BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nasocomial pathogen. The active surveillance of MRSA is essential to limit its transmission. The BD GeneOhm MRSA real-time PCR assay (Becton Dickinson Diagnostics, San Diego, USA) has been recently developed and used for same-day MRSA detection directly from nasal swab specimens. The authors of the present study compared GeneOhm MRSA PCR with culture methods to evaluate its diagnostic performance for MRSA active surveillance. METHODS: The present study was conducted on patients admitted to the ICU for six months. A total of 371 nasal swab specimens were obtained from patients at admission day and at the seven-day follow-up. The swab was streaked onto culture media, and presumptive S. aureus colonies were confirmed as MRSA using the BD Phoenix automated microbiology system (Becton Dickinson Diagnostic Systems, Sparks, USA). In addition, GeneOhm MRSA PCR was performed. For discrepant results between Gene-Ohm MRSA PCR and culture, the enrichment broth culture method was performed. RESULTS: There were 34 samples with discrepant results between the GeneOhm MRSA PCR and culture. The overall agreement was 90.7%. For the detection of MRSA, the GeneOhm MRSA PCR was 96.8% sensitive and 86.3% specific, with positive and negative predictive values of 83.9% and 97.3%, respectively. CONCLUSION: Identification of MRSA-colonized patients was achieved in as little as two hours, and the high negative predictive value of GeneOhm MRSA PCR suggests that the assay is a rapid method for the identification of persons who are not colonized with MRSA. However, due to the low positive predictive value, GeneOhm MRSA PCR combined with enrichment culture in cases of positive GeneOhm MRSA PCR is potentially useful for active MRSA surveillance activities.
Colon ; Culture Media ; Follow-Up Studies ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction

BACKGROUND: We compared the LightCycler MRSA advanced test (Roche Diagnostics, Germany) with enrichment culture methods to evaluate the relative diagnostic performance of the LightCycler MRSA advanced test for active surveillance in a high-prevalence setting. METHODS: A total of 342 nasal swab specimens were obtained from patients in the intensive care unit at admission and on the seventh day for follow-up. The results of LightCycler MRSA advanced test were compared to those of the enrichment culture. For discrepant results, mecA gene PCR was performed. RESULTS: For the detection of methicillin-resistant Staphylococcus aureus (MRSA), the LightCycler MRSA advanced test showed 98.5% sensitivity and 78.6% specificity and had positive and negative predictive values of 75.0% and 98.8%, respectively. A total of 46 samples had discrepant results between the LightCycler MRSA advanced test and enrichment culture. Of the 44 specimens that were positive in the LightCycler MRSA advanced test but negative by enrichment culture, mecA genes were detected in 37 specimens. In addition, of the original 44 cases, 21 patients had a history of MRSA colonization or infection within the last month; of those 21 specimens, 20 were positive for mecA gene as shown by PCR. Seven mecA-negative discrepant specimens comprised 3 methicillin-sensitive S. aureus-culture positive and only 2 patients had MRSA infections. CONCLUSIONS: Despite its low specificity and positive predictive value, the LightCycler MRSA advanced test could serve as a rapid test for patients colonized with MRSA.

BACKGROUND: We evaluated three indigenously produced immunochromatography (ICA) kits for the rapid detection of hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) by comparing them with a microparticle enzyme immunoassay (MEIA). METHODS: HBsAg and anti-HBs were tested by the ICA kits manufactured by three domestic companies, SD HBsAg and Anti-HBs (Standard Diagnostics, Inc., Yongin, Korea); Asan Easy Test(R) HBsAg and Anti-HBs (Asan Pharm Co., Ltd., Whasung, Korea); and GENEDIA(R) HBsAg Rapid Device and Anti-HBs Rapid Device (Green Cross MS, Inc., Yongin, Korea). RESULTS: Results by ICA agreed completely with those of MEIA in all the 20 HBsAg-negative sera and in all the anti-HBs-negative sera except one sample. Among the 20 HBsAg-positive sera by MEIA, 17 were positive by ICA using Green Cross MS, 16 using Asan Pharm Co., and 13 using SD and reverse passive hemagglutination. Among the 20 anti-HBs-positive sera by MEIA, 19 were positive by ICA using Green Cross MS and Asan Pharm Co., 17 using SD, and 18 by passive hemagglutination. Elapsed time for the control and test line to be visualized in ICA might be longer and the color of the lines lighter when using SD than Green Cross MS or Asan Pharm Co. CONCLUSIONS: Three indigenously produced ICA kits are as sensitive as MEIA for the detection of anti-HBs, but are less sensitive than MEIA for HBsAg. The ICA kits for the rapid detection of HBsAg might be recommended for a limited use in the clinical laboratory.
Chungcheongnam-do ; Gyeonggi-do ; Hemagglutination ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Immunochromatography* ; Immunoenzyme Techniques

