Mycobacterium abscessus is the second most important pathogen in pulmonary disease caused by nontuberculous mycobacteria (NTM), following Mycobacterium avium. Mycobacterium abscessus is classified into three subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Mycobacterium abscessus is the most difficult to treat NTM due to its resistance to many antibiotics. Treatment should include an initial regimen of 2–3 injectable and oral antibiotics for several weeks or months, followed by inhaled amikacin and 1–3 oral antibiotics, depending on the subspecies and drug susceptibility patterns, including macrolide susceptibility. The continuation phase should be continued for a minimum of 12 months after culture conversion. Suitable injectable antibiotics include amikacin, imipenem, cefoxitin, and tigecycline, while oral antibiotics include macrolides (azithromycin or clarithromycin), clofazimine, linezolid, and moxifloxacin. Surgery can be a useful adjunctive therapy for some patients with refractory disease. However, the overall treatment prognosis is still unsatisfactory. Therefore, novel and more effective interventions are required for the treatment of M. abscessus pulmonary disease.
Amikacin ; Anti-Bacterial Agents ; Cefoxitin ; Clofazimine ; Humans ; Imipenem ; Linezolid ; Lung Diseases ; Macrolides ; Mycobacterium avium ; Mycobacterium ; Nontuberculous Mycobacteria ; Prognosis

ObjectiveTo evaluate the effect of cefoxitin prophylactic in reducing the incidence of severe infection after transrectal prostate biopsy (TRPB).

METHODSThis retrospective study included 155 cases of TRPB with a 5-day administration of oral levofloxacin at 200 mg bid (the control group) and another 167 cases with a 3-day administration of oral levofloxacin at the same dose plus intravenous cefoxitin at 2.0 g 2 hours before TRPB (the experimental group) according to the distribution characteristics of drug-resistance bacteria in our department. The patients of the control and experimental groups were aged (68.68 ± 8.12) and (68.72 ± 7.51) years, with PSA levels of (19.78 ± 21.57) and (21.15 ± 42.63) μg/L, involving (11.68 ± 1.44) and (11.77±1.02) biopsy cores, respectively. Comparisons were made between the two groups of patients in the incidence rate of severe infection, which was defined as lower urinary track symptoms plus the systemic inflammatory response syndrome (SIRS) within 7 days after TRPB.

RESULTSThe incidence rate of postoperative severe infection was significantly lower in the experimental group than in the control (0.6% ［1/167］ vs 5.8% ［9/155］, P < 0.05). Blood cultures revealed positive E-coli strains in 6 cases in the control group, including 5 ESBL-positive and 4 quinolone-resistant and amikacin-sensitive cases, all sensitive to cefoxitin, cefoperazone/sulbactam and imipenem. The only one case of severe infection was shown to be negative in blood culture.

CONCLUSIONSPreoperative intravenous administration of cefoxitin according to the specific distribution characteristics of drug-resistance bacteria can significantly reduce the incidence of severe infection after TRPB.

Aged ; Anti-Bacterial Agents ; therapeutic use ; Biopsy ; adverse effects ; methods ; Cefoxitin ; therapeutic use ; Drug Resistance, Bacterial ; Escherichia coli ; isolation & purification ; Escherichia coli Infections ; microbiology ; prevention & control ; Humans ; Levofloxacin ; therapeutic use ; Male ; Middle Aged ; Postoperative Complications ; blood ; prevention & control ; Prostate ; pathology ; Retrospective Studies

A 72-year-old man underwent spinal anesthesia for artificial urinary sphincter placement for urinary incontinence. After the block level was confirmed below T6, 1 g of cefotetan, which had not shown any reaction on skin test, was administered as a prophylactic antibiotic. The patient began complaining of chest discomfort and dyspnea shortly after injection. ST elevation appeared on the electrocardiogram and the patient's pulse could not be palpated. Accordingly, cardiopulmonary resuscitation was performed for 5 minutes; the patient recovered spontaneous circulation. The patient was diagnosed as experienced coronary artery spasm by coronary angiography with spasm test. Because coronary artery spasm can also develop in patients with no history of coronary artery disease and under spinal anesthesia, careful observation, suspicion of coronary artery spasm and prompt response to hemodynamic and electrocardiogram changes are necessary.
Aged ; Anesthesia, Conduction ; Anesthesia, Spinal* ; Cardiopulmonary Resuscitation ; Cefotetan ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels* ; Dyspnea ; Electrocardiography ; Heart Arrest* ; Hemodynamics ; Humans ; Skin Tests ; Spasm* ; Thorax ; Urinary Incontinence ; Urinary Sphincter, Artificial

