• KSBB Journal
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• v.14 no.4
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• pp.460-464
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• 1999

Methicillin-resistant Staphyloccus aureus (MRSA) has been known to be resistant to many kinds of antibiotics and causes a problem of nosnocomial infection since the third generation of cephalosporines has been introduced in the 1980s. As antibiotic sensitivity tests which have been routinely used to detect MRSA in the laboratory depend on the culture conditions such as, pH, temperature, and time, etc., it is difficult to decide in the case of borderline- or low-level of MRSA. Therefore it would be necessary to develope a new method based on the molecular biological technique to overcome these problems. In this study, we extracted DNA from S. aureus and performed polymerase chain reaction (PCR) to amplify mec A gene, encoding penicillin-binding protein 2' (PBP-2'), which is known to confer bacteria resistance to the bacteriostatic action of methicillin. The results were compares with those of minimal inhibitory concentration (MIC) test. When MIC test with oxacillin was performed on the 120 isolates of S. aureus from each patient's specimens, 64 of them were MRSA and 56 of them were methicillin-sensitive Staphylococcus aureus (MSSA). In pus specimen, more precisely, 61.9% (26/42) of MRSA was detected, and 44.2% (19/43), 60% (9/15) and 50% (10/20) of MRSA were detected in sputum, body fluid, and other specimen respectively. When 40 isolates of MRSA and MSSA were tested by PCR method and compares with the results of MIC method, different results were obtained from 1 isolate of MRSA (2.5%) and in 2 isolates of MSSA (5%) suggesting that PCR method should be performed at the same time for more accurate clinical test of MRSA.

• Korean Journal of Veterinary Research
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• v.39 no.2
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• pp.376-382
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• 1999

A methicillin-resistant Staphylococcus aureus (MRSA) isolate was recovered from a 9-month-old female Shih-Tzu dog with canine distemper virus infection. We performed in vitro antimicrobial susceptibility test to determine the most effective antimicrobial drug against the isolate and thus, to emphasize its potential clinical importance in animal practices. Isolate was confirmed MRSA by oxacillin agar screening test. The isolate was fully resistant to all $\beta$-lactam antibiotics and was susceptible to glycopeptides. Of the other antibiotics, mupirocin, TMP/SMZ (trimethoprim-sulfamethoxazole), and chloramphenicol showed inhibitory effect at the concentration of 4x MIC. The MICs ranged 0.25->$128{\mu}g/ml$, and MBCs ranged 0.5->$128{\mu}g/ml$. The combined TMP/SMZ with cefamandole or novobiocin showed synergistic effect, whereas the combination of novobiocin plus cefamandole or teicoplanin resulted in antagonistic effects. Although MRSA in animals so far has been reported in the geographically limited countries, at least theoretically, it could be occurred in the future more frequently through either human or animal origin. The use of this combination may be of value in this situation. As with all antimicrobial agents, inappropriate or unnecessarily prolonged therapy may contribute to the emergence of resistance strains and loss of efficacy.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.62-66
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• 2016

Skin and soft tissue infections (SSTIs) caused by community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have become a worldwide concern. An otherwise healthy 16-month-old Korean girl was admitted because of skin abscess on the left chest wall with a history of recurrent SSTIs since the age of 6 months. Immunologic evaluation including serum immunoglobulin level and nitroblue-tetrazolium (NBT) test were normal. Pus and nasal swab cultures revealed CA-MRSA ST714-SCCmec type IV with the Panton-Valentine leukocidin (PVL) genes, which was initially reported in the Netherlands in 2006 and has not been previously reported in Korea. The skin abscesses were successfully treated by needle aspiration and the use of antibiotics. In addition, nasal mupirocin was applied as a decolonization method. No more episodes of SSTI were observed over a follow-up period of 10 months.