BACKGROUND: The aim of this study was to compare the BD Phoenix (Beckton Dickinson Diagnostic Systems, USA) extended-spectrum beta-lactamase (ESBL) test with the Clinical and Laboratory Standards Institute (CLSI) ESBL phenotypic confirmatory test by disk diffusion (CLSI ESBL test) in Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis. METHODS: We tested 224 clinical isolates of E. coli, K. pneumoniae, K. oxytoca and P. mirabilis during May 2006 to March 2007. These isolates were examined by the Phoenix and the CLSI ESBL tests simultaneously. For the isolates showing discordant results between the two tests, boronic acid disk test was performed to differentiate AmpC beta-lactamase and ESBL. RESULTS: Among the 224 clinical isolates, 75 and 79 isolates were positive for ESBL by CLSI ESBL test and Phoenix test, respectively. Having detected 4 more isolates as ESBL-producers, Phoenix test showed a 98.2% agreement with a 100% sensitivity and 97.3% specificity compared with CLSI ESBL test. Among the four false positive isolates, three were AmpC-positive but ESBL-negative. CONCLUSIONS: The BD Phoenix ESBL test was sensitive and specific, and can be used as a rapid and reliable method to detect ESBL production in E. coli, Klebsiella species, and P. mirabilis.
Automation ; Bacterial Proteins/classification/*metabolism ; Disk Diffusion Antimicrobial Tests ; Escherichia coli/drug effects/*enzymology/isolation & purification ; Humans ; Klebsiella/*enzymology ; Klebsiella oxytoca/drug effects/enzymology/isolation & purification ; Klebsiella pneumoniae/drug effects/enzymology/isolation & purification ; *Microbial Sensitivity Tests ; Proteus mirabilis/drug effects/*enzymology/isolation & purification ; Reagent Kits, Diagnostic ; Sensitivity and Specificity ; beta-Lactamases/classification/*metabolism

BACKGROUND: We compared the results of automated and quantitative methods for the diagnosis of syphilis, Mediace Rapid Plasma Reagin (RPR) and Mediace Treponema pallidum Latex Agglutination (TPLA) (Sekisui Chemical Co., Ltd, Japan) with those of conventional methods. METHODS: Sera from 3,896 persons who had health checkups between December 2005 and November 2006 were included in the evaluation of positive rates and biological false positives (BFP) for Mediace RPR and TPLA. In addition, 134 patients' sera positive for automated Mediace RPR or TPLA were tested for VDRL and TPHA. Discrepancies between TPLA and TPHA results were confirmed by the RecomBlot Treponemal IgG/IgM (Mikrogen GmbH, Germany). Automated Mediace RPR and TPLA were performed using the Hitachi 7600 chemistry autoanalyzer (Hitachi, Japan). Samples with positive Mediace RPR and negative TPLA results were defined as BFP. RESULTS: Positive rate of automated Mediace RPR was 0.23% (9/3,896). BFP of the Mediace RPR was 0.18%. Positive rate of automated TPLA was 1.62% (37/2,284). Among the 134 patients' sera, 33 (24.6%) showed a discrepancy between conventional VDRL and automated Mediace RPR results: Among 31 Mediace RPR(+)/VDRL(-) sera, 13 were positive and 18 were negative for TPLA. The remaining 2 sera of discrepancy with Mediace RPR(-)/VDRL(+) were all positive for TPLA. There were seven sera that showed a discrepancy between automated TPLA and TPHA results: Two sera with Mediace RPR(+)/TPLA(-)/TPHA(+) showed negative recomBlot Treponemal IgG/IgM results, and among five sera with TPLA(+)/TPHA(-), three demonstrated IgG or IgM by recomBlot Treponemal IgG/IgM. CONCLUSIONS: The results of comparison data demonstrated that automated TPLA results had a high concordance with recomBlot Treponemal IgG/IgM results. Moreover, there are additional advantages of automated methods such as quantitative detection, low infection risk, and no influence by human handling.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Agglutination ; False Positive Reactions ; Female ; Humans ; Immunoglobulin G/analysis ; Immunoglobulin M/analysis ; Latex Fixation Tests ; Male ; Middle Aged ; Reagent Kits, Diagnostic ; Reagins/*blood ; Syphilis/*diagnosis ; Syphilis Serodiagnosis/*methods ; Treponema pallidum/*immunology/isolation & purification

