Antibacterial activity of EA, a preparation of water soluble components made from carpophores of Elfvingia applanata (Pers.) Karst, was examined by macrobroth diltution method against a number of bacterial species. Antibacterial effects of EA were expressed as minimal inhibitory concentration (MIC) for growth. Among twelve species of bacteria tested, six strains of each gram positive bacteria and gram negative bacteria, EA showed the most potent antibacterial activity against Staphylococcus epidermidis and Proteus vulgaris, of which MICs were 1.25 mg/ml of EA. To investigate the antibacterial effects of combinations of EA with third generation cepholosporins, such as cefotaxime, ceftriaxone, ceftazidime, and cefixime, the fractional inhibitory concentration (FIC) and fractional inhibitory concentration index (FICI) were determined by macrodilution checkerboard assay for twelve bacterial strains. Combinations of EA and third generation cephalosporins exhibited either additive or indifferent effects in most instances. However, synergistic effects were observed in six instances. No antagonistic effect was observed in any cases.
Bacteria ; Cefixime ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins* ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Proteus vulgaris ; Staphylococcus epidermidis

7-ACA(7-aminocephalosporanic acid) and ACT(aminocephalosporanic thiazine) are basic materials for development of 2nd and 3rd generation cephalosporin. Occupational asthmas(OA) induced by these materials have been very rarely reported. We had experienced 2 cases of OA by them. One was 26 year-old male laboratorian involving 7ACA manufacturing directly. The other case was 40 year-old male asthmatics working at the ware house keeping 7ACA and ACT, not directly making these. The result of skin prick test with 55 common inhalant allergens and 7ACA, ACT and several cephalosporins including Cefazolin, Cefuroxime, Ceftazidime, Cefotaxime, Ceftriaxone and Cefotetan. First case revealed positive reactions to 7ACA and Ceftriaxone, but second case, only positive to ACT. In first case, bronchial challenge with 7ACA only showed positive, but in second, those with 7ACA and ACT both showed positive, though negative to 7ACA in skin test.
Adult ; Allergens ; Asthma, Occupational* ; Cefazolin ; Cefotaxime ; Cefotetan ; Ceftazidime ; Ceftriaxone ; Cefuroxime ; Cephalosporins ; Humans ; Male ; Skin ; Skin Tests

BACKGROUND: The MicroScan MICroSTREP plus panel for susceptibility testing of various streptococci, including Streptococcus pneumoniae, has recently been introduced in Korea. The current study evaluated the usefulness of MicroScan MICroSTREP plus panel for antimicrobial susceptibility test of S. pneumoniae. METHODS: A total of 75 clinical isolates of S. pneumoniae were tested for antimicrobial susceptibility to penicillin, cefotaxime, ceftriaxone, meropenem, vancomycin, clindamycin, erythromycin, and levofloxacin with the MicroScan MICroSTREP plus panel and clinical and laboratory standard institute (CLSI) reference broth microdilution method. For 46 of 75 isolates, additional susceptibility tests to penicillin and cefotaxime were performed with Etest. RESULTS: The overall essential agreement of MICs (within one dilution of MICs) defined by the MicroScan MICroSTREP plus panel and reference method was 93.0%. Overall there were 11.7% minor, 0.7% major, and 0.7% very major interpretative category errors observed. The results of antibiotic susceptibility testing by Etest were similar to those obtained by the MicroScan MICroSTREP plus panel. CONCLUSION: The MicroScan MICroSTREP plus panel, a commercial broth microdilution method, has a comparable accuracy to CLSI broth microdilution method for the resistance testing of S. pneumonia. This panel can be used for determining susceptibilities of S. pneumoniae to a wide variety of antimicrobial agents in clinical microbiology laboratories.
Anti-Infective Agents ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Erythromycin ; Korea ; Ofloxacin ; Penicillins ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae ; Thienamycins ; Vancomycin

