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A Clinico-Epidemiological Comparison Study of Pediatric Acute Viral Gastroenteritis at a Tertiary Care Hospital.

Bo Hyun KIM ; Tae Hyoung KIM ; Mi Kyung LEE

Annals of Clinical Microbiology.2016;19(2):33-38. doi:10.5145/ACM.2016.19.2.33

BACKGROUND: Acute viral gastroenteritis is a common illness in young children. Rotavirus, norovirus and enteric adenovirus are the major agents for viral gastroenteritis. Their detection rates have gradually increased in Korea. Our aim was to monitor the epidemiologic characteristics of the aforementioned viruses and to determine the laboratory and clinical characteristics of pediatric patients infected with these viruses. METHODS: From December 2009 to November 2010, 685 stool specimens from patients hospitalized at Chung-Ang University Hospital were tested for the aforementioned viruses using multiplex PCR. A corresponding medical record review was retrospectively conducted. RESULTS: The overall prevalence rate was 44.8%, with rates of 16.3%, 1.9%, 22.7%, 3.1%, and 0.8% for rotavirus, norovirus genogroup I, norovirus genogroup II, enteric adenovirus, and astrovirus, respectively. Mixed virus infections were detected in 37 patients (5.4%). The highest incidence rates occurred in March 2010 (18.9%), in the 13-24 month age group (38.1%), and in males (53.1%). Fever and chills were most frequently observed in patients with adenovirus (44.4%) than other viruses, while diarrhea was most frequently observed in patients with rotavirus (93.7%). Leukocytosis (55.0%) and lymphocytosis (21.0%) were more common in the norovirus-infected group than other viruses-infected group. CONCLUSION: Our results show different prevalence rates and clinical findings for each gastroenteritis-associated virus. To better understand the clinico-epidemiological features observed in this study, further epidemiologic and clinical investigations are needed.
Adenoviridae ; Child ; Chills ; Diarrhea ; Epidemiology ; Fever ; Gastroenteritis* ; Genotype ; Humans ; Incidence ; Korea ; Leukocytosis ; Lymphocytosis ; Male ; Medical Records ; Multiplex Polymerase Chain Reaction ; Norovirus ; Pediatrics ; Polymerase Chain Reaction ; Prevalence ; Retrospective Studies ; Rotavirus ; Tertiary Healthcare*

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Two Cases of Bacteremias Caused by Clostridium ramosum.

Yong Kwan LIM ; Se Min OH ; Oh Joo KWEON ; Mi Kyung LEE

Annals of Clinical Microbiology.2015;18(3):98-101. doi:10.5145/ACM.2015.18.3.98

Clostridium ramosum is Gram-positive anaerobic bacillus and is known as a non-pathogenic enteric bacterium. It is a member of the RIC group, which is a subgroup of Clostridium having atypical characteristics. Rarely, it has been reported as a pathogen of otitis media in young children or the cause of infection in immunosuppressed adults. Here, we report the first two Korean cases of C. ramosum bacteremia in colon cancer and pressure sore cases, respectively.
Adult ; Bacillus ; Bacteremia* ; Child ; Clostridium* ; Colonic Neoplasms ; Humans ; Immunocompromised Host ; Otitis Media ; Pressure Ulcer

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Successful Treatment of Fungemia Caused by Cyberlindnera fabianii with Anidulafungin: A Case Report.

Jeong In LEE ; Shinae YU ; Jong Sin PARK ; Eun Jeong JOO ; Jong Hee SHIN ; Min Jung KWON

Annals of Clinical Microbiology.2015;18(3):94-97. doi:10.5145/ACM.2015.18.3.94

Cyberlindnera fabianii (previously known as Hansenula fabianii, Pichia fabianii, and Lindnera fabianii) is a yeast species that forms a biofilm, allowing it to resist azole drugs. In this study, we report a case of fungemia with C. fabianii that was successfully treated with anidulafungin. In this case, the organism was initially misidentified as Candida utilis (with a high probability of 93%, suggesting good identification) using the VITEK 2 yeast identification card (YST ID; bio-Merieux, USA). The species responsible for the patient's fungemia was correctly identified after sequencing the internally transcribed spacer region and the D1/D2 domain of the large subunit (26S) rDNA gene. The CLSI M27-A3 broth microdilution method was used to determine the in vitro antifungal activity of anidulafungin and fluconazole against C. fabianii. The MICs of anidulafungin and fluconazole were found to be 0.03 microg/mL and 2 microg/mL, respectively. The patient recovered after 14 days of anidulafungin treatment.
Biofilms ; Candida ; Danazol ; DNA, Ribosomal ; Fluconazole ; Fungemia* ; Humans ; Pichia ; Yeasts

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Activities of Quality Improvement for Blood Culture at a University Hospital.

