BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.
Cefotaxime ; Humans ; Immunization Programs ; Korea ; Levofloxacin ; Multiplex Polymerase Chain Reaction ; Penicillins ; Pneumococcal Vaccines ; Pneumonia ; Serogroup ; Streptococcus pneumoniae ; Streptococcus ; Vaccines

The aim of this study was to determine antimicrobial susceptibility of recent clinical Stenotrophomonas maltophilia isolates from Korea, and to compare the activity levels of several combinations of antimicrobials. A total of 206 non-duplicate clinical isolates of S. maltophilia was collected in 2010 from 11 university hospitals. Antimicrobial susceptibility testing was performed using the Clinical Laboratory Standards Institute agar dilution method. In vitro activity of antimicrobial combinations was tested using the checkerboard method. The susceptibility rates to trimethoprim-sulfamethoxazole and minocycline were 96% and 99%, respectively. The susceptibility rate to levofloxacin was 64%. All of four antimicrobial combinations showed synergy against many S. maltophilia isolates. A combination of trimethoprim-sulfamethoxazole plus ticarcillin-clavulanate was most synergistic among the combinations. None of the combinations showed antagonistic activity. Therefore, some of the combinations may be more useful than individual drugs in the treatment of S. maltophilia infection. Further clinical studies are warranted to validate our in vitro test results.
Anti-Infective Agents/*pharmacology ; Gram-Negative Bacterial Infections/microbiology ; Hospitals, University ; Humans ; Microbial Sensitivity Tests ; Minocycline/pharmacology ; Ofloxacin/pharmacology ; Republic of Korea ; Stenotrophomonas maltophilia/*drug effects/isolation & purification ; Trimethoprim-Sulfamethoxazole Combination/pharmacology

Laparoscopic management is the ideal form of treatment for tubal pregnancy, most common type of ectopic pregnancy. Not only abdominal pregnancy including intraligamentary pregnancy is an rare form of ectopic pregnancy, but intraligamentary pregnancies are usually diagnosed and managed by emergency explorative laparotomy. We present the case of an intraligamentary pregnancy of a 28-year-old woman managed by laparoscopic treament without any complication.
Adult ; Emergencies ; Female ; Humans ; Laparoscopy ; Laparotomy ; Pregnancy ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Pregnancy, Tubal

Laparoscopic management is the ideal form of treatment for tubal pregnancy, most common type of ectopic pregnancy. Not only abdominal pregnancy including intraligamentary pregnancy is an rare form of ectopic pregnancy, but intraligamentary pregnancies are usually diagnosed and managed by emergency explorative laparotomy. We present the case of an intraligamentary pregnancy of a 28-year-old woman managed by laparoscopic treament without any complication.
Adult ; Emergencies ; Female ; Humans ; Laparoscopy ; Laparotomy ; Pregnancy ; Pregnancy, Abdominal ; Pregnancy, Ectopic ; Pregnancy, Tubal

Recently, we experienced a case of subacute infective endocarditis caused by A. haemolyticum on mitral valve prolapse complicated with systemic emboli, which was successfully treated with antibiotics and valve replacement surgery. To our knowledge, this is the first report to address infective endocarditis caused by A. haemolyticum in a immunocompetent patient who had mitral valve prolapse and survived with successful treatment. Greater awareness of this uncommon organism is needed to make an accurate diagnosis and perform a better clinical management in the early stage of the disease. Recommendation for the treatment of septic A. haemolyticum infections has not been established. Therefore, the treatment should be based on clinical experiences and in vitro susceptibility profiles of the individual strain. The site of infection as well as antimicrobial susceptibility profiles should be considered for appropriate antibiotics choice and decision to perform a surgical intervention.
Anti-Bacterial Agents ; Arcanobacterium* ; Diagnosis ; Endocarditis* ; Humans ; Mitral Valve Prolapse* ; Mitral Valve*

