BACKGROUND: Rapid screening of vancomycin-resistant enterococci (VRE) is very important for controlling and preventing the spread of VRE in hospitals. We compared the performance characteristics of a chromogenic agar (ChromID VRE, bioMerieux, France: CA) to that of Enterococcosel agar (supplemented with 6 microgram/mL of vancomycin :EA) for direct detection of VRE from stool swabs. METHODS: Total 125 rectal swabs were collected from 57 patients in the intensive care units of an 850-bed university hospital over a period of 3 months. The samples were inoculated on EA, CA and into broth enrichment containing 6 microgram/mL of vancomycin (BE). BE was subcultured on CA after overnight incubation. RESULTS: Eighty two samples from 22 patients were positive for VRE by BE. At 24 h, the sensitivity/specificity of EA and CA were 89%/100% and 72%/100%, respectively. At 48 h, the sensitivity/specificity of EA and CA were 94%/89% and 89%/100%, respectively. CONCLUSION: CA provides equivalent sensitivity comparable to EA for the recovery of VRE at 48 h incubation, and has additional advantage of being able to differentiate between vancomycine resistant E. faecium and E. faecalis.
Agar ; Humans ; Imidazoles ; Intensive Care Units ; Mass Screening ; Nitro Compounds ; Vancomycin

Acute uncomplicated urinary tract infections (UTI), episodes of cystitis or pyelonephritis that occur in healthy non-pregnant women with no functional or anatomic abnormalities of the urinary tract, are among the most commonly encountered bacterial infections. Unfortunately, there has been a recent trend of increasing resistance to antibiotics among uropathogens in many countries including Korea. The resistance rates of Escherichia coli from acute uncomplicated UTI during 2009 to ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (SXT) and cefotaxime were 84.1%, 67.2% and 95.4%, respectively. Resistance both to SXT and CIP was detected in 10.6% of the E. coli isolates. Therefore, it is difficult to recommend the antibiotics which would not worsen the resistance problem and would be effective for community-acquired uncomplicated UTI as well. Considering the high resistance of uropathogens in Korea, several academic societies made the guideline for UTI, which will be briefly reviewed in this manuscript.
Anti-Bacterial Agents ; Bacterial Infections ; Cefotaxime ; Ciprofloxacin ; Cystitis ; Drug Resistance, Microbial ; Escherichia coli ; Female ; Humans ; Korea ; Pyelonephritis ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract ; Urinary Tract Infections

Acute uncomplicated urinary tract infections (UTI), episodes of cystitis or pyelonephritis that occur in healthy non-pregnant women with no functional or anatomic abnormalities of the urinary tract, are among the most commonly encountered bacterial infections. Unfortunately, there has been a recent trend of increasing resistance to antibiotics among uropathogens in many countries including Korea. The resistance rates of Escherichia coli from acute uncomplicated UTI during 2009 to ciprofloxacin (CIP), trimethoprim-sulfamethoxazole (SXT) and cefotaxime were 84.1%, 67.2% and 95.4%, respectively. Resistance both to SXT and CIP was detected in 10.6% of the E. coli isolates. Therefore, it is difficult to recommend the antibiotics which would not worsen the resistance problem and would be effective for community-acquired uncomplicated UTI as well. Considering the high resistance of uropathogens in Korea, several academic societies made the guideline for UTI, which will be briefly reviewed in this manuscript.
Anti-Bacterial Agents ; Bacterial Infections ; Cefotaxime ; Ciprofloxacin ; Cystitis ; Drug Resistance, Microbial ; Escherichia coli ; Female ; Humans ; Korea ; Pyelonephritis ; Trimethoprim, Sulfamethoxazole Drug Combination ; Urinary Tract ; Urinary Tract Infections

