BACKGROUND: Many genes encoding aminoglycoside modifying enzymes (AMEs) on transposon or plasmid were transferred from one strain to another strain and inserted into a staphylococcal chromosomal cassette mec (SCCmec). There are very diverse subtypes in SCCmec type to the insertion of resistant genes. Therefore, we researched the resistance rates of antibiotics and distribution of AME genes according to SCCmec type in MRSA strains. MATERIALS AND METHODS: We isolated 640 Staphylococcus aureus from non-tertiary hospitals in 2004, detected mecA, aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia using the multiplex PCR method, tested antibacterial susceptibility disk diffusion and minimal inhibitory concentration, and determined SCCmec type. RESULTS: Of 640 S. aureus isolates, MRSA rate was 39.7% and all MRSA isolates carried mecA gene. Among 214 MRSA selected, aminoglycoside-resistant rates were 98.1% in kanamycin and tobramycin, 68.7% in gentamicin, 30.8% in amikacin, and 2.8% in netilmicin. The detection rates for aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia were 77.1%, 13.1%, and 53.3%, respectively. Also, SCCmec type was 50.9% in SCCmec type II, 16.4% in type III, and 32.7% in type IV. The genes encoding AMEs were distributed aac(6')-aph(2") (49.5%) and aac(6')-aph(2")/ant(4')-Ia (36.7%) in SCCmec type II, aph(3')-IIIa/aac(6')-aph(2") (60%) and aac(6')-aph(2") (31.4%) in type III, and aac(6')-aph(2")/ant(4')-Ia (41.4%) and ant(4')-Ia (50%) in type IV. CONCLUSION: 39.7% of S. aureus isolated from non-tertiary hospitals was resistant to methicillin. More than 90% of MRSA isolates were detected aac(6')-aph(2") in SCCmec type II and III, and ant(4')-Ia in type IV. With these results, the genes encoding AMEs may be closed related to SCCmec type.
Adenosine ; Amikacin ; Amphotericin B ; Anti-Bacterial Agents ; Diffusion ; Gentamicins ; Kanamycin ; Kanamycin Kinase ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Multiplex Polymerase Chain Reaction ; Netilmicin ; Plasmids ; Sprains and Strains ; Staphylococcus aureus ; Tobramycin

BACKGROUND: Many genes encoding aminoglycoside modifying enzymes (AMEs) on transposon or plasmid were transferred from one strain to another strain and inserted into a staphylococcal chromosomal cassette mec (SCCmec). There are very diverse subtypes in SCCmec type to the insertion of resistant genes. Therefore, we researched the resistance rates of antibiotics and distribution of AME genes according to SCCmec type in MRSA strains. MATERIALS AND METHODS: We isolated 640 Staphylococcus aureus from non-tertiary hospitals in 2004, detected mecA, aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia using the multiplex PCR method, tested antibacterial susceptibility disk diffusion and minimal inhibitory concentration, and determined SCCmec type. RESULTS: Of 640 S. aureus isolates, MRSA rate was 39.7% and all MRSA isolates carried mecA gene. Among 214 MRSA selected, aminoglycoside-resistant rates were 98.1% in kanamycin and tobramycin, 68.7% in gentamicin, 30.8% in amikacin, and 2.8% in netilmicin. The detection rates for aac(6')-aph(2"), aph(3')-IIIa, and ant(4')-Ia were 77.1%, 13.1%, and 53.3%, respectively. Also, SCCmec type was 50.9% in SCCmec type II, 16.4% in type III, and 32.7% in type IV. The genes encoding AMEs were distributed aac(6')-aph(2") (49.5%) and aac(6')-aph(2")/ant(4')-Ia (36.7%) in SCCmec type II, aph(3')-IIIa/aac(6')-aph(2") (60%) and aac(6')-aph(2") (31.4%) in type III, and aac(6')-aph(2")/ant(4')-Ia (41.4%) and ant(4')-Ia (50%) in type IV. CONCLUSION: 39.7% of S. aureus isolated from non-tertiary hospitals was resistant to methicillin. More than 90% of MRSA isolates were detected aac(6')-aph(2") in SCCmec type II and III, and ant(4')-Ia in type IV. With these results, the genes encoding AMEs may be closed related to SCCmec type.
Adenosine ; Amikacin ; Amphotericin B ; Anti-Bacterial Agents ; Diffusion ; Gentamicins ; Kanamycin ; Kanamycin Kinase ; Methicillin ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Multiplex Polymerase Chain Reaction ; Netilmicin ; Plasmids ; Sprains and Strains ; Staphylococcus aureus ; Tobramycin

