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Takahashi T, Kim H, Kim HS, Kim HS, Song W, Kim JS. Comparative Genomic Analysis of Staphylococcal Cassette Chromosome mec Type V Staphylococcus aureus Strains and Estimation of the Emergence of SCC mec V Clinical Isolates in Korea. Ann Lab Med 2024; 44:47-55. [PMID: 37665285 PMCID: PMC10485862 DOI: 10.3343/alm.2024.44.1.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/08/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Background Staphylococcal cassette chromosome mec type V (SCCmec V) methicillin-resistant Staphylococcus aureus (MRSA) has been recovered from patients and livestock. Using comparative genomic analyses, we evaluated the phylogenetic emergence of SCCmec V after transmission from overseas donor strains to Korean recipient strains. Methods Sixty-three complete MRSA SCCmec V genomes (including six Korean clinical isolates) were used to construct a phylogenetic tree. Single-nucleotide polymorphisms were identified using Snippy, and a maximum-likelihood-based phylogenetic tree was constructed using RAxML. The possible emergence of the most common ancestor was estimated using BactDating. To estimate mecA horizontal gene transfer (HGT) events, Ranger-dtl was applied to 818 SCCmec V strains using publicly available whole-genome data. Results The phylogenetic tree showed five major clades. German strains formed a major clade; their possible origin was traced to the 1980s. The emergence of Korean SCCmec V clinical isolates was traced to 2000-2010. mecA HGT events in Staphylococcus spp. were identified in seven strains. P7 (Hong Kong outbreak strain) served as the donor strain for two Korean sequence type (ST) 59 strains, whereas the other five recipient strains emerged from different SCCmec V donors. Conclusions Most Korean SCCmec V strains may have emerged during 2000-2010. A unique MRSA SCCmec V strain, ST72 (a Korean common type of community-associated MRSA), was also identified. The genomic dynamics of this clone with a zoonotic background should be monitored to accurately understand MRSA evolution.
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Affiliation(s)
- Takashi Takahashi
- Laboratory of Infectious Diseases, Graduate School of Infection Control Sciences & Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Hyaekang Kim
- Bioresources Collection and Research Division, Bioresources Collection and Bioinformation Department, Nakdonggang National Institute of Biological Resources (NNIBR), Sangju, Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Wonkeun Song
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
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Yoon S, Guk J, Lee SG, Chae D, Kim JH, Park K. Model-informed precision dosing in vancomycin treatment. Front Pharmacol 2023; 14:1252757. [PMID: 37876732 PMCID: PMC10593454 DOI: 10.3389/fphar.2023.1252757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction: While vancomycin remains a widely prescribed antibiotic, it can cause ototoxicity and nephrotoxicity, both of which are concentration-associated. Overtreatment can occur when the treatment lasts for an unnecessarily long time. Using a model-informed precision dosing scheme, this study aims to develop a population pharmacokinetic (PK) and pharmacodynamic (PD) model for vancomycin to determine the optimal dosage regimen and treatment duration in order to avoid drug-induced toxicity. Methods: The data were obtained from electronic medical records of 542 patients, including 40 children, and were analyzed using NONMEM software. For PK, vancomycin concentrations were described with a two-compartment model incorporating allometry scaling. Results and discussion: This revealed that systemic clearance decreased with creatinine and blood urea nitrogen levels, history of diabetes and renal diseases, and further decreased in women. On the other hand, the central volume of distribution increased with age. For PD, C-reactive protein (CRP) plasma concentrations were described by transit compartments and were found to decrease with the presence of pneumonia. Simulations demonstrated that, given the model informed optimal doses, peak and trough concentrations as well as the area under the concentration-time curve remained within the therapeutic range, even at doses smaller than routine doses, for most patients. Additionally, CRP levels decreased more rapidly with the higher dose starting from 10 days after treatment initiation. The developed R Shiny application efficiently visualized the time courses of vancomycin and CRP concentrations, indicating its applicability in designing optimal treatment schemes simply based on visual inspection.
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Affiliation(s)
- Sukyong Yoon
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Jinju Guk
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, Republic of Korea
| | - Sang-Guk Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongwoo Chae
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Ho Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungsoo Park
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Seo CW, Kim YK, An JL, Kim JS, Kwon PS, Yu YB. The effect of photodynamic therapy using Radachlorin on biofilm-forming multidrug-resistant bacteria. Osong Public Health Res Perspect 2022; 13:290-297. [PMID: 36097751 PMCID: PMC9468690 DOI: 10.24171/j.phrp.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/25/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aimed to test the effect of photodynamic therapy (PDT) on the inhibition and removal of biofilms containing multidrug-resistant Acinetobacter baumannii. Methods Using multidrug-resistant A. baumannii strains, an antibiotic susceptibility test was performed using the Gram-negative identification card of the Vitek 2 system (bioMérieux Inc., France), as well as an analysis of resistance genes, the effects of treatment with a light-emitting diode (LED) array using Radachlorin (RADA-PHARMA Co., Ltd., Russia), and transmission and scanning electron microscopy to confirm the biofilm-inhibitory effect of PDT. Results The antibiotic susceptibility test revealed multiple resistance to the antibiotics imipenem and meropenem in the carbapenem class. A class-D–type β-lactamase was found, and OXA-23 and OXA-51 were found in 100% of 15 A. baumannii strains. After PDT using Radachlorin, morphological observations revealed an abnormal structure due to the loss of the cell membrane and extensive morphological changes, including low intracellular visibility and small vacuoles attached to the cell membrane. Conclusion PDT involving a combination of LED and Radachlorin significantly eliminated the biofilm of multidrug-resistant A. baumannii. Observations made using electron microscopy showed that PDT combining LED and Radachlorin was effective. Additional studies on the effective elimination of biofilms containing multidrug-resistant bacteria are necessary, and we hope that a treatment method superior to sterilization with antibiotics will be developed in the future.
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Lee H, Kim JL, Jung DH, Seo Y, Kim M, Yong D, Lee K, Chong Y. Evaluation of Disk carbapenemase test using improved disks for rapid detection and differentiation of clinical isolates of carbapenemase-producing Enterobacterales. J Infect Chemother 2021; 27:1205-1211. [PMID: 33888420 DOI: 10.1016/j.jiac.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Rapid detection of carbapenemase-producing Enterobacterales (CPE) is important to control spread of the resistance. We previously reported that imipenem disks prepared from injectable imipenem-cilastatin could rapidly detect KPC- and NDM-type carbapenemases. In the present study, we evaluated performance of disks of IPM and combined disks of imipenem-tazobactam and imipenem-EDTA, which were prepared from powders of imipenem and inhibitors. METHODS Isolates of Enterobacterales were recovered from specimens of patients at a tertiary care hospital in Korea during January 2017 and March 2018. Routine CPE detection was performed by the CPE surveillance personnel whereas evaluation of the Disk carbapenemase test (DCT) was performed by the other personnel without knowing the results of surveillance. The DCT was carried out by pressing disks on to colonies and rehydrating in Petri plates and observing color change. RESULTS The DCT differentiated 688 of 694 (sensitivity 99.1%) carbapenemase-producing isolates in 2.5-20 min: 630 with KPC, 51 with NDM, three with IMP, one with VIM, two with KPC and IMP, and one with NDM and OXA-181. The DCT failed to detect six OXA- 48-like enzyme-producing isolates, but the modified method using 96-well flat-bottom microplates with mineral oil cover detected all 29 OXA-48-like enzyme-producing isolates in 20-120 min. The DCT was negative for all 440 ertapenem-nonsusceptible, carbapenemase gene-negative isolates (specificity 100%). CONCLUSION The procedure of DCT is simple and can differentiate isolates of Enterobacterales with KPC-, NDM-, IMP- and VIM-type carbapenemases rapidly, and the modified DCT can detect isolates with OXA-48-like enzymes rapidly.
