Antibacterial drugs are one of the most important therapeutic agents of bacterial infections but multidrug resistant Escherichia coli (MDREC) is an increasing problem worldwide. Major resistance mechanism of MDREC is horizontal gene transfer of R plasmids harboring integrons, which the integron integrase (IntI) catalyzes gene cassette insertion and excision through site specific recombination. In this study, resistance profiles of integron harboring E. coli isolated in Korea and the genetic environments of integron gene cassettes were analyzed by PCR and direct sequencing to clarify the mechanisms of spread of integron harboring E. coli. Resistance rates of integron harboring E. coli, including β-lactams, aminoglycosides, and fluoroquinolones and MDR frequencies were significantly higher than that of E. coli without integron (p < 0.01). Majority (80%) of integron harboring E. coli showed resistance transfer by conjugation. Most (80%) of E. coli had dfrA17-aadA5 cassette array and PcH1 hybrid promoter; 16.7% of E. coli had dfrA12-orfF-aadA2 cassette array and PcW promoter. The higher prevalence of weak Pc variants among most (96.7%) of integron harboring MDREC suggests that a flexible cassette array is more important than enhanced expression. All the integrons had LexA binding motif suggests that SOS responses control the expression of these integrons. In conclusion, the genetic bases of integrons were diverse, and the spread and the expression of prevalent gene cassette arrays may be deeply related with strengths of Pc promoters in integrons. These informations will provide important knowledge to control the increase of integron harboring MDREC.
Aminoglycosides ; Bacterial Infections ; Escherichia coli ; Escherichia ; Fluoroquinolones ; Gene Transfer, Horizontal ; Integrases ; Integrons ; Korea ; Polymerase Chain Reaction ; Prevalence ; R Factors ; Recombination, Genetic ; SOS Response (Genetics)

PURPOSE: The goal of this study was to characterize the patterns of antimicrobial resistance and virulence genes in samples of Staphylococcus aureus (S. aureus) isolated from periodontitis patients. METHODS: From July 2015 to August 2015, oral saliva was collected from a total of 112 patients diagnosed with periodontitis, including 80 outpatients in dental hospitals and 32 patients in dental clinics located in Seoul and Cheonan. The samples were subjected to a susceptibility test to evaluate the prevalence of antimicrobial resistance, and the pathogenic factors and antimicrobial resistance factors in the DNA of S. aureus were analyzed using polymerase chain reaction. RESULTS: A susceptibility test against 15 antimicrobial agents showed that 88% of cultures were resistant to ampicillin, 88% to penicillin, and 2% to oxacillin. Resistance to at least two drugs was observed in 90% of cultures, and the most common pattern of multidrug resistance was to ampicillin and penicillin. Enterotoxins were detected in 65.9% of samples. The cell hemolysin gene hld was detected in 100% of cultures and hla was detected in 97.6% of samples. All strains resistant to penicillin and ampicillin had the blaZ gene. The aph(3')IIIa gene, which encodes an aminoglycoside modifying enzyme, was detected in 46.3% of samples. CONCLUSIONS: In the treatment of oral S. aureus infections, it is important to identify the pathogenic genes and the extent of antimicrobial resistance. Furthermore, it is necessary to study patterns of antimicrobial resistance and cross-infection in the context of periodontological specialties in which antimicrobials are frequently used, such as maxillofacial surgery, where the frequency of antimicrobial use for minor procedures such as implant placement is increasing.
Ampicillin ; Anti-Infective Agents ; Chungcheongnam-do ; Dental Clinics ; DNA ; Drug Resistance, Multiple ; Enterotoxins ; Humans ; Mouth* ; Outpatients ; Oxacillin ; Penicillins ; Periodontitis* ; Polymerase Chain Reaction ; Prevalence ; R Factors ; Saliva ; Seoul ; Staphylococcus aureus* ; Staphylococcus* ; Surgery, Oral ; Virulence

