• Clinical and Experimental Pediatrics
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• 제48권10호
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• pp.1107-1115
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• 2005

목 적 : ESBL 생산 S. sonnei에 의한 장염의 대규모 발생은 과거 국내는 물론 세계에서도 유래를 찾아볼 수 없었다. 저자들은 집단 발생한 ESBL 생산 S. sonnei에 의한 장염 환자의 임상적 특징과 치료에 대한 반응 등을 분석하여 ESBL 생산 S. sonnei 감염증에 대한 치료 지침을 마련하는데 도움이 되고자 한다. 방 법 : 연구 대상은 2004년 11월 충주 ${\bigcirc}{\bigcirc}$초등학교를 중심으로 집단 발생한 급성 장염 환자 중 분변 배양 검사상 S. sonnei가 검출되어 치료받은 환자 103명을 대상으로 하였다. 환자에서 분리된 S. sonnei에 대해 항생제 감수성 검사와 DNA 염기 서열 검사를 시행하였고, 환자들의 임상적 특징과 검사 소견, 그리고 항생제에 대한 반응 등을 후향적으로 분석하였다. 결 과 : 임상 증상은 발열 96.1%, 설사 93.2%, 복통 76.7%, 두통 71.8%, 구토 65.0%, 그리고 구역 41.7% 순으로 나타났다. 발열은 평균 2.0일간 지속되었고, 설사는 평균 3.9일간 지속되었다. 설사의 양상은 수양성 설사는 69%, 점액성 설사는 26%, 그리고 혈변은 5%에서 관찰되었다. 말초 혈액 검사에서 백혈구 증다증을 보이는 경우는 53.4%이었고, 혈청 검사에서 CRP 양성을 보이는 경우는 78.6%이었다. 대변 직접 도말 검사에서 백혈구가 고배율 당 50개 이상인 경우가 11.7%, 그리고 5-20개인 경우 9.7%이었다. 대변 잠혈 반응은 71%에서 양성이었다. 본 유행에서 분리된 ESBL의 유형은 염기 서열을 분석한 결과 CTX-M-14 유형으로 밝혀졌다. 항생제 투여에 대한 미생물학적 치료 결과는 ciprofloxacin 투여자 중 100%(9/9), azithromycin 투여자 중 100%(5/5), cefdinir 투여자 중 6.9%(5/72), ceftriaxone 투여자 중 0%(0/8), ceftizoxime 투여자 중 12.5%(1/8), TMP/SMX 투여자 중 0%(0/8), ampicillin/sulbactam 투여자 중 42.9%(3/7), amoxicillin/clavulanic acid 투여자 중 20%(1/5), 그리고 imipenem/cilastatin 투여자 중 68.8%(11/16)에서 추적 검사상 음전 되었다. 결 론 : 소아에서 발생한 ESBL 생산 S. sonnei에 의한 세균성 이질에 대한 항생제 선택에서 비용-효과 면이나 안전성 면에서 azithromycin이 매력적인 일차 선택약일 수 있을 것으로 사료된다. Ciprofloxacin은 비용-효과 면에서는 우수한 약제일 수는 있으나 소아에서의 사용은 아직 이르다고 생각된다.

• Journal of Microbiology and Biotechnology
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• 제24권3호
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• pp.421-426
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• 2014

To characterize the extended-spectrum beta-lactamases (ESBLs) in diarrheagenic Escherichia coli from Korea in 2008-2011, we screened seven enterotoxigenic E. coli (ETEC) and one enteroaggregative E. coli (EAEC) that produce ESBLs from a nationwide survey. All eight isolates produced CTX-M-type ESBLs, including CTX-M-12 (n = 4), CTX-M-14 (n = 2), and CTX-M-15 (n = 2). PCR-based replicon typing indicated that the $bla_{CTX-M-12}$ genes of four ETEC isolates were carried on a conjugative IncF plasmid, whereas the $bla_{CTX-M-14}$ of one EAEC was located on an IncK plasmid. This is the first report of the occurrence of $bla_{CTX-M}$ genes in clinical isolates of EAEC in Korea. The ESBL-producing isolates were shown to be different based on pulsed-field gel electrophoresis and multilocus sequence typing, whereas the four isolates with CTX-M-12 were clonally related. These observations raise an alarm for the spread of plasmid-mediated resistance to ESBL among diarrheagenic E. coli.