Mycobacterium abscessus was isolated from cultures of seven blood samples from a 64-year-old diabetic female who was admitted due to steroid-unresponsive adrenal insufficiency. The isolates were difficult to identify using the conventional commercial systems, VITEK 2 (bioMérieux, France) or MicroScan (Siemens Healthcare Diagnostics, USA), but were rapidly identified as M. abscessus by a matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS)-based Bruker Biotyper system (Bruker Daltonics, USA). Identification of M. abscessus was confirmed by a reverse hybridizationbased assay (Genotype Mycobacterium CM/AS 12, Hain Lifescience) and direct sequencing of a heatshock protein gene. After removal of her central venous catheter, the patient was successfully treated with a combination therapy comprising clarithromycin, amikacin, cefoxitin, and imipenem. Our findings demonstrate that MALDI-TOF MS can facilitate rapid and accurate identification of M. abscessus from blood cultures, which enables prompt administration of appropriate therapy following catheter removal.
Adrenal Insufficiency ; Amikacin ; Bacteremia* ; Catheters ; Cefoxitin ; Central Venous Catheters ; Clarithromycin ; Delivery of Health Care ; Diagnosis* ; Female ; Humans ; Imipenem ; Mass Spectrometry* ; Middle Aged ; Mycobacterium*

Cefotetan is a commonly prescribed second-generation cephalosporin that acts against a wide range of bacteria. However, cefotetan-induced hypersensitivity has rarely been reported. We report 2 cases of cefotetan-induced anaphylaxis with immunologic evaluation. The first case was a 70-year-old asthmatic woman who had dyspnea and hypotension during administration of cefotetan, in which high serum-specific IgE to cefotetan-human serum albumin (HSA) conjugate was detected by enzyme-linked immunosorbent assay. The second case was a 63-year-old asthmatic woman who complained of chest tightness and dyspnea during cefotetan infusion, in which high serum-specific IgG1 and IgG4 with no serum specific IgE to cefotetan-HSA conjugate was detected. The basophil activation test using basophils from the patient showed a significant up-regulation of CD63 with the addition of anti-IgG4 antibody compared with that in non-atopic healthy controls. In conclusion, cefotetan can induce anaphylaxis, which may involve both IgE- and IgG4-mediated responses in the pathogenic mechanism.
Aged ; Anaphylaxis* ; Bacteria ; Basophils ; Cefotetan ; Dyspnea ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypersensitivity ; Hypotension ; Immunoglobulin E ; Immunoglobulin G ; Middle Aged ; Serum Albumin ; Thorax ; Up-Regulation

To analyze the regularity in combined medication with Xiyanping injection (Xiyanping for short) in the real world by as- sociation rules. Totally 5 822 patients using Xiyanping injection was collected from the 18 Class III Grade I hospitals nationwide to study the combined medication information of the patient with lung infection and make the analysis by using association rules and Apriori. According to the results, major drugs combined with Xiyanping in treatment of lung infection included compound amino acid, inosine, coenzyme A, cytidine triphosphate, vitamin C. Common drugs combined with Xiyanping can be divided into 5 categories: nutrition support therapy (vitamin C, compound amino acid) , coenzymes (coenzyme A, cytidine triphosphate, inosine), expectorants and antiasthmatics (ambroxol, salbutamol, doxofylline), hormones (dexamethasone, budesonide), antibiotics (mainly cefminox). The main combined medicines mostly conformed to the regularity for drugs treating lung infection. In addition, there were two most common medical combination models: the model for Xiyanping combined a single medicine is Xiyanping + nutrition support therapy, while the model for Xiyanping combined two or more than two medicines is Xiyanping + nutrition support therapy + coenzyme. Pharmacologically, Xiyanping is mostly combined with western medicines with similar pharmacological effects to substitute or supplement the antibiotic effect in treating lung infection. However, further studies shall be conducted for the safety and rationality of the combined medication based on clinical practices, in order to provide reference for clinical medication.
Adult ; Anti-Bacterial Agents ; administration & dosage ; Ascorbic Acid ; administration & dosage ; Cephamycins ; administration & dosage ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Hospital Information Systems ; Humans ; Lung Diseases ; drug therapy ; Male ; Middle Aged ; Young Adult

