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A Case of Enterococcus casseliflavus Bacteremia.

Young UH ; Hyeun Gyeo LEE ; Gyu Yel HWANG ; Kap Jun YOON ; Hyo Youl KIM

Korean Journal of Clinical Microbiology.2001;4(2):146-149.

Although Enterococcus casseliflavus with intrinsic low-level vancomycin resistance has rarely been isolated from clinical specimens, this organism may cause serious invasive infections such as endocarditis and bacteremia. This low prevalence may be due, in part, to the inability of automated systems to recognize this organism. Vancomycin may not be effective against E. casseliflavus, despite in vitro results that indicate vancomycin susceptibility. It is important that all E. casseliflavus isolates obtained from clinical specimens that are related to serious infections should be identified to species level for appropriate antibiotic therapy. We report a case of bacteremia caused by E. casseliflavus in a 44-year-old female patient with liver disease.
Adult ; Bacteremia* ; Endocarditis ; Enterococcus* ; Female ; Humans ; Liver Diseases ; Prevalence ; Vancomycin ; Vancomycin Resistance

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A Case of Septicemia by Plesiomonas shigelloides.

Hyun Mi CHO ; Young UH ; Kap Jun YOON ; Won Yeon LEE ; Hyo Youl KIM

Korean Journal of Clinical Microbiology.2001;4(2):142-145.

Plesiomonas shigelloides is an oxidase-positive, fermentative, gram-negative rod currently classified as a member of the family Vibrionaceae. P. shigelloides has been implicated as the causative agents of gastroenteritis as well as extraintestinal infections such as septicemia, neonatal meningitis, cellulitis, and cholecystitis. Septicemia due to P. shigelloides is very rare but is severe and has been associated with a high mortality rate. We report a case of septicemia caused by P. shigelloides in a 66-year-old male with diabetes mellitus who had diagnosed as liver cirrhosis 7 years before.
Aged ; Cellulitis ; Cholecystitis ; Diabetes Mellitus ; Gastroenteritis ; Humans ; Liver Cirrhosis ; Male ; Meningitis ; Mortality ; Plesiomonas* ; Sepsis* ; Vibrionaceae

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A Case of Hafnia alvei Peritonitis with Septicemia.

Wonkeun SONG ; Taek Kyung KIM ; Min Jeong PARK ; Kyu Man LEE

Korean Journal of Clinical Microbiology.2001;4(2):139-141.

Hafnia alvei is gram-negative bacilli that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, pneumonia, meningitis, bacteremia, and nosocomial wound infections. But, no case of extraintestinal H. alvei infection was documented in Korea to our knowledge. A 50-year-old man with hepatocellular carcinoma was admitted to our hospital via emergecy department because of abdominal pain. The peritoneal fluid and 3 consecutive blood cutures yielded H. alvei. The organism was susceptible to all antimicrobial agents tested, except cefazolin. Despite treatment with intravenous cefotaxime, the patient was expired after 4 days due to septicemia.
Abdominal Pain ; Anti-Infective Agents ; Ascitic Fluid ; Bacteremia ; Carcinoma, Hepatocellular ; Cefazolin ; Cefotaxime ; Gastroenteritis ; Hafnia alvei* ; Hafnia* ; Humans ; Korea ; Meningitis ; Middle Aged ; Peritonitis* ; Pneumonia ; Sepsis* ; Wound Infection

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Analysis of Enterovirus Genotypes Using Single-Strand Conformational Polymorphism.

Jung Hyun KIM ; Jung Hee LEE ; Je Kue LEE ; Won Ki BANG ; Jung Yon HONG ; Eui Chong KIM

Korean Journal of Clinical Microbiology.2001;4(2):134-138.