PURPOSE: To characterize the pathogens and their antibiotic susceptibilities in more than 24-month-old children with urinary tract infection (UTI) and to study the Escherichia coli antimicrobial susceptibility trend. METHODS: We retrospectively reviewed the record of more than 24-month-old children with UTI between January 2003 and December 2008. Positive results for 1 bacterial species with a colony count of > or =10(5) CFU/mL was considered statistically significant. We analyzed uropathogens and their antibiotic susceptibilities. To investigate E. coli antibiotic susceptibility trend, we compared 2 study periods (group A: 2003-2005 versus group B: 2006-2008) using the chi-square test for trend. RESULTS: In all, 63 bacterial isolates were identified in children with febrile UTI. The most common pathogen was E. coli (77.8%). There was no difference in the resistance patterns of uropathogens during the 2 study periods (P>0.05). Antibiotic susceptibility of the E. coli isolates to aztreonam, cefotetan, cefotaxime, ceftriaxone, cefepime, amikacin, and imipenem was >90% to trimethoprim/sulfamethoxazol, 49% and to ampicillin and ampicillin/sulbactam, 20-25%. Over the 2 study period, the E. coli susceptibilities to most antibiotics did not change: the susceptibility to cefuroxime increased from 74.1% to 95.5% (P=0.046) and that to ciprofloxacin increased from 59.3% to 86.4% (P=0.039). CONCLUSION: Empirical treatment with trimethoprim/sulfamethoxazole, ampicillin, and ampicillin/sulbactam alone appeared to be insufficient in childhood UTI because of the high resistance of E. coli and other gram-negative uropathogens. Antibiotics for empirical therapy should be selected based on the sensitivity and resistance pattern of uropathogens found in a particular region.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Aztreonam ; Cefotaxime ; Cefotetan ; Ceftriaxone ; Cefuroxime ; Cephalosporins ; Child ; Ciprofloxacin ; Drug Resistance, Microbial ; Escherichia coli ; Humans ; Imipenem ; Preschool Child ; Retrospective Studies ; Urinary Tract ; Urinary Tract Infections

BACKGROUND: Streptococcus pneumoniae is the most common human pathogen causing community-acquired pneumonia. There is little information on the recent antimicrobial susceptibility patterns of S. pneumoniae in Busan and Gyeongnam of Korea. The aim of this study was to investigate the distribution and antimicrobial resistance of S. pneumoniae at 4 university hospitals in Busan and Gyeongnam. METHODS: We collected and analyzed the antimicrobial susceptibility results of 850 S. pneumoniae strains isolated from regional 4 university hospitals during the last 2 years from July 2013 through June 2015. RESULTS: Among 850 S. pneumoniae strains, 635 strains were isolated from respiratory specimens, followed by blood (N=121), CSF (N=13), and others (N=81). Antimicrobial susceptibility rates to penicillin, cefotaxime and ceftriaxone were 79.4%, 76.6% and 83.6%, respectively. The resistant rates to erythromycin and clindamycin were 80.9% and 68.2%, respectively. The resistant rates to levofloxacin were 9.2%. There were some differences in resistant rates by age groups, years, and specimen types. CONCLUSION: We found the changes of antimicrobial resistance of S. pneumoniae during the last 2 years. It is necessary to monitor the antimicrobial susceptibility of S. pneumoniae regularly for empirical therapy and for early detection of the changes of resistance.
Busan* ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Drug Resistance ; Erythromycin ; Hospitals, University* ; Humans ; Korea ; Levofloxacin ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus*

BACKGROUND: Escherichia coli and Klebsiella pneumoniae resistant to 3rd generation cephalosporin have been reported with increasing frequency in tertiary-care hospital in Korea. MicroScan Neg Combo Panel Type 21 (Type 21) contains a 1 microgram/mL cepfodoxime (POD) in addition to other screen wells containing ceftazidime, cefotaxime, ceftriaxone, and aztreonam, which are designed for detecting extended-spectrum beta-lactamase (ESBL)-producing E. coli and Klebsiella species. We evaluated the Type 21 panel for its ability to detect ESBL. METHODS: From November to December in 1998, 496 E. coli and 326 K. pneumoniae strains isolated from clinical specimens were tested with Type 21 panel The isolates flagged as ESBL producers by the panel were confirmed by the double disk synergy test (DDS). To evaluate the specificity of POD, n-lactamases of 54 E, coli and 20 K. pneumoniae strains that were flagged by, POD only from January to May 1999 were analyzed by isoelectric focusing(IEF). RESULTS: 75/496(15%) E. coli and 68/326(21%) K. pneumoniae were flagged as ESBL producers by Type 21 panel. Of those, 94 isolates including 38/75 (51%) of E. coli and 56/68 (82%) of K. pneumoniae were positive for DDS. Among the 94 ESBL producers, all were detected by POD, 84% by cefotaxime, 85% by ceftazidime, 84% by ceftriaxone, and 86% by aztreonam. The 74 strains that were flagged as ESBL producers by POD screen well only were mostly DDS-negative, cefoxitin- resistant and showed beta-lactamases with pls of 5.4 and 7.6 or no band, which could be interpreted as the presence of TEM-1 or SHV-1 type beta-lactamases and/or basal AmpC beta-lactamases, not ESBL. CONCLUSION: MicroScan Neg Combo Panel Type 21 was able to detect a greater number of ESBL producers by inclusion of POD in its screening well. However, the specificity of POD was compromised by flagging a significant number of DDS negative strains. We conclude that the isolates with reduced susceptibility to 3rd generation cephalosporins as well as POD can be reported as ESBL-producers and those resistant to POD only should be confirmed by DDS.
Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Escherichia coli ; Klebsiella ; Klebsiella pneumoniae ; Korea ; Mass Screening ; Pneumonia ; Sensitivity and Specificity

