No abstract available.
Streptococcus*

BACKGROUND: Group A streptococci (GAS) is the most common cause of bacterial pharyngitis. Recently, a high frequency of resistance to erythromycin (EM), the drug of choice for penicillin-allergic patients, has been reported, especially in countries where antibiotics are overused. Resistance is classified as constitutive, inducible, or M according to the sensitivity results with EM and clindamycin (CC). These EM resistance phenotype is attributable to the erm , ermTR, and mefA genes, respectively. Although EM resistance of GAS is a serious problem in our country, there are very few reports regarding to its mechanism. METHODS: GAS were isolated from elementary school children of Jinju in 2002. Antibiotic sensitivity testing by disk diffusion was performed against tetracycline (TC), ofloxacin, EM and CC, and the results were compared to the previous one in 1995 at the same area. The phenotypes of EM resistance were evaluated, and the frequency of ermB and mefA genes was determined by PCR. The resistance pattern was analyzed by each emm genotype. RESULTS: The resistance rate to EM and CC was 51% and 34%, respectively, which is significantly higher than the rate of 25% and 9% recorded in 1995. Constitutive resistance was seen in 64% of the EM-resistant strains, the M phenotype in 34%, and inducible resistance in only 2%, compared to 38% of constitutive resistance and 62% of M phenotype in 1995. The ermB and mefA genes were present in 64% and 34% of strains, respectively. Most (88%) of the emm12 strains showed constitutive resistance, while emm18 and emm75 showed M phenotype. The organisms with most of the other emm genotypes were susceptible to EM. CONCLUSION: The EM and CC resistance rate had increased more than twofold. Constitutive resistance was twice as common as the M phenotype, whereas the mefA gene was more common in 1995. The resistance pattern was variable according to emm type, which suggests an association between the emm and resistance genes. Continuous microbiologic and epidemiological surveillance should be conducted and the seriousness of antibiotic resistance should be underscored in our community.
Anti-Bacterial Agents ; Child* ; Clindamycin ; Diffusion ; Drug Resistance, Microbial* ; Erythromycin ; Genotype ; Gyeongsangnam-do* ; Humans ; Ofloxacin ; Pharyngitis ; Phenotype ; Polymerase Chain Reaction ; Tetracycline

BACKGROUND: The SD Bioline Strep A Ultra (SD, Yongin, Korea) is a recently developed rapid antigen detection test (RADT) for diagnosing bacterial pharyngitis caused by Group A Streptococcus, We evaluated the performance of SD Bioline Strep A Ultra, using the number of colony forming units and color intensity. METHODS: Three throat swabs each were taken from 343 children with pharyngitis who visited pediatric clinics. We evaluated the performance of SD Bioline Strep A Ultra and compared its positive rate with the number of colony forming units, using the Fisher exact test. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value (95% confidence interval) were 97.4% (94.0–99.1%), 90.8% (85.0–94.9%), 93.0% (88.5–96.1%), and 96.5% (92.0–98.9%), respectively. Positive rate significantly differed by number of colony forming units (P=0.021). ROC plot for color intensity showed 0.938 of AUC (area under curve). CONCLUSIONS: SD Bioline Strep A Ultra showed excellent performance, and its positive rate differed by the number of colony counts. This RADT could be used as a sensitive and semi-quantitative method detecting bacterial pharyngitis.
Area Under Curve ; Child ; Gyeonggi-do ; Humans ; Methods ; Pharyngitis ; Pharynx ; Sensitivity and Specificity ; Stem Cells* ; Streptococcus

