No abstract available.
Carbapenems* ; Korea*

No abstract available.
Carbapenems* ; Korea*

Carbapenem-resistant Enterobacteriaceae (CRE) are now spread worldwide. In Korea, the number of CRE isolation is rapidly increasing, and impending endemicity is a concern. To cope well with CRE, thorough infection control, such as active surveillance, early detection, strict contact precaution, cleaning the environment, and antibiotic stewardship is very important. Therapeutic options include polymyxin, tigecycline, fosfomycin or the combination of them with carbapenem, which is currently the mainstay of treatment. In addition, various combination regimens with new carbapenemase inhibitors such as avibactam, vaborbactam, or relebactam, and other classes of antimicrobials such as plazomicin and siderophore cephalosporin are in the process of evaluation.
Carbapenems ; Enterobacteriaceae* ; Fosfomycin ; Infection Control ; Korea ; Polymyxins

Among the bacteria isolated from clinical specimens of hospitalized patients, one of the most intractable species was Pseudomonas aeruginosa, the causative agent of P. aeruginosa. It resists a variety of antibacterial agents. Carbapenem is known as one of a few that are efficacious for P. aeruginosa infections. Maintaining the drug susceptibility of pathogens leads to the favorable clinical outcome in patients with infections diseases. The excessive use of carbapenem and other antimicrobial agents results in the increase of drug-resistant mutants of P. aeruginosa. At a meeting of the Health Ministry's infectious disease control committee in June 2007, the necessity of using antibacterial agents in more rational ways was highlighted on the suggestion of some member pharmacists. Incidentally, during the periods from January to June and from July to December 2007, we studied the antimicrobial use density (AUD) of carbapenem agents and the occurrence ratio of carbapenem-resistant mutamts of P. aeruginosa. The results showed that the occurrence of drug-resistant mutants decreased in proportion to the decrease of AUD. We believe the investigation of the AUD of any antibacterial agents is an important task pharmacists should take upon themselves to control infectious diseases. By reporting the results of our investigation on a regular basis, we are going to make a modest contribution toward the optimum use of antimicrobial agents.
Pseudomonas aeruginosa ; Antibacterial drugs ; Carbapenems ; control ; occurrence

BACKGROUND: Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are resistant to most β-lactam antibiotics except carbapenems. In recent years, infrequently isolated Enterobacteriaceae that produce carbapenemase pose a serious threat in the selection of appropriate therapeutic antibiotics. The rapid detection method of carbapenemase-producing Enterobacteriaceae (CPE) is necessary to prevent the spread of CPE into healthcare facilities. METHODS: One hundred clinical Enterobacteriaceae isolates (Klebsiella pneumoniae 40, Escherichia coli 40, others 20) showing susceptibility to carbapenems and positivity in the CLSI ESBL phenotypic test from November 2015 to March 2016 and 59 stocked Enterobacteriaceae isolates harboring resistance genes producing carbapenemase (K. pneumoniae 56, Enterobacter cloacae 2, E. coli 1; types of CPE: KPC 36, GES 12, NDM 6, VIM 2, OXA 2, IMP 1) were subjected to the RAPIDEC CARBA NP test (bioMérieux, France) and CPE phenotypic test using the modified Hodge test (MHT) and carbapenemase inhibition test. RESULTS: All of the 100 Enterobacteriaceae isolates with carbapenem susceptibility and ESBL positivity were negative on the RAPIDEC CARBA NP test and CPE phenotypic test. Of 59 stock CPE isolates, 53 and 42 showed positive results to the RAPIDEC CARBA NP test and MHT, respectively. The sensitivity and specificity of the RAPIDEC CARBA NP test for detecting CPE were 89.8% and 100%, respectively. CONCLUSION: The RAPIDEC CARBA NP test is simple and produces a result within 3 hr. In conclusion, the test is a useful screen for detecting CPE because it shows high sensitivity and specificity for CPE detection.
Anti-Bacterial Agents ; Carbapenems ; Delivery of Health Care ; Enterobacter cloacae ; Enterobacteriaceae* ; Escherichia coli ; Methods ; Pneumonia ; Sensitivity and Specificity

