• Biomolecules & Therapeutics
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• 제14권4호
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• pp.220-225
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• 2006

Derivatives of penicillanic acid sulfones are known to be irreversible inhibitors of $\beta$-lactamase. Eight 6-tricyclic methylene penicillanic acid sulfones were prepared, and their $\beta$-lactamase inhibitory activities were evaluated against $\beta$-lactamase types I, II, III and IV. Among the tricycles attached to 6-exomethylenepenam sulfones, thiazolobenzimidazole(12a-12b), fluorene(12c), and carbazole(12e), showed inhibitory activity on type I, II and III $\beta$-lactamase. But phenanthrene(12d), and anthracene(12f-12h) derivatives showed little $\beta$-lactamase inhibitory activity. The synergic effects of the selected compound(l2b) in 1:4 combination with piperacillin showed some protection to piperacillin for the resistant strains of E. coli DC2 and P. aeruginosa 1771.

• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4549-4553
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• 2014

Background: Infection is a serious cause of mortality in febrile neutropenia of pediatric cancer patients. Recently, monotherapy has replaced the combination therapy in empirical treatment of febrile neutropenia. Since there has been no reported trial comparing the efficacy of meropenem and piperacillin-tazobactam (PIP/TAZ) monotherapies, the present retrospective study was conducted to compare safety and efficacy in febrile neutropenic children with cancer. Materials and Methods: Charts of febrile, neutropenic children hospitalized at our center between March 2008 and April 2011 for hemato-oncological malignancies were reviewed. Patients received PIP/TAZ 360 mg/kg/day or meropenem 60 mg/kg/day intravenously in three divided doses. Duration of fever and neutropenia, absolute neutrophil count, modification, and success rate were compared between the two groups. Resolution of fever without antibiotic change was defined as success and resolution of fever with antibiotic change or death of a patient was defined as failure. Modification was defined as changing the empirical antimicrobial agent during a febrile episode. Results: Two hundred eighty four febrile neutropenic episodes were documented in 136 patients with a median age of 5 years. In 198 episodes meropenem and in 86 episodes PIP/TAZ were used. Duration of fever and neutropenia, neutrophil count, sex, and primary disease were not different between two groups. Success rates and modification rate between two groups showed no significant differences (p>0.05). Overall success rate in the meropenem and PIP/TAZ groups were 92.4% and 91.9% respectively. No serious adverse effects occurred in either of the groups. Conclusions: Meropenem and PIP/TAZ monotherapy are equally safe and effective in the initial treatment of febrile neutropenia in children with cancer.

• Journal of Microbiology and Biotechnology
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• 제25권8호
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• pp.1299-1306
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• 2015

This study aims to investigate the mechanism of action of the cinnamon bark essential oil (CB), when used singly and also in combination with piperacillin, for its antimicrobial and synergistic activity against beta-lactamase TEM-1 plasmid-conferred Escherichia coli J53 R1. Viable count of bacteria for this combination of essential oil and antibiotic showed a complete killing profile at 20 h and further confirmed its synergistic effect by reducing the bacteria cell numbers. Analysis on the stability of treated cultures for cell membrane permeability by CB when tested against sodium dodecyl sulfate revealed that the bacterial cell membrane was disrupted by the essential oil. Scanning electron microscopy observation and bacterial surface charge measurement also revealed that CB causes irreversible membrane damage and reduces the bacterial surface charge. In addition, bioluminescence expression of Escherichia coli [pSB1075] and E. coli [pSB401] by CB showed reduction, indicating the possibility of the presence of quorum sensing (QS) inhibitors. Gas-chromatography and mass spectrometry of the essential oil of Cinnamomum verum showed that trans-cinnamaldehyde (72.81%), benzyl alcohol (12.5%), and eugenol (6.57%) were the major components in the essential oil. From this study, CB has the potential to reverse E. coli J53 R1 resistance to piperacillin through two pathways; modification in the permeability of the outer membrane or bacterial QS inhibition.

