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Article ; Online: Current state of antimicrobial stewardship in organ transplantation in Singapore.

Chung, Shimin Jasmine / Liew, Yixin / Lee, Winnie Hui Ling / Kwa, Andrea Lay Hoon / Tan, Thuan Tong / Tan, Ban Hock

Transplant infectious disease : an official journal of the Transplantation Society

2022 Volume 24, Issue 5, Page(s) e13886

Abstract: Background: Antibiotic stewardship programs (ASPs) are well established in the public hospitals in Singapore, but they are not mandatory for transplant programs. Given the positive impact of ASPs in non-organ transplant patients (improved use of broad- ... ...

Abstract	Background: Antibiotic stewardship programs (ASPs) are well established in the public hospitals in Singapore, but they are not mandatory for transplant programs. Given the positive impact of ASPs in non-organ transplant patients (improved use of broad-spectrum antibiotics, reduced length of stay, and lower healthcare costs), stewardship principles are likely to benefit transplant recipients. Methods: We reviewed the progress made in ASPs in the Asia Pacific region as well as the progress of our ASP over the last decade since it was established. We also described how stewardship strategies have evolved for the purposes of our transplant program. Results: Currently, pressing stewardship issues for our transplant program include high antibiotic consumption, as well as the burden, morbidity, and mortality associated with drug-resistant bacterial infections. Transplanting the model of stewardship onto a transplant program ignores the intricacies of transplant patients; the bespoke form of stewardship, "handshake stewardship", is more appropriate. Conclusion: To advance the cause of ASP in the transplant unit in Singapore, stakeholder buy-in is key; empowering transplant physicians to be stewardship-focused would be more sustainable in the long run. In addition, expanding our diagnostic armamentarium, optimizing existing therapeutics and multi-disciplinary team involvement (including stakeholders from microbiology, and infection prevention teams) are vital.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship ; Bacterial Infections/microbiology ; Humans ; Organ Transplantation/adverse effects ; Singapore
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-06-25
Publishing country	Denmark
Document type	Journal Article ; Review
ZDB-ID	1476094-0
ISSN	1399-3062 ; 1398-2273
ISSN (online)	1399-3062
ISSN	1398-2273
DOI	10.1111/tid.13886
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Article ; Online: Therapeutic drug monitoring is necessary for patients receiving posaconazole tablet.

Zhou, Peijun Yvonne / Lim, Tze Peng / Tang, Si Lin Sarah / Lim, Jia Le / Liew, Yixin / Chua, Nathalie Grace / Lim, Li Ling Cheryl / Lee, Hui Ling Winnie / Lai, Oi Fah / Tan, Thuan Tong / Wong, Gee Chuan / Kwa, Lay Hoon Andrea

The Journal of infection

2021 Volume 82, Issue 6, Page(s) e18–e21

MeSH term(s)	Administration, Oral ; Antifungal Agents/therapeutic use ; Drug Monitoring ; Humans ; Tablets ; Triazoles
Chemical Substances	Antifungal Agents ; Tablets ; Triazoles ; posaconazole (6TK1G07BHZ)
Language	English
Publishing date	2021-03-29
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	424417-5
ISSN	1532-2742 ; 0163-4453
ISSN (online)	1532-2742
ISSN	0163-4453
DOI	10.1016/j.jinf.2021.03.021
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Article ; Online: Antimicrobial stewardship programme: a vital resource for hospitals during the global outbreak of coronavirus disease 2019 (COVID-19).

Liew, Yixin / Lee, Winnie Hui Ling / Tan, Lunyi / Kwa, Andrea Lay Hoon / Thien, Siew Yee / Cherng, Benjamin Pei Zhi / Chung, Shimin Jasmine

International journal of antimicrobial agents

2020 Volume 56, Issue 5, Page(s) 106145

Abstract: Healthcare resources are being diverted for the containment and control of coronavirus disease 2019 (COVID-19). During this outbreak, it is cautioned that antibiotic misuse may be increased, especially for respiratory tract infections. With stewardship ... ...