No abstract available.
Pancytopenia*

No abstract available.
beta-Thalassemia* ; Thalassemia*

Salmonellae have been recognized as uncommon etiological organisms causing osteomyelitis in patients with sickle cell anemia and other immunocompromised conditions. A 34-year old man who had no underlying illness except for congenital block vertebrae at T10-11 vertebrae was admitted to the hospital due to lower back pain and fever for a week. Vertebral osteomyelitis was diagnosed and surgical drainage was performed. Salmonella enterica serovar Othmarschen was isolated from the drained pus. Therapy with ciprofloxacin for 8 weeks was successful without relapse. We describe here a case of vertebral osteomyelitis which was caused by S. Othmarschen in an immunocompetent patient.
Anemia, Sickle Cell ; Ciprofloxacin ; Drainage ; Fever ; Humans ; Low Back Pain ; Osteomyelitis ; Recurrence ; Salmonella ; Salmonella enterica ; Spine ; Suppuration

Salmonellae have been recognized as uncommon etiological organisms causing osteomyelitis in patients with sickle cell anemia and other immunocompromised conditions. A 34-year old man who had no underlying illness except for congenital block vertebrae at T10-11 vertebrae was admitted to the hospital due to lower back pain and fever for a week. Vertebral osteomyelitis was diagnosed and surgical drainage was performed. Salmonella enterica serovar Othmarschen was isolated from the drained pus. Therapy with ciprofloxacin for 8 weeks was successful without relapse. We describe here a case of vertebral osteomyelitis which was caused by S. Othmarschen in an immunocompetent patient.
Anemia, Sickle Cell ; Ciprofloxacin ; Drainage ; Fever ; Humans ; Low Back Pain ; Osteomyelitis ; Recurrence ; Salmonella ; Salmonella enterica ; Spine ; Suppuration

A fixed drug eruption (FDE) is not difficult to diagnose, given its clinical characteristics. However, the causative agent can be difficult to identify, particularly when the patient denies ingestion of any drugs. To the best of our knowledge, we present herein the first reported case of an FDE caused by antibiotics taken in food; doxycycline and erythromycin contained in pork and fish. A 57-year-old female experienced repeated episodes of well-demarcated erythematous patches covering her entire body. She denied taking any medications, but she thought that the lesions appeared after consuming pork and/or fish. An oral provocation test showed positive results for doxycycline and erythromycin, commonly used antibiotics in live-stock farming and in the fishing industry. Because of the antibiotics' thermostability, cooking does not guarantee the elimination of residual drugs. From the patient's history, we concluded that doxycycline and erythromycin contained in the pork and fish that she ate were the cause of the FDE.
Anti-Bacterial Agents ; Cooking ; Doxycycline ; Drug Eruptions ; Eating ; Erythromycin ; Female ; Humans