BACKGROUND: Trends in the isolation of enteropathogenic bacteria may differ depending on environmental sanitation. The aims of this study were to determine trends in the isolation and antimicrobial resistance patterns of enteropathogenic bacteria over the last 10 years. METHODS: We analyzed stool cultures of Salmonella spp., Shigella spp., Plesiomonas shigelloides, Yersinia spp., Vibrio spp., and Campylobacter spp. collected at Severance Hospital between 2001 and 2010. Antimicrobial susceptibility testing was performed using the disk diffusion method for nontyphoidal Salmonella (NTS) and Campylobacter. RESULTS: The number of specimens for stool culture significantly increased from 13,412 during 1969-1978 to 60,714 over the past 10 years, whereas the ratio of positive specimens significantly decreased from 12.9% (1,732) to 1.1% (648). The proportion of Salmonella Typhi decreased from 97.2% in 1969-1978 to 0.8% in 2001-2010, whereas the proportion of NTS increased from 2.8% to 99.2%. The proportion of Shigella among all enteric pathogens was over 50% from 1969 to 1983, while only seven strains were isolated from 2001 to 2010, with the exception of one outbreak. Campylobacter is the second most prevalent organism. The rates of susceptibility to ampicillin and cotrimoxazole were 61% and 92%, respectively, for NTS isolated from 2006 to 2010. The ciprofloxacin susceptibility rate was 79.5% for Campylobacter between 2006 and 2010. CONCLUSION: The number of isolates of Salmonella Typhi and Shigella significantly decreased, while the proportion of NTS and Campylobacter increased. Continuous monitoring of ciprofloxacin-resistant Campylobacter isolates is necessary.
Ampicillin ; Bacteria ; Campylobacter ; Ciprofloxacin ; Diffusion ; Plesiomonas ; Salmonella ; Salmonella typhi ; Sanitation ; Shigella ; Tertiary Healthcare ; Trimethoprim, Sulfamethoxazole Drug Combination ; Vibrio ; Yersinia

BACKGROUND: Testing for possible microorganism contamination in umbilical cord blood (UCB) is essential for validating the product safety of allogeneic cellular therapeutics. We analyzed the level of contamination and related factors at the largest public cord blood bank in Korea. In addition, we also studied the influence of cryopreservation on contaminating microorganisms. METHODS: UCB was collected, transported, processed, and stored according to standard operating procedures. Microbial detection and identification was performed using a conventional automated blood culture system (BacT/ALERT; bioMerieux, France) with an inoculum of 5-10 mL plasma for pre-freezing UCB. Forty randomly selected non-conforming units were thawed and studied for microbiologic recovery with an inoculum of 2.5 mL. RESULTS: Among a total of 21,236 UCB, 677 (3.19%) were positive for culture. The most frequently identified organism was Lactobacillus spp. (17.2%), followed Bacteroides spp. (10.1%), coagulase negative staphylococcus (6.4%), except the unidentified gram-positive bacillus (21.4%). The contamination rate was higher in vaginal delivery specimens than in cesarean section specimens (4.1% vs. 0.7%, P<0.001), and differed by collection center (0.7-25.4%, P<0.001). Only 55% after-thaw cultures of non-conforming units were positive. CONCLUSION: We determined the contamination rate of UCB in Korea in a large sample size. The results of this study could be used as baseline data at collection centers for quality control purposes. The low recovery rate of microorganisms after cryopreservation presents a possible way to rescue some non-conforming cord blood units, although further study is needed to confirm the reduction of microbiological burden.
Bacillus ; Bacteria ; Bacteroides ; Biological Specimen Banks ; Cesarean Section ; Coagulase ; Cryopreservation ; Female ; Fetal Blood ; Korea ; Lactobacillus ; Plasma ; Pregnancy ; Quality Control ; Sample Size ; Staphylococcus ; Umbilical Cord