BACKGROUND: Epidemics of aseptic meningitis due to enteroviruses has occurred annually in the late spring and early summer season. The early detection of such epidemics is important for the prevention of further infection. Enteroviruses consist of 67 serotypes but one or two serotypes may be the causative agents of epidemics in the year and several different serotypes involve sporadic cases. In order to discriminate epidemics from sporadic infection, the serotype should be determined. We evaluated the significance of the single-strand conformational polymorphism (SSCP) of reverse transcription-polymerase chain reaction (RT-PCR) products of 5'-untranslated region (UTR) for the determination of serotypes. METHODS: The specimens of patients were cultured with RD cell and the RT-PCR was performed in case of the positive cytopathic effect. For the amplification of 153-bp of 5'-UTR, primers (EN1: 5'-CTC CGG CCC CTG AAT GCG GCT AAT-3'; EN2: 5'-ATT GTC ACC ATA AGC AGC CA-3') were used. The RT-PCR products were denatured with 95% formamide at 95degrees C for 5 min and SSCP was performed. 12.5% polyacrylamide gel (49/1 acrylamide/bis) was made by using Mighty SmallTM SE245 Dual Gel Caster (Hoefer Scientific Instruments Inc., USA). Electrophoresis was done at 10 mA for 1.5 h, and silver nitrate stain was performed. The SSCP patterns were compared with serotypes determined by sequence analysis of VP1 region. RESULTS: Coxsackievirus A9 (two strains), coxsackievirus A16 (10), coxsackievirus B2 (two), coxsackievirus B3 (two), echovirus 3 (two), echovirus 11 (two), echovirus 16 (seven), echovirus 19 (two), echovirus 30 (three), and enterovirus 71 (six) showed the different SSCP patterns according to their serotypes. The same pattern was observed in the same serotype, except echovirus 30 showing two different patterns. CONCLUSIONS: The SSCP of RT-PCR products of 5'-UTR may be helpful to determine the serotype and discriminate epidemics from sporadic cases. This has the advantage to be able to test the specimens directly without the viral culture. But the serotype should be determined by other method such as neutralization or sequence analysis in case of the first isolate in the epidemic season and the stains showing the new SSCP patterns.
Coloring Agents ; Electrophoresis ; Enterovirus B, Human ; Enterovirus* ; Genotype* ; Humans ; Meningitis, Aseptic ; Polymorphism, Single-Stranded Conformational ; Seasons ; Sequence Analysis ; Silver Nitrate ; Natural Resources

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Utility of 293 Cells in Culture of Enteroviruses.

Han Sung KIM ; Wonkeun SONG ; Kyu Man LEE

Korean Journal of Clinical Microbiology.2001;4(2):129-133.

BACKGROUND: Viral isolation in cell culture remains as a reference method for diagnosis of enteroviral infection. Enteric adenoviruses are cultivated in 293 cells. Enteroviral and enteroadenovrial tropisms for the gastrointestinal tract lead to the assumption that 293 cells would be useful in enteroviral isolation. We evaluated usefulness of 293 cells in the diagnosis of enteroviral infection. METHODS: Human embryonic lung fibroblasts (HEL), HeLa, RD and 293 cells were used to evaluate viral isolation from clinical specimens, susceptibilities of the cell lines to reference enteroviral strains and influence to stool extracts on the viral isolation. Forty-four stool specimens collected from patients during the epidemic period of type 9 echoviral aseptic meningitis and type 30 echoviral culture-positive 33 stool and 58 cerebrospinal fluid (CSF) specimens were inoculated onto cell lines. RESULTS: Echovirus type 9 was isolated from 31 of 44 stool specimens. Of 31 echovirus 9 isolates, 22 (71.0%), 21 (67.7%), 6 (19.4%) and 3 (9.7%) were detected in HEL, 293, RD and HeLa, respectively. Of 33 echovirus 30 isolates from stool specimens, 32 (97.0%) were detected in 293; 17 (51.5%) were detected in RD. Of 58 echovirus 30 isolates from CSF specimens, 39 (67.2%) were detected in 293; 30 (51.7%) were detected in RD. 293 cells were sensitive for coxsackievirus A9 reference strain and echovirus 7 reference strain. Stool extracts induced enhanced cytopathic effect by echovirus 9 infection in 293 and HEL. CONCLUSIONS: 293 cells are useful in the diagnosis of echoviral and some enteroviral infection.
Adenoviridae ; Cell Culture Techniques ; Cell Line ; Cerebrospinal Fluid ; Diagnosis ; Echovirus 9 ; Enterovirus B, Human ; Enterovirus* ; Fibroblasts ; Gastrointestinal Tract ; Humans ; Lung ; Meningitis, Aseptic ; Tropism

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Comparison of Chlorhexidine-Alcohol and Povidone-Iodine for Skin Antisepsis and the Effect of Increased Blood Volume in Blood Culture.

Hyekyung KANG ; Seong Chun KIM ; Sunjoo KIM

Korean Journal of Clinical Microbiology.2012;15(1):37-42. doi:10.5145/KJCM.2012.15.1.37

BACKGROUND: Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample. METHODS: The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection. RESULTS: After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001). CONCLUSION: Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.
Adult ; Antisepsis ; Blood Volume ; Disinfectants ; Disinfection ; Emergencies ; Humans ; Povidone-Iodine ; Sepsis ; Skin

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Frequency of Mycoplasma pneumoniae Antibodies in Children Living on Jeju Island.

