacterial Infections; Hospitals, Teaching; Humans; Intensive Care Units; Length of Stay; Malaysia; Male; Pneumonia, Bacterial; Prevalence; Risk Factors; Wound Infection; Young Adult

Melioidosis is endemic in Malaysia. Cutaneous melioidosis is one manifestation and it may progress to necrotizing fasciitis. The case highlights a 46-year-old male, a chicken-seller who presented with scalp cellulitis which later progressed to necrotizing fasciitis and pneumonia are presented here. It illustrates several key features of the presentation, prompt laboratory diagnosis and early treatment of melioidosis which saved the patient's life.

Topics: Animals; Cellulitis; Chickens; Endemic Diseases; Fasciitis, Necrotizing; Humans; Malaysia; Male; Melioidosis; Middle Aged; Occupational Diseases; Pneumonia, Bacterial; Poultry Diseases; Risk Factors

Topics: Anti-Bacterial Agents; beta-Lactams; Community-Acquired Infections; Female; Humans; Macrolides; Malaysia; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Reproducibility of Results; Severity of Illness Index

The aims of this study were to investigate the frequency of Mycobacterium tuberculosis as a cause of community-acquired pneumonia (CAP) requiring hospitalization in Malaysia, and to define the clinical features of pulmonary tuberculosis (PTB) that distinguish it from non-TB CAP.. A prospective study was performed on consecutive non-immunocompromised patients aged 12 years and older, who were hospitalized for CAP.. Of a total of 346 patients hospitalized for CAP, the aetiological agent was identified in 163 patients (47.1%). M. tuberculosis was isolated in 17 patients (4.9%). Multivariate analysis revealed that the following features were significantly associated with culture-positive PTB: duration of symptoms of more than 2 weeks before hospital admission (odds ratio (OR) 25.10; 95% confidence interval (CI) 4.63-136.05; P<0.001), history of night sweats (OR 5.43; 95% CI 1.10-26.79; P=0.038), chest radiograph showing upper lobe involvement (OR 8.23; 95% CI 1.59-42.53; P=0.012) or cavitary infiltrates (OR 19.41; 95% CI 2.94-128.19; P=0.002), total white blood cell count on admission of 12x10(9)/L or less (OR 6.28; 95% CI 1.21-32.52; P=0.029) and lymphopenia (OR 4.73; 95% CI 1.08-20.85; P=0.040).. Mycobacterium tuberculosis was not an uncommon cause of CAP requiring hospitalization in Malaysia. A longer duration of symptoms, history of night sweats, upper lobe involvement, cavitary infiltrates, lower total white blood cell count and lymphopenia were predictive of PTB.

Topics: Adult; Aged; Community-Acquired Infections; Diagnosis, Differential; Female; Hospitalization; Humans; Leukocyte Count; Lung; Lymphopenia; Malaysia; Male; Middle Aged; Mycobacterium tuberculosis; Pneumonia, Bacterial; Prospective Studies; Radiography, Thoracic; Sweat; Tuberculosis, Pulmonary

Current clinical practice guidelines, including those in south Asia, recommend the addition of a macrolide to a broad-spectrum antibiotic for the treatment of severe hospitalized community-acquired pneumonia (CAP). The aim of this study was to observe the influence of macrolide addition on clinical outcomes of hospitalized adult patients with CAP.. Over a 16-month period between 2002 and 2004, 141 eligible patients were prospectively recruited from an urban-based teaching hospital in Malaysia.. Of the 141 patients, 63 (44.7%) patients (age (standard deviation (SD)) 56 (20.0) years; 50.8% male) received a macrolide-containing antibiotic regimen, while 78 (55.3%; age (SD) 57 (20.2) years; 52.6% male) were on a single broad-spectrum antibiotic only. In total, 39 (27.7%) and 102 (72.3%) patients had severe and 'non-severe' pneumonia, respectively. Irrespective of whether they had severe or non-severe pneumonia, there were no significant differences in mortality (non-severe pneumonia, 6.5% vs. 5.4%, P = 0.804; severe pneumonia, 17.6% vs. 18.2%, P = 0.966), need of ventilation (non-severe pneumonia, 8.7% vs. 3.6%, P = 0.274; severe pneumonia, 23.5% vs. 13.6%, P = 0.425) or median length of hospital stay (non-severe pneumonia, 5.5 vs. 5 days, P = 0.954; severe pneumonia, 7 vs. 6 days, P = 0.401) between the two treatment regimens.. This observational, non-randomized study suggests that addition of a macrolide may not convey any extra clinical benefits in adult hospitalized patients with CAP.

