BACKGROUND: It is well known that Methicillin-resistant Staphylococcus aureus (MRSA) is hardly controllable organism among pathogens of nosocomial infection. The MRSA infection control measures have been initiated at a brand new tertiary care teaching hospital which was opened in June, 1994. However, the control measures did bring out little effect. In 1997, reenforcement of all control measures were practiced in intensive care units. The measures brought out a significant improvement in reducing the incidence of MRSA infection, subsequently the same control measures were implemented through-out the entire inpatient area. METHODS: The following control measures have been reenforced since March 1997: first, application of thorough surveillance of confirmed MRSA infected patients: second, providing cohort care: third, enforcing handwashing practices after patient contact; fourth, establishing infected patients isolation zone: fifth, tagging infected patient's bed and medical record, providing disinfectant spray for washing hands, identifying and treating carriers among patient contact staffs, separate disposal of contaminated wastes, and finally repeating education of nursing staff and family members of the patients. Each month the number of incidence in MRSA nosocomial infection were followed and the leu supervisors were notified the outcome. RESULTS: The incidence of MRSA infection started to decline soon after the initiation of the control measures, from 132% in March 1997 to 5.8% in July 1997. In 1998, the infection rate maintained close to 2-3%. There had been 467 MRSA infected cases (5.7%) out of 8,253 discharges during the study period; among them 319 cases were infected once; 40 cases twice; 15 cases three times: four cases four times and 1 case seven times. The order of preference of organs infected are lungs (56.3%), wounds(11.8%), blood (7.9%), and urinary tract (1.9%). The highest incidence of this infection was found in Medicine (34.8%) and Neurosurgery (22.8%) CONCLUSION: The implementation and reenforcement of infection control measures are key to successful control of nosocomial infection, in particular, hand washing of patient contact staffs and eradication of carriers could be the most effective measures.
Cohort Studies ; Cross Infection* ; Education ; Hand ; Hand Disinfection ; Hospitals, Teaching ; Humans ; Incidence ; Infection Control ; Inpatients ; Intensive Care Units* ; Critical Care* ; Lung ; Medical Records ; Methicillin-Resistant Staphylococcus aureus* ; Neurosurgery ; Nursing Staff ; Tertiary Healthcare ; Urinary Tract

No abstract available.
Thyroid Function Tests* ; Thyroid Gland*

No abstract available.
Blood Donors* ; Humans

Since vancomycin-resistant enterococci (VRE) were first isolated in Europe, rates of VRE colonization and infection have risen steadily. Today VRE have emerged as important nosocomial pathogens worldwide; hence, it is crucial to understand the underlying mechanism in the spreading of VRE. This article reviews the mechanism of resistance to vancomycin and global epidemiology of VRE, as well as the current molecular techniques that are being applied to the epidemiological studies of VRE.
Colon ; Epidemiologic Studies ; Europe ; Vancomycin

No abstract available.

BACKGROUND: Vancomycin-resistant enterococci (VRE) have been increasingly isolated world-wide as a nosocomial pathogen. To target infection control, epidemiologic investigations of VRE should include analysis of the resistance gene in addition to typing of strains. We performed molec-ular characterization of the vanA resistance gene to evaluate the inter or intraconstitutional spread. METHODS: Twenty isolates of VanA VRE from the Centers for Disease Control and Prevention (CDC) and 17 from Ajou University Hospital (AUH) were investigated. Minimum inhibitory concen-trations of vancomycin, teicoplanin, and ampicillin were tested by the agar dilution method. Pulsed-field gel electrophoresis (PFGE) and long PCR-restriction fragment length polymorphism (long PCR-RFLP) were performed. The long PCR negative strains were typed by ORF1-, vanS-vanH-, vanX-, vanY-vanZ-, vanZ-, and IS1216-specific PCRs. Filter matings were performed by using rifampin-resistant, fusidic acid-resistant E. faecalis J H2-2 as the recipient. RESULTS: The PFGE from the VRE of the CDC showed 15 patterns including 4 clusters and PFGE from isolates of AUH revealed 6 patterns including 3 clusters. Tn1546 amplicons were detected in 18 of 20 (90%) CDC strains and 16 of 17 (94%) AUH strains. RFLP of Tn1546 amplicons revealed 5 different patterns in the VRE of the CDC strains, and 2 patterns in the VRE of the AUH strains. The mean transfer efficiency of the CDC and the AUH strains are 3.0 X 10(-8)and 4.9 X 10(-5)transconju-gant/ donor, respectively. CONCLUSIONS: Molecular typing of isolates from the CDC suggests the horizontal spread of vanA genes among genetically diverse strains. Analysis of the VRE from the AUH shows a mixed pattern with clonal dissemination of strains and horizontal transfer of vanA.
Agar ; Ampicillin ; Centers for Disease Control and Prevention (U.S.) ; Electrophoresis, Gel, Pulsed-Field ; Furosemide ; Humans ; Infection Control ; Molecular Typing ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Teicoplanin ; Tissue Donors ; Vancomycin