• The Korean Journal of Medicine
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• 제99권3호
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• pp.149-157
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• 2024

목적: 장내세균에서 3세대 cephalosporin 계열 항생제에 내성을 나타내는 주된 내성 기전은 extended spectrum β-lactamase(ESBL)를 생성하는 것이다. ESBL 생성 장내세균은 ESBL 생성균이라고 하더라도 piperacillin/tazobactam 감수성 균인 경우 piperacillin/tazobactam을 사용해 볼 수 있으며 후향적 연구에서 carbapenem 계열 항생제를 투여한 경우에 비해 열등하지 않은 치료 효과가 보고된 바 있다. 하지만 미국감염학회 2023년 지침에서는 ESBL 생성 그람음성균 감염에서 carbapenem 계열 항생제를 권고하고 piperacillin/tazobactam 감수성인 그람음성균이더라도 carbapenem 계열 항생제를 투여하도록 하고 있다. 하지만 carbapenem 내성 장내세균의 증가 등으로 비 carbapenem 계열의 항생제들의 사용 필요성에 대한 평가는 아직도 필요한 상황이다. 이에 제주대학교병원의 ESBL 생성 장내세균속 균혈증 환자들의 carbapenem과 비 carbapenem 계열 항생제의 치료 효과를 보고한다. 방법: 2021년 1월부터 12월까지 527명의 성인 장내세균속 균혈증 환자들 중에서 ESBL 생성 장내세균속 환자 152명을 대상으로 후향적 자료를 수집하고 3개월 이내 장내세균 감염이 있었던 환자들과 30일 후 추적 관찰을 하지 못한 환자들을 제외하고 분석하였다. 결과: 총 118명의 ESBL 생성 장내세균속 균혈증 환자들중에서 54명의 환자가 확정적 항생제로 비 carbapenem 계열 항생제로 치료하였고 64명의 환자가 carbapenem 계열 항생제로 치료하였다. Kaplan-Meier 생존 분석 방법으로 30일 치료 실패율과 사망률을 분석한 결과 30일 치료 실패율은 비 carbapenem군이 16.7%, carbapenem군이 18.8%로 양 군 간의 유의한 차이는 없었다(p = 0.65). 30일 사망률은 비 carbapenem 계열군이 14.8%, carbapenem 계열군이 17.2%로 양 군 간의 유의한 차이는 없었다(p = 0.63). 전체 환자들 중에서 치료 실패한 환자들을 다변량 로지스틱 회귀 분석한 결과에서 요로 감염 외 감염과 이전 30일 이내 항생제 사용력이 있는 경우 치료 실패의 위험인자로 확인되었다. 결론: ESBL 생성 장내세균속 균혈증 환자들은 국내에서 확정적 항생제로 비 carbapenem 계열의 항생제를 사용해 볼수 있으나 중증 환자들을 포함한 다기관, 전향적 후속 연구들이 필요하다.

• 한국임상약학회지
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• 제28권3호
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• pp.167-173
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• 2018

Background: In July 2016, the Infectious diseases society of america and the american thoracic society (IDSA & ATS) published a guideline recommending piperacillin/tazobactam (Pip/Tazo) 18 g/day as the anti-pseudomonal dose for the treatment of pathogenic pneumonia. After the guideline was published, the Pip/Tazo dose used for the treatment of pathogenic pneumonia was changed from 13.5 g/day to 18 g/day in a superior general hospital intensive care unit (ICU). In this study, we analyzed the effectiveness and safety of the new dose. Methods: Adult patients aged ${\geq}19years$ who were diagnosed with pneumonia in ICU and who received Pip/Tazo for 7 days or more from September 1, 2015 to May 31, 2017 were included in the study. The electronic medical record (EMR) was retrospectively analyzed. Results: At baseline, there was a significant difference between 44 patients treated with 13.5 g/day and 31 patients treated with 18 g/day of Pip/Tazo. The 18 g/day-treatment group comprised more elderly patients than the 13.5 g/day-treatment group (p=0.028). The results of the treatment-effects analysis showed no significant difference between the two groups. In case of safety data, there were significant differences in two parameters related to blood count, namely hemoglobin (p=0.016) and platelet count (p=0.011). Conclusion: Based on the significant difference in baseline age, there is a possibility that high-dose Pip/Tazo showed improved therapeutic effect. However, when high-dose Pip/Tazo was used, the blood cell count was found to drop from the reference value more frequently. Therefore, blood cell count should be monitored carefully when high-dose Pip/Tazo is administered.

