With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.
Anti-Bacterial Agents/*administration & dosage ; Cell Survival/*drug effects ; Cephalosporins/administration & dosage ; Ciprofloxacin/administration & dosage ; Community-Acquired Infections/drug therapy/*microbiology ; Dose-Response Relationship, Drug ; Drug Combinations ; Drug Resistance, Bacterial/drug effects ; Escherichia coli/*drug effects ; Escherichia coli Infections/drug therapy/*microbiology ; Fosfomycin/administration & dosage ; Humans ; Nitrofurantoin/administration & dosage ; Penicillins/administration & dosage ; Republic of Korea ; Sulfadoxine/administration & dosage ; Treatment Outcome ; Trimethoprim/administration & dosage ; Urinary Tract Infections/diagnosis/*microbiology

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.
Anti-Bacterial Agents/*administration & dosage ; Cell Survival/*drug effects ; Cephalosporins/administration & dosage ; Ciprofloxacin/administration & dosage ; Community-Acquired Infections/drug therapy/*microbiology ; Dose-Response Relationship, Drug ; Drug Combinations ; Drug Resistance, Bacterial/drug effects ; Escherichia coli/*drug effects ; Escherichia coli Infections/drug therapy/*microbiology ; Fosfomycin/administration & dosage ; Humans ; Nitrofurantoin/administration & dosage ; Penicillins/administration & dosage ; Republic of Korea ; Sulfadoxine/administration & dosage ; Treatment Outcome ; Trimethoprim/administration & dosage ; Urinary Tract Infections/diagnosis/*microbiology

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: Binary toxin-producing Clostridium difficile infections (CDI) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. There has been few data of binary toxin-producing CDI in Korea. Objective of the study is to characterize clinical and microbiological trait of CDI cause by binary-toxin producing isolates in Korea. MATERIALS AND METHODS: From September 2008 through January 2010, clinical characteristics, medication history and treatment outcome of all the CDI patients were collected prospectively. Toxin characterization, PCR ribotyping and antibiotic susceptibility were performed with the stool isolates of C. difficile. RESULTS: During the period, CDI caused by 11binary toxin-producing isolates and 105 toxin A & toxin B-positive binary toxin-negative isolates were identified. Comparing the disease severity and clinical findings between two groups, leukocytosis and mucoid stool were more frequently observed in patients with binary toxin-positive isolates (OR: 5.2, 95% CI: 1.1 to 25.4, P = 0.043; OR: 7.6, 95% CI: 1.6 to 35.6, P = 0.010, respectively), but clinical outcome of 2 groups did not show any difference. For the risk factors for acquisition of binary toxin-positive isolates, previous use of glycopeptides was the significant risk factor (OR: 6.2, 95% CI: 1.4 to 28.6, P = 0.019), but use of probiotics worked as an inhibitory factor (OR: 0.1, 95% CI: 0.0 to 0.8; P = 0.026). PCR ribotypes of binary toxinproducing C. difficile showed variable patterns: ribotype 130, 4 isolates; 027, 3 isolates; 267 and 122, 1 each isolate and unidentified C1, 2 isolates. All 11 binary toxin-positive isolates were highly susceptible to clindamycin, moxifloxacin, metronidazole, vancomycin and piperacillin-tazobactam, however, 1 of 11 of the isolates was resistant to rifaximin. CONCLUSIONS: Binary toxin-producing C. difficile infection was not common in Korea and those isolates showed diverse PCR ribotypes with high susceptibility to antimicrobial agents. Glycopeptide use was a risk factor for CDI by those isolates.
Anti-Infective Agents ; Aza Compounds ; Clindamycin ; Clostridium ; Clostridium difficile ; Glycopeptides ; Humans ; Korea ; Leukocytosis ; Metronidazole ; Polymerase Chain Reaction ; Probiotics ; Prospective Studies ; Quinolines ; Ribotyping ; Risk Factors ; Sprains and Strains ; Treatment Outcome ; Vancomycin

