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 aim of this study was to survey the nationwide susceptibilities of E. coli and K. pneumoniae against third generation cephalosporins and aztreonam in order to determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producers and to characterize genotypes of ESBLs. METHODS: A total of 6, 567 E. coli and 2, 652 K. pneumoniae non-duplicate strains were isolated from 13 hospitals in April to June 2002. Antimicrobial susceptibilities were tested by the disk diffusion method. Twenty isolates of E. coli and 20 K. pneumoniae were collected from each hospital. ESBL production was determined by a double-disk synergy test. The ceftazidime-resistance of the ESBL-producers was transferred to azide-resistant E. coli J53 by conjugation. MICs of beta-lactam antibiotics to transconjugants were determined by the agar dilution method. Searches for blaTEM , blaSHV , blaCTX-M and blaCMY genes in transconjugants were performed by PCR amplification. RESULTS: Eighty-nine percents of E. coli and 71% of K. pneumoniae isolates were susceptible to ceftazidime. Nine percents of E. coli (23/249) and 30% (78/260) of K. pneumoniae isolates showed positive results in the double-disk synergy test. Ceftazidime-resistance of 13 (57%) E. coli and 42 (53%) K. pneumoniae isolates were transferred to E. coli J53 by conjugation. Among 55 transconjugants, 46 strains were resistant to ceftazidime, while only 16 strains were resistant to cefotaxime. Twelve transconjugants were also resistant to cefoxitin and cefotetan. Banding patterns of PCR amplification showed that the blaTEM , blaSHV , blaCTX-M and blaCMY genes were harboured by 44, 39, 4 and 5 transconjugants, respectively. CONCLUSIONS: E. coli and K. pneumoniae isolates producing TEM-, SHV-type, or CTX-M-type ESBLs are wide spread in Korean hospitals. The spread of ESBL genes could compromise the future usefulness of 3rd generation cephalosporins and aztreonam for the treatment of E. coli and K. pneumoniae infections.
Agar ; Anti-Bacterial Agents ; Aztreonam ; beta-Lactamases* ; Cefotaxime ; Cefotetan ; Cefoxitin ; Ceftazidime ; Cephalosporins ; Diffusion ; Escherichia coli* ; Genotype ; Klebsiella pneumoniae* ; Pneumonia ; Polymerase Chain Reaction ; Prevalence*

Clinical isolates of Enterobacteriaceae (189 Klebsiella, 61 Enterobacter, 32 Serratia, 19 E. coli, 7 Proteus, and 3 Citrobacter) from one university hospital were epidemiologically analyzed by using transferable R plasmids resistant beta-lactam antibiotics including broad-spectrum cephalosporins. About 30% of E. cloacae and S. marcescens and about 5% of K. pneumoniae were resistant to one or more broad-spectrum j3-lactam antibiotics including cefotaxim, ceftazidime, aztreonam, or cefoxitin but all isolates of E. aerogenes, K oxytoca, and P. mirabilis were susceptible. Thirty-six conjugative R plasmids including 8 plasmids resistant expanded-spectrum cephalosporins were obtained from multiple resistant K. pneumoniae (19), E. cloacae (9), E. coli (4), and C. freundii (1). Thirty-one plasmids were subjected to R plasmid analysis and classified 20 different plasmid types. Among them 5, 2, and 2 plasmids belong to 3 different types respectively showed identical molecular size, endonuclease fragment pattern by Southem hybridization pattern by TEM-1 probe, pI value by isoelctric focusing, and also identical antibiogram and biotype of wild strains harboring plasmids. But all of plasmids resistant to cefotaxim, ceftazidime, aztreonam or cefoxitin showed different palsmid anlysis patterns. These results indicate that the epidemic strains of 3 clonal types had been present in this hospital and anlysis using transferable R plasmid and bla gene can be used to discriminate multi-resistant clinical isolates of Enterobacteriaceae.
Anti-Bacterial Agents* ; Aztreonam ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Cephalosporins ; Cloaca ; Dermatoglyphics* ; Enterobacter ; Enterobacteriaceae* ; Klebsiella ; Microbial Sensitivity Tests ; Mirabilis ; Plasmids* ; Pneumonia ; Proteus ; R Factors ; Serratia

