• 약학회지
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• 제51권2호
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• pp.108-114
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• 2007

The predominant Macrolides-Lincosamide-Streptogramin B (MLS$_B$) antibiotics resistance genes in staphylococci are erm(A) and erm(C). There is the phenomenon that the ratio of constitutively MLS$_B$ antibiotics resistance (cMLS) in erm(A) is much higher than in erm(C). Thus, we confirmed that the difference of the mutation ratio between erm(A) and erm(C) makes the phenomenon. We examined 8 staphylococci carrying inducibly expressed (iMLS) erm(A) or erm(C) genes. After overnight incubation in the presence of the non-inducer MLS$_B$ antibiotics, spontaneous mutants constitutively expressed MLS$_B$ resistance were selected. Against our expectation, the mutation ratio of erm(A) was lower than erm(C). Therefore, possibilities of other factors determining the ratio of cMLS phenotype might be concerned. All the mutants showed sequence alterations in translational attenuator and all the alterations seemed to give rise to change the second structure of mRNA to express constitutively. For erm(A), 4 different types of sequence deletions ranging from 72 bp to 122 bp and 3 different types of duplications ranging 24 bp to 93 bp were detected. Also, there were 9 different types of duplications ranging 15bp to 154bp in erm(C).

• 한국임상약학회지
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• 제9권1호
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• pp.1-14
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• 1999

Vancomycin-resistant Enterococci (VRE) have recently emerged in Korean hospitals, as well as in those of other countries. VRE have been partially attributed to the overuse and misuse of vancomycin. The mecbanisms of VRE resistance are related to VanA, VanB, and VanC. Both VanA and VanB produce abnormal ligase enzymes to form D-ala-D-lactate termini in E. faecium and E. faecalis, instead of D-ala-D-ala termini. Meanwhile, Van C produces D-ser-D-ala termini in E. gallinarum and E. casseliflavus. These abnormal termini have a low affinity to vancomycin. As a result, VRE avoid the activity of vancomycin by these mechanisms. Unfortunately, there is no approved therapy for the treatment of VRE. Thus, available but uncommonly prescribed antibiotics (due to their toxicity or unproven efficacy) may become possible options. They include chloramphenicol, novobiocin, fosfomycin, and bacitracin. The combination therapy of available agents may also be the other options. They include high doses of a penicillin- or ampicillin-aminoglycoside combination, high doses of an ampicillin/sulbactam and aminoglyoosidcs combination, an ampicillin and vancomycin combination, and a ciprofloxacin, aminoglycosides, and rifampin combination. With respect to the near future, many types of investigational agents will most likely expand their treatment options for VRE. Teicoplanin, a glycopeptide, can be used for VanB- and VanC-related VRE. LY333328, a new generation of glycopeptide, is effective in treating VanA as well as VanB and VanC. RP59500 (quinupristin/dalfopristin), a streptogramin, is effective in treating vancomycin-resistant E. faecium. New generation quinolones (especially clinatloxacin) are potential options for the treatment of VRE, even though they cannot work as effectively against VRE as they can against Staphylococci. Both glycylcyclines (a new generation of tetracyclines) and ketolides (a new generation of macrolides) show good activity against Enterococci, regardless of vancomycin susceptibility. Oxazolidinones (i. e. eperezolid and 1inezolid) and everninomicins (i. e. SCH27899) are new groups of antibiotics, which also demonstrate good activity against VRE. It is imperative that clinical pharmacists take the responsibility of investigating new treatment options for VRE in order to combat this growing problem throughout the world.

• Journal of Korean Medical Science
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• 제33권43호
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• pp.268.1-268.11
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• 2018

Background: We aimed to compare the therapeutic efficacy of prolonged macrolide (PMC), corticosteroids (CST), doxycycline (DXC), and levofloxacin (LFX) against macrolide-unresponsive Mycoplasma pneumoniae (MP) pneumonia in children and to evaluate the safety of the secondary treatment agents. Methods: We retrospectively analyzed the data of patients with MP pneumonia hospitalized between January 2015 and April 2017. Macrolide-unresponsiveness was clinically defined with a persistent fever of ${\geq}38.0^{\circ}C$ at ${\geq}72$ hours after macrolide treatment. The cases were divided into four groups: PMC, CST, DXC, and LFX. We compared the time to defervescence (TTD) after secondary treatment and the TTD after initial macrolide treatment in each group with adjustment using propensity score-matching analysis. Results: Among 1,165 cases of MP pneumonia, 190 (16.3%) were unresponsive to macrolides. The proportion of patients who achieved defervescence within 48 hours in CST, DXC, and LFX groups were 96.9% (31/33), 85.7% (12/14), and 83.3% (5/6), respectively. The TTD after initial macrolide treatment did not differ between PMC and CST groups (5.1 vs. 4.2 days, P = 0.085), PMC and DXC groups (4.9 vs. 5.7 days, P = 0.453), and PMC and LFX groups (4.4 vs. 5.0 days, P = 0.283). No side effects were observed in the CST, DXC, and LFX groups. Conclusion: The change to secondary treatment did not show better efficacy compared to PMC in children with macrolide-unresponsive MP pneumonia. Further studies are needed to guide appropriate treatment in children with MP pneumonia.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.15-26
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• 2019

The pathogen Mycobacterium avium complex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment. The prognostic factors for the progression of MAC pulmonary disease are low body mass index, poor nutritional status, presence of cavitary lesion(s), extensive disease, and a positive acid-fast bacilli smear. A regimen consisting of macrolides (clarithromycin or azithromycin) with rifampin and ethambutol has been recommended; this regimen significantly improves the treatment of MAC pulmonary disease and should be maintained for at least 12 months after negative sputum culture conversion. However, the rates of default and disease recurrence after treatment completion are still high. Moreover, treatment failure or macrolide resistance can occur, although in some refractory cases, surgical lung resection can improve treatment outcomes. However, surgical resection should be carefully performed in a well-equipped center and be based on a rigorous risk-benefit analysis in a multidisciplinary setting. New therapies, including clofazimine, inhaled amikacin, and bedaquiline, have shown promising results for the treatment of MAC pulmonary disease, especially in patients with treatment failure or macrolide-resistant MAC pulmonary disease. However, further evidence of the efficacy and safety of these new treatment regimens is needed. Also, a new consensus is needed for treatment outcome definitions as widespread use of these definitions could increase the quality of evidence for the treatment of MAC pulmonary disease.

• Journal of Veterinary Science
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• 제21권4호
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• pp.57.1-57.11
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• 2020

Background: Streptococcus dysgalactiae subspecies equisimilis (SDSE) acts as an etiological agent for lameness, neurological signs, and high mortality in pigs. Despite its importance in pig industries and zoonotic potential, little is known about the effects of this pathogen. Objectives: This study aimed to determine the molecular characteristics and antimicrobial resistance of SDSE strains isolated from diseased pigs. Methods: A total 11 SDSE isolates were obtained from diseased pigs. Bacterial identification, PCR for virulence genes, emm typing, and antimicrobial resistance genes, multilocus sequence typing, and antimicrobial susceptibility test were performed. Results: Nine isolates were from piglets, and 8 showed lameness, sudden death, or neurological signs. The isolates were PCR-positive for sla (100%), sagA (100%), and scpA (45.5%), and only 1 isolate amplified the emm gene (stL2764). Eight different sequence types were detected, categorized into 2 clonal complexes and 4 singletons. All the isolates in this study were included in a small cluster, which also contained other strains derived from humans and horses. The minimum inhibitory concentrations for the tested beta-lactams were low, while those for macrolides, tetracyclines, and fluoroquinolones were relatively high. PCR analysis of the macrolide and tetracycline resistance genes demonstrated that the isolates carried erm(B) (18.2%, n = 2), mef(A/E) (9.1%, n = 1), tet(M) (18.2%, n = 2), and tet(O) (90.2%, n = 10). Two isolates presented a mutation in parC, which is associated with fluoroquinolone resistance. Conclusion: This study provided insight into swine-derived SDSE, as it is related to veterinary medicine, and elucidated its zoonotic potential, in the context of molecular epidemiology and antimicrobial resistance in public health.

• Journal of Microbiology and Biotechnology
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• 제32권7호
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• pp.911-917
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• 2022

As valuable antibiotics, microbial natural products have been in use for decades in various fields. Among them are polyene compounds including nystatin, amphotericin, and nystatin-like Pseudonocardia polyenes (NPPs). Polyene macrolides are known to possess various biological effects, such as antifungal and antiviral activities. NPP A1, which is produced by Pseudonocardia autotrophica, contains a unique disaccharide moiety in the tetraene macrolide backbone. NPP B1, with a heptane structure and improved antifungal activity, was then developed via genetic manipulation of the NPP A1 biosynthetic gene cluster (BGC). Here, we generated a Streptomyces artificial chromosomal DNA library to isolate a large-sized NPP B1 BGC. The NPP B1 BGC was successfully isolated from P. autotrophica chromosome through the construction and screening of a bacterial artificial chromosome (BAC) library, even though the isolated 140-kb BAC clone (named pNPPB1s) lacked approximately 8 kb of the right-end portion of the NPP B1 BGC. The additional introduction of the pNPPB1s as well as co-expression of the 32-kb portion including the missing 8 kb led to a 7.3-fold increase in the production level of NPP B1 in P. autotrophica. The qRT-PCR confirmed that the transcription level of NPP B1 BGC was significantly increased in the P. autotrophica strain containing two copies of the NPP B1 BGCs. Interestingly, the NPP B1 exhibited a previously unidentified SARS-CoV-2 RNA-dependent RNA polymerase (RdRp) inhibition activity in vitro. These results suggest that the Streptomyces BAC cloning of a large-sized, natural product BGC is a valuable approach for titer improvement and biological activity screening of natural products in actinomycetes.

• 대한환경공학회지
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• 제32권3호
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• pp.278-286
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• 2010

축산용 항생물질은 동물의 질병예방, 치료와 더불어 성장촉진 및 사료효율 증대를 위한 목적으로 널리 사용되고 있다. 우리나라에서 사용되는 항생물질의 가축 사육수 당 사용량은 선진국에 비해 매우 높으며 이로 인해 환경 내로 유입될 가능성이 상대적으로 높다. 특히 환경으로 유입된 항생물질은 내성 박테리아의 유발 등 여러 가지 환경적 문제를 야기할 수 있어 이에 대한 연구가 요구된다. 이에 본 연구는 국내 대규모 계분 처리시설을 중심으로 주변의 농경지 토양, 하천수 및 저질토 등으로의 환경 유출 가능성이 높은 항생물질 4가지 계열(tetracyclines[TCs], sulfonamides[SAs], macrolides[MLs], inopohores[IPs])을 대상으로 환경요소 내의 잔류 특성을 조사하였다. 연구결과 환경으로 유입된 TCs 항생물질은 일반적으로 토양 양이온과 흡착하여 안정화 되는 경향을 보였다. 우리나라에서 사용량이 가장 높은 TCs의 tetracycline(TC)가 토양, 하천수 및 저질토에서 50% 이상의 검출비율을 보였으며 최대 35.6 ${\mu}g/kg$까지 검출되었다. 반면 SAs 계열은 높은 이동성을 보였으며 연구지역 특성상 잔류 농도는 상대적으로 낮았지만 수질 시료 중 검출비율이 86.7~93.3%으로 다른 항생물질보다 높았다. IPs 중 monensin(MNS)는 양계용 사료에 많이 사용된다고 알려진 바와 같이 토양 중 최대 6.9 ${\mu}g/kg$으로 높은 수치 를 보였다. MLs의 tylosin(TYL)은 토양과 저질토에서 최대 농도가 각각 16.6 ${\mu}g/kg$, 114.3 ${\mu}g/kg$로 저질토에 흡착되어 잔류하는 특성이 강했다.

• Clinical and Experimental Pediatrics
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• 제58권6호
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• pp.211-217
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• 2015

Purpose: Mycoplasma pneumoniae (MP) infection is a major cause of respiratory infection in school-aged children. Extrapulmonary manifestations of MP infection are common, but liver involvement has been rarely reported. The aim of this study was to determine the clinical characteristics of MP-associated hepatitis. Methods: This prospective study included 1,044 pediatric patients with MP infection diagnosed serologically with MP IgM at one medical center from January 2006 to December 2012. Eighty of these patients had elevated levels of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), each greater than 50 IU/L, without any other specific liver disorder and were compared with the 964 children without liver disorders. Results: In total, 7.7% of patients with MP infection had a diagnosis of hepatitis, especially in fall and winter. The ratio of male to female patients was 1.7:1, and the mean age of the patients was 5 years and 5 months. The most common symptoms were cough, fever, and sputum. Anorexia was the most common gastrointestinal symptom, followed by nausea/vomiting, diarrhea, and abdominal pain. Mean levels of AST and ALT were 100.65 IU/L and 118.73 IU/L, respectively. Serum AST/ALT level was normalized within 7.5 days on average without complications. The mean duration of hospitalization (11.3 days) was longer for children with hepatitis than for those without hepatitis (P=0.034). Conclusion: MP-associated hepatitis is not uncommon and has a relatively good prognosis. Therefore, clinicians should be concerned about liver involvement in MP infection but avoid further unnecessary evaluation of hepatitis associated with MP.

• 한국환경농학회지
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• 제29권3호
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• pp.273-281
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• 2010

본 연구는 강원도 원주 지역의 계분 퇴비화 시설 인근의 농경지 토양, 지표수 및 저질토에 대한 TCs계열 3종(TC, CTC 및 OTC), SAs 계열 3종(SMX, STZ 및 SMT), IPs 계열 3종(LSL, MNS 및 SLM) 및 MLs 계열 1종(TYL) 등 총 4개 계열 10종의 항생물질을 선정하여 영농시기 별 잔류특성을 조사하였다. 토양 시료의 경우 TCs가 다른 계열 항생물질과 비교하여 가장 높은 농도로 검출되었으며 이는 TCs 내 케톤기와 토양 내 2가 양이온이 복합체를 형성, 표토에 강하게 흡착되어 심토까지 이동하지 않고 축적된 것으로 추측된다. 반면 TCs와 비교해 토양 내 SAs 잔류량이 낮은 이유는 적은 사용량과 낮은 흡착계수에서 기인된 것으로 판단되었다. 수질시료의 TCs는 집중강우로 인한 토양유실 및 이후 유량 감소로 인해 6월보다 9월에 높은 농도를 보였다. 저질토 내 TCs 농도 증가 이유가 양이온간의 복합체 형성, 이온교환 및 부식산의 수소결합으로 인해 지표수로 유입된 TCs가 저질토로 흡착, 축적되었기 때문으로 판단된다. 본 연구를 통해 계분퇴비 시용시 주변환경으로 높은 농도의 항생물질이 유입될 가능성이 있으며, 이로 인해 토양 내 내성 박테리아 생성 및 생태계 교란뿐만 아니라 직 간접적으로 인간에게 피해가 우려되는 바 지속적인 모니터링을 통한 관리방안 마련이 필요할 것으로 판단된다.

• Tuberculosis and Respiratory Diseases
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• 제65권5호
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• pp.410-415
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• 2008

폐쇄성 세기관지염은 골수 이식 후 폐에 발생하는 합병증이다. 현재 스테로이드와 면역 억제제를 투여하여 적극적인 치료를 하더라도 폐기능의 호전을 보이는 경우는 일부에 불과하다. 저자들은 기존의 치료에도 불구하고 호전을 보이지 않은 골수 이식 후 발생한 폐쇄성 세기관지염 환자에서 macrolide계 항생제인 azithromycin을 1년간 경구 투여하여 폐기능이 호전됨을 경험하였기에 문헌고찰과 함께 보고하는 바이다.