1.Molecular characterization of vancomycin-resistant Enterococci.
He WANG ; Ying-Chun XU ; Xiu-Li XIE ; Peng WANG ; Ren-Yuan ZHU ; Xiao-Jiang ZHANG ; Hui WANG ; Min-Jun CHEN
Acta Academiae Medicinae Sinicae 2008;30(5):521-524
OBJECTIVETo investigate the homology and resistant mechanism of vancomycin-resistant Enterococci (VRE) isolates.
METHODSA total of 9 VRE isolates were collected from 2006 to 2007 at PUMC hospital. The susceptibility of these isolates to 10 different antibiotics including vancomycin was tested by E-test. These strains were processed by brain heart infusion agar screening in the presence of vancomycin (6 microg/ml), and were analyzed for genotypic characteristics using the multiplex PCR. The homology of the isolates was determined by pulsed-field gel electrophoresis (PFGE).
RESULTSAll the 9 VRE isolates were identified as Enterococci faecium. The visual analysis of PFGE patterns revealed 6 different PFGE types. The vanA gene was confirmed by PCR and sequencing in 9 VRE isolates, which were consistent between phenotype and genotype for glycopeptides resistance.
CONCLUSIONSOnly vanA genotype was detected in PUMC hospital. Clonal dissemination, horizontal gene transfer, and the selective pressure of antimicrobial agents may contribute to the increase of VRE.
Bacterial Proteins ; genetics ; Bacterial Typing Techniques ; Drug Resistance, Multiple, Bacterial ; Enterococcus faecium ; classification ; drug effects ; genetics ; isolation & purification ; Gram-Positive Bacterial Infections ; microbiology ; Humans ; Vancomycin Resistance
2.Evaluation of the Usefulness of Selective Chromogenic Agar Medium (ChromID VRE) and Multiplex PCR Method for the Detection of Vancomycin-resistant Enterococci.
Do Hoon KIM ; Jae Hee LEE ; Jung Sook HA ; Nam Hee RYOO ; Dong Seok JEON ; Jae Ryong KIM
The Korean Journal of Laboratory Medicine 2010;30(6):631-636
BACKGROUND: Accurate and early detection of vancomycin-resistant enterococci (VRE) is critical for controlling nosocomial infection. In this study, we evaluated the usefulness of a selective chromogenic agar medium and of multiplex PCR for detection of VRE, and both these techniques were compared with the conventional culture method for VRE detection. METHODS: We performed the following 3 methods for detecting VRE infection in stool specimens: the routine culture method, culturing in selective chromogenic agar medium (chromID VRE, bioMerieux, France), and multiplex PCR using the Seeplex(R) VRE ACE Detection kit (Seegene Inc., Korea) with additional PCR for vanC genes. RESULTS: We isolated 109 VRE strains from 100 stool specimens by the routine culture method. In chromID VRE, all the isolates showed purple colonies, including Enterococcus gallinarum and E. raffinosus, which were later identified using the Vitek card. All VRE isolates were identified by the multiplex PCR method; 100 were vanA-positive E. faecium, 8 were vanA- and vanC-1-positive E. gallinarum, and 1 was vanA-positive E. raffinosus. CONCLUSIONS: For VRE surveillance, culturing the isolates in chromID VRE after broth enrichment appears to be an accurate, rapid, and easy method for routine screening test. Multiplex PCR is relatively expensive and needs skilled techniques for detecting VRE, but it can be an auxiliary tool for rapid detection of genotype during a VRE outbreak.
Agar/chemistry
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Chromogenic Compounds/*chemistry
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Enterococcus/drug effects/genetics/*isolation & purification
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Enterococcus faecium/genetics/isolation & purification
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Feces/microbiology
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Genotype
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Humans
;
Phenotype
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Polymerase Chain Reaction/*methods
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Reagent Kits, Diagnostic
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*Vancomycin Resistance
3.Epidemiology and Control of an Outbreak of Vancomycin-Resistant Enterococci in the Intensive Care Units.
Young Kyung YOON ; Hee Sun SIM ; Jeong Yeon KIM ; Dae Won PARK ; Jang Wook SOHN ; Kyung Ho ROH ; Seung Eun LEE ; Min Ja KIM
Yonsei Medical Journal 2009;50(5):637-643
PURPOSE: This study was aimed to describe a vancomycin-resistant enterococci (VRE) outbreak across three intensive care units (ICUs) of a Korean hospital from September 2006 to January 2007 and the subsequent control strategies. MATERIALS AND METHODS: We simultaneously implemented multifaceted interventions to control the outbreak, including establishing a VRE cohort ward, active rectal surveillance cultures, daily extensive cleaning of environmental surfaces and environmental cultures, antibiotic restriction, and education of hospital staff. We measured weekly VRE prevalence and rectal acquisition rates and characterized the VRE isolates by polymerase chain reaction (PCR) of the vanA gene and Sma1-pulsed-field gel electrophoresis (PFGE). RESULTS: During the outbreak, a total of 50 patients infected with VRE were identified by clinical and surveillance cultures, and 46 had vancomycin-resistant Enterococcus faecium (VREF). PFGE analysis of VREF isolates from initial two months disclosed 6 types and clusters of two major types. The outbreak was terminated 5 months after implementation of the interventions: The weekly prevalence rate decreased from 9.1/100 patients-day in September 2006 to 0.6/100 by the end of January 2007, and the rectal acquisition rates also dropped from 6.9/100 to 0/100 patients-day. CONCLUSION: Our study suggests that an aggressive multifaceted control strategy is a rapid, effective approach for controlling a VRE outbreak.
