Anaerobiospirillum succiniciproducens is a spiral-shaped, gram-negative anaerobic bacterium. A. succiniciproducens is a rare cause of bacteremia in human, especially immunocompromised patients. This organism may be mistakenly identified when using an automated bacterial identification system, and may be mistaken for Campylobacter spp. when using Gram staining. We report a case of bacteremia caused by A. succiniciproducens, which was negative for catalase, oxidase, and urease and confirmed by 16S rRNA sequencing (analysis revealed a 99% similarity), in a 69-year-old patient who was undergoing chemotherapy for treatment of a malignancy. To the best of our knowledge, this is the first report of bacteremia caused by A. succiniciproducens in Korea.
Aged ; Anaerobiospirillum ; Bacteremia ; Campylobacter ; Catalase ; Humans ; Immunocompromised Host ; Korea ; Oxidoreductases ; Urease

Cryptococcus neoformans (C. neoformans) is a ubiquitous yeast-like fungus that has been a common opportunistic human pathogen, especially in immunocompromised patients. Although skin lesions due to C. neoformans are found in 10-15% of patients with systemic cryptococcosis, primary cutaneous cryptococcosis without systemic infection is rare and now considered a distinct clinical entity. We report a case of primary cutaneous cryptococcosis in a patient with iatrogenic Cushing's syndrome. A 73-year-old woman presented with pain and discharge from lesions on her left forearm. The patient had been treated with oral corticosteroids for 20 years, and as a result had developed iatrogenic Cushing's syndrome. A skin fragment of the ulcer was cultured, and the encapsulated fungus were isolated and identified as C. neoformans using a Vitek2 system (Vitek2 ID-YST, bio Merieux, France) and API 20C (bioMerieux). Concurrent blood and urine cultures were negative for growth. At first, she was treated with antibiotics due to suspicion of cellulitis. After surgical resection and treatment with systemic and oral fluconazole, her wound was improved with scar. Primary cutaneous cryptococcosis should be considered when skin lesions are not responsive to antibiotics and accurate identification is important for proper treatment.
Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Cellulitis ; Cicatrix ; Cryptococcosis ; Cryptococcus neoformans ; Cushing Syndrome ; Female ; Fluconazole ; Forearm ; Fungi ; Humans ; Immunocompromised Host ; Skin ; Ulcer

The authors calculated the number of blood cultures per 1,000 admitted patient days at seven university-affiliated hospitals in 2010, which ranged from 65 to 129 (mean 110). The number of blood cultures per 1,000 patient days could possibly be a good parameter for assessing the appropriateness of blood culture.
Humans ; Korea ; Quality Control ; Sepsis

BACKGROUND: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been used for the identification of bacteria worldwide. To our knowledge, the evaluation of MALDI-TOF MS for the identification of bacteria in Korea has not been studied. In this paper we compared the identification results of aerobic bacteria using MALDI-TOF MS to those results using conventional biochemical methods. METHODS: We evaluated the performance of a MALDI-TOF MS system (Bruker Daltonics, Leipzig, Germany) on consecutive aerobic isolates collected from January to February of 2011 which were identified using conventional methods (biochemical testing and commercial identification kits). Either directly smearing onto the target plate or protein extraction methods were additionally used if no reliable or discordant results were obtained. RESULTS: Among 523 isolates tested, 506 (97%) isolates had valid scores (> or =2.0), 11 (2%) isolates gave intermediate scores (1.7< or = score <2.0), and 6 (1%) isolates yielded no reliable identification (score <1.7). Of the 506 valid results (score > or =2.0) by MALDI-TOF MS, the identification matched at the species level in 486 (96%) isloates, matched at the genus level in 17 (3%) isloates, and was discordant at the genus and species levels in 3 (1%) isloates. CONCLUSION: The overall matching rate at the species level of MALDI-TOF MS was very high. When MALDI-TOF MS did not yield reliable results by direct smear, additional direct smears or protein extraction methods could be used to obtain better results. Our results showed that MALDI-TOF MS is a very useful method for the identification of aerobic bacteria isolated in clinical microbiology laboratories.
Bacteria ; Bacteria, Aerobic ; Korea ; Mass Spectrometry