BACKGROUND: In 2010, the Clinical and Laboratory Standards Institute (CLSI) revised the minimum inhibitory concentration (MIC) breakpoints of cephalosporins and aztreonam to exempt extended-spectrum beta-lactamase (ESBL) confirmatory tests for Enterobacteriaceae. However, the CLSI did not change the MIC breakpoint of cefepime. Here, a proficiency survey of a strain of ESBL-producing Klebsiella pneumoniae was analyzed for MIC distribution and interpretation of cephalosporins and aztreonam. METHODS: The survey strain, K. pneumoniae, which produced SHV-18, was distributed to 170 clinical laboratories as 1 of 5 presumptive clinical specimens through the proficiency survey of the clinical microbiology division of the Korean Association of Quality Assurance for Clinical Laboratories (KAQACL). MIC, zone diameter of inhibition (ZDI), and interpretation of tested antimicrobials, methods of antimicrobial susceptibility testing (AST), and ESBL confirmatory results were collected. RESULTS: According to the revised breakpoints of the 2010 CLSI guidelines, MIC results indicated resistance to aztreonam in 100%, cefepime in 5.5%, cefotaxime in 20%, ceftazidime in 100%, and ceftriaxone in 100% of samples by broth microdilution methods. ZDI results also indicated resistance to aztreonam in 75%, cefepime in 0%, cefotaxime in 66.7%, ceftazidime in 100%, and ceftriaxone in 80% of samples by disk diffusion method. Ninety (75.6%) participants performed an ESBL confirmatory test, and 89 (98.9%) reported ESBL-positive tests. Of the 55 laboratories that tested the susceptibility of cefepime, 50 (90.9%) self-reported to be "resistant" because of ESBL-positive results. CONCLUSIONS: In conclusion, susceptibility testing of ESBL producers against certain cephalosporins is not reliable enough to apply the revised breakpoints presented in the 2010 CLSI guidelines. It is therefore necessary to reach a consensus for interpretation of ASTs of ESBL producers in Korea. Ideally, clinicians should be provided two interpretations based on both the revised breakpoints and ESBL confirmatory testing.
Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Consensus ; Diffusion ; Enterobacteriaceae ; Klebsiella ; Klebsiella pneumoniae ; Korea ; Microbial Sensitivity Tests ; Pneumonia ; Sprains and Strains

Penicillin resistance in Streptococcus pneumoniae has increased sharply within the past few years and extended-spectrum cephalosporins haute been recommended for the empiric therapy of bacterial meningitis. However, therapeutic failure are being reported with increasing frequency due to extended-spectrum cephalosporin-resistant strains. We report two cases of meningitis caused by S. pneumoniae resistant to penicillin and cefotaxime. Both patients were recovered after ceftriaxone and vancomycin treatment, but one of them was left with neurological sequelae because of a delay in the institution of an antibiotic therapy appropriate for resistant pneumococci. This report indicates that extended-spectrum cephalosporin-resistance must be considered In all clinical isolates of S. pneumoniae and in vitro susceptibility testings should be performed promptly and accurately to detect antibiotic resistance.
Cefotaxime ; Ceftriaxone ; Cephalosporins ; Drug Resistance, Microbial ; Humans ; Meningitis* ; Meningitis, Bacterial ; Penicillin Resistance ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus* ; Vancomycin