Children with chronic illness are known to have an increased risk of emotional and behavioral problems. Many studies have been conducted to identify risk and resistance factors associated with differences in adjustment among these children. It is a major theoretical framework of the Wallander and Varni model that modifiable risk and resistance factors can be identified empirically. Risk factors in the original model include disease/ disability parameters, functional dependence in the activities of daily living, and psychosocial stressors. Resistance factors in the original model are delineated in three categories: intrapersonal factors such as competence, temperament; socialecological factors such as family psychological environment, social support; and stressprocessing factors such as cognitive appraisal and coping strategies. In addition, it is proposed that the factors such as age of onset, certainty of diagnosis and prognosis of illness affect adjustment. Children with chronic illness are known to have an increased risk of emotional, behavioral, academic problems. Research findings show that children with chronic illnesses are at a higher risk for developing emotional problems such as anxiety, depression, social withdrawal and low self-esteem. The parents of children with Type 1 diabetes and asthma reported emotional and behavioral problems more. Also children with chronic illness tend to more behavior problems than healthy peers. Especially, increased risk of children with neurological conditions is explained by the lower level of cognitive functioning. The association of poor school performance with type I diabetes and sickle cell anemia is proposed.
Activities of Daily Living ; Affective Symptoms ; Age of Onset ; Anemia, Sickle Cell ; Anxiety ; Asthma ; Behavioral Symptoms ; Child ; Chronic Disease ; Depression ; Humans ; Mental Competency ; Parents ; Prognosis ; R Factors ; Risk Factors ; Social Environment

INTRODUCTIONAt the time of the study, 3 plasmid-borne qnr determinants (qnrA, qnrB and qnrS) and 1 plasmid-borne aminoglycoside-modifying enzyme determinant that confers quinolone resistance (aac(6')-Ib-cr) had been described in the literature.

MATERIALS AND METHODSWe studied the prevalence of the 3 qnr determinants in a total of 117 nalidixic acid-resistant urinary isolates of Klebsiella pneumoniae (61 isolates) and Escherichia coli (56 isolates) using multiplex polymerase chain reaction (PCR). Further, a subset of the original strains (comprising 14 E. coli and 38 K. pneumoniae) showing reduced susceptibility to the aminoglycosides underwent PCR for aac(6')-Ib, followed by restriction digestion with BtsCI to detect the variant aac(6')-Ib-cr.

RESULTSTwenty-eight of 61 (45.9%) Klebsiella isolates were found to possess at least 1 qnr determinant. Only 1/56 (1.8%) E. coli isolates were found to possess a qnr determinant. Two of the Klebsiella isolates possessed 2 qnr determinants each (qnrB and qnrS). The predominant determinant was qnrB (19 isolates). There were 11 isolates harbouring qnrS, and only 1 with qnrA. 1/14 (7.1%) E. coli and 35/38 K. pneumoniae (92.1%) were found to possess aac(6')-Ib-cr. There was pairwise association between each of qnr, aac(6')-Ib-cr and the presence of an extended-spectrum beta-lactamase.

CONCLUSIONSA high prevalence of plasmid-mediated quinolone resistance determinants [i.e., qnrS, qnrB and aac(6')-Ib-cr] was found in quinolone-resistant K. pneumoniae isolated in a large hospital in Singapore.

Drug Resistance, Bacterial ; Escherichia coli ; drug effects ; isolation & purification ; Hospitals ; Humans ; Klebsiella pneumoniae ; drug effects ; isolation & purification ; Molecular Sequence Data ; Quinolones ; pharmacology ; R Factors ; Singapore ; Urine ; microbiology

The frequency of antibiotic resistance among Salmonella enterica serovar Typhimurium has increased due to the transfer of multiple resistance factors. We detected the 13 antibiotic resistance genes by multiplex-PCR and compared with the results of phage typing and antibiotic disk diffusion for 49 S. typhimurium isolated from food-poisoning outbreaks in Seoul from 1999 to 2002. Resistance genes for tetracycline, streptomycin, ampicillin, sulfonamide, amino-glycoside-modifying enzyme, chloramphenicol, kanamycin, and trimethoprim were detected in 67.3%, 57.1%, 26.5%, 8.1%, 8.1%, 5%, 2.0%, and 0% of isolates, respectively. Overall 28 isolates (57.1%) possessed two or more antibiotic resistance genes. Class 1 integron carrying multidrug resistace genes, ant(3")-IaB, blaPSE, qacE delta1/sul, and tet G were amplified especially in only DT104 isolates. Among the related resistance genes for same antibiotics, strA and strB for streptomycin resistance were simultaneously detected but tetA and tetB for tetracycline were sporadically detected. DT 104 isolates contained only aadA2 and tetG.
Ampicillin ; Anti-Bacterial Agents ; Bacteriophage Typing ; Chloramphenicol ; Diffusion ; Disease Outbreaks ; Drug Resistance, Microbial ; Humans ; Integrons ; Kanamycin ; R Factors ; Salmonella enterica* ; Salmonella* ; Seoul* ; Streptomycin ; Tetracycline ; Trimethoprim