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Affiliation(s)
- Hyukmin Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jung Lim Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Da Hee Jung
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Younghee Seo
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Myungsook Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Dongeun Yong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea; Seoul Clinical Laboratories Academy, Yongin, 16954, South Korea.
| | - Yunsop Chong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
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Shin E, Hong H, Lee HJ, Lee Y. Antimicrobial Resistance Profiles and Molecular Characteristics of Coagulase-Negative Staphylococci Isolated from Two Tertiary Hospitals Before and 15 Years After Implementation of the Separation of Drug Prescribing and Dispensing Policy of Korea. Microb Drug Resist 2020; 26:251-260. [DOI: 10.1089/mdr.2019.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eunju Shin
- Culture Collection of Antimicrobial Resistant Microbes, Department of Horticulture, Biotechnology, and Landscape Architecture, College of Natural Sciences, Seoul Women's University, Seoul, Korea
| | - Hyunjin Hong
- Culture Collection of Antimicrobial Resistant Microbes, Department of Horticulture, Biotechnology, and Landscape Architecture, College of Natural Sciences, Seoul Women's University, Seoul, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yeonhee Lee
- Culture Collection of Antimicrobial Resistant Microbes, Department of Horticulture, Biotechnology, and Landscape Architecture, College of Natural Sciences, Seoul Women's University, Seoul, Korea
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Park CE, Kwon PS. Antimicrobial Effects of Essential Oils for Multidrug-Resistant Acinetobacter baumanii. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.4.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Chang-Eun Park
- Department of Biomedical Laboratory Science, Molecular Diagnostics Research Institute, Namseoul University, Cheonan, Korea
| | - Pil Seung Kwon
- Department of Clinical Laboratory Science, Wonkwang Health Science University, Iksan, Korea
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Kim HS, Park SB, Kim SH, Kim S, Hyun SH, Kim YK. Molecular Genetic Characteristics of Methicillin-Resistant Staphylococcus aureus Isolated from Patients and Environment of General Hospital Intensive Care Unit in a Chungnam Province, Korea. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.2.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hye-Suk Kim
- Department of Laboratory Medicine, Hongsung Medical Center, Hongseong, Korea
| | - Sung-Bae Park
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan, Korea
| | - Sang-Ha Kim
- Department of Laboratory Medicine, Konyang University Hospital, Daejeon, Korea
| | - Sunghyun Kim
- Department of Clinical Laboratory Science, College of Health Sciences, Catholic University of Pusan, Busan, Korea
| | - Sung-Hee Hyun
- Department of Biomedical Laboratory Science, School of Medicine, Eulji University, Daejeon, Korea
| | - Young-Kwon Kim
- Department of Biomedical Laboratory Science, College of Medical Sciences, Konyang University, Daejeon, Korea
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Antimicrobial-resistant Staphylococcus aureus and MRSA prevalence among Korean families and household items. Food Sci Biotechnol 2017; 27:269-275. [PMID: 30263749 DOI: 10.1007/s10068-017-0208-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/29/2017] [Accepted: 09/07/2017] [Indexed: 01/19/2023] Open
Abstract
One-hundred-and-seventy-nine Staphylococcus aureus strains, collected from a total of 825 resident and household item samples in Korean homes nationwide, were tested, to survey the spread of antimicrobial-resistant S. aureus including the methicillin-resistant S. aureus (MRSA) strain. Antimicrobial resistance to sulfamethoxazole-trimethoprim (0.0%), teicoplanin (0.0%), tetracycline, vancomycin (0.0%,) chloramphenicol (0.0%), ciprofloxacin (1.1%), clindamycin (1.1%), amikacin (2.2%), gentamicin (8.4%), oxacillin (17.9%), erythromycin (21.8%), ampicillin (96.6%) and penicillin (96.6%), was detected by disk diffusion method and 7.3% (13/179) of the antimicrobial-resistant isolates, were multi-drug resistant (resistant to ≥3 antimicrobial classes). Nine of 32 oxacillin-resistant strains, were positive for the mecA gene and identified as MRSA, in 4 residents and 4 loofah samples, by polymerase chain reaction. These findings provide public health information and contribute to preventing circulation of antimicrobial-resistant strains in community settings including healthy homes.
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Archibald LK. Gram-Negative, Hospital-Acquired Infections: A Growing Problem. Infect Control Hosp Epidemiol 2015; 25:809-11. [PMID: 15518020 DOI: 10.1086/502300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yoon J. Urinary Isolates and Antimicrobial Resistance in the Urine Collected from Patients Admitted into Primary-Care Hospital in Shiheung District. ANNALS OF CLINICAL MICROBIOLOGY 2013. [DOI: 10.5145/acm.2013.16.3.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kim TS, Kim MJ, Kim SH, Kee HY, Seo JJ, Kim ES, Moon YU, Ryu PY, Ha DR. Profile of Antimicrobial Resistance of Staphylococcus aureusand Molecular Epidemiologic Characterization of Methicillin-resistant Staphylococcus aureus(MRSA) Isolated from Hands of People Using Multitude Facilities. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.4.289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tae Sun Kim
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Min Ji Kim
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Sun Hee Kim
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Hye-young Kee
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Jin-jong Seo
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Eun-Sun Kim
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Yong-Un Moon
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
| | - Puil Youl Ryu
- Department of Microbiology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Ryong Ha
- Health & Environment Institute of Gwangju, Health Research Department, Microbioloy Division, Gwangju, Korea
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Kwon JC, Kim SH, Park SH, Choi SM, Lee DG, Choi JH, Park C, Shin NY, Yoo JH. Molecular epidemiologic analysis of methicillin-resistant Staphylococcus aureus isolates from bacteremia and nasal colonization at 10 intensive care units: multicenter prospective study in Korea. J Korean Med Sci 2011; 26:604-11. [PMID: 21532849 PMCID: PMC3082110 DOI: 10.3346/jkms.2011.26.5.604] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 02/28/2011] [Indexed: 01/23/2023] Open
Abstract
We investigated molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolated at 10 intensive care units (ICUs) in Korea. MRSA isolates from bacteremia and nasal colonization were collected prospectively from October 2008 through May 2009 at 10 University-affiliated hospital ICUs. A total of 83 and 175 MRSA strains were isolated from bacteremia and nasal colonization, respectively. Acquired group accounted for 69.9% (n = 58) of bacteremia and 73.1% (n = 128) of nasal colonization. Pulsed-field gel electrophoresis (PFGE) type B (SCCmec type II/ST5) was dominant in the acquired group followed by PFGE type D (SCCmec type IVA/ST72; a community genotype). Seven of 58 (12.1%) acquired bacteremia and 15 of 128 (11.8%) acquired nasal colonizations had SCCmec type IVA/ST72 genotype, which indicated that the community genotype had already emerged as a cause of ICU acquired MRSA infection or colonization. Antibiotic resistance rates to ciprofloxacin, tetracycline, clindamycin and trimethoprim/ sulfamethoxazole were 84.4%, 67.1%, 78.1%, and 12.0%, respectively. Susceptibility to ciprofloxacin best predicted a community genotype (sensitivity 96.5%; specificity 96.9%; odds ratio 861; 95% confidence interval 169-4,390, P < 0.001) and the positive predictive value was 90.2%. Among 23 nasal re-colonized strains, 7 MRSA strains (30.4%) were different from the originally colonized strains on the basis of PFGE types.
