Clinical isolates of Acinetobacter spp. in Korea exhibit higher antimicrobial resistance rates than in foreign countries and frequently show multi-drug resistance. Approximately 67% (272/405) of Acinetobacter baumannii isolates collected from 19 hospitals in Korea in 2008 exhibited intermediate susceptibility or resistance to imipenem and/or meropenem. The most important mechanisms in acquiring carbapenem resistance in A. baumannii in Korea are production of OXA-23 and overproduction of OXA-51, while that in non-baumannii Acinetobacter is the production of metallo-beta-lactamases. All the carbapenem-resistant A. baumannii isolates were identified as clonal complex 92 and belonged to worldwide clone 2.
Acinetobacter ; Acinetobacter baumannii ; Clone Cells ; Drug Resistance, Multiple ; Imipenem ; Korea ; Thienamycins

PURPOSE: This study was designed to evaluate the bacteriological characteristics and antibiotics sensitivity in acute appendicitis. METHODS: The microbiologic culture and antibiotics sensitivity tests were done on 165 patients who underwent laparoscopic appendectomy under the diagnosis of acute appendicitis. The postoperative complications were also checked. The microbiologic and clinical results were compared between perforated and non-perforated groups. RESULTS: The most common organism cultured from the periappendiceal fluid was Escherichia coli (51.2%), followed by Enterobacter (16.2%) and Pseudomonas (8.9%). In the antibiotics sensitivity test, ciprofloxacin and levofloxacin were highly susceptible. Ceftriaxone and cefotaxime were also highly susceptible. Piperacillin/tazobactam, imipenem and meropenem were very highly susceptible. The complication rate of perforated appendicitis group (17.9%) was higher than that of the non-perforated appendicitis group (7.1%) (P<0.001). A surgical drain was used more frequently in perforated group (23% vs 84.6%, P<0.001). The mean in-patient days were longer in the perforated group (5.7 vs 7.2 days, P<0.001). In the patients with infectious wound complication, antibiotic resistance was more prominent in the non-perforated group than in the perforated group. CONCLUSION: In the perforated appendicitis group, more precise and careful procedure was required. In the non-perforated appendicitis group, more prudent use of the available antibiotics to conserve valuable therapeutic resources and improved infection control to limit the spread of resistant organisms was required.
Anti-Bacterial Agents ; Appendectomy ; Appendicitis ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Drug Resistance, Microbial ; Enterobacter ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Ofloxacin ; Postoperative Complications ; Pseudomonas ; Thienamycins

Peritonitis is a common and potentially serious infection in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common organisms usually associated with CAPD peritonitis are Staphylococcus aureus and Staphylococcus epidermidis. Rarely, aerobic gram negative bacilli have been the causative agents of CAPD peritonitis. The treatment of CAPD peritonitis requires removal of the peritoneal catheter and treatment with parenteral antibiotics active against the causative pathogen. While hospitalized for CAPD peritonitis, a 55-year-old man on CAPD had nosocomial peritonitis secondary to infection by ESBL-producing E.coli, that was sensitive to imipenem and meropenem. He was treated successfully with a 4-week course of intraperitoneal meropenem therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy.
Anti-Bacterial Agents ; Catheters ; Dialysis ; Escherichia coli ; Humans ; Imipenem ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Recurrence ; Staphylococcus aureus ; Staphylococcus epidermidis ; Thienamycins ; Ultrafiltration

OBJECTIVE: To determine the drug resistance of Comamonas testosteroni (C. testosteroni) by the Kirby-Bauer (K-B) method without Clinical and Laboratory Standards Institute (CLSI) explanation or the minimum inhibitory concentration (MIC) method with the standard CLSI explanation to evaluate the sensitivity of K-B method in detection of C. testosteroni.
 METHODS: K-B method and MIC method was used to determine the sensitivity of C. testosteroni to Piperacillin, Cefepime, Piperacillin/tazobactam, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, Ceftazidime and Ciprofloxacin. The interpretation standard for Pseudomonas aeruginosa was temporary used for the K-B method. The coincident rate was compared between the two methods.
 RESULTS: The complete or partial coincident rate for K-B method and MIC method to detect Piperacillin and Cefepime was 97.4% or 2.6%; the complete coincidence rate to detect Piperacillin/tazobactam, Imipenem and Meropenem was 100%; the complete or partial coincident rate to detect Amikacin, Gentamicin and Tobramycin 94.7% or 5.3%; the complete or partial coincident rate to detect Ceftazidime was 97.4% or 2.6%; the complete or partial coincident rate to detect Ciprofloxacin 86.8% or 10.6%, and the full non-coincidence rate was 2.6%.
 CONCLUSION The results of drug sensitive test from the two methods are highly consistent. We suggest that the microbiology labs do not report the interpretive results for C. testosteroni with K-B method but report the test results.
Anti-Bacterial Agents ; Cefepime ; Cephalosporins ; Comamonas testosteroni ; Imipenem ; Meropenem ; Microbial Sensitivity Tests ; Penicillanic Acid ; analogs & derivatives ; Piperacillin ; Piperacillin, Tazobactam Drug Combination ; Pseudomonas aeruginosa ; Thienamycins