PURPOSE: The aim of this study was to determine the prevalence and risk factors of extended spectrum beta-lactamase (ESBL)-producing microorganisms in urinary tract infection. MATERIALS AND METHODS: total of 2,312 patients older than 25 years and diagnosed from January 2007 to December 2009 as having urinary tract infection were studied. The prevalence of ESBL-producing microorganisms including Escherichia coli and the antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient status, previous hospitalization, recent history of urinary catheterization, recent exposure to specific antibiotics, and past history of urogenital organ operation as risk factors for the emergence of ESBL-producing microorganisms. Then, multivariate analysis was performed with all significant variables. RESULTS: In outpatient urinary tract infection, the antimicrobial susceptibility of E. coli to each of the third-generation cephalosporins, cefotaxime, ceftazidime, and ceftriaxone, was 87.6%, 93.4%, and 87.7%, respectively, and the prevalence of ESBL-producing E. coli was 12.1%. In inpatient urinary tract infection, the susceptibility of E. coli was 78%, 84.5%, and 76.9%, respectively, and the prevalence was 23.1%. CONCLUSIONS: The overall prevalence of ESBL-producing microorganism was 12.6% and the risk appeared to be increased in cases with a previous hospitalization, a recent history of urinary catheterization, inpatient status, cefaclor medication, cefminox administration, and female gender.
Anti-Bacterial Agents ; beta-Lactamases ; Cefaclor ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Escherichia coli ; Female ; Hospitalization ; Humans ; Inpatients ; Multivariate Analysis ; Outpatients ; Prevalence* ; Risk Factors* ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections*

PURPOSE: The aim of this study was to determine the prevalence and risk factors of extended spectrum beta-lactamase (ESBL)-producing microorganisms in urinary tract infection. MATERIALS AND METHODS: total of 2,312 patients older than 25 years and diagnosed from January 2007 to December 2009 as having urinary tract infection were studied. The prevalence of ESBL-producing microorganisms including Escherichia coli and the antimicrobial susceptibility of E. coli were examined. Univariate analyses were performed with gender, age, inpatient status, previous hospitalization, recent history of urinary catheterization, recent exposure to specific antibiotics, and past history of urogenital organ operation as risk factors for the emergence of ESBL-producing microorganisms. Then, multivariate analysis was performed with all significant variables. RESULTS: In outpatient urinary tract infection, the antimicrobial susceptibility of E. coli to each of the third-generation cephalosporins, cefotaxime, ceftazidime, and ceftriaxone, was 87.6%, 93.4%, and 87.7%, respectively, and the prevalence of ESBL-producing E. coli was 12.1%. In inpatient urinary tract infection, the susceptibility of E. coli was 78%, 84.5%, and 76.9%, respectively, and the prevalence was 23.1%. CONCLUSIONS: The overall prevalence of ESBL-producing microorganism was 12.6% and the risk appeared to be increased in cases with a previous hospitalization, a recent history of urinary catheterization, inpatient status, cefaclor medication, cefminox administration, and female gender.
Anti-Bacterial Agents ; beta-Lactamases ; Cefaclor ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Cephalosporins ; Escherichia coli ; Female ; Hospitalization ; Humans ; Inpatients ; Multivariate Analysis ; Outpatients ; Prevalence* ; Risk Factors* ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections*

BACKGROUND: ESBL-producing Klebsiella spp. are increasing worldwide, and infections with ESBL-producing organisms are usually hospital-acquired and common infections with ESBL-producing organisms include urinary tract infections, peritonitis, cholangitis, intraabdominal abscesses and nosocomial pneumonia. We studied the phenotypic and genotypic characteristics of ESBL-producing K. pneumoniae, which were isolated from the patients in St. Vincent Hospital. METHODS: Susceptibility to antibiotic was determined by standard disk diffusion and agar dilution methods for all 22 strains of K. pneumoniae. PCR amplifications were performed with primers specific for TEM. SHY, and CMY-1 genes, and the DNA of the amplified products were sequenced. Total DNA was extracted from the isolates restricted with XbaI, and fingerprinted using pulsed-field gel electrophoresis. Crude preparations of beta-lactamase were obtained by sonications and used for characterization of beta-lactamase by isoelectric focusing. RESULTS: The MIC90 values for ceftazidime and aztreonam were 128 microgram/mL and 64 microgram/mL, respectively. The MIC90 values for cefotaxime and sulperazon were 8 microgram/mL and 4microgram/mL, respectively, and that for cefoxitin was 1.0 microgram/mL, which is much lower than the value for third-generation cephalosporins. The MICs for ciprofloxacin. cefepime, and imipenem were less than 1 microgram/mL for all organisms, which is within the susceptible range. Isoelectric focusing studies demonstrated three beta-lactamases with pls of 5.. (TEM-1), 7.6 (SHV-2a), and 8.2 (SHV-12). The presence of blaSHV and blaTEM genes was confirmed by specific PCRs and DNA sequencing analysis. but blaCMY-1 genes were not found. According to DNA sequencing analysis, 21 K. pneumoniae strains produced SHV-12 ESBL and one strain produced SHV-2a ESBL. CONCLUSIONS: Our results suggest that the resistance of K. pneumoniae from clinical isolates to extended spectrum beta-lactam antibiotics may be due to the production of SHY-type ESBL. This approach in detecting and characterizing ESBL will be valuable for the control of infection and antibiotics use in medical institution.
Abscess ; Agar ; Anti-Bacterial Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Cephalosporins ; Cholangitis ; Ciprofloxacin ; Dermatoglyphics ; Diffusion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Imipenem ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Peritonitis ; Pneumonia ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Sonication ; Urinary Tract Infections