• Korean Journal of Veterinary Research
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• v.39 no.2
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• pp.383-389
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• 1999

A randomized experimental study was done to evaluate short course therapeutic efficacies of two types of mupirocin ointment (Bactroban Nasal and Bactroban) in the elimination of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization (16 dogs) and wound infection (3 dogs or 18 wound sites) in dogs. In each model, dogs being assigned to TR-1 treatment group was given ointment twice a day for two consecutive days, and those that assigned to TR-2 treatment group was given the same dose for three days. Neither TR-1 nor TR-2 regimen was effective to clear nasal carriage completely with a clearing rate of 62.5% and 87.5%, respectively. Whereas, for 2 days at least twice daily application of mupirocin for wound infection was quite enough to eliminate MRSA, with a clearing rate of 83.3~100% by 4 weeks follow-up. No apparent side effects were observed in each model, and in no case was it necessary to discontinue the treatment. Further controlled studies on the elimination of nasal colonization are required to establish cost-effective and efficient regimen on companion animals.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.381-386
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• 2010

Background: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). Material and Method: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. Result: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). Conclusion: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.

• Pediatric Infection and Vaccine
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• v.20 no.2
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• pp.63-70
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• 2013

Purpose : This study aimed to explore how prevalent the community-related methicillin-resistant Staphylococcus aureus (CA-MRSA) was in children with muscular-skeletal infections. Methods : We retrospectively reviewed the medical records of patients of 18 years or under who were diagnosed with suppurative arthritis or osteomyelitis and S. aureus from September 2000 through August 2012 at the CHA Bundang Medical center. Results : Thirty-one cases of suppurative arthritis or osteomyelitis were identified. The patients were between 17 days old and 18 years old with an average age of 7. Eleven cases (33.5%) of suppurative arthritis and 16 cases (51.6%) of osteomyelitis were observed. Five cases were accompanied by the two diseases. Methicillin sensitive S. aureus (MSSA) was isolated in 25 cases (80.6%) and methicillin resistant S. aureus (MRSA) was isolated in 6 cases (19.4%). Multidrug resistant strains were not observed. MRSA was not found from 2000 through 2005. All patients were treated with antibiotics and the duration of antibiotics treatment was $26.4{\pm}12.7$ days. Vancomycin was used as the initial antibiotic treatment in 4 cases (12.9%) and vancomycin was used as the definitive antibiotics in the 10 cases (32.3%). Conclusions : The result of this study showed that methicillin resistance rate of S. aureus from muscular-skeletal infections was concentrated in the latter half of the 12 year period.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.5
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• pp.3315-3322
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• 2015

Staphylococcus aureus is the major causative organism of nasocomial infection being the important pathogen in the clinic. Appearance of staphylococcus aureus resistant to methicillin (MRSA) is becoming a big problem in clinics and dynamics all over the world acquiring antibiotic resistance with virulence factors as its feature differentiated from other pathogenic bacteria fast. This research intended to compare and analyze the correlation of antibiotics resistance between strains with toxin genes and distribution of toxin genes of MRSA 101 strains acquired from clinical specimen in one general hospital (enterotoxin(se), toxic shock syndrome toxin-1(tst), exfoliative toxin(et), Panton Valentine leukocidin(pvl)). seg gene, isolated the most among toxin genes, was detected in 59 strains (58.4%) and more than two toxin genes were detected in 70 strains (69.3%). As a combination possessing toxin genes, it was detected in 19 strains (18.8%) as seb, sec, seg, sei, tst and the second frequent combination was sec, seg, sei shown in 11 strains (10.9%). 19 strains (18.8%) with combinations of toxin genes same with seb, sec, seg, sei, tst had 100% resistance Ampicillin, Benzylpenicillin, Ciprofloxacin, Clindamycin, Gentamicin, Erythromycin, Telithromycin, Tetracycline antibiotics. Strains with many toxin genes showed high correlation of antibiotic resistance. Afterwards, effective therapy and thorough infection management should be preceded not to spread the resistance of MRSA strain.

