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V C Cheng

Publications and source records attributed to V C Cheng.

9 recordsLinked to original sources
PubMed2006

Rapidly progressive necrotising fasciitis following a stonefish sting: a report of two cases.

Two patients developed rapidly progressive necrotising fasciitis after being stung by a stonefish. Both were given a hot-water bath for pain relief. The hot water may have accelerated bacterial growth and the consequent development of necrotising fasciitis. Vibrio vulnificus was cultured from one patient. It is recommended that patients should receive high dose of oral and intravenous antibiotic prophylaxis for vibrio prevention. Antibiotics should be given before or during, not after, a hot-water bath, and the patient's condition should be monitored closely.

Adult↗
PubMed2001

Risk factors for acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study.

A case-control study was conducted to identify the risk factors associated with levofloxacin-resistant Streptococcus pneumoniae (LRSP) colonization or infection. Twenty-seven case patients (patients with LRSP) were compared with 54 controls (patients with levofloxacin-susceptible S. pneumoniae). Risk factors that were significantly associated with LRSP colonization or infection, according to univariate analysis, included an older age (median age, 75 years for case patients versus 72.5 years for controls), residence in a nursing home (odds ratio [OR], 7.2), history of recent (OR, 4.6) and multiple (OR, 4.4) hospitalizations, prior exposure to fluoroquinolones (OR, 10.6) and beta-lactams (OR, 8.6), presence of chronic obstructive pulmonary disease (COPD; OR, 5.9), and nosocomial origin of the bacteria (OR, 5.7). Multivariate analysis showed that presence of COPD (OR, 10.3), nosocomial origin of the bacteria (OR, 16.2), residence in a nursing home (OR, 7.4), and exposure to fluoroquinolones (OR, 10.7) were independently associated with LRSP colonization or infection. Thus, a distinct group of patients with COPD is the reservoir of LRSP.

Aged↗
PubMed2001

Immunorestitution diseases in patients not infected with HIV.

The aim of this study was to assess the clinical spectrum of immunorestitution disease (IRD) in hospitalized patients over a 12-month period. In nine of 18 patients who presented with clinical deterioration during reduction or cessation of immunosuppressants (n = 6) or bone marrow engraftment (n = 3), IRD cases included the following infections: scabies infestation (n = 1); gastric strongyloidiasis (n = 1); hepatosplenic candidiasis (n = 1); methicillin-resistant Staphylococcus aureus abscess formation (n = 2); polyomavirus-related hemorrhagic cystitis (n = 3); and influenza A pneumonitis (n = 1). Immunopathological damage during withdrawal of immunosuppression is an incidental way to uncover an asymptomatic infectious disease. Serial monitoring of hematological and clinical profiles is essential in making a diagnosis of IRD.

Adult↗
PubMed2001

Curtailing unnecessary vancomycin usage in a hospital with high rates of methicillin resistant Staphylococcus aureus infections.

AIMS: To implement and monitor the effectiveness of a strategy to curb unnecessary use of vancomycin and teicoplanin for inpatients in a teaching hospital/tertiary referral centre where 33% of S. aureus isolates (72% from ICU patients) were methicillin resistant. METHODS: A sample of 182 vancomycin/teicoplanin inpatient prescriptions surveyed, revealed that only 31 (17%) conformed with Centre for Disease Control (CDC) guidelines. Following education (ward-rounds, bulletins) on appropriate CDC based guidelines for prescribing glycopeptides directed at relevant clinicians, 'Immediate Concurrent Feedback' (ICF) was gradually deployed throughout the hospital. This entailed review of respective inpatient records on the next working day. If the indication was deemed not to conform with our guidelines, the prescriber was issued a memo (copied to the supervising doctor). Each memo detailed the 'errant' incident, listed appropriate indications and explicitly advised desisting from such prescribing and suggested alternative therapy if necessary. Corresponding glycopeptide usage data for our hospital and others in Hong Kong were retrieved and analysed as were samples of records of our inpatients with staphylococcal septicaemia (pre and during ICF). RESULTS: Compared with baseline values, during 2 years of ICF, inpatient prescribing of vancomycin and teicoplanin deemed to conform increased to 71% (773/1086); difference 54% (P < 0.0001, 95% CIs 47-62%). Corresponding average monthly usage (DDDs/1000 admissions) decreased from 76 (pre-ICF) to 45; mean difference 31 (P < 0.0001, 95% CIs 24, 38). Mortality from staphylococcal bacteraemia remained unchanged. No comparable changes in glycopeptide usage ensued in comparator hospitals. CONCLUSIONS: ICF can be used safely to curb irrational overuse of vancomycin and teicoplanin in a hospital with high methicillin resistant S. aureus infection rates.

Anti-Bacterial Agents↗
PubMed2001

Invasive disease due to Mucorales: a case report and review of the literature.