BACKGROUND: To reduce production of resistant bacteria by over-use of antibiotics, an antibiotics restriction policy became effective in several hospitals. However, there are different views on its effect. This study aims to examine antibiotic resistance of pathogenic organisms cultured in tracheal aspirates of the patients who need to maintain mechanical ventilation in medical intensive care unit before and after the antibiotics restriction policy. METHODS: Before and after 2 years from August 2003, when carried out the antibiotics restriction policy in Gyeongsang university hospital, it was retrospectively investigated the antibiotic resistance pattern of bacteria cultured in tracheal aspirates of the patient who is maintained by mechanical ventilation more than 48 hours in the medical intensive care unit. Restricted antibiotics are ceftazidime, piperacillin/tazobactam, imipenem, meropenem, vancomycin, and teicoplanin. RESULTS: Before the antibiotics restriction policy, (Sep 2001~Aug 2003) and after, (Sep 2003~Aug 2005), there were 306 and 565 patients applied in each case and the total use of antibiotics, except piperacillin/tazobactam, was reduced and that of cefotaxime and ceftriaxone was increased. There was no significant change in antibiotic resistance among Acinetobacter, Pseudomonas, and Enterobacter species. CONCLUSION: The result of this study shows that the antibiotics restriction policy does not reduce production of antibiotic resistant bacteria in tracheal aspirate in a medical intensive care unit. However, it is considered that long-term observation may be necessary.
Acinetobacter ; Anti-Bacterial Agents ; Bacteria ; Cefotaxime ; Ceftazidime ; Ceftriaxone ; Drug Resistance, Microbial ; Enterobacter ; Humans ; Imipenem ; Intensive Care Units ; Pseudomonas ; Respiration, Artificial ; Retrospective Studies ; Thienamycins ; Vancomycin

Previously, Pseudomonas putida was considered a low-virulence pathogen and was recognized as a rare cause of bacteremia. Recently, however, multidrug-resistant and carbapenem-resistant P. putida isolates have emerged, causing difficult-to-treat nosocomial infections in seriously ill patients. Currently, the outcome of multidrug-resistant or carbapenem-resistant P. putida bacteremia remains uncertain. Here, we report 18 cases of P. putida bacteremia with high rates of carbapenem resistance and mortality. From January 2005 through December 2011, all cases of nosocomial P. putida bacteremia were identified and analyzed at Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Electronic medical records were reviewed retrospectively. Four (22%) and five (23%) of 18 P. putida isolates were resistant to imipenem and meropenem, respectively. Common primary infection sites were central venous catheter (7, 39%), pneumonia (5, 28%), and cholangitis (2, 11%). Fourteen (78%) patients had indwelling devices related to the primary site of infection. The 30-day mortality rate was 39% (7/18): 40% (2/5) in patients with carbapenem-resistant P. putida bacteremia vs. 38% (5/13) in patients with carbapenem-susceptible P. putida bacteremia. Nosocomial P. putida bacteremia showed high resistance rates to most potent beta-lactams and carbapenems and was associated with high mortality rates.
Bacteremia ; beta-Lactams ; Carbapenems ; Central Venous Catheters ; Cholangitis ; Cross Infection ; Drug Resistance ; Electronic Health Records ; Humans ; Imipenem ; Pneumonia ; Pseudomonas ; Pseudomonas putida ; Retrospective Studies ; Thienamycins

No abstract available.
Aged ; Drug Resistance, Bacterial ; Humans ; Imipenem/pharmacology/therapeutic use ; Klebsiella Infections/diagnosis/drug therapy/*microbiology ; Klebsiella pneumoniae/drug effects/isolation & purification/*physiology ; Male ; Microbial Sensitivity Tests ; Phenotype ; Sepsis/diagnosis/drug therapy/*microbiology ; Thienamycins/pharmacology/therapeutic use

