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Extensive contact tracing and screening to control the spread of vancomycin-resistant Enterococcus faecium ST414 in Hong Kong

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Chinese Medical Journal 2012年第19期125卷 3450-3457页

作者： CHENG Vincent Chi-chung TAI Josepha Wai-ming NG Modissa Lai-ming CHAN Jasper Fuk-woo wong sally cheuk-ying LI Iris Wai-sum CHUNG Hon-ping LO Wai-kei YUEN Kwok-yung HO Pak-leung Department of Microbiology Queen Mary Hospital Hong Kong Special Administrative Region China Infection Control Team Queen Mary Hospital Hong Kong Special Administrative Region China Department of Surgery Tung Wah Hospital Hong Kong Special Administrative Region China Infection Control Team Tung Wah Hospital Hong Kong Special Administrative Region China

Background Proactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci （VRE） endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intra- and inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong. Methods We described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing （MLST） was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE. Results Between November 26 and December 17, 2011, 11 patients （1 exogenous case and 10 secondary cases） in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% （10/361）. There were 8 males and 3 females with a median age of 78 years （range, 40-87 years）. MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay （P 〈0.001）, a higher proportion with chronic cerebral and cardiopulmonary conditions （P=0.001）, underlying malignancies （P 〈0.001）, and presence of urinary catheter （P 〈0.001）, wound or ulcer （P 〈0.001）, and a greater proportion of these patients were receiving β-lactam/ β-1actamase inhibitors （P=0.009）, carbapenem group （P 〈0.001）, fluoroquinolones （P=0.003）, or vancomycin （P=0.001） when compared with the controls. Conclusion Extensive contact tracing and screening with a

关键词： vancomycin-resistant Enterococcus faecium ST414 outbreak contact tracing screening

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An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong

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Chinese Medical Journal 2012年第23期125卷 4283-4290页

作者： CHENG Vincent Chi-chung wong Samson Sai-yin CHEN Jonathan Hon-kwan CHAN Jasper Fuk-woo TO Kelvin Kai-wang POON Rosana Wing-shan wong sally cheuk-ying CHAN Kwok-hung TAI Josepha Wai-ming HO Pak-leung TSANG Thomas Ho-fai YUEN Kwok-yung Department of Microbiology Queen Mary Hospital Hong Kong China Infection Control Team Queen Mary Hospital Hong Kong China Centre for Health Protection Department of Health Hong Kong China

Background The environmental sources associated with community-acquired or nosocomial legionellosis were not always detectable in the mainland of China and Hong Kong, China. The objective of this study was to illustrate the control measures implemented for nosocomial and community outbreaks of legionellosis, and to understand the environmental distribution of legionella in the water system in Hong Kong, China. Methods We investigated the environmental sources of two cases of legionellosis acquired in the hospital and the community by extensive outbreak investigation and sampling of the potable water system using culture and genetic testing at the respective premises. Results The diagnosis of nosocomial legionellosis was suspected in a patient presenting with nosocomial pneumonia not responsive to multiple beta-lactam antibiotics with subsequent confirmation by Legionella pneumophila serogroup 1 antigenuria. High counts of Legionella pneumophila were detected in the potable water supply of the 70-year-old hospital building. Another patient on continuous ambulatory peritoneal dialysis presenting with acute community-acquired pneumonia and severe diarrhoea was positive for Legionella pneumophila serogroup 1 by polymerase chain reaction （PCR） testing on both sputum and nasopharyngeal aspirate despite negative antigenuria. Paradoxically the source of the second case was traced to the water system of a newly commissioned office building complex. No further cases were detected after shock hyperchlorination with or without superheating of the water systems. Subsequent legionella counts were drastically reduced. Point-of-care infection control by off-boiled or sterile water for mouth care and installation of water filter for showers in the hospital wards for immunocompromised patients was instituted. Territory wide investigation of the community potable water supply showed that 22.1% of the household water supply was positive at a mean legionella count of 108.56 CFU/ml （range 0.10 to 639.30 CFU/ml）. Conclusions Potable wa

关键词： outbreak nosocomial legionellosis community-acquired legionellosis

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Proactive infection control measures to prevent nosocomial transmission of carbapenem-resistant Enterobacteriaceae in a non-endemic area

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Chinese Medical Journal 2013年第23期126卷 4504-4509页

作者： CHENG Vincent Chi-Chung CHAN Jasper Fuk-Woo wong sally cheuk-ying CHEN Jonathan Hon-Kwan TAI Josepha Wai-Ming YAN Mei-Kum KWAN Grace See-Wai TSE Herman TO Kelvin Kai-Wang HO Pak-Leung YUEN Kwok-Yung Department of Microbiology Queen Mary Hospital Hong KongChina Infection Control Team Queen Mary Hospital Hong Kong China