Kyutaeg LEE ; Woo Jin KIM ; Dong Lyul KIM ; Jae Hyang KIM ; Moo Sang CHONG

Korean Journal of Clinical Microbiology.2012;15(1):32-36. doi:10.5145/KJCM.2012.15.1.32

BACKGROUND: Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. Currently, no study exists regarding the frequency of the mycoplasmal antibody on Jeju Island. The aim of the present study was to investigate the frequency of mycoplasmal antibody among children living on Jeju Island. METHODS: From March 2009 to February 2011, the frequency of mycoplasmal antibody among 1580 pediatric (<10 years old) patients who were tested for the mycoplasmal antibody titer in Cheju Halla Hospital were retrospectively investigated. The authors also analyzed the positive rates according to age, sex, and season. RESULTS: The frequency of mycoplasmal antibody titers were 69.4% for an antibody titer >1:40, 20.8% in an antibody titer >1:320, and 10.7% in an antibody titer >1:640. The positive rates of each antibody titer were lowest in children under the age of 6 months, and the positive rates increased gradually with age until 4 years, where the frequency showed a "plateau." There were minor cyclic increases of positive rate (>1:320, >1:640) every three months from August 2009 to June 2010, and there was a major increase of positive rate (>1:320, >1:640) from July 2010 to January 2011. However, there was no positive rate cyclic pattern of mycoplasmal antibody in the lower titer (>1:40) patients. CONCLUSION: The frequency of mycoplasmal antibody titer is lowest under the age of 6 months. The positive rates rise gradually with age until the age of 4 years. The present study showed minor peaks of mycoplasmal antibody titer every three months and a major peak of mycoplasmal antibody titer. The results can be helpful for the interpretation and diagnosis of MP among pediatric patients on Jeju Island.
Antibodies ; Child ; Humans ; Mycoplasma ; Mycoplasma pneumoniae ; Pneumonia ; Pneumonia, Mycoplasma ; Retrospective Studies

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Direct Detection of Methicillin-Resistant Staphylococcus aureus from Blood Cultures Using Three Non-Molecular Methods: PBP2a Latex Agglutination, PBP2a Rapid Immunochromatographic Assay and MRSA-Chromogenic Medium.

Seung Bok HONG ; Bo Ra SON ; Kyeong Seob SHIN

Korean Journal of Clinical Microbiology.2012;15(1):27-31. doi:10.5145/KJCM.2012.15.1.27

BACKGROUND: This study compared three non-molecular methods for the detection of methicillin-resistance directly from blood cultures containing Staphylococcus aureus: penicillin-binding protein (PBP) 2a latex agglutination (LA), PBP2a immunochromatographic assay (ICA) and MRSA chromogenic medium (CM). METHODS: Fifty methicillin-resistant S. aureus (MRSA) and 50 methicillin-susceptible S. aureus (MSSA) were seeded into blood-culture bottles. When isolates returned a positive signal, 5 mL of culture was added to serum separator tubes and centrifuged at 1,300 g for 10 min. The pellets were then used as the inoculum for the PBP2a LA, MRSA-CM and PBP2a ICA. The pure colony was used for PBP2a LA test, additionally. RESULTS: The respective sensitivities and specificities were 98 and 100% for PBP2a ICA, and 100 and 100% for MRSA-CM in direct detection of MRSA from positive blood culture. The results of PBP2a LA test using pure colony were entirely compatible with those by mecA gene PCR but the PBP2a LA test using the pellets directly isolated from positive blood culture showed sometimes ambiguous agglutination; its sensitivity and specificity were 78 and 100%, if ambiguous results were scored as negative, and were 90 and 92%, if ambiguous results were scored as positive, respectively. CONCLUSION: For direct detection of MRSA in positive blood culture, MRSA-CM and PBP2a ICA provided excellent results. The PBP2a LA test using pure colony also gave excellent results but the PBP2a LA test by the direct method using pellet of positive blood culture was slightly less sensitive than the other two methods.
Adenosine ; Agglutination ; Immunochromatography ; Latex ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Penicillin-Binding Proteins ; Polymerase Chain Reaction ; Seeds ; Sensitivity and Specificity ; Staphylococcus

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Clinical Features Associated with Blood Cultures According to the Use of Antimicrobial Agents Prior to Blood Collection.

