Clinical microbiology laboratories play a critical role in diagnosing tuberculosis (TB) and monitoring its treatment. Poor quality laboratory services remain a major barrier to diagnosis by microscopy and culture, and may complicate the interpretation of drug susceptibility testing (DST) results. External quality assessment (EQA) for microscopy is an important component of quality assurance, and includes panel testing, slide rechecking, and on-site supervision. Periodic panel testing is the simplest way to assess the performance of laboratories. Rechecking of a sample of routine smears by a higher-level laboratory is the method of choice for evaluation and continuous motivation of peripheral laboratories. On-site supervision allows the observation of workers' performance under actual conditions, including equipment handling, laboratory safety, adequacy of supplies, and the processes used for smearing, staining, reading, recording, and reporting. Culture performance is not easily measured, and existing EQA programs are not sensitive enough to estimate the sensitivity of the process. Therefore, laboratory regulations and accreditation programs are critical to assure the quality of cultures. The Supranational Reference Laboratory Network (SRLN) was organized in 1994 to ensure optimal performance of laboratories conducting DST. A panel of 30 pretested and coded isolates is exchanged annually within the network for proficiency testing. It has been demonstrated that education and an EQA program can improve the proficiency of TB laboratories. However, quality programs in Korea are still weak. Expanded and strengthened laboratory quality improvement systems are necessary to achieve TB control in this country.
Accreditation ; Dietary Sucrose ; Equipment and Supplies ; Handling (Psychology) ; Korea ; Microscopy ; Motivation ; Organization and Administration ; Quality Improvement ; Social Control, Formal ; Tuberculosis

No abstract available.
Publications

No abstract available.
Publications

Non-tuberculous mycobacteria (NTM) are being recognized increasingly as the causative agents of opportunistic infections in humans. This study investigated the epidemiologic trends of NTM recovery from various clinical specimens in 2 Korean tertiary-care hospitals. We reviewed the laboratory records of patient samples cultured for mycobacteria between 2009 and 2015 at 2 tertiary-care hospitals in Korea. The medical records for patients with positive NTM samples were also reviewed. During the study period, 144,540 specimens were cultured for mycobacteria. The proportion of NTM-positive samples increased from 23.3% in 2009 to 48.2% in 2015. The 2 most frequently isolated NTM were Mycobacterium intracellulare (38.3%) and M. avium (23.1%). The number of clinically significant diseases caused by NTM in inpatients and outpatients increased from 6.8 to 12.9 per 100,000 patients over the same period. The rates of recovery of NTM from clinical specimens and the number of patients with NTM infections increased significantly (P < 0.001, testing for trend) between 2009 and 2015.
Humans ; Inpatients ; Korea ; Medical Records ; Mycobacterium avium ; Mycobacterium avium Complex ; Mycobacterium tuberculosis ; Opportunistic Infections ; Outpatients

BACKGROUND: During the specimen preparation, neutralization after alkali processing is not necessary when inoculate into agar or broth media, but into 3% Ogawa media, the mostly used egg-based media in Korea. To simplify the specimen processing, the recovery of mycobacteria from 3% Ogawa media inoculating differently processed sputa, was evaluated. Futhermore, the recovery from the three different media was evaluated, too. METHODS: 209 sputa were included. Each specimen was divided into 3 bottles.(A) One was only decontaminated by 4% NaOH before inoculation.(B) Another was decontaminated, and concentrated without neutralization. These two specimens were inoculated into 3% Ogawa media.(C) The other was decontaminated, neutralized and concentrated, and innoculated into 3% Ogawa, Middlebrook 7H9 selective broth and 7H10 selective agar media. The isolates were identified by AccuProbe method. RESULTS: M. tuberculosis were isolated from 43(20.5%) specimens. The recovery number and time from Ogawa media, inoculating specimens processed by A, B, and C method, were 29(13.9%), 35(16.7%), and 36(17.2%), and 23, 23, and 19 days, respectively. The recovery number and time from Ogawa, 7H10 agar and 7H9 broth media, inoculating specimens processed by C method, were 36(17.2%), 42(20.1%), and 41(19.6%), and 26, 24, and 22 days, respectively. CONCLUSIONS: Neutralization of alkali-decontaminated specimens could be used to inoculate into 3% Ogawa media. Inoculation into homemade 7H10 agar and 7H9 broth media in addition to 3% Ogawa media improved the recovery rate and time of mycobacteria.
Agar ; Alkalies ; Korea ; Mycobacterium tuberculosis ; Sputum ; Tuberculosis

