Identification of AbaR4 #Acinetobacter baumannii #resistance island in clinical isolates of blaOXA-23-positive #Proteus mirabilis (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Identification of AbaR4 Acinetobacter baumannii resistance island in clinical isolates of blaOXA-23-positive Proteus mirabilis

Sophie Octavia, Weizhen Xu, Oon Tek Ng, Kalisvar Marimuthu, Indumathi Venkatachalam, Bernadette Cheng, Raymond T P Lin, Jeanette W P Teo

Journal of Antimicrobial Chemotherapy, dkz472,

Published: 14 November 2019




blaOXA-23 is a class D carbapenemase-encoding gene typical of the Acinetobacter genus. However, its occurrence in the Enterobacteriaceae is uncommon. Here we provide the genome characterization of blaOXA-23-positive Proteus mirabilis.


In Singapore, a national surveillance of carbapenem non-susceptible clinical Enterobacteriaceae has enabled the collection of OXA-23 bearing isolates. Three clinical P. mirabilis were whole-genome sequenced using Oxford Nanopore MinION and Illumina platforms. The sequence accuracy of MinION long-read contigs was enhanced by polishing with Illumina-derived short-read data.


In two P. mirabilis genomes, blaOXA-23 was detected as two copies, present on the chromosome and on a 60 018 bp plasmid. blaOXA-23 was associated with the classic Acinetobacter composite transposon Tn2006, bounded by two copies of ISAba1 bracketing the carbapenemase gene. The Tn2006 itself was embedded within an Acinetobacter baumannii AbaR4 resistance island. In the chromosome, the AbaR4 was found integrated into the comM gene, which is also the preferred ‘hotspot’ in A. baumannii. In the plasmid, AbaR4 integrated into a putative colicin gene.


Our description of an A. baumannii AbaR4 encoding blaOXA-23 in P. mirabilis is to our knowledge the first description of an Acinetobacter resistance island in Proteus and suggests that P. mirabilis may be a reservoir for this class D carbapenemase gene.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email:

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Acinetobacter baumannii; Proteus mirabilis; Singapore.


#Adenoviral #Infections in #Singapore: Should New #Antiviral #Therapies and #Vaccines Be Adopted? (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Adenoviral Infections in Singapore: Should New Antiviral Therapies and Vaccines Be Adopted?

Kristen K Coleman, Chui Ching Wong, Jayanthi Jayakumar, Tham T Nguyen, Abigail W L Wong, Su Yadana, Koh C Thoon, Kwai Peng Chan, Jenny G Low, Shirin Kalimuddin, Shoaleh Dehghan, June Kang, Amirhossein Shamsaddini, Donald Seto, Yvonne C F Su, Gregory C Gray

The Journal of Infectious Diseases, jiz489,

Published: 30 September 2019




A number of serious human adenovirus (HAdV) outbreaks have been recently reported: HAdV-B7 (Israel, Singapore, and USA), HAdV-B7d (USA and China), HAdV-D8, -D54, and -C2 (Japan), HAdV-B14p1 (USA, Europe, and China), and HAdV-B55 (China, Singapore, and France).


To understand the epidemiology of HAdV infections in Singapore, we studied 533 HAdV-positive clinical samples collected from 396 pediatric and 137 adult patients in Singapore from 2012-2018. Genome sequencing and phylogenetic analyses were performed to identify HAdV genotypes, clonal clusters and recombinant or novel HAdVs.


The most prevalent genotypes identified were HAdV-B3 (35.6%), HAdV-B7 (15.4%) and HAdV-E4 (15.2%). We detected four new HAdV-C strains and detected incursions with HAdV-B7 (odds ratio [OR], 14.6 [95% CI, 4.1-52.0]) and HAdV-E4 (OR, 13.6 [3.9-46.7]) among pediatric patients over time. Additionally, immunocompromised patients (adjusted OR [aOR], 11.4 [3.8-34.8]) and patients infected with HAdV-C2 (aOR, 8.5 [1.5-48.0]), HAdV-B7 (aOR, 3.7 [1.2-10.9]), or HAdV-E4 (aOR, 3.2 [1.1-8.9]) were at increased risk for severe disease.


