• The Korean Journal of Pain
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• 제36권1호
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• pp.11-50
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• 2023

As the field of interventional pain management (IPM) grows, the risk of surgical site infections (SSIs) is increasing. SSI is defined as an infection of the incision or organ/space that occurs within one month after operation or three months after implantation. It is also common to find patients with suspected infection in an outpatient clinic. The most frequent IPM procedures are performed in the spine. Even though primary pyogenic spondylodiscitis via hematogenous spread is the most common type among spinal infections, secondary spinal infections from direct inoculation should be monitored after IPM procedures. Various preventive guidelines for SSI have been published. Cefazolin, followed by vancomycin, is the most commonly used surgical antibiotic prophylaxis in IPM. Diagnosis of SSI is confirmed by purulent discharge, isolation of causative organisms, pain/tenderness, swelling, redness, or heat, or diagnosis by a surgeon or attending physician. Inflammatory markers include traditional (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count) and novel (procalcitonin, serum amyloid A, and presepsin) markers. Empirical antibiotic therapy is defined as the initial administration of antibiotics within at least 24 hours prior to the results of blood culture and antibiotic susceptibility testing. Definitive antibiotic therapy is initiated based on the above culture and testing. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria infections appears to be superior to monotherapy in mortality with the risk of increasing antibiotic resistance rates. The never-ending war between bacterial resistance and new antibiotics is continuing. This article reviews prevention, diagnosis, and treatment of infection in pain medicine.

• Journal of Oral Medicine and Pain
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• 제47권1호
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• pp.52-61
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• 2022

Purpose: Most cases of oral and maxillofacial infections are usually easily treated by proper diagnosis, elimination of causative factors, and antibiotic therapy. However, the emergence and the increase of multidrug-resistant bacteria make treatment challenging. "ESKAPE" pathogens are the most common opportunistic organisms in nosocomial infections and have resistant to commonly used antibiotics. There are many medical reviews of ESKAPE pathogens, but few in dentistry. This study focuses on oral and maxillofacial infection especially with ESKAPE pathogens. The purpose of this study is to prepare feasible data about tracing and treatment of infection related to pathogens that may be beneficial to clinicians. Methods: A total of 154 patients with oral and maxillofacial infections were reviewed by analyzing retrospectively hospitalized data in the Department of Oral and Maxillofacial surgery, Chosun University Hospital, Korea, past 5 years from January 2014 to December 2018. Based on the medical records and microbiological tests, the results were divided into two groups: infections with ESKAPE pathogens and other bacteria. Results: A total of 22 species were isolated from 154 patients. The proportion of ESKAPE pathogens among all bacterial isolates collected from infected patients was 39.6%. Causative factors, especially in post-operative infection, showed a statistically significant correlation to ESKAPE infections (29 cases). And average of treatment period in ESKAPE group was longer than non-ESKAPE groups. Overall, Klebsiella pneumoniae (60.7%) was the most frequently isolated ESKAPE pathogen. And high antibiotic resistance rates had been detected in the ESKAPE during the five-year period. Conclusions: Infections with ESKAPE pathogens are now a problem that can no longer be overlooked in Dentistry. Based on results of this study, ESKAPE pathogens were highly associated with post-operative or opportunistic infections. Clinicians should be careful about these antibiotic resistant pathogens and use appropriate antibiotics to patients while having dental treatments.

• 한국환경농학회지
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• 제41권4호
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• pp.344-354
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• 2022

BACKGROUND: Although antibiotics have contributed to treatment of bacterial infection, the antibiotic abuse can lead to antibiotic resistant bacteria. Impact of human activities on distribution of antibiotic resistance has been intensively issued and occurrence of antibiotic resistant bacteria in contaminated environments would not be a surprise. Nonetheless, anthropogenic contamination with the dissemination of antibiotic resistance along uncontaminated environments has been less considered. The aim of this study is to investigate antibiotic resistant bacteria across Ulleungdo, known as antibiotic resistance free and anthropogenic pollution free environment in Rep. of Korea. METHODS AND RESULTS: Antibiotic resistant bacteria in coastal seawater of Ulleungdo were investigated in July 2021. Antibiotic susceptibility test using the disk diffusion method was applied with six drugs according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Total 43 bacterial isolates were tested and 20 isolates among of them showed multidrug resistance. Particularly, the number and ratio of resistant bacteria were relatively high in a densely populated area of Ulleungdo. The bacterial communities were investigated using 16S rRNA gene metabarcoding approach in the coastal seawater and soils of Ulleungdo. In the bacterial communities, Firmicutes were selectively distributed only in seawater, suggesting the possibility of anthropogenic contamination in coastal seawater of Ulleungdo. CONCLUSION(S): We found antibiotic resistant bacteria in a populated area of Ulleungdo. The occurrence of antibiotic resistant bacteria in Ulleungdo seems to result from the recent anthropogenic impact. Consistent monitoring of antibiotic resistant bacteria in the uncontaminated environment needs to considered for future risk assessment of antibiotics.

