• Journal of Life Science
• /
• v.23 no.5
• /
• pp.703-709
• /
• 2013

The aim of this study was to investigate the prevalence of Extended-spectrum ${\beta}$-lactamase (ESBL) gene and quinolone resistance determinant (qnr) and the pattern of antibiotic resistance in the ESBL-producing Escherichia coli clinical isolates. The 42 ESBL-producing strains from total 274 isolates were detected using a double disk synergy test. They were isolated from various specimens, such as urine (28 strains), sputum (6 strains), pus (3 strains), wound (2 strains), blood (2 strains), and tissue (1 strain). Using the PCR with the specific primers ESBL, ESBL and qnr gene types were determined. Thirty-five strains possessed one or two ESBL genes. CTX-M-1 type was the most abundant followed by CTX-M-9 type and TEM, but SHV, CTX-M-2, and CTX-M-8 gene types were not detected. qnr gene types were detected from ten isolates in the order of qnrB4, qnrB1, and qnrS. Coexistence of ESBL and qnr genes was found. ESBL-producing isolates showed high resistance against some antibiotics, such as cefotaxmie (80.0%), levofloxacin (82.9%), and ampicillin (100%). Neither a synergy effect from the coexistence of ESBL and qnr genes on antibiotic resistance nor a correlation between the production of qnr gene and quinolone resistance were found.

• Neonatal Medicine
• /
• v.18 no.2
• /
• pp.265-271
• /
• 2011

Purpose: Extended spectrum $\beta$-lactamase (ESBL) producing organism is an important cause of infections in the neonatal intensive care unit (NICU) since 1990s. The aim of this study is to investigate the differences of clinical characteristics and hematologic studies between neonates with ESBL-positive organism and those with ESBL-negative organism. Methods: The subjects included 48 neonates admitted to NICU at Inje University Sanggye Paik Hospital from January 2005 to September 2010, from whom a total of 58 Escherichia coli or Klebsiella pneumonia were detected. The data were categorized in 2 groups, neonates with ESBL-positive and ESBL-negative. We compared clinical characteristics and hematologic studies between two groups. Results: Of 48 neonates and 53 isolates, ESBL-positive were 18 neonates and 20 isolates. Both ESBL-positive and ESBL-negative isolates were largely found in urine, each with 10 and 23. Of 20 ESBL-positive isolates, 13 (65%) and 7 (35%) were ESBL producing Escherichia coli and Klebsiella pneumonia, respectively. ESBL-positive neonates were associated with low 1 and 5 minutes Apgar scores (P=0.002 and P=0.001, respectively), more uses of oxygen (56% vs. 27%; P=0.005), longer duration of oxygen uses (15.8${\pm}$38.43 days vs. 4.3${\pm}$12.5 days; P=0.008) and more frequent anemia (33% vs. 7%; P=0.040). Conclusion: ESBL-positive neonates may have more anemia and lower Apgar score at birth. We can consider the use of cabapenem earlier if infant with previous antibiotics is confirmed to be infected with ESBL-positive organisms.

• Childhood Kidney Diseases
• /
• v.8 no.2
• /
• pp.214-222
• /
• 2004

Purpose: Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended-Spectrum ${\beta}-Lactamase(ESBL)$ is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL (+) E. coli in community-acquired childhood UTI. Methods: In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI. Results: Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(+) E. coli compared with control patients (P<0.05). Although ceftriaxone showed 100% resistance in ESBL(+) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%). Conclusion: Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(+) E. coli UTI and changes in selection of empirical antibiotics should be considered.

• Pediatric Infection and Vaccine
• /
• v.22 no.1
• /
• pp.29-35
• /
• 2015

Purpose: The purpose of this study was to investigate the clinical characteristics and outcome of febrile urinary tract infections (UTIs) caused by community-acquired extended-spectrum ${\beta}$-lactamase (CA-ESBL)-producing and -nonproducing bacteria. Methods: We analyzed febrile UTIs in children hospitalized at Gachon University Gil Medical Center from January 2011 to December 2013 through retrospective data collection from their medical records. Results: Among pathogens causing 374 episodes of UTIs, the proportion of ESBL-producing bacteria was 13.1% (49/374). The proportion of ESBL-producing Escherichia coli and Klebsiella spp. was 13.6% (48/354) and 5.0% (1/20), respectively. There was no significant difference between the CA-ESBL and CA non-ESBL groups in duration of fever ($4.2{\pm}2.7$ vs. $3.7{\pm}2.1$ days, P=0.10) and bacterial eradication rate with empirical antibiotics (100% vs. 100%). The risk of cortical defects on renal scan significantly depended on existence of vesicoureteral reflux rather than ESBL production of pathogen. Conclusions: There was no significant difference between the CA-ESBL and CA non-ESBL groups in renal cortical defects and clinical outcome. Careful choice of antibiotics is important for treatment of community-acquired UTI in children.