Since the introduction of Rh-immune globulin in 1968, the incidence of Rh D hemolytic disease of the newborn(HDN) had become markedly reduced but in the contrary the HDN by minor blood group antibodies has become increased relatively. As anti-E is the most common minor blood group antibody identified in antenatal serology and because of the frequency of E-negative people in Korea is ranged from 38.8% to 50.3%, the probability of HDN caused by anti-E is expected relatively high. We had experienced antenatal therapy for a E-isoimmunized pregnant woman, who has the history of one previous stillbirth and one neonatal death. In addition to above obstetric history, she had a history of blood transfusion, in which she was given 7 units of whole blood during the operation of brain cyst 7 years ago, before her marriage. Therapeutic plasma exchanges were repeated from the 22nd to 25th weaks of gestation. During the period a mean volume of 350mL plasma volume was exchanged on average twice a week. After the period, therapeutic plasma exchange procedure was failed because of unsuccessful vascular access. So that we gave her intravenous immunoglobulin(IVIG), 0.4gm/kg for 5 days, and two intrauterine transfusion were given at 25th and 27th weeks of gestation to relief from grave HDN. The maximal antiglobulin titer of anti-E during the gestation period was 1:32. In spite of intensive therapy as above mentioned, she was delivered a severely hydropic fetus weighing 1,900g at 29th weeks of gestation under Cesarean section. The neonate died 2 days after the birth with severe erythroblastosis fetalis and disseminated intravascular coagulation (DIC). Even though we could not save the baby, we report this experience as a reviewable case of antenatal treatment modalities for Rh immunization and the serious consequence of blood transfusion before marriage.
Antibodies ; Blood Transfusion ; Blood Transfusion, Intrauterine* ; Brain ; Cesarean Section ; Disseminated Intravascular Coagulation ; Erythroblastosis, Fetal ; Female ; Fetus ; Humans ; Immunization ; Immunoglobulins, Intravenous* ; Incidence ; Infant, Newborn ; Korea ; Marriage ; Parturition ; Plasma Exchange* ; Plasma Volume ; Plasma* ; Pregnancy ; Pregnant Women ; Stillbirth

BACKGROUND: The vanA gene cluster of vancomycin-resistant enterococci (VRE) is carried as a part of Tn1546-like elements. In this study we characterized the structure of Tn1546-like elements in Enterococcus. faecium isolated from patients in Korea. The isolates were also typed by pulsed-field gel electrophoresis (PFGE). METHODS: During 2000, 21 clinical isolates of vanA-containing E. faecium were collected from ten university hospitals in Korea. E. faecium BM4147 was used as a control. PFGE was performed on a CHEF-DR III apparatus. For structural analysis of Tn1546, the overlapping PCR amplification of internal regions of Tn1546 was performed. The purified PCR products were directly sequenced by using ABI Prism 3100 DNA SEQUENCER. RESULTS: All isolates were divided into 3 types according to the distribution of insertion sequences (IS elements) integrated Tn1546 elements. Type I and II were characterized by an IS1542 insertion in the orf2-vanR intergenic region and an IS1216V insertion in the vanX-vanY intergenic region. Type III represented two copies of IS1216V at the orf1 and in the vanX-vanY intergenic region as well as IS1542 in the orf2-vanR intergenic region. No isolates were identical to the prototype, which was identical to the predicted pattern for the published sequence of Tn1546. The PFGE results revealed that all strains except A13, C1, A2 and A9 were genetically unrelated. CONCLUSIONS: The distribution of IS in Tn1546-like elements of the Korean isolates is similar to that of the European VREs. Considering the results of PFGF and Tn1546 typing, the horizontal transfer of vanA resistance gene may be occurring among genetically diverse strains of E. faecium in Korea.
DNA ; DNA, Intergenic ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus ; Hospitals, University ; Humans ; Korea ; Multigene Family ; Polymerase Chain Reaction

