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Fulltext Prevalence, Risk Factors and Microbiological Profile of Orthopaedic Surgical Site Infection in North-Eastern Peninsular Malaysia

Chua WC, Rahman SA, Deris ZZ

Malays Orthop J, 2022 Nov;16(3):94-103.
PMID: 36589372 DOI: 10.5704/MOJ.2211.015

INTRODUCTION: The devastating outcome of orthopaedic surgical site infections (SSI) are largely preventable if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional area are known.
MATERIALS AND METHODS: We conducted a retrospective study to address the lack of epidemiological and microbiological data on orthopaedic SSI in Malaysia. All the 80 patients diagnosed and treated for microbiologically proven orthopaedic SSIs in a tertiary hospital in Malaysia from April 2015 to March 2019 were included in a 1:2 case control study.
RESULTS: The prevalence of SSI in clean and clean-contaminated surgeries was 1.243%, which is consistent with most of the studies worldwide, but is low compared to other studies done in Malaysia. The most common type of orthopaedics SSI were internal fixation infections (46.25%), superficial SSIs (25.2%) and Prosthetic joint infections (18.75%). Obesity and tobacco use were found to be significant risk factors of orthopaedic SSI. The most common perioperative prophylaxis used was IV cefuroxime. Majority of the cases (86.5%) received prolonged prophylactic antibiotics. The most common causative agent was Staphylococcus aureus (31.25%), followed by Pseudomonas aeruginosa (26.25%) and Enterobacter spp (7.5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 20% of the S. aureus infections. Up to 19.4% of the Gram-negative organisms are multidrug resistant. The higher rate of isolation of organisms resistant to the prophylactic antibiotics being used may be related to the prolonged use of prophylactic antibiotics, which exerted selective pressure for the acquisition of resistant organisms.
CONCLUSION: Despite its relatively low prevalence in our local institution and worldwide, the prevention of SSI in orthopaedic practice is crucial to avoid morbidity, mortality and high healthcare cost. This may be achieved by control of modifiable risk factors such as obesity and tobacco use, appropriate use of prophylactic antibiotics and implementation of good surgical and infection control practices.
Underdiagnosis of Borderline oxacillin-resistant Staphylococcus aureus (BORSA) - Case series

Samsudin N, Chua WC, Hasan H, Hassan SA, Deris ZZ

Malays J Pathol, 2024 Apr;46(1):95-102.
PMID: 38682849

Borderline oxacillin-resistant Staphylococcus aureus (BORSA) are mecA-negative strains with oxacillin minimum inhibitor concentration (MIC) close to the resistance breakpoint of ≥ 4μg/mL. Instead of producing penicillin-binding protein with low affinity to methicillin (oxacillin) mediated by mecA gene as in methicillin-resistant S. aureus (MRSA), BORSA strains are characterised by the hyperproduction of β-lactamase enzymes, thus able to break down methicillin. Common laboratory methods to detect MRSA such as cefoxitin disk diffusion alone may fail to detect methicillin resistance due to BORSA. We report five cases of BORSA blood-stream infections in a university teaching hospital. All isolates were found to be susceptible to cefoxitin using disk diffusion, resistant to oxacillin using automated MIC method, and did not harbour mecA gene. All patients were suscessfully treated with anti-MRSA antibiotics, and removal of primary sources were done if identified. A more cost-effective method for screening and diagnosis of BORSA is needed in addition to cefoxitin disk diffusion test, in order to monitor the spread, and to enable routine detection and treatment of this pathogen.
Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary

Chua WC, Velayudham VL, Hassan HA, Hanet SA

Ultrasound Obstet Gynecol, 2024 Sep;64 Suppl 1:181.
PMID: 39248804 DOI: 10.1002/uog.28317
Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary

Chua WC, Velayudham VL, Hassan HA, Hanet SA

Ultrasound Obstet Gynecol, 2024 Sep;64 Suppl 1:144.
PMID: 39249356 DOI: 10.1002/uog.28152
Fulltext Fetal acalvaria with lateral cleft lip and palate: A rare presentation

Mohd Jamil AA, Chua WC, Valayudham VR, Hassan HA, Jalal HA

Radiol Case Rep, 2024 Jan;19(1):374-377.
PMID: 38033668 DOI: 10.1016/j.radcr.2023.10.036