Since 2001, ten more OXA-48 variants have been identified. Shewanella spp. has been thought to be the original host for OXA-48-like enzymes. These enzymes strongly hydrolyze penicillins and weakly hydrolyze carbapenems, with very weak activity against broad-spectrum cephalosporins. The OXA-48-like genes are always plasmid-borne and have been located in insertion sequences. OXA-48-like carbapenemases have been identified mainly from Turkey, North African countries, the Middle East, and India. Furthermore, the emergence and outbreak of OXA-48-like producers in Korea have been reported recently. Because some OXA-48-like-producing Enterobacteriaceae isolates do not exhibit resistance to broad-spectrum cephalosporins and only decreased susceptibility to carbapenems, their detection can be difficult. Adequate screening and detection methods are required to prevent and control the dissemination of OXA-48-like-producing Enterobacteriaceae.
Carbapenems ; Cephalosporins ; Enterobacteriaceae* ; India ; Korea ; Mass Screening ; Middle East ; Penicillins ; Shewanella ; Turkey

Antimicrobial resistance in bacteria is problematic in clinical settings and is a growing threat to public health. Multidrug-resistant and pandrug-resistant non-fermenters such as Acinetobacter spp. and Pseudomonas aeruginosa have recently emerged as a great concern worldwide. Particularly, the prevalence of carbapenem resistance in Acinetobacter spp. and P. aeruginosa is problematic, and emergence of polymyxin resistance is ominous. In this review, we discuss carbapenem and polymyxin resistance in Acinetobacter spp. and P. aeruginosa isolates and their major clones.
Acinetobacter ; Bacteria ; Carbapenems ; Clone Cells ; Polymyxins ; Prevalence ; Pseudomonas ; Pseudomonas aeruginosa ; Public Health

BACKGROUND: With the time course, the cost and the amounts of produced antibiotics are increasing but it is difficult to get the exact data and there were limitations to know the trend of antibiotics usage. So we examined the trend of antibiotics usage every five year during 1981-1998 by using two parameters; the cost and the amount of antibiotics produced in South Korea. METHODS: We used the data from 'Annual products of medicine' published by Korea Pharmaceutical Manufactures Association. Every antibiotics were classified to generic names, and the cost and the amounts of produced antibiotics were compared each year. RESULTS: In 1998, the total cost of produced antibiotics was 1,150 billion won and the amount was 708.6 ton. The cost was increased by 20.0% compared to that of 1995. Cephalosporins made the largest proportion of the cost in antibiotic production that was 43.8% (503.3 billion won) in 1998. With the time course proportion of the third and the second generation cephalosporins were increased. Penicillins made the largest proportion (46%) of the total amount and were produced 325.7 ton. Among them, aminopenicillins were 86% of the total cost of penicillins and 95% of the total amount of penicillins. Especially the cost of aminopenicillins with beta-lactamase inhibitor was 2.3 times increased since 1993 thus made the major cause of increase. Quinolones were increased 2.1 times and macrolides were increased 2.2 times in production cost for 5 years. Tetracyclines, lincosamides and chloramphenicols were decreased in both production cost and amount, but penicillins and macrolides were increased in production cost even though production amounts were decreased. CONCLUSION: There seemed to be an increase in the cost and the amount of antibiotic production in Korea. Especially productions of newer drugs such as aminopenicillins with beta-lactamase inhibitor, third generation cephalosporins, some of macrolides and carbapenems were increased remarkably. And the use of glycopetides, anti-fungal agents, and antiviral agents were increasing also. Some drugs were thought to be an inappropriate use. More epidemiologic study and the guidelines for the proper use of antibiotics are needed.
Anti-Bacterial Agents* ; Antiviral Agents ; beta-Lactamases ; Carbapenems ; Cephalosporins ; Chloramphenicol ; Korea* ; Lincosamides ; Macrolides ; Penicillins ; Quinolones ; Tetracyclines

