No abstract available.
Ceftazidime ; Endophthalmitis ; Humans ; Intravitreal Injections ; Vancomycin

In 44 out of 218 cases of contact lens related infectious keratitis from 19 hospitals throughout the country, contact lenses or contact lens storge cases were cultured. Microorganism was detected in 40 cases[90.9%]. Two or more organisms were isolated in 31 cases[77.5%]. Pseudomonas was the most common organism isolated from contact lens or contact lens storage medium[31 out of 84, 45.2%], followed by Serratia[15 out of 84, 17.9%], fungi [4], and acanthamoeba[4]. Acanthamoeba was found only in one hospital. Antibiotic sensitivity test for isolated pseudomonas showed that 96%of cases was sensitive to ciprofloxacin and 88%to ceftazidime.
Acanthamoeba ; Ceftazidime ; Ciprofloxacin ; Contact Lenses ; Fungi ; Keratitis* ; Pseudomonas

BACKGROUND: The prevalence of extended-spectrum -lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli has been increased in Korea, but the testing and reporting ESBL-mediated resistance remains unclear. We undertook a study to evaluate the method to screen isolates of ESBL-producing K. pneumoniae and E. coli using cefpodoxime disk. METHODS: Fifty-eight strains of K. pneumoniae and 28 strains of E. coli were tested for production of ESBLs by the double disk synergy test. Susceptibility to cefpodoxime, ceftazidime, cefotaxime, and aztreonam was determined by disk diffusion method. RESULTS: All strains that produced ESBLs were resistant to cefpodoxime, whereas those that not produced ESBLs were susceptible (97%) to this agents. The disk diffusion test exhibited 100% sensitivity and 97% specificity when NCCLS conventional interpretive criteria were used. All other oxyimino- -lactam agents tested were inferior discriminators between the two groups of organisms. When NCCLS ESBL interpretive criteria were used, the disk diffusion test using cefpodoxime exhibited 100% sensitivity and 83% specificity. CONCLUSIONS: Routine disk diffusion susceptibility test with cefpodoxime disk (10g) can be used to detect strains of ESBL-producing K. pneumoniae and E. coli without include supplemental testing for ESBL production.
Aztreonam ; Cefotaxime ; Ceftazidime ; Diffusion ; Escherichia coli* ; Escherichia* ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Pneumonia ; Prevalence ; Sensitivity and Specificity

BACKGROUND: Acinetobacter baumannii has been reported as a major cause of nosocomial infections with increasing frequency. Recently, the emergence of carbapenem-resistant strains has become a major problem in treatment. The use of nontraditional agents such as colistin and a combination therapy have been tried. The purpose of this study was to evaluate the activity of antimicrobial combinations against multidrug-resistant (MDR) A. baumannii. METHODS: Twenty-nine strains of MDR A. baumannii, either resistant or intermediate to imipenem, were collected from February 2003 to February 2004. Minimum inhibitory concentrations (MICs) were determined by the agar dilution method. The checkerboard method was used to assess the activity of ampicillin-sulbactam in combination with amikacin, tobramycin or meropenem and colistin in combination with ceftazidime, meropenem, or rifampin. RESULTS: The MIC90 of ceftazidime and cefepime were 2, 048 g/mL and 512 g/mL, respectively, while the MIC90 of colistin was 0.5 g/mL. The antimicrobial combinations that showed an additive effect for one or two strains were colistin with rifampin or ceftazidime and ampicillin-sulbactam with tobramycin or meropenem. Other antimicrobial combinations showed indifferent effects against most strains. There were no synergistic or antagonistic combinations. CONCLUSIONS: These data suggested that colistin may be an alternative drug for MDR A. baumannii. For the effective treatment of patients infected with these resistant strains, further studies are needed to evaluate antimicrobial combinations against a large number of heterogeneous isolates, and these studies must be followed by clinical trials.
Acinetobacter baumannii* ; Agar ; Amikacin ; Ceftazidime ; Colistin ; Cross Infection ; Humans ; Imipenem ; Microbial Sensitivity Tests ; Rifampin ; Tobramycin