A new sisomicin resistance gene sisR was cloned from sisomicin-producing Micromonospora inyoensis. The sisR fragment was obtained by PCR amplification. The primer pairs were designed based on grm gene sequence from gentamicin-producing Micromonospora purpurea. The template DNA was isolated from Micromonospora inyoensis. A series of different DNA fragments were amplified by PCR, which were sub-cloned to vector pUC19 for further identification. It was found that five specific transformants containing target DNA fragments could resist high concentrations of sisomicin (over 1000 microg/mL sisomicin). One of them designated as sisR, was then sequenced and the alignment among sisR and other related genes showed that sisR gene differs from any known genes. It was concluded that sisR gene is a sequence that has not been reported so far.
Anti-Bacterial Agents ; pharmacology ; Bacterial Proteins ; genetics ; Base Sequence ; Cloning, Molecular ; Drug Resistance, Microbial ; genetics ; Genes, Bacterial ; Micromonospora ; genetics ; Molecular Sequence Data ; Sisomicin ; pharmacology

The histopathological alterations in the vestibule due to aminoglycosides are well defined. Although there are reports comparing the vestibulotoxic effects of the many aminoglycosides, this is the first study to compare the effects of the most commonly used aminoglycosides i.e., streptomycin, gentamicin, amikacin and netilmicin administered both transtympanically and systemically. The transtympanic and systemic administration of each aminoglycoside caused similar histopathological alterations in the vestibule. The most severe degeneration in the cristae ampullaris, utriculus and sacculus was observed after streptomycine administration. The severity of the vestibular damage in terms of magnitude was in the order of streptomycine, gentamicin, amikacin, and netilmicin.
Amikacin/administration & dosage/*poisoning ; Animals ; Comparative Study ; Gentamicins/administration & dosage/*poisoning ; Guinea Pigs ; Injections, Intraperitoneal ; Netilmicin/administration & dosage/*poisoning ; Streptomycin/administration & dosage/*poisoning ; Tympanic Membrane ; Vestibule/*drug effects

PURPOSE: With the development of neonatal intensive care and the increased use of systemic antibiotics, candida sepsis has become one of the most important causes of neonatal morbidity and mortality. The purpose of this study was to investigate the prevalence rate and its associated risk factors. METHODS: We retrospectively reviewed medical records of 28 cases with candida sepsis who were admitted in the neonatal intensive care unit(NICU) of Chonnam University Hospital from July 1995 to June 2001. Twenty-nine patients without candida sepsis were enrolled for the control group to verify the risk factors. RESULTS: The overall incidence of candida sepsis was 0.61% for all NICU admissions and 3.68% for all very low birth weight infants with the gradual increase of the annual prevalance rate over time. The endotracheal intubation, percutaneous central vein catheter(PCVC), umbilical vein catheter, total parenteral nutrition, intralipid and dopamine were more applied than the control group (P<0.01 for all). The durations of mechanical ventilator care, central catheter appliance, nothing per os, and admission were also significantly longer than the control group(P<0.01 for all). Ampicillin/sulbactam, ceftazidime, amikacin, netilmicin, teicoplanin and imipenem/cilastatin were significantly more used than the control group(P<0.05). The durations of ampicillin/sulbactam, ceftazidime, netilmicin and imipenem/cilastatin administration were also proved to be significant as the risk factors(P<0.01). CONCLUSION: The average annual prevalence rate of candida sepsis in NICU for six years was 0.61% with gradual increasing tendency over time. The elimination of the above risk factors is important in decreasing neonatal morbidity and mortality associated with candida sepsis.
Amikacin ; Anti-Bacterial Agents ; Candida* ; Catheters ; Ceftazidime ; Dopamine ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal* ; Intubation, Intratracheal ; Jeollanam-do ; Medical Records ; Mortality ; Netilmicin ; Parenteral Nutrition, Total ; Prevalence* ; Retrospective Studies ; Risk Factors* ; Sepsis* ; Teicoplanin ; Umbilical Veins ; Veins ; Ventilators, Mechanical