Singapore would benefit from more frequent studies of clinical HAdV genotypes to identify patients at risk for severe disease and help guide the use of new antiviral therapies, such as brincidofovir, and potential administration of human adenovirus 4 and 7 vaccine.

Adenovirus, genotyping, respiratory disease, molecular epidemiology, pediatric disease

Issue Section: Major Article

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail:

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (

Keywords: Adenovirus; Antivirals; Brincidofovir; Vaccines; Singapore.


Conjugative IncX 1 #plasmid harboring #colistin #resistance gene #mcr-5.1 in #E coli isolated from #chicken rice retailed in #Singapore (Antimicrob Agents Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Conjugative IncX 1 plasmid harboring colistin resistance gene mcr-5.1 in E. coli isolated from chicken rice retailed in Singapore

Siyao Guo, Moon Y.F. Tay, Aung Kyaw Thu, Kelyn Lee Ghee Seow, Yang Zhong, Lee Ching Ng, Joergen Schlundt

DOI: 10.1128/AAC.01043-19



Colistin is regarded as one of the last resort antimicrobials to Gram-negative bacterial infection (1).…


Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Colistin; MCR5; Plasmids; Food Safety; Singapore.


Seasonal #influenza-associated #ICU #admission and #death in #tropical #Singapore, 2011-2015 (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 18 June 2019 / In Press, Accepted Manuscript

Seasonal influenza-associated intensive care unit admission and death in tropical Singapore, 2011-2015

Zoe X.Z. Zhang a,b,1, Win Mar Kyaw b,1, Hanley J. Ho b, Min Zhi Tay b,c, Hongjie Huang a, Aung Aung Hein b, AngelaChow b

{a} Department of Epidemiology, Singapore General Hospital, Singapore; {b}
Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore; {c} Preventive Medicine Residency Programme, National University Health System, Singapore

Received 9 February 2019, Revised 6 June 2019, Accepted 15 June 2019, Available online 18 June 2019. DOI:



  • Seasonal influenza occurs all year-round in tropical Singapore and has posed significant social and economic burden.
  • Patients with severe seasonal influenza were characterized by advanced age, hypoalbuminemia and presence of pneumonia on admission.
  • Age ≥65 years, malignancy, and hypoalbuminemia were associated with increased mortality, while antiviral therapy and ventilation were associated with decreased mortality.




Seasonal influenza can cause severe illness leading to intensive care unit (ICU) admission and death.


To define the clinical and epidemiological features of severe seasonal influenza infection and factors associated with mortality.

Study design:

A retrospective review was conducted on all patients with laboratory-confirmed influenza infection who were either admitted into the ICU or died in the two largest tertiary hospitals in Singapore from 2011-2015.


Of 520 patients included in our study, 423 (81.3%) had influenza A infection and the rest with influenza B. Of patients with influenza A infection, 70.0% (296/423) were subtyped, of whom 24.0% (71/296) had A/H1N1pdm2009 and 76.0% (225/296) had A/H3N2. The median age of patients was 72 years (IQR 61-82). Males constituted 53.1% (276/520). Median Charlson comorbidity index score was 1 (IQR 0-3). About 70% had physical or radiological evidence of pneumonia upon admission. In-hospital mortality was 58.1% (302/520). On multiple logistic regression analysis, factors positively associated with mortality were age ≥65 years (adjusted odds ratio, aOR = 3.64, 95%CI 2.21-5.99, p < 0.001), malignancy (aOR = 2.53, 95%CI 1.12-5.73; p = 0.026), and hypoalbuminemia (aOR = 2.16, 95%CI 1.26-3.73; p = 0.005), while antiviral therapy (aOR = 0.33, 95%CI 0.17-0.63; p < 0.001) and ventilation (aOR = 0.23, 95% CI 0.13-0.39; p < 0.001) were negatively associated.


