• Title/Summary/Keyword: Rifampin

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Characteristics of Antimicrobial Susceptibility of Enterobacter Species (Enterobacter균종의 항균제 감수성의 본태)

  • Kim, Sang-Woon;Lee, Sang-Hwa;Kim, Jung-Wan;Seol, Sung-Yong;Cho, Dong-Taek
    • The Journal of the Korean Society for Microbiology
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    • v.22 no.3
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    • pp.251-258
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    • 1987
  • A total of 58 strains of Enterobacter species isolated from clinical specimens at Kyungpook National University Hospital in Taegu and Yonsei University Hospital in Seoul were tested for the molecular characterization to investigate the nosocomial infection through the study of R plasmids which might spread among Gram negative organisms regardless of their originated strains. All strains resistant to ampicillin, cefoxitin and cephalothin but susceptible to moxalactam were subjected to the further test for the determination of in detail MIC value against 23 drugs of common use including beta-lactam antibiotics and R plasmid profile analysis. The reistance frequency of strains against carbenicillin (53.4%) was similar to those against chloramphenicol, tobramycin, and sulfisomidine. Though the MIC values of resistance criteria against ceftazidime, aztreonam, imipenem, and norfloxacine in NCCLS manual were not available but MIC ranges of strains tested were very low. There were differences in patterns and frequencies of resistance between the strains isolated in Seoul and Taegu isolates. Seoul isolates showed a tendency of higher multiplicity of resistance than those of Taegu isolates. The resistances against cefoxitin, cephalothin, cefoperazone, cefotaxime, nalidixic acid, and rifampin were not conferred to the conjugally transferable R plasmid. The approximate molecular size of conjugally transferable R plasmids ranged 30 to 151 megadalton, and one or 2 to 3 R plasmids were identified in each transconjugants.

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Vaneomycin-Resistant Enteroeocci (VRE) Treatment Options (Vaneomycin-Resistant Enteroeocci (VRE) 약물치료방법)

  • Kim, Myo Kyoung
    • Korean Journal of Clinical Pharmacy
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    • v.9 no.1
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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.

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Pathologic characteristics for the Rhodococcus equi infection in foals in Jeju (제주지역 망아지에서 Rhodococcus equi 감염증의 병리학적 특징)

  • Song, Kyung-Ok;Yang, Hyoung-Seok;Son, Won-Geun;Kim, Jae-Hoon
    • Korean Journal of Veterinary Research
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    • v.59 no.3
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    • pp.141-149
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    • 2019
  • From 1996 to 2014, 14 foals from nine farms in Jeju were diagnosed with a Rhodococcus equi infection. Clinically, most foals showed characteristic respiratory signs, including hyperthermia and dyspnea. The seasonal occurrence of R. equi infection in foals was higher in summer, such as June (eight foals; 57.1%) and July (four foals; 28.6%), than in the other seasons. The major cases of R. equi infections were observed among two-month-old (eight foals; 57.1%) and three-month-old (three foals; 21.4%) foals. Histopathologically, bronchopneumonia, abscess, and granulomatous pneumonia were the most prevalent lesions in the lungs of foals. Colonic ulcers and submucosal abscesses were found in a foal. Some foals showed granulomatous lymphadenitis and abscesses in the mesenteric and other lymph nodes. According to the polymerase chain reaction using 10 tissue samples of foals and nine R. equi isolates, the vapA gene was detected in 11/11 (100%) foals. Immunohistochemical staining using the anti-VapA monoclonal antibody was applied to detect the R. equi VapA antigen in the organs of foals. R. equi VapA antigens were demonstrated in most lungs and some mesenteric and hilar lymph nodes of 13 foals. Isolated virulent R. equi VapA bacteria showed high sensitivity to gentamicin, quinolones, rifampin, and vancomycin.

Treatment of Mycobacterium avium Complex Pulmonary Disease

  • Kwon, Yong-Soo;Koh, Won-Jung;Daley, Charles L.
    • Tuberculosis and Respiratory Diseases
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    • v.82 no.1
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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.

