• 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 Korean Biological Nursing Science
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• v.21 no.4
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• pp.283-291
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• 2019

Purpose: The aim of this study was to identify awareness and competency for Multi-Drug Resistant Organisms (MDRO) infection control in nursing students with experience of clinical practice. Methods: This cross-sectional descriptive study was conducted from March 2019 to May 2019 by including 231 nursing students in four nursing schools located in Seoul, Gyeonggi-do and Chungcheongnam-do. The data were collected using self-report questionnaires. Results: The awareness and the competency for Carbapenem-Resistant Enterobacteriaceae (CRE) infection control were lower than that of Methicillin-Resistant Staphylococcus aureus (MRSA). The agreement between the awareness and the competency of MDRO infection control in participants was low with regard to isolation, contact precautions, and disinfection for MRSA. Also, it was low with respect to disinfection, isolation, contact precautions, and carrier identification for CRE. The awareness and the competency of MDRO infection control exhibited significant positive correlation. Conclusion: The infection control competency is required to prevent MDRO infection. In order to enhance the infection control competency, it is important to raise awareness about MDRO infection control by providing education based on the guidelines and the principles of infection control.

• Journal of Life Science
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• v.22 no.9
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• pp.1268-1276
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• 2012

The emergence and dissemination of carbapenem-resistant bacteria have resulted in limitations of antibiotic treatment and potential outbreaks of metallo-${\beta}$-lactamase (MBL) producing Pseudomonas aeruginosa resistant to carbapenems. In this study, we conducted molecular characterization of the MBL genes of the ${\beta}$-lactam drug-resistant P. aeruginosa and prepared basic data for treatment and prevention of proliferation of antimicrobial-resistant bacterial infections. Forty-two P. aeruginosa isolates of 254 were resistant to imipenem or meropenem. Among the 42 isolates, 28 isolates were positive for the Hodge test, and 23 isolates were positive for the EDTA-disk synergy test (EDST). MBLs were detected in 59.5% (25/42) of P. aeruginosa isolates. Eight isolates harbored $bla_{IMP-6}$, whereas 17 isolates harbored $bla_{VIM-2}$. The $bla_{IMP-6}$ gene was in a class 1 integron containing five gene cassettes: $bla_{IMP-6}$, qac, aacA4, $bla_{OXA-1}$, and aadA1. Some strains that produce IMP-6 and VIM-2 showed epidemiological relationships. The $bla_{IMP-6}$ gene in carbapenem-resistant P. aeruginosa showed an identical pattern to a gene cassette that was reported at a hospital in Daegu, Korea. Therefore, MBL-producing P. aeruginosa is already endemic in the community. We are concerned that the existence of carbapenem-resistant bacteria containing the blaMBL gene may increase pressure on antibiotic selection when treating infections. We believe that we should select appropriate antibiotics based on the antibiotic susceptibility test and continue the research to prohibit the emergence and spread of antibiotics resistant bacteria.

• Korean Journal of Clinical Laboratory Science
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• v.54 no.4
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• pp.265-272
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• 2022

The emergence and dissemination of carbapenemase-producing Enterobacteriaceae (CPE), particularly the Klebsiella pneumoniae carbapenemase-2 (KPC-2) producing Klebsiella pneumoniae, has been rapidly increasing worldwide and is becoming a serious public health threat. Since the epidemiology and characteristics of these KPC-2-producing K. pneumoniae vary according to the region and period under consideration, this study investigated the prevalence of carbapenemases and the epidemiological relationship of 78 carbapenem-resistant K. pneumoniae (CRKP) isolated from a tertiary hospital in Daejeon, from March 2017 to December 2020. The antimicrobial susceptibility tests were identified using the disk-diffusion method. PCR and DNA sequencing were used to determine the carbapenemase genes. In addition, molecular epidemiology was performed by multilocus sequence typing (MLST). Among the 78 CRKP isolates, 35 isolates (44.9%) were carbapenemase-producing K. pneumoniae (CPKP) and the major carbapenemase type was KPC-2 (30 isolates, 85.7%). The New Delhi metallo-enzyme-1 (NDM-1) and NDM-5 were identified in 4 isolates (11.4%) and 1 isolate (2.9%), respectively. Multilocus sequence typing (MLST) analysis showed 10 sequence types (STs) and the most prevalent ST was ST307 (51.4%, 18/35). All the ST307 isolates were KPC-2-producing K. pneumoniae and were multidrug-resistant (MDR). In addition, ST307 has gradually emerged during a four-year period. These findings indicate that continuous monitoring and proper infection control are needed to prevent the spread of KPC-2-producing K. pneumoniae ST307.

