Mycobacterium is an uncommon cause of peritonitis in patients receiving peritoneal dialysis (PD), and the incidence of nontuberculous mycobacterium (NTM) peritonitis is even rarer since the majority of mycobacterial peritonitis cases are caused by Mycobacterium tuberculosis. However, NTM peritonitis has been known to result in a high mortality rate with delayed diagnosis and treatment. In this study, we report a case of Mycobacterium abscessus peritonitis in a 52-year-old male under continuous ambulatory peritoneal dialysis (CAPD).
Delayed Diagnosis ; Humans ; Incidence ; Male ; Mycobacterium ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis

In July 2010, we identified an outbreak of vancomycin-resistant enterococci (VRE) in our 26-bed neonatal intensive care unit. We performed an epidemiological investigation after clinical cultures of 2 neonates were positive for VRE. Identification, susceptibility testing, and molecular characterization were performed. Cultures of 3 surveillance stool samples of inpatients and 5 environmental samples were positive for VRE. All isolates were identified as Enterococcus faecium containing the vanA gene. Two distinct clones were identified by performing pulsed-field gel electrophoresis. The 2 clones exhibited different pulsotypes, but they represented identical Tn1546 types. Two sequence types, ST18 and ST192, were identified among all of the isolates with multilocus sequence typing. Our investigation determined that the outbreak in the neonatal intensive care unit was caused by 2 genetically different clones. The outbreak may have occurred through clonal spread and horizontal transfer of the van gene.
Anti-Bacterial Agents/pharmacology ; Bacterial Proteins/genetics ; Bacterial Typing Techniques ; Carbon-Oxygen Ligases/genetics ; DNA, Bacterial/analysis ; *Disease Outbreaks ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium/drug effects/*genetics/isolation & purification ; Feces/microbiology ; Genotype ; Gram-Positive Bacterial Infections/diagnosis/epidemiology/*microbiology ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Multilocus Sequence Typing ; Vancomycin/pharmacology ; *Vancomycin Resistance

Listeria grayi is a catalase-positive, non-spore forming, and glucose-fermenting Gram-positive rod. L. grayi is widely distributed in environments such as soil, water and fresh food. Human infection by L. grayi is very rare, and there have been no cases reported in Korea, and only two cases worldwide. Dermabacter hominis is a relatively new species belonging to the coryneform bacteria and is a component of the normal human skin flora. D. hominis is a non-motile, glucose-fermenting, Gram-positive rod that has similar biochemical characteristics to L. grayi. The authors of the present study report a case initially misidentified as L. grayi via a traditional morphological and biochemical identification method but that was subsequently confirmed as D. hominis using sequence analysis of 16S rRNA.
Bacteria ; Humans ; Korea ; Listeria ; Sequence Analysis ; Skin ; Soil

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

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

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: Influenza virus is a cause of annual outbreaks of acute respiratory disease and is responsible for considerable mortality and morbidity in all age groups. To achieve maximum efficacy antiinfluenza drugs must be started within 48 h of the development of influenza symptoms. Improvements in rapid diagnosis methods are needed to identify influenza infections. The aim of this study was to compare a quick rapid antigen test with viral culture assays. METHODS: A total of 87 nasopharyngeal swab specimens were collected from symptomatic paediatric patients during March, 2004. The performance of the Quick S-Influ A/B rapid test for influenza virus detection was compared to that of the viral culture. RESULTS: The overall rate of detection for viral culture was 23.4% for influenza A virus and 13.4% for influenza B virus. The Quick S-Influ A/B assay identified 17 of 18 influenza A viruses (sensitivity, 94.4%; specificity, 96.8%; PPV, 89.5%; NPV, 98.4%), and identified 7 of 9 influenza B viruses (sensitivity, 77.8%; specificity, 98.4%; PPV, 87.5%; NPV, 96.8%). CONCLUSIONS: The Quick S-Influ A/B assay was easy to perform and showed comparable sensitivities and specificities. This rapid test kit can be an alternative tool for interventions in disease management.
Diagnosis ; Disease Management ; Disease Outbreaks ; Humans ; Influenza A virus ; Influenza B virus ; Influenza, Human* ; Mortality ; Orthomyxoviridae* ; Sensitivity and Specificity