Antimicrobial Resistance in Escherichia coli Isolated from Oyster Crassostrea gigas and Inland Pollution Sources in the Yongnam-Gwangdo Area, Korea (용남광도 해역의 굴(Crassostrea gigas) 및 육상오염원에서 분리한 대장균(Escherichia coli)의 항생제 내성)

  • Kwon, Soon Jae;Jung, Yeoun Joong;Yoon, Hyun Jin;Mok, Jong Soo;Kwon, Ji Young
    • Korean Journal of Fisheries and Aquatic Sciences
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    • v.51 no.6
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    • pp.673-681
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    • 2018
  • We isolated and characterized Escherichia coli (E. coli) from oyster Crassostrea gigas and inland pollution sources on Yongnam-Gwangdo island and neighboring areas on the southern coast of Korea in 2014-2015. A total of 222 strains of E. coli were isolated from 132 oysters and 88 samples from inland pollution sources. These 222 isolates were tested for their susceptibility to 24 antimicrobial agents, and 221 isolates were found resistant to the tested antibiotics. Of these 99.5% and 70.7% of the isolates showed very high resistance to rifampin and cephalothin respectively, followed by tobramycin (23.4%), streptomycin (20.2%), tetracycline (19.4%), cefepime (18.9%), ceftazidime (18.9%) and nalidixic acid (16.7%). The resistance rate of E. coli isolated from oysters was higher than that from inland pollution sources. In addition, multiple resistance to at least four antibiotics were present in 73.2% and 26.5% of E. coli isolates from oysters and inland pollution source samples, respectively.

Head-to-Head Comparison between Xpert MTB/RIF Assay and Real-Time Polymerase Chain Reaction Assay Using Bronchial Washing Specimens for Tuberculosis Diagnosis

  • Son, Eunjeong;Jang, Jinook;Kim, Taehwa;Jang, Jin Ho;Chung, Jae Heun;Seol, Hee Yun;Yeo, Hye Ju;Yoon, Seong Hoon;Lee, Seung Eun;Cho, Woo Hyun;Kim, Yun Seong;Jeon, Doosoo
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.89-95
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    • 2022
  • Background: With the introduction of Xpert MTB/RIF assay (Xpert), its incorporation into tuberculosis (TB) diagnostic algorithm has become an important issue. The aim of this study was to evaluate the performance of the Xpert assay in comparison with a commercial polymerase chain reaction (PCR) assay. Methods: Medical records of patients having results of both Xpert and AdvanSure TB/NTM real-time PCR (AdvanSure) assays using the same bronchial washing specimens were retrospectively reviewed. Results: Of the 1,297 patients included in this study, 205 (15.8%) were diagnosed with pulmonary TB. Using mycobacterial culture as the reference method, sensitivity of the Xpert assay using smear-positive specimens was 97.5%, which was comparable to that of the AdvanSure assay (96.3%, p=0.193). However, the sensitivity of the Xpert assay using smear-negative specimens was 70.6%, which was significantly higher than that of the AdvanSure assay (52.9%, p=0.018). Usng phenotypic drug susceptibility testing as the reference method, sensitivity and specificity for detecting rifampicin resistance were 100% and 99.1%, respectively. Moreover, a median turnaround time of the Xpert assay was 1 day, which was significantly shorter than 3 days of the AdvanSure assay (p<0.001). Conclusion: In comparison with the AdvanSure assay, the Xpert assay had a higher sensitivity using smear-negative specimens, a shorter turnaround time, and could reliably predict rifampin resistance. Therefore, the Xpert assay might be preferentially recommended over TB-PCR in Korean TB diagnostic algorithm.

Isolation and Antimicrobial Susceptibility of Nontuberculous Mycobacteria in a Tertiary Hospital in Korea, 2016 to 2020