PURPOSE: Cefodizime is a new third-generation cephalosporin which has a structure and immunomodutation properties similar to cefotaxime. Various studies on cefodizime have demonstrated the direct eradication of bacteria in cooperation with the host defense mechanism, particularly with phagocytosis. We evaluated the effects of cefodizime on the phagocytosis of COS-1 cells transfected with FcgammaRI/gammagamma or FcgammaRIIA cDNA. METHODS: Phagocytosis was measured using the in vitro COS-1 cell modeling system according to Schreiber's method. COS-1 cells, which lack endogenoous Fcgammareceptors but have phagocytic potential, were transfected with either FcgammaRI/gammagammaor FcgammaRIIA cDNA. COS-1 cells, as target cells, were treated with antibiotics for 1 or 24 hours and incubated for 30 min with IgG coated sheep RBCs. Adhered IgG coated sheep RBCs were removed after brief exposure to hypotonic phosphate buffered saline. Phagocytosis index (PI) was calculated as the number of ingested RBCs per 100 phagocytic cells after wright-Giemsa staining. RESULTS: COS-1 cells tranfected with FcgammaR (either FcgammaRI/gammagamma or FcgammaRIIA cDNA) showed the phagocytic activity against IgG coated sheep RBC, while untransfected COS-1 cells did not. After treatment with cefodizime, phagocytic activity of FcgammaRI/gammagammacDNA transfected COS-1 cells was significantly increased, while that of FcgammaRIIA cDNA transfected COS-1 cells did not. Marked enhancement of phagocytosis of COS-1 cells was observed after treatment with cefodizime, but was not observed with ceftriaxone or moxalactam. CONCLUSION: Cefodizime showed marked enhancement of phagocytic activity of FcgammaR transfected COS-1 cells. FcgammaRI seems to play an important role in the enhancement of phagocytosis. Further studies will be required.
Animals ; Anti-Bacterial Agents ; Bacteria ; Cefotaxime ; Ceftriaxone ; COS Cells ; DNA, Complementary ; Immunoglobulin G ; Moxalactam ; Phagocytes ; Phagocytosis* ; Sheep

BACKGROUND: Because extended-spectrum -lactamase (ESBL) producing strains can frequent-ly cause therapeutic failure and infectious outbreaks in hospitals, rapid and accurate detection of these strains are important. We compared the Vitek ESBL test with the NCCLS ESBL phenotypic confirmatory test by disk diffusion (NCCLS ESBL test) and double disk synergy test (DDST). METHODS: For a total of 316 clinical isolates composed of Escherichia coli (184), Klebsiella pneu-moniae (120) and Klebsiella oxytoca (12), we performed the Vitek ESBL test and the NCCLS ESBL test. For sixty-eight ESBL producing isolates, the Vitek ESBL test was compared with the NCCLS ESBL test and the DDST. The ESBL producer was defined as an organism showing an increase in the inhibited zone diameter of >or=5 mm for either cefotaxime or ceftazidime in combination with clavu-lanic acid versus its single test. The DDST was performed with 20 mm and 30 mm for interdisk diam-eter. For seven false negative isolates in the Vitek ESBL test, the DDST of cefepime was performed. RESULTS: Compared with the NCCLS ESBL test, the Vitek ESBL test showed one false positive (specificity, 99.6%), seven false negatives (sensitivity, 89.7%) and 97.5% agreement. Seven false negative isolates of the Vitek ESBL test were the cefoxitin-resistant ESBL producer. In positivity for the NCCLS ESBL test of 68 ESBL producing isolates, cefotaxime-clavulanic acid and ceftazidime-clavulanic acid were 94% and 91%. Cefotaxime, ceftazidime, aztreonam and ceftriaxone showed 95/90%, 100/55%, 100/85% and 95/80% positivity in double-disk synergy with amoxicillin-clavulanic acid (AMC) for 20/30 mm of the interdisk diameter respectively. For seven false negative isolates of the Vitek ESBL test, cefepime showed a distinct synergic effect with AMC. CONCLUSIONS: The Vitek ESBL test may be a useful method for clinical laboratories due to its easy, rapid and sensitive method but its method was less sensitive to cefoxitin-resistant ESBL. For these cases, if the NCCLS ESBL test or DDST with cefepime are added, the detection rate of the ESBL pro-ducer can be augmented.
Amoxicillin-Potassium Clavulanate Combination ; Aztreonam ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Diffusion ; Disease Outbreaks ; Escherichia coli* ; Escherichia* ; Klebsiella oxytoca ; Klebsiella*