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Affiliation(s)
- Jae-Cheol Kwon
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si-Hyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chulmin Park
- Clinical Research Institutes of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na-Young Shin
- Clinical Research Institutes of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Hong Yoo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Impact of de-escalation therapy on clinical outcomes for intensive care unit-acquired pneumonia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R79. [PMID: 21366903 PMCID: PMC3219332 DOI: 10.1186/cc10072] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 02/09/2011] [Accepted: 03/02/2011] [Indexed: 01/02/2023]
Abstract
Introduction De-escalation therapy is a strategy currently used for the management of nosocomial pneumonia. In this study, we evaluated clinical outcomes and risk factors related to de-escalation therapy in patients with intensive care unit (ICU)-acquired pneumonia. Methods This was a retrospective observational cohort study of ICU patients who developed pneumonia more than 48 hours after admission to the ICU at Samsung Medical Center from September 2004 to December 2007. Results The 137 patients comprised 44 (32.1%) who received de-escalation therapy and 93 in the non-de-escalation group. The de-escalation group showed a lower pneumonia-related mortality rate than the non-de-escalation group by day 14 (2.3% vs. 10.8%, respectively; P = 0.08) and by day 30 (2.3% vs. 14%, respectively; P = 0.03) after the diagnosis of pneumonia. The variables independently associated with ICU-acquired pneumonia-related mortality included the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the modified Clinical Pulmonary Infection Score (CPIS) after 5 days with pneumonia. The non-de-escalation group had significantly higher APACHE II score and modified CPIS after 5 days with ICU-acquired pneumonia compared to the de-escalation group. Among all patients, 20.4% (28 of 137) had negative cultures for pathogens, and 42.9% (12 of 28) received de-escalation therapy. The latter 12 patients received de-escalation therapy and survived 30 days after the diagnosis of pneumonia. Conclusions Patients in the de-escalation group showed a significantly lower mortality rate compared to patients in the non-de-escalation group. De-escalation therapy can be safely provided to patients with ICU-acquired pneumonia if they are clinically stable by day 5, even in those whose respiratory specimen cultures yield no specific pathogens.
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Unno T, Han D, Jang J, Widmer K, Ko G, Sadowsky MJ, Hur HG. Genotypic and Phenotypic Trends in Antibiotic Resistant Pathogenic Escherichia coli Isolated from Humans and Farm Animals in South Korea. Microbes Environ 2011; 26:198-204. [DOI: 10.1264/jsme2.me10194] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tatsuya Unno
- Department of Environmental Science and Engineering, Gwangju Institute of Science and Technology
| | - Dukki Han
- Department of Environmental Science and Engineering, Gwangju Institute of Science and Technology
| | - Jeonghwan Jang
- Department of Environmental Science and Engineering, Gwangju Institute of Science and Technology
| | - Kenneth Widmer
- International Environmental Research Center, Gwangju Institute of Science and Technology
| | - GwangPyo Ko
- Department of Environmental Public Health, Seoul National University
| | - Michael J. Sadowsky
- Department of Soil, Water, and Climate and BioTechnology Institute, University of Minnesota
| | - Hor-Gil Hur
- Department of Environmental Science and Engineering, Gwangju Institute of Science and Technology
- International Environmental Research Center, Gwangju Institute of Science and Technology
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Shin NY, Yoo JH, Park C, Lee DG, Choi SM, Kwon JC, Kim SH, Park SH, Choi JH. Application of Infrequent-Restriction-Site Polymerase Reaction (IRS-PCR) to the Molecular Epidemiologic Analysis of Methicillin Resistant Staphylococcus aureus(MRSA). Infect Chemother 2011. [DOI: 10.3947/ic.2011.43.5.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Na-Young Shin
- Department of Biomedical Science, The Catholic University of Korea, Graduate School, Seoul, Korea
| | - Jin-Hong Yoo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chulmin Park
- Catholic Research Institutes of Medical Science, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Mi Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Cheol Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Si-Hyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hyun Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Park SH, Jang YH, Sung H, Kim MN, Kim JS, Park YJ. [Performance evaluation of BD GeneOhm MRSA PCR assay for detection of nasal colonization of methicillin-resistant Staphylococcus aureus at endemic intensive care units]. Korean J Lab Med 2010; 29:439-47. [PMID: 19893353 DOI: 10.3343/kjlm.2009.29.5.439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The BD GeneOhm MRSA PCR assay (Becton Dickinson, USA) is a qualitative real-time PCR test for rapid detection of nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). We evaluated the performance of BD GeneOhm MRSA PCR assay versus MRSASelect (Bio-Rad, France) and broth enrichment cultures for detection of MRSA from nasal swabs. METHODS From August 2008 to January 2009, 295 nasal swabs were taken from patients in intensive care units and transported to the laboratory with BD CultureSwab Liquid Stuart Single Swab (Becton Dickinson, USA). The swabs were inoculated onto MRSASelect first and then suspended into GeneOhm sample buffer: 100 microL of the suspension was inoculated into 6.5% NaCl-tryptic soy broth (Becton Dickinson, USA), which was subcultured on MRSASelect after overnight incubation (TSBS). Performances of GeneOhm MRSA and MRSASelect were compared to TSBS. RESULTS With GeneOhm MRSA, 125 swabs (44.6%) were positive for MRSA, 13 (4.4%) were unresolved, and 2 were not determined. With MRSASelect and TSBS 86 (29.4%) and 106 swabs (36.2%), respectively, were positive. The sensitivity, specificity, and positive and negative predictive value of GeneOhm MRSA were 85.8%, 77.5%, and 72.8% and 93.5%, respectively, and corresponding values for MRSASelect were 78.3%, 94.8%, and 96.5% and 88.9%. Of the 33 patients whose 34 specimens were found false positive in GeneOhm MRSA, 23 patients were MRSA-positive either previously or subsequently to this study. All of the 10 patients with false-negative specimens in GeneOhm MRSA PCR assay were previously MRSA or methicilln-resistant coagulase negative staphylococci (MRCNS)-positive and were treated for MRSA, but they became MRSA-positive after 1 to 4 negative surveillance cultures. CONCLUSIONS GeneOhm MRSA PCR assay showed a relatively high negative predictive value. However, its low specificity and frequent occurrence of unresolved results would be problematic in the endemic areas with a high prevalence of MRSA.