BACKGROUND: We investigated whether culture using an automated blood culture system enhances the recovery of bacteria and fungi from body fluids other than blood when compared to conventional solid media culture methods. METHODS: A total of 734 specimens [ascites (n=457), bile (n=5), CAPD (n=28), CSF (n=32), joint fluids (n=165), pericardial fluid (n=17), and pleural fluid (n=30)] were included in the study. Half of the volume of each specimen was inoculated directly into automated blood culture bottles (bioMeriux, Marcy-I'Etoile, France). The remaining volume was inoculated onto conventional solid media (sheep blood agar, chocolate agar, and phenylethyl alcohol agar) after centrifuging at 3,000 rpm for 10 min. RESULTS: Clinically significant microorganisms were isolated from 62 specimens (8.5%) by automated blood culture and 61 specimens (8.3%) by the conventional solid media culture (kappa index: 0.81, 95% confidence interval: 0.75~0.89). Contamination was observed in 11 (1.8%) of the automated blood culture specimens and 3 (0.4%) of the solid media culture specimens. The mean turnaround times of the automated blood cultures and the conventional solid media cultures were 3.7 and 2.8 days, respectively (P<0.0001). CONCLUSION: Compared with conventional culture methods, no improvement in the recovery of clinically significant microorganisms was noted with the use of the automated blood culture system for the culture of body fluids other than blood.
Agar ; Bacteria ; Bile ; Body Fluids ; Cacao ; Fungi ; Joints ; Peritoneal Dialysis, Continuous Ambulatory ; Phenylethyl Alcohol

PURPOSE: The increasing incidence and mortality of Methicillin-resistant Staphylococcus aureus (MRSA) colonization or blood-stream infection is an important problem in neonatal intensive care unit (NICU). The aims of this study are to evaluate the effective eradication of MRSA through the aggressive isolation program with or without the use of 2% chlorhexidine-gluconate (CHG) and to investigate significant risk factors of MRSA colonization in NICU. METHODS: This study is a retrospective collected data among 414 neonates admitted to a NICU from June 1, 2007, through October 31, 2009. We divided the groups into 3 periods according to isolation program or the use of 2% CHG. RESULTS: The aggressive isolation program decreased the incidence of MRSA colonization and the additional use of 2% CHG has reduced much more the incidence of MRSA colonization and bacteremia. Days of hospitalization, use of central line, days of using central line, presence of respiratory distress syndrome (RDS) or bronchopulmonary dysplasia (BPD), isolation program, and isolation program + use of CHG were significant factors associated with MRSA colonization or bacteremia in univariate logistic regression analysis. Days of using central line and isolation program + use of CHG were significant after in multivariate logistic regression analysis. CONCLUSION: Hand hygiene, active MRSA surveillance culture, isolation, contact isolation, nursing/doctor cohorts and the use of 2% CHG as skin sterilizer were effective in eradicating to MRSA. The effort of shortening the days of using central line is also necessary.
Bacteremia ; Bronchopulmonary Dysplasia ; Chlorhexidine ; Cohort Studies ; Colon ; Hand Hygiene ; Hospitalization ; Humans ; Incidence ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal ; Logistic Models ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Risk Factors ; Skin

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in both nosocomial and community settings, and screening for a carrier is an important infection control practice in many hospitals. We evaluated the sensitivity and specificity of the ChromID MRSA assay (bioM?rieux, Marcy I'Etoile, France). METHODS: A total of 190 clinical samples were collected from the anterior nares of premature infants in a newborn intensive care unit (N-ICU). Equal volumes (100microliter) of the samples were inoculated on mannitol salt agar with oxacillin 6 mg/L (MSAO) and ChromID MRSA after emulsifying the screening swab in brain-heart Infusion broth with oxacillin 6 mg/L (BE). The specimens in BE were subcultured on ChromID MRSA after an overnight incubation. RESULTS: Twenty-one of 190 samples (11%) was positive for MRSA by BE. After a 24 h incubation, the sensitivity/specificity of MSAO was 52%/98% and that of ChromID MRSA was 62%/100%, and at 48 h, the sensitivity/specificity of MSAO was 62%/92% and that of ChromID MRSA was 81%/99%. CONCLUSION: ChromID MRSA is a useful selective medium for the rapid isolation and identification of MRSA.
Agar ; Humans ; Infant, Newborn ; Infant, Premature ; Infection Control ; Intensive Care Units ; Mannitol ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Sensitivity and Specificity