BACKGROUND: Parainfluenza virus (PIV) is a significant cause of acute respiratory infections. Epidemiological information on PIV infection could be very helpful for patient management. The aim of this study was to investigate the epidemiology of PIV infection in Seoul and a neighboring area with regard to PIV type. METHODS: The diagnosis of PIV infection was made by virus isolation. The R-mix Too cell system (Diagnostic Hybrids, Inc., Athens, OH, USA) and D3 Ultra DFA Respiratory Virus Screening & ID kits (Diagnostic Hybrids, Inc.) were used for virus culture and identification. The medical records of patients with positive virus cultures were reviewed retrospectively. RESULTS: Seven hundred and ten PIV viruses (5.6%) were isolated from 12,723 specimens. The number of subjects with PIV type III, I and II was 357, 304 and 49, respectively. PIV infection showed a peak incidence in the first year of life regardless of subtypes. The most common diagnosis among all PIV subtypes was pneumonia. Lower respiratory tract infections constituted the majority (76.3%) of PIV infections. The most common diagnosis of PIV type I and II was croup and that of PIV type III was pneumonia. A difference in seasonal variation between subtypes was observed. PIV I (62.2%) was mainly isolated from July to September while PIV type III (86.8%) was isolated from April to July. CONCLUSION: Lower respiratory infection was most commonly found in hospitalized patients with PIV infection. Clinical features of PIV infection were similar those seen in Western PIV reports, with the exception of the seasonal outbreak pattern.
Chimera ; Croup ; Humans ; Incidence ; Mass Screening ; Medical Records ; Parainfluenza Virus 1, Human ; Paramyxoviridae Infections ; Pneumonia ; Respiratory Tract Infections ; Seasons ; Viruses

BACKGROUND: The female genital tract is equipped to deal with a variety of foreign substances including a wide array of microorganisms. It is important to consider Candida-bacterial interactions in balance between healthy colonization versus vaginitis. The objectives of this study were to evaluate the association between microorganism distribution and vaginitis, and to investigate the possibility of an interaction between vaginal Candida and other microorganisms in female genital tract. METHODS: A total of 516 vaginal secretions were collected between October 2008 and June 2010 from patients with suspected vaginitis. Identification of Candida species and detection of 6 fastidious microorganisms (Trichomonas vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum) were performed using a VITEK 2 system (bioMerieux, Inc., Hazelwood, MO, USA) and multiplex PCR (Seegene, Biotechnology, Inc., Seoul, Korea), respectively. RESULTS: M. genitalium, U. urealyticum, and C. trachomatis were more often detected in association with vaginal candidiasis. A statistically significant association between Candida and M. genitalium was observed (P<0.05). N. gonorrhoeae was detected less often in women with vaginal candidiasis. CONCLUSION: The results of this study suggest the possibility that vaginal Candida may associate with some microorganisms in patients with vaginitis. Further studies will be required to define the Candida-bacterial interactions and its mechanisms.
Bacteria ; Biotechnology ; Candida ; Candidiasis ; Chlamydia trachomatis ; Colon ; Female ; Humans ; Microbial Interactions ; Multiplex Polymerase Chain Reaction ; Mycoplasma genitalium ; Mycoplasma hominis ; Neisseria gonorrhoeae ; Trichomonas vaginalis ; Ureaplasma ; Vaginitis

The global emergence and spread of multidrug resistant bacterial infections in communities and hospitals has become an important issue in public health. The resistance rate of gram-positive cocci to vancomycin and the resistance rate of several gram-negative bacilli against cefotaxime and carbapenem have been continuously increasing. Surveillance of antimicrobial resistance is essential for providing information on the magnitude of and trend in multidrug resistance. Therefore, beginning 2011, more robust and effective management is to be legally required for six multidrug-resistant bacteria that have been linked to healthcare-related infections: vancomycin-resistant Staphylococcus aureus (VRSA), vancomycin-resistant enterococci (VRE), methicillin-resistant S. aureus (MRSA), multidrug-resistant Pseudomonas aeruginosa (MRPA), multidrug-resistant Acinetobacter baumannii (MRAB), and carbapenem-resistant Enterobactericeae (CRE). We have also performed laboratory-based sentinel surveillance for VRSA/VISA since 2002 and carbapenemase-producing Enterobacteriaceae since November, 2010. This article reviews the national surveillance programs, and molecular epidemiology of multidrug-resistant bacteria.
Acinetobacter baumannii ; Bacteria ; Bacterial Infections ; Cefotaxime ; Drug Resistance, Multiple ; Enterobacteriaceae ; Gram-Positive Cocci ; Methicillin Resistance ; Molecular Epidemiology ; Nitriles ; Pseudomonas aeruginosa ; Public Health ; Pyrethrins ; Sentinel Surveillance ; Staphylococcus aureus ; Vancomycin