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Affiliation(s)
- Sang Hyuk Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Lee H, Jung D, Yeom JS, Son JS, Jung SI, Kim YS, Kim CK, Chang HH, Kim SW, Ki HK, Moon CS, Chung DR, Peck KR, Song JH, Woo GJ. Evaluation of ceftriaxone utilization at multicenter study. Korean J Intern Med 2009; 24:374-80. [PMID: 19949738 PMCID: PMC2784983 DOI: 10.3904/kjim.2009.24.4.374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Accepted: 01/21/2009] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND/AIMS As bacterial resistance to antimicrobial agents has grown due to the increasing use of antimicrobial agents, we sought to evaluate the suitability of ceftriaxone usage (representative of third generation cephalosporins) at 10 university hospitals in Korea. METHODS We prospectively evaluated the appropriateness of antibiotic usage in 400 adult patients who received ceftriaxone between February 1, 2006 and June 30, 2006. Drug utilization evaluation (DUE) methods were based on standards set forth by the American Society of Hospital Pharmacists. The DUE criteria used in this study were modified to be more suitable in our hospital setting: justification of drug use, critical and process indications, complications, and outcome measures. RESULTS The average patient age was 64.4 years. The utilization of ceftriaxone was appropriate in 262 cases (65.5%) for the justification of use, while inappropriate use was observed in 138 cases (34.5%). Common reasons for inappropriate use of ceftriaxone included continued empiric use for presumed infections, prophylactic perioperative injection, and empiric therapy for fever. Most of the critical indications showed a high rate of suitability (66.5-98.5%). Complications occurred in 37 cases (9.3%). With respect to outcome measures, clinical responses were observed in 60.7% of cases, while only 15.7% of cases showed evidence of infection eradication via negative cultures. CONCLUSIONS Appropriate use (65.5%) of ceftriaxone was higher than inappropriate use (34.5%) at university hospitals in Korea. Inappropriate utilization, however, including continued empiric use for presumed infections and prophylactic perioperative injection remained high. Intensification of educational programs and antibiotic control systems for ceftriaxone is needed to improve the suitability of antimicrobial use.
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Affiliation(s)
- Hyuck Lee
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Dongsik Jung
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Joon Sup Yeom
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Jun Seong Son
- Department of Internal Medicine, Kyung Hee University East-West Neo Medical Center, Seoul, Korea
| | - Sook-In Jung
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yeon-Sook Kim
- Department of Internal Medicine, Chungnam National University Hospital, Daejon, Korea
| | - Chun Kwan Kim
- Department of Internal Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Hyun-Ha Chang
- Department of Internal Medicine, Kyungpook National University Hopital, Daegu, Korea
| | - Shin-Woo Kim
- Department of Internal Medicine, Kyungpook National University Hopital, Daegu, Korea
| | - Hyun Kyun Ki
- Department of Internal Medicine, Konkuk University Hospital, Seoul, Korea
| | - Chi Sook Moon
- Department of Internal Medicine, Inje University Paik Hospital, Busan, Korea
| | - Doo Ryeon Chung
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyong Ran Peck
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Jae-Hoon Song
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Gun-Jo Woo
- Korea Food & Drug Administration, Seoul, Korea
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Absence of Escherichia coli phylogenetic group B2 strains in humans and domesticated animals from Jeonnam Province, Republic of Korea. Appl Environ Microbiol 2009; 75:5659-66. [PMID: 19592524 DOI: 10.1128/aem.00443-09] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiplex PCR analyses of DNAs from genotypically unique Escherichia coli strains isolated from the feces of 138 humans and 376 domesticated animals from Jeonnam Province, South Korea, performed using primers specific for the chuA and yjaA genes and an unknown DNA fragment, TSPE4.C2, indicated that none of the strains belonged to E. coli phylogenetic group B2. In contrast, phylogenetic group B2 strains were detected in about 17% (8 of 48) of isolates from feces of 24 wild geese and in 3% (3 of 96) of isolates obtained from the Yeongsan River in Jeonnam Province, South Korea. The distribution of E. coli strains in phylogenetic groups A, B1, and D varied depending on the host examined, and there was no apparent seasonal variation in the distribution of strains in phylogenetic groups among the Yeongsan River isolates. The distribution of four virulence genes (eaeA, hlyA, stx(1), and stx(2)) in isolates was also examined by using multiplex PCR. Virulence genes were detected in about 5% (38 of 707) of the total group of unique strains examined, with 24, 13, 13, and 9 strains containing hlyA, eaeA, stx(2), and stx(1), respectively. The virulence genes were most frequently present in phylogenetic group B1 strains isolated from beef cattle. Taken together, results of these studies indicate that E. coli strains in phylogenetic group B2 were rarely found in humans and domesticated animals in Jeonnam Province, South Korea, and that the majority of strains containing virulence genes belonged to phylogenetic group B1 and were isolated from beef cattle. Results of this study also suggest that the relationship between the presence and types of virulence genes and phylogenetic groupings may differ among geographically distinct E. coli populations.
