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

The endoscopic diagnosis of gastric carcinoid has been considered difficult. Reported cases of this tumor diagnosed by endoscopic examination are rare. And the gastric carcinoid with massive upper gastrointestinal bleeding is a rare disease entity. We experienced a case of gastric carcinoid admitted to the hospital because of hematemesis, melena and syncope. And it was diagnosed by endoscopic biopsy, although it resembled type IIa+IIc early gastric cancer at endoscopic examination. To our knowledge, this is the first case report of gastric carcinoid tumor mimicking early gastric cancer. So we report this case with a review of relevant literatures.
Biopsy ; Carcinoid Tumor* ; Diagnosis ; Hematemesis ; Hemorrhage ; Melena ; Rare Diseases ; Stomach Neoplasms* ; Syncope