BACKGROUND/AIMS: The inhibitory effects of the combination of beta-lactam with ciprofloxacin or amikacin against clinical isolates of multidrug-resistant Pseudomonas aeruginosa were evaluated. METHODS: This study examined ten isolates with variable levels of resistance to ceftazidime, cefepime, piperacillin/tazobactam, meropenem, ciprofloxacin, and amikacin. The efficacy of the combined antibiotics was studied using a checkerboard method or in vitro killing assay. RESULTS: The combination of ceftazidime, cefepime, aztreonam, piperacillin-tazobactam, or meropenem with amikacin showed synergistic effects for all of the strains regardless of the minimum inhibitory concentration (MIC) of amikacin, but combination with ciprofloxacin showed a synergistic effect for the isolate with a low MIC of ciprofloxacin by the checkerboard method. The isolates with a high MIC of ciprofloxacin showed an indifferent effect in combination with beta-lactam and ciprofloxacin. The in vitro killing assay showed that meropenem with ciprofloxacin acted synergistically for the isolates with a MIC of 16 microgram/mL of ciprofloxacin. However, amikacin showed synergistic effects with meropenem for the isolates with high-level resistance against amikacin, i.e., up to an MIC of 128 microgram/mL. Contrary to the checkerboard method results, no synergy was observed for the combination of ceftazidime/piperacillin-tazobactam and amikacin. CONCLUSIONS: Meropenem with amikacin can be the first choice for infections caused by multidrug-resistant P. aeruginosa when the level of resistance is not known.
Amikacin ; Anti-Bacterial Agents ; Aztreonam ; Ceftazidime ; Cephalosporins ; Ciprofloxacin ; Homicide ; Microbial Sensitivity Tests ; Pseudomonas ; Pseudomonas aeruginosa ; Thienamycins

PURPOSE: We encountered two patients who developed Bacillus cereus endophthalmitis following trauma and eventually underwent enucleation, after aggressive antibiotic therapy. METHODS: When removing the intraocular foreign bodies, vancomycin and ceftazidime were injected intravitreally. The patients received postoperative topical fortified antibiotics hourly and underwent intravenous antibiotic therapy. RESULTS: After the operation, rapid corneal melting progressed to impending perforation in one patient's eye and enucleation was done on postoperative day 11. The eye of another patient progressed to phthisis bulbi and the patient underwent enucleation on postoperative day 45. CONCLUSIONS: Bacillus cereus is one of the most aggressive and devastating organisms that causes post-traumatic endophthalmitis and results in poor visual outcome. It is thought to be better to prevent the loss of anatomic integrity and visual function than to perform early intravitreal injection of antibiotics when the operation might be delayed.
Anti-Bacterial Agents ; Bacillus cereus* ; Bacillus* ; Ceftazidime ; Endophthalmitis* ; Foreign Bodies ; Freezing ; Humans ; Intravitreal Injections ; Vancomycin

BACKGROUND: This study was designed to evaluate the ability of the Vitek and MicroScan ESBL test by comparing with NCCLS ESBL phenotypic confirmatory test by disk diffusion and to know the frequency of ESBL producers in the Seoul Veterans Hospital. METHODS: A total of 1,261 isolates(Escherichia coli 705, Klebsiella pneumoniae 502, K. oxytoca 54) from 883 patients were included in ESBL screening test by Vitek (494 strains) and MicroScan (767 strains). After excluding repetitive isolates from same patients, NCCLS ESBL confirmatory test was performed for 197 ESBL screening positives and 184 ESBL screening negatives. RESULTS: The overall frequency of ESBL screening positives was 22.3% (by MicroScan 26.2%, by Vitek 15.6%), and that of NCCLS ESBL positives was 18.9%(18.3% in E. coli, 21% in K. pneumoniae). MicroScan and Vitek ESBL test showed 100% and 92.3% sensitivity, 77.1% and 95.5% specificity, respectively. Among the 158 NCCLS ESBL positives, 17.7% showed clavulanic acid effect in cefotaxime only, 10.1% in ceftazidime only, and 72.2% in both. MicroScan Neg ComboPanel Type 21 test revealed that 91.4% of suspicious ESBL producers flagged by one or two antimicrobials were erroneous. In contrast, 96.2% of strains flagged by all five antimicrobials were correct. CONCLUSION: Suspicious ESBL producers by MicroScan showing three or four antimicrobial flags should be retested by NCCLS ESBLconfirmatory test. But strains with two or less flags and strains with all 5 flags can be reported as Non-ESBL producers and ESBL producers, respectively.
Cefotaxime ; Ceftazidime ; Clavulanic Acid ; Diffusion ; Hospitals, Veterans ; Humans ; Klebsiella pneumoniae ; Mass Screening ; Sensitivity and Specificity ; Seoul