Hae In BANG ; Hyun Mi LIM ; Eui Young JANG ; Eun Su PARK ; Eun Jung LEE ; Tae Hyong KIM ; Rojin PARK ; Jeong Won SHIN ; Tae Youn CHOI

Annals of Clinical Microbiology.2015;18(3):88-93. doi:10.5145/ACM.2015.18.3.88

BACKGROUND: Blood culture is a critical test for diagnosing bloodstream infections. Frequent microbial contamination during sampling and testing leads to abuse of antimicrobial agents. We evaluated methods for reducing contamination and obtaining more reliable results. METHODS: We analyzed blood cultures obtained between 2009 and 2015. We established 6 quality indicators: true positive rate, contamination rate, blood sampling volume, number of sets of blood cultures, delayed transportation rate, and percentage of samples collected from the femoral region, with reference to the CLSI guideline M47-A, 2007. Education was provided for interns and nurses responsible for blood sampling and transportation of specimens, and data were analyzed monthly. RESULTS: At baseline, the true positive rate was 12.8%, and the contamination rate was 4.0%. During the intervention period, these were decreased to 10.9% and 1.9%, respectively. The percentage of samples smaller than 5 mL decreased from 29.7% to 2.7-11.3%. The rate of one set of blood cultures being ordered was always <5%. The delayed transportation rate decreased from 35.6% to 5.5-7.7%. Finally, the percentage of samples collected from the femoral region decreased from 41.5% to 22.0-31.0%, because of which we did not attain our goal, 20.8%. CONCLUSION: The results showed improvements in contamination rate, specimen volume, specimen transportation time, and the percentage of samples collected from the femoral region. The quality management of blood cultures in 2011 was comparatively poor, which led to increased contamination rate, large number of samples containing <5 mL of blood, and increased percentage of samples collected from the femoral region. Thus, quality improvement methods can produce more reliable results of blood cultures.
Anti-Infective Agents ; Education ; Femoral Artery ; Femoral Vein ; Quality Improvement* ; Quality Indicators, Health Care ; Transportation

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Comparison of Three Chromogenic Media for Recovery of Vancomycin-Resistant Enterococci from Rectal Swab Samples.

Irene JO ; Chang Eun SONG ; Kang Gyun PARK ; Yeon Joon PARK

Annals of Clinical Microbiology.2015;18(3):82-87. doi:10.5145/ACM.2015.18.3.82

BACKGROUND: Three chromogenic media using direct inoculation were compared with enriched enterococcosel broth for vancomycin-resistant Enterococcus faecium and/or Enterococcus faecalis (VRE) surveillance. METHODS: A total of 174 rectal swabs were included for VRE surveillance. The specimens were transferred in enterococcosel broth (EB). An aliquot of the broth was inoculated onto Brilliance VRE, chromID VRE, and VRESelect media and incubated for up to 48 h. We examined each media and EB after 24 h and 48 h of incubation. When appropriately colored colonies were observed, identification was confirmed using the VITEK-2 system and/or VITEK MS. Vancomycin susceptibility was confirmed by disk diffusion test. The presence of resistance genes was confirmed using Anyplex VanR Real-time Detection (Seegene, Korea). RESULTS: Of the 174 rectal swab specimens, 73 VRE were isolated. For enterococcosel broth, Brilliance VRE, chromID VRE, and VRESelect, the sensitivity at 24 h was 79.2%, 83.3%, 79.2%, and 79.2%, respectively. The sensitivity at 48 h was 91.7%, 93.1%, 91.4%, and 90.3%, respectively. The specificity at 24 h was 85.3%, 97.1%, 98.0%, and 98.0%, while that at 48 h was 79.4%, 85.3%, 95.2%, and 95.1%, respectively. The specificity of chromogenic media at 24 h and 48 h was significantly higher than that of EB. Furthermore, the specificity at 48 h was significantly higher for chromID VRE and VRESelect than Brilliance VRE, although color distinction was easier with VRESelect. CONCLUSION: Based on our results, use of chromID VRE or VRESelect is more reliable and convenient for screening of VRE. In addition, five vanA-positive Enterococcus gallinarum, Enterococcus avium and Enterococcus durans were isolated, and two of them (one E. avium and one E. durans) were detected only on VRESelect.
Diffusion ; Enterococcus ; Enterococcus faecalis ; Enterococcus faecium ; Mass Screening ; Sensitivity and Specificity ; Vancomycin

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Epidemiology and Molecular Characterization of Vancomycin-Resistant Enterococcus faecalis.