BACKGROUND: The isolation of nontuberculous mycobacteria (NTM) has been increasing worldwide as well as its clinical importance. The aim of this study was to investigate the distribution and clinical significance of NTM that has been isolated from respiratory specimens during a recent two-year period at a tertiary hospital. METHODS: We analyzed respiratory samples that were obtained between January 2009 and December 2010 for AFB culture. We retrospectively reviewed the electronic medical records of these patients to obtain both clinical and radiologic information. NTM pulmonary disease was defined by using the guidelines provided by the America Thoracic Society/Infectious Diseases Society of America. RESULTS: Among the 1,601 specimens that resulted in a positive AFB culture, 310 (19.4%) were NTM. In 189 patients, the most common isolate was M. avium-intracellulare complex (MAC) (127, 67.2%), which was then followed by M. abscessus (31, 16.4%), M. fortuitum (10, 5.3%), M. kansasii (9, 4.8%), and other NTM species. Of these, 93 (49.2%) patients were diagnosed with NTM pulmonary disease. MAC, M. abscessus, and M. kansasii were more virulent than the other species. None of the cases of NTM pulmonary disease were caused by M. fortuitum, M. chelonae, M. peregrinum, M. terrae complex, or M. gordonae. CONCLUSION: In Korea, the prevalence of NTM isolates is increasing, as are the cases of pulmonary disease. The pathogenic potential of NTM differs enormously by species and as a result the treatment of NTM lung disease depends on which species has caused the infection. The isolation and identification of NTM isolated from respiratory specimens are mandatory in order for clinical microbiology laboratories to make an accurate diagnosis and suggest the proper treatment of the NTM disease.
Americas ; Electronic Health Records ; Humans ; Korea ; Lung Diseases ; Nontuberculous Mycobacteria ; Prevalence ; Retrospective Studies

BACKGROUND: The aim of the present study was to investigate the epidemiologic characteristics of extrapulmonary tuberculosis (EPTB) in Korea. In addition, the results of culture-confirmed (CC) EPTB were compared with those of clinically-diagnosed (CD) EPTB. METHODS: We retrospectively reviewed non-duplicate data of tuberculosis from the Samsung Medical Center from 1995 to 2010. A total of 6,249 and 38,726 cases of tuberculosis were CC and CD EPTB cases, respectively. The cases were categorized according to the type of specimen or by the clinically-affected sites. RESULTS: The proportions of EPTB among all tuberculosis cases were 12% (745/6,249) and 22% (8,608/38,726) of the CC and CD cases, respectively. The distribution of both age and gender between pulmonary tuberculosis (PTB) and EPTB cases were significantly different (P<0.001). The most common types of EPTB were tuberculous lymphadenitis, pleural TB, and abdominal TB. Pleural involvement was more common in males, while lymph node involvement was observed more frequently in females in both the CC and CD cases (M/F ratio in regards to pleura were 1.63 and 2.08, while M/F ratio in regards to the lymph node were 0.46 and 0.54). CONCLUSION: The dataset of EPTB cases in Korea was first evaluated over a 16-year period and compared the cases of CC EPTB to those of CD EPTB. The epidemiologic characteristics of EPTB were different from that of PTB as well as the EPTB of other countries. The present study might provide useful information regarding the epidemiology of EPTB in Korea and other countries.
Female ; Humans ; Korea ; Lymph Nodes ; Male ; Pleura ; Retrospective Studies ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary

BACKGROUND: Clostridium difficile is the main etiologic agent of antibiotic-associated diarrhea and the most common cause of hospital-acquired diarrhea. Recently, the incidence of C. difficile infections (CDI) has increased and new highly virulent C. difficile strains have emerged. Therefore, accurate and rapid diagnosis is needed. We compared the results of using chromID C. difficile (chromID CD, bioMerieux, France) with the conventional C. difficile Selective Agar (CDSA; BD, USA) for the isolation of C. difficile. METHODS: A total of 738 stool specimens of suspected CDI patients at the Severance Hospital from July to August 2011 were inoculated onto CDSA. Among them, 104 stool specimens revealed colonies on CDSA that were then re-inoculated onto chromID CD. The stool samples were stored at -20degrees C until the time of the re-inoculation. Cultured agars were interpreted after 24 hrs and 48 hrs, respectively. Species identification was performed on the basis of colony characteristics on agar plates as well as the ATB 32A system (API System SA, France). RESULTS: The recovery rates of CDSA and chromID CD were 30.1% and 77.5% after 24 hrs, and 77.5% and 98.6% after 48 hrs, respectively. All of the C. difficile isolates were recovered as typical gray/black colonies on chromID CD. CONCLUSION: The performance of chromID CD for the isolation of C. difficile was better than that of conventional CDSA. The chromID CD could provide easy and sensitive detection of C. difficile even after 24hrs of incubation.
Agar ; Clostridium ; Clostridium difficile ; Diarrhea ; Humans ; Incidence