Streptococcus bovis bacteremia in humans has been traditionally associated with infective endocarditis, colorectal cancer, and liver cirrhosis. S. bovis strains were previously categorized by biotype, but since the 2000s, they have been reclassified by DNA homology. We report a case of S. gallolyticus subsp. gallolyticus bacteremia, identified by 16S rRNA sequencing, in a patient diagnosed with liver cirrhosis. A 61-yr-old man with a history of liver cirrhosis presented to the hospital with a complaint of fever. Blood culture revealed the presence of gram-positive cocci, and the isolated organism was identified as S. bovis by the MicroScan identification kit (Beckman Coulter, USA), but as Enterococcus saccharolyticus by the Vitek 2 identification kit (bioMérieux, USA). The organism was finally confirmed as S. gallolyticus subsp. gallolyticus by 16S rRNA sequencing.
Bacteremia* ; Colorectal Neoplasms ; DNA ; Endocarditis ; Enterococcus ; Fever ; Gram-Positive Cocci ; Humans ; Liver Cirrhosis* ; Liver* ; Streptococcus bovis ; Streptococcus*

Although neutrophils function in both defense and tissue destruction, their defensive roles have rarely been studied in association with periodontitis. We hypothesized that peripheral neutrophils are pre-activated in vivo in periodontitis and that hyperactive neutrophils would show enhanced phagocytic ability as well as an increased production of reactive oxygen species (ROS). Peripheral blood neutrophils from patients with aggressive periodontitis and age/gender-matched healthy subjects (10 pairs) were isolated. The levels of CD11b and CD64 expression on the neutrophils and the level of plasma endotoxin were determined by flow cytometry and a limulus amebocyte lysate test, respectively. In addition, neutrophils were subjected to a flow cytometric phagocytosis assay and luminol-enhanced chemiluminescence for non-opsonized Fusobacterium nucleatum in parallel. The neutrophilsfrom most patients expressed increased levels of both CD11b and CD64. In addition, the plasma from these patients tended to contain a higher level of endotoxin than the healthy controls. In contrast, no differences were found between the two groups with regard to phagocytosis or ROS generation by F. nucleatum. The ability to phagocytose F. nucleatum was found to positively correlate with the ability to produce ROS. In conclusion, peripheral neutrophils from patients with aggressive periodontitis are hyperactive but not hyperreactive to F. nucleatum.
Aggressive Periodontitis ; Flow Cytometry ; Fusobacterium nucleatum ; Horseshoe Crabs ; Humans ; Luminescence ; Neutrophils ; Periodontitis ; Phagocytosis ; Phenotype ; Plasma ; Reactive Oxygen Species

BACKGROUND: Staphylococcus saprophyticus is the second most common cause of urinary tract infections (UTIs) in young women. As little is known about the incidence of UTIs caused by this organism in Korea, we examined its frequency and clinical characteristics. METHODS: We analyzed the frequency of S. saprophyticus among organisms isolated from urine specimens in Wonju Christian Hospital from July 1996 to June 2008 and reviewed clinical characteristics retrospectively. RESULTS: Of 24,277 strains isolated from urine specimens during the past 12 years, 21 (0.09%) were S. saprophyticus. Outpatients were more common in the S. saprophyticus group than in all patients group (12 of 21, 57% vs 5,098 of 24,277, 21%). The incidence of S. saprophyticus in women was the highest in the group of 15 to 34 years of age. Monthly distributions of isolates were almost constant in all patient groups, while 16 of 21 (76%) cases of the S. saprophyticus group occurred in summer and fall (June to November). CONCLUSION: The fequencies of S. saprophyticus among organisms isolated from urine specimens in all patient groups and women were 0.09% and 0.17%, respectively, and are much lower than those in other countries. However, we need further studies to examine the prevalence of S. saprophyticus UTIs in other regions of this country.
Female ; Humans ; Incidence ; Korea ; Outpatients ; Prevalence ; Staphylococcus ; Staphylococcus saprophyticus ; Urinary Tract ; Urinary Tract Infections

BACKGROUND: Increased resistance rates to macrolide-lincosamide-streptogramin B (MLSB) antibiotics among clinical isolates of staphylococci are considered as a consequence of an expanded use of these antibiotics in the treatment of Gram-positive infections. The proportion of MLSB resistance phenotypes of staphylococci is quite different by geographical variations and study periods. The aim of the present study was to determine the distribution of MLSB resistance phenotypes among clinical isolates of staphylococci in a university hospital. METHODS: The MLSB resistance phenotypes of clinical isolates of staphylococci were investigated by the double-disk diffusion test using erythromycin and clindamycin disks. RESULTS: Of 7,916 isolates, 55.7% exhibited a constitutive resistance phenotype (cMLSB) whereas 8.1% expressed an inducible resistance phenotype (iMLSB). Among 3,419 coagulase-negative staphylococci (CNS), 32.6% and 10.0% exhibited cMLSB and iMLSB resistance phenotypes, respectively. Of 4,497 Staphylococcus aureus isolates, 73.1% and 6.8% were cMLSB and iMLSB resistance phenotypes, respectively. cMLSB was detected among 90.2% of methicillin-resistant S. aureus (MRSA), 46.5% of methicillin-resistant CNS (MRCNS), 3.2% of methicillin-susceptible CNS (MSCNS), and 2.2% of methicillin-susceptible S. aureus (MSSA). iMLSB was detected among 16.5% of MSSA, 11.5% of MRCNS, 6.7% of MSCNS, and 4.4% of MRSA. CONCLUSION: MLSB resistance was more prevalent among S. aureus isolates than CNS strains. Although cMLSB was the most frequently detected resistance phenotype among the total staphylococcal isolates, methicillin-susceptible strains exhibited somewhat higher iMLSB resistance rates compared with methicillin-resistant strains.
Anti-Bacterial Agents ; Clindamycin ; Diffusion ; Erythromycin ; Methicillin Resistance ; Phenotype ; Staphylococcus aureus