BACKGROUND: The widespread dissemination of Tn1546 has been attributed to transposition into plasmid or transferable elements. The transposition has been achieved through the activity of insertion sequences. Genetic diversity in Tn1546 includes integration of IS elements such as IS1216V, IS1251, IS1476 and IS1542. We investigated molecular typing and the distribution of insertion sequences in vanA-containing Enterococcus faecium isolated from patients in a teaching hospital. METHODS: Sixteen strains of vanA-containing E. faecium isolated from Ajou university hospital were analyzed. PCR amplification of internal regions of Tn1546 was performed and PCR amplicons were directly sequenced on both DNA strands by the dideoxy termination method. RESULTS: For all 16 isolates, IS1216V sequences were located within Tn1546. IS1542 sequences were detected in the genome of 9 isolates. One isolate contained IS1216V in the vanS intragenic region. The structural analysis of Tn1546 in VRE isolates produced three different groups by the presence of the insertion sequences. Group I was characterized by deletions of orf1 and orf2 and IS1216V insertion in the vanXY intergenic region. Group II represented IS1542 in the orf2-vanR and IS1216V in the vanXY intergenic region with deletion of orf1 region. Group III represented IS1542 in the orf2-vanR and IS1216V in the vanXY intergenic region without any deletion. CONCLUSIONS: Most of Korean isolates contained IS1216V and IS1542 sequences. Transposon typing of isolates in this study revealed a similarity to the European's. The identification of insertion sequence within vanA gene cluster can be a useful tool in epidemiological investigations.
DNA ; DNA Transposable Elements ; DNA, Intergenic ; Enterococcus faecium* ; Enterococcus* ; Genetic Variation ; Genome ; Hospitals, Teaching* ; Humans ; Molecular Typing ; Multigene Family ; Plasmids ; 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: The Korean Society of Laboratory Medicine (KSLM) Laboratory Inspection and Accreditation Program (IAP) has been developed after one year of study supported by a research grant from the Ministry of Health and Welfare (MOHW) of the Republic of Korea from June 1998 to May 1999 to assess objectively the quality of laboratory work and assist the laboratories in improving the quality of their work. The IAP is based on peer review and voluntary participation. The IAP has been continuously improved since the first laboratory inspection began in May 1999 and it was soon expanded nationwide. The improvement was made by updating the inspection checklists to reflect feedback from inspection activities and holding frequent inspectors training workshops. This paper describes the progress and outcome of the IAP. METHODS: The IAP has been implemented nationwide through the following steps: 1) preliminary review of application papers including laboratory quality control policies and external proficiency survey results, as well as on-site inspection by inspectors; 2) addition of newly approved "Inpatient Interpretive Summary Report"checklist (IISR); 3) inspectors training workshop for the "IISR"checklist; 4) continuation of the IAP for all checklist areas including "IISR"; and 5) the first revision of checklists. RESULTS: One hundred nineteen laboratories were accredited during the first year of the IAP. Due to the implementation of the MOHW approved health insurance reimbursement item for laboratory physicians, the "IISR"checklist was created. The mean score of the laboratory inspection results was 92.8 and hospital laboratories showed a higher score on routine testing areas, however, commercial reference laboratories showed a better score on special testing areas. The checklists were revised according to the feedback from the first round of inspections. CONCLUSIONS: The nationwide implementation of the KSLM laboratory IAP was accomplished through this study. The IAP appears to have provided a firm basis for the improvement of quality and efficiency of clinical laboratories in the country.
Accreditation* ; Checklist ; Education ; Financing, Organized ; Insurance, Health, Reimbursement ; Korea ; Laboratories, Hospital ; Peer Review ; Quality Control ; Republic of Korea