BACKGROUND: Nontuberculous mycobacteria (NTM) have usually been considered to be contaminants or colonizers when isolated from respiratory specimens in Korea, where there is a high prevalence of tuberculosis and a low rate of HIV infections. Therefore, there has been few studies on the clinical significance of NTM in a pulmonary infection. In this study, the prevalence of pulmonary NTM and the clinical significance of NTM species in immunocompetent patients were investigated. METHOD: Thirty-five NTM isolates, for which species identification was requested by the treating physicians during 1999 at the Asan Medical Center, were retrospectively analyzed. They were identified to the species level by mycolic acid analysis using high-performance liquid chromatography. The medical records of the patients with the NTM isolates were reviewed to identify those patients who met the American Thoracic Society (ATS)'s criteria for mycobacterial pulmonary infection. Their antimicrobial susceptibility data were compared with the clinical outcomes. RESULTS: The NTM were identified as M. intracellulare (6 isolates), M. avium (5), M. abscessus (5), M. gordonae (5), M. terrae complex (4), M. szulgai (2), M. kansasii (2), M. fortuitum (2), M. peregrinum (1), M. mucogenicum (1), M. celatum (1), and M. chelonae (1). All 35 patients showed clinical symptoms and signs of chronic lung disease, but none had a HIV infections; 16 (45.7%) patients were found to be compatible with a NTM pulmonary infection according to the ATS criteria, 5 and 4 cases were affected with M. intracellulare and M. abscessus, respectively; 8 patients had a history of pulmonary tuberculosis. 13 patients received antimycobacterial therapy for an average of 21 months and 9 patients were treated with second-line drugs. Only 4 patients had improved radiologically. CONCLUSION: A NTM should be considered a potential pathogen of pulmonary infections in immunocompetent patients with chronic pulmonary diseases. Most NTM infections were left untreated for a prolonged period and showed a poor outcome as a result. M. intracellulare and M. abscessus were the two most frequent causes of NTM pulmonary infections in this study. Species identification and antimycobacterial susceptibility tests based on the species are needed for the optimum management of a NTM pulmonary infection in patients.

Enterococcus gallinarum carrying both vanA and vanC1 genes were detected from a surveillance culture from a patient staying at the surgical intensive care unit for a few years. E. gallinarum, SI04, was highly resistant to vancomycin (MIC of >or=256ng/mL) and teicoplanin (MIC of >or=256ng/mL). Multiplex PCR for vanA, vanB, vanC1 and vanC2/3 genes revealed SI04 to be positive for both vanA and vanC1 genes. This finding supports the fact that genotyping is needed to classify vancomycin-resistant enterococci (VRE). This is the first report on VanC VRE accompanying vanA gene in Korea.
Enterococcus* ; Humans ; Critical Care ; Korea ; Multiplex Polymerase Chain Reaction ; Teicoplanin ; Vancomycin

BACKGROUND: Glutaraldehyde is used most commonly as a high-level disinfectant for semicritical patient-care equipments. However, its potential toxicity to healthcare workers and a long exposure time needed to kill mycobacteria can be problematic. Recently, Perasafe(R) (Antec International, UK) has been introduced in the market as a safe and very effective disinfectant. This study was to evaluate the efficacy of Perasafe(R) against not only bacteria and yeast but also mycobacteria and bacterial spores and compare it with glutaraldehyde. MATERIAL AND METHOD: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Mycobacterium tuberculosis, and Bacillus subtilis were used for the test. Perasafe(R) and Cidex(R) were used at the final concentration of 1.62% and 2.25%, respectively; the disinfectants were neutralized by Tween 80 (0.5%) in the mycobacterial test and by lecithin (0.75%) in all other tests. Bacterial suspensions were made in phosphate buffer with or without fetal bovine serum (1%) to simulate dirty or clean conditions, respectively. The disinfectants were tested at 0, 24 and 48 hr of preparation to check stability. An effective disinfectant activity was defined as a 5 log10 reduction in viable counts. RESULTS: E. coli, S. aureus, P. aeruginosa and C albicans were effectively disinfected in less than 5 min by both Perasafe(R) and Cidex(R) and the both disinfectants remained equally effective under the dirty conditions or at 48 hr of preparation. Perasafe(R) was effective in 1 min against B. subtilis spores compared to Cidex(R) which took 30 min for the same activity. M. tuberculosis was effectively disinfected in 10 min by Perasafe(R) and 20 min by Cidex(R). CONCLUSIONS: Perasafe(R) showed greater tuberculocidal and sporicidal activities than Cidex(R), although both disinfectants were equally effective against common bacterial and yeast pathogens. Perasafe(R) may be an outstanding high-level disinfectant for endoscopes and other semicritical medical equipment.
Bacillus subtilis ; Bacteria* ; Candida albicans ; Delivery of Health Care ; Disinfectants ; Endoscopes ; Escherichia coli ; Glutaral ; Lecithins ; Mycobacterium tuberculosis ; Polysorbates ; Pseudomonas aeruginosa ; Spores ; Spores, Bacterial* ; Staphylococcus aureus ; Suspensions ; Tuberculosis ; Yeasts*