Recently, we experienced a case of subacute infective endocarditis caused by A. haemolyticum on mitral valve prolapse complicated with systemic emboli, which was successfully treated with antibiotics and valve replacement surgery. To our knowledge, this is the first report to address infective endocarditis caused by A. haemolyticum in a immunocompetent patient who had mitral valve prolapse and survived with successful treatment. Greater awareness of this uncommon organism is needed to make an accurate diagnosis and perform a better clinical management in the early stage of the disease. Recommendation for the treatment of septic A. haemolyticum infections has not been established. Therefore, the treatment should be based on clinical experiences and in vitro susceptibility profiles of the individual strain. The site of infection as well as antimicrobial susceptibility profiles should be considered for appropriate antibiotics choice and decision to perform a surgical intervention.
Anti-Bacterial Agents ; Arcanobacterium* ; Diagnosis ; Endocarditis* ; Humans ; Mitral Valve Prolapse* ; Mitral Valve*

The Mycobacterium avium-intracellulare complex (MAC) is the most common pathogen in pulmonary disease caused by a nontuberculous mycobacteria. Patients with MAC pulmonary disease tend to be older, are more likely to have underlying lung disease than tuberculosis patients. The insidious nature of MAC pulmonary disease has been emphasized in many reports because symptoms may be present for months or years before a diagnosis can be made. Most patients experience chronic coughing, which is usually productive of purulent sputum. A MAC pulmonary infection is rarely accompanied by acute respiratory symptoms and lobar pneumonic consolidation on chest radiography. We report a very rare case of M. intracellulare pulmonary disease presenting as acute pneumonia.
Cough ; Diagnosis ; Humans ; Lung Diseases ; Mycobacterium avium Complex* ; Mycobacterium avium-intracellulare Infection ; Mycobacterium* ; Nontuberculous Mycobacteria ; Pneumonia* ; Radiography ; Sputum ; Thorax ; Tuberculosis

No abstract available.

BACKGROUND: Sentinel node biopsy has emerged recently as an alternative to routine axillary node dissection in predicting axillary nodal metastasis, and various studies have shown its effectiveness in patients with breast cancer. However, there have been some controversies in clinical application because of its high false negative rate. METHODS: One hundred forty patients with breast cancer underwent operative management in consideration of the results of sentinel node biopsies at the department of surgery, Samsung Medical Center, between Sep. 1995 and Jul. 1998. Sixty-three patients with tumor sizes of T1 or less were retrospectively evaluated. Intraoperative lymphatic mappings using vital blue dye and using a combination of vital dye and a 99mTc-antimony sulphide colloid were performed for 53 patients and 10 patients, respectively. RESULTS: Patient's ages were in the third decade for 2 patients (3.2%), in the fourth decade for 18 (28.6%), in the fifth decade for 18 (28.6%), in the sixth decade for 13 (20.6%) and in the seventh decade for 12 (19.0%). An infiltrating ductal carcinoma was observed in 51 patients (81.0%), an intraductal carcinoma in 8 (12.6%), a medullary carcinoma in 2 (3.2%), an infiltrating lobular carcinoma in 1 (1.6%) and a mucinous carcinoma in 1 (1.6%). Sentinel node was detected in 42 of the 53 patients (79.2%) evaluated with vital blue dye only and in 10 of the 10 patients (100%) evaluated with a combination of vital dye and a 99mTc-antimony sulphide colloid. Among the group of T1 or less, the sensitivity rates of vital dye and the combination were 81.8% and 100% and their accuracies of them were 95.2% and 100%, respectively. The false negative rates for all cases were 12.2% and 8.3%, respectively, but they were decreased to 6.1% and even 0% for the group of T1 or less. CONCLUSIONS: The detection rate and the accuracy of sentinel node biopsy were enhanced in patients with T1 or less breast cancer. If a combination of vital dye and a radioisotope is used, sentinel node biopsy may be applied clinically in limited patients such as those with T1 or less breast cancer.
Adenocarcinoma, Mucinous ; Biopsy* ; Breast Neoplasms ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Carcinoma, Medullary ; Colloids ; Humans ; Neoplasm Metastasis ; Retrospective Studies