• 한국임상수의학회지
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• 제34권1호
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• pp.23-26
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• 2017

Otitis externa (OE) is an inflammatory disease of the externa auditory meatus that occurs commonly in dogs. Antimicrobial susceptibility tests should be performed in case of chronic OE for successful treatment. In this study, identification and antimicrobial susceptibility test of bacteria isolated from dogs with chronic OE was performed. From 60 dogs with chronic OE, 60 bacterial species were identified. The most frequently identified species were Staphylococcus spp. (51%), followed by Pseudomonas spp. (15%) and Enterococcus spp. (14%). A single bacterial infection and multiple bacterial infections were observed in 67.5% and 32.5%, respectively. Staphylococcus spp. was susceptible to imipenum. Pseudomonas spp. was found to be susceptible to amikacin, cefepime, imipenum and piperacillin-tazobactam. Enterococcus spp. was susceptible to ampicillin-sulbactam, imipenum and piperacillin-tazobactam. Imipenum was highly susceptible antibiotic against both Gram-positive and negative bacteria whereas aztreonam and vancomycin were highly resistant. These results could suggest the optimal choice of antimicrobial agents for canine OE treatment.

• Childhood Kidney Diseases
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• 제19권2호
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• pp.143-147
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• 2015

Purpose: Burkholderia cepacia is an aerobic, glucose-non-fermenting, gram-negative bacillus that mainly affects immunocompromised and hospitalized patients. Burkholderia cepacia has high levels of resistance to many antimicrobial agents, and therapeutic options are limited. The authors sought to analyze the incidence, clinical manifestation, risk factors, antimicrobial sensitivity and outcomes of B. cepacia urinary tract infection (UTI) in pediatric patients. Methods: Pediatric patients with urine culture-proven B. cepacia UTI between January 2000 and December 2014 at Samsung Medical Center, a tertiary referral hospital in Seoul, Republic of Korea, were included in a retrospective analysis of medical records. Results: Over 14 years, 14 patients (male-to-female ratio of 1:1) were diagnosed with B. cepacia UTI. Of 14 patients with UTI, 11 patients were admitted to the intensive care unit, and a bladder catheter was present in 9 patients when urine culture was positive for B. cepacia. Patients had multiple predisposing factors for UTI, including double-J catheter insertion (14.2%), vesico-ureteral reflux (28.6%), congenital heart disease (28.6%), or malignancy (21.4%). Burkholderia cepacia isolates were sensitive to piperacillin-tazobactam and sulfamethoxazole-trimethoprim, and resistant to amikacin and colistin. Treatment with parenteral or oral antimicrobial agents including piperacillin-tazobactam, ceftazidime, meropenem, and sulfamethoxazole-trimethoprim resulted in complete recovery from UTI. Conclusion: Burkholderia cepacia may be a causative pathogen for nosocomial UTI in pediatric patients with predisposing factors, and appropriate selection of antimicrobial therapy is necessary because of high levels of resistance to empirical therapy, including aminoglycosides.

• 대한임상검사과학회지
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• 제39권3호
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• pp.167-177
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• 2007

From the total 121,294 clinical materials submitted to the Department of Laboratory Medicine of "C" hospital from December 1, 2004 to November 30, 2006, 3,408 Pseudomonas spp. were isolated. The isolation frequencies of Pseudomonas spp. were as follows, P. aeruginosa 95.5%, P. putida 2.5%, P. fluorescens 0.8%, along with low frequencies of P. luteola, P. alcaligenes, P. stutzeri, P. oryzihabitants, P. mendocina and unidentified Pseudomonas species. The isolation rates of Pseudomonas spp. according to season and sex were evenly distributed. The isolated frequency of Pseudomonas spp. in male was two times higher than that of in female showing significantly more male patients in surgical areas and more female patients in internal areas (p<0.001). In monthly analysis, Pseudomonas spp. were the most frequently isolated in July (10.4%), but lowest in February (5.6%). Half of Pseudomonas spp. were isolated from sputum (48.2%). In the susceptibility analysis of Pseudomonas spp. by VITEK II AST cards, the Pseudomonas spp showing higher susceptibility against antimicrobial agents were piperacillin/tazobactam (82.7%) in P. aeruginosa; amikacin (84.7%), colistin (83.3%) in P. putida; and amikacin (96.3%), cefepime (87.5%), ceftazidime (87.5%) ciprofloxacin (92.3%), colistin (88.5%) gentamicin (96.2%), isepamicin (96,1%), meropenem (92.3%), netilmicin (96.0%), piperacillin/ tazobactam (95.4%) and tobramycin (92.6%) in P. fluorescens.