BACKGROUND: Carbapenem-resistant Acinetobacter spp. are being isolated with increasing frequency from clinical sources. This study was designed to determine the resistance mechanism to carbapenems of Acinetobacter spp. isolates from patients of a tertiary care hospital in Busan, Korea. METHODS: Nonduplicated clinical isolates of Acinetobacter spp. resistant to carbapenems were collected during the period of 2000-2001 in Kosin Medical Center, Busan, Korea. Antimicrobial susceptibilities were tested by disk diffusion method. Carbapenem-resistant Acinetobacter spp. isolates were examined for metallo-beta-lactamase-production by modified Hodge and EDTA-disk synergy tests. For the detection of blaIMP-1 and blaVIM-2 genes, polymerase chain reactions (PCR) were performed, and the DNA sequences of amplified products were determined by using dideoxy- chain termination method. RESULTS: Among 21 clinical isolates of Acinetobacter spp. intermediate or resistant to carbapenems, 17 isolates showed positive reactions in modified Hodge and EDTA-disk synergy tests. Nine isolates showed positive reaction in PCR for the detection of blaIMP-1 genes, and 8 isolates showed positive reaction in PCR for the detection of blaVIM-2 genes. Sequencing of amplified products showed that they were blaIMP-1 or blaVIM-2 genes. CONCLUSION: Acinetobacter spp. isolates with carbapenem-resistance are not uncommon in Kosin Medical Center, and most of the carbapenem-resistant isolates acquired resistance by production of IMP-1 or VIM-2 metallo-beta-lactamases. The spread of metallo-beta-lactamase genes could compromise the future usefulness of carbapenem for the treatment of gram-negative bacilli infections.
Acinetobacter* ; Base Sequence ; Busan ; Carbapenems ; Diffusion ; Genotype* ; Humans ; Korea ; Polymerase Chain Reaction ; Tertiary Healthcare

OBJECTIVE:This study was performed to compare the in vitro antimicrobial activities of prepenem (PRPM) with those of imipenem (IMPM) and meropenem (MRPM) against several clinical isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Streptococcus pneumoniae. METHODS: We tested the in vitro antimicrobial activities of PRPM, IMPM, and MRPM against total 300 clinical isolates of E. coli, K. pneumoniae, and P. aeruginosa and 134 chinical isolated of S. pneumoniae (41 penicillin-susceptible, 93 penicillin-resistant strains) collected in 5 different university hospitals (March to June, 2002). According to NCCLS guidelines, MICs of PRPM, IMPM, MRPM, and/or ceftazidime were determined. RESULTS: MIC90s of E. coli to IMPM, PRPM, and MRPM were 1, 1, and 0.125 microgram/mL, respectively. Those of K. pneumoniae were 1, 0.5, and 0.125 microgram/mL, respectively. In case of P. aeruginosa, MIC90s to IMPM, PRPM, MRPM, and ceftazidime were 16, 32, 8, and 64 microgram/mL, respectively. In penicillin-susceptible S. pneumoniae, MIC90s to IMPM, PRPM, MRPM were 0.25, 0.25, 0.5 microgram/mL, while those of penicillin-nonsusceptible strains were 1, 1, and 2 microgram/mL, respectively. IMPM and PRPM showed similar pattern of distribution of MIC to various bacterial species. CONCLUSION: E. coli, K. pneumoniae, and S. pneumonia were susceptible to PRPM, which had a pattern similar to IMPM. The antimicrobial activity of PRPM to P. aeruginosa was also comparable to that of IMPM. PRPM could be potentially useful drugs for treatment of infections caused by E. coli, K. pneumoniae, P. aeruginosa and S. pneumoniae.
Carbapenems* ; Ceftazidime ; Escherichia coli ; Hospitals, University ; Imipenem ; Klebsiella pneumoniae ; Korea* ; Pneumonia ; Pseudomonas aeruginosa ; Streptococcus pneumoniae