Head of Infectious Diseases Unit, Medical Department, UKM Medical Centre
He completed his undergraduate training in University Science Malaysia and postgraduate training in internal medicine in the National University of Malaysia and Infectious Diseases Training with the Ministry of Health for 2 years and completed 1 year of clinical fellowship in Infectious Diseases at St Vincent's Hospital, Sydney 2009.
Special field of interest
HIV and general infectious diseases work
||Update on The Management of Difficult to Treat Gram-Negative Bacterial Infection
||The Human and Economic cost of Antimicrobial Resistance (AMR) is expected to cause 10 million deaths attributed to AMR in 2050. There could be a reduction of 2% to 3.5% in Gross Domestic Product (GDP) costing the world up to 100 trillion USD to manage this silent pandemic soon.
WHO publishes its first ever list of antibiotic-resistant "priority pathogens" - a catalogue of 12 families of bacteria that pose the greatest threat to human health. Priority 1 which is CRITICAL are carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae (CRE).
We will look at the common multi drug resistant organisms around this region and see how the new drugs cater to our own country needs. Some of the drugs that are already available in our shores are Zerbaxa (Ceftolozane/Tazobactam) and Zavicefta (ceftazidime and avibactam) . We will see how best we can use them. However there still seems to be a big hole left in terms of treatment which is the treatment of metallo beta lactamase (MBL) CRE and CRAB in our country. For this, we will explore some potential new antibiotics like cefiderocol and ervacycline in terms of treatment of this difficult organism.
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||Prevention of Antimicrobial Resistance - Is It Possible?
||Without much fanfare and shadowed by Covid 19 many of us did not realise that we had the 4th pandemic which was the Post Antibiotics ERA 2019. The global burden associated with drug-resistant infections assessed across 88 pathogens and drug combinations cost in 2019 was an estimated 4Ã?Â·95 million. A staggering 1Ã?Â·27 million deaths were directly attributable to drug resistance.
With that in mind, is broad spectrum antibiotics necessary all the time? Studies have shown initial antimicrobial therapy that is too broad is associated with poor outcomes. Not only that, broad-spectrum antibiotic treatment has been associated with an increased mortality risk.
Duration also matters in the treatment of infection. Risk of new resistance emergence increases for each day of additional exposure to antipseudomonal Ã?Â²-lactam antibiotics
However, haematology patients and hematopoietic stem cell transplantation recipients undergoing intensive myelosuppressive/ immunosuppressive treatment are at high risk for severe, life-threatening, bacterial infections. 13 - 60% of HSCT recipients develop BSI, which are associated with 12 - 42% mortality.
What are the evidence to support stopping antibiotics when patient is stable despite still febrile/afebrile neutropenia? What factors influence empiric antibiotic choice? Most importantly are the risk factors for infection with resistant bacteria and risk factors for a complicated clinical course.
They are some challenges when implementing ECIL 4 guidelines and here we will see some solutions in the other studies for example the How long trial and antibiostop therapy to name a few in guiding us.
With this and some old fashioned antibiotic stewardship, it is my hope, antimicrobial resistance can be delayed or even prevented.
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