• Childhood Kidney Diseases
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• 제23권1호
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• pp.29-35
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• 2019

Purpose: We aimed to determine characteristics of host, causative organisms, and antibiotic susceptibility of bacteria in pediatric patients with UTI living in metropolitan area of Korea. Methods: Retrospective investigation was done for the causative organisms of UTI in 683 pediatric cases treated at Ajou University Hospital from 2012 to 2017. Patients were classified into Escherichia coli and non-E. coli group, where E. coli group was subdivided into ESBL(+) and ESBL(-) groups based on whether the bacteria could produce extended spectrum beta-lactamase (ESBL). Antibiotic susceptibility of the causative organism was also determined. Results: A total of 683 UTIs occurred in 550 patients, of which 463 (67.8%) were first-time infection and 87 (32.2%) were recurrent ones (2-7 recurrences, 2.52 average), and 64.9% were male and 35.1% were female. The most common causative organism was E. coli (77.2%) and ESBL(+) E. coli was found in 126 cases. The susceptibility of E. coli to 3rd or 4th generation cephalosporin was relatively higher than that to ampicillin or amoxicillin/clavulanic acid. ESBL(+) E. coli showed higher resistance rate to 3rd or 4th generation cephalosporin than ESBL(-) E. coli. Conclusion: New treatment guideline should be considered due to the incidence of ESBL(+) E. coli increased up to one quarter of UTI cases.

• 한국동물위생학회지
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• 제37권1호
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• pp.19-27
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• 2014

This study was conducted to investigate the antimicrobial resistance, presence of ${\beta}$-lactamase genes and integrons in 83 ESBL-producing Escherichia coli isolated from Nakdong river and Geumho river in Daegu. Among the ${\beta}$-lactam antimicrobials, all isolates were resistant to ampicillin, cephalothin, cefamandole and cefotaxime, followed by piperacillin (98.8%), ampicillin/sulbactam (86.7%), aztreonam (60.2%) and cefepime (59.0%), whereas resistance to piperacillin/tazobacram, ticarcillin/clavulanic acid and cefoxitin was less than 30%. Many of the ESBL-producing Escherichia coli were also resistant to non-${\beta}$-lactams antimicrobials such as nalidixic acid (83.1%), sulfonamides (72.3%), ciprofloxacin (62.7%) and gentamicin (38.6%). All isolates showed resistance to seven or more antimicrobial agents. The most frequently detected gene was $bla_{TEM+CTX-M}$ (49.4%), followed by $bla_{CTX-M}$ (27.7%), $bla_{TEM}$ (6.0%) and $bla_{OXA}$ (1.2%). But $bla_{SHV}$ was not found. Class 1 integrons were found in 61.4% (51 isolates) of isolates, however, class 2 and 3 integrons were not detected. The results showed water from Nakdong river and Geumho river is contaminated with ESBL-producing E. coli isolates. These results suggest the need for further investigation of antibiotic resistant bacteria to prevent public health impacts in the water environment.

• Urogenital Tract Infection
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• 제13권3호
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• pp.72-78
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• 2018

Purpose: This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB). Materials and Methods: A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1 g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1 g, IV) before one hour TRUSPB and again on the day after TRUSPB. Results: Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2. Conclusions: Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.

• 한국식품위생안전성학회지
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• 제29권1호
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• pp.47-52
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• 2014

This study was performed to evaluate antimicrobial resistance of food-borne pathogens isolated from retail meat in Korea. A total of 157 samples of beef, pork, and chicken were collected and analyzed for E. coli, Salmonella, Campylobacter. Resistances to tetracycline were declined in accord with reduced usage of tetracycline in live stock production. E. coli stains from chicken meat had higher multi-drug resistance ratio than strains from other meat. One extended spectrum beta lactamase (ESBL) producing E. coli and two ESBL producing Salmonella were identified in this study. ESBL producing Salmonella strains were confirmed to carry CTX-M-1 type genes.

• Clinical and Experimental Pediatrics
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• 제64권6호
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• pp.293-300
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• 2021

Background: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. Purpose: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. Methods: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated. Results: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). Conclusion: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.