• Genomics & Informatics
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• 제21권3호
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• pp.42.1-42.23
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• 2023

Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis, one of the most deadly infections in humans. The emergence of multidrug-resistant and extensively drug-resistant Mtb strains presents a global challenge. Mtb has shown resistance to many frontline antibiotics, including rifampicin, kanamycin, isoniazid, and capreomycin. The only licensed vaccine, Bacille Calmette-Guerin, does not efficiently protect against adult pulmonary tuberculosis. Therefore, it is urgently necessary to develop new vaccines to prevent infections caused by these strains. We used a subtractive proteomics approach on 23 virulent Mtb strains and identified a conserved membrane protein (MmpL4, NP_214964.1) as both a potential drug target and vaccine candidate. MmpL4 is a non-homologous essential protein in the host and is involved in the pathogen-specific pathway. Furthermore, MmpL4 shows no homology with anti-targets and has limited homology to human gut microflora, potentially reducing the likelihood of adverse effects and cross-reactivity if therapeutics specific to this protein are developed. Subsequently, we constructed a highly soluble, safe, antigenic, and stable multi-subunit vaccine from the MmpL4 protein using immunoinformatics. Molecular dynamics simulations revealed the stability of the vaccine-bound Tolllike receptor-4 complex on a nanosecond scale, and immune simulations indicated strong primary and secondary immune responses in the host. Therefore, our study identifies a new target that could expedite the design of effective therapeutics, and the designed vaccine should be validated. Future directions include an extensive molecular interaction analysis, in silico cloning, wet-lab experiments, and evaluation and comparison of the designed candidate as both a DNA vaccine and protein vaccine.

• 한국수산과학회지
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• 제56권5호
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• pp.626-633
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• 2023

Vibrio spp. are aquatic bacteria that are ubiquitous in warm estuarine and marine environments. Especially, V. vulnificus and V. cholerae are currently known to cause potentially fatal infections in humans. This study investigated the distribution and antibiotic resistance of V. vulnificus and V. cholerae isolated from coastal areas of Gyeongsangnam-do in 2022. A total of 252 samples of water, shellfish and coastal sediment were collected from 7 locations along the coast, and 124 samples of fishery products were collected from markets. Among the 252 samples, forty-four V. vulnificus (11.7%) and fourteen V. cholerae non-O1/non-O139 (3.7%), none of which carried the ctx gene, were isolated. Out of the 124 samples, 6 (4.8%) tested positive for V. vulnificus and V. cholerae was not detected. The isolation rates of V. vulnificus and V. cholerae showed a significant correlation with environmental factors such as seawater temperature and salinity. In an antibiotic resistance test, V. vulnificus was susceptible to amikacin, gentamicin, imipenem trimethoprim/sulfamethoxazole, and ciprofloxacin, but resistant to cefoxitin (100.0%), followed by tetracycline (9.1%). Multidrug resistance was also observed. Continuous monitoring of Vibrio pathogens with water temperature and salinity is expected to help reduce the outbreaks, and rational use of antibiotic agents is needed to prevent the accession of antibiotic-resistant microorganisms in aquatic ecosystems.

• Journal of Veterinary Science
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• 제25권3호
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• pp.39.1-39.11
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• 2024

Importance: Salmonella outbreaks linked to poultry meat have been reported continuously worldwide. Therefore, Salmonella contamination of poultry meats in slaughterhouses is one of the critical control points for reducing disease outbreaks in humans. Objective: This study examined the carry-over contamination of Salmonella species through the entire slaughtering process in South Korea. Methods: From 2018 to 2019, 1,097 samples were collected from the nine slaughterhouses distributed nationwide. One hundred and seventeen isolates of Salmonella species were identified using the invA gene-specific polymerase chain reaction, as described previously. The serotype, phylogeny, and antimicrobial resistance of isolates were examined. Results: Among the 117 isolates, 93 were serotyped into Salmonella Mbandaka (n = 36 isolates, 30.8%), Salmonella Thompson (n = 33, 28.2%), and Salmonella Infantis (n = 24, 20.5%). Interestingly, allelic profiling showed that all S. Mbandaka isolates belonged to the lineage of the sequence type (ST) 413, whereas all S. Thompson isolates were ST292. Moreover, almost all S. Thompson isolates (97.0%, 32/33 isolates) belonging to ST292 were multidrug-resistant and possessed the major virulence genes whose products are required for full virulence. Both serotypes were distributed widely throughout the slaughtering process. Pulsed-field gel electrophoretic analysis demonstrated that seven S. Infantis showed 100% identities in their phylogenetic relatedness, indicating that they were sequentially transmitted along the slaughtering processes. Conclusions and Relevance: This study provides more evidence of the carry-over transmission of Salmonella species during the slaughtering processes. ST292 S. Thompson is a potential pathogenic clone of Salmonella species possibly associated with foodborne outbreaks in South Korea.