Bacterial endophthalmitis is an ocular emergency that requires rapid diagnosis and therapeutic decision making. Before the use of intravitreal antibiotics, endophthalmitis almost always resulted in the loss of vision in the affected eye. The introduction of intravitreal injection of antibiotics had been a major advancement because it has resulted in a marked improvement in visual outcome. Current therapy is to administer broad-spectrum antibiotic agents covering both gram-positive and gram-negative organisms. Typically, vancomycin hydrochloride and aminoglycoside, such as amikacin sulfate, are administered as separate intrvitreal injections on an empiric basis. We experienced a case of culture-proven Pseudomonas aeruginosa endophthalmitis treated with intravitreal ceftazidime injection. We present it with a review of literature.
Amikacin ; Anti-Bacterial Agents ; Ceftazidime* ; Decision Making ; Diagnosis ; Emergencies ; Endophthalmitis* ; Intravitreal Injections ; Pseudomonas aeruginosa* ; Pseudomonas* ; Vancomycin

BACKGROUND: The aim of this study was to determine a nation-wide prevalence of Ambler class A and D extended-spectrum-lactamases (ESBL) in Klebsiella pneumoniae isolates in Korea. METHODS: During the period of April to May 2005, 189 isolates of K.pneumoniae were collected from 11 Korean hospitals. Antimicrobial susceptibilities to ceftazidime and cefotaxime were tested by the disk diffusion method, and ESBL production was determined by double-disk synergy test. Determinants of ceftazidime or cefotaxime-resistance were transferred to Escherichia coli J53 (azide-resistant) by transconjugation. Genotypes of class A and D ESBL genes were determined by PCR amplification and sequencing. RESULTS: One hundred-sixty isolates of K.pneumoniae showed positive results in double-disk synergy test. The most prevalent ESBL was SHV-12 (n=148). Also detected were genes encoding ESBLs including TEM-52 (n=1), SHV-2a (n=2), CTX-M-3 (n=15), CTX-M-9 (n=6), CTX-M-12 (n=2), CTX-M-14 (n=9), CTX-M-15 (n=1), PER-1 (n=1), GES-5 (n=3), and OXA-30 (n=2) beta-lactamases. CONCLUSION: With the emergence of CTX-M-12, PER-1, and OXA-30 beta-lactamases, the ESBLs in K.pneumoniae isolates are becoming more diverse in Korea.
beta-Lactamases ; Cefotaxime ; Ceftazidime ; Diffusion ; Escherichia coli ; Genotype ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Polymerase Chain Reaction ; Prevalence

PURPOSE: There has not been any reports of Ralstonia paucula causing any ophthalmologic disease. However, we have detected Ralstonia paucula in the lens washing agents of a corneal ulcer patient wearing contact lens. METHODS: A 26-years-old female patient was admitted to our hospital complaining of loss of visual acuity and hyperemia. Slit lamp biomicroscopy and smear culture was done to the anterior segment of the eye and the lens cleansing agent. The patient was treated with antibiotic eye drop and intravenous antibiotic medication. RESULTS: The results of both smear and culture showed the presence of Ralstonia pacula and responded well to antibiotics treatment with ceftazidime.
Anti-Bacterial Agents ; Ceftazidime ; Corneal Ulcer* ; Detergents ; Female ; Humans ; Hyperemia ; Ralstonia* ; Visual Acuity