Bacillary dysentery is still an important food-borne infection worldwide. Because a small inoculum can establish the infection, contact, food, and water are the usual transmission route. Abdominal pain and diarrhea are the early symptoms, followed by bloody and mucoid stool and tenesmus. Although the diagnosis of shigellosis is based on the stool culture, diarrhea with general symptoms persisting for several days and intrafamilial spread suggest the shigellosis. The high resistance rate against the first-line antimicrobials is a serious social problem in developing countries. In countries showing a high resistance rate of trimethoprim-sulfamethoxazole or ampicillin, including Korea, the treatment choice for shigellosis is fluoroquinolone for 3 days in adults. In Korea, there has been a dramatic increase of shigellosis from 1998. Shigella sonnei is the most common pathogen, and S. flexneri has been isolated continuously in a small number. Analyzing the incidence by age and provinces, the infection occurred most frequently in the age group under twenties, and Cheju, Kyeongnam, Chonnam, and Kangwon show the high incidence rate of shigellosis. Although seasonal variation of shigellosis was influenced by regional outbreaks, the infection occurred most commonly in late spring and early autumn. The resistance rate of trimethoprim-sulfamethoxazole was very high, over 90%, but ampicillin resistance varied widely according to the epidemics or regions. The analyses of several epidemics of shigellosis from 1998 to 2000 indicate that the school lunch program is the most important cause for the recent increase of shigellosis in Korea. The strict regulation of mass food handling is critical for the control of shigellosis.
Abdominal Pain ; Adult ; Ampicillin ; Ampicillin Resistance ; Developing Countries ; Diagnosis ; Diarrhea ; Disease Outbreaks ; Dysentery, Bacillary* ; Food Handling ; Gangwon-do ; Gyeongsangnam-do ; Humans ; Incidence ; Jeju-do ; Jeollanam-do ; Korea ; Lunch ; Seasons ; Shigella sonnei ; Social Problems ; Trimethoprim, Sulfamethoxazole Drug Combination

METHODS: We investigated and compared the epidemiologic characteristics of the E. cloacae isolation in the period of outbreak (April-June, 1998) with those in the control period (January-March, 1998). To identify the risk factors for E. cloacae sepsis, we retrospectively conducted a chart review for the patients who had E. cloacae sepsis during the period of outbreak. On the basis of these results, environmental culture was performed hospital wide. RESULTS: Ten clinical isolates E. cloacae were recovered from the blood of ten patients from April to June. 1998. Seven out of 10 patients recieved ERCP procedure just before E. cloacae sepsis. Hence, we performed surveillance study in the endoscopy room before and after the procedure. The survey showed that distilled water which was used for washing the endoscopy was contaminated with E. cloacae, which was suspected to be the common source of this outbreak. Therefore, we changed distilled water into sterilized distilled water on washing the endoscopy. After this correction was performed, the incidence of ERCP-associated E. cloacae sepsis declined markedly (P<0.011). CONCLUSION: We investigated an outbreak of ERCP-related E. cloacae sepsis and the outbreak was successfully controlled by removing the source of infection.
Cholangiopancreatography, Endoscopic Retrograde* ; Cloaca ; Endoscopy ; Enterobacter cloacae* ; Enterobacter* ; Humans ; Incidence ; Methods ; Retrospective Studies ; Risk Factors ; Sepsis* ; Water

No abstract available.
Anti-Bacterial Agents ; Diarrhea*

BACKGROUND: Recently, new plasmid-mediated extended-spectrum beta-lactamases have been reported. These are not derived from TEM or SHV enzymes but are related to cephalosporins of Enterobacteriaceae (AmpCenzymes), that confer to all cephalosporins including cefoxitin. METHODS: Fifteen clinical isolates of cefoxitin-resistant Klebsiella pneumoniae were charaterized. Antimicroilutin method. Crude beta-lactamases were prepared by sonication and isoelectric focusing of the enzyme preparations was performed in polyacrylamide gel. The transmissibility of resistance was tested by mating to E. coli J53. We performed PCR and hybridization for further characterization of the AmpC-type beta-lactamse. RESULTS: Seven strains were found to have the plasmid-mediated AmpC type beta-lactamase as a pI of 8.0 and this was confirmed to be cmy-1 beta-lactamase by PCR and hybridization analysis. These strains were resistant to ampicillin and piperacillin with MICs above 128microgram/ml. Cefoxitin resistance could be transferred from 4 strains via a large plasmi with molecular sizes approximately 77 or 130 kb. The molecular weight of CMY-1 enzyme is approximately 38kDa. We analyzed the OMP of six cefoxitin-resistance K. pneumoniae. Two of six strains were lacking a major OMP of approximately 40 kDa, but four of them showed another 39 kDa sized band just below the 40 kDa major OMP, which were thought to be a modified 40 kDa OMP. CONCLUSION: With these results, we conclude that resistance to cefoxitin in K. pneumoniae isolated from Korean patients is either associated with the productin of CMY-a, a plasmid-mediated AmpC type beta-lactamase, of altered expressin of an outer membrane protein.
Ampicillin ; beta-Lactamases* ; beta-Lactams ; Cefoxitin ; Cephalosporins ; Enterobacteriaceae ; Humans ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Membrane Proteins ; Molecular Weight ; Piperacillin ; Pneumonia ; Polymerase Chain Reaction ; Sonication