Decontamination
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Disease Outbreaks/*prevention & control
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Enterococcus faecium/*drug effects/isolation & purification
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Gram-Positive Bacterial Infections/drug therapy/*epidemiology/prevention & control
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Humans
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Intensive Care Units
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Patient Isolation
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Prevalence
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*Vancomycin Resistance
4.Predictors of vancomycin-resistant enterococcus (VRE) carriage in the first major VRE outbreak in Singapore.
Kok-Soong YANG ; Yuke-Tien FONG ; Heow-Yong LEE ; Asok KURUP ; Tse-Hsien KOH ; David KOH ; Meng-Kin LIM
Annals of the Academy of Medicine, Singapore 2007;36(6):379-383
INTRODUCTIONUntil recently, vancomycin-resistant enterococcus (VRE) infection or colonisation was a rare occurrence in Singapore. The first major VRE outbreak involving a 1500-bed tertiary care institution in March 2005 presented major challenges in infection control and came at high costs. This study evaluates the predictors of VRE carriage based on patients' clinical and demographic profiles.
MATERIALS AND METHODSStudy patients were selected from the hospital inpatient census population during the VRE outbreak (aged 16 years or more). Clinical information from 84 cases and 377 controls were analysed.
RESULTSSignificant predictors of VRE carriage included: age>65 years Odds ratio (OR), 1.98; 95% CI (confidence interval), 1.14 to 3.43); female gender (OR, 2.15; 95% CI, 1.27 to 3.65); history of diabetes mellitus (OR, 1.94; 95% CI, 1.14 to 3.30), and staying in a crowded communal ward (OR, 2.75; 95% CI, 1.60 to 4.74). Each additional day of recent hospital stay also posed increased risk (OR, 1.03; 95% CI, 1.01 to 1.04).
CONCLUSIONElderly diabetic females with prolonged hospitalisation in crowded communal wards formed the profile that significantly predicted VRE carriage in this major hospital-wide outbreak of VRE in Singapore. It is imperative that active VRE surveillance and appropriate infection control measures be maintained in these wards to prevent future VRE outbreaks.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cross Infection ; drug therapy ; epidemiology ; microbiology ; Disease Outbreaks ; Enterococcus ; drug effects ; Enterococcus faecalis ; isolation & purification ; Enterococcus faecium ; isolation & purification ; Female ; Humans ; Infection Control ; Male ; Medical Audit ; Middle Aged ; Risk Factors ; Singapore ; epidemiology ; Streptococcal Infections ; drug therapy ; epidemiology ; Vancomycin ; pharmacology ; therapeutic use ; Vancomycin Resistance
5.Further Increase of Vancomycin-Resistant Enterococcus faecium, Amikacin- and Fluoroquinolone-Resistant Klebsiella pneumoniae, and Imipenem-Resistant Acinetobacter spp. in Korea: 2003 KONSAR Surveillance.
Kyungwon LEE ; Ki Hyung PARK ; Seok Hoon JEONG ; Hwan Sub LIM ; Jong Hee SHIN ; Dongeun YONG ; Gyoung Yim HA ; Yunsop CHONG
Yonsei Medical Journal 2006;47(1):43-54
Monitoring temporal trends of antimicrobial resistance can provide useful information for the empirical selection of antimicrobial agents to treat infected patients and for the control of nosocomial infections. In this study, we analyzed antimicrobial resistance of clinically relevant bacteria in 2003 at Korean hospitals and at a commercial laboratory. The following organism-antimicrobial agent resistance combinations were very prevalent: oxacillin-resistant Staphylococcus aureus (68%), expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (25%), and fluoroquinolone-resistant Escherichia coli (33%), Acinetobacter spp. (58%), and Pseudomonas aeruginosa (40%). Moreover, gradual increases in vancomycin-resistant Enterococcus faecium (20%), cefoxitin-resistant E. coli (10%) and K. pneumoniae (23%), and imipenem-resistant P. aeruginosa (20%) and Acinetobacter spp. (13%) were also observed. The resistance rates of Acinetobacter spp. to most antimicrobial agents at hospitals and at the commercial laboratory were similar. Among the Acinetobacter spp. isolated at a tertiary-care hospital, 46.2% were multidrug-resistant to 9-12 of 13 antimicrobial agents, and 18.3% were panresistant. The exclusion of duplicate isolates at a tertiary-care hospital significantly lowered the proportion of oxacillin-resistant S. aureus, vancomycin-resistant E. faecium, and fluoroquinolone-resistant E. coli.
