BACKGROUND: Clinical isolates of AmpC beta-lactamase- producing Enterobacteriaceae were evaluated to determine the prevalence of CTX-M extended-spectrum beta-lactamases (ESBLs) and their genetic environments. METHODS: A total of 250 non-duplicate isolates of Eneterobacter aerogenes, E. cloacae, Citrobacter freundii, Serratia marcescens and Morganella morganii were collected at a Korean hospital. ESBL production was determined by double disk synergy test. For ESBL producers, bla genes were sequenced and blaCTX-M environment was characterized by PCR mapping and sequencing. RESULTS: Among the 250 isolates 29 (11.6%) produced ESBL, and 14 of the 29 isolates produced CTX-M ESBLs, including CTX-M-9 by 8 isolates, CTX-M-3 by 4 isolates, CTX-M-12 by 1 isolate, and CTX-M-14 by 1 isolate. ISEcp1 was present upstream of blaCTX-M-3, 12, and 14. Three of the four CTX- M-3 producers had the same genetic environment (pemK-ISEcp1-blaCTX-M-3-orf477-mucA). An IS903-like element was found downstream of blaCTX-M-14. ISCR1 was identified upstream of blaCTX-M-9 and ISCR1 and blaCTX-M-9 were located on sul1-type class 1 integron. The variable region between the 5'-CS and the first 3'-CS contained dfrA16 and aadA2. Its structure was similar to that of In60, but our isolates did not have IS3000 or second 3'-CS. CONCLUSION: CXT-M type ESBL was prevalent in AmpC beta-lactamase-producing Enterobacteriaceae, particularly E. cloacae. blaCTX-M genes were associated with ISEcp1 or ISCR1. This is the first report on the genetic environment of blaCTX-M in Korean isolates.
beta-Lactamases ; Citrobacter freundii ; Cloaca ; Enterobacteriaceae ; Integrons ; Korea ; Morganella morganii ; Polymerase Chain Reaction ; Prevalence ; Serratia marcescens

We evaluated the impact of revised Clinical and Laboratory Standards Institute (CLSI) breakpoints for broad-spectrum cephalosporins (BSCs) on the susceptibilities of 1,742 isolates of Enterobacter species, Serratia marcescens, Citrobacter freundii, and Morganella morganii. The 2011 CLSI criteria for cefotaxime and ceftazidime reduced the rates of susceptibility by 2.9% and 5.9%, respectively. The 2014 CLSI criteria for cefepime reduced the rate of susceptibility by 13.9%, and categorized 11.8% isolates as susceptible-dose dependent (SDD) for cefepime. Among 183 isolates with extended-spectrum ß-lactamase (ESBL) phenotype, implementation of the new criteria reduced the rates of susceptibility to cefotaxime, ceftazidime, and cefepime by 2.8%, 14.8%, and 53.6%, respectively. The proportion of ESBL phenotype among BSC-susceptible isolates was low (0.9% for cefotaxime, 3.0% for ceftazidime, and 3.3% for cefepime). In summary, implementation of new CLSI criteria led to little change in susceptibility to cefotaxime and ceftazidime but a substantial change in susceptibility to cefepime. The recognition of revised CLSI criteria for BSC and SDD will help clinicians to select the optimal antibiotic and dosing regimen.
Cefotaxime ; Ceftazidime ; Cephalosporins ; Citrobacter freundii ; Enterobacter ; Enterobacteriaceae* ; Morganella morganii ; Phenotype ; Serratia marcescens

Morganella morganii, a gram, negative rod is often regarded as an opportunistic, secondary invader rather than a primary pathogen on the skin. It has been isolated from blood, sputa, and pus from patients with respiratory tract and wound infections or with bacteremia. A 2-year-old boy presented with erythematous ulcerative lesions on the cheeks and left knee which had a tendency to superficial scarring. The organism isolated from the ulcer displayed a biochemical char acteristics typical of Morganella morganii. The lesions responded well to systemic antibiotic therapy with amikacin and carbenicillin, which were recognized as effective drugs in in vitro sensitivity testing.
Amikacin ; Bacteremia ; Carbenicillin ; Cheek ; Child, Preschool ; Cicatrix ; Humans ; Knee ; Male ; Morganella morganii* ; Morganella* ; Respiratory System ; Skin Ulcer* ; Skin* ; Suppuration ; Trout ; Ulcer ; Wound Infection