• Proceedings of the PSK Conference
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• 2000.04a
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• pp.127.2-128
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• 2000

• Bulletin of the Korean Chemical Society
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• v.18 no.5
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• pp.475-478
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• 1997

(3R,4R)-4-Acetoxy-3-[(1'R-tert-butyldimethylsilyloxy)ethyl]-2-azetidinone, one of the best synthons for carbapenems and penems was efficiently synthesized from readily available L-threonine via double azetidinone ring formation.

• Proceedings of the PSK Conference
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• 2003.04a
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• pp.238.2-238.2
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• 2003

The synthesis of a new series of 1${\beta}$-methylcarbapenems having the substituted aminoethyl-carbamoylpyrrolidine moiety is described. Their in vitro antibacterial activities against both Gram-positive and Gram-negative bacteria were tested and the effect of substituent on the pyrrolidine ring was investigated. In particular. the compound 11 g having piperazinyl urea moiety showed the most potent antibacterial activity.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1996.04a
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• pp.228-228
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• 1996

1, 흰쥐에서 IPM 단독투여시보다 DHP-I 저해제인 CS와의 병용투여시 AUC가 4배 이상, t$_{1}$2/가 약 3배 증가하였으며 MEPM의 경우는 AUC가 5배 이상, t$_{1}$2/가 약 1.8배 증가하였다. 2. Guinea pig에서 IPM 단독투여시보다 CS와의 병용투여시 AUC가 약 2.5배, t$_{1}$2/가 약 1.4배 증가하였으며 MEPM의 경우는 AUC, t$_{1}$2/ 모두 거의 변함이 없었다. 3. 위의 결과 흰쥐에서 IPM과 MEPM에 대한 CS의 영향이 매우 큰 것으로 나타났으며 따라서 약물동력학적인 파라메타에도 커다란 변화를 주었다. 반대로 Guinea Pig에서는 CS의 병용투여로 IPM의 AUC에만 변동을 주었을 뿐 t$_{l}$ 2/에는 크게 영향을 미치지 않았고 MEPM의 체내동태에는 거의 영향을 미치지 않았다. 4. Guinea pig에서 전체 투여량에 대한 MEPM의 요중회수율은 66.58$\pm$3.44%이었고 IPM의 경우는 7.00$\pm$0.95%이었다. 그러나 DHP-I 저해제인 CS와의 병용투여시 IPM의 요중회수율이 57.77$\pm$11.46%로 증가하여 MEPM과 거의 비슷한 양상을 나타냈다. 이는 guinea pig에서 DHP-I에 의한 IPM의 대사가 CS에 의해 차단됨을 시사하는 것이라고 사료되며 guinea pig에 존재하는 DHP-I은 MEPM보다 IPM에 대해 더 높은 친화도를 갖는 것으로 사료된다. 5. Carbapenem계 항생제의 약물동력학적 스크리닝을 위한 소동물로는 흰쥐보다도 guinea pig가 적합한 것으로 생각되나 동물종차에 의한 약물동력학적 연구 및 DHP-I의 활성에 대한 연구가 더 면밀히 이루어져야 할 것으로 생각되며 BO-2727, panipenem, biapenem 등 다른 carbapenem 항생제에 대한 광범위한 약물동력학적 연구가 진행되어 새로운 carbapenem계 항생제 개발에 따른 인체내 거동을 예측할 수 있는 치적의 실험동물모델이 확립되어야 할 것이다.