Forty-seven ampicillin-resistant R plasmids derived from 218 Shigella sonnei isolates from Daegu and Gwangju areas from 1980 to 2000 were epidemiologically compared by fragments of restriction endonuclease patterns by EcoRI and SmaI, and by Southern hybridization with a blaTEM-1 probe. All the ampicillin-resistant strains isolated in the 1980S carried a conjugative R plasmid responsible for multiple resistance other than ampicillin, and an ampicillin-resistance plasmid. Ampicillin-resistant strains isolated in the 1990S harbored single conjugative R plasmid encoding ampicillin resistance along with variable antimicrobial resistances. The restriction endonuclease digestion patterns and Southern hybridiztion analysis of conjugative R plasmids showing identical resistance pattern and a same size showed different fragment and Western blotting patterns according to different isolation years and areas, while identical patterns were observed among the plasmids derived from a same isolation year and area. These findings suggest that ampicillin resistance among S. sonnei isolates was due to introduction of ampicillin-resistant R plasmids originated from different sources.
Ampicillin Resistance* ; Ampicillin* ; Blotting, Western ; Daegu ; Digestion ; DNA Restriction Enzymes ; Gwangju ; Plasmids ; R Factors ; Shigella sonnei* ; Shigella*

The study was performed on 90 Salmonella typhi strains isolated from patients in Hanoi, Hue and Ho Chi Minh city. The results showed that: the multi-antibiotic resistant Salmonella typhi strains have already spread over the country; 2 plasmid with size about 120 kilobase (Kb) and 102 Kb. Plasmid 120 Kb is conjugated, self-transmitted R-plasmid and carrying at least 5 antibiotic resistant genes to chloramphenicol, ampicillin, tetracycline and trimethoprim/sulfamethoxazole. The initial analysis by a restricted enzyme of EcoRi showed that these self-transmitted R-plasmid in S.typhi strains isolated in 3 areas Hanoi, Hue and Hochiminh city maybe the same origin.
Salmonella typhi ; R Factors ; epidemiology

Thirty-four Shigella sonnei isolates from 6 outbreaks and sporadic cases from May 1999 until January 2000 in Daegu and 9 regions of Gyeongsangbuk-Do were epidemiologically analyzed by plasmid profiling, pulsed-field gel electrophoresis (PFGE), and hybridization with 2 antimicrobial resistance gene probes, tetA and dfrA1. In outbreak cases, resistance pattern in all of the strains was identical: they were resistant to tetracycline (Tc), streptomycin (Sm), sulfisomidine (Su), trimethoprim (Tp), and nalidixic acid (Na). In sporadic cases, Tc, Sm, Su, Na, ampicillin (Ap), and kanamycin (Km) pattern and TcSmSuTpApNa pattern were additionally observed. Isolates from the same outbreak showed identical plasmid profile and PFGE pattern. Most of different outbreak strains and sporadic strains showed different plasmid profiles, and identical or different PFGE patterns, while all of the isolates shared common tetA gene on a non-conjugative 18.3 kbp R plasmid carrying resistance to tetracycline, streptomycin, and sulfisomidine, and dfrA1 gene on the chromosome. Non-conjugative R plasmids derived from all of the isolates were confirmed to be identical by the Southern hybridization analysis of restriction endonuclease treated or non-treated plasmid profiles using the tetA probe. The same strains also reacted with dfrA1 probe at the same-sized DNA fragment (60 kbp) on pulsed-field gel electrophoresis of total genomic DNA. Our findings suggested that epidemic strains of Shigella sonnei prevalent in the Daegu and Gyeongsangbuk-Do area during the test period should have originated from an identical or closely related strain source although most of strains did not show the same plasmid profile and PFGE pattern.
Ampicillin ; Daegu ; Disease Outbreaks ; DNA ; DNA Restriction Enzymes ; Electrophoresis, Gel, Pulsed-Field ; Gyeongsangbuk-do ; Kanamycin ; Nalidixic Acid ; Plasmids ; R Factors ; Shigella sonnei* ; Shigella* ; Streptomycin ; Sulfisomidine ; Tetracycline ; Trimethoprim