PURPOSE: The main objectives of this work were to characterize the mechanism of resistance to imipenem of Morganella morganii KU158 isolated in Busan, Korea and to analyze the structure of the integron, which carries the resistance gene that confers resistance to imipenem. MATERIALS AND METHODS: Antimicrobial susceptibilities of M. morganii KU158 were tested by using the disk diffusion method. The modified Hodge and EDTA-disk synergy tests were performed for the screening of metallo-beta-lactamase-producing isolates. blaIMP and blaVIM genes were detected using the polymerase chain reaction (PCR) amplification. To detect the presence of the integron, the PCR method was used. The PCR product was cloned through the use of primers, 5'CS-F and 3'CS-R, and it was used to determine the sequence of the integron through the dideoxy-mediated chain termination method. RESULTS: M. morganii KU158 was intermediately resistant to imipenem and showed a positive result for the modified Hodge and EDTA-disk synergy tests, which suggest the production of metallo-beta-lactamase, and also was positive in the PCR result for the detection of blaVIM gene. The genotype of the PCR product from the blaVIM gene was blaVIM-2. Sequencing of the 5,031 bp-cloned fragment revealed the structure of the class I integron, such as the 5'-CS element containing an Intl1 integrase gene with its own promoter region, the attI1 recombination site, and the 3'-CS element containing qacE1. The integron contained insert gene cassettes blaVIM-2, aac(6')-Ib, aadA1, "orfII", and "orfIII". The blaVIM-2 gene was located immediately downstream of the aac(6')-Ib gene. CONCLUSIONS: M. morganii KU158 acquired the resistance to imipenem through the production of metallo-beta-lactamase VIM-2. The gradual increase in the number of VIM-2-producing bacterial species may indicate the highly mobile nature of the blaVIM-2 cassette. The spread of blaVIM-2 could compromise the future usefulness of carbapenem in treating gram-negative bacilli infections.
beta-Lactamases ; Busan ; Clone Cells ; Diffusion ; Genotype ; Imipenem ; Integrases ; Integrons* ; Korea ; Mass Screening ; Morganella morganii* ; Morganella* ; Polymerase Chain Reaction ; Promoter Regions, Genetic ; Recombination, Genetic

BACKGROUND: Among the inducible AmpC beta-lactamase-producing members of the family Enterobacteriaceae such as Enterobacter spp., Citrobacter spp., Serratia spp., and Morganella morganii (ECSM), the prevalence of ESBL-producing isolates are increasing. However, there have been only a limited number of studies that have investigated the prevalence for ESBL-production in blood isolates of these organisms. MATERIALS AND METHODS: We performed a prospective observational study to evaluate the prevalence for ESBL production among ECSM blood isolates. All consecutive blood isolates in the Samsung Medical Center were included from Oct 2006 to Mar 2008. Antimicrobial susceptibility test was performed by broth microdilution method. ESBLs were confirmed by double-disk synergy test and ESBL phenotypes were determined by PCR. RESULTS: The 124 isolates (94 Enterobacter spp., 18 Citrobacter spp., 8 Serratia spp. and 4 Morganella spp.) were investigated. Among 124 ESCM isolates, 30 isolates (24.2%) showed ESBL-producing activity. Derepressed or partially derepressed AmpC mutants and derepressed AmpC mutants with ESBL production accounted for 36.3% (45/124) and 16.9% (21/124), respectively. Of ESBL producers, the most prevalent ESBL was SHV-12 (5/24, 20.8%). CONCLUSIONS: The prevalence of ESBL-producing isolates is high in Enterobacter spp., Serratia marcescens and Citrobacter spp. clinical isolates. It suggested that routine screening test for ESBLs among Enterobacteriacae blood isolates with inducible AmpC beta-lactamase should be needed.
Bacterial Proteins ; beta-Lactamases ; Citrobacter ; Enterobacter ; Enterobacteriaceae ; Humans ; Mass Screening ; Morganella ; Morganella morganii ; Phenotype ; Polymerase Chain Reaction ; Prevalence ; Prospective Studies ; Serratia ; Serratia marcescens