  • Keun Ju Kim;Seung-Hwan Oh;Doosoo Jeon;Chulhun L. Chang
    • Tuberculosis and Respiratory Diseases
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    • v.86 no.1
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    • pp.47-56
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    • 2023
  • Background: There is a global increase in isolation of nontuberculous mycobacteria (NTM). The aim of the study was to analyze longitudinal trends of NTM identification and pattern of antimicrobial susceptibility testing. Methods: NTM recovery rates, distribution of NTM species identification, and antimicrobial susceptibility pattern of NTM at Pusan National University Yangsan Hospital between January 2016 and December 2020 were retrospectively analyzed. Results: A total of 52,456 specimens from 21,264 patients were submitted for mycobacterial culture, of which 2,521 from 1,410 patients were NTM positive over five years (January 2016 to December 2020). NTM isolation showed an increasing trend from 2016 to 2020 (p<0.001, test for trend) mainly caused by Mycobacterium avium complex. The vast majority of M. avium complex were susceptible to key agents clarithromycin and amikacin. For Mycobacterium kansasii, resistance to rifampin and clarithromycin is rare. Amikacin was the most effective drug against Mycobacterium abscessus subspecies abscessus and Mycobacterium subspecies massiliense. Most of M. subspecies massiliense were susceptible to clarithromycin, while the majority of M. abscessus subspecies abscessus were resistant to clarithromycin (p<0.001). Conclusion: There was an increasing trend of NTM isolation in our hospital. Resistance to key drugs was uncommon for most NTM species except for M. abscessus subspecies abscessus against clarithromycin.

Study on antimicrobial resistance and detection of MRSA of Staphylococcus aureus isolated from carcass in Daegu slaughterhouses (대구지역 도축장 출하가축의 도체에서 분리한 Staphylococcus aureus의 항생제 내성과 MRSA 검출에 관한 연구)

  • Hyun-Sook Lim;Dong-Keun Suh;Hwan-Deuk Kim;Hye-Hwa Lee;Jeong-Mi Kim;MiHa Im;Jae-Keun Cho
    • Korean Journal of Veterinary Service
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    • v.47 no.1
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    • pp.27-33
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    • 2024
  • At the present study, it was aimed to explore the states of antimicrobial resistant Staphylococcus aureus isolates from 1,360 chickens, pigs and cattle carcass (400 chickens, 480 pigs and 480 cattle) in Daegu province from January 2022 to December 2022. Among 1,360 samples, 81 of S. aureus were isolated cattle (1.4%), pigs (7.7%) and chickens (9.2%). In antimicrobial susceptibility test, all of the isolates were demonstrated susceptibility to rifampin. But the isolates were showed resistance other antibiotics in order of tetracycline (62.9%), ciprofloxacin (62.9%), tobramycin (58.0%), gentamicin (51.8%), amikacin (40.7%), penicillin (39.5%), clindamycin (35.8%), enrofloxacin (33.3%), trimethoprim/sulfamethoxazole (30.8%), oxacillin (30.8%), minocycline (29.6%), erythromycin (25.9%), quinupristin/dalfopristin (20.9%), chloramphenicol (12.3%), cefoxitin (9.8%). Among the 81 S. aureus isolates, 25 (30.8%) methicillin-resistant staphylococcus aureus (MRSA) were observed. Seven (28.0%) of 25 MRSA harbored mecA gene. About 96% of MRSA were multidrug resistance to at least 3 more drugs. A continuous monitoring and surveillance program to prevent antimicrobial resistance in livestock products is demanded.

Performance of the BD MAX MDR-TB assay in a clinical setting and its impact on the clinical course of patients with pulmonary tuberculosis: a retrospective before-after study

  • Sung Jun Ko;Kui Hyun Yoon;Sang Hee Lee
    • Journal of Yeungnam Medical Science
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    • v.41 no.2
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    • pp.113-119
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    • 2024
  • Background: Missing isoniazid (INH) resistance during tuberculosis (TB) diagnosis can worsen the outcomes of INH-resistant TB. The BD MAX MDR-TB assay (BD MAX) facilitates the rapid detection of TB and INH and rifampin (RIF) resistance; however, data related to its performance in clinical setting remain limited. Moreover, its effect on treatment outcomes has not yet been studied. Methods: We compared the performance of BD MAX for the detection of INH/RIF resistances to that of the line probe assay (LPA) in patients with pulmonary TB (PTB), using the results of a phenotypic drug sensitivity test as a reference standard. The treatment outcomes of patients who used BD MAX were compared with those of patients who did not. Results: Of the 83 patients included in the study, the BD MAX was used for an initial PTB diagnosis in 39 patients. The sensitivity of BD MAX for detecting PTB was 79.5%. The sensitivity and specificity of BD MAX for INH resistance were both 100%, whereas these were 50.0% and 95.8%, respectively, for RIF resistance. The sensitivity and specificity of BD MAX were comparable to those of LPA. The BD MAX group had a shorter time interval from specimen request to the initiation of anti-TB drugs (2.0 days vs. 5.5 days, p=0.001). Conclusion: BD MAX showed comparable performance to conventional tests for detecting PTB and INH/RIF resistances. The implementation of BD MAX as a diagnostic tool for PTB resulted in a shorter turnaround time for the initiation of PTB treatment.