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Chung JL, Seo KY, Yong DE, Mah FS, Kim TI, Kim EK, Kim JK. Antibiotic susceptibility of conjunctival bacterial isolates from refractive surgery patients. Ophthalmology 2009; 116:1067-74. [PMID: 19395038 DOI: 10.1016/j.ophtha.2008.12.064] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Revised: 12/26/2008] [Accepted: 12/29/2008] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the in vitro antibiotic susceptibility patterns of conjunctival bacterial flora isolated before surgery from patients undergoing refractive surgery. DESIGN In vitro laboratory investigation. PARTICIPANTS One hundred five eyes from 105 patients scheduled for refractive surgery at Balgensesang Ophthalmology Clinic between September 2005 and January 2006 were studied. Among 105 patients, 71 (67.6%) underwent LASIK using a femtosecond laser, 24 (22.9%) underwent LASIK using an automated microkeratome, 8 (7.6%) underwent LASEK, and 2 (1.9%) patients underwent phakic intraocular lens implantation. METHODS Preoperative conjunctival swab samples were inoculated directly in culture media at the bedside before topical anesthetic or antibiotic application. Blood agar, chocolate agar, thioglycolate broth, Sabouraud dextrose agar, and Ogawa media were used for bacterial, fungal, and mycobacterial cultures. MAIN OUTCOME MEASURES Minimum inhibitory concentrations (MICs) of ofloxacin (OFX), levofloxacin (LEV), gatifloxacin (GAT), moxifloxacin (MOX), gemifloxacin (GEM), and other commonly used antibiotics were determined using an E test. RESULTS From 105 patients, 73 (85%) coagulase-negative staphylococci (CNS), 2 (2.3%) Staphylococcus aureus, 1 (1.2%) Streptococcus pneumoniae, and 5 (4.8%) gram-negative bacilli were isolated. No fungi or mycobacteria were isolated. The MIC that would inhibit the growth of 90% of the tested bacterial isolates (MIC(90)) of OFX, LEV, GAT, MOX, and GEM for methicillin-susceptible CNS (n = 46) were 0.5 microg/ml, 0.19 microg/ml, 0.094 microg/ml, 0.047 microg/ml, and 0.023 microg/ml, respectively. The MIC(90) values for methicillin-resistant CNS (n = 27) were 32 microg/ml, 4 microg/ml, 1 microg/ml, 0.5 microg/ml, and 0.25 microg/ml, respectively (P<0.001). CONCLUSIONS The most effective against conjunctival bacteria isolated from refractive surgery patients were GEM, MOX, and GAT; however, resistance to earlier-generation fluoroquinolones (OFX and LEV) is increasing among methicillin-resistant CNS. It may be a therapeutic option to use newer fluoroquinolones in patients undergoing refractive eye surgery to reduce such infections as methicillin-resistant CNS. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jae Lim Chung
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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20
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Ashour HM, El-Sharif A. Species distribution and antimicrobial susceptibility of gram-negative aerobic bacteria in hospitalized cancer patients. J Transl Med 2009; 7:14. [PMID: 19228413 PMCID: PMC2654854 DOI: 10.1186/1479-5876-7-14] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Accepted: 02/19/2009] [Indexed: 01/10/2023] Open
Abstract
Background Nosocomial infections pose significant threats to hospitalized patients, especially the immunocompromised ones, such as cancer patients. Methods This study examined the microbial spectrum of gram-negative bacteria in various infection sites in patients with leukemia and solid tumors. The antimicrobial resistance patterns of the isolated bacteria were studied. Results The most frequently isolated gram-negative bacteria were Klebsiella pneumonia (31.2%) followed by Escherichia coli (22.2%). We report the isolation and identification of a number of less-frequent gram negative bacteria (Chromobacterium violacum, Burkholderia cepacia, Kluyvera ascorbata, Stenotrophomonas maltophilia, Yersinia pseudotuberculosis, and Salmonella arizona). Most of the gram-negative isolates from Respiratory Tract Infections (RTI), Gastro-intestinal Tract Infections (GITI), Urinary Tract Infections (UTI), and Bloodstream Infections (BSI) were obtained from leukemic patients. All gram-negative isolates from Skin Infections (SI) were obtained from solid-tumor patients. In both leukemic and solid-tumor patients, gram-negative bacteria causing UTI were mainly Escherichia coli and Klebsiella pneumoniae, while gram-negative bacteria causing RTI were mainly Klebsiella pneumoniae. Escherichia coli was the main gram-negative pathogen causing BSI in solid-tumor patients and GITI in leukemic patients. Isolates of Escherichia coli, Klebsiella, Enterobacter, Pseudomonas, and Acinetobacter species were resistant to most antibiotics tested. There was significant imipenem -resistance in Acinetobacter (40.9%), Pseudomonas (40%), and Enterobacter (22.2%) species, and noticeable imipinem-resistance in Klebsiella (13.9%) and Escherichia coli (8%). Conclusion This is the first study to report the evolution of imipenem-resistant gram-negative strains in Egypt. Mortality rates were higher in cancer patients with nosocomial Pseudomonas infections than any other bacterial infections. Policies restricting antibiotic consumption should be implemented to avoid the evolution of newer generations of antibiotic resistant-pathogens.
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Affiliation(s)
- Hossam M Ashour
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
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Clinical significance of cerebrospinal fluid inhibitory titers of antibiotics, based on pharmacokinetic/pharmacodynamic parameters, in the treatment of bacterial meningitis. J Infect Chemother 2009; 15:233-8. [DOI: 10.1007/s10156-009-0697-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 04/11/2009] [Indexed: 10/20/2022]
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Kim JS, Kim HS, Song W, Cho HC, Lee KM, Kim EC. [Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolates with toxic shock syndrome toxin and staphylococcal enterotoxin C genes]. Korean J Lab Med 2008; 27:118-23. [PMID: 18094562 DOI: 10.3343/kjlm.2007.27.2.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many methicillin-resistant Staphylococcus aureus (MRSA) isolates in Korea possess a specific profile of staphylococcal enterotoxins in that the toxic shock syndrome toxin gene (tst) coexists with the staphylococcal enterotoxin C gene (sec). Because the analysis of staphylococcal cassette chromosome mec (SCCmec), a mobile genetic element mecA gene encoding methicillin resistance, showed that majority of these are SCCmec type II, these MRSA isolates with tst and sec may be genetically related with each other. This study was performed to investigate the genetic relatedness of tstand sec-harboring MRSA strains isolated in Korea by using pulsed-field gel electrophoresis (PFGE). METHODS A total of 59 strains of MRSA isolates of SCCmec type II possessing tst and sec were selected for PFGE and phylogenetic analyses. These isolates were collected from 13 health care facilities during nationwide surveillance of antimicrobial resistance in 2002. RESULTS The 59 MRSA isolates were clustered into 11 PFGE types, including one major group of 26 strains (44.1%) isolated from 7 healthcare facilities. Seven PFGE types contained 2 or more isolates each, comprising 55 isolates in total. CONCLUSIONS Most of SCCmec type II MRSA isolates containing tst and sec showed closely related PFGE patterns. Moreover, MRSA isolates collected from different healthcare facilities showed identical PFGE patterns. These findings suggested a clonal spread of MRSA strains possessing tst and sec in Korean hospitals.
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Affiliation(s)
- Jae Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Korea
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Uh Y, Hwang GY, Jang IH, Cho HM, Noh SM, Kim HY, Kwon O, Yoon KJ. Macrolide resistance trends in beta-hemolytic streptococci in a tertiary Korean hospital. Yonsei Med J 2007; 48:773-8. [PMID: 17963333 PMCID: PMC2628142 DOI: 10.3349/ymj.2007.48.5.773] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Erythromycin-resistant beta-hemolytic streptococci (BHS) has recently emerged and quickly spread between and within countries throughout the world. In this study, we evaluate the antimicrobial susceptibility patterns and erythromycin resistance mechanisms of BHS during 2003-2004. MATERIALS AND METHODS The MICs of seven antimicrobials were determined for 204 clinical isolates of BHS from 2003 to 2004. Resistance mechanisms of erythromycin-resistant BHS were studied by the double disk test as well as by polymerase chain reaction (PCR). RESULTS Compared with our previous study, resistance among Streptococcus pyogenes isolates to a variety of drugs decreased strikingly: from 25.7% to 4.8% in erythromycin; 15.8% to 0% in clindamycin; and 47.1% to 19.0% in tetracycline. The prevalent phenotypes and genotypes of macrolide-lincosamide-streptograminB (MLSB) resistance in Streptococcus pyogenes isolates have been changed from the constitutive MLSB phenotype carrying erm(B) to the M phenotype with mef(A) gene. In contrast with Streptococcus pyogenes, resistance rates to erythromycin (36.7%), clindamycin (43.1%), and tetracycline (95.4%) in Streptococcus agalactiae isolates did not show decreasing trends. Among the Streptococcus dysgalactiae subsp. equisimilis isolates (Lancefield group C, G), resistance rates to erythromycin, clindamycin, tetracycline and chloramphenicol were observed to be 9.4%, 3.1%, 68.8%, and 9.4%, respectively. CONCLUSION Continual monitoring of antimicrobial resistance among large-colony-forming BHS is needed to provide the medical community with current data regarding the resistance mechanisms that are most common to their local or regional environments.