BACKGROUND: It is well-known that silver ions and silver compounds are broad-spectrum antimicrobial agents effective against gram-positive and gram-negative bacteria, and yeasts. Thus, silver ions, as an antibacterial agent, have been used in the components of materials used in medical devices or coatings. Recently, advances in nanotechnology have enabled manufacturers to develop silver particles of a nanometer size with a safer and more effective antimicrobial activity. So, we evaluate the antimicrobial activity of nanoSilver-coated gauze against clinical isolates. METHODS: Three kinds of nanoSilver-coated gauzes (100A, 800A, and 1,500A) were tested for antimicrobial activity by the disk diffusion method. The organisms tested included clinical isolates of nonfermentative gram-negative bacilli (143 isolates), aerobic gramnegative bacteria (188), aerobic gram-positive bacteria (397), anaerobic bacteria (46), and yeasts (161), and three reference ATCC strains. RESULTS: The susceptible rates to NanoSilver of nonfermentative gram-negative bacilli (NFB), aerobic gramnegative bacteria and aerobic gram-positive bacteria were 87%, 87% and 78%, respectively. Antimicrobial activity of NanoSilver against imipenem-resistant NFB, extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, and methicillin-resistant Staphylcoccus aureus (MRSA) was similar to that against imipenem-sensitive NFB, ESBL non-producing Enterobacteriaceae, and methicillin-susceptible S. aureus. CONCLUSION: NanoSilver-coated gauze exhibits broad spectrum antimicrobial activities to a large number of gram-negative and gram-positive bacteria including imipenem-resistant NFB, ESBL producing Enterobacteriaceae, and MRSA.
Anti-Infective Agents ; Bacteria ; Bacteria, Anaerobic ; beta-Lactamases ; Diffusion ; Enterobacteriaceae ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Ions ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Nanotechnology ; Silver ; Silver Compounds ; Yeasts

BACKGROUND: Accurate detection of extended spectrum beta-lactamase (ESBL) is important because ESBLproducing organisms may appear susceptible to oxyimino- beta-lactams in standard susceptibility tests, but are considered to be clinically resistant to these drugs. And continued monitoring of isolation trend of ESBL-producing organisms is essential for the guideline settlement of antibiotic usage and infection control program. METHODS: Disk diffusion test using the Clinical and Laboratory Standards Institute's ESBL phenotypic confirmatory test were performed on 5,511 clinical isolates of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis during the recent six years (April 2001-March 2007). The ESBL producer was defined as an organism showing an increase in the zone diameter of > or =5 mm for either cefotaxime or ceftazidime with clavulanic acid versus that without clavulanic acid (CTC confirmatory test, CZC confirmatory test, respectively). RESULTS: The ESBL-positive rates were 34.8% in K. pneumoniae, 9.3% in K. oxytoca, 8.4% in E. coli, and 6.5% in P. mirabilis. Among the ESBL-positive organisms, the detection rates of ESBL CTC and CZC confirmatory tests were as follows: 91.3% vs 68.7% in K. pneumoniae, 96.3% vs 44.4% in K. oxytoca, 94.8% vs 45.4% in E. coli, and 100% vs 20% in P. mirabilis. ESBL-producing K. pneumoniae had shown a continuously increasing trend from 24.3% in 2001 to 46.4% in 2006. CONCLUSION: Both of the ESBL confirmatory tests should be simultaneously tested for the accurate detection of ESBL-producing K. pneumoniae, K. oxytoca, E. coli, and P. mirabilis. In addition, an active infection control approach is needed for ESBL-producing K. pneumoniae.
beta-Lactamases* ; beta-Lactams ; Cefotaxime ; Ceftazidime ; Clavulanic Acid ; Diffusion ; Escherichia coli* ; Escherichia* ; Infection Control ; Klebsiella oxytoca ; Klebsiella pneumoniae ; Klebsiella* ; Mirabilis ; Pneumonia ; Proteus mirabilis* ; Proteus*