Enantioselective hydrolysis of 2-carboxyethyl-3-cyano-5-methylhexanoic acid (CNDE) is the key step in chemoenzymatic synthesis of pregabalin. We purified an intracellular carboxyl esterase from Morganella morganii ZJB-09203, which exhibited high enantioselectivity and activity towards CNDE. The carboxyl esterase was purified to electrophoretic homogeneity by ammonium sulfate fraction precipitation, Phenyl Sepharose 6 FF hydrophobic interaction chromatography, anion exchange with DEAE Sephadex A-50 and Bio-Scale CHT column. The purified enzyme was a monomer with molecular mass of 68 kDa determined by SDS-PAGE and gel chromatography. Substrate specificity of the enzyme towards p-nitrophenyl esters suggested that the purified enzyme was an esterase. The optimal reaction pH for CNDE hydrolysis was 9.0, and optimal temperature was 45 degrees C. The esterase was stable between pH 7.0 and 9.0, and at 40 degrees C. The enzyme activity was enhanced by Ca2+, Cu2+ and Mn2+, whereas strongly inhibited by Co2+, Fe3+, Ni2+ and EDTA. Meanwhile, we investigated the kinetic parameters of the esterase towards p-nitrophenyl esters and effect of CNDE concentration on conversion. The present study reported the esterase capable of stereospecific hydrolysis of CNDE for the first time. Our research will provide foundations for industrial production of Pregabalin using the new biocatalyst.
Chromatography, Gel ; Electrophoresis, Polyacrylamide Gel ; Esterases ; metabolism ; Hydrogen-Ion Concentration ; Kinetics ; Molecular Weight ; Morganella morganii ; enzymology ; Substrate Specificity ; Temperature

Morganella morganii is a facultative gram-negative and anaerobic rod. It may be a cause of devastating infections in neonates and immunocompromised hosts. Some bacterial infections such as Clostridium and Vibrio are associated with hemolysis. However, massive hemolysis caused by M. morganii sepsis has not yet been reported. We observed a 59-yr-old man who had chemotherapy-induced neutropenia and was found to have massive hemolysis and metabolic acidosis due to sepsis. He died 6 hr after admission in spite of aggressive treatment. Two sets of blood cultures revealed the growth of M. morganii. We report here that M. morganii sepsis can cause fatal massive hemolysis leading to death.
Antineoplastic Agents/adverse effects ; Bacteremia/*complications ; Enterobacteriaceae Infections/*complications ; *Hemolysis ; Humans ; Male ; Middle Aged ; *Morganella morganii ; Neutropenia/complications

PURPOSE: To report a case of spontaneous eye ball rupture without trauma in a 94-year-old patient. CASE SUMMARY: A 94-year-old female patient diagnosed with cataract in both eyes 20 years was referred to this ophthalmologic department for treatment consultation of a painful left eye with spontaneous bleeding. She has used anti-cataract eye drops and artificial tears three times a day for several years without consulting a doctor. Fifteen days prior to presentation, the patient suffered severe left eyeball pain and headache and was diagnosed with acute angle-closure glaucoma secondary to hypermature cataract. She underwnet eviceration after ocular examination and systemic evaluation. Surgical findings included a thin cornea at the inferior limbus and protruding intraocular tissues. Additionally, the eyeball was filled with a blood clot from a choroidal hemorrhage. Morganella morganii were grown in a bacterial swap culture, and a corneal biopsy revealed suppurative inflammation. CONCLUSIONS: In old age, a thin corneal limbus due to infection and complicated acute angle-closure glaucoma can cause massive suprachoroidal hemorrhage with spontaneous eyeball rupture.
Biopsy ; Cataract ; Choroid Hemorrhage ; Cornea ; Eye ; Female ; Glaucoma ; Glaucoma, Angle-Closure ; Headache ; Hemorrhage ; Humans ; Limbus Corneae ; Morganella morganii ; Ophthalmic Solutions ; Rupture