BACKGROUND: Periodic monitoring of regional or institutional resistance trends of clinically important anaerobic bacteria is recommended, because the resistance of anaerobic pathogens to antimicrobial drugs and inappropriate therapy are associated with poor clinical outcomes. There has been no multicenter study of clinical anaerobic isolates in Korea. We aimed to determine the antimicrobial resistance patterns of clinically important anaerobes at multiple centers in Korea. METHODS: A total of 268 non-duplicated clinical isolates of anaerobic bacteria were collected from four large medical centers in Korea in 2012. Antimicrobial susceptibility was tested by the agar dilution method according to the CLSI guidelines. The following antimicrobials were tested: piperacillin, piperacillin-tazobactam, cefoxitin, cefotetan, imipenem, meropenem, clindamycin, moxifloxacin, chloramphenicol, metronidazole, and tigecycline. RESULTS: Organisms of the Bacteroides fragilis group were highly susceptible to piperacillin-tazobactam, imipenem, and meropenem, as their resistance rates to these three antimicrobials were lower than 6%. For B. fragilis group isolates and anaerobic gram-positive cocci, the resistance rates to moxifloxacin were 12-25% and 11-13%, respectively. Among B. fragilis group organisms, the resistance rates to tigecycline were 16-17%. Two isolates of Finegoldia magna were non-susceptible to chloramphenicol (minimum inhibitory concentrations of 16-32 mg/L). Resistance patterns were different among the different hospitals. CONCLUSIONS: Piperacillin-tazobactam, cefoxitin, and carbapemems are highly active beta-lactam agents against most of the anaerobes. The resistance rates to moxifloxacin and tigecycline are slightly higher than those in the previous study.
Agar ; Bacteria, Anaerobic* ; Bacteroides fragilis ; Cefotetan ; Cefoxitin ; Chloramphenicol ; Clindamycin ; Gram-Positive Cocci ; Imipenem ; Korea ; Metronidazole ; Piperacillin

In this study, 78 isolates of Escherichia coli isolated from Korean beef cattle farms were investigated for the production of extended-spectrum beta-lactamase (ESBL) and/or AmpC beta-lactamase. In the disc diffusion test with ampicillin, amoxicillin, cephalothin, ceftiofur, cefotaxime, ceftazidime, and cefoxitin, 38.5% of the isolates showed resistance to all of ampicillin, amoxicillin, and cephalothin. The double disc synergy method revealed that none of the isolates produced ESBL or AmpC beta-lactamases. DNA sequencing showed that all isolates encoded genes for TEM-1-type beta-lactamase. Moreover, 78.2% of the isolates transferred the TEM-1-type beta-lactamase gene via conjugation. In plasmid replicon typing of all donors, IncFIB and IncFIA were identified in 71.4% and 41.0% of plasmids, respectively. In transconjugants, IncFIB and IncFIA were the most frequent types detected (61.5% and 41.0%, respectively). Overall, the present study indicates that selection pressures of antimicrobials on beta-lactamases in beef cattle may be low relative to other livestock animals in Korea. Moreover, to reduce selection pressure and dissemination of beta-lactamase, the long-term surveillance of antimicrobial use in domestic beef cattle should be established.
Amoxicillin ; Ampicillin ; Animals ; beta-Lactamases* ; Cattle* ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Cephalothin ; Diffusion ; Escherichia coli* ; Escherichia* ; Humans ; Korea ; Livestock ; Plasmids* ; Replicon* ; Sequence Analysis, DNA ; Tissue Donors

