Mycobacterium massiliense, an emerging pathogen that is increasingly reported as a causative agent in infections occurring during medical procedures, is difficult to be identified using conventional methods. Here we report the case of a cutaneous M. massiliense infection that was associated with repeated surgical procedures and that was identified via a comparative sequence analysis of rpoB and hsp65. The patient showed a substantial response to treatment with a combination of antimicrobial therapies consisting of clarithromycin, amikacin, and cefoxitin for 6 months.
Amikacin ; Cefoxitin ; Clarithromycin ; Humans ; Mycobacterium ; Sequence Analysis

BACKGROUND: Periodic monitoring of regional or institutional resistance trends of clinically important anaerobic bacteria is recommended, because the resistance of anaerobic pathogens to antimicrobial drugs and inappropriate therapy are associated with poor clinical outcomes. There has been no multicenter study of clinical anaerobic isolates in Korea. We aimed to determine the antimicrobial resistance patterns of clinically important anaerobes at multiple centers in Korea. METHODS: A total of 268 non-duplicated clinical isolates of anaerobic bacteria were collected from four large medical centers in Korea in 2012. Antimicrobial susceptibility was tested by the agar dilution method according to the CLSI guidelines. The following antimicrobials were tested: piperacillin, piperacillin-tazobactam, cefoxitin, cefotetan, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, metronidazole, and tigecycline. RESULTS: Organisms of the Bacteroides fragilis group were highly susceptible to piperacillin-tazobactam, imipenem, and meropenem, as their resistance rates to these three antimicrobials were lower than 6%. For B. fragilis group isolates and anaerobic gram-positive cocci, the resistance rates to moxifloxacin were 12-25% and 11-13%, respectively. Among B. fragilis group organisms, the resistance rates to tigecycline were 16-17%. Two isolates of Finegoldia magna were non-susceptible to chloramphenicol (minimum inhibitory concentrations of 16-32 mg/L). Resistance patterns were different among the different hospitals. CONCLUSIONS: Piperacillin-tazobactam, cefoxitin, and carbapemems are highly active beta-lactam agents against most of the anaerobes. The resistance rates to moxifloxacin and tigecycline are slightly higher than those in the previous study.
Agar ; Bacteria, Anaerobic* ; Bacteroides fragilis ; Cefotetan ; Cefoxitin ; Chloramphenicol ; Clindamycin ; Gram-Positive Cocci ; Imipenem ; Korea ; Metronidazole ; Piperacillin

To elucidate the role of plasmid-mediated AmpC-type B-lactamases in clinical practice, cefoxitin-resistant isolates of E. coli (19 strains) and K. pneumoniae (7 strains) from three hospitals in Korea were studied. All of the 26 isolates produced at least one j3-lactamase and 16 (62%) isolates produced AmpC-type B-lactamases poorly inhibited by clavulanic acid. In 16 such isolates, 4 kinds of AmpC enzymes were detected; the pI 8.0 AmpC enzyme in 11 isolates, the pI 8.9 in 3 isolates of E. coli, the pI 8.5 in 1 isolate of E. coli, and the pI 7.8 in 1 isolate of K pneumoniae. The pI 8.0 and 7.8 AmpC enzymes had an apparent molecular mass of 38 kDa and the pI 8.5 and 8.9 AmpC enzymes had a molecular mass of 35 kDa. Cefoxitin resistance was transmissible in six E. coli and three K pneumoniae strains due to a common AmpC-type B-lactamase with a pl of 8.0. This enzyme was confirmed to be CMY-1 B-lactamase by Southern blotting and PCR analysis. Four E. coli isolates produced large amounts of AmpC-type j3-1actamase. They were chromosomal AmpC hyperproducers carrying some alterations in the promoter and attenuator regions of the ampC chromosomal gene. The pI 7.8 AmpC enzyme is currently under study. In conclusion, this study showed that the CMY-1 plasmid-mediated cephamycinase play an important role in cephamycin resistance of K. pneumoniae and E. coli clinical isolates in Korea.
beta-Lactamases* ; Blotting, Southern ; Cefoxitin ; Clavulanic Acid ; Korea ; Pneumonia* ; Polymerase Chain Reaction