Burkholderia pseudomallei is a gram-negative opportunistic intracellular pathogen that causes an acute and fatal septicemic melioidosis in humans. The organism is mainly found in Southeastern Asia and Northern Australia. Recently, we encountered a case of melioidosis in a Korean patient and performed the laboratory diagnosis of melioidosis. As a result, a gram negative bacterium was isolated from a melioidosis patient, and it was identified as B. pseudomallei on DNA sequencing of 16S ribosomal RNA with 99.9% homology and biochemical examination of VITEK gram-negative identification card. Also, DNA from cultured bacteria was tested in multiplex PCR, a 245 bp fragment amplified from the metalloprotease gene and a fragment of variable size ranging from 400~700 bp resulting from amplification of the 10 bp repetitive element for B. pseudomallei were confirmed after electrophoresis. The bacterium was sensitive to ceftazidime, imipenem and meropenem but resistant to ticarcillin. So far, there are no domestic cases of melioidosis in Korea, however, due to the increase in international travelers, the incidence of melioidosis is likely to increase. We report a recent case of melioidosis in a Korean patient.
Asia, Southeastern ; Australia ; Bacteria ; Burkholderia pseudomallei ; Ceftazidime ; Clinical Laboratory Techniques ; DNA ; Electrophoresis ; Humans ; Imipenem ; Incidence ; Korea ; Melioidosis ; Multiplex Polymerase Chain Reaction ; RNA, Ribosomal, 16S ; Sequence Analysis, DNA ; Thienamycins ; Ticarcillin

OBJECTIVETo analyze the distribution of Enterobacteriaceae isolated from West China Hospital, investigate the antibiotic resistance profile of Enterobacteriaceae with decreased susceptibility to carbapenems and explore the molecular mechanism.

METHODSForty-five Enterobacteriaceae strains resistant or with reduced susceptibility to carbapenems were isolated from patients in West China Hospital. The antimicrobial susceptibility and carbapenemase-producing phenotypes of the bacteria were examined and specific PCR were performed to determine the molecular mechanism.

RESULTSOf the 45 isolates, 17, 21 and 36 were resistant or intermediate strains to imipenem, meropenem and ertapenem, respectively. The majority of these isolates showed resistance to cephalosporins. The modified Hodge test resulted in the highest positivity rate (77.8%), followed by EDTA disc test (57.8%) and PBA disc test (22.2%). BlaTEM, blaSHV and blaCTX-M were detected in 60.0%, 53.3% and 15.6% of these strains with reduced susceptibility. The rate of strains carrying 2 or more genes was 44.4%, and the detection rate of blaIMP was 48.9%. BlaKPC was identified in 4 (8.9%) high-level resistant strains and confirmed to locate on the plasmid.

CONCLUSIONProduction of carbapenemase contributes to reduced susceptibility of carbapenems in Enterobacteriaceae. The presence of blaKPC, MBL and ESBL, and their possible combinations can be the main factor contributing to carbapenem resistance or reduced susceptibility in Enterobacteriaceae. The KPC-2 carbapenemase gene located on the plasmids we found in this study can cause potential horizontal transmission across strains.

Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; genetics ; metabolism ; Carbapenems ; pharmacology ; Cephalosporins ; pharmacology ; Enterobacteriaceae ; drug effects ; enzymology ; genetics ; Gene Amplification ; Imipenem ; pharmacology ; Microbial Sensitivity Tests ; Polymerase Chain Reaction ; Thienamycins ; pharmacology ; beta-Lactam Resistance ; beta-Lactamases ; genetics ; metabolism ; beta-Lactams ; pharmacology

OBJECTIVETo investigate the pathogen distribution and drug resistance in coal workers' pneumoconiosis associated with pneumonia and to provide a scientific basis for early guidance for rational clinical application of antibacterial agents.

METHODSSeventy-six patients with coal workers' pneumoconiosis associated with pneumonia who were admitted to our hospital from June 2011 to June 2014 were enrolled as subjects. The sputum specimens were aseptically collected for bacterial culture and drug sensitivity tests.

RESULTSIn 245 sputum specimens collected from 76 patients, a total of 218 strains of pathogens, including 163 strains of Gram-negative bacilli (74.77%), 39 strains of Gram-positive cocci (17.89%), and 16 strains of fungi (7.34%) were isolated by bacteriological tests. The main Gram-negative bacilli had high rates of resistance to amoxicillin/clavulanic acid, ampicillin, cotrimoxazole, cefotaxime, and aztreonam, and were sensitive to amikacin, imipenem, and meropenem. The main Gram-positive cocci had high rates of resistance to penicillin, erythromycin, amoxicillin/clavulanic acid, ampicillin, cefotaxime, and clindamycin, and were sensitive to vancomycin and teicoplanin.

CONCLUSIONThe main pathogens in these patients with coal workers' pneumoconiosis associated with pneumonia are Gram-negative bacilli, which are highly resistant to common clinically used antibacterial agents. The pathogen distribution and drug resistance should be well understood, and the antibacterial agents should be rationally selected according to the results of drug sensitivity tests.

Anthracosis ; microbiology ; Anti-Bacterial Agents ; pharmacology ; Coal Mining ; Drug Resistance, Bacterial ; Gram-Negative Bacteria ; drug effects ; Humans ; Imipenem ; pharmacology ; Microbial Sensitivity Tests ; Occupational Exposure ; adverse effects ; Pneumonia ; microbiology ; Thienamycins ; pharmacology