Yersinia pseudotuberculosis is a relatively infrequent cause of human infections, mostly as intestinal yersinosis. A septicemic form of Y. pseudotuberculosis infection has been reported only rarely. It is usually seen in patients with underlying disorders such as diabetes, hepatic cirrhosis or iron overload. A 63-year-old man with diabetes mellitus and liver fibrosis was admitted to Asan Medical Center via emergency department because of epigastric pain, fever and watery diarrhea; he was septic. The stool culture did not grow Salmonella, Shigella, or Yersinia. But, in the blood culture Y. pseudotuberculosis grew from one anaerobic vial among two sets of aerobic and anaerobic blood cultures. Serotype of Y. pseudotuberculosis strain was could not be determined because it was a rough type. The isolate was positive in the autoagglutination test and polymerase chain reaction for the virF gene. The serum levels of iron, TIBC and ferritin were within normal range. The patient received ceftriaxone therapy for 3 days and was discharged with a clinical improvement.
Ceftriaxone ; Chungcheongnam-do ; Diabetes Mellitus ; Diarrhea ; Emergency Service, Hospital ; Ferritins ; Fever ; Humans ; Iron ; Iron Overload ; Liver Cirrhosis ; Middle Aged ; Polymerase Chain Reaction ; Reference Values ; Salmonella ; Sepsis* ; Shigella ; Yersinia pseudotuberculosis* ; Yersinia*

BACKGROUND: It is well established that automated blood culture systems require no more than five days of incubation for the detection of the majority of pathogens. It is not clear, however, whether continuous monitoring of blood culture systems also routinely require five days of incubation. This study was conducted to determine the clinical impact of incubating blood cultures for 4 days rather than for 5 days using the BACTEC 9240 blood culture system. METHODS: During the 6-month period from July to November 1998, 22,167 blood cultures were performed. Positive culture sets and the isolates were sorted by times to detection of isolates. Chart reviews were done for isolates detected on day 3 or later to determine whether therapy was changed due to this blood culture result. RESULTS: Of 2,426 isolates (2,319 positive cultures), 2,344 (96.6%) were recovered within 3 days and 52 (2.1%) were recovered on day 4, and 30 (1.2%) on day 5. Chart reviews showed that 21 of the 52 isolates detected on day 4 were considered clinically significant and 10 of those affected the treatment of the patients. On day 5, 5 of the 30 isolates were considered clinically significant and 3 of those affected the treatment. CONCLUSIONS: Four-days rather than a 5-day incubation period reduced culture sensitivity by 1.2% but most of those were clinically irrelevant. These data suggest that the 4-day protocol for the BACTEC 9240 system is adequate for detection of positive blood cultures.
Humans