BACKGROUND: Staphylococcus aureus is one of the most important pathogens, causing severe morbidity and fatal infections. To date rapid evolution of antibiotic resistance in S. aureus, including recent emergence of vancomycin-resistant S. aureus (VRSA), has been a serious concern and an obstacle to the effective treatment. The purpose of this study is to update the resistance patterns against aminoglycoside antibiotics which play an important role in the therapy of serious staphylococcal infections. METHODS: Clinical isolates were collected from 8 university-affiliated hospitals during the period of June 1999 to January 2001. Susceptibility tests against 9 antibiotics were performed by disk diffusion method. Minimum inhibitory concentrations (MICs) of arbekacin against non-susceptible strains were determined by microbroth dilution method RESULTS: Among total 682 isolates exclusive of consecutive ones from the same patients, 199 (29%) were from pus, 152 (22%) from respiratory specimens, 137 (20%) from blood, 38 (6%) from urine. Of 682 isolates, 588 (87%) isolates were resistant to at least one of the aminoglycosides tested. Overall prevalence of MRSA was 64% (439/682), and resistance rates of MRSA were summarized as follows; kanamycin (KM) 98%, tobramycin (TOB) 98%, gentamicin (GM) 95%, amikacin (AMK) 90%, neomycin (NEO) 63%, streptomycin (SM) 31%, netilmicin (NET) 18%, arbekacin (ABK) 13%. MRSA isolates were resistant to multiple aminoglycosides, and 88% of them were resistant to all four aminoglycosides of KM, TOB, GM, and AMK. MICs of ABK against 58 non-susceptible strains ranged from 2 to 128 microgram/mL. CONCLUSION: More than 90% of MRSA isolates were resistant against kanamycin, tobramycin, gentamicin, and amikacin. Moreover, most of MRSA isolates were multi-drug resistant to all these four aminoglycosides. Resistance rates against arbekacin and netilmicin were less than 20%. Arbekacin was the most susceptible antibiotic of the aminoglycosides tested.
Amikacin ; Aminoglycosides ; Anti-Bacterial Agents* ; Diffusion ; Drug Resistance, Microbial ; Gentamicins ; Humans ; Kanamycin ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Neomycin ; Netilmicin ; Prevalence ; Staphylococcal Infections ; Staphylococcus aureus ; Streptomycin ; Suppuration ; Tertiary Care Centers* ; Tobramycin

BACKGROUND: When pediatric patients with normal renal function were given the recommended keep-up amount of aminoglicocide for the use, they showed a better clinical symptom not indicating the poisonous without checking serum concentrations. We studied this subject against the patients who used Netimilcin in order to know if the blood creatinine significantly increases in a clinic and if it reaches the maximum and minimum concentrations without adjusting the amount and the symptom of infection and the result get better. METHODS: We picked the maximum concentration of drugstuffs 30 minutes after injection and its minimum just prior to the next injection within 24~32 hours with a vein injection of 2 mg/kg/dose Netilmicin with the 8 hours difference against 16 patients at the age between 3 months and 14 years. We measured the blood creatinine at the beginning of the treatment and at the closing, and we decided the medicine serum concentration with TDX system and we counted the result of Pharmaco-kinetic parameter with Simkin PC clinical Database system. To check the patients' result of better clinical conditions, leukocyte values and the temperature were measured 72 hours after the treatment. The analysis of statistics was performed with the use of paired t-test. RESULTS: The average age of 16 patients shows 3.5+/-3.2, average weight 15.2+/-8.5 kg, the leukocyte value first 14.9+/-6.6X10X10X10/mm3, and 72 hours after the treatment it shows 6.6+/-1.9X10X10X10/mm3, average temperature fell from 37.7+/-1 celsius into 36.3+/-0.4 celsius. The average drug amount taken in case of patients showed 2.06+/-0.4, the average treatment period was 7.6+/-2.3 days, the maximum serum concentration shows 5.5+/-1.1 mg/mL, the minimum concentration shows 0.5+/-0.3 mg/mL. The average blood creatinine was first 0.52+/-0.19 mg/mL, and at closing 0.46+/-0.11 mg/dL (P=0.209). The minimum concentration didn't show more than 2 mcg/mL, the blood creatinine didn't increase showing 0.5 mg/mL(P=0.201). CONCLUSION: At the result of checking the medicine concentration of Netilmicin in pediatric patients in our clinic, there is no detecting the betterment of the clinical symptom owing to the decrease of the values of leukocyte. There was no necessity to adjust the amount of medicine from the beginning to the end as there was no sign of change of blood creatinine. In view of this result, we can understand that we don't need the regular examination of the medicine concentration about the aminoglicocide from Korean pediatric patients with normal renal function.
Creatinine ; Humans ; Leukocytes ; Netilmicin* ; Pediatrics ; Veins

PURPOSE: Prophylactic antibiotics have been used in nonperforated appendicitis for preventing infection after an appendectomy. However, the duration of antibiotic administration for surgical prophylaxis in Korea has been noted to be longer than those recommended in other countries. PURPOSE: The objective of this study was to identify the appropriate duration of prophylactic antibiotic therapy in nonperforated appendicitis by comparing the wound infection rates of two different antibiotic regimens, 24 hours of cephalosporin (cefoxitin) alone and 72 hours of cephalosporin (cefoxitin) with aminoglycoside (sissomicin). METHODS: One hundred thirty-four (134) patients of nonperforated appendicitis were enrolled in this prospective, randomized, open trial and were assigned to one of two antibiotic regimens: 1) cefoxitin 1 g every 8 hours given intravenously for 24 hours and 2) cefoxitin 1 g every 8 hours given intravenously plus sissomicin 75 mg every 12 hours given intramuscularly for 72 hours. First doses were given just prior to the induction of anesthesia. RESULTS: Postoperative wound infections were detected in 3 cases (4.5%) of the 72-hour-treated group (n=66) whereas none occurred in the 24-hour-treated group (n=68). However, the difference in the rates of wound infections between the two groups was not statistically significant. Cost analysis identified a saving of 43,470 won per patient in the 24-hour-treated group. CONCLUSION: In nonperforated appendicitis cefoxitin administration alone for 24 hours is sufficient as a surgical prophylaxis.
Anesthesia ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Cefoxitin ; Costs and Cost Analysis ; Humans ; Korea ; Prospective Studies* ; Sisomicin ; Surgical Wound Infection ; Wound Infection

Aortic valve is usually involved in infective endocarditis. Aortic valve endocarditis produces destruction and perforation of leaflets and results in ring abscess, frequently. Less commonly, direct extension or infected aortic regurgitant jet can produce secondary involvement of anterior mitral leaflet (AML) and result in the formation of an aneurysm or perforation of AML. A 60-year-old woman was admitted to Kyung Hee University hospital because of a febrile illness and dyspnea. Transthoracic echocardiography (TTE) showed an aortic valve vegetation, an aneurysm of AML, and an eccentric jet of mitral regurgitation through AML. Transe-sophageal echocardiography (TEE) showed a perforation of AML. -streptococcus was isolated from blood culture. The patient was treated with Vancomycin and Sisomicin sulfate. On hospital day 21, heart failure was aggravated and emergent double valve replacement was done. The patient was recovered and discharged.
Abscess ; Aneurysm* ; Aortic Valve* ; Dyspnea ; Echocardiography ; Endocarditis* ; Female ; Heart Failure ; Humans ; Middle Aged ; Mitral Valve Insufficiency ; Sisomicin ; Vancomycin

Aminoglycoside has a broad-spectrum bactericidal activity and especially excellent effect on gram negative bacteria. But, its harmful effect is existed about kidney and ear. Among these, many studies were done about aminoglycoside nephrotoxicity. Until now, many authors have been reported its incidence was 4.45-45%. We needed parameters monitoring about nephrotoxicity. So, our study was done using 99mTc-DTPA renal scan to evaluate nephrotoxicity. We enrolled forty patients who admitted due to infection. 32 patients received Netilmicin and 8 patients Isepamicin. Mean duration and dosage were 8 days, 200mg daily. We accomplished 99mTc-DTPA renal scan, 24hr urine study and blood sampling before starting antibiotics. After mean 8 days, same procedure was repeated. Aminoglycoside nephrotoxicity(defined as 50% GFR reduction) was presented in only one patient. She didn't have risky factor, such as hepatic dysfunction, hypotension, previous renal problem. However, duration was longer than other patients(13 days). GFR was fallen by 25-50% in 6 patients. This finding represent nephrotoxic effects of aminoglycoside indirectly. Above 6 patients had not any characteristics compared to other 33 patients. In addition to renal scan, sodium excretion was increased compared to pre-antibiotics, and glomerular filtration rate using 99mTc-DTPA renal scan was positively correlated with 24hr urine creatinine clearance, GFR by Cockcroft & Gault equation. I conclude that aminoglycoside has nephrotoxic effect when used for longer period. Thus, I suggest that DTPA renal scan including other many renal monitoring method has usefulness in revealing aminoglycoside nephrotoxicity.
Anti-Bacterial Agents ; Creatinine ; Ear ; Glomerular Filtration Rate ; Gram-Negative Bacteria ; Humans ; Hypotension ; Incidence ; Kidney ; Netilmicin ; Pentetic Acid ; Sodium