• Korean Journal of Clinical Pharmacy
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• v.22 no.3
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• pp.234-238
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• 2012

Background: Valproic acid is widely used in the treatment of generalized tonic-clonic and partial seizures. The carbapenem class is the most potent and widest spectrum of antimicrobial activity. Concomitant administration of carbapenems and valproic acid has been reported to decrease the serum concentration of valproic acid, which is sometimes associated with seizures. The purpose of this study is to evaluate the changes in valproic acid concentration and half life and the frequency of seizure during concomitant administration of valproic acid and carbapenems. Method: This study was performed retrospectively on total 40 cases with identified valproic acid concentration during concomitant administration of valproic acid and carbapenems at Kangbuk Samsung Hospital from February 1st, 2006 to October 31st, 2011. Patients were classified into 3 groups: ertapenem group (n=14), imipenem group (n=12), meropenem group (n=14). Results: The mean serum concentrations in each group during combined treatment were $9.50{\pm}8.84$, $21.88{\pm}8.17$ and $10.62{\pm}8.67$ mg/L, respectively (p < 0.001). The mean half-lives in each group during concurrent use of valproic acid and carbapenems were $3.18{\pm}0.81$, $4.63{\pm}1.97$ and $2.67{\pm}1.69$ hr, respectively (p < 0.001). The valproic acid serum concentration decreased by 75.5%, 54.1% and 84.1% and the half-life of valporoic acid decreased by 65.6%, 35.7% and 73.5%, respectively. Total cases with seizure were 12(30%) with 5(35.7%) in the ertapenem group, 3 (25.0%) in the imipenem group and 4(28.6%) in the meropenem group (p=0.911). There were no specific factors to influence on seizure development during combined treatment. Conclusion: Concurrent use of carbapenems and valproic acid should be avoided. If concomitant administration is essential, very close serum concentration monitoring and clinical observation are necessary.

• Korean Journal of Clinical Pharmacy
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• v.30 no.2
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• pp.120-126
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• 2020

Objective: The rising number of carbapenemase-resistant Enterobacteriaceae (CRE) cases has become a concern worldwidely. This study investigated patient characteristics with CRE and analyzed the risk factors associated with its acquisition. Methods: A retrospective review of the electronic medical records of the Kangbuk Samsung Medical Center from May 2016 to April 2019 was performed. The inclusion criterion was hospitalized patients aged ≥18 years with confirmed CRE acquisition. Patients were divided by CRE acquired and non-required patients. CRE acquired patients were those with CRE confirmed by their active surveillance cultures, while non-acquired patients were those with carbapenemase-sensitive Enterobacteriaceae (CSE). If CRE was isolated more than once during hospitalization, only the first isolation was used for data analysis. Patient characteristics, antibiotic used, and the duration of use were compared between two groups using univariate analysis, and the risk factors associated with CRE were analyzed using multiple logistic regression analysis. Results: Among the 73 CRE acquired patients, 44 (60.3%) were positive for carbapenemase-producing Enterobacteriaceae (CPE). Infection from Klebsiella pneumonia (42 cases, 57.5%), Escherichia coli (17 cases, 23.3%), and Enterobacter cloacae (5 cases, 6.8%). The risk of CRE acquisition was significantly increased by 4.99 times [confidence interval (CI), 1.40-17.78; p=0.013] with mechanical ventilation, 3.86 times (CI, 1.59-9.36; p=0.003) with penicillin administration, and 21.19 times (CI, 6.53-68.70; p<0.001) with carbapenem administration. Conclusions: Proper antibiotic use including the selection, frequency, and duration, and patients on mechanical ventilators need close monitoring.