• Korean Journal of Adult Nursing
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• v.14 no.1
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• pp.26-33
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• 2002

Purpose: This is a clinical experimental study aimed to provide basic data to ensure quality care. The purpose of this study is to increase nurses hand washing behavior and decrease respiratory isolation rate of MRSA. Method: This study was conducted in Kangnam St. Marys hospital. The subjects included 5 nurses working at the NS ICU and 165 specimen for nasal swabs and 46 specimen for sputum cultures from 106 patients admitted to the NS ICU. The data were collected from June to September 2000. Results: 1.The percentage of the nurses hand washing was 15.6percent but was improved to 46.5 percent after the educational intervention. In particular, hand washing behavior was increased in situations such as after suctioning, before parenteral nutrition, and after providing hygiene care. 2. Results of nasal swab showed that MRSA isolation rate was reduced from 42.8 percent before the education to 18.6percent after the education. The sputum culture results also showed that the MRSA rate was reduced from 40.7percent before the education to 34.6percent after the education. Conclusion: The findings showed the nurses' strict hand washing behavior and use of disposable gloves and paper towers as well as use of hand sterilization spray by visitors or families can decrease the MRSA isolation rate in the NS ICU patients. Since the NS ICU patients may have respiratory complications due to long-term hospitalization, the nurses regular hand washing is important enough to be emphasized. Future research should be focused on the impact of nurses' hand washing behavior on the incidence of pneumonia, an iatrogenic infection.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.13 no.3
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• pp.359-367
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• 2006

Purpose: This study was a within subject repeated pretest-posttest design done to compare the effect of disinfection and the degree of MRSA(Methicillin- resistant staphylococcus aureus) isolation from hand disinfectant in ICU nurses. Method: Out of the total internal medicine/surgery ICU nurses at a university hospital in Seoul, 29 female nurses who were participating in direct patient care were participants in this study. After collection of samples, Staphylococcus aureus and MRSA were isolated from the palms, nails and nasal cavities of the nurses according to disinfectants (soap and beta-scrub). Results: The effect of disinfection was greater in the beta-scrub group than in the soap group, and the effect of disinfection on palms was higher in the beta-scrub group than in the soap group. As for the degree of MRSA isolation, there was more isolation in palms in the soap group than in the beta-scrub group but there was no difference in the degree of MRSA isolation from the hand disinfectant in nails and nasal cavities. Conclusion: Beta-scrub showed a superior prolonged effect against transient bacteria compared with soap. Further, to reduce MRSA infection, we recommend interventions focused on these aspects.

• Pediatric Infection and Vaccine
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• v.16 no.2
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• pp.150-161
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• 2009

Purpose : Staphylococcus aureus causes a variety of infections, ranging from benign skin infections to fatal invasive infections. Recently, methicillin-resistant S. aureus (MRSA) infections have emerged in patients who do not have established risk factors. This study was conducted to characterize S. aureus infections in children with an emphasis on communityassociated MRSA infections at a tertiary care pediatric facility during a 3-year period. Methods : Four hundred twenty-nine cases of S. aureus infections diagnosed at the Seoul National University Children's Hospital between January 2004 and December 2006 were retrospectively reviewed. The cases were classified as hospitalonset (HO) or community-onset (CO), healthcare-associated (HA), or community-associated (CA) infections. Results : Among the 206 cases <1 year of age, 72%, 7%, and 21% were HO-HA, CO-HA, and CA infections, respectively, as compared to 48%, 28%, and 24% among the 223 cases >1 year of age. The proportion of CO-HA infections among HA infections (8.6% vs. 37.1%, P<0.001) and the proportion of HA infections among the CO infections (24.5% vs. 54.3%, P <0.001) were greater in older children than in infants. Overall, 57% of the isolates were methicillin-resistant. Twenty-nine (30%) of 96 CA strains were MRSA, and the most common site of CA-MRSA infection was the skin and soft tissues (26 cases). Conclusion : The methicillin resistance rate of S. aureus from CA infections was high and CA-MRSA was most often associated with skin and soft tissue infections.