OBJECTIVE: To review the mycology, pathogenesis, clinical characteristics, investigations, and treatment modalities of mucormycosis. DATA SOURCES: A local case of mucormycosis; MEDLINE and non-MEDLINE search of the literature. STUDY SELECTION: Key words for the literature search were 'mucormycosis' and 'Mucorales'; all available years of study were reviewed. DATA EXTRACTION: Original articles, review papers, meta-analyses, and relevant book chapters were reviewed. DATA SYNTHESIS: Mucormycosis is a fungal infection that is rare but increasingly recognised in the growing population of immunocompromised patients. It is caused by saprophytic non-septate hyphae of the order Mucorales. The pulmonary and disseminated forms commonly occur in patients with haematological malignancy, especially acute leukaemia and lymphoma, and those receiving treatment with immunosuppressive effects. The rhinocerebral form is more prevalent in patients with diabetes mellitus, particularly those with the complication of diabetic ketoacidosis. The use of amphotericin B combined with surgery remains the mainstay of treatment. The prognosis largely depends on prompt correction of the underlying risk factors. New strategies to combat this life-threatening infection will result from better understanding of its pathogenesis. CONCLUSION: A high index of suspicion is needed, in appropriate clinical settings, to diagnose and aggressively treat this infection in view of the high mortality rate for susceptible patients.

Humans↗
PubMed2000

Immunorestitution disease involving the innate and adaptive response.

Immunorestitution disease (IRD) is defined as an acute symptomatic or paradoxical deterioration of a (presumably) preexisting infection that is temporally related to the recovery of the immune system. We report the temporal sequence of events that led to IRD caused by Pneumocystis carinii and Aspergillus terreus in 2 human immunodeficiency virus (HIV)-negative patients soon after the recovery of adaptive and innate immunity, respectively, and we review episodes noted in the English-language literature that fit the definition of IRD (109 episodes in 107 patients). The median time from the recovery of neutrophil counts or termination of steroid therapy to the development of IRD was 8 days in cases of pulmonary aspergillosis (23 episodes) and hepatosplenic candidiasis (8) and 21 days for viral diseases such as hepatitis B (24) and viral pneumonitis (6). For IRD due to mycobacteriosis (27 episodes) and cryptococcosis (4) in HIV-positive patients, the median interval between the initiation of highly active antiretroviral therapy (HAART) and the onset of IRD was 11 days; for viral infections, including those due to cytomegalovirus (14), hepatitis B virus (1), and hepatitis C virus (2), the median interval was 42 days. As an emerging clinical entity, IRD merits further study to optimize treatment of immunosuppressed patients.

Adult↗
PubMed2000

Cellulitis complicating lymphoedema.

In ten hospitalised patients with cellulitis complicating lymphoedema encountered over a 3-year period (1996-1998), the underlying diseases were carcinoma of the cervix (n = 4), uterus (n = 1), vagina (n = 1), breast (n=2) and nasopharynx (n= 1), and retroperitoneal squamous cell carcinoma (n = 1). Three of the ten patients had positive blood cultures, compared to none of the 20 age-matched, sex-matched controls hospitalised for cellulitis without lymphoedema. The mean duration of fever, tachycardia and cellulitis was significantly longer in patients with lymphoedema than in those without (P<0.05, P<0.05, and P<0.005 respectively). Early treatment initiated by patients themselves may help stop bacterial replication in the initial stages and minimise further damage to the lymphatic system.

Adult↗
PubMedDate not supplied

Polymicrobial outbreak of intermittent peritoneal dialysis peritonitis during external wall renovation at a dialysis center.

OBJECTIVE: To investigate an outbreak of peritonitis in intermittent peritoneal dialysis (IPD) patients. DESIGN: An outbreak investigation was performed to identify the etiology of the polymicrobial outbreak, and a retrospective case-control study was conducted to assess the risk factors for development of peritonitis. SETTING: Renal dialysis center. PATIENTS: Ten episodes of peritonitis occurred in 8 of 61 patients over a 6-month period in which 669 IPD procedures were analyzed. INTERVENTIONS: Field visit to renal dialysis center to examine the entire IPD procedure, inspect the hospital environment, and perform air bacterial count. MAIN OUTCOME MEASURES: The environmental factors and risk factors contributing to the polymicrobial peritonitis outbreak in IPD patients. The incidence of IPD peritonitis was determined before and after interventions. RESULTS: The causative organisms included Acinetobacter baumanii (6), Stenotrophomonas maltophilia (2), Pseudomonas aeruginosa (1), Candida albicans (1), C. tropicalis (1), Enterococcus (3), and Enterobacteriaceae (2). Four episodes of peritonitis involved infection by more than one organism. Air sampling of the environment detected a median of 110 colony forming units of bacteria per cubic meter of air, 10% of which were found to be Acinetobacter baumanii. The source of this polymicrobial outbreak was attributed to the bamboo scaffolding structure covering the external wall of the hospital during renovation. A retrospective case-control study indicated that the absence of the flush-before-fill step was a risk factor for development of peritonitis. CONCLUSION: In addition to invasive aspergillosis in transplant or oncology patients, Acinetobacter peritonitis in dialysis patients should be considered another microbial cause of outbreak associated with hospital renovation.

Aged↗