Abstract	Healthcare resources are being diverted for the containment and control of coronavirus disease 2019 (COVID-19). During this outbreak, it is cautioned that antibiotic misuse may be increased, especially for respiratory tract infections. With stewardship interventions, the duration of antibiotic therapy and length of stay of hospitalized patients can be reduced significantly. Antibiotic stewardship programmes should continually engage and educate prescribers to mitigate antibiotic misuse during the COVID-19 pandemic.
MeSH term(s)	Antimicrobial Stewardship/methods ; Antiviral Agents/therapeutic use ; Betacoronavirus/drug effects ; COVID-19 ; Coronavirus Infections/drug therapy ; Drug Misuse/prevention & control ; Humans ; Length of Stay ; Pandemics ; Pneumonia, Viral/drug therapy ; SARS-CoV-2
Chemical Substances	Antiviral Agents
Keywords	covid19
Language	English
Publishing date	2020-08-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1093977-5
ISSN	1872-7913 ; 0924-8579
ISSN (online)	1872-7913
ISSN	0924-8579
DOI	10.1016/j.ijantimicag.2020.106145
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Article: Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic.

Lim, Shena Y C / Zhou, Yvonne P / Yii, Daphne / Chin, De Zhi / Hung, Kai Chee / Lee, Lai Wei / Lim, Jia Le / Loo, Li Wen / Koomanan, Narendran / Chua, Nathalie Grace / Liew, Yixin / Cherng, Benjamin P Z / Thien, Siew Yee / Lee, Winnie H L / Kwa, Andrea L H / Chung, Shimin J

Antibiotics (Basel, Switzerland)

2022 Volume 11, Issue 7

Abstract: At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. ... ...

Abstract	At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify “high yield” interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6−8) vs. 6 (3−8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to “complete the course” (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber’s practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance.
Language	English
Publishing date	2022-06-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2681345-2
ISSN	2079-6382
ISSN	2079-6382
DOI	10.3390/antibiotics11070846
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Article: Antimicrobial stewardship programme: a vital resource for hospitals during the global outbreak of coronavirus disease 2019 (COVID-19)

Liew, Yixin / Lee, Winnie Hui Ling / Tan, Lunyi / Kwa, Andrea Lay Hoon / Thien, Siew Yee / Cherng, Benjamin Pei Zhi / Chung, Shimin Jasmine

International journal of antimicrobial agents. 2020 Nov., v. 56, no. 5

2020

Abstract	Healthcare resources are being diverted for the containment and control of coronavirus disease 2019 (COVID-19). During this outbreak, it is cautioned that antibiotic misuse may be increased, especially for respiratory tract infections. With stewardship interventions, the duration of antibiotic therapy and length of stay of hospitalized patients can be reduced significantly. Antibiotic stewardship programmes should continually engage and educate prescribers to mitigate antibiotic misuse during the COVID-19 pandemic.
Keywords	Coronavirus infections ; Orthocoronavirinae ; antibiotics ; duration ; health services ; hospitals ; length ; pandemic ; patients ; respiratory tract diseases ; therapeutics
Language	English
Dates of publication	2020-11
Publishing place	Elsevier Ltd
Document type	Article
Note	NAL-light
ZDB-ID	1093977-5
ISSN	1872-7913 ; 0924-8579
ISSN (online)	1872-7913
ISSN	0924-8579
DOI	10.1016/j.ijantimicag.2020.106145
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Antimicrobial stewardship programme

Liew, Yixin / Lee, Winnie Hui Ling / Tan, Lunyi / Kwa, Andrea Lay Hoon / Thien, Siew Yee / Cherng, Benjamin Pei Zhi / Chung, Shimin Jasmine

International Journal of Antimicrobial Agents

a vital resource for hospitals during the global outbreak of coronavirus disease 2019 (COVID-19)

2020 Volume 56, Issue 5, Page(s) 106145

Keywords	Microbiology (medical) ; Pharmacology (medical) ; Infectious Diseases ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	1093977-5
ISSN	1872-7913 ; 0924-8579
ISSN (online)	1872-7913
ISSN	0924-8579
DOI	10.1016/j.ijantimicag.2020.106145
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Article: Antimicrobial stewardship programme: a vital resource for hospitals during the global outbreak of coronavirus disease 2019 (COVID-19)

Liew, Yixin / Lee, Winnie Hui Ling / Tan, Lunyi / Kwa, Andrea Lay Hoon / Thien, Siew Yee / Cherng, Benjamin Pei Zhi / Chung, Shimin Jasmine