• 대한미생물학회지
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• 제21권1호
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• pp.33-45
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• 1986

On hundred and forty stains of shigella cultures isolated from the twelve hygiene laboratories of cities and provincial general hospital laboratories in 1983 were tested for their resistance to thirteen antimicrobial drugs and their R-plasmid transfer. Antimicrobial drugs were used amikacin, ampicillin, cephalothin, chloramphenicol, gentamicin, kanamycin, nalidixic acid, rifampicin, streptamycin, tetracycline, tobramycin, cefoperazone and piperacillin. All strains were resistant to one or more of thirteen antimicrobial drugs but 94.3% were susceptible to amikacin, gentamicin and tobramycin of total isolated. The most strains commonly found resistance was to chloramphenicol (94%) followed by streptamycin (93%), tetracyline (92%) piperacillin (90%) ampicillin (83%), cefoperazone (42%), nalidixic acid (14%), cephalothin (17%), rifampicin (22%) and kanamycin (6%), sixty percent of strains among 140 were resistance to ampicillin, chloramphenicol, streptomycin, tetracycline at the same time. The transfer of drug resistance by conjugation was tested and ninety four strains (94.3%) were resistant to one or more drugs were found to transfer their drug resistance of E. coli. percentage of transfer frequency by conjugation was one strains (54%), the transfer frequency of drug resistance varied by donor strains and recipients, but not by selecting drugs. Resistance to nalidixic acid was not transferred by conjugation to recipients. Percentage of plasmid curing after the treatment of acriflavine, acridine orange was about 8%. Among strains cured two strains were tested compare original strains with them in biochemical properties in arginine dihydrolase and arabinose fermentation reaction. It was found to growth curves of No.2 shigella flexneri, serotype 1b, and its derivatives cured with acriflavine in $M{\ddot{u}}ller$ Hinton broth medium (pH 7.4, $38^{\circ}C$) by temperature Gradient Biophoto Recorder TN-1120 (Tokyo, Japan).

• Journal of Applied Biological Chemistry
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• 제58권3호
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• pp.227-232
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• 2015

A microarray study has been employed to understand changes of gene expression in E. coli KD43162 resistant to ampicillin, ampicillin-sulbactam, piperacillin, piperacillin-tazobactam, cefazolin, cefepime, aztreonam, imipenem, meropenem, gentamicin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, fosfomycin, and trimethoprim-sulfamethoxazole except for amikacin using disk diffusion assay. Using Sodium dodecyl sulphate-polyacrylamide gel electrophoresis and MALDI-TOF MS analyses, 36 kDa of outer membrane proteins (OMPs) was found to be deleted in the multidrug resistant E. coli KD 43162. Microarray analysis was used to determine up- and down-regulated genes in relation to multidrug resistant E. coli KD43162. Among the up-regulated genes, these genes were corresponded to express the proteins as penicillin-binding proteins (PBPs), tartronate semialdehyde reductase, ethanolamine utilization protein, shikimate kinase I, allantoinase, predicted SAM-dependent methyltransferase, L-glutamine: D-fructose-6-phosphate aminotransferase (GFAT), phospho-glucosamine mutase, predicted N-acetylmannosamine kinase, and predicted N-acetylmannosamine-6-P epimerase. Up-regulation of PBPs, one of primary target sites of antibiotics, might be responsible for the multidrug resistance in E. coli with increasing amount of target sites. Up-regulation of GFAT enzyme may be related to the up-regulation of PBPs because GFAT produces N-acetylglucosamine, a precursor of peptidoglycans. One of GFAT inhibitors, azaserine, showed a potent inhibition on the growth of E. coli KD43162. In conclusion, up-regulation of PBPs and GFATs with the loss of 36 kDa OMP refers the multidrug resistance in E. coli KD 43162.