Patients with severe seasonal influenza infection were characterized by advanced age, hypoalbuminemia and presence of pneumonia on admission. Age ≥65 years, malignancy, and hypoalbuminemia were associated with increased mortality, and antiviral therapy and ventilation with decreased mortality.

Abbreviations: ICU=intensive care unit – HD=high dependency unit – RT-PCR=real-time reverse transcription-polymerase chain reaction – CCI=Charlson’s comorbidity index – IQR=interquartile range – LOS=length of hospital stay – WHO=World Health Organization – CDC=Centers for Disease Control and Prevention

Keywords: seasonal influenza – mortality – epidemiology

{1} Z. ZXZ and W. MK contributed equally to the study.

© 2019 Published by Elsevier B.V.

Keywords: Seasonal Influenza; ICU; Singapore.


First Case of #Ceftriaxone- #Resistant #MDR #Neisseria gonorrhoeae in #Singapore (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

First Case of Ceftriaxone-Resistant Multidrug-Resistant Neisseria gonorrhoeae in Singapore

Karrie Kwan Ki Ko, Martin TW Chio, Sui Sin Goh, Ai Ling Tan, Tse Hsien Koh, Nurdyana Binte Abdul Rahman

DOI: 10.1128/AAC.02624-18



Amid the global crisis of increasing gonococcal antimicrobial resistance, we report the first case of ceftriaxone-resistant multidrug-resistant Neisseria gonorrhoeae in Singapore.…


Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs resistance; Neisseria gonorrhoeae; Singapore.


Healthy #elderly #Singaporeans show no age-related humoral hyporesponsiveness nor diminished #plasmablast generation in response to #influenza vaccine (Immunity Ageing., abstract)

[Source: Immunity & Ageing, full page: (LINK). Abstract, edited.]

Healthy elderly Singaporeans show no age-related humoral hyporesponsiveness nor diminished plasmablast generation in response to influenza vaccine

Xavier Camous, Lucian Visan, Crystal Tan Tze Ying, Brian Abel, Ma Shwe Zin Nyunt, Vipin Narang, Michael Poidinger, Christophe Carre, Sanie Sesay, Nabil Bosco, Nicolas Burdin, Paul Anantharajah Tambyah, Ng Tze Pin and Anis Larbi

Immunity & Ageing, 201815:28 / DOI:

©  The Author(s). 2018

Received: 28 September 2018 – Accepted: 2 November 2018 – Published: 12 November 2018



Improving influenza vaccine efficacy is a priority to reduce the burden of influenza-associated morbidity and mortality. By careful selection of individuals based on health we show sustained response to influenza vaccination in older adults. Sustaining health in aging could be an important player in maintaining immune responses to influenza vaccination.

Trial registration NCT03266237. Registered 30 August 2017,

Keywords: Seasonal Influenza; Vaccines; Singapore.


#Fatal Case of #Diphtheria and #Risk for Reemergence, #Singapore (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 11—November 2018 / Dispatch

Fatal Case of Diphtheria and Risk for Reemergence, Singapore

Yingqi Lai  , Parthasarathy Purnima, Marc Ho, Michelle Ang, Rama N. Deepak, Ka Lip Chew, Shawn Vasoo, Dimatatac F. Capulong, and Vernon Lee

Author affiliations: Ministry of Health, Singapore (Y. Lai, M. Ho, M. Ang, V. Lee); Khoo Teck Puat Hospital, Singapore (P. Purnima, R.N. Deepak); National Public Health Laboratory, Singapore (M. Ang); National University Hospital, Singapore (K.L. Chew); Tan Tock Seng Hospital, Singapore (S. Vasoo, D.F. Capulong)



We report a fatal autochthonous diphtheria case in a migrant worker in Singapore. This case highlights the risk for individual cases in undervaccinated subpopulations, despite high vaccination coverage in the general population. Prompt implementation of public health measures and maintaining immunization coverage are critical to prevent reemergence of diphtheria.

Keywords: Diphtheria; Singapore.