Topics: Adult; Aged; Community-Acquired Infections; Female; Follow-Up Studies; Humans; Inpatients; Length of Stay; Macrolides; Malaysia; Male; Middle Aged; Observation; Pneumonia, Bacterial; Prospective Studies; Severity of Illness Index; Survival Rate; Treatment Outcome; Urban Population

Chlamydia pneumoniae, a bacterium that causes respiratory infections, is probably under-diagnosed. There is also interest in its possible role in the aetiology of coronary heart disease. This is the first population-based seroprevalence survey of C. pneumoniae infection in Singapore.. A random sample of 1,068 people aged 18-69 years was selected from the participants of the Singapore National Health Survey conducted in 1998. Sera and data on certain clinical measurements and conditions had been collected. IgG antibodies for C. pneumoniae were detected using an indirect microimmunofluorescence test and positivity graded. Seropositivity was defined as IgG titre >/=1:16.. There were no statistically significant differences in the prevalence rates of seropositivity to C. pneumoniae for age group 18-69 years among the three ethnic groups, i.e. Chinese (males 76.7%, females 68.3%), Malays (males 75.4%, females 59.1%), and Asian Indians (males 74.6%, females 59.4%). The seropositivity rate for people aged 18-69 years in Singapore was 75.0% for males and 65.5% for females (difference of 9.5%, P < 0.001). In both genders combined, seropositivity increased from 46.5% in the age group 18-29 to reach a plateau of 78.9% in the age group 40-49, which remained stable to 60-69 years. There was no association of seropositivity with smoking, diabetes mellitus, hypertension or body mass index after adjustment for age and gender.. The high prevalence rates in our study population and the higher rate in males compared to females are consistent with studies from other parts of the world. No significant difference in prevalence rates was observed among Chinese, Malays and Indians. The pattern of rising and levelling off of seropositivity with age suggests that C. pneumoniae infection occurs early in life, and in older ages the high level of seropositivity is probably maintained by re-infections or chronic infections. Chlamydia pneumoniae infection was not found to be associated with the cardiovascular risk factors examined.

Topics: Adolescent; Adult; Age Distribution; Aged; Antibodies, Bacterial; China; Chlamydophila Infections; Chlamydophila pneumoniae; Female; Fluorescent Antibody Technique, Indirect; Humans; Immunoglobulin G; India; Malaysia; Male; Middle Aged; Pneumonia, Bacterial; Seroepidemiologic Studies; Sex Distribution; Singapore

Mycoplasma pneumoniae is increasingly recognized as an important cause of community acquired pneumonia (CAP) in children. We determined the importance of M. pneumoniae as a causative agent in 170 children aged 1 month to 15 years who were hospitalized with CAP over a 6-month period. The diagnosis of M. pneumoniae infection was based on serological evidence obtained by a particle agglutination test (SERODIA-MYCO II). A positive serological diagnosis was made if the acute phase serum titer was more than 1:160 or paired samples taken 2-4 weeks apart showed a four-fold or greater rise in the serum titer. M. pneumoniae was identified as the causative agent in 40 (23.5%) children. Children with M. pneumoniae infection were more likely to be older than 3 years (OR 4.0 95%CI 1.8-9.1, p<0.001), Chinese (OR 4.3 95%CI 2.0-8.9, p<0.001), have a duration of illness longer than 7 days prior to admission (OR 6.0 95%CI 2.7-13.5, p<0.001) and have perihilar interstitial changes on chest X-ray (OR 4.6 95%CI 2.2-9.9, p<0.001). A significant number of hospital admissions for CAP in Malaysian children can be attributed to M. pneumoniae. It is important to identify these children so as to administer the most appropriate antibiotic treatment.

Topics: Adolescent; Child; Child, Preschool; Community-Acquired Infections; Female; Hospitalization; Humans; Malaysia; Male; Mycoplasma Infections; Mycoplasma pneumoniae; Pneumonia, Bacterial

A study was carried out to determine the pattern of microbiological organisms causing community acquired pneumonia in adult patients admitted to Penang Hospital between November 1999 and August 2000. Altogether, 98 patients (64 males, 34 females) with a mean age (+/- S.D.) of 55.9 (+/- 19.0) (range 15 to 87) years were included in the study. Causative organisms were identified in 42 patients (42.9%). Mycobacterium tuberculosis was the commonest pathogen being identified in 15.3% of cases, followed by Klebsiella pneumoniae (7.2%), Pseudomonas aeruginosa (6.1%) and Staphylococcus aureus (5.1%). Streptococcus pneumoniae and Acinetobacter spp accounted for 3 cases each (3.1%) and Haemophilus influenzae, non-haemolytic Streptococcus, Mycoplasma pneumoniae, Salmonella typhi, Escherichia coli, Klebsiella spp and Pseudomonas spp for 1 case each (1.0%). Four patients (4.1%) had dual infections and no case of legionella pneumonia was found in this series.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cross Infection; Female; Hospitalization; Humans; Malaysia; Male; Middle Aged; Pneumonia, Bacterial