Clinical isolates of Enterobacteriaceae (189 Klebsiella, 61 Enterobacter, 32 Serratia, 19 E. coli, 7 Proteus, and 3 Citrobacter) from one university hospital were epidemiologically analyzed by using transferable R plasmids resistant beta-lactam antibiotics including broad-spectrum cephalosporins. About 30% of E. cloacae and S. marcescens and about 5% of K. pneumoniae were resistant to one or more broad-spectrum j3-lactam antibiotics including cefotaxim, ceftazidime, aztreonam, or cefoxitin but all isolates of E. aerogenes, K oxytoca, and P. mirabilis were susceptible. Thirty-six conjugative R plasmids including 8 plasmids resistant expanded-spectrum cephalosporins were obtained from multiple resistant K. pneumoniae (19), E. cloacae (9), E. coli (4), and C. freundii (1). Thirty-one plasmids were subjected to R plasmid analysis and classified 20 different plasmid types. Among them 5, 2, and 2 plasmids belong to 3 different types respectively showed identical molecular size, endonuclease fragment pattern by Southem hybridization pattern by TEM-1 probe, pI value by isoelctric focusing, and also identical antibiogram and biotype of wild strains harboring plasmids. But all of plasmids resistant to cefotaxim, ceftazidime, aztreonam or cefoxitin showed different palsmid anlysis patterns. These results indicate that the epidemic strains of 3 clonal types had been present in this hospital and anlysis using transferable R plasmid and bla gene can be used to discriminate multi-resistant clinical isolates of Enterobacteriaceae.
Anti-Bacterial Agents* ; Aztreonam ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Cephalosporins ; Cloaca ; Dermatoglyphics* ; Enterobacter ; Enterobacteriaceae* ; Klebsiella ; Microbial Sensitivity Tests ; Mirabilis ; Plasmids* ; Pneumonia ; Proteus ; R Factors ; Serratia

One hundred and thirty trimethoprim-resistant R plasmids derived from of Escherichia coli isolated from clinical specimens and feces of healthy collegians were examined for incompatibility, EcoRI endonuclease restriction fragment pattern, and Southern hybridization with DHFR I, II, III, V, and VII probe. 1. Most trimethoprim-resistant R plasmids were resistant to ampicillin, tetracycline, chloramphenicol, gentamicin, and kanamycin, and showed multiple drug resistance and various antimicrobial resistance patterns. 2. Trimethoprim-resistant R plasmids ranged from 90 to 50 kilobase and 42.3% of R plasmids tested were classified to incompatibilty group Inc FI, Inc FII or Inc FIV, 3. Among 48 random selected R plasmids from various origin, 14 R plasmids (including 9 of 14 Inc FII plasmids and 3 of 14 Inc FI plasmids) hybridized with DHFR VII oligonucleotide probe but others did not respond to any of DHFR probes used. 4. Most R plasmids showed various EcoRI endonuclease fragments and different reaction sites by Southern hybridization. Six plasmids showed identical or nearly identical molecular weight, EcoRI endonuclease fragment patterns and different sites of Southern hybridization. But 2 Inc FII plasmids derived from urine and feces showed identical pattern. These findings, if confirmed by further studies, suggest that normal flora E. coli can act as reservoir of resistant genes and, consequently, as a factor in the dissemination of these genes among enteric pathogens and need to be examined further.
Ampicillin ; Chloramphenicol ; Deoxyribonuclease EcoRI ; Drug Resistance, Multiple ; Escherichia coli* ; Escherichia* ; Feces ; Gentamicins ; Immunodeficiency Virus, Feline ; Kanamycin ; Molecular Biology* ; Molecular Weight ; Plasmids ; R Factors ; Tetracycline ; Trimethoprim Resistance* ; Trimethoprim*