Cephalosporins are the most important -lactams that induce IgE-mediated reactions. Also, cephalosporins have been known as a causative agent for occupational asthma in pharmaceutical workers. To our knowledge, this is the first report of cephalosporin-induced bronchial asthma in a housewife with no history of occupational exposure. We experienced a 30-year old female who had developed shortness of breath, coughing and itching sensation of the skin since 3 years ago whenever she handled drug powder for upper respiratory infections (URI) prescribed for her two sons with bronchial asthma. She had handled drug powder for 7 years because her sons had experienced frequent URI. Skin prick test with cefadroxil (10mg/ml) and cefaclor (10mg/ml) showed positive reactions. Bronchial challenge test with cefadroxil showed immediate asthmatic reaction, and bronchial challenge with cefaclor showed immediate urticaria and angioedema without significant fall in FEV1. We confirmed cefadroxil-induced bronchial asthma sensitized by intermittent inhalation in a non-occupational setting.
Adult ; Angioedema ; Asthma* ; Asthma, Occupational ; Bronchial Provocation Tests ; Cefaclor ; Cefadroxil* ; Cephalosporins ; Cough ; Dyspnea ; Female ; Humans ; Inhalation ; Occupational Exposure ; Pruritus ; Respiratory Tract Infections ; Sensation ; Skin ; Urticaria

Several of the newer broad-spectrum, potent antibiotics are currently being used for the treatment of meningitis, ventriculitis and shunt-tract infection. The risk of complications following intrathecal administration of some of this newer antibiotics varies considerably. Possible complications of immediate or delayed seizure, cortical electric depression, radiculopathy, transverse myelopathy, and arachnoiditis after intrathecal or intraventricular administration must be weighed against the potential value of this route. These risks may influence the therapeutic management of a specific clinical situation. The author studied the effect of the first generation of cephalosporins(cepalothin, cefazolin, cepharadine, cephapirin), the second generation of cephalosporins(cefamandole, cefmetazole), and the third generation of cephalosporins(cefotaxime, cetriaxone, cefotetan), on electrocortical activity of cerebral cortex. The results are as follows : 1) The topical application of cephalothin, cefazolin, cephapirin 8mg/ml shows electrocortical spike activity. In higher concentration, each cases show intense electrocortical spike activity. The topical application of cephradine 100mg/ml shows electrocortical spike activity and in higher concentration, electrocortical spike activity continued. 2) The topical application of cefamandole 64mg/ml shows electrocortical spike activity first and that of cefmetazole 100mg/ml shows electrocortical spike activity and in higher concentration of each cases, intense electrocortical spike activity continued. 3) The topical application of cefotaxime 16mg/ml shows electrocortical spike activity and that of ceftriaxon 200mg/ml and cefatetan 100mg/ml shows mild electrocortical spike activity. In higher concentration of each cases, electrocortical spike activity continued. In conclusion, the degrees of epileptogenic effect was most severe in the first generation of cephalosporins and the second generation of cephalosporins and the third generation of cephalosporins on the decreasing order.
Anti-Bacterial Agents ; Arachnoid ; Arachnoiditis ; Cefamandole ; Cefazolin ; Cefmetazole ; Cefotaxime ; Ceftriaxone ; Cephalosporins* ; Cephalothin ; Cephapirin ; Cephradine ; Cerebral Cortex* ; Depression ; Meningitis ; Radiculopathy ; Seizures ; Spinal Cord Diseases

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

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