• Korean Journal of Veterinary Research
• /
• v.48 no.3
• /
• pp.259-265
• /
• 2008

This study was conducted to investigate incidence of extended-spectrum ${\beta}$-lactamase (ESBL) producing strains and characteristics of ESBL gene in pathogenic Escherichia coli isolated from poultry during the period from April 2003 to December 2005 in Korea. Among 203 isolates, 4 isolates (3 from broilers and 1 from layer) were confirmed as ESBL producing strains by double disk synergy test, polymerase chain reaction and sequencing for ${\beta}$-lactamase genes. $bla_{CTX-M-15}$ and $bla_{CMY-2}$ were detected in these 4 isolates and were transferred to recipient by conjugation, respectively. Also, these ESBL producing strains were associated with multiple drug resistance. In conclusion, these results exhibit incidence of CTX-M and CMY-2 ${\beta}$-lactamase in pathogenic E coli from poultry in Korea, and clinically important meaning in human. And they also suggest the needs for rapid and broad surveillance to monitor ESBL genes and R plasmid transferring resistant gene in poultry.

• Microbiology and Biotechnology Letters
• /
• v.46 no.2
• /
• pp.135-144
• /
• 2018

The rapid increase in number and diversity of Extended Spectrum ${\beta}$-Lactamases (ESBLs) producing Enterobacteriaceae in natural aquatic environment is a major health concern worldwide. This study investigates abundance and distribution of ESBL producing multidrug resistant Enterobacteriaceae and molecular characterization of ESBL genes among isolates from highly polluted stretch of river Yamuna, India. Water samples were collected from ten different sites distributed across Delhi stretch of river Yamuna, during 2014-15. A total of 506 non duplicate Enterobacteriaceae isolates were obtained. Phenotypic detection of ESBL production and antibiotic sensitivity for 15 different antibiotics were performed according to CLSI guidelines (Clinical and Laboratory Standard Institute, 2015). A subset of ESBL positive Enterobacteriaceae isolates were identified by 16S rRNA gene and screened for ESBL genes, such as $bla_{CTX-M}$, $bla_{TEM}$ and $bla_{OXA}$. Out of 506 non-duplicate bacterial isolates obtained, 175 (34.58%) were positive for ESBL production. Susceptibility pattern for fifteen antibiotics used in this study revealed higher resistance to cefazolin, rifampicin and ampicillin. A high proportion (76.57%) of ESBL positive isolates showed multidrug resistance phenotype, with MAR index of 0.39 at Buddha Vihar and Old Delhi Railway bridge sampling site. Identification and PCR based characterization of ESBL genes revealed the prevalence of $bla_{CTX-M}$ and $bla_{TEM}$ genes to be 88.33% and 61.66%, respectively. Co-occurrence of $bla_{CTX-M}$ and $bla_{TEM}$ genes was detected in 58.33% of the resistant bacteria. The $bla_{OXA}$ gene was not detected in any isolates. This study highlights deteriorating condition of urban aquatic environment due to rising level of ESBL producing Enterobacteriaceae with multidrug resistance phenotype.

• Biomedical Science Letters
• /
• v.10 no.4
• /
• pp.501-506
• /
• 2004

Extended spectrum β-lactamase (ESBL) generated Enterobacteriaceae including Escherichia coli is responsible for resisting antibiotics, which is clinical problem. This study was performed to investigate the isolation rates of 111 strains having positive of VITEK ESBL test 111 ESBL-strains in each month and season and statistically to determine their patterns of antibiotic test. One hundred eleven ESBL-strains were collected among 1,688 strains of E. coli isolated from various clinical specimen of one general hospital in Busan during 2002 to 2003. Month rates of ESBL-strains were 0％ to 13.3％, while the seasonal rates were highest at autumns during two years. The resistance to ampicillin, cefazolin, azteronam, ceftriaxone, and cefepime were 100％ in 2002. In ampicillin and cefazolin the resistances were 100％ during the two years. There were significant differences of cefoxitin and piperacillin/tazobactam between the two years but not significant between specimens. Four groups were divided according to the pattern of resistance and then the highest group had 93∼100％ of the resistance to 8 drugs but not resistant to imipenem.