Int J Antimicrob Agents

Abstract	Healthcare resources are being diverted for the containment and control of coronavirus disease 2019 (COVID-19). During this outbreak, it is cautioned that antibiotic misuse may be increased, especially for respiratory tract infections. With stewardship interventions, the duration of antibiotic therapy and length of stay of hospitalized patients can be reduced significantly. Antibiotic stewardship programmes should continually engage and educate prescribers to mitigate antibiotic misuse during the COVID-19 pandemic.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #731783
Database	COVID19

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Article ; Online: Prolonged infusion versus intermittent boluses of β-lactam antibiotics for treatment of acute infections: a meta-analysis.

Teo, Jocelyn / Liew, Yixin / Lee, Winnie / Kwa, Andrea Lay-Hoon

International journal of antimicrobial agents

2014 Volume 43, Issue 5, Page(s) 403–411

Abstract: The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether ... ...

Abstract	The clinical advantages of prolonged (extended/continuous) infusion remain controversial. Previous studies and reviews have failed to show consistent clinical benefits of extending the infusion time. This meta-analysis sought to determine whether prolonged β-lactam infusions were associated with a reduction in mortality and improvement in clinical success. A search of PubMed, EMBASE and The Cochrane Library for randomised controlled trials (RCTs) and observational studies comparing prolonged infusion with intermittent bolus administration of the same antibiotic in hospitalised adult patients was conducted. Primary outcomes evaluated were mortality and clinical success. A total of 29 studies with 2206 patients (18 RCTs and 11 observational studies) were included in the meta-analysis. Compared with intermittent boluses, use of prolonged infusion appeared to be associated with a significant reduction in mortality [pooled relative risk (RR) = 0.66, 95% confidence interval (CI) 0.53-0.83] and improvement in clinical success (RR = 1.12, 95% CI 1.03-1.21). Statistically significant benefit was supported by non-randomised studies (mortality, RR = 0.57, 95% CI 0.43-0.76; clinical success, RR = 1.34, 95% CI 1.02-1.76) but not by RCTs (mortality, RR = 0.83, 95% CI 0.57-1.21; clinical success, RR = 1.05, 95% CI 0.99-1.12). The positive results from observational studies, especially in the face of increasing antibiotic resistance, serve to justify the imperative need to conduct a large-scale, well-designed, multicentre RCT involving critically ill patients infected with high minimum inhibitory concentration pathogens to clearly substantiate this benefit.
MeSH term(s)	Administration, Intravenous/methods ; Anti-Bacterial Agents/administration & dosage ; Bacterial Infections/drug therapy ; Bacterial Infections/mortality ; Humans ; Randomized Controlled Trials as Topic ; Survival Analysis ; Treatment Outcome ; beta-Lactams/administration & dosage
Chemical Substances	Anti-Bacterial Agents ; beta-Lactams
Language	English
Publishing date	2014-05
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1093977-5
ISSN	1872-7913 ; 0924-8579
ISSN (online)	1872-7913
ISSN	0924-8579
DOI	10.1016/j.ijantimicag.2014.01.027
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Article: Engineering carbon nanotubes wrapped ammonium polyphosphate for enhancing mechanical and flame retardant properties of poly(butylene succinate)

Zhang, Yan / Yixin Hu / Junling Wang / Wenxiang Tian / Kim Meow Liew / Yi Zhang / Bibo Wang

Composites. 2018 Dec., v. 115

2018

Abstract: The performance of CNTs with different amounts and dispersion states were explored in the flame retardant system as PBS/APP. Herein, A series of CNTs wrapped ammonium polyphosphate (named CAPP) were successfully prepared and characterized, and then ... ...