Approximately 90% of nontuberculous mycobacterium (NTM) infections involve the pulmonary system; NTM infections involving areas of the musculoskeletal system such as the joints or spine are uncommon. This report describes a case of refractory knee swelling in a patient with systemic lupus erythematosus (SLE). Indolent arthritis of the knee eventually progressed to spondylitis and a paraspinal abscess requiring surgical incision and drainage. The cause of the infectious arthritis and spondylitis was diagnosed as NTM infection, specifically Mycobacterium kansasii. This case emphasizes the importance of a high index of clinical suspicion for mycobacterial infection, as well as repeated attempts to isolate the organism, in patients with SLE who present with atypical chronic arthritis.
Abscess ; Arthritis* ; Arthritis, Infectious ; Drainage ; Humans ; Joints ; Knee ; Lupus Erythematosus, Systemic ; Musculoskeletal System ; Mycobacterium kansasii ; Nontuberculous Mycobacteria* ; Spine ; Spondylitis*

BACKGROUND: Stool cultures are essential for diagnosing bacterial gastrointestinal infections. Laboratory procedures and target organisms for stool culture testing can vary by institute. Therefore, a nationwide survey was conducted to determine the stool culture procedures performed in clinical laboratories of Korea. METHODS: Questionnaires were delivered by electronic mail to 98 clinical microbiologists and by Google survey to the 301 institutes participating in the Korean External Quality Control Program of Bacterial Cultures. RESULTS: Of the 68 institutes sent complete responses, Gram staining and wet smears were performed in 73.5% and 64.7%, respectively. A molecular test was conducted in 32.4% of laboratories, and blood agar plates were used in 23.5%. Staphylococcus aureus , Pseudomonas aeruginosa , and Candida species were reported for predominant growth by 17.6%, 8.8%, and 7.4% of the respondents, respectively. Campylobacter culture was available only in 25.0% of laboratories, whereas Clostridium difficile could be cultivated in 38.2%. Susceptibility testing results of Salmonella-Shigella were reported for all tested antibiotics in 22.1% of laboratories, whereas 69.1% reported results for antibiotics specified by the Clinical and Laboratory Standard Institute guidelines. CONCLUSIONS: Methods and results of gram staining, wet smears, use of stool culture media, target microorganisms, and antibiotic susceptibility differed among the institutes. Further discussion is needed to develop a standardized protocol for stool culture to maximize isolation of bacterial pathogens that cause gastroenteritis.
Academies and Institutes ; Agar ; Anti-Bacterial Agents ; Campylobacter ; Candida ; Clostridium difficile ; Culture Media ; Diagnosis* ; Diarrhea ; Electronic Mail ; Gastroenteritis* ; Korea* ; Methods* ; Pseudomonas aeruginosa ; Quality Control ; Staphylococcus aureus ; Surveys and Questionnaires

BACKGROUND: Several automated and nonautomated systems have been developed and are commercially available for the identification of gram-negative bacilli. EASY 24E+ kit was recently developed as Korean kit for identification of gram-negative bacilli. So we evaluated the accuracy and clinical utility of EASY 24E+ compared with API 20E and VITEK GNI+. METHODS: The 221 clinical isolates of Enterobacteriaceae, including 17 C. freundii, 20 E. cloacae, 31 E. coli, 6 E. aerogenes, 29 K. pneumoniae, 3 K. oxytoca, 11 M. morganii, 13 P. mirabilis, 16 Salmonella spp., 20 S. marcescens, 9 Shigella spp., 22 S. sonnei, 16 S. typhi, 8 Y. pseudotuberculosis and 10 control strains were identified by API 20E, EASY 24E+, and VITEK GNI+. Discrepant strains were performed repeat identifications and we evaluated overall accuracy. RESULTS: All of control strains were correctly identified by three systems. The overall correct results at species level and at the genus level for 221 clinical isolates, were 96.8% and 99.1% by the VITEK GNI+, 97.7% and 97.7% by the EASY 24+ and 99.1% and 100% by the API 20E. All of Salmonella spp., S. typhi and Shigella spp. were correctly identified by all three systems and the discrepant identifications of species were 2 Y. pseudotuberculosis, 3 K. pneumoniae and 2 K. oxytoca by VITEK GNI+, 4 C. freundii and 1 P. mirabilis by EASY 24+, and 2 S. marcescens by API 20E. CONCLUSIONS: All three identification systems are accurate methods for the identification of Enterobacteriaceae, and EASY 24+ is comparable with API 20E and VITEK GNI+.
Cloaca ; Enterobacteriaceae* ; Mirabilis ; Pneumonia ; Salmonella ; Shigella

