BACKGROUND: Increase in Escherichia coli and Klebsiella pneumoniae isolates with extended- spectrum beta-lactamase (ESBL) have been noted recently in Korea. Current NCCLS disk diffusion test is not sensitive to detect ESBL-producing strains. We have more isolates with intermediate or resistance to cefotaxime than to ceftazidime disk test. The aim of this study was to characterize the ESBLs produced by strains isolated from clinical specimens. METHODS: E. coli and K. pneumoniae strains with cefotaxime intermediate or resistance by disk method were tested for ESBL production by double-disk synergy, transfer of resistance by conjugation, and relative hydrolysis of beta-lactams and isoelectric point (pI) of cell sonicate. The types of beta-lactamase gene were determined by PCR. RESULTS: Nine of the 10 E. coli and all of the 18 K. pneumoniae strains tested were synergy test positive. The MIC of cefotaxime ranged from 1.5 to 400microgram/mL, with the inoculum of 10(4) CFU, but was much higher with larger inoculum. Some selected isolates showed that the resistance was transferable and the size of the plasmid was approximately 39 MDa. The MIC of cefotaxime was higher than that of was ceftazidime in majority of the transconjugants. The hydrolytic activity of the sonicate higher for cefotaxime than ceftazidime. TEM- and SHV-type genes were detected by PCR and the pI of the beta-lactamase was 5.9 for 4 TEM-type and 7.8 for one SHV-type. CONCLUSION: Majority of the cefotaxime intermediate or resistant E. coli and K. pneumoniae isolated from the tertiary care hospital are TEM- or SHV- type ESBL producers. The inoculum size significantly affects the MIC value of beta-lactams for the ESBL-producing strains. The ESBL hydrolyzes cefotaxime more actively than ceftazidime, and the ESBL gene is transferable by conjugation.
beta-Lactamases ; beta-Lactams ; Cefotaxime ; Ceftazidime ; Diffusion ; Escherichia coli* ; Escherichia* ; Hydrolysis ; Isoelectric Focusing ; Isoelectric Point ; Klebsiella pneumoniae* ; Klebsiella* ; Korea ; Plasmids ; Pneumonia ; Polymerase Chain Reaction ; Tertiary Healthcare

BACKGROUND: Panipenem is a carbapenem antimicrobial agent which has been shown to have broad-spectrum activities against various aerobic and anaerobic bacteria. In this study, in vitro activities of panipenem against recent clinical isolates of aerobic and anaerobic bacteria were determined. METHODS: Aerobic and anaerobic bacteria were isolated in 2001 and in 2000-2001, respectively, from a tertiary-care hospital patients. Antimicrobial susceptibility was tested by the NCCLS agar dilution method. RESULTS: MIC90s of panipenem were:similar to those of imipenem for aerobic gram-positive cocci and Enterobacteriaceae; slightly lower than those of meropenem for gram-positive cocci, but slightly higher for Enterobacteriaceae; slightly higher than imipenem for A. baumannii, but similar for anaerobic bacteria. CONCLUSION: MIC90s of panipenem were similar to those of imipenem for aerobic and anaerobic bacterial isolates, which frequently involve respiratory, urinary, intraabdominal and wound infections. When imipenem breakpoints are applied to interpret panipenem susceptibilities, panipenem can be considered useful for the treatment of various infections, including nosocomially acquired ones.
Agar ; Bacteria, Anaerobic* ; Enterobacteriaceae ; Gram-Positive Cocci ; Humans ; Imipenem ; Wound Infection

BACKGROUND: Panipenem is a carbapenem antimicrobial agent which has been shown to have broad-spectrum activities against various aerobic and anaerobic bacteria. In this study, in vitro activities of panipenem against recent clinical isolates of aerobic and anaerobic bacteria were determined. METHODS: Aerobic and anaerobic bacteria were isolated in 2001 and in 2000-2001, respectively, from a tertiary-care hospital patients. Antimicrobial susceptibility was tested by the NCCLS agar dilution method. RESULTS: MIC90s of panipenem were:similar to those of imipenem for aerobic gram-positive cocci and Enterobacteriaceae; slightly lower than those of meropenem for gram-positive cocci, but slightly higher for Enterobacteriaceae; slightly higher than imipenem for A. baumannii, but similar for anaerobic bacteria. CONCLUSION: MIC90s of panipenem were similar to those of imipenem for aerobic and anaerobic bacterial isolates, which frequently involve respiratory, urinary, intraabdominal and wound infections. When imipenem breakpoints are applied to interpret panipenem susceptibilities, panipenem can be considered useful for the treatment of various infections, including nosocomially acquired ones.
Agar ; Bacteria, Anaerobic* ; Enterobacteriaceae ; Gram-Positive Cocci ; Humans ; Imipenem ; Wound Infection

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.