BACKGROUND: The aim of the study was to determine prevalence of potential heterogeneous vancomycin-resistant Staphylococcus aureus (h-VRSA) among methicillin-resistant S. aureus (MRSA) isolated in Korea by using Mu-3 agar and to determine the effect of in vitro vancomycin exposure on the resistance. METHODS: MRSAs isolated in 1980-1999 were screened for the presence of VISA or h-VRSA using Mu-3 agar. MIC of vancomycin was tested by NCCLS agar dilution and broth microdilution tests. Suspected h-VRSA were selected by vancomycin-containing media and change of resistance was determined by population analysis. A strain with Mu50 type growth was serially exposed to 8 pg/ml of vancomycin containing media and change of the vancomycin resistance was determined. RESULTS: Among the 455 MRSA isolates, 18 (3.9 %) grew on selective brain heart infusion agar (BHIA), and 354 (77,8%) on Mu-3 agar, 66 (14.5%) with Mu3 type growth and 78 (17.1%) with Mu50 type growth. MIC of vancomycin was 11 pg/ml for some of the isolates when inocula were approximately 10' CFU, but VISA was not present when tested by NCCLS broth microdilution test. Exposure of the isolates to van-cornycin raised the MIC. Serial exposure once to 8 pg/ml of vancomycin resulted in significant decrease of cells susceptible to 8-12 pg/ml of vancomycin. CONCLUSION: VISA was not present among the test isolates, but 34.2% were suspected to be potential h-VRSAs, suggesting possible emergence of VISA if vancomycin was administered prolonged period. It is considered that suitable screening media are vancomycin containing BHIA for VISA and Mu-3 agar for h-VRSA. The isolates showing Mu50 type growth on Mu-3 agar are not always VISA, but rather h-VRSA.
Agar* ; Brain ; Heart ; Korea ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Prevalence ; Staphylococcus aureus* ; Staphylococcus* ; Vancomycin Resistance ; Vancomycin*

BACKGROUND: beta-lactam antibiotics are one of the most frequently used antimicrobial agents. However, with the increase of beta-lactamase-producing bacteria, penicillins arid 1 st generation cephalosporins have become less useful. Cefatrizine and clavulanic acid combination (CTCA) was developed to restore the activity. The aim of this study was to determine the activities of CTCA against major recent clinical isolates. METHODS: Aerobic and anaerobic bacteria tested were isolated from clinical specimens in Severance Hospital during 1996 to 1999. Antimicrobial susceptibility was determined by the NCCLS agar dilution methods. RESULTS: MICs of cefatrizine (CT) and CTCA were similar for methicillin-susceptible Staphylococcus aureus, Streptococcus pyogenes and S. pneumoniae. For Moraxella (Branhamella) catarrhalis, MIC90 CTCA was 1 microgram/mL, which was 1/8-fold lower than that of cefatrizine. MIC90S of CTCA for Escherichia coli and Klebsiella pneumoniae were 4 microgram/mL and 8 microgram/mL, respectively, which were 1/4- to 1/16-fold lower than those of CT. However, it was less active against Citrobacter freundii, Enterobacter cloacae and Serratia marcescens. Against Bacteroides fragilis group organisms, it showed good activities similar to those of other beta-lactam and beta-lactamase inhibitor combinations. CONCLUSIONS: CTCA showed good antimicrobial activities against M. (B.) catarrhalis, Haemophilus influenzae, Neisseria gonorrhoeae, extended spectrum beta-lactamase-producing E. coli and K. pneumoniae, Proteus vulgaris and B. fragilis. In conclusion, it would be useful for the treatment of infections due to those organisms, and for the empirical treatment of respiratory and urinary tract infections.
Agar ; Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteria* ; Bacteria, Anaerobic ; Bacteroides fragilis ; beta-Lactamases ; Cefatrizine ; Cephalosporins ; Citrobacter freundii ; Clavulanic Acid ; Enterobacter cloacae ; Escherichia coli ; Haemophilus influenzae ; Klebsiella pneumoniae ; Moraxella (Branhamella) catarrhalis ; Neisseria gonorrhoeae ; Penicillins ; Pneumonia ; Proteus vulgaris ; Serratia marcescens ; Staphylococcus aureus ; Streptococcus pyogenes ; Urinary Tract Infections

Group B Streptococcus (GBS, S. agalactiae) is known to be the leading cause of neonatal sepsis and meningitis and the infection has been increasingly noted in adults, particularly in those with underlying diseases. Penicillin G is the drug of choice for GBS infection. However, the MIC of penicillin for GBS is greater than that for S. pyogenes. Therefore some GBS infections may be difficult to be treated. However, in Korea, our knowledge on GBS infection is limited. We observed 7 cases of GBS bacteremia during 1993-1996 in a hospital, Of the 7 patients, 3 were less than one month of age with no known underlying disease and 4 were adults with liver cirrhosis or malignancy. One adult patient developed disseminated intravascular coagulopathy and expired. Among the GBS isolates, 4 were serotype III and 3 were Ib. All of the isolates were susceptible to ampicillin, teicoplanin and vancomycin, but most were intermediate or resistant to clindamycin, erythromycin or tetracycline. It is concluded that GBS also cause severe infections in adult with underlying diseases and the serotypes III and I b may be more virulent than other serotypes. Early detection and antimicrobial susceptibility test of GBS from severe infection may be necessary for the proper treatment of the patients.
Adult ; Ampicillin ; Bacteremia ; Clindamycin ; Erythromycin ; Humans ; Korea ; Liver Cirrhosis ; Meningitis ; Penicillin G ; Penicillins ; Sepsis ; Streptococcus* ; Teicoplanin ; Tetracycline ; Vancomycin

Objectives: Women experience more stress in middle age than in other periods of their lives. Therefore, health management programs that enable middle-aged women to cope with and manage stress are needed. This study investigated the psychological effects of a meditation-focused forest therapy program among 53 middle-aged women living in urban areas in Korea. Methods: Participants were divided into 2 groups: one group underwent the program for 3 days in a forest, followed by 3 days in an urban environment, and the other group underwent the program for 3 days in the urban environment, followed by 3 days in the forest. The psychological effects of the forest therapy program were evaluated using the Profile of Mood States-Brief (POMS-B). Differences in mood state before and after the program conducted in the forest (experimental group) and in the urban environment (control group) were evaluated using the paired-samples t-test. Results: The program in the forest significantly reduced tension, depression, anger, fatigue, and confusion among the domains of the POMS-B. The program in the urban area significantly reduced tension, but not depression, anger, fatigue, or confusion. Conclusions Meditation-focused forest therapy programs are expected to contribute to promoting psychological health and enhancing the quality of life of middle-aged women.

The peripherally inserted central catheter (PICC) is used frequently in preterm infants. The known complications associated with the PICC include infection, thrombosis, extravasation, phlebitis, leakage of insertion site, fracture, accidental removal, occlusion of the PICC, and arrhythmia. We herein report a case of a spontaneously fractured PICC remnant that was successfully removed by cardiac catheterization.
Arrhythmias, Cardiac ; Cardiac Catheterization* ; Cardiac Catheters* ; Catheters* ; Humans ; Infant, Newborn ; Infant, Premature* ; Phlebitis ; Thrombosis