• Korean Journal of Clinical Laboratory Science
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• v.38 no.3
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• pp.166-172
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• 2006

Metallo-${\beta}$-lactamase (MBL) can hydrolyze all ${\beta}$-lactams except monobactams and frequently coexists with various antibiotic resistance genes such as aminoglycoside resistance, sulfonamide resistance gene, etc. Therefore, the effective antibiotics against infections by these bacteria are markedly limited or can't even be found. We tried to search in-vitro antimicrobial combinations with synergistic effects for a VIM-2 type MBL producing Pseudomonas aeruginosa, isolated from clinical specimen. On the selection of antibiotic combinations with synergistic effects, we performed a one disk synergy test, modified Pestel's method, in agar without aztreonam (AZT). The bacteriostatic synergistic effects of this tests were scored as $S_1$ (by susceptibility pattern in agar without antibiotics), $S_2$ (by the change of susceptibility in agar with or without antibiotics) and $S_3$ ($S_1$ + $S_2$) and was classified into weak (1 point), moderate (2 points) and strong (3 points) by $S_3$ score. Subsequently, we carried out the time-killing curve for the antibiotic combinations with the strong synergistic bacteriostatic effect. One VIM-2 type MBL producing P. aeruginosa confirmed by the PCR showed all resistance against all ${\beta}$-lactams except AZT, aminoglycoside and ciprofloxacin. In the one disk synergy test, this isolate showed a strong bacteriostatic synergistic effect for the antibiotic combination of AZT and piperacillin-tazobactam (PIP-TZP) or AZT and amikacin (AN). On the time-killing curve after six hours of incubation, the colony forming units (CFUs/mL) of this bacteria in the medium broth with both combination antibiotics were decreased to 1/18.7, 1/17.1 of the least CFUs of each single antibiotics. The triple antibiotic combination therapy including AZT, PIP-TZP and AN was shown to be significantly synergistic after 8 hrs of exposure. In a VIM-2 MBL producing P. aeruginosa with susceptibility for AZT, the triple antibiotic combination therapy including AZT, PIP-TZP and AN may be considered as an alternative antibiotics modality against the infection by some MBL type. But the antimicrobial combination therapy for many more MBL producing isolates is essential to know as soon as possible for the selection of effective treatment against the infection by this bacteria.

• Korean Journal of Microbiology
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• v.44 no.4
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• pp.339-345
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• 2008

This study was to detect MBL (metallo-${\beta}$-lactamase) among glucose non-fermenting Gram-negative bacilli isolated from clinical specimen and to search antimicrobial combination therapy against MBL producing Pseudomonas aeruginosa. Among fifty one isolates of Gram-negative bacilli with reduced imipenem susceptibility ($MIC{\ge}8{\mu}g/ml$), nine isolates have shown positive results in MBL detection test. They were seven Achromobacter xylosoxidans subsp. xylosoxidans and two P. aeruginosa. The results from EDTA-DDST coin-cided with those of PCR and nucleotide sequence analysis which showed the presence of $bla_{VIM-2}$. The combination of aztreonam (AZT) and piperacillin-tazobactarn (TZP) or AZT and amikacin (AN) screened by one disk synergy test showed no synergistic effect. Triple antibiotic combination therapy with AZT, TZP and AN, however, was shown to be effective and the most synergistic after 8 hrs of exposure. This result strongly suggest that the triple combination therapy of AZT, TZP, and AN could be useful for the treatment of infection caused by MBL producing Gram-negative bacilli.

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

• Biomedical Science Letters
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• v.25 no.4
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• pp.321-330
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• 2019

Carbapenem is recently considered as the last resort of the therapeutics for gram negative bacterial infection. Increasing of organisms producing metallo-β-lactamase (MBL), we have difficulty in choosing the antimicrobial agents. Among 345 clinical isolates of Pseudomonas spp., 61 isolates (17.7%) were positive for the modified imipenem or meropenem-Hodge test and 55 isolates (15.9%) were positive for the imipenem-EDTA + SMA double disk synergy test (DDS). PCR and sequencing of bla_VIM-2-allele and bla_IMP-1-allele showed that 17 isolates of Pseudomonas aeruginosa, 9 isolates of Pseudomonas taiwnensis and 2 Pseudomonas plecoglossicida had bla_VIM-2, and 22 isolates of P. aeruginosa and one Pseudomonas otitidis had bla_IMP-6. These MBL genes were all in class 1 integron. The size of class 1 integron with bla_VIM-2 ranged from 3.5 kb to 5.5 kb in clinical isolates of Pseudomonas spp. including P. aeruginosa. bla_VIM-2 was most often located first in the class 1 integron, sometimes in the second or third position, and these integrons often had aacA4 or aadA1. Strict infection control measures are needed to more effectively prevent further spread of these MBL-producing Pseudomonas spp. In addition, MBL-producing Pseudomonas spp. is expected to continue to spread in various countries and regions.