BACKGROUND: Although enriched broth cultures have been recommended as an adjuvant to the direct plating of tissue and body fluid specimens, the cost-effectiveness of broth cultures has been questioned in regard with the clinical significance of "broth only isolates(BOI)". The purpose of this study was to investigate the usefulness of thioglycollate broth(THIO) cultures. METHODS: We reviewed retrospectively results in the culture specimens of body fluids, tissue biopsies, and puses received during the month of July 1997. All specimens were inoculated into THIO in addition to agar plates. We reviewed the medical records of culture-positive patients to determine the clinical significance and relevance of their isolates. Clinically significant isolates were defined as those for which an appropriate antimicrobial therapy was done except one judged as contaminants by clinicians and clinically relevant isolates as the clinically significant one isolated first. RESULT: Of 2,008 specimens, 512(25.4%) from 365 patients grow 561 isolates 464 plate isolates and 97 BOI. Two hundred eighty nine(62.3%) of the 464 isolates from plate cultures were clinically significant, compared to only 12(12.4%) of 97 BOI (P<0.05). Only four (4.1%) BOI were clinically relevant, including one Pseudomonas aerugiosa from ascites. one Klebsiella pneumoniae and two Staphylococcus aureus from tissue specimens. CONCLUSION: A routine use of enriched broth culture rarely recover clinically relevant isolates. Considering the laboratory and medical costs of the recovery of contaminants and clinically irrelevant isolates, the enrichment broth cultures should be used more selectively.
Agar ; Ascites ; Biopsy ; Body Fluids ; Humans ; Klebsiella pneumoniae ; Medical Records ; Pseudomonas ; Retrospective Studies ; Staphylococcus aureus

BACKGROUND: Rapid and reliable identification of Candida albicans becomes more important because the incidence of yeast infections has increased in recent years. Murex C. albicans 50(CA50) assay was developed for rapid and presumptive identification of C. albicans. We evaluated the CA50 assay to identify C. albicans. METHOD: Seventy four yeast isolates from clinical specimens were tested with CA50 and germ tube test. They were identified to species level by API 20C and chlamydospore agar test. RESULT: Of the 74 isolates, 52 were C. albicans and 22 were non-albicans Candida. The sensitivity and specificity for CA50 were 88.5% and 86.4%, respectively. The sensitivity and specificity of the germ tube test using human serum were 88.5% and 90.9% respectively, and those using fetal bovine serum(FBS) were 92.3% and 90.9% respectively. CONCLUSION: CA50 was a rapid and easy-to-perform test, and it was comparable to germ tube test in regard of sensitivity and specificity.
Agar ; Candida albicans* ; Candida* ; Humans ; Incidence ; Sensitivity and Specificity ; Yeasts

BACKGROUND: Kluyvera, a new genus in the family Enterobacteriaceae, has been rarely isolated from clinical specimens and regarded as an opportunistic pathogen. Although there were several case reports in Korea, most of them were reported at a genus level except a case of K. cyrocrescens. We isolated Kluyvera species from seven patients from July 1996 to January 1999. We identified them to species level and investigated their clinical significance. METHODS: The medical records of seven patients were reviewed for demographical findings, underlying diseases, diagnoses, the association of Kluyvera isolates with disease, antibiotic treatments, and clinical outcomes. Eight strains were identified and tested for the antimicrobial susceptibilities by MicroScan Neg Combo type 14 and 21 Panel(Dade Behring, USA). Five of the eight strains had been stored at -70degrees C and were tested for ascorbate fermentation, the ability to grow and ferment glucose at 5degrees C, and the zone of inhibition around carbenicillin and cephalothin. RESULTS: Kluyvera isolates were regarded as true pathogens in six of seven cases including Hickman-catheter associated sepsis(HCAS), empyema, peritonitis, necrotizing cholecystitis, sepsis, and liver abscess although the latter four cases yielded mixed cultures. While three of the six patients had underlying diseases, malignant lymphoma, hepatocellular carcinoma and stomach cancer, other three were previousely healthy. Most of them were improved with an empirical therapy, but Kluyvera species was repeatedly isolated from the HCAS case in spite of the antibiotic treatment; it was cured bacteriologically after the removal of the catheter. The five isolates were all confirmed to be K. ascorbata by positive ascorbate test, and failure to grow at 5degrees C. CONCLUSIONS: Six of the seven cases including three with no underlying diseases, isolates of Kluyvera species were found clinically significant, suggesting that Kluyvera species is potentially pathogenic in healthy individuals as well as compromized hosts. MicroScan system is capable of identifying Kluyvera species at the genus level, but not at the species level. The ascorbate test is simple and useful for differ entiation of K. ascorbata from K. cryocrescens.
Carbenicillin ; Carcinoma, Hepatocellular ; Catheters ; Cephalothin ; Cholecystitis ; Diagnosis ; Empyema ; Enterobacteriaceae ; Fermentation ; Glucose ; Humans ; Kluyvera* ; Korea ; Liver Abscess ; Lymphoma ; Medical Records ; Peritonitis ; Sepsis ; Stomach Neoplasms