BACKGROUND: Some bacteria have typical antibiogram profiles which can be used to verify antimicrobial susceptibility tests and organisms identification. So, we developed interpretative reporting and quality control software program using antibiogram of disk susceptibility test for more accurate results and helping physician's decision making in antibiotic therapy. METHODS: A computer program was developed with knowledge base rules based on antimicrobial disks tested, bacterial classification, bacteria's resistance mechanism and phenotypic probability to antibiogram results. And comment contents according to detection code of antibiogram were coded. All comment code were displayed to computer's screen, and interpreted results were printed to the final report after the validation and correction of the disk susceptibility test results. RESULTS: Detection code for evaluating aminoglycoside susceptibility pattern of gram-negative bacilli were detected, in order of decreasing frequency, Stenotrophomonas maltophilia (9.1%), Citrobacter freundii (9.1%), Enterobacter species (8.3%), Klebsiella pneumoniae (7.6%), Escherichia coli (3.6%), and Acinetobacter species (3.3%). More than 5% of C. freundii, Enterobacter species, E. cloacae, E. aerogenes, and Morganella morganii were detected by detection code for evaluating natural resistance. CONCLUSIONS: It is considered that this program is useful in quality control of antimicrobial susceptibility test and decision making in antimicrobial therapy of patients. And detection rate of rule check codes on natural resistances of gram-negative bacilli in this study were higher than those previously reported. Finally, it is concluded that further studies on natural resistance of antimicrobials about gram-negative bacilli, and the addition and reformation of codes for rule check and comment contents are needed.
Acinetobacter ; Bacteria ; Citrobacter freundii ; Classification ; Cloaca ; Decision Making ; Enterobacter ; Escherichia coli ; Humans ; Immunity, Innate ; Klebsiella pneumoniae ; Knowledge Bases ; Microbial Sensitivity Tests* ; Morganella morganii ; Quality Control* ; Stenotrophomonas maltophilia

BACKGROUND: The aim of this study was to investigate the value of colonoscopy for assessment of colonic mucosal lesions and for microbial identification in patients with acute diarrhea. METHODS: From March 2000 to August 2000, forty-one patients with watery or bloody diarrhea lasting less than 15 days were participated after the exclusion of patients who had previous history or presumption of inflammatory bowel disease, radiation colitis, ischemic colitis, or pseudomembranous colitis. Both biopsy specimens and colonic luminal fluid were taken during the colonoscopy and used for bacterial cultures. RESULTS: Male and female ratio was 22:19 and mean age was 45+/-20 years. The extent of acute colitis was as followed: the normal colonoscopic finding in five cases (12.2%), involvement of one segment in 3 cases (7.3%), involvement of two or more segments in 14 cases (34.1%), pancolitis in 10 cases (24.4%) and pancolitis with terminal ileitis in 9 cases (22.0%). In culture study, identification of more than one pathogen was in 19/41 (46.3%) and the common pathogens were Enterobacter (11 cases), Salmonella species (6 cases), Citrobacter freundii complex (2 cases), Klebsiella oxytoca (2 cases) and Morganella morganii (1 case). Pathogen could be identified in 11.8% with stool specimen, 46.2% with biopsy specimen and 62.5% with intraluminal fluid, but without statistical significance. CONCLUSION: Colonoscopy was useful in the evaluation of extent and severity of acute infectious colitis. Obtaining the biopsy specimens and intraluminal fluid during colonoscopy seemed to assist in identifying the pathogen in patients with acute diarrhea.
Biopsy* ; Citrobacter freundii ; Colitis ; Colitis, Ischemic ; Colon ; Colonoscopy* ; Crohn Disease ; Diarrhea* ; Enterobacter ; Enterocolitis, Pseudomembranous ; Female ; Humans ; Inflammatory Bowel Diseases ; Klebsiella oxytoca ; Male ; Morganella morganii ; Phenobarbital ; Salmonella