BACKGROUND: Antimicrobial surveillance is important for providing an up-to-date understanding of the epidemiology of antimicrobial resistance and for creating a forum for rational drug development. In this study, we analyzed antimicrobial test data generated in 2011 by hospitals and commercial laboratories participating in the Korean Nationwide Surveillance of Antimicrobial Resistance program (KONSAR). MATERIALS AND METHODS: Data on the results of susceptibility tests conducted in 32 hospitals and two commercial laboratories were analyzed. Data on isolates from patients admitted to an intensive care unit (ICU) and those admitted to other wards were compared. Intermediate susceptibility was not analyzed and duplicate isolates were excluded. RESULTS: Escherichia coli was the most prevalent organism identified in both the hospital and commercial laboratories. Among the hospital isolates, methicillin-resistant Staphylococcus aureus (MRSA), penicillin G-non-susceptible Streptococcus pneumoniae, and ampicillin-resistant Enterococcus faecium remained as prevalent as they were in 2009. The proportion of vancomycin-resistant E. faecium (VR-EFM) slightly decreased from 29% in 2009 to 23% in 2011. Resistance rates of Klebsiella pneumoniae to ceftazidime, cefoxitin, fluoroquinolone, and amikacin were 24%, 14%, 27%, and 8%, respectively. Resistance rates of Pseudomonas aeruginosa to fluoroquinolone, ceftazidime, imipenem, and amikacin were 33%, 20%, 22%, and 16%, respectively, whereas those of Acinetobacter spp. resistance were 71%, 66%, 64, and 51%, respectively. The prevalence of oxyimino-cephalosporin-resistant E. coli and K. pneumoniae, carbapenem-resistant Acinetobacter spp. and P. aeruginosa, MRSA, and VR-EFM among ICU isolates was higher than those among non-ICU isolates. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae, imipenem-resistant P. aeruginosa, and VR-EFM were more prevalent among isolates from commercial laboratories than those from hospitals. Resistance rates of K. pneumoniae to ceftazidime and amikacin decreased from 32% and 24% in 2005 to 24% and 8% in 2011, respectively. The resistance rate of P. aeruginosa to amikacin decreased from 22% in 2005 to 16% in 2011. The proportion of imipenem-resistant Acinetobacter spp. increased from 16% in 2005 to 64% in 2011. CONCLUSIONS: The prevalence of MRSA, penicillin G-non-susceptible S. pneumoniae, and ampicillin-resistant E. faecium among clinical isolates tested in laboratories remained high. Multidrug resistance was more prevalent among isolates from ICUs. The prevalence of ceftazidime-resistant and amikacin-resistant K. pneumoniae and amikacin-resistant P. aeruginosa decreased after 2005, while the prevalence of imipenem-resistant Acinetobacter spp. increased.
Acinetobacter* ; Amikacin ; Cefoxitin ; Ceftazidime ; Drug Resistance, Multiple ; Enterococcus faecium ; Epidemiology ; Escherichia coli ; Humans ; Imipenem ; Intensive Care Units ; Klebsiella pneumoniae ; Korea ; Methicillin-Resistant Staphylococcus aureus ; Penicillins ; Pneumonia ; Prevalence* ; Pseudomonas aeruginosa ; Salmonella* ; Staphylococcus ; Streptococcus pneumoniae

BACKGROUND: Epidermal cyst is a common acquired skin cyst. When such cysts may be inflamed, they are often referred to as being infected. To clarify the etiology of inflamed epidermal cysts, several studies have carried bacteriology of inflamed and uninflamed epidermal cyst and sought to identify the role of micro-organisms. OBJECTIVE: The aim of this study is to evaluate the bacterial influences on inflammatory process of epidermal cysts and the antibiotic sensitivity of cultured aerobic bacteria in epidermal cysts. METHODS: We carried out the bacterial cultures using sterile swabbing internal materials in each cyst which has been incised after surgical removals of epidermal cyst. An inflamed epidermal cyst was defined as a known cyst that developed a fluctuant soft-tissue swelling surrounded by the erythema and contained a localized collection of purulent material. For the aerobic culture, samples were cultured on blood agar plates, McConkey agar plate and chocolate agar plates in 5% CO2 at 35degrees C for 5 days. Colonies formed were identified based on VITEK2 system. Then antimicrobial susceptibility test were also done on VITEK2 system. RESULTS: Total of 100 epidermal cyst specimens from 96 patients (67 men and 29 women) were involved had confirmed histopathological findings by dermatologists. Seventy were from face and neck, 24 from trunk, 4 from the extremities, 2 from buttock. Of the 53 inflamed cysts, 30 (56.6%) yielded bacterial growth. On the other hand, from the 47 uninflamed cysts, 15 (31.9%) cyst resulted in bacterial growth (p=0.013). The predominant bacteria from inflamed and uninflamed cyst were coagulase-negative Staphylococci (32 isolate of 45 specimens, 71.1%). All cultured bacteria were susceptible to almost all of antibiotics except amoxicillin/clavulanic acid, ampicillin, benzylpenicillin, cefoxitin, cephalothin, fucidic acid, piperacillin, piperacillin/Tazobactam. CONCLUSION: Our study showed that CoNS was predominant in inflamed cysts, which strongly suggests that aerobic bacteria play a role in the inflammatory process and treatment with antibiotics is necessary for epidermal cyst.
Agar ; Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Bacteria, Aerobic ; Bacteriology ; Buttocks ; Cacao ; Cefoxitin ; Cephalothin ; Epidermal Cyst ; Erythema ; Extremities ; Hand ; Humans ; Male ; Neck ; Penicillin G ; Piperacillin ; Skin