Nosocomial infections are known cause of increased mortality and morbidity and are an important factor in prolonging the length of hospital stay. The intensive care unit (ICU) is highly vulnerable to nosocomial infections largely due to disease severity and consequent lowered resistance to infection as well as the frequency of invasive interventions for the patients. This manuscript will briefly review the epidemiology, risk factors and control measures for nosocomial infections focused on patients in the ICU. Furthermore, recent strategies to control device-associated infections such as catheter-associated urinary tract infections, catheter-associated blood- stream infections and ventilator-associated pneumonias will be described.
Cross Infection ; Humans ; Infection Control ; Intensive Care Units ; Length of Stay ; Pneumonia, Ventilator-Associated ; Risk Factors ; Rivers ; Urinary Tract Infections ; Critical Care

BACKGROUND: Vibrio parahaemolyticus belonged to the new 03:K6 serotype was demonstrated an unusual potential to spread and an enhanced propensity to cause infection in the worldwide. Recently, increased numbers of V. parahaemolyticus 03:K6 had been isolated in Korea, and we analyzed the prevalence and molecular genetic characteristics of V. parahaemolyticus 03:K6 isolates. METHODS: V. parahaemolyticus were isolated from clinical specimens of patients with diarrhea in Hanyang University Hospital, Seoul, Korea, from 1998 to 2005. The serovars of isolates were determined by slide agglutination test with specific antisera. All isolates were examined for the presence of tdh/trh genes. AGS-PCR method detecting the new 03:K6 clone was used in this study. We analyzed clonality of these isolates by infrequent restriction site-polymerase chain reaction (IRS-PCR). RESULTS: Thirty-six strains were isolated from 1998 to 2005. The main serotype of isolates were 03:K6 (24/36: 67%), All of them have tdh gene but not trh gene and an unique toxRS gene of the new 03:K6. The morphotypes of 03:K6 isolates show a same pattern of IRS-PCR, but can easily be differentiated from non-03:K6 and 04:K68 isolates. CONCLUSION: The 03:K6 was a main serotype of V. parahaemolyticus isolated from 1998 to 2005 and they show same molecular characteristics.
Agglutination Tests ; Clone Cells ; Diarrhea ; Humans ; Immune Sera ; Korea ; Molecular Biology* ; Prevalence* ; Seoul ; Vibrio parahaemolyticus* ; Vibrio*

Extended-spectrum beta-lactamases (ESBLs) in gram-negative organisms have been implicated as the enzymes responsible for resistance to oxyimino-cephalosporins. The incidence of ESBL- producers in Korean isolates of Escherichia coli and Klebsiella pneumoniae were in the range of 4.8 7.5% and 22.5 22.8%, respectively. The ESBL-producing isolates revealed variable levels of resistance to cefotaxime, ceftazidime and aztreonam. They also showed the elevated MIC values of non-beta-lactam antibiotics. SHV-12 and SHV-2a were the enzymes most frequently found in K. pneumoniae strains, but TEM-52 was the most prevalent in E. coli isolates. About 15% of ESBL-producing isolates of Enterobacteriaceae produced CMY-1 enzyme, which conferred resistance to cephamycins such as cefoxitin as well as oxyimino-cephalosporins. Thus, the most common types of ESBLs in Korea are TEM-52, SHV-12, SHV-2a, and CMY-1.
Drug Resistance, Microbial/physiology ; Enterobacteriaceae/isolation & purification ; Enterobacteriaceae/chemistry* ; Enterobacteriaceae Infections/microbiology ; Human ; Korea ; beta-Lactamases/analysis*