Vancomycin Resistance
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Vancomycin/pharmacology
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Population Surveillance
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Microbial Sensitivity Tests
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Korea/epidemiology
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Klebsiella pneumoniae/drug effects/isolation & purification
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Klebsiella Infections/drug therapy/epidemiology/microbiology
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Imipenem/pharmacology
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Humans
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Gram-Positive Bacterial Infections/drug therapy/epidemiology/*microbiology
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Gram-Negative Bacterial Infections/drug therapy/epidemiology/*microbiology
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Gammaproteobacteria/*drug effects/isolation & purification
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Fluoroquinolones/pharmacology
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Enterococcus faecium/*drug effects/isolation & purification
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*Drug Resistance, Bacterial
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Anti-Bacterial Agents/*pharmacology
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Amikacin/pharmacology
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Acinetobacter Infections/drug therapy/epidemiology/microbiology
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Acinetobacter/drug effects/isolation & purification
6.First Case Report of Human Infection With Ochrobactrum tritici Causing Bacteremia and Cholecystitis.
Duck Jin HONG ; Keon Han KIM ; Jung Ok KIM ; Jun Sung HONG ; Seok Hoon JEONG ; Kyungwon LEE
Annals of Laboratory Medicine 2016;36(3):278-280
No abstract available.
Aged
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Anti-Bacterial Agents/pharmacology/therapeutic use
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Bacteremia/blood/*diagnosis/microbiology
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C-Reactive Protein/analysis
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Cholecystitis/blood/cerebrospinal fluid/microbiology
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Electrophoresis, Gel, Pulsed-Field
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Enterococcus faecium/drug effects/isolation & purification/metabolism
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Humans
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Male
;
Microbial Sensitivity Tests
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Microscopy, Electron, Scanning
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Ochrobactrum/drug effects/isolation & purification/*metabolism
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RNA, Ribosomal, 16S/analysis/genetics/metabolism
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Sequence Analysis, DNA
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Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
7.A Case of Steroid-induced Hyperinfective Strongyloidiasis with Bacterial Meningitis.
Joo Yun CHO ; Joong Goo KWON ; Kyung Ho HA ; Jae Young OH ; Myung In JIN ; Seong Wook HEO ; Geun Ho LEE ; Chang Ho CHO
The Korean Journal of Gastroenterology 2012;60(5):330-334
Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.
Adrenal Insufficiency/drug therapy
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Aged
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Animals
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Bronchoalveolar Lavage Fluid/parasitology
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Endoscopy, Gastrointestinal
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Enterococcus faecium/isolation & purification
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Female
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Humans
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Immunocompromised Host
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Intestinal Mucosa/pathology
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Larva/physiology
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Magnetic Resonance Imaging
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Meningitis, Bacterial/complications/*diagnosis/microbiology
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Steroids/adverse effects/therapeutic use
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Strongyloides stercoralis/growth & development/isolation & purification
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Strongyloidiasis/complications/*diagnosis/parasitology
8.Characterization of a Vancomycin-resistant Enterococcus faecium Outbreak Caused by 2 Genetically Different Clones at a Neonatal Intensive Care Unit.
Wee Gyo LEE ; Sun Hyun AHN ; Min Kwon JUNG ; Hye Young JIN ; Il Joong PARK
Annals of Laboratory Medicine 2012;32(1):82-86
In July 2010, we identified an outbreak of vancomycin-resistant enterococci (VRE) in our 26-bed neonatal intensive care unit. We performed an epidemiological investigation after clinical cultures of 2 neonates were positive for VRE. Identification, susceptibility testing, and molecular characterization were performed. Cultures of 3 surveillance stool samples of inpatients and 5 environmental samples were positive for VRE. All isolates were identified as Enterococcus faecium containing the vanA gene. Two distinct clones were identified by performing pulsed-field gel electrophoresis. The 2 clones exhibited different pulsotypes, but they represented identical Tn1546 types. Two sequence types, ST18 and ST192, were identified among all of the isolates with multilocus sequence typing. Our investigation determined that the outbreak in the neonatal intensive care unit was caused by 2 genetically different clones. The outbreak may have occurred through clonal spread and horizontal transfer of the van gene.
Anti-Bacterial Agents/pharmacology
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Bacterial Proteins/genetics
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Bacterial Typing Techniques
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Carbon-Oxygen Ligases/genetics
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DNA, Bacterial/analysis
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*Disease Outbreaks
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Electrophoresis, Gel, Pulsed-Field
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Enterococcus faecium/drug effects/*genetics/isolation & purification
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Feces/microbiology
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Genotype
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Gram-Positive Bacterial Infections/diagnosis/epidemiology/*microbiology
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Humans
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Infant, Newborn
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Intensive Care Units, Neonatal
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Male
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Multilocus Sequence Typing
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Vancomycin/pharmacology
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*Vancomycin Resistance