BACKGROUND: The association of Streptococcus bovis biotypes with the type of clinical infection and underlying malignancies and data on antimicrobial susceptibility of S. bovis have rarely been reported in Korea. The aim of this investigation was to characterize the clinical features of patients with S. bovis bacteremia, and to determine the antimicrobial susceptibility of S. bovis strains isolated from blood cultures. METHODS: The clinical data of 67 S. bovis isolates between May 1998 and April 2005 at Wonju Christian Hospital were retrospectively analyzed. The organism was identified by API Strep 32 kit and, for blood isolates, antimicrobial susceptibility testing was performed by the disk diffusion method and penicillin MICs were determined by E test. RESULTS: Of the 67 S. bovis isolates, 18 (27%) were biotype I and 49 (73%) were biotype II. Isolation rates by specimen type were, in decreasing order, wound. 37%; blood, 19%; and urine, 12%. Of the 13 S. bovis bacteremias, 2 were caused by biotype I and 11 were by biotype II; liver diseases (46%) were the most common underlying diseases; none of the 13 patients had gastrointestinal malignancies; one and three isolates were intermediate and resistant to penicillin, respectively; eleven were resistant to erythromycin; two and five were intermediate and resistant to clindamycin, respectively. CONCLUSION: Most of the S. bovis isolates from blood were biotype II. Liver diseases were the most common underlying diseases. S. bovis isolates from blood displayed a high rate of resistance to erythromycin and clindamycin.
Bacteremia* ; Clindamycin ; Diffusion ; Erythromycin ; Gangwon-do ; Humans ; Korea ; Liver Diseases ; Penicillins ; Retrospective Studies ; Streptococcus bovis* ; Streptococcus* ; Wounds and Injuries

Verotoxin-producing Escherichia coli O157 is a primary cause of severe and bloody diarrhea. Campylobacter spp. are one of the commonly reported bacterial cause of gastrointestinal infections throughout the world. Only a few cases involving both E. coli O157 and Campylobacter species have been reported. The authors simultaneously isolated verotoxin-producing E. coli O157 and Campylobacter species from the stool of a 3 year-old male with bloody diarrhea, fever and abdominal pain.
Abdominal Pain ; Campylobacter* ; Child, Preschool ; Diarrhea ; Escherichia coli O157* ; Escherichia coli* ; Escherichia* ; Fever ; Gastroenteritis* ; Humans ; Male ; Shiga Toxins ; Shiga-Toxigenic Escherichia coli

Cystic retrochiasmatic craniopharyngioma may reach enormous size by expanding into the posterior fossa along the retroclival area, which is very unusual finding. An 11-year-old girl presented with walking disturbance and irritability. On the neurological examination, she had positive Babinski sign, hyperactive deep tendon reflex, and left lateral gaze nystagmus. She also had right hearing disturbance. Initial magnetic resonance(MR) images revealed a huge, thin capsuled cystic mass which extended into the cerebellopontine angle down to the medulla oblongata. Secondary adjuvant chemotherapy, radiotherapy, and reoperation were necessary after first tumor removal by a suboccipital approach, due to the progression of disease. Finally, neurological condition was much improved without remnant tumor although some sequelae were remained. We report this interesting case because of its rarity, complex clinical presentation, and challenge in its management.
Cerebellopontine Angle ; Chemotherapy, Adjuvant ; Child ; Craniopharyngioma* ; Female ; Hearing ; Humans ; Medulla Oblongata* ; Neurologic Examination ; Radiotherapy ; Reflex, Babinski ; Reflex, Stretch ; Reoperation ; Walking

OBJECTIVE: The purpose of this study is to review retrospectively 28 patients with re-operation due to complications related to instrumentation from thoracic and lumbar spinal fusion surgery. METHODS: A total of 285 patients underwent spinal fusion surgery with instrumentation between 1996 and 2000. Of these, 11 men and 17 women(mean age 46 years, range 21 to 69 years) presented with complications related to instrumentation. Previous surgery was preformed for vertebral column instability secondary to fracture(4), spondylolisthesis(12), failed back surgery syndrome(7), osteomyelitis(1), herniated nuclus pulposus(4). All patients underwent repeated spinal surgery including removal of instrument, new instrument fixation, or I & D. The mean follow-up period after second operation was 19 months. RESULTS: The complications related instrumentation system include six interbody fusion system retropulsion, eight screw loosenings, five screw fractures, three screw malpositions, three osteomyelitis, and one donor site infection. After repeated surgery, eight became asymptomatic and did not require further treatment, but eleven showed persistent low back pain without neurological deficits and the remaining nine continued to have nerve root deficits. CONCLUSION: In conclusion, spinal fusion surgery with instrumentation offers an immediate postoperative stability of the thoracic and lumbar spine and enhances early fusion. However, it may be associated with few, but significant, complications which may permanantly. The proper selection of patients and meticulous surgical technique for surgery are probably the most important factors associated good outcomes and prevention of complications.
Follow-Up Studies ; Humans ; Low Back Pain ; Male ; Osteomyelitis ; Retrospective Studies ; Spinal Fusion* ; Spine ; Spondylolisthesis ; Tissue Donors