BACKGROUND: A hand hygiene policy has been introduced by the Joint Commission International Accreditation Standards for Hospitals (JCI); the purpose of this policy is to ensure that systematic standards are continuously practiced at hospitals in order to improve the quality of medical care and the safety of patients and health care workers. This policy requires that phlebotomists wear new gloves and disinfect their hands before attending a patient to prevent nosocomial infections and to protect the phlebotomists. This study aimed to assess the responses of patients and guardians regarding the hand hygiene procedures. METHODS: Between January and February 2010, a questionnaire survey was performed at our hospital for 310 outpatients, 93 inpatients, and 189 guardians. RESULTS: In all, 70.8% of respondents answered that phlebotomists did not require considerable time to remove and wear gloves, and 69.9% responded that phlebotomists could readily detect veins even with their gloves on. Besides, 81.9% respondents thought that it was sanitarily important for phlebotomists to remove their gloves and disinfect their hands after a venipuncture, whereas only 2.8% thought that this practice caused discomfort. CONCLUSION: The patients and guardians recognized that the hand hygiene procedures were important for their own safety and encouraged their application rather than considering them uncomfortable or inappropriate. Introduction and maintenance of the hand hygiene policy of JCI would not be difficult because patients or guardians recognized its importance.
Accreditation ; Cross Infection ; Surveys and Questionnaires ; Delivery of Health Care ; Dietary Sucrose ; Gloves, Protective ; Hand ; Hand Disinfection ; Hand Hygiene ; Humans ; Inpatients ; Joints ; Outpatients ; Phlebotomy ; Veins

The Coronavirus Disease 19 (COVID-19), which emerged as pneumonia from an unknown agent for the first time at the end of 2019, has dramatically transformed our world into one that is highly unrecognizable today. Newly emerging infectious diseases have been occurring more frequently than ever. Opportunities of such deadly microorganisms to adapt to humans—as well as spread between people on a massive scale—are growing because of active human mobility. We have translated and published the book, “One Health: People, Animals, and the Environment.” The original book, published in 2014 by ASM Press, shows the concept and applications of One Health. The current book comprises five parts: definition and importance of One Health, zoonotic and environmental drivers of emerging infectious diseases, One Health and antibiotic resistance, disease surveillance, and realizing the One Health Initiative’s objectives. This translation and publication was the first science book publishing project performed under the name of the Korean Society of Clinical Microbiology. We are actively working toward providing academic information and advancing our identity in other scientific fields as well as to the public.

There are several problems in mycobacterial detection and drug susceptibility testing. One problem is that some test results are unnecessarily delayed because the tests are postponed until patients revisit clinics and pay the cost of the tests. Another problem is that critical and important tests are not requested because patients do not agree with their necessity. These inefficient practices may be due to the fee-for-service policy that the Korean medical insurance system is adopting and because many test methods used for mycobacterial infection have each test codes. Therefore, we propose a new test code encompassing several test items necessary for laboratory diagnosis of mycobacterial infection. This new code enables all necessary tests to be performed sequentially without delay and also prevents performance of unnecessary tests. These changes will help control tuberculosis without any further medical insurance financial input.
Clinical Laboratory Techniques ; Humans ; Insurance ; Tuberculosis