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections in many communities. MRSA is usually resistant to beta-lactam antibiotics which are commonly used to treat methicillin-susceptible S. aureus (MSSA) infections, and initial discordant therapy for community-acquired (CA)-MRSA infections frequently lead to treatment failure. This study evaluated the clinical characteristics and risk factors associated with CA-MRSA infections among patients admitted to a large urban public hospital. MATERIALS AND METHODS: From January 1st 2001 through December 31st 2004, all patients for whom S. aureus was isolated from clinical specimen cultures within first 72 hours after admission to Gyeongsang National University Hospital were retrospectively analyzed. CA-MRSA isolate was defined as MRSA isolates from patients who had no established risk factors for MRSA infections. Patients with CA-MRSA infections were compared with patients with CA-MSSA infections. RESULTS: During the 4 years of the study, 41 patients with CA-MRSA infection and 102 patients with CA-MSSA infection were included, respectively. In univariate analysis, CA-MRSA infections were more common in such conditions that were the previous isolation of MRSA from 1 year through 3 years before admission (17.5% vs. 1.0%, O.R=21.4, P=0.001), previous hospitalization from 1 year through 3 years before admission (33.3% vs. 10.7%, O.R=4.16, P=0.007), and previous alcohol drinking history (22% vs. 6.9%, O.R=3.81, P=0.017). Bone and joint infections (22.0% vs. 7.8%, O.R=3.30, P=0.025) were more common in CA-MRSA infections than CA-MSSA infections. Multiple logistic regression analysis showed that the previous isolation of MRSA from 1 year through 3 years before admission (OR:6.59 [95% CI, 1.040-41.741]) was the only significant risk factor for CA- MRSA infections. CONCLUSION: The previous isolation of MRSA from 1 year through 3 years before admission was an independent risk factor for CA-MRSA infections.
Alcohol Drinking ; Anti-Bacterial Agents ; Community-Acquired Infections ; Hospitalization ; Hospitals, Public ; Humans ; Joints ; Logistic Models ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Retrospective Studies ; Risk Factors* ; Staphylococcus aureus* ; Staphylococcus* ; Treatment Failure

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of infections in many communities. MRSA is usually resistant to beta-lactam antibiotics which are commonly used to treat methicillin-susceptible S. aureus (MSSA) infections, and initial discordant therapy for community-acquired (CA)-MRSA infections frequently lead to treatment failure. This study evaluated the clinical characteristics and risk factors associated with CA-MRSA infections among patients admitted to a large urban public hospital. MATERIALS AND METHODS: From January 1st 2001 through December 31st 2004, all patients for whom S. aureus was isolated from clinical specimen cultures within first 72 hours after admission to Gyeongsang National University Hospital were retrospectively analyzed. CA-MRSA isolate was defined as MRSA isolates from patients who had no established risk factors for MRSA infections. Patients with CA-MRSA infections were compared with patients with CA-MSSA infections. RESULTS: During the 4 years of the study, 41 patients with CA-MRSA infection and 102 patients with CA-MSSA infection were included, respectively. In univariate analysis, CA-MRSA infections were more common in such conditions that were the previous isolation of MRSA from 1 year through 3 years before admission (17.5% vs. 1.0%, O.R=21.4, P=0.001), previous hospitalization from 1 year through 3 years before admission (33.3% vs. 10.7%, O.R=4.16, P=0.007), and previous alcohol drinking history (22% vs. 6.9%, O.R=3.81, P=0.017). Bone and joint infections (22.0% vs. 7.8%, O.R=3.30, P=0.025) were more common in CA-MRSA infections than CA-MSSA infections. Multiple logistic regression analysis showed that the previous isolation of MRSA from 1 year through 3 years before admission (OR:6.59 [95% CI, 1.040-41.741]) was the only significant risk factor for CA- MRSA infections. CONCLUSION: The previous isolation of MRSA from 1 year through 3 years before admission was an independent risk factor for CA-MRSA infections.
Alcohol Drinking ; Anti-Bacterial Agents ; Community-Acquired Infections ; Hospitalization ; Hospitals, Public ; Humans ; Joints ; Logistic Models ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Retrospective Studies ; Risk Factors* ; Staphylococcus aureus* ; Staphylococcus* ; Treatment Failure