BACKGROUND: Nosocomial infections caused by vancomycin-resistant enterococci (VRE) are increasing problem in Korea. Until now, no nationwide study has been performed. The aim of the present study was to monitor the antimicrobial resistance of vancomycin-resistant Enterococcus faecium (VREF). METHODS: Two hundred and two E. faecium isolated in 10 teaching hospital were studied. To detect VRE, the brain heart infusion agar containing 6 /mL vancomycin was used as the screening agar. The MIC was determined using agar dilution test. The vancomycin resistance genes (vanA, vanB & vanD) and genes (aac(6 ') Ie-aph(2 ") Ia & ant(6 ') Ia encoding the aminoglycoside-modifying enzymes were detected by multiplex PCR using specific primers. RESULTS: Thirty-nine VREF were detected from 202 isolates. All had vancomycin MICs > or =256 /mL and harboured vanA gene. No isolates revealed positive results for the vanB or vanD gene. However, the MIC range for teicoplanin was 2 to > or =256 /mL. All isolates with gentamicin MIC > or = 500 /mL gave positive results for the aac(6 ') Ie aph(2 ") Ia genes and with streptomycin > or =2000 /mL gave positive results for the ant(6 ') Ia gene. CONCLUSIONS: All VREF harboured vanA gene. According to MIC tests, 7 isolates(18%) showed intermediate or susceptible to teicoplanin. Therefore we need a study concerning the clinical meaning. The VREF in Korea contain at least one of genes encoding the aminoglycoside-modifying enzymes. This means there are only limited numbers of antibiotics to choose.
Agar ; Anti-Bacterial Agents ; Brain ; Cross Infection ; Enterococcus faecium* ; Enterococcus* ; Gentamicins ; Heart ; Hospitals, Teaching ; Korea* ; Mass Screening ; Multiplex Polymerase Chain Reaction ; Streptomycin ; Teicoplanin ; Vancomycin ; Vancomycin Resistance

BACKGROUND: Multilocus sequence typing (MLST) is useful in determining the long-term evolutionary process and minimizes differences in experimental results across individuals and laboratories. It is also useful in determining evolutionary origins and backgrounds of bacterial species. This study carries out MLST analysis on VanA-type vancomycin-resistant Enterococcus faecium isolated from patient specimens in a single university hospital over nine years in order to observe changes in genetic evolution over time. METHODS: During the years from 2007 to 2015, 44 clinical isolates of vanA-containing E. faecium were collected from Ajou University Hospital in Korea. Species were identified by the VitekII system (bio-Merieux, USA), and antibiotic susceptibility testing was performed by disk diffusion and E-test according to Clinical and Laboratory Standards Institute (CLSI) guidelines. To determine genetic relatedness, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF M/S) was employed. To characterize clonal diversity, MLST analysis was used. RESULTS: All isolates were highly resistant to ampicillin, ciprofloxacin, and vancomycin but showed variable levels of resistance to teicoplanin. The 44 clinical isolates were genetically unrelated according to MALDI-TOF M/S analysis. MLST showed that the clinical isolates harbored 6 sequence types (ST), with ST17 (n=19) being the most common, followed by ST78 (n=13), ST192 (n=6), ST64 (n=4), ST262 (n=1), and ST414 (n=1). CONCLUSION: The MLST analysis showed that the sequence types of most isolates belonged to clonal complex 17 This is consistent with outbreaks in hospitals. We had single observations for ST262 and ST414, suggesting that they were random occurrences. MLST can be useful for speculating the genetic evolution of VanA-containing E. faecium isolates.
Ampicillin ; Ciprofloxacin ; Diffusion ; Disease Outbreaks ; Enterococcus faecium* ; Enterococcus* ; Evolution, Molecular ; Humans ; Korea ; Mass Spectrometry ; Multilocus Sequence Typing* ; Teicoplanin ; Vancomycin