We report a case of acalvaria diagnosed prenatally via ultrasound and MRI. Acalvaria is a rare, fatal congenital condition characterized by the absence of flat bones of the cranial vault, dura mater, and its associated muscles with an intact central nervous system. A 41-year-old gravida 5, para 2 + 2A, presented to us at 26 weeks gestation age (GA) with ultrasound findings of a fragile and hypomineralized skull in the fetus. The patient was not keen on whole-axon sequencing. Fetus magnetic resonance imaging (MRI) revealed large cutaneous/skull nonvisualization of the fetus skull, possibly acrania without anencephaly. She delivered via cesarean section at 37 weeks because of two previous cesarean sections. A female infant weighing 2650 g was born with an intact sac to minimize excessive external pressure to the brain tissue. A diagnosis of acalvaria with bilateral lateral cleft lip and palate was made postdelivery. The infant was managed conservatively per multidisciplinary discussion and expired 3 weeks later.
Fulltext Corrigendum to "Fetal acalvaria with lateral cleft lip and palate: A rare presentation" [Radiology Case Reports 19 (2024) 374-377]

Jamil AAM, Chua WC, Valayudham VR, Hassan HA, Jalal HA

Radiol Case Rep, 2024 Mar;19(3):1232.
PMID: 38259716 DOI: 10.1016/j.radcr.2023.11.061

[This corrects the article DOI: 10.1016/j.radcr.2023.10.036.].
The Cross-Sectional Relations of COVID-19 Fear and Stress to Psychological Distress among Frontline Healthcare Workers in Selangor, Malaysia

Subhas N, Pang NT, Chua WC, Kamu A, Ho CM, David IS, et al.

Int J Environ Res Public Health, 2021 Sep 28;18(19).
PMID: 34639482 DOI: 10.3390/ijerph181910182

Previous pandemics have demonstrated short and long-term impacts on healthcare workers' mental health, causing knock-on effects on patient care and professional functioning. Indeed, the present COVID-19 pandemic has created unprecedented disruption in social interactions and working conditions. Malaysia has been under the Recovery Movement Control Order since June 2020; however, with the upsurge of cases, healthcare workers face pressure not only from working in resource-deprived settings but also from the increasing patient load. The primary objective of the present study was to examine the cross-sectional relationship of COVID-19 fear and stress to psychological distress (operationalized as anxiety and depression) in healthcare workers. The present sample included 286 frontline healthcare workers from three hospitals in Selangor, Malaysia. Self-administered questionnaires containing sociodemographic and occupational items, the Malay versions of the Coronavirus Stress Measure scale, the Fear of Coronavirus-19 scale, the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9 were distributed via online platforms. Hierarchical multiple regression findings suggest that age, shift work, and COVID-19 stress consistently predicted anxiety and depression among frontline healthcare workers after adjusting for sociodemographic and occupational variables. The present findings suggest that frontline healthcare workers are not only inoculated against COVID-19 itself but also against the psychological sequelae of the pandemic.
Fulltext Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis

Chua WC, Mazlan MZ, Ali S, Che Omar S, Wan Hassan WMN, Seevaunnantum SP, et al.

IDCases, 2017;9:91-94.
PMID: 28725564 DOI: 10.1016/j.idcr.2017.05.002

We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.
First reported cases of Borrelia and dengue co-infection: A case series

Irekeola AA, Ahmed N, Abdul Hadi MI, Yung TC, Mohd Shukri MF, Mafauzy MM, et al.

Trop Biomed, 2024 Sep 01;41(3):316-318.
PMID: 39548786 DOI: 10.47665/tb.41.3.012

Dengue fever is one of the most common diagnoses in patients presenting with acute febrile illness in tropical countries. Borrelia, on the other hand, is the cause of vector-borne infections of relapsing fever and Lyme disease. While co-infections of dengue with chikungunya, Zika, malaria, influenza and typhoid have been reported, clinical cases of Borrelia infections have never been reported in Malaysia. Based on available evidence, this is the first case series to report dengue fever and Borrelia spp. co-infection. All three patients in this report were admitted to medical wards on day 3 to day 8 of illness for dengue fever as evidenced by a positive dengue NS1 antigen test. The clinical manifestations were typical of dengue fever, with all patients having high grade fever, myalgia, and arthralgia. All patients also had thrombocytopenia. Features of severe dengue, such as shock, hemorrhage and impaired consciousness were absent. Borrelia DNA were detected in the blood samples of the patients. However, all the patients denied having skin lesions and a history of insect bites. All the patients were given intravenous fluid therapy and were discharged after 3 to 5 days of hospitalization.