BACKGROUND: Group B streptococci (GBS) are major cause of meningitis and septicemia in neonates and pregnant women, but the importance in non-pregnant adults has not been clearly defined. METHODS: Medical records of all patients with group B streptococcal bacteremia from 1988 to 1997 at Asan Medical Center were reviewed. We compared the clinical and laboratory findings of non-pregnant adults to those of neonates. RESULTS: In a 8-year period there were 41 patients with GBS bacteremia. Thirteen (31.7%) patients were neonates (mean age 14.0+/-11.5 day) and 28 (68.3%) were non-pregnant adults (mean age 52.8+/-13.3 year). Community-acquired infections were 2 cases (15.4%) in the neonates and 7 cases (25.0%) in the non-pregnant adults. In the non-pregnant adults, the most common clinical diagnosis was bacteremia without identified source (15 cases, 53.6%). The others were bone or joint infection (6), urinary tract infection (4), pneumonia (2), skin infection (2), peritonitis (2), and meningitis (1). GBS bacteremia was more common in old age (50 years, 20 cases, 71.4%), the presence of diabetes mellitus (10), solid tumors (10) and liver cirrhosis (10). The mortality rate in non-pregnant adults was 35.7% (10 cases), accounting for 10.7% (3) of deaths related to GBS. In the neonates, early onset infection were 5 cases (38.5%) and late onset infection were 8 (61.5%). The presumed portal of entries were bacteremia without identified focus (5 cases, 38.5%), and meningitis (8, 61.5%). The mortality rate in the neonates was 23.1% (3 cases) and 7.1% (1) related to GBS bacteremia. CONCLUSION: GBS bacteremia is a serious problem not only in the neonates and pregnant women but also in the non-pregnant adults, especially those who are elderly patients with significant underlying diseases.
Adult* ; Aged ; Bacteremia* ; Chungcheongnam-do ; Community-Acquired Infections ; Diabetes Mellitus ; Diagnosis ; Female ; Humans ; Infant, Newborn* ; Joints ; Liver Cirrhosis ; Medical Records ; Meningitis ; Mortality ; Peritonitis ; Pneumonia ; Pregnant Women ; Sepsis ; Skin ; Urinary Tract Infections

BACKGROUND/AIMS: Conventional disinfectants are expensive, hazardous, and often require long periods of exposure. The aim of this study was to evaluate the effectiveness of a new endoscopic disinfector (Cleantop(R)) that uses superoxidized water (SW) as a disinfectant. METHODS: Immediately after patient examinations, endoscopes were cleaned manually and disinfected with SW for seven minutes. Cultures were taken from valves (swabbing), biopsy channels (rinsing), and biopsy channels after brushing (rinsing). The results were compared with those of other disinfectants tested previously by the same culture methods. RESULTS: Of 12 endoscopes disinfected with SW, disinfection rates were 83.3%, 58.3% and 25% at valves, channels and channels after brushing, respectively. In no instances were more than 100 colony forming units (cfu) of bacteria recovered from each endoscope. SW was similar to peroxygen compound (33.3%, 50%, 50%) and 2% glutaraldehyde (100%, 16.7%, 16.7%) in its disinfectant effect, since 100 or more cfu of bacteria were recovered only from endoscopes disinfected with peroxygen compound. The number of bacterial recovered from endoscopes disinfected with 2% glutaraldehyde was less than 10 cfu. CONCLUSIONS: Disinfection with SW appears to be an effective and time-saving alternative to conventional disinfectants.
Bacteria ; Biopsy ; Disinfectants ; Disinfection* ; Endoscopes ; Glutaral ; Humans ; Stem Cells ; Water*