Prevalence and Predictors of Methicillin-Resistant Staphylococcus aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL) Gram-Negative Bacteria at Hospital Presentation in Singapore

Pada, Surinder; Lye, DC; Krishnan, Prabha; Chan, J.; Chan, Siew‐Pang; Cham, Gregory; Ang, Brenda; Leo, Yee Sin

doi:10.1016/j.ijid.2008.05.1190

Cited by 3 publications

(3 citation statements)

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“…The reasons for this divergent trend between the Enterobacteriaceae could not be ascertained in a surveillance study, but it is plausible that an increase in incidence density of community extended-spectrum beta-lactamase (ESBL)-producing and quinolone-resistant E. coli isolates may have contributed to this phenomenon. Pada and coworkers had found that up to 12% of more than 1,000 emergency department attendees without previous health care association at hospital 2 in 2007 were colonized with ESBL-positive Enterobacteriaceae-the vast majority of which were E. coli (16). Unfortunately, we could not reliably distinguish between communityand hospital-associated infections in our study.…”

Section: Discussionmentioning

confidence: 64%

Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals

Hsu

Tan

Tam

et al. 2010

Antimicrob Agents Chemother

114

108

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Section: Discussionmentioning

confidence: 64%

Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals

Hsu

Tan

Tam

et al. 2010

Antimicrob Agents Chemother

114

108

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“…In Singapore, patients admitted to local public hospitals have one of the highest rates of antimicrobial resistance worldwide [2, 3], with local use of oral antibiotics in the community shown to be associated with increased colonization with Extended-Spectrum Beta-Lactamase (ESBL) Gram-Negative Bacteria on admission [4]. The impact of antibiotic resistance include increased morbidity and mortality from antibiotic-resistant infections [5], increased socioeconomic burden and greater healthcare costs [1, 6].…”

Section: Introductionmentioning

confidence: 99%

Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore

et al. 2016

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BackgroundPatients’ expectations can influence antibiotic prescription by primary healthcare physicians. We assessed knowledge, attitude and practices towards antibiotic use for upper respiratory tract infections (URTIs), and whether knowledge is associated with increased expectations for antibiotics among patients visiting primary healthcare services in Singapore.MethodsData was collected through a cross-sectional interviewer-assisted survey of patients aged ≥21 years waiting to see primary healthcare practitioners for one or more symptoms suggestive of URTI (cough, sore throat, runny nose or blocked nose) for 7 days or less, covering the demographics, presenting symptoms, knowledge, attitudes, beliefs and practices of URTI and associated antibiotic use. Univariate and multivariate logistic regression was used to assess independent factors associated with patients’ expectations for antibiotics.ResultsNine hundred fourteen out of 987 eligible patients consulting 35 doctors were recruited from 24 private sector primary care clinics in Singapore. A third (307/907) expected antibiotics, of which a substantial proportion would ask the doctor for antibiotics (121/304, 40 %) and/or see another doctor (31/304, 10 %) if antibiotics were not prescribed. The majority agreed “antibiotics are effective against viruses” (715/914, 78 %) and that “antibiotics cure URTI faster” (594/912, 65 %). Inappropriate antibiotic practices include “keeping antibiotics stock at home” (125/913, 12 %), “taking leftover antibiotics” (114/913, 14 %) and giving antibiotics to family members (62/913, 7 %). On multivariate regression, the following factors were independently associated with wanting antibiotics (odds ratio; 95 % confidence interval): Malay ethnicity (1.67; 1.00–2.79), living in private housing (1.69; 1.13–2.51), presence of sore throat (1.50; 1.07–2.10) or fever (1.46; 1.01–2.12), perception that illness is serious (1.70; 1.27–2.27), belief that antibiotics cure URTI faster (5.35; 3.76–7.62) and not knowing URTI resolves on its own (2.18; 1.08–2.06), while post-secondary education (0.67; 0.48–0.94) was inversely associated. Those with lower educational levels were significantly more likely to have multiple misconceptions about antibiotics.ConclusionMajority of patients seeking primary health care in Singapore are misinformed about the role of antibiotics in URTI. Agreeing with the statement that antibiotics cure URTI faster was most strongly associated with wanting antibiotics. Those with higher educational levels were less likely to want antibiotics, while those with lower educational levels more likely to have incorrect knowledge.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0547-3) contains supplementary material, which is available to authorized users.