Joon KIM ; Kyung Ho CHOI ; Young Sun KIM ; Wee Gyo LEE

Annals of Clinical Microbiology.2015;18(3):76-81. doi:10.5145/ACM.2015.18.3.76

BACKGROUND: Vancomycin-resistant Enterococci (VRE) infections are caused by Enterococcus faecium in about 90% of the cases but can also be caused by Enterococcus faecalis. Thus, this study investigates factors that cause a low isolation rate of vancomycin-resistant E. faecalis (VREfs). To this end, the authors study the clinical traits, resistant gene structure, genomic classification, and molecular characteristics of the virulent factor. METHODS: From January 2001 through September 2011, 17 vanA-containing E. faecalis isolates were collected from hospitalized patients at Ajou University Hospital in Korea. Identification, antimicrobial susceptibility testing, and PCR of van and esp genes were performed. Pulsed-field gel electrophoresis (PFGE) was used for strain typing. PCR and sequencing of the internal regions of Tn1546 were performed for structural analysis of the van gene. RESULTS: Of 4,235 VRE infections, 3,918 (92.5%) were caused by E. faecium, and 95 (2.2%) were caused by E. faecalis. In 67% of VREfs infections, there was a preceding occurrence of E. faecium infection. All isolates were of genotype vanA. Our isolates were divided into three types according to the distribution of IS elements integrated into Tn1546 (types I to IIb). The PFGE results showed no clonal relatedness among isolates. CONCLUSION: Our study found that VREfs infections affect patients who have experienced vancomycin-resistant E. faecium. (VREfm) infection or undergo invasive procedures. The VREfs seems to involve the horizontal transfer of Tn1546 transposon from VREfm.
Classification ; DNA Transposable Elements ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecalis* ; Enterococcus faecium ; Enterococcus* ; Epidemiology* ; Genotype ; Humans ; Korea ; Polymerase Chain Reaction

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Late Prosthetic Joint Infection and Bacteremia by Bacillus cereus Confirmed by 16S rRNA Sequencing and Hip Joint Tissue Pathology.

Jihye HA ; Yu Jin PARK ; Yee Jeong KIM ; Hyun Cheol OH ; Young Ah KIM

Annals of Clinical Microbiology.2016;19(2):54-57. doi:10.5145/ACM.2016.19.2.54

Bacillus cereus is a widespread organism in nature and a member of the B. cereus group of catalasepositive, aerobic, spore-forming, Gram-positive bacilli. B. cereus found in blood is often dismissed as a contaminant in the absence of repeated isolation from multiple cultures. Soft tissue and bone infection due to B. cereus have been associated with trauma, intravenous drug use, and an immunocompromised state. We report a very late prosthetic joint infection of the hip joint and consequent bacteremia caused by B. cereus, which occurred 13 years after total hip replacement surgery in the absence of recent trauma or intervention.
Arthritis ; Arthroplasty, Replacement, Hip ; Bacillus cereus* ; Bacillus* ; Bacteremia* ; Hip Joint* ; Hip* ; Joints* ; Pathology* ; Prostheses and Implants

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Distribution and Antimicrobial Resistance of Streptococcus pneumoniae at Four University Hospitals in Busan and Gyeongnam.

Si Hyun KIM ; Sae Am SONG ; Jongyoun YI ; Duyeal SONG ; Chulhun Ludgerus CHANG ; Dong Chul PARK ; Sang Hwa URM ; Hye Ran KIM ; Jeong Hwan SHIN