• Journal of Microbiology
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• v.44 no.4
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• pp.423-431
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• 2006

Among 53 Acinetobacter baumannii isolates collected in 2004, nine imipenem-resistant isolates were obtained from clinical specimens taken from patients hospitalized in Busan, Korea. Nine carbapenemase-producing isolates were further investigated in order to determine the mechanisms underlying resistance. These isolates were then analyzed via antibiotic susceptibility testing, microbiological tests of carbapenemase activity, pI determination, transconjugation test, enterobacterial repetitive consensus (ERIC)-PCR, and DNA sequencing. One outbreak involved seven cases of infection by A. baumannii producing OXA-23 ${\beta}-lactamase$, and was found to have been caused by a single ERIC-PCR clone. During the study period, the other outbreak involved two cases of infection by A. baumannii producing IMP-1 ${\beta}-lactamase$. The two clones, one from each of the outbreaks, were characterized via a modified cloverleaf synergy test and an EDTA-disk synergy test. The isoelectric focusing of the crude bacterial extracts detected nitrocefin-positive bands with pI values of 6.65 (OXA-23) and 9.0 (IMP-1). The PCR amplification and characterization of the amplicons via direct sequencing showed that the clonal isolates harbored $bla_{IMP-1}$ or $bla_{oxA-23}$ determinants. The two clones were characterized by a multidrug resistance phenotype that remained unaltered throughout the outbreak. This resistance encompassed penicillins, extended-spectrum cephalosporins, carbapenems, monobactams, and aminoglycosides. These results appear to show that the imipenem resistance observed among nine Korean A. baumannii isolates could be attributed to the spread of an IMP-lor OXA-23-producing clone. Our microbiological test of carbapenemase activity is a simple method for the screening of clinical isolates producing class D carbapenemase and/or class B $metallo-{\beta}-lactamase$, in order both to determine their clinical impact and to prevent further spread.

• Biomedical Science Letters
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• v.11 no.3
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• pp.389-396
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• 2005

Resent studies have reported increased isolation of extended-spectrum $\beta-lactamase$ (ESBL) producing strains at several hospital in Korea. We studied to investigate the isolation rates of ESBL strains from clinical isolates of Klebsiella pneumoniae and to characterize differences in types using analyses of genotyping and antibiotic susceptibility test. Antibiotic susceptibility test with confirmation of ESBL by double disk synergy test was performed on the 54 ESBL strains of Klebsiella pneumoniae from a hospital in Busan. Transfer of resistant gene in ESBL strains resistant to 3rd generated antibiotics was confirmed by transconjugation test using E. coli $RG176^{nal(r)}$. blaTEM, blaSHV, blaCTX-M genes were detected by PCR. ESBL producing strains had 100% of resistant rate to ampicillin, azteronam, cefazolin, cefepime and ceftriaxone ($\beta-lactam$ antibiotics). Forty strains of bla TEM$(74\%)$, 41 strains of bla SHV $(76\%)$, 23 strains of bla CTX-M $(43\%)$ were found, respectively. The strains had one or more genes. They had high resistant rates to $\beta-lactam$ antibiotics including cephalosporin. The resistant rates of strains with multiple resistant genes were higher than those of strains with single resistant gene.

• Korean Journal of Veterinary Service
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• v.34 no.1
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• pp.37-43
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• 2011

This study was conducted to investigate the prevalence and genotypes of extended-spectrum ${\beta}$-lactamase (ESBL) in 377 Escherichia coli isolated from healthy and sick animals. Two isolates (0.5%), each of which were isolated from diseased swine and chicken, respectively, were confirmed as ESBL producing isolates by double disk synergy test, and showed a multidrug resistant phenotype. Minimum inhibitory concentration of cefotaxime for the two ESBL producing isolates were 3~4 times higher than those of ceftazidime, respectively. By PCR and sequencing, one isolate from swine have both $bla_{CTX-15}$ and $bla_{TEM-1}$, and one isolate from chicken have $bla_{CTX-15}$ and $bla_{TEM-116}$. Also, these genes were transferred to E. coli J53 by conjugation. These two isolates showed unrelated pulsed-field gel electrophoresis. To our knowledge, this is the first time that $bla_{TEM-116}$ gene was identified in E. coli isolated from animals in Korea. These results suggest more prudent use of third- generation cephalosporins, and surveillance and monitoring for ESBL producing E. coli in both animals and their environments should be necessary.