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Affiliation(s)
- Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Ilsan-dong 162, Wonju, Gangwon-do, Korea.
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Molecular Epidemiology of Community-Associated Antimicrobial-ResistantStaphylococcus aureusin Seoul, Korea (2003): Pervasiveness of Multidrug-Resistant SCCmecType II Methicillin-ResistantS. aureus. Microb Drug Resist 2007; 13:178-85. [DOI: 10.1089/mdr.2007.709] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lee SS, Kim HS, Kang HJ, Kim JK, Chung DR. Rapid spread of methicillin-resistant Staphylococcus aureus in a new hospital in the broad-spectrum antibiotic era. J Infect 2007; 55:358-62. [PMID: 17692383 DOI: 10.1016/j.jinf.2007.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 05/28/2007] [Accepted: 06/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It has been known that it takes a long time for methicillin-resistant Staphylococcus aureus (MRSA) to introduce and become endemic within a hospital. During the last decade, widespread use of broad-spectrum antibiotics might have affected the time required for MRSA to spread and become endemic in hospitals. However, there has been no report on this issue. We investigated how fast MRSA has spread and become endemic in a hospital opened in the broad-spectrum antibiotic era. METHODS The study was performed at a Korean hospital, which opened in 1999. We examined the change of antimicrobial susceptibility and antimicrobial use density (AUD) for 6 years since hospital opening. RESULTS S. aureus susceptibility to oxacillin decreased from 64% in the first month to 33% in the second month (P=.05), and then has maintained around 30%. AUD was remarkably high from the first year, in which total AUD and those of aminopenicillins, second-generation cephalosporins, fluoroquinolones, and macrolides were 4674.6, 1444.6, 1700.9, 421.3, and 520.0 DDD/1000 patient-days, respectively. CONCLUSIONS MRSA has spread within a few months in a hospital opened in the broad-spectrum antibiotic era. Excessively high use of broad-spectrum antibiotics seems to be responsible for rapid spread of MRSA in the hospital.
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Affiliation(s)
- S S Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, South Korea
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Lim SK, Lee HS, Nam HM, Cho YS, Kim JM, Song SW, Park YH, Jung SC. Antimicrobial resistance observed in Escherichia coli strains isolated from fecal samples of cattle and pigs in Korea during 2003–2004. Int J Food Microbiol 2007; 116:283-6. [PMID: 17363100 DOI: 10.1016/j.ijfoodmicro.2006.12.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Revised: 10/30/2006] [Accepted: 12/29/2006] [Indexed: 11/17/2022]
Abstract
A total of 744 Escherichia coli strains isolated from 830 fecal samples of healthy cattle and pigs in all provinces of Korea were examined for resistance to 16 antimicrobials. The most frequently observed resistance in cattle isolates was to tetracycline (30.5%), followed by resistance to streptomycin (20.4%), ampicillin (12.0%) and chlorampenicol (6.9%). Prevalences of resistance to the same four antimicrobials in swine isolates were 96.3%, 66.8%, 66.1%, and 47.6%, respectively. The prevalence of resistance in pigs was much higher than that in cattle, with 98.3% of pig isolates and 37.1% of cattle isolates showing resistance to one or more of the antimicrobial agents tested.
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Affiliation(s)
- Suk-Kyung Lim
- National Veterinary Research and Quarantine Service, Ministry of Agriculture and Forestry, Anyang, Kyonggido, Republic of Korea
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Kim JS, Song W, Kim HS, Cho HC, Lee KM, Choi MS, Kim EC. Association between the methicillin resistance of clinical isolates of Staphylococcus aureus, their staphylococcal cassette chromosome mec (SCCmec) subtype classification, and their toxin gene profiles. Diagn Microbiol Infect Dis 2006; 56:289-95. [PMID: 16854552 DOI: 10.1016/j.diagmicrobio.2006.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 05/08/2006] [Accepted: 05/09/2006] [Indexed: 10/24/2022]
Abstract
Virulence and antimicrobial resistance are important determinators of the clinical manifestations and of the treatments of bacterial infections. Here, we studied the associations between the methicillin resistance of clinical Staphylococcus aureus isolates, their classifications as particular staphylococcal cassette chromosome mec (SCCmec) subtypes, and their toxin gene profiles. In total, 252 S. aureus isolates were collected from 13 healthcare facilities in 6 Korean provinces. The overall prevalence of methicillin-resistant S. aureus (MRSA) was 63%. SCCmec typing and toxin gene analysis were performed by multiplex polymerase chain reaction. One or more staphylococcal toxin genes were found in 190 (75.4%) strains. Methicillin-resistant S. aureus strains carried toxin genes more frequently than methicillin-susceptible S. aureus strains (85.5% versus 53.8%). SCCmec subtypes differed in terms of their frequencies of toxin gene carriage (95.9% in SCCmec II, 74.4% in SCCmec III, and 68.8% in SCCmec IV). Specific SCCmec subtypes frequently harbored particular toxin gene combinations: 77.3% of SCCmec II strains carried sec and tst genes, 48.8% of SCCmec III strains carried sea and see genes, and 46.9% of SCCmec IV carried sea and seb genes. Indeed, the most prevalent combination in MRSA strains, that of sec and tst, was only observed in SCCmec II strains, and these strains failed to show the coexistence of sea and see or sea and seb genes. Thus, the SCCmec subtypes of S. aureus revealed specific staphylococcal toxin profiles. We revealed that certain staphylococcal toxin gene profiles are associated not only with the methicillin resistance of S. aureus but also with their SCCmec subtypes.