Abstract	The performance of CNTs with different amounts and dispersion states were explored in the flame retardant system as PBS/APP. Herein, A series of CNTs wrapped ammonium polyphosphate (named CAPP) were successfully prepared and characterized, and then blended into Poly(butylene succinate) (PBS) as an additive-type flame retardant. The obtained PBS/CAPP contributes to forming much more graphitized char layers to reduce the heat transfer and toxic gases release. For instance, PBS-3 containing 20% CAPP1 wrapped by only 1% of CNTs shows the best anti-dripping effect and the lowest toxic gases release, where CO2 and CO yield dramatically reduced by about 68.3% and 72.6%. With the same content of CNTs, the tensile strength, elongation at break and unnotched impact strength of PBS-3 increased about 10.8%, 14.2% and 5.3% than PBS-5 (CNTs added directly). Thus, the well dispersion state of moderate CNTs has a positive impact on improving mechanical properties, flame retardancy and smoke suppression.
Keywords	ammonium polyphosphates ; carbon dioxide ; carbon monoxide ; carbon nanotubes ; composite materials ; engineering ; flame retardants ; gases ; heat transfer ; impact strength ; smoke ; tensile strength ; toxic substances ; toxicity
Language	English
Dates of publication	2018-12
Size	p. 215-227.
Publishing place	Elsevier Ltd
Document type	Article
ZDB-ID	2012223-8
ISSN	1359-835X
ISSN	1359-835X
DOI	10.1016/j.compositesa.2018.09.020
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: The utility of voriconazole therapeutic drug monitoring in a multi-racial cohort in Southeast Asia.

Zhou, Peijun Yvonne / Lim, Tze Peng / Tang, Si Lin Sarah / Liew, Yixin / Chua, Sy Grace Nathalie / Lim, Li Ling Cheryl / Lee, Hui Ling Winnie / Tan, Si Xuan / Lai, Oi Fah / Tan, Thuan Tong / Wong, Gee Chuan / Kwa, Lay Hoon Andrea

Journal of global antimicrobial resistance

2019 Volume 21, Page(s) 427–433

Abstract: Objectives: Voriconazole serum concentration, which is affected by several factors, is associated with treatment response and toxicity. There is paucity of data on voriconazole therapeutic drug monitoring (TDM) among Southeast Asians, who exhibit a ... ...

Abstract	Objectives: Voriconazole serum concentration, which is affected by several factors, is associated with treatment response and toxicity. There is paucity of data on voriconazole therapeutic drug monitoring (TDM) among Southeast Asians, who exhibit a higher prevalence of CYP2C19-poor metabolisers compared with Caucasians and East Asians. Hence, there are concerns for higher risk of voriconazole accumulation and toxicity. We aim to determine the utility of voriconazole TDM through establishing: (1) proportion of patients achieving therapeutic troughs without dose adjustments; (2) characterisation of patients with sub-therapeutic, therapeutic and supra-therapeutic levels; (3) appropriate dose titrations/dose required for therapeutic troughs; (4) correlation between troughs and adverse events, treatment response/fungal breakthrough. Patients and methods: A single-centre retrospective analysis of data from adults (≥21 years old) with ≥1 voriconazole trough measured at Singapore General Hospital from 2015 to 2017 was performed. Results: Thirty-two patients (45.7%) among 70 patients achieved therapeutic troughs (defined as 2.0-5.5 mg/L) without dose adjustments. Eleven patients (15.7%) experienced hepatotoxicity (troughs 0.5 to >7.5 mg/L). Neurotoxicity occurred in three patients (4.3%) (troughs ≥6.7 mg/L) and all patients had symptom resolution upon dose reduction. Treatment failure of invasive fungal infection appeared less in patients with therapeutic troughs compared with sub-therapeutic troughs (11.4% vs. 14.2%). Two patients experienced treatment failure despite supra-therapeutic voriconazole troughs. Conclusions: TDM should be implemented due to significant unpredictability in dose exposure. TDM can reduce unnecessary switches to alternatives due to intolerability and rule in the possibility of resistant organisms in the event of treatment failure despite therapeutic troughs, alerting clinicians to switch to alternatives promptly.
MeSH term(s)	Adult ; Antifungal Agents/adverse effects ; Asia, Southeastern ; Drug Monitoring ; Humans ; Retrospective Studies ; Singapore ; Voriconazole/adverse effects ; Young Adult
Chemical Substances	Antifungal Agents ; Voriconazole (JFU09I87TR)
Language	English
Publishing date	2019-12-14
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2710046-7
ISSN	2213-7173 ; 2213-7165
ISSN (online)	2213-7173
ISSN	2213-7165
DOI	10.1016/j.jgar.2019.12.004
Database	MEDical Literature Analysis and Retrieval System OnLINE

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