Hyekyung KANG ; Sunjoo KIM

Korean Journal of Clinical Microbiology.2012;15(1):21-26. doi:10.5145/KJCM.2012.15.1.21

BACKGROUND: Previous antibiotic exposure may inhibit the growth of microorganisms in blood culture bottles. The authors investigated the frequency of previous antibiotic usage and analyzed the relationships among antibiotic usage, microbiological culture results and mortality of sepsis patients. METHODS: From April to May 2011, all blood cultures requested from inpatients were analyzed according to the admitted ward and antibiotic prescription records. The BacT/Alert 3D system (bioMerieux Inc.) was used with a standard bottle (SA, SN) for blood culture. RESULTS: Of 900 inpatients, 48% had been receiving antimicrobial agents when blood cultures were ordered. This group had a significantly higher mortality rate (36.2%) compared to the patients who had not received antibiotics (11.1%). Gram-negative rod bacteremia (37.1%) and candidemia (100%) resulted in a significantly higher mortality rate compared to Gram-positive cocci bacteremia (16.4%). In the analysis of 21 cases resulting in death, 15 (71.4%) patients died before or on the date when blood culture results were reported. CONCLUSION: Patients who receive antibiotics prior to blood collection may be at a higher risk for mortality. In the present study, Gram-negative rod bacteremia and candidemia cases showed a rapid progression of sepsis as indicated by Gram staining and thus should be regarded seriously.
Anti-Bacterial Agents ; Anti-Infective Agents ; Bacteremia ; Candidemia ; Gram-Positive Cocci ; Humans ; Inpatients ; Prescriptions ; Sepsis ; Sydnones

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A Korean Nationwide Surveillance Study for Non-Typhoidal Salmonella Isolated in Humans and Food Animals from 2006 to 2008: Extended-Spectrum beta-Lactamase, Plasmid-Mediated AmpC beta-Lactamase, and Plasmid-Mediated Quinolone Resistance qnr Genes.

Hae Sun CHUNG ; Hyukmin LEE ; Yangsoon LEE ; Dongeun YONG ; Seok Hoon JEONG ; Bok Kwon LEE ; Suk Chan JUNG ; Suk Kyung LIM ; Kyungwon LEE ; Yunsop CHONG

Korean Journal of Clinical Microbiology.2012;15(1):14-20. doi:10.5145/KJCM.2012.15.1.14

BACKGROUND: The emergence of non-typhoidal Salmonella (NTS) with decreased susceptibilities to fluoroquinolone, ampicillin, or ceftriaxone has been reported worldwide. However, current surveillance studies of resistance among NTS in Korea are limited. Thus, the antimicrobial susceptibilities; resistance mechanisms such as extended-spectrum beta-lactamase (ESBL), plasmid-mediated AmpC beta-lactamase (PABL), and plasmid-mediated quinolone resistance (PMQR); and molecular epidemiologic characteristics were investigated in the present study. METHODS: National Institute of Health and National Veterinary Research and Quarantine Service collected NTS strains from 219 clinical and 293 non-clinical specimens from 2006 to 2008. The antimicrobial susceptibilities were determined using the Clinical and Laboratory Standards Institute disk diffusion test. ESBL, PABL, and qnr genotyping were performed using PCR and nucleotide sequencing. Pulsed-field gel electrophoresis was used for the molecular epidemiologic study. RESULTS: The resistance to ampicillin in clinical and non-clinical NTS was 49% and 18 to 47%, respectively. The resistance rates to trimethoprim-sulfamethoxazole in clinical and non-clinical NTS were 8% and 0 to 41%, respectively. The rates to extended-spectrum cephalosporin were 0 to 1%. One CTX-M-15-producing isolate and four CMY-2-producing isolates were detected. Notably, PFGE analysis showed four isolates carrying bla CMY-2, including one non-clinical strain had high clonality. Although the rate of ciprofloxacin resistance was very low, two qnrS1-carrying NTS strains were detected in non-clinical specimens. CONCLUSION: The resistance rates to ampicillin in both clinical and non-clinical NTS were high, while those to trimethoprim-sulfamethoxazole varied depending on the specimen. NTS strains harboring CTX-M-15-type ESBL or CMY-2-type PABL were detected even though the resistance rates to cephalosporins were very low. Four NTS strains carrying the blaCMY-2-gene implied zoonotic infection. Continuous effort to minimize transfer of resistance genes in NTS is necessary.
Ampicillin ; Animals ; Bacterial Proteins ; beta-Lactamases ; Ceftriaxone ; Cephalosporins ; Ciprofloxacin ; Diffusion ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Korea ; Lifting ; Polymerase Chain Reaction ; Quarantine ; Salmonella ; Sprains and Strains ; Trimethoprim, Sulfamethoxazole Drug Combination

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