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Affiliation(s)
- Jae-Seok Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, South Korea
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Eun SH, Lee YS, Cha JO, Yoo JI, Lee JG, Lee HJ, Kim BS. The point prevalence and associated factors of nasal methicillin-resistant Staphylococcus aureus colonisation in eight geriatric hospitals in Korea. Clin Microbiol Infect 2006; 12:81-3. [PMID: 16460551 DOI: 10.1111/j.1469-0691.2005.01313.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence and associated factors of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonisation were investigated among patients in geriatric hospitals in Korea. S. aureus was isolated from 317 (50.2%) of 632 patients. The nasal MRSA colonisation prevalence was 36.1%. In bivariate analysis, stay in an intensive care unit, decreased functional status, recent use of antibiotics, use of urinary catheters and the existence of skin breaks were associated with nasal MRSA colonisation (p < 0.05). Of these factors, only decreased functional status and recent use of systemic antibiotics were associated independently with nasal MRSA colonisation following logistic regression analysis.
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Affiliation(s)
- S H Eun
- Division of Antimicrobial Resistant Pathogens, Department of Bacteriology, National Institute of Health, Seoul, Korea
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Hoe CH, Yasin RM, Koh YT, Thong KL. Antimicrobial susceptibility and pulsed-field gel electrophoresis of Shigella sonnei strains in Malaysia (1997-2000). J Appl Microbiol 2005; 99:133-40. [PMID: 15960673 DOI: 10.1111/j.1365-2672.2005.02581.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Antimicrobial resistance of Shigella sonnei from Malaysia was determined and subtyping was carried by pulsed-field gel electrophoresis (PFGE) to assess the extent of genetic diversity of these strains. METHODS AND RESULTS A total of 62 isolates of S. sonnei from sporadic cases of shigellosis in different parts of Malaysia were studied by antimicrobial susceptibility test and PFGE. Approximately 35.5% of the strains showed resistance to three or more antimicrobial agents. Eight resistant phenotypes, i.e. RI to RVIII, was defined. Resistant phenotype RV and RVIII only appeared in year 2000. PFGE analysis with NotI and XbaI restriction showed that a great heterogeneity existed at the DNA level among Malaysian S. sonnei isolates. Fifty-eight NotI and 61 XbaI-PFGE profiles were observed in 63 S. sonnei isolates, including ATCC 11060 isolate. Drug sensitive isolates displayed very different profiles from drug-resistant isolates, with a few exceptions. Isolates of resistant phenotype RVI (SXTr.TETr.STRr) showed a greater similarity among each other compared with isolates of resistant phenotype RI and drug-sensitive isolates. CONCLUSION Multi-drug-resistant S. sonnei were circulated in different parts of Malaysia and the emergence of new resistant phenotype was observed. Wide genetic variations among Malaysian S. sonnei were observed and the drug-sensitive strains could be differentiated from drug-resistant strains by PFGE. SIGNIFICANCE AND IMPACT OF THE STUDY The present study verifies the usefulness of PFGE in characterizing and comparing strains of S. sonnei. Minor variations among S. sonnei isolates could be detected by PFGE.
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Affiliation(s)
- C H Hoe
- Microbiology Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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Kim J, Lim YM. Prevalence of derepressed ampC mutants and extended-spectrum beta-lactamase producers among clinical isolates of Citrobacter freundii, Enterobacter spp., and Serratia marcescens in Korea: dissemination of CTX-M-3, TEM-52, and SHV-12. J Clin Microbiol 2005; 43:2452-5. [PMID: 15872281 PMCID: PMC1153749 DOI: 10.1128/jcm.43.5.2452-2455.2005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The resistance mechanism of extended-spectrum cephalosporins in clinical isolates of Citrobacter freundii, Enterobacter spp., and Serratia marcescens was studied. Of 152 isolates, 45 isolates (29.6%) were derepressed AmpC mutants and 39 isolates (25.7%) produced extended-spectrum beta-lactamase (ESBLs). The most prevalent ESBLs were CTX-M enzymes, followed by TEM-52 and SHV-12.
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Affiliation(s)
- Jungmin Kim
- Department of Microbiology, Kyungpook University School of Medicine, Daegu, Korea.
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Lee JK, Lee YS, Park YK, Kim BS. Alterations in the GyrA and GyrB subunits of topoisomerase II and the ParC and ParE subunits of topoisomerase IV in ciprofloxacin-resistant clinical isolates of Pseudomonas aeruginosa. Int J Antimicrob Agents 2005; 25:290-5. [PMID: 15784307 DOI: 10.1016/j.ijantimicag.2004.11.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Accepted: 11/30/2004] [Indexed: 11/22/2022]
Abstract
The presence of fluoroquinolone resistance-associated alterations in topoisomerase II and IV were investigated for 103 nfxC-like type Pseudomonas aeruginosa isolates. The most nfxC-like type isolates (98.1%) possessed the substitution of Ile for Thr-83 in GyrA. A single alteration in GyrA (Thr-83-->Ile) was the most frequently detected and the next common alteration was two alterations with Thr-83-->Ile in GyrA and Ser-87-->Leu in ParC. A novel alteration at position Glin-106 of GyrA, which was suggested to be responsible for fluoroquinolone resistance, was identified. Our study revealed that the alterations in GyrB (Glu-468-->Asp) and in ParE (Asp-419-->Asn or Glu-459-->Asp) play a complementary role in the acquisition of resistance to fluoroquinolone. There was a correlation between the ciprofloxacin MIC and the number of resistance-associated alterations in GyrA, GyrB, ParC and ParE of P. aeruginosa isolates.
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Affiliation(s)
- Jeom Kyu Lee
- Department of Bacteriology, National Institute of Health, Korea Center for Disease Control and Prevention, 5 Nokbeon-dong, Eunpyeong-gu, Seoul, Republic of Korea
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Byarugaba DK. A view on antimicrobial resistance in developing countries and responsible risk factors. Int J Antimicrob Agents 2004; 24:105-10. [PMID: 15288307 DOI: 10.1016/j.ijantimicag.2004.02.015] [Citation(s) in RCA: 206] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Antimicrobial resistance is one of the biggest challenges facing global public health. Although antimicrobial drugs have saved many lives and eased the suffering of many millions, poverty, ignorance, poor sanitation, hunger and malnutrition, inadequate access to drugs, poor and inadequate health care systems, civil conflicts and bad governance in developing countries have tremendously limited the benefits of these drugs in controlling infectious diseases. The development of resistance in the responsible pathogens has worsened the situation often with very little resource to investigate and provide reliable susceptibility data on which rational treatments can be based as well as means to optimise the use of antimicrobial agents. The emergence of multi-drug-resistant isolates in tuberculosis, acute respiratory infections and diarrhoea, often referred to as diseases of poverty, has had its greatest toll in developing countries. The epidemic of HIV/AIDS, with over 30 million cases in developing countries, has greatly enlarged the population of immunocompromised patients. The disease has left these patients at great risk of numerous infections and even greater risks of acquiring highly resistant organisms during long periods of hospitalisation. This review discusses antimicrobial resistance in developing countries and the risk factors responsible.
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Affiliation(s)
- D K Byarugaba
- Department of Veterinary Microbiology and Parasitology, Faculty of Veterinary Medicine, Makerere University, P.O. Box 7062, Kampala, Uganda.