BACKGROUND: A high proportion of currently isolated gram-negative bacilli are resistant to beta-lactams by producing beta-lactamases. beta-lactam and beta-lactamase inhibitor combinations have been successfully used to overcome the resistance. In this study, in vitro antimicrobial activity of a new combination, cefatrizine-clavulanic acid, was determined against gram-negative bacilli isolated from community-acquired urinary track infections. METHODS: Nonduplicate strains of Enterobacteriaceae, isolated in 2003 from urine specimens of outpatients and inpatients of less than 3 hospital days at Severance Hospital, were tested by the NCCLS agar dilution method. RESULTS: Of a total of 204 isolates, 144 (71%) were Escherichia coli and 30 (15%) were Klebsiella spp. MIC50 and MIC90 of cefatrizine for E. coli were 2 microgram/mL and 16 microgram/mL, respectively. MIC90s of both cefaclor and cefoxitin were also 16 g/mL. MIC50 and MIC90 of cefatrizine-clavulanic acid for E. coli were 1 microgram/mL and 4 microgram/mL, respectively, which were 1/2-1/4 of those of cefaclor and cefoxitin. For Klebsiella spp., MIC90 of cefatrizine was 4 microgram/mL with an MIC range of 1->128 microgram/mL, whereas that of cefatrizine-clavulanic acid was 2 microgram/mL with an MIC range of 0.5-32 microgram/mL. In vitro activity of cefatrizine-clavulanic acid was higher than that of cefatrizine. CONCLUSIONS: Improved in vitro activity of cefatrizine-clavulanic acid against isolates of E. coli and Klebsiella spp. from community-acquired urinary track infection suggested that the combination is useful for an empirical treatment of the infection.
Agar ; beta-Lactamases ; beta-Lactams ; Cefaclor ; Cefatrizine ; Cefoxitin ; Enterobacteriaceae ; Escherichia coli ; Humans ; Inpatients ; Klebsiella ; Outpatients

Mycobacterium massiliense is an emerging pathogen that is increasingly reported as a causative agent occurring during medical procedures, at surgical sites, and intramuscularly [1]. Although previously classified as part of M. abscessus, M. massiliense has recently been identified as a new species of rapidly growing nontuberculous mycobacteria [1,3] via a comparative sequence analysis of rpoB and hsp65 [3,5]. However, the clinical manifestations of M. massiliense have not been well characterized. We report here in a case of recurrent pneumonia for 3 years that improved with antibiotic treatment for M. massiliense in a 37-year-old woman with Sjogren's syndrome. The patient showed a substantial response to treatment with a combination of antimicrobial therapies comprising clarithromycin and amikacin without cefoxitin for 6 months. This is the first report of pulmonary infection of M. massiliense with Sjogren's syndrome in Korea.
Adult ; Amikacin ; Cefoxitin ; Clarithromycin ; Female ; Humans ; Korea ; Mycobacterium ; Nontuberculous Mycobacteria ; Pneumonia ; Sequence Analysis ; Sjogren's Syndrome

OBJECTIVETo discuss the effect and safety of preventive administration of antibiotics to patients with benign prostatic hyperplasia (BPH) before urodynamic examination.

METHODSA total of 256 BPH patients to undergo urodynamic examination were randomly divided into a control group (n = 118) and a trial group (n = 138). The former received no pre-treatment while the latter were given cefoxitin sodium iv at 1.0 g 30 minutes before complete urodynamic examination. Then we compared the incidence rates of urinary tract infection between the two groups.

RESULTSStatistically significant differences were found in the incidence rate of urinary tract infection between the control and trial groups (20.3% [24/118] vs 7.3% [10/138], P < 0.01), as well as in those with diabetes mellitus (6.7% [3/45] vs 23.5% [8/34], P < 0.05), those with residual urine > 50 ml (5.4% [3/56] vs 18.5% [10/54], P < 0.05), and those with both diabetes mellitus and residual urine (9.5% [2/21] vs 44.4% [8/18], P < 0.05). Only 3 patients (2.2%) in the trial group had mild adverse drug reactions.

CONCLUSIONFor BPH patients, particularly those with diabetes mellitus and residual urine, preventive administration of antibiotics before urodynamic examination is safe and can effectively protect the patients against urinary tract infection.

Antibiotic Prophylaxis ; Cefoxitin ; administration & dosage ; Humans ; Male ; Prostatic Hyperplasia ; diagnosis ; Urinary Tract Infections ; prevention & control ; Urodynamics

Staphylococcus species are one of prevalent pathogens found in hospitals. Microbes that are a primary cause of nosocomial infection were isolated from a dental and medical environment it may assist the reader to explain what this is and how it differs from the 'dental health care providers and ward health care providers'. To investigate the distribution of staphylococcus species in this environment, we used vitek II to measure drug sensitivity, and further performed biochemical testing. The isolation rate of staphylococcus species from the dental and medical environment was 100% but from dental health care providers and ward health care providers were 44.4% and 33.3%, respectively. In the analyses, staphylococcus species showed resistance to diffusion of cefoxitin and oxacillin discs. These staphylococci may be sufficiently positive for the mecA gene. Our results suggest that staphylococci might be an important cause of nosocomial infection in the dental clinic.
Adenosine ; Anti-Infective Agents ; Cefoxitin ; Cross Infection ; Delivery of Health Care ; Dental Clinics ; Diffusion ; Health Personnel ; Humans ; Oxacillin ; Staphylococcus