Background Identification of hospitalized carbapenem-resistant Enterobacteriaceae （CRE）-positive patient is important in preventing nosocomial transmission.The objective of this study was to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between October 1,2010 and December 31,2011.Methods The program included active surveillance culture in patients with history of medical tourism with hospitalization and surgical operation outside Hong Kong within 12 months before admission,and ＂added test＂ as an opportunistic CRE screening in all fecal specimens submitted to the laboratory.Outbreak investigation and contact tracing were conducted for CRE-positive patients.Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.Results During the study period,a total of 6533 patients were screened for CRE,of which 76 patients were positive （10 from active surveillance culture,65 from ＂added test＂,and 1 secondary case from contact tracing of 223 patients with no nosocomial outbreak）,resulting in an overall rate of CRE fecal carriage of 1.2％.The median time of fecal carriage of CRE was 43 days （range,13-119 days）.Beta-lactam-beta-lactamase-inhibitors,cephalosporins,and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection,while use of cephalosporins,carbapenems,and fiuoroquinolones after CRE detection are significantly associated with longer duration of carriage.The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load （Pearson correlation：0.53; P=0.02）.Conclusion Proactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.

关键词： surveillance nosocomial transmission carbapenem-resistant Enterobacteriaceae

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In-Home Drug Storage by Older Adults

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Journal of Geriatric Medicine 2020年第3期2卷 22-31页

作者： Lori Suet Hang Lo Linda Yin King Lee Irene Yuen Fung wong Yuen Yan Lai Hoi Tong Au Tsz ying wong Chui Ping Chueng Wai Lam Shek Choi Yi wong Hoi Lam Chan Hon Sze cheuk Nga Hing Mark Shu Ching wong Wing Yan Cheung The Open University of Hong Kong Hong KongChina

Globally,in-home drug-storage compliance is often unsatisfactory,especially among older adults,and can lead to negative health outcomes.This study used a cross-sectional and descriptive design to examine inhome drug-storage compliance among older adults.Convenience sampling was used to recruit 117 older adults in Hong Kong.An in-home drugstorage checklist was used to assess the in-home drug-storage environments(light,temperature,and humidity)and drug-storage methods(drug safety,packaging,information,and expiration)of each older adult.The findings showed that Hong Kong older adults’overall compliance rate in drug storage was 87.25%,and their compliance rate for drug-storage methods(84.59%)was lower than that for drug-storage environments(97.02%).Older adults who were of advanced age,who were less educated or who lived alone demonstrated lower in-home drug-storage compliance.This indicates the need to revise existing health-education strategies to encourage in-home drug-storage compliance.Healthcare professionals should assess older adults’drug-storage compliance to identify less compliant subgroups and deliver specific drug-storage support as required.Family members should also be involved in this process.

关键词： Drug storage Compliance Older adults Home

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中国香港17种植物新记录

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热带亚热带植物学报 2021年第2期29卷 123-131页

作者：刘金刚幸敬阳黄筑君韩卓希 WILLIAMS Craig 马锡成李玉来张金龙 FISCHER Gunter A 嘉道理农场暨植物园植物保育部中国香港英华书院中国香港香港空运货站有限公司中国香港

报道了香港17种植物新记录:无配膜叶铁角蕨[Hymenasplenium apogamum(N.Murak.&Hatan.)Nakaike]、似薄唇蕨(Leptochilus decurrens Blume)、穿心藤[Amydrium hainanense(H.Li,Y.Shiao&S.L.Tseng)H.Li]、毛背桂樱[Laurocerasus hypotricha(Rehder)T.T.Yu&L.T.Lu]、寒莓(Rubus buergeri Miq.)、毛果青冈(Quercus pachyloma Seemen)、粉绿柯(Lithocarpus glaucus Chun&C.C.Huang ex H.G.Ye)、龙眼柯(L.longanoides C.C.Huang&Y.T.Chang)、豆叶九里香(Murraya euchrestifolia Hayata)、崖柿(Diospyros chunii F.P.Metcalf&L.Chen)、打铁树[Myrsine linearis(Lour.)Poir.]、针齿铁仔(M.semiserrata Wall.)、疏齿木荷(Schima remotiserrata Hung T.Chang)、台湾醉魂藤(Heterostemma brownii Hayata)、华南水壶藤[Urceola napeensis(Quint.)D.J.Middleton]、斜果挖耳草(Utricularia minutissima Vahl)、馥芳艾纳香(Blumea aromatica DC.);其中,醉魂藤属(Heterostemma Wight&Arn.)为香港新记录属。同时描述了每种植物的生境、主要识别特征以及与相似种的区别。多数新记录种都发现于山地或沟谷中的偏僻生境。对这些生境的持续探索有望进一步丰富香港的植物类群。

关键词：香港新记录植物区系物种保存维管植物

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