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“…An increase in incidence density of community extended-spectrum beta-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli isolates may have contributed to this phenomenon. Pada and co-workers had found that up to 12% of more than 1,000 emergency department attendees without previous health care association at hospital 2 in 2007 were colonized with ESBL-positive enterobacteriaceae—the vast majority of which were Escherichia coli [ 30 ]. This was because the extensive use of ciprofloxacin in community acquired infections had probably led to a continual increase in incidences of ESBLs colonization in the community.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Ertapenem use with Impact Assessment on Extended-Spectrum Beta-Lactamases (ESBL) Production and Gram-Negative resistance in Singapore General Hospital (SGH)

Lim

Lee

et al. 2013

BMC Infect Dis

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BackgroundErtapenem (preferred choice for ESBL-producing organisms) use exhibited an increasing trend from 2006 to 2008. As extensive use of ertapenem might induce the mutation of resistant bacteria strains to ertapenem, we aimed to assess the appropriateness and impact of ertapenem-use, on ESBL production, the trends of gram-negative bacterial resistance and on the utilization of other antibiotics in our institution.MethodsInpatients who received a dose of ertapenem during 1 January 2006 to 31 December 2008, were reviewed. Pertinent patient clinical data was extracted from the pharmacy databases and assessed for appropriateness based on dose and indication. Relevant data from Network for Antimicrobial Resistance Surveillance (Singapore) (NARSS) was extracted, to cross-correlate with ertapenem via time series to assess its impact on hospital epidemiology, trends of gram-negative resistance and consumption of other antibiotics from 2006 to mid-2010.Results906 cases were reviewed. Ertapenem therapy was appropriate in 72.4% (93.7% success rate). CNS adverse events were noted in 3.2%. Readmission rate (30-day) due to re-infection (same pathogen) was 5.5%. Fifty cases had cultures growing Pseudomonas aeruginosa within 30 days of ertapenem initiation, with 25 cases growing carbapenem-resistant Pseudomonas aeruginosa.Ertapenem use increased from 0.45 DDD/100 patient days in 2006 to 1.2 DDD/100 patient days in mid-2010. Overall, the increasing trend of ertapenem consumption correlated with 1) increasing incidence-densities of ciprofloxacin-resistant/cephalosporin-resistant E. coli at zero time lag; 2) increasing incidence-densities of ertapenem-resistant Escherichia. coli and Klebsiella spp. at zero time lag; 3) increasing incidence-density of carbapenem-resistant Pseudomonas aeruginosa, at zero time lag.Increasing ertapenem consumption was significantly correlated with decreasing consumption of cefepime (R2 = 0.37344) 3 months later. It was significantly correlated with a decrease in imipenem consumption (R2 = 0.31081), with no time lag but was correlated with subsequent increasing consumption of meropenem (R2 = 0.4092) 6 months later.ConclusionErtapenem use was appropriate. Increasing Ertapenem consumption did not result in a decreasing trend of ESBL producing enterobacteriaceae and could result in the selection for multi-drug resistant bacteria.

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Prevalence and Predictors of Methicillin-Resistant Staphylococcus aureus (MRSA) and Extended-Spectrum Beta-Lactamase (ESBL) Gram-Negative Bacteria at Hospital Presentation in Singapore

Cited by 3 publications

References 0 publications

Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals

Surveillance and Correlation of Antibiotic Prescription and Resistance of Gram-Negative Bacteria in Singaporean Hospitals

Knowledge, attitudes and practices towards antibiotic use in upper respiratory tract infections among patients seeking primary health care in Singapore

Evaluation of Ertapenem use with Impact Assessment on Extended-Spectrum Beta-Lactamases (ESBL) Production and Gram-Negative resistance in Singapore General Hospital (SGH)

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