• Clinical and Experimental Vaccine Research
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• 제12권1호
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• pp.70-76
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• 2023

Purpose: Typhoid remains a major health problem, especially in the developing world. Furthermore, the emergence of multidrug-resistant and extensively drug-resistant strains of Salmonella typhi added a sense of urgency to develop more effective typhoid vaccines, one of which is bacterial ghosts (BGs), prepared by both genetic and chemical means. The chemical method includes incubation with numerous agents for a short time at their minimum inhibitory or minimum growth concentrations. This study included the preparation of BGs by a sponge-like reduced protocol (SLRP). Materials and Methods: Critical concentrations of sodium dodecyl sulfate, NaOH, and H₂O₂ were used. Moreover, high-quality BGs were visualized by scanning electron microscope (SEM). Subculturing was used to confirm the absence of vital cells. Besides, the concentrations of the released DNA and protein were estimated spectrophotometrically. In addition, the integrity of cells was proved by visualizing Gram-stained cells using a light microscope. Furthermore, a comparison between the immunogenicity and safety of the prepared vaccine and the available whole-cell killed vaccine was established. Results: Improved preparation of high-quality BGs of S. typhi, visualized by SEM, revealed punctured cells with intact outer shells. Moreover, the absence of vital cells was confirmed by subculturing. At the same time, the release of respective amounts of proteins and DNA is another evidence of BGs' production. Additionally, the challenge test provided evidence that the prepared BGs are immunogenic and have the same efficacy as the whole cell vaccine. Conclusion: The SLRP provided a simple, economical, and feasible method for BGs preparation.

• 한국미생물·생명공학회지
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• 제51권3호
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• pp.268-279
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• 2023

The pharmaceutical industry in Bangladesh produces a diverse range of antibiotics for human and animal use, however, waste disposal management is inadequate. This results in substantial quantities of antibiotics being discharged into water bodies, which provide suitable environment for the growth of antibiotic-resistant bacteria, capable of spreading resistance genes. This study intended for exploring the bacterial antibiotic resistance profile in adjoining aquatic environmental sources of pharmaceutical manufacturing facilities in Bangladesh. Seven surface water samples were collected from the vicinity of two pharmaceutical industries located in the Savar area and 51 Escherichia coli isolates were identified using both phenotypic and genotypic methods. Antibiotic susceptibility tests revealed the highest percentage of resistance against ampicillin, azithromycin, and nalidixic acid (100%) and the lowest resistance against meropenem (1.96%) out of sixteen different antibiotics tested. 100% of the study E. coli isolates were observed with Multidrug resistance phenotypes, with the Multiple Antibiotic Resistance (MAR) value ranging from 0.6-1.0. Furthermore, 69% of the isolates were Extended Spectrum Beta-Lactamases (ESBL) positive as per the Double Disk Diffusion Synergy Test (DDST). ESBL resistance genes bla_TEM, bla_CTX-M-13, bla_CTX-M-15, and bla_SHV were detected in 70.6% (n = 36), 60.8% (n = 32), 54.9% (n = 28), and 1.96% (n = 1) of the isolates, respectively, by Polymerase Chain Reaction (PCR). Additionally, 15.68% (n = 8) of the isolates were positive for E. coli specific virulence genes in PCR. These findings suggest that pharmaceutical wastewater, if not properly treated, could be a formidable source of antibiotic resistance spread in the surrounding aquatic environment. Therefore, continued surveillance for drug resistance among bacterial populations around drug manufacturing facilities in Bangladesh is necessary, along with proper waste disposal management.

• 한국미생물·생명공학회지
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• 제51권4호
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• pp.432-440
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• 2023

Irrational and injudicious use of antibiotics, easy availability of them as over-the-counter drugs in economically developing countries, and unavailability of regulatory policies governing antimicrobial use in agriculture, animals, and humans, has led to the development of multi-drug resistance (MDR) bacteria. The use of medicinal plants can be considered as an alternative, with a consequent impact on microbial resistance. We tested extracts of Piper longum fruits as new natural products as agents for reversing the resistance to antibiotics. Six crude extracts of P. longum fruits were utilized against a clinical isolate of multidrug-resistant Staphylococcus aureus.The antibiotic susceptibility testing disc method was used in the antibiotic resistance reversal analysis. Apart from cefoxitin and erythromycin, all other antibiotics used (lincosamides [clindamycin], quinolones [levofloxacin and ciprofloxacin], and aminoglycosides [amikacin and gentamicin]) were enhanced by P. longum extracts. The extracts that showed the greatest synergy with the antibiotics were EAPL (ethyl acetate [extract of] P. longum), n-BPL (n-butanol [extract of] P. longum), and MPL (methanolic [extract of] P. longum The results of this study suggest that P. longum extracts have the ability to increase the effectiveness of different classes of antibiotics and reverse their resistance. However, future studies are needed to elucidate the molecular mechanisms behind the synergy between antibiotic and phytocompound(s) and identify the active biomolecules of P. longum responsible for the synergy in S. aureus.

• 한국동물위생학회지
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• 제47권1호
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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.