• 한국융합학회논문지
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• 제6권5호
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• pp.77-84
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• 2015

본 연구는 항균제에 내성을 보이는 대장균의 특성을 알아보기 위해 설사환자에서 분리된 대장균에 대한 항균제 감수성 및 병원성 인자의 상관성을 분자융합적 기술을 통해 조사하였다. 분리한 대장균의 항균제 내성은 60주에서 ESBL(extendede spectrum ${\beta}$-lactamase) positive균주가 8주이고, negative균주는 52주였다. ESBL 양성 8주 중 2주는 병원성 유전자가 검출되지 않았으며, stb(3주), flich7(1주), flich7-eae(2주)로 나타났다. ESBL 음성 52주 중 26주는 병원성 유전자가 검출되지 않았고, stx1(3주), stb(10주), flich7 및 eae(각 2주), stx1-flich7(2주), stx1-stb(4주), flich7-stb(2주), flich7-stb-eae(1주)이었다. 결론적으로 항균제 내성이 증가하는 시대에 분자 융합적 관점에서 독력 유전자의 분포와 항균제 내성과의 관계는 적게 나타났으나, 향후 다양한 독력 유전자의 분석을 통한 융합기술연구가 이루어진다면 보다 정확한 병원성 인자를 추정할 수 있을 것으로 사료된다.

• 한국동물위생학회지
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• 제42권1호
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• pp.17-24
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• 2019

The aim of this study was to investigate the prevalence and characterization of plasmid-mediated quinolone resistance (PMQR) gene in 79 Enterobacteriaceae isolated from dogs and cats. Of 79 isolates, PMQR genes were found in 10 (12.7%) isolates, including aac(6')-lb-cr, qnrB, qnrS and qnrA detected alone or in combination in 8 (10.1%), 4 (5.1%), 2 (2.5%) and 1 (1.3%) isolates, respectively. Interestingly, two qnrS genes were detected in nalidixic acid and ciprofloxacin susceptible isolates. Extended-spectrum ${\beta}$-lactamase (ESBL) was detected in 90% (9 isolates) of PMQR positives isolates. Among ESBL genes, CTX-M, TEM and SHV were detected in 9, 8 and 3 isolates, respectively. Almost all PMQR genes were detected in co-existence with ESBL genes. All PMQR positives isolates were multidrug resistance (i.e. resistant to five or more antibiotics). qepA, OXA and CMY-2 genes were not found. The six transconjugants were obtained by conjugation experiment. The aac(6')-lb-cr, qnrB and qnrS were co-transferred with CTX-M, TEM and/or SHV, whereas qnrA was not observed among transconugants. This is the first report of the presence of aac(6')-lb-cr and qnrA gene among Enterobacteriaceae isolates from dogs in Korea. The prudent use of antimicrobials and continuous monitoring for companion animals are required.

• Tuberculosis and Respiratory Diseases
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• 제49권1호
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• pp.72-81
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• 2000

연구배경 : 본 연구에서는 기계 호흡 관련 폐렴 환자에서 항생제의 사용이 기관지 폐포 세척술에 미치는 영향과 원인 균주의 특성을 알아 보고자 하였다. 방법 : 1999년 4월부터 9월까지 영동 세브란스 병원에서 기계 호흡과 항생제 치료를 함께 받던 환자 25명을 대상으로 전향적 연구를 하였다. 대상 환자들은 대조군과 인공 호흡기 관련 폐렴군으로 나누었다. 기관지 폐포 세척액의 세균의 정량 배양이 진단 역치는 $10^4$ cfu/ml로 잡았다. 결과 : 1) 기관지 폐포 세척액의 그랑 염색에서 대조군 중 1명에서 VAP 환자군에서는 4명에서 양성의 결과를 나타내었다. 정량 배양에서 대조군에서는 모두 진단 역치 이하 였으나 VAP 군에서는 9명에서 양성의 결과를 보여 전체적으로 진단의 민감도는 43.8%였다. 2) 배양된 균주들의 빈도는 E. cloacae, S. aureus, K. pneumoniae, A. baumani 등의 순이었다. S. aureus 와 Staphylococcus coagulase(-)는 모두 oxacillin에 저항성을 보였으며 그람 음성 균주들 중 10례 중 3례를 제외한 나머지 모두가 cefotaxime과 ceftazidime에 저항성을 보여 extended spectrum $\beta$-lactamase(ESBL)를 생산하는 균주로 추정되었다. 3) 기관 흡인 검체와 기관지 세포 세척액의 그람 염색 결과는 1례에서만 일치하였다고 배양된 균주들도 3예에서만 일치하였다. 결 론 : 항생제 사용 중 발생한 기계 관련 폐렴에서는 기관지 폐포 세척액의 그람 염색과 정량 배양의 정확도는 높은 편이나 민감도는 낮은 편이었고, 통상적인 기관 흡입 검체를 이용한 검사 결과와의 일치율도 낮으므로 해석에 주의를 하여야 할 것으로 생각된다. 나아가 약제 내성 균주의 빈도도 외국의 경우와 큰 차이가 없이 높으므로 항생제의 선택과 사용에도 신중을 기하여야 할 것으로 생각된다.