BACKGROUND: We investigated the prevalence of various pathogens (13 enteric bacteria and 5 viruses) which cause diarrhea using multiplex PCR of stool specimens and compared two multiplex PCR methods for detecting diarrheagenic Escherichia coli. METHODS: A total of 405 stool specimens submitted between November 2010 to February 2011 for routine culture of enteric pathogens were included and screened for five viruses (astrovirus, Group A rotavirus, enteric adenovirus, norovirus G1/G2) and eight bacteria (Salmonella spp., Shigella spp., Campylobacter spp., Vibrio spp., C. difficile Toxin B, C. perfringens, Y. enterolytica, Aeromonas spp.) using the Seeplex(R) Diarrhea ACE detection kit (Seegene). In addition, virulence-associated genes of enteropathogenic E. coli, (EPEC), enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli, (EIEC), enterotoxigenic E. coli (ETEC), and enteroaggressive E. coli (EAEC) were detected using 16-plex PCR and a commercial diarrheagenic E. coli detection (DEC) PCR kit (SSI Diagnostica). RESULTS: Overall, 138 (34.1%) of 405 samples was positive for pathogen. The positive rate for virus was 18.5%. norovirus G2, Group A rotavirus, enteric adenovirus, astrovirus and norovirus G1 were detected in 40, 23, 8, 3 and 1 samples, respectively. The positive rate for bacteria was 24.4% (99/405). C. difficile toxin B was the most frequently detected, followed by C. perfringens, EPEC, and EAEC. The agreements of the two multiplex PCR methods for detecting EPEC and EHEC were 99.3% and 100%, respectively. CONCLUSION: The detection rate was high (34.1%) including various diarrheagenic E. coli (6.2%) and C. perfringens (5.2%). Multiplex PCR is thus useful for detecting various pathogens.
Adenoviridae ; Aeromonas ; Bacteria ; Campylobacter ; Diarrhea ; Enterobacteriaceae ; Enterohemorrhagic Escherichia coli ; Enteropathogenic Escherichia coli ; Enterotoxigenic Escherichia coli ; Escherichia ; Escherichia coli ; Multiplex Polymerase Chain Reaction ; Norovirus ; Polymerase Chain Reaction ; Prevalence ; Rotavirus ; Shigella ; Vibrio ; Viruses

BACKGROUND: Cholera is a representative water-borne disease that is caused by V. cholera ctx (+). V. cholera El Tor was previously the primary pathogen, but after the seventh pandemic outbreak, it was replaced by a V. cholera El Tor variant with a classical phenotype and genotype. In this study, we investigated the genotypic and phenotypic characteristics of imported V. cholerae El Tor in Korea. METHODS: Forty-nine V. cholerae O1 El Tor strains isolated from 2004 to 2011 were used in this study. Polymerase chain reaction amplification of the ctxB and rstR genes was used for biotype determination. An antimicrobial susceptibility test was performed for phenotypic analysis, and pulse field gel electrophoresis (PFGE) was used for analysis of genetic relatedness. RESULTS: Classical ctxB genes were found in all of the isolates, while classical, El Tor, and combined rstR genes were found. Twenty strains showed antimicrobial resistance against streptomycin, sulfamethoxazole/trimethoprim, nalidixic acid, and ciprofloxacin. Based on PFGE, all isolates were grouped as cluster B. The country of origin and resistance pattern were highly related, although the time of influx and serogroup were not. CONCLUSION: Isolates of V. cholera El Tor imported since 2004 were hybrids of V. cholera El Tor, which has the classical ctxB gene and is considered to be a CTX prophage. The SXT element plays an important role in antimicrobial resistance. PFGE patterns, which can be used for analysis of imported V. cholera, revealed the relatedness of the resistant isolates.
Chimera ; Cholera ; Ciprofloxacin ; Electrophoresis ; Genotype ; Korea ; Nalidixic Acid ; Pandemics ; Phenotype ; Polymerase Chain Reaction ; Prophages ; Streptomycin ; Vibrio ; Vibrio cholerae ; Vibrio cholerae O1

BACKGROUND: Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in immunocompromised patients. We compared the abilities of the recently developed Real-Q Cytomegalovirus Kit (Biosewoom Inc., Korea) and the previously used PANA mPCR CMV Detection Kit (Panagene Inc., Korea) to detect CMV. METHODS: We analyzed 300 samples (whole blood: 262, urine: 37, CSF: 1) submitted for qualitative CMV PCR testing during October 2011 at Yonsei University College of Medicine Severance Hospital. Real-time PCR was performed with a Real-Q Cytomegalovirus Kit and conventional PCR was conducted with a PANAmPCR CMV Detection Kit. RESULTS: The positive rates of both Real-time PCR and conventional PCR were 25.3% (76/300), and the kappa coefficient (K) was 0.96 (95% confidence interval (CI), 0.93-1.00). The concordance rate of the Real-Q Cytomegalovirus Kit and the PANAmPCR CMV Detection Kit was 98.7% (296/300), and four out of 300 samples showed discordant results. If the concordant results of 296 samples and the four results confirmed by direct sequencing were assumed to be true, the sensitivity and specificity of the Real-Q Cytomegalovirus Kit were 97.4% (95% CI, 93.8-100.0%) and 99.1% (95% CI, 97.9-100.0%), respectively. CONCLUSION: The recently developed Real-Q Cytomegalovirus Kit showed excellent sensitivity and specificity, and had a high concordance rate with the previously established PANAmPCR CMV Detection Kit, which uses conventional PCR. Furthermore, Real-time PCR could decrease the test time, as the electrophoresis step required for conventional PCR is not required for Real-time PCR.
Cytomegalovirus ; Electrophoresis ; Immunocompromised Host ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction

BACKGROUND: Pulmonary tuberculosis is an infectious disease of the lungs caused by Mycobacterium tuberculosis complex (MTB) designated by law in Korea, and accurate diagnosis and urgent treatment are necessary for the maintenance of public health. Recently, nontuberculous mycobacteria (NTM) have been more frequently isolated in respiratory system specimens, which were confused with MTB. We investigated whether the incidence of NTM isolation is increasing in Jeju, Korea. METHODS: The results of microbacterial cultures of acid fast bacilli (AFB) from respiratory system specimens were collected at Jeju National University Hospital, Jeju, Korea from 2004 to 2011. The incidences of MTN or NTM isolation were analyzed. RESULTS: A total of 15,484 AFB cultures were performed in 6,281 patients. In 2004, 365 AFB cultures were requested, and the number increased to 1,550 in 2011. However, the culture-positive rate decreased from 18.7% in 2004 to 6.19% in 2011. Among the 573 cultured specimens, 506 MTB (88.3%, mean age of 49.7, male 63.2%) and 72 NTM (12.6%, mean age of 65.8, male 50.0%) were identified. The proportions of NTM isolations were less than 10% until 2009, but increased to 30% after 2010 (P<0.001). M. avium complex (MAC) was the most frequently isolated NTM, followed by M. abscessus. CONCLUSION: The proportion of NTM isolation is increasing. A clinical diagnosis of pulmonary tuberculosis based on respiratory system specimens should be made with caution, especially in cases of positive AFB smears.
Communicable Diseases ; Humans ; Incidence ; Jurisprudence ; Korea ; Lung ; Male ; Mycobacterium ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Public Health ; Respiratory System ; Tuberculosis, Pulmonary

Shigella bacteremia is rare, occurring mainly in children. Shigella species often cause diarrhea or gastrointestinal inflammation in humans and are rarely associated with bacteremia. This report describes an unusual case of Shigella boydii bacteremia in an 84-year-old patient visiting our hospital after experiencing nausea, vomiting, and febrile sensation for 2 days. Peripheral blood cultures revealed S. boydii and 16S rDNA sequence analysis produced the same result. However, the organism was not isolated from the patient's stool. She was started on ciprofloxacin, to which this organism is sensitive, and was subsequently discharged with instructions to complete a 14-day course of ciprofloxacin. Shigellosis is usually a self-limiting enteric disease. However, in contrast to its isolation from both blood and stool, isolation of the organism from blood only is associated with a high mortality rate. As is frequently pointed out, blood cultures should be obtained from elderly or immunocompromised patients with acute febrile gastroenteritis to detect infection caused by enteric pathogens, including Shigella.
Aged ; Aged, 80 and over ; Bacteremia* ; Child ; Ciprofloxacin ; Diarrhea ; DNA, Ribosomal ; Dysentery, Bacillary ; Gastroenteritis ; Humans ; Immunocompromised Host ; Inflammation ; Mortality ; Nausea ; Sensation ; Sequence Analysis ; Shigella boydii* ; Shigella* ; Vomiting

BACKGROUND: By varying the collected blood volume and storage temperature of the blood culture bottles prior to entry in an automated blood culture system, growth of organisms will be affected. METHODS: Blood culture bottles with a 20 mL blood volume per set were stored at 37degrees C (1st period) and room temperature (RT, 2nd period) upon arrival at the laboratory after working hours compared to baseline period (10 mL, RT). The time to detection (TTD) for all strains and the number of days until the final report after bottle entry were compared among the three periods. RESULTS: The median TTD for all strains was 13.5 h, 10.6 h, and 11.3 h in the baseline (N=268), 1st (N=454), and 2nd period (N=370), respectively (P<0.001). The final identification report was available within two days of bottle entry for 12.3%, 30.6% and 15.1% of bottles in the three different periods, respectively (P<0.001). CONCLUSION: Collecting an adequate blood volume is critical to reduce TTD. The preincubation of blood culture bottles at 37degrees C during the night shift might enable earlier final reports than storage at RT for samples with the same collected blood volume.
Blood Volume*