Variability in Drug Interaction According to Genetic Polymorphisms in Drug Metabolizing Enzymes

  • Jang, In-Jin;Yu, Kyung-Sang;Cho, Joo-Youn;Chung, Jae-Yong;Kim, Jung-Ryul;Lim, Hyeong-Seok;Shin, Sang-Goo
    • Environmental Mutagens and Carcinogens
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    • v.24 no.1
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    • pp.15-18
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    • 2004
  • There are significant differences in the extent of drug interactions between subjects. The influence of the genetic make up of drug metabolizing enzyme activities (CYP3A5, CYP2C19 and UDP-glucuronosyl transferase) on the pharmacokinetic drug interaction potential were studied in vivo. Nineteen healthy volunteers were grouped with regard to the $CYP3A5^{*}3$ allele, into homozygous wild-type (CYP3A5^{*}1/1^{*}1$, n=6), heterozygous $(CYP3A5^{*}1/^{*}3$, n=6), and homozygous variant-type $(CYP3A5^{*}3/^{*}3$, n=7) subject groups. The pharmacokinetic profile of intravenous midazolam was characterized before and after itraconazole administration (200 mg once daily for 4 days), and also following rifampin pretreatment (600 mg once daily for 10 days), with a washout period of 2 weeks in between. For omeprazole and moclobemide pharmacokinetic interaction study 16 healthy volunteers were recruited. The volunteer group comprised 8 extensive metabolizers and 8 poor metabolizers of CYP2C19, which was confirmed by genotyping. Subjects were randomly allocated into two sequence groups, and a single-blind, placebo-controlled, two-period crossover study was performed. In study I, a placebo was orally administered for 7 days. On the eighth morning, 300 mg of moclobemide and 40 mg of placebo were coadministered with 200 mL of water, and a pharmacokinetic study was performed. During study n, 40 mg of omeprazole was given each morning instead of placebo, and pharmacokinetic studies were performed on the first and eighth day with 300 mg of moclobemide coadministration. In the UGT study pharmacokinetics and dynamics of 2 mg intravenous lorazepam were evaluated before and after rifampin pretreatment (600 mg once daily for 10 days), with a washout period of 2 weeks in between. The subjective and objective pharmacodynamic tests were done before and 1, 2, 4, 6, 8, and 12 hrs after lorazepam administration. The pharmacokinetic profiles of midazolam and of its hydroxy metabolites did not show differences between the genotype groups under basal and induced metabolic conditions. However, during the inhibited metabolic state, the $CYP3A5^{*}3/^{*}3$ group showed a greater decrease in systemic clearance than the $CYP3A5^{*}1/^{*}1$ group $(8.5\pm3.8$ L/h/70 kg vs. $13.5\pm2.7$ L/h/70 kg, P=0.027). The 1'-hydroxymidazolam to midazolam AUC ratio was also significantly lower in the $CYP3A5^{*}3/^{*}3$,/TEX> group $(0.58\pm0.35,$ vs. $1.09\pm0.37$ for the homozygous wild-type group, P=0.026). The inhibition of moclo-bemide metabolism was significant in extensive metabolizers even after a single dose of omeprazole. After daily administration of omeprazole for 1 week, the pharmacokinetic parameters of moclobemide and its metabolites in extensive metabolizers changed to values similar to those in poor metabolizers. In poor meta-bolizers, no remarkable changes in the pharmacokinetic parameters were observed. The area under the time-effect curves of visual analog scale(VAS), choice reaction time, and continuous line tracking test results of lorazepam was reduced by 20%, 7%, 23% respectively in induced state, and in spite of large interindividual variablity, significant statistical difference was shown in VAS(repeated measures ANOVA, p=0.0027).

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