BACKGROUND: We evaluated the recently marketed UriDoctor analyser (DFI Co., Ltd., Korea) for urinalysis and measurement of microalbumin and creatinine in urine. METHODS: The precision within and betweenruns was evaluated using commercial control materials. The comparison evaluations were performed using patient urine samples. Urine dipstick tests for blood, bilirubin, urobilinogen, ketones, protein, nitrite, glucose, pH, specific gravity, and leukocyte esterase were performed with UriDoctor using CYBOW10 strips (DFI Co., Ltd., Korea) and with AX4030 using Aution Sticks 10EA (Arkray Inc., Japan), and the results were compared. Additionally, tests for microalbumin and creatinine were performed with UriDoctor using CYBOW2AC strips and with the Cobas c501 system (Roche Diagnostics, Germany), and the results were compared. RESULTS: The within-run and between-run precisions for urinalysis using UriDoctor were both 100%. The concordance rates and concordance rates including +/-1 grade between UriDoctor and AX4030 were as follows: blood (90%, 100%); bilirubin (97%, 100%); urobilinogen (98%, 100%); ketones (92%, 100%); protein (83%, 100%); nitrite (100%, 100%); glucose (85.0%, 100%); pH (58%, 94%); specific gravity (32%, 80%); leukocyte esterase (89%, 93%). The concordance rates between UriDoctor and the Cobas c501 system were as follows: microalbumin (71%); creatinine (46%); albumin-creatinine ratio (65%). CONCLUSIONS: UriDoctor showed good precision. There was significant agreement between the results of UriDoctor and AX4030, except for pH and specific gravity. The albumin-creatinine ratio showed relatively low specificity and high sensitivity; therefore, it would be more suitable for screening patients. The performance of UriDoctor when used with CYBOW10 and CYBOW2AC strips was satisfactory for clinical application.
Albuminuria ; Bilirubin ; Creatinine ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Ketones ; Kidney Diseases ; Leukocytes ; Mass Screening ; Sensitivity and Specificity ; Specific Gravity ; Urinalysis ; Urobilinogen

BACKGROUND: Nineteen strains of Shigella sonnei isolated from the patients were examined regarding their biochemical characterization, serotype, and antibiotics resistance, and then analyzed for plasmid DNA profile. METHODS: Strains were tested for possession of set1A, set1B, sen, ipaH, ial, stx and invE genes using the polymerase chain reaction (PCR) method and were analyzed using the pulsed-field gel electrophoresis (PFGE) pattern against 7 outbreak isolates (10 strains). RESULTS: These strains had the typical biochemical characterization of S. sonnei with positive ornithine decarboxylase and -galactosidase activity, but were negative in mannitol fermentation. Serotype were identified as the I phase in 13 strains (68.0%) and the II phase in 6 strains (32.0%). All strains were resistant to erythromycin, vancomycin, tetracycline, and penicillin. The antibiogram type showed 4 groups from I to IV. The strains showed 8 types of plasmid profiles and were designated as P1 to P8. By the PCR, the ipaH gene and the set1B gene were detected from all of the 16 strains. The invE was detected from 9 strains (56.3%), and the sen gene was detected from 5 strains. All strains were negative for the Stx and the set1A gene. High-molecular-weight genomic DNA was prepared from 7 outbreak isolates (10 strains) and digested with the restriction endonuclease XbaI. Restriction fragment patterns of chromosomal DNA were demonstrated by PFGE. XbaI produced about 23 fragments in all strains with the their size ranged from 40 to 680 kb. Ten strains could be differentiated to 3 patterns by chromosomal DNA fingerprint. CONCLUSIONS: All of the Shigella sonnei strains that were isolated from Busan Province showed similar chromosomal DNA fragment patterns, while the Japanese differed in chromosomal DNA fingerprint pattern. PFGE is useful for the epidemiological study of Shigella sonnei associated endemic diarrhea.
Anti-Bacterial Agents ; Asian Continental Ancestry Group ; Busan ; Diarrhea ; DNA ; DNA Fingerprinting ; DNA Restriction Enzymes ; Electrophoresis, Gel, Pulsed-Field ; Erythromycin ; Fermentation ; Genotype ; Humans ; Mannitol ; Microbial Sensitivity Tests ; Ornithine Decarboxylase ; Penicillins ; Plasmids ; Polymerase Chain Reaction ; Shigella sonnei* ; Shigella* ; Tetracycline ; Vancomycin ; Virulence Factors* ; Virulence*