PURPOSE: Prophylactic antibiotics have been used in nonperforated appendicitis for preventing infection after an appendectomy. However, the duration of antibiotic administration for surgical prophylaxis in Korea has been noted to be longer than those recommended in other countries. PURPOSE: The objective of this study was to identify the appropriate duration of prophylactic antibiotic therapy in nonperforated appendicitis by comparing the wound infection rates of two different antibiotic regimens, 24 hours of cephalosporin (cefoxitin) alone and 72 hours of cephalosporin (cefoxitin) with aminoglycoside (sissomicin). METHODS: One hundred thirty-four (134) patients of nonperforated appendicitis were enrolled in this prospective, randomized, open trial and were assigned to one of two antibiotic regimens: 1) cefoxitin 1 g every 8 hours given intravenously for 24 hours and 2) cefoxitin 1 g every 8 hours given intravenously plus sissomicin 75 mg every 12 hours given intramuscularly for 72 hours. First doses were given just prior to the induction of anesthesia. RESULTS: Postoperative wound infections were detected in 3 cases (4.5%) of the 72-hour-treated group (n=66) whereas none occurred in the 24-hour-treated group (n=68). However, the difference in the rates of wound infections between the two groups was not statistically significant. Cost analysis identified a saving of 43,470 won per patient in the 24-hour-treated group. CONCLUSION: In nonperforated appendicitis cefoxitin administration alone for 24 hours is sufficient as a surgical prophylaxis.
Anesthesia ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Cefoxitin ; Costs and Cost Analysis ; Humans ; Korea ; Prospective Studies* ; Sisomicin ; Surgical Wound Infection ; Wound Infection

BACKGROUND: Extended-spectrum beta -lactamase (ESBL) producing Escherichia coli and Klebsiella spp. isolates are clinically resistant to all the beta -lactams except carapenems and cephamycins. This study was to determine the prevalence of ESBL producing E. coli and Klebsiella spp. and the rates and trends of resistance to extended-spectrum beta -lactams and other antimicrobial agents in ESBL producing E. coli and Klebsiella spp.. METHODS: During the periods of 2002, a total 2,551 clinical isolates of E. coli & Klebsiella spp. were collected from patients of the Samsung medical center, Seoul, Korea. Antimicrobial susceptibility test and determination of ESBL production were performed by Vitek GNS-433 card. RESULTS: 151/1,594 (9.5%) of E. coli isolates, 128/896 (14.3%) of K. pneumoniae isolates and 11/61 (18.0%) of K. oxytica were ESBL producing strains. Resistance to cefoxitin and cefepime were 2.4% and 13.4% in ESBL producing isolates. Imipenem had excellent activity against E .coli and Klebsiella spp. (100% susceptible). CONCLUSION: In this study, ESBL-producing E. coli and Klebsiella spp were more resistant to beta -lactams including cefepime than ESBL non-producing E. coli and Klebsiella spp.. ESBL producing E. coli and Klebsiella spp. showed a high level of co-resistance with aminoglycosides and fluoroquinolones. Imipenem showed the highest level of activity against E. coli and Klebsiella spp..
Aminoglycosides ; Anti-Infective Agents ; Cefoxitin ; Cephamycins ; Escherichia coli* ; Escherichia* ; Fluoroquinolones ; Humans ; Imipenem ; Klebsiella* ; Korea ; Microbial Sensitivity Tests* ; Pneumonia ; Prevalence ; Seoul

BACKGROUND: Of the plasmid-mediated AmpC beta-lactamases (ABLs), CMY-2 is the most prevalent and is distributed in many countries. However, little is known about the emergence and characteristics of CMY-2 among Escherichia coli isolates in Korea. The aims of this study were to detect the emergence of the CMY-2 beta-lactamase in clinical isolates of E. coli from various regions in Korea. METHODS: Eighteen cefoxitin non-susceptible isolates of 1, 130 consecutive, nonrepeat isolates of E. coli at five university hospitals were tested for antimicrobial susceptibility by the broth microdilution method. The cefoxitin non-susceptible isolates were further investigated by AmpC disk tests, double disk synergy (DDS) tests, isoelectric focusing, CMY-2-specific PCR, DNA sequencing, and plasmid analysis. RESULTS: Seven (0.6%) isolates of plasmid-mediated ABL-producing E. coli were found at three of the five hospitals; all seven isolates produced CMY-2 beta-lactamase and one of the isolates was also tested positive by the DDS test. All isolates demonstrated different plasmid patterns by plasmid analysis. CONCLUSIONS: Our data indicate that CMY-2-producing E. coli has emerged and is prevalent in the medical institution in Korea. Therefore, constant surveillance is needed to prevent its further spread.
beta-Lactamases ; Cefoxitin ; Escherichia coli* ; Hospitals, University ; Isoelectric Focusing ; Korea ; Plasmids ; Polymerase Chain Reaction ; Sequence Analysis, DNA