• Childhood Kidney Diseases
• /
• v.16 no.1
• /
• pp.38-45
• /
• 2012

Purpose: The incidence of community-acquired urinary tract infection (UTI) due to extended-spectrum ${\beta}$-lactamase producing $Escherichia$ $coli$ (ESBL(+) $E.$ $coli$) has increased worldwide. ESBL causes resistance to various types of the newer ${\beta}$-lactam antibiotics, including the expanded spectrum cephalosporins and monobactams. We aimed to investigate the severity of UTI and associated genitourinary malformations in children with febrile UTI caused by ESBL(+) $E.$ $coli$. Methods: We retrospectively reviewed the medical records of 290 patients diagnosed as febrile UTI caused by $E.$ $coli$ between January 2008 and October 2010 at Korea University Medical center. We classified the patients into two groups with ESBL(+) and ESBL(-) $E.$ $coli$ group according to the sensitivity of urine culture. Fever duration, admission period, white blood cell (WBC) counts and C-reactive protein (CRP) in peripheral blood, the presence of hydronephrosis, cortical defects, vesicoureteral reflux (VUR) and renal scar were compared between the two groups. Results: Patients with ESBL(+) $E.$ $coli$ were 32, and those with ESBL(-) $E.$ $coli$ were 258. If we excluded those tested with a sterile urine bag, patients with ESBL(+) $E.$ $coli$ were 22, and those with ESBL(-) $E.$ $coli$ were 212. Whether the results of sterile urine bag tests were included or not, there was no significant difference in all parameters between the two groups statistically. Conclusion: Our data shows that ESBL(+) $E.$ $coli$ may not be related to the severity of UTI and associated genitourinary malformations.

• Microbiology and Biotechnology Letters
• /
• v.34 no.4
• /
• pp.342-351
• /
• 2006

The aim of this study was to survey susceptibilities of Escherichia coli and Klebsiella pneumoniae isolates against cefotaxime and to determine the prevalences of CTX-M type extended-spectrum $\beta$-lactamases (ESBLs) producing E. coli and K. pneumoniae in Korea. During the period of February to July, 2005, 153 E. coli and 52 K. neumoniae isolates were collected from 2 hospitals in Busan. Antimicrobial susceptibilities to cefotaxime were tested by the disk diffusion method. ESBL production of E. coli and K. pneumoniae was determined by the double disk synergy test. MICs of $\beta$-lactam antibiotics were determined by the agar dilution method. Blac$_{CTX-M}$ genes of the organism were detected by PCR. Among 153 isolates of E. coli and 52 isolates of K. neumoniae, 27 (17.6%) and 25 (48.0%) were intermediate or resistant to cefotaxime, respectively. Twenty-three (15.0%) isolates out of 153 E. coli and 13 (25.0%) out of 52 K. neumoniae isolates showed positive results for ESBL by the double disk synergy test. Twenty isolates out of 23 ESBL producing E. coli and 12 out of 13 ESBL producing K. neumoniae isolates harbored biacTx-M gene,11 of ESBL producing E. coli and 12 of ESBL producing K. neuinoniae isolates harbored bla$_{CTX-M}$ gene, 11 of the ESBL producing E. coli and 2 of ESBL producing K. neumoniae isolates harbored bla$_{TEM}$ gene, and 1 of the ESBL producing E. coli and 12 of ESBL producing K. neumoniae isolates harbored bla$_{SHV}$ gene. E. coli and K. neumoniae isolates producing CTX-M-type ESBLs were not uncommon in Korea. It is thought that continuous survey are necessary for inspecting the spread and novel variants of CTX-M-type ESBL genes. Further me]'e investigation and research on ESBL producing strains are needed in order to prevent the spread of resistant bacteria.

• Korean Journal of Microbiology
• /
• v.37 no.4
• /
• pp.277-283
• /
• 2001

The emergence of extended spectrum beta-lactamase(ESBL) producing bacteria is causing very serious problems in Korea. Although there have been many reports about these bacteria isolated from patients and clinical specimens, there is no report of ESBL-producing organisms isolated from natural evironment in Korea. This is the first study on the ESBL producing bacteria out of the medical system in Korea. Twenty-six ESBL producing bacteria were isolated only from sewerage plant drain water at Kwang-an beach among the sampling collected sites including snakehead fish plants in Myungi, Aquaculture Engineering Lab. in Pukyong National University and two public-bathrooms in Pusan, Korea. ESBL producing bacteria were identified by double-disk synergy test, conjugation, isoelectric focusing values and PCR. The species of ESBL producing bacteria were Enterobacter cloacae(4 strains), E. sakazakii(8 strains), Klebsiella pneumoniae subsp. pneumoniae(8 strains) and K. pneumoniae subsp. ozaenae(6 strains). TEM and SHV specific PCR products were detected from all the ESBL strains produced TEM+SHV products on the PCR plates. The pI values of ESBL produced by Klebsiella pneumoniae subsp. pneumoniae, K. pneumoniae subsp. ozaenae, Enterobacter cloacae, and E. sakazakii were 5.9, 5.9+5.4; 5.9, $5.9+5.4;{\ge}8.5$, 8.0+5.4, and 8.0+5.4, respectively on the IEF. Seven strains of the isolates were transfered their genes to E. coli RG488 $Rif^r$ by conjugation.