BACKGROUND: Amniotic fluid is a rich source of fetal mesenchymal stem cells (MSCs). However, little is known about whether bisphosphonates affect the differentiation into adipocytes. Therefore, this study was aimed to investigate whether zoledronate influences the differentiation of AFMSCs into adipocytes. METHODS: Amniotic fluid cells samples were obtained from 6 pregnant women by second trimester amniocentesis for performing fetal karyotyping. The cells were treated with various concentration (10(-10), 10(-8), 10(-6) M) of zoledronate and the cells were analyzed over 21 days of culture. Differentiation into adipocytes was determined by oil-red O staining and for fatty acid synthase (FAS), acetyl CoA carboxylase 1 (ACC1) and sterol regulatory elementary binding protein-1 (SREBP-1). RESULTS: Differentiation of AFMSCs into adipocytes was found by oil-red O staining. Zoledronate influenced the differentiation of AFMSCs into adipocytes in a dose- and time-dependent manner. At 7 days of culture, the expressions of FAS and SREBP-1 showed no significant differences compared to that of the control regardless of the dose of zoledronate. Very little ACC1 expression was found. However, the expressions of these three markers were remarkably increased at 14 days of culture. Of them, the ACC1 expression was significantly increased by 10(-8) M and 10(-6) M of zoledronate. At 21 days of culture, there were no effects of zoledronate on the expressions of FAS and SREBP-1. However, the ACC1 expression was decreased with an increasing dose of zoledronate (P<.05). CONCLUSION: This study shows that AFMSCs can be differentiated into adipocytes. The induction of this differentiation following zoledronate treatment appears to be dose dependent and time-of-culture dependent.
Acetyl-CoA Carboxylase ; Adipocytes ; Amniocentesis ; Amniotic Fluid ; Diphosphonates ; Fatty Acid Synthetase Complex ; Female ; Humans ; Imidazoles ; Karyotyping ; Mesenchymal Stromal Cells ; Pregnancy ; Pregnancy Trimester, Second ; Pregnant Women ; Stem Cells

BACKGROUND: Rapid screening of vancomycin-resistant enterococci (VRE) is very important for controlling and preventing the spread of VRE in hospitals. We compared the performance characteristics of a chromogenic agar (ChromID VRE, bioMerieux, France: CA) to that of Enterococcosel agar (supplemented with 6 microgram/mL of vancomycin :EA) for direct detection of VRE from stool swabs. METHODS: Total 125 rectal swabs were collected from 57 patients in the intensive care units of an 850-bed university hospital over a period of 3 months. The samples were inoculated on EA, CA and into broth enrichment containing 6 microgram/mL of vancomycin (BE). BE was subcultured on CA after overnight incubation. RESULTS: Eighty two samples from 22 patients were positive for VRE by BE. At 24 h, the sensitivity/specificity of EA and CA were 89%/100% and 72%/100%, respectively. At 48 h, the sensitivity/specificity of EA and CA were 94%/89% and 89%/100%, respectively. CONCLUSION: CA provides equivalent sensitivity comparable to EA for the recovery of VRE at 48 h incubation, and has additional advantage of being able to differentiate between vancomycine resistant E. faecium and E. faecalis.
Agar ; Humans ; Imidazoles ; Intensive Care Units ; Mass Screening ; Nitro Compounds ; Vancomycin

BACKGROUND: This is the first annual data on the surveillance of intensive care unit (ICU) module by the Korean Nosocomial Infections Surveillance System (KONIS) from July 2007 through June 2008. METHODS: The KONIS performed a prospective surveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 96 ICUs in 56 hospitals. Nosocomial infection (NI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 2,637 NIs were found during the study period; 1,391 UTIs (1,365 cases were urinary catheter-associated), 667 BSIs (563 were central line-associated), and 579 PNEUs (357 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.43 cases per 1,000 device-days (95% confidence interval, 4.20-4.67) and urinary catheter utilization ratio was 0.84 (0.839-0.841). The rate of central line-associated BSIs was 2.83 (2.61-3.07) and the utilization ratio was 0.54 (0.538-0.542). The rate of ventilator-associated PNEUs was 2.49 (2.25-2.76) and the utilization ratio was 0.39 (0.388-0.392). Although the ventilator utilization ratios were lower in the hospitals with less than 900 beds than in the hospitals with more than 900 beds, the rates of ventilator-associated PNEUs were higher in the smaller hospitals than in the larger ones. CONCLUSION: This result suggests that ongoing targeted surveillance and implementation of proven infection control strategies are needed.
Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical