• 대한간호학회지
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• 제50권4호
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• pp.621-630
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• 2020

Purpose: This study was aimed to evaluate the external validity of a carbapenem-resistant Enterobacteriaceae (CRE) acquisition risk prediction model (the CREP-model) in a medium-sized hospital. Methods: This retrospective cohort study included 613 patients (CRE group: 69, no-CRE group: 544) admitted to the intensive care units of a 453-beds secondary referral general hospital from March 1, 2017 to September 30, 2019 in South Korea. The performance of the CREP-model was analyzed with calibration, discrimination, and clinical usefulness. Results: The results showed that those higher in age had lower presence of multidrug resistant organisms (MDROs), cephalosporin use ≥ 15 days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 21 points, and lower CRE acquisition rates than those of CREP-model development subjects. The calibration-in-the-large was 0.12 (95% CI: - 0.16~0.39), while the calibration slope was 0.87 (95% CI: 0.63~1.12), and the concordance statistic was .71 (95% CI: .63~.78). At the predicted risk of .10, the sensitivity, specificity, and correct classification rates were 43.5%, 84.2%, and 79.6%, respectively. The net true positive according to the CREP-model were 3 per 100 subjects. After adjusting the predictors' cutting points, the concordance statistic increased to .84 (95% CI: .79~.89), and the sensitivity and net true positive was improved to 75.4%. and 6 per 100 subjects, respectively. Conclusion: The CREP-model's discrimination and clinical usefulness are low in a medium sized general hospital but are improved after adjusting for the predictors. Therefore, we suggest that institutions should only use the CREP-model after assessing the distribution of the predictors and adjusting their cutting points.

• Journal of Microbiology and Biotechnology
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• 제31권5호
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• pp.733-739
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• 2021

Acinetobacter strains are widely present in the environment. Some antimicrobial-resistant strains of this genus have been implicated in infections acquired in hospitals. Genetic similarities have been reported between Acinetobacter strains in nosocomial infections and those isolated from foods. However, the antimicrobial resistance of Acinetobacter strains in foods, such as meat, remains unclear. This study initially aimed to isolate Campylobacter strains; instead, strains of the genus Acinetobacter were isolated from meat products, and their antimicrobial resistance was investigated. In total, 58 Acinetobacter strains were isolated from 381 meat samples. Of these, 32 strains (38.6%) were from beef, 22 (26.5%) from pork, and 4 (4.8%) from duck meat. Antimicrobial susceptibility tests revealed that 12 strains were resistant to more than one antimicrobial agent, whereas two strains were multidrug-resistant; both strains were resistant to colistin. Cephalosporin antimicrobials showed high minimal inhibitory concentration against Acinetobacter strains. Resfinder analysis showed that one colistin-resistant strain carried mcr-4.3; this plasmid type was not confirmed, even when analyzed with PlasmidFinder. Analysis of the contig harboring mcr-4.3 using BLAST confirmed that this contig was related to mcr-4.3 of Acinetobacter baumannii. The increase in antimicrobial resistance in food production environments increases the resistance rate of Acinetobacter strains present in meat, inhibits the isolation of Campylobacter strains, and acts as a medium for the transmission of antimicrobial resistance in the environment. Therefore, further investigations are warranted to prevent the spread of antimicrobial resistance in food products.

• Journal of Microbiology and Biotechnology
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• 제31권12호
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• pp.1632-1642
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• 2021

Tuberculosis is a highly contagious disease caused by Mycobacterium tuberculosis. It affects about 10 million people each year and is still one of the leading causes of death worldwide. About 2 to 3 billion people (equivalent to 1 in 3 people in the world) are infected with latent tuberculosis. Moreover, as the number of multidrug-resistant, extensively drug-resistant, and totally drug-resistant strains of M. tuberculosis continues to increase, there is an urgent need to develop new anti-tuberculosis drugs that are different from existing drugs to combat antibiotic-resistant M. tuberculosis. Against this background, we aimed to develop new anti-tuberculosis drugs using probiotics. Here, we report the anti-tuberculosis effect of Pediococcus acidilactici PMC202 isolated from young radish kimchi, a traditional Korean fermented food. Under coculture conditions, PMC202 inhibited the growth of M. tuberculosis. In addition, PMC202 inhibited the growth of drug-sensitive and -resistant M. tuberculosis- infected macrophages at a concentration that did not show cytotoxicity and showed a synergistic effect with isoniazid. In a 2-week, repeated oral administration toxicity study using mice, PMC202 did not cause weight change or specific clinical symptoms. Furthermore, the results of 16S rRNA-based metagenomics analysis confirmed that dysbiosis was not induced in bronchoalveolar lavage fluid after oral administration of PMC202. The anti-tuberculosis effect of PMC202 was found to be related to the reduction of nitric oxide. Our findings indicate that PMC202 could be used as an anti-tuberculosis drug candidate with the potential to replace current chemical-based drugs. However, more extensive toxicity, mechanism of action, and animal efficacy studies with clinical trials are needed.

• Tuberculosis and Respiratory Diseases
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• 제59권2호
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• pp.179-185
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• 2005

배 경 : 다제내성 폐결핵환자에서 폐병소의 근치절제술 후 일차 항결핵제로 구성된 처방으로 치료하였을 때의 성적을 알아보고자 하였다. 방 법 : 전향적 연구로 국립마산결핵병원에서 1998년 2월부터 2004년 12월 사이에 다제내성 폐결핵으로 수술전 HRCT에서 공동을 포함하는 국소적 병소인 것과 수술 중에 절제부위 이외에 잔존병소가 없다고 판단 된 환자 17명에게 수술 후 3HERZS/3HERS/6HER로 투약하고 그 임상적 경과를 살펴보았다. 결 과 : 대상환자들은 약제감수성검사에서 INH, RFP이외에 평균 4가지 항결핵제에 내성을 보였으며, 술 후 균음전은 평균 2일째 이루어졌다. 평균 39개월의 추구관찰 기간 동안 치료를 중단한 1명을 제외한 94%(15/16) 환자에서 치유되었으며 균음전에 실패한 1명과 치료종결하고 약 7년 후에 재발된 1명은 본원의 처방지침에 따라 이차 항결핵제로 처방을 변경 투약하여 모두 균음전에 성공하였다. 결 론 : 국소적 병변을 가진 다제내성결핵 환자에서 병소의 근치절제후 일차 항결핵제로 구성된 처방으로도 양호한 치료성적을 얻을 수 있었다. 하지만 이러한 경험을 일반화하기 위해서는 더 많은 경험과 병소별 결핵균 주의 특성에 관한 연구 등이 필요할 것으로 사료된다.

• 미생물학회지
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• 제45권2호
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• pp.99-104
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• 2009

본 연구에서는 2004년 1월부터 2008년 12월까지 인천지역 5개 종합 병 의원에 설사증상으로 입원 또는 내원한 환자의 대변에서 분리한 115주의 S. Enteritidis의 항생제 내성 및 다제내성 양상을 모니터링하였다. 그 결과, 가장 내성율이 높은 항생제는 nalidixic acid (54.8%)이었고, ampicillin (40.0%), ticarcillin (38.3%), chloramphenicol (20.9%), tetracycline (17.4%) 순이었다. 분리균의 91.3%는 1제 이상의 항생제에 내성이 있었다. 항생제 내성 유형을 살펴본 결과 nalidixic acid 단일 내성이 44.3%로 가장 높았으며, ampicillin-chloramphenicol-ticarcillin (11.3%) 및 ampicillin-ticarcillin (10.4%) 순이었다. 전체적으로 1제 내성이 51.9%, 2제 내성 18.2%, 3제 내성 14.5%, 4제 내성 5.8% 그리고 5제 이상 내성은 9.7%이었다.

• 생명과학회지
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• 제16권4호
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• pp.664-671
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• 2006

1996년부터 2005년까지 부산지역에서 분리된 Salmonella enterica serovar Typhi 균주에 대한 항균제 내성 변화양상 및 Pulsed-field gel electrophoresis(PFGE)를 이용한 분리주의 분자역학적 형별을 분석하였다. 전체 424주에 대한 항균제 감수성 시험결과 multidrug-resistant (MDR) 6주(1.4%)와 nalidixic acid에만 내성을 보이는 2주를 제외한 나머지 416주(98.1%)가 시험 항균제 18종 모두에 감수성을 보였다. 부산지역 분리 장티푸스균의 유전적 이질성을 확인하고자 실시한 산발 분리 50주의 PFGE/XbaI 시험결과, 최소 32종의 다양한 패턴이 나타났다. 각 패턴별로 제한효소 절편 수는 13개에서 18개까지였고, 절편크기는 약 20 kb에서 630 kb 범위였다. 본 시험결과 부산지역의 장티푸스의 산발 또는 집단 발생시 PFGE는 유용한 역학적 지표로 사용가능함을 알 수 있었으며 또한 전국적 PulseNet 구축의 기초 자료로서 활용도가 높을 것으로 사료된다.

• 대한화상학회지
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• 제22권1호
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• pp.1-9
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• 2019

Purpose: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns. Methods: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy. Results: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. Conclusion: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

• 한국수산과학회지
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• 제49권6호
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• pp.800-806
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• 2016

In total, 151 Escherichia coli isolates from Ruditapes philippinarum in Gomso Bay were analyzed for their susceptibility to 18 different antimicrobial agents and for genes associated with virulence. For virulence genes, each strain of the isolates was positive for the enterotoxigenic E. coli (ETEC)-specific heat-stable toxin (estA), enteroinvasive E. coli (EIEC)-specific invasion-associated locus (iaa) gene and enteropathogenic E. coli (EPEC)-specific attaching and effacing (eae) gene. According to a disk diffusion susceptibility test, resistance to ampicillin was most prevalent (23.2%), followed by resistance to amoxicillin (22.5%), ticarcillin (20.5%), tetracycline (18.5%), nalidixic acid (12.6%), ciprofloxacin (10.6%), streptomycin (9.9%), and chloramphenicol (6.6%). More than 35.8% of the isolates were resistant to at least one antimicrobial agent, and 19.9% were resistant to four or more classes of antimicrobials; these were consequently defined as multidrug resistant. Minimum inhibitory concentration (MIC) ranges for the antimicrobial resistance of the 15 different antimicrobial agents of 54 E. coli strains were confirmed by varying the concentrations from $32-2,048{\mu}g/mL$. Overall, these results not only provide novel insights into the necessity for seawater and R. philippinarum sanitation in Gomso Bay but they also help to reduce the risk of contamination by antimicrobial-resistant bacteria.

• 한국동물위생학회지
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• 제42권2호
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• pp.53-60
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• 2019

This study was performed to investigate antimicrobial resistance in bacterial isolates obtained from companion dogs in veterinary hospitals and an animal shelter in Incheon. Drug resistance was examined respectively with the isolates of Escherichia coli, Enterococcus faecalis, and Staphylococcus pseudintermedius. The prevalence of drug resistance was calculated for each bacterial species towards 163 E. coli isolates, 156 E. faecalis isolates, and 86 S. pseudintermedius isolates by using selected antimicrobials. E. coli isolates were highly resistant to ampicillin, ciprofloxacin and tetracycline (47.9%, 28.2% and 28.2%, respectively). E. faecalis isolates were highly resistant to quinupristin-dalfopristin, tetracycline, kanamycin, rifampicin (69.8%, 66.0%, 53.8% and 51.9%, respectively). Higher levels of resistance were detected for ampicillin, penicillin, tetracycline, erythromycin, trimethoprim/sulfamethoxazole, telithromycin in S. pseudintermedius isolates (83.7%~52.6%, respectively). Occurrence of methicillin-resistant S. pseudintermedius (MRSP) was confirmed by oxacillin disc diffusion method, resulted in 23.3% occurrence among the S. pseudintermedius isolates (20/86 strains). The occurrence ratio of multidrug-resistance in the isolates of E. coli, E. faecalis, and S. pseudintermedius was 34.5%, 56.9%, and 67.9%, respectively. In this study, higher levels of antimicrobial drug resistance were observed in bacterial isolates obtained from dogs in Incheon. A regular monitoring and surveillance program should be implemented to prevent the emergence and spread of the drug-resistant bacteria carried in companion dogs.

• Tuberculosis and Respiratory Diseases
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• 제82권2호
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• pp.143-150
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• 2019

Background: The purpose of this study was to analyze the relationship between the gene mutation patterns by the GenoType MTBDRplus (MTBDRplus) assay and the phenotypic drug susceptibility test (pDST) results of isoniazid (INH) and prothionamide (Pto). Methods: A total of 206 patients whose MTBDRplus assay results revealed katG or inhA mutations were enrolled in the study. The pDST results were compared to mutation patterns on the MTBDRplus assay. Results: The katG and inhA mutations were identified in 68.0% and 35.0% of patients, respectively. Among the 134 isolated katG mutations, three (2.2%), 127 (94.8%) and 11 (8.2%) were phenotypically resistant to low-level INH, high-level INH, and Pto, respectively. Among the 66 isolated inhA mutations, 34 (51.5%), 18 (27.3%) and 21 (31.8%) were phenotypically resistant to low-level INH, high-level INH, and Pto, respectively. Of the 34 phenotypic Pto resistant isolates, 21 (61.8%), 11 (32.4%), and two (5.9%) had inhA, katG, and both gene mutations. Conclusion: It is noted that Pto may still be selected as one of the appropriate multidrug-resistant tuberculosis regimen, although inhA mutation is detected by the MTBDRplus assay until pDST confirms a Pto resistance. The reporting of detailed mutation patterns of the MTBDRplus assay may be important for clinical practice, rather than simply presenting resistance or susceptibility test results.