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Hong H, Chun J, Lee Y. Detection of extended-spectrum beta-lactamase-producing, multidrug-resistant environmental isolates of Escherichia coli that bind to human bladder cells. Microb Drug Resist 2004; 10:184-9. [PMID: 15256035 DOI: 10.1089/1076629041310145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Compared to the number of studies examining extended-spectrum beta-lactamase (ESBL)-producing clinical isolates, environmental ESBL-producers have not been studied extensively. To investigate environmental ESBL-producing Escherichia coli, 22 cephalothin-resistant E. coli were isolated from Han River in Seoul, Korea. These isolates were resistant to ampicillin, cephalothin, and gentamicin, and 14 isolates among these were resistant to norfloxacin. All of these isolates produce AmpC and CMY, OXA, or TEM as determined by isoelectric point focusing (IEF) gel electrophoresis and PCR. One isolate (57-214) producing AmpC and OXA was resistant to all antibiotics (ampicillin, cephalothin, norfloxacin, gentamicin, cefotaxime, ceftazidime) tested in this study. Six isolates, including isolate 57-214, could adhere to T24 human bladder cells, and these isolates were not related to each other as shown with random amplified polymorphic DNA (RAPD). Results showed that environmental ESBL-producing E. coli is able to colonize in bladder cells and directly cause antibiotic-resistant urinary tract infection.
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Affiliation(s)
- Hyungin Hong
- Department of Biology and Culture Collection of Antimicrobial Resistant Microbes, Seoul Women's University, Seoul 139-774, Korea
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Kim HB, Jang HC, Nam HJ, Lee YS, Kim BS, Park WB, Lee KD, Choi YJ, Park SW, Oh MD, Kim EC, Choe KW. In vitro activities of 28 antimicrobial agents against Staphylococcus aureus isolates from tertiary-care hospitals in Korea: a nationwide survey. Antimicrob Agents Chemother 2004; 48:1124-7. [PMID: 15047511 PMCID: PMC375260 DOI: 10.1128/aac.48.4.1124-1127.2004] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, one of the most frequently isolated pathogens in both hospitals and the community, has been particularly efficient at developing resistance to antimicrobial agents. As methicillin-resistant S. aureus (MRSA) has prevailed and, furthermore, as S. aureus with reduced susceptibility to vancomycin has emerged, the therapeutic options for the treatment of S. aureus infections have become limited. To update the current status of antibiotic resistance, clinical S. aureus isolates were collected from eight university-affiliated hospitals from June 1999 to January 2001. Susceptibility tests with 28 antibiotics were performed by the disk diffusion method. Among a total of 682 isolates, the methicillin resistance rate was 64% (439 of 682), and most of the MRSA isolates were resistant to multiple classes of antibiotics. Although a constitutive macrolide-lincosamide-streptogramin B resistance phenotype was common, no isolates were resistant to quinupristin-dalfopristin or linezolid. Rifampin, fusidic acid, trimethoprim-sulfamethoxazole, and arbekacin showed superior in vitro activity compared with the other antibiotics against the MRSA isolates. No isolates showed reduced susceptibility to vancomycin.
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Affiliation(s)
- Hong Bin Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul 110-744, Republic of Korea
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Sudden increase of vancomycin-resistant enterococcal infections in a Korean tertiary care hospital: possible consequences of increased use of oral vancomycin. J Infect Chemother 2003. [DOI: 10.1007/s10156-003-0235-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yong D, Park R, Yum JH, Lee K, Choi EC, Chong Y. Further modification of the Hodge test to screen AmpC beta-lactamase (CMY-1)-producing strains of Escherichia coli and Klebsiella pneumoniae. J Microbiol Methods 2002; 51:407-10. [PMID: 12223302 DOI: 10.1016/s0167-7012(02)00053-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cefoxitin-resistant Escherichia coli and Klebsiella pneumoniae are widespread in Korea. Significant proportions of them are considered to be CMY-1 producers. For effective screening of CMY-1 producers, the Hodge test was modified by using a cefoxitin disk and the performance was evaluated. The sensitivity and specifity of the test were 100% and 94.9%, respectively. The test was easier to perform than the three-dimensional extract test. This modified test should be suitable for screening CMY-1-producing strains of E. coli and K. pneumoniae.
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Affiliation(s)
- Dongeun Yong
- Department of Clinical Pathology and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Kim BN, Woo JH, Kim MN, Ryu J, Kim YS. Clinical implications of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae bacteraemia. J Hosp Infect 2002; 52:99-106. [PMID: 12392901 DOI: 10.1053/jhin.2002.1288] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To identify the clinical implications of extended-spectrum beta-lactamase (ESBL) production, 162 cases of Klebsiella pneumoniae bacteraemia in 154 adults were analysed. Of these cases, 44 (27.2%) were ESBL-producing (ESBLKP). Common sources of ESBLKP bacteraemia included primary bacteraemia (34.1%) and biliary infection (29.5%). The placement of a biliary drainage catheter, nosocomial acquisition, and prior antibiotic therapy were independently associated with ESBL production in multivariate analysis. More cases of ESBLKP than non-ESBLKP received inappropriate antibiotic therapy before culture results were reported (54.5 vs. 3.4%; P = 0.001). In 19 cases of ESBLKP, no significant difference in mortality was observed between patients who received appropriate empiric antibiotic therapy and those who did not (26.3 vs. 20.8%; P = 0.67). The mean length of hospital stay after the onset of bacteraemia was longer in the cases of ESBLKP than in the cases of non-ESBLKP (39.6 vs. 23.9 days; P = 0.008). Directly related mortality was not significantly different between the cases of ESBLKP and the cases of non-ESBLKP (23.3 vs. 20.0%; P = 0.65). None of the patients with biliary infection due to ESBLKP died (0/12; P = 0.03). In conclusion, ESBL production was not significantly associated with death but it had a considerable impact on patients with K. pneumoniae bacteraemia.
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Affiliation(s)
- B-N Kim
- Division of Infectious Diseases, Asan Medical Center, Seoul, Korea.
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Matsushima T, Miyashita N, File TM. Etiology and management of community-acquired pneumonia in Asia. Curr Opin Infect Dis 2002; 15:157-62. [PMID: 11964917 DOI: 10.1097/00001432-200204000-00010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The causative organisms of community-acquired pneumonia, especially in Japan and Korea, are essentially similar to those in Western countries. If there are any differences, these are due to the laboratory tests and criteria used to define pathogenicity. Overall, Streptococcus pneumoniae is the most frequently occurring pathogen and Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses follow. Legionella spp. look likely to be low frequency pathogens in Asian countries, but a reason for this might be limitations of the laboratory tests used. A high frequency of Gram-negative bacilli as pathogens of community-acquired pneumonia in some Asian countries may be due to different criteria used to identify disease-causing organisms. A small number of papers about antibiotic resistance have shown no large differences between Asian countries, but considerable differences to Western countries, such as frequency of macrolide-resistant S. pneumoniae. Some Asian countries have their own guidelines for community-acquired pneumonia, but these are written in their own languages.
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Affiliation(s)
- Toshiharu Matsushima
- Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Japan.
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