PURPOSE: To report a case of fungal keratitis caused by Drechslera species. CASE SUMMARY: A 77-year-old man visited our clinic complaining of left ocular pain and decrease of visual acuity for 1 week On slit-lamp examination, epithelial defect and stromal infiltration on the corneal center with numerous inflammatory cells in the anterior chamber were found. There was no improvement after routine antibiotic treatment. A corneal biopsy and culture were performed on the corneal lesion. The KOH smear study reported hyphae, thus the patient was treated with 0.25% amphotericin B, 0.2% fluconazole and 5% natamycin eye drops. A clinical improvement was observed on the corneal lesion and Drechslera species was identified by the culture study. CONCLUSIONS: The authors report an experience of fungal keratitis caused by Drechslera species.
Aged ; Amphotericin B ; Anterior Chamber ; Biopsy ; Fluconazole ; Humans ; Hyphae ; Keratitis ; Natamycin ; Ophthalmic Solutions ; Visual Acuity

BACKGROUND: Enterococci have become increasingly predominant as causative agents of nosocomial infections. Infections due to multi-drug resistant enterococci have drawn increasing attention during the past two decades. The purpose of the present study was to evaluate the occurrence of virulence factors and antimicrobial resistance in enterococci isolated from patients with bacteremia or urinary tract infection. METHODS: A total of 209 strains of enterococi (102 Enterococcus faecalis and 107 E. facium) isolated during 8 months of 2005 were collected from 10 university hospitals in Korea. Disk diffusion susceptibility tests were performed using Mueller-Hinton agar. The antimicrobial resistance genes and virulence factors were determined using PCR. RESULTS: In E. faecalis, the rate of resistance to ciprofloxacin, tetracycline, and quinupristindalfopristin was 27.4%, 83.3%, and 85.2%, respectively; no isolates were resistant to ampicillin, vancomycin, teicoplanin, or linezolid. In E. faecium, the rate of resistance to ampicillin, ciprofloxacin, tetracycline, vancomycin, and teicoplanin was 86.9%, 87.9%, 8.4%, 19.6%, and 6.5%, respectively; no strains were resistant to quinupristin-dalfopristin or linezolid. All the E. faecalis strains tested were found to harbor multiple virulence factors, but E. faecium strains were generally without virulence factors except esp. The prevalence of the esp gene was significantly higher in enterococci isolated from urinary tract infection than in those from bacteremia. CONCLUSION: A similar pattern of resistance to antimicrobial agents and prevalence of virulence factors was observed in both the enterococci isolated from bacteremia and urinary tract infection. Our study indicates that host factors are more likely than bacterial properties to influence the development of bacteremia.
Agar ; Ampicillin ; Anti-Infective Agents ; Bacteremia* ; Ciprofloxacin ; Cross Infection ; Diffusion ; Enterococcus faecalis ; Hospitals, University ; Humans ; Korea ; Polymerase Chain Reaction ; Prevalence ; Teicoplanin ; Tetracycline ; Urinary Tract Infections* ; Urinary Tract* ; Vancomycin ; Virulence Factors* ; Virulence* ; Linezolid