Annals of Clinical Microbiology.2016;19(2):48-53. doi:10.5145/ACM.2016.19.2.48

BACKGROUND: Streptococcus pneumoniae is the most common human pathogen causing community-acquired pneumonia. There is little information on the recent antimicrobial susceptibility patterns of S. pneumoniae in Busan and Gyeongnam of Korea. The aim of this study was to investigate the distribution and antimicrobial resistance of S. pneumoniae at 4 university hospitals in Busan and Gyeongnam. METHODS: We collected and analyzed the antimicrobial susceptibility results of 850 S. pneumoniae strains isolated from regional 4 university hospitals during the last 2 years from July 2013 through June 2015. RESULTS: Among 850 S. pneumoniae strains, 635 strains were isolated from respiratory specimens, followed by blood (N=121), CSF (N=13), and others (N=81). Antimicrobial susceptibility rates to penicillin, cefotaxime and ceftriaxone were 79.4%, 76.6% and 83.6%, respectively. The resistant rates to erythromycin and clindamycin were 80.9% and 68.2%, respectively. The resistant rates to levofloxacin were 9.2%. There were some differences in resistant rates by age groups, years, and specimen types. CONCLUSION: We found the changes of antimicrobial resistance of S. pneumoniae during the last 2 years. It is necessary to monitor the antimicrobial susceptibility of S. pneumoniae regularly for empirical therapy and for early detection of the changes of resistance.
Busan* ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Drug Resistance ; Erythromycin ; Hospitals, University* ; Humans ; Korea ; Levofloxacin ; Penicillins ; Pneumonia ; Streptococcus pneumoniae* ; Streptococcus*

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Molecular Epidemiology and Characterization of Carbapenemase-Producing Enterobacteriaceae Isolated at a University Hospital in Korea during 4-Year Period.

Sunyoung AHN ; Ji Yeon SUNG ; Hyunsoo KIM ; Myung Sook KIM ; Younjee HWANG ; Sori JONG ; Younghee SEO ; Eunjin HA ; Eun Suk PARK ; Jun Yong CHOI ; Dongeun YONG ; Kyungwon LEE

Annals of Clinical Microbiology.2016;19(2):39-47. doi:10.5145/ACM.2016.19.2.39

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) has been increasingly reported worldwide in the past 10 years, which is an important infection control concern. Since the epidemiology and characteristics of these CPEs vary according to institutes, we aimed to characterize CPEs in a university hospital during the recent 4 years. METHODS: From October 2011 to September 2015, CPE isolates from clinical specimens and hospital surveillance cultures were collected. Carbapenem resistance was confirmed by disk diffusion method and Minimal Inhibitory Concentration (MIC) was determined by agar dilution method. Carbapenemase production was tested by double disk test using aminophenylboronic acid and dipicolic acid. PCR and sequence analysis were performed to detect bla(KPC), bla(IMP-1), bla(VIM-2), bla(NDM-1)-like genes and bla(OXA-48) gene. Pulsed-field gel electrophoresis (PFGE) and Multilocus sequence typing (MLST) were conducted for KPC-producing Klebsiella pneumoniae isolates. RESULTS: Twenty-five isolates (11%) of CPE were identified among 222 carbapenem-resistant Enterobacteriacae isolates during the study period. The most prevalent CPE was KPC-producing K. pneumonia and others were IMP-1, VIM-2, NDM-1 type and OXA-48 producing CPEs. Most of these CPEs showed resistance to carbapenems with variable MICs. The sequence types (STs) of KPC-producing K. pneumoniae were ST307 and ST11. The PFGE of ST11 and ST307 showed clonality in each group suggesting the possibility of in-hospital outbreak. CONCLUSION: The prevalence of CPE has been increasing. In our institute, KPC-producing K. pneumoniae was the most frequently isolated CPE in the recent 4 years. CPE including KPC producers can easily transfer their resistance. Therefore continuous monitoring and more intensified infection control for CPE should be considered.
Academies and Institutes ; Agar ; Carbapenems ; Diffusion ; Drug Resistance, Bacterial ; Electrophoresis, Gel, Pulsed-Field ; Enterobacteriaceae* ; Epidemiology ; Infection Control ; Klebsiella pneumoniae ; Korea* ; Methods ; Molecular Epidemiology* ; Multilocus Sequence Typing ; Pneumonia ; Polymerase Chain Reaction ; Prevalence ; Sequence Analysis

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Erratum: Comparison of the BACTEC Peds Plus Pediatric Blood Culture Bottle to the BacT/Alert PF Pediatric Blood Culture Bottle for Culturing Blood from Pediatric Patients.

Kon Hee LEE ; Wonkeun SONG ; Min Jeong PARK ; Jeongwon HYUN ; Hyun Soo KIM ; Kyu Man LEE

Annals of Clinical Microbiology.2013;16(3):152-152. doi:10.5145/ACM.2013.16.3.152

English abstract of the paper, there is an error in the following to correct it.

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