• Korean Journal of Microbiology
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• v.40 no.4
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• pp.295-301
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• 2004

Recently, the rapid increase and global spread of extended-spectrum $\beta-lactamase$ producing clinical isolates has become a serious problem. The incidence of extended-spectrum $\beta-lactamase$ producing clinical isolates of Escherichia coli in Korea and susceptibility to antimicrobial agents were investigated. Total 233 isolates of E. coli were obtained from urine from hospitalized patients in Guro hospital, Korea University in 2001. One hun­dred and eighty four isolates $(78.9\%)$ were resistant to ampicillin, 80 isolates $(34.3\%)$ were resistant to ceph­alothin, 93 isolates $(39.9\%)$ were resistant to gentamicin, and 64 isolates $(27.5\%)$ were resistant to norfloxacin. Among 233 isolates, 17 isolates $(7.3\%)$ were positive as determined by the double disk synergy test. When min­imal inhibitory concentrations were assayed with additional 6 antimicrobial agents, 13 isolates $(76.5\%)$ were multi-drug resistant to at least four different class antimicrobial agents. Extended-spectrum $\beta-lactamase$ were characterized with isoelectric focusing gel electrophoresis and DNA sequencing. They were TEM-1 in 5 iso­lates, TEM-15 in 1 isolate, TEM-20 in 1 isolate, TEM-52 in 4 isolates, TEM-1 and AmpC in 2 isolates, TEM-1 and OXA-30 in 1 isolate, TEM-1 and OXA-33 in 1 isolate, TEM-1, CTX-M-3, and AmpC in 1 isolate, but SHV was not detected. Antimicrobial resistance genes were transferred to animal isolate of E. coli (CCARM No. 1203) by the filter mating method. Extended spectrum $\beta-lactamase$ producers studied in the current study have low correlation to each other as determined by random amplified polymorphic DNA and pulsed field gel elec­trophoresis. This is a contradictory result from the general hypothesis that extended-spectrum $\beta-lactamase$ pro­ducers in one hospital is a result from a clonal spread.

• Journal of Yeungnam Medical Science
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• v.16 no.2
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• pp.270-276
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• 1999

Background: Extended-spectrum ${\beta}$-lactamases(ESBL) are enzymes that confer resistance to oxyimino-${\beta}$-lactams as well as to penicillins and cephalosporins. Strains of Klebsiella pneumoniae and Escherichia coli that produce ESBL have been increasingly prevalent in many countries. The purpose of this study was to investigate the ESBL production rate of K. pneumoniae and E. coli at the in Yeungnam University Medical Center. Materials and Methods: Thirty-one isolates of K pneumoniae and twenty-five isolates of E. coli were examined for ESBL by double disk synergy test, using 20/$10{\mu}g$ ticarcillin/clavulanic acid and $30{\mu}g$ oxyimino-${\beta}$-lactam(ceftazidime, ceftaxime, ceftriaxone and aztreonam) disks. Results: Fifty-two percent of K. pneumoniae and sixteen percent of E. coli isolates revealed double disk synergism. Majority of ESBL-producing strains(fifty-five percent) were isolated from patients in the intensive care unit. Conclusion: ESBL production of K. pneumoniae and E. coli were also common at the Yeungnam University Medical Center and pose a serious problem for antimicrobial therapy.

• Journal of Life Science
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• v.19 no.12
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• pp.1718-1723
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• 2009

In this study, we characterized extended-spectrum $\beta$-lactamase (ESBL)-producing Enterobacteriaceae isolated from clinical specimens in Korea and found two strains harboring plasmid-mediated $bla_{SHV-11}$, Klebsiella pneumoniae. First, the isolates were detected using the Vitek system and confirmed by the double-disk synergy test. The classification of gene coding for ESBL was also performed by polymerase chain reactions and followed by DNA sequencing. The transmission of genes was confirmed by transconjugation and transformation. Resistant expression of transformants was determined by broth microdilution minimal inhibitory concentration test. Genotypic analysis revealed that one strain harbored the $bla_{TEM-1}$, $bla_{SHV-11}$ and $bla_{CTX-M-15}$ and the other strain harbored the $bla_{SHV-11}$ and $bla_{CTX-M-15}$. They showed high resistance to oxyiminocephalosphorins (3rd-generation cephalosporins), while the transformant containing only $bla_{SHV-11}$ did not show any resistance to the antibiotics.