BACKGROUND: Streptococcus agalactiae (Group B streptococcus, GBS) is known to be the leading cause of neonatal sepsis and meningitis in the United States and Europe. In addition, GBS infection has been increasingly noted in adults, particularly in those with underlying diseases, such as diabetes mellitus, malignancy and liver disease. A few studies reported that resistances to antibiotics, such as erythromycin, clindamycin, tetracycline are increasing. We report clinical and microbiological characteristics of GBS bacteremic patients in Jeju Island. METHODS: We retrospectively analyzed medical records, such as age, sex, underlying disease, mortality, skin defects, laboratory results and antibiotic resistances of GBS in hospitalized adult patients who were diagnosed with GBS bacteremia from 2008 to 2013 in Jeju Island. RESULTS: Twenty two adult patients were diagnosed as GBS bacteremia from 2008 to 2013. The mean age of GBS bacteremic patients was 66.2 years old. Of 22 bacteremic patients, fifteen patients (68%) were older than 60. Twenty patients (91%) of bacteremic patients had underlying diseases such as diabetes mellitus, malignancy and liver disease. Ten (45%) patients had skin defects which were on the lower extremities and buttock, fifteen (68%) patients had fever at the time of admission, twenty one (95%) patients were admitted via the emergency department. Two (9%) patients died. The mean white blood cell (WBC) count, percentile of neutrophil count, and C-reactive protein (CRP) levels were 11,488/microL, 84.3 %, 13.5 mg/dL respectively. All GBS isolates from bacteremia showed sensitivities to penicillin, ampicillin, and vancomycin, and showed resistances to erythromycin (25%), clindamycin (30%), and tetracycline (55%). CONCLUSION: Bacteremia caused by GBS was prevalent in adult patients with underlying diseases. Most of the GBS bacteremic patients were emergency cases, with a high body temperature, WBC, CRP level, and neutrophil count. Half of them had skin defects, which are considered a source of GBS bacteremia.
Adult* ; Ampicillin ; Anti-Bacterial Agents ; Bacteremia* ; Body Temperature ; Buttocks ; C-Reactive Protein ; Clindamycin ; Diabetes Mellitus ; Drug Resistance ; Emergencies ; Emergency Service, Hospital ; Erythromycin ; Europe ; Fever ; Humans ; Leukocytes ; Liver Diseases ; Lower Extremity ; Medical Records ; Meningitis ; Mortality ; Neutrophils ; Penicillins ; Retrospective Studies ; Sepsis ; Skin ; Streptococcus agalactiae* ; Streptococcus* ; Tetracycline ; United States ; Vancomycin

Europe has taken many political actions since 1999 to better control antimicrobial resistance and use, including two European Council Recommendations and actions taken by numerous European Union (EU) presidencies. These presidencies triggered many public health and research actions in the EU. Europe developed several very successful surveillance programmes on antimicrobial resistance and antimicrobial use, both currently coordinated by the European Centre for Disease Prevention and Control (ECDC). These surveillance programmes were able to identify emerging problems of antibiotic resistance and targets for quality improvement of antimicrobial use; they also conducted impact assessments of campaigns to reduce antibiotic use and increase hand hygiene. The public antibiotic awareness campaigns were very successful in reducing antibiotic use and resistance in countries like Belgium and France. The successes of these campaigns inspired ECDC to launch an annual European Antibiotic Awareness Day on November 18, 2008. The hand hygiene campaigns resulted in a dramatic decrease of MRSA infections in many EU Member States. However, ESBL-producing Gram-negative bacteria and Carbapenem-resistant Enterobacteriaceae and non-fermenters are increasing in most EU countries. Finally, the EU is investing hundreds of millions of EUROs in a Public Private Partnership (PPP), called the Innovative Medicines Initiative (IMI). An important initiative of IMI is the launch of the Combating Antibiotic Resistance NewDrugs4BadBugs programme. The goal of this new research programme is to create an innovative and collaborative PPP-based approach that will positively impact all aspects of the antimicrobial resistance issue, from the discovery of novel products to Phase 1-3 clinical trials.
Belgium ; Drug Resistance ; Drug Resistance, Microbial* ; Enterobacteriaceae ; Europe ; European Union ; France ; Gram-Negative Bacteria ; Hand Hygiene ; Methicillin-Resistant Staphylococcus aureus ; Public Health ; Quality Improvement