Characterization of a New Metallo-β-Lactamase Gene, blaNDM-1, and a Novel Erythromycin Esterase Gene Carried on a Unique Genetic Structure in Klebsiella pneumoniae Sequence Type 14 from India

Yong, Dongeun,Toleman, Mark A.,Giske, Christian G.,Cho, Hyun S.,Sundman, Kristina,Lee, Kyungwon,Walsh, Timothy R. American Society for Microbiology 2009 Antimicrobial Agents and Chemotherapy Vol.53 No.12

<B>ABSTRACT</B><P>A Swedish patient of Indian origin traveled to New Delhi, India, and acquired a urinary tract infection caused by a carbapenem-resistant <I>Klebsiella pneumoniae</I> strain that typed to the sequence type 14 complex. The isolate, <I>Klebsiella pneumoniae</I> 05-506, was shown to possess a metallo-β-lactamase (MBL) but was negative for previously known MBL genes. Gene libraries and amplification of class 1 integrons revealed three resistance-conferring regions; the first contained <I>bla</I>CMY-4 flanked by IS<I>EcP1</I> and <I>blc</I>. The second region of 4.8 kb contained a complex class 1 integron with the gene cassettes <I>arr</I>-<I>2</I>, a new erythromycin esterase gene; <I>ereC</I>; <I>aadA1</I>; and <I>cmlA7</I>. An intact IS<I>CR1</I> element was shown to be downstream from the <I>qac</I>/<I>sul</I> genes. The third region consisted of a new MBL gene, designated <I>bla</I>NDM-1, flanked on one side by <I>K. pneumoniae</I> DNA and a truncated IS<I>26</I> element on its other side. The last two regions lie adjacent to one another, and all three regions are found on a 180-kb region that is easily transferable to recipient strains and that confers resistance to all antibiotics except fluoroquinolones and colistin. NDM-1 shares very little identity with other MBLs, with the most similar MBLs being VIM-1/VIM-2, with which it has only 32.4% identity. As well as possessing unique residues near the active site, NDM-1 also has an additional insert between positions 162 and 166 not present in other MBLs. NDM-1 has a molecular mass of 28 kDa, is monomeric, and can hydrolyze all β-lactams except aztreonam. Compared to VIM-2, NDM-1 displays tighter binding to most cephalosporins, in particular, cefuroxime, cefotaxime, and cephalothin (cefalotin), and also to the penicillins. NDM-1 does not bind to the carbapenems as tightly as IMP-1 or VIM-2 and turns over the carbapenems at a rate similar to that of VIM-2. In addition to <I>K. pneumoniae</I> 05-506, <I>bla</I>NDM-1 was found on a 140-kb plasmid in an <I>Escherichia coli</I> strain isolated from the patient's feces, inferring the possibility of in vivo conjugation. The broad resistance carried on these plasmids is a further worrying development for India, which already has high levels of antibiotic resistance.</P>

Poster Session : PS 1464 ; Infectious Diseases : A Case of Brain Abscess Caused by Aggregatibacter Aphrophilus in Korea

( Yong Duk Jeon ),( Jung Ho Kim ),( Hea Won Ann ),( Jin Young Ahn ),( Sun Bean Kim ),( Nam Su Ku ),( Sang Hoon Han ),( Jun Yong Choi ),( Dongeun Yong ),( Kyungwon Lee ),( June Myung Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Backgrouond: Aggregatibacter aphrophilus (A. aphrophilus) is a gram negative, capnophilic, fermentative, coccobacillus that is occasionally isolated from patients with infective endocarditis. It has also been reported to cause brain abscess, empyema, meningitis, osteomyelitis and joint infection. Herein we report the first case of brain abscess caused by A. aphrophilus in Korea. Case: A 26-year-old man visited hospital for a headache during three weeks. He presented fever, nausea and vomiting for three days. His blood pressure was 108/69 mmHg and his body temperature was 36.9 ℃ at that time. His past medical history was unremarkable. Brain magnetic resonance imaging (MRI) was performed and revealed the 4 cm sized abscess in the frontal lobe with profound perilesional edema and subdural empyema. He received empirical intravenous antibiotic treatment with ceftriaxone 2.0 g every 12 hours, vancomycin 1.0 g every 12 hours and metronidazole 500 mg every 8 hours. On the 4th hospital day, he had decompressive craniectomy and drainage of the abscess. On the 8th hospital day, A. aphrophilus was identified in the culture of abscess. Vancomycin and metronidazole were discontinued and ceftriaxone monotherapy was maintained because it was susceptible to the 3rd generation cephalosporin. On the 11th hospital day, transthoracic echocardiography was performed, but there was no evidence of endocarditis. After a eight-week course of intravenous ceftriaxone therapy, follow-up MRI revealed almost resolved abscess. Intravenous ceftriaxone was changed to oral cefixime 100 mg every 12 hours and he was discharged. He treated with oral cefixime for 12 weeks in outpatient clinic until the complete resolution of brain abscess on MRI.

Fluconazole-Resistant <i>Candida parapsilosis</i> Bloodstream Isolates with Y132F Mutation in <i>ERG11</i> Gene, South Korea

Choi, Yong Jun,Kim, Yae-Jean,Yong, Dongeun,Byun, Jung-Hyun,Kim, Taek Soo,Chang, Yun Sil,Choi, Min Ji,Byeon, Seung Ah,Won, Eun Jeong,Kim, Soo Hyun,Shin, Myung Geun,Shin, Jong Hee U.S. Department of Health and Human Services * Cen 2018 Emerging Infectious Diseases Vol.24 No.9

<P>We recently observed the emergence of fluconazole-resistant <I>Candida parapsilosis</I> bloodstream isolates harboring a Y132F substitution in Erg11p in South Korea. These Y132F isolates had a higher propensity to cause clonal transmission than other fluconazole-resistant isolates and persisted within hospitals for several years, as revealed by microsatellite typing.</P>

Fecal Transplantation using a Nasoenteric Tube during an Initial Episode of Severe <i>Clostridium difficile</i> Infection

Jeon, Yong Duk,Hong, Namki,Kim, Jung Ho,Park, Se Hee,Kim, Sung Bae,Song, In Ji,Ann, Hea Won,Ahn, Jin Young,Kim, Sun Bean,Ku, Nam Su,Lee, Kyungwon,Yong, Dongeun,Kim, June Myung,Choi, Jun Yong The Korean Society of Infectious Diseases and Kore 2016 Infection and Chemotherapy Vol.48 No.1

<P>The incidence of <I>Clostridium difficile</I> infection is increasing worldwide, and its severity and resulting mortality are also on the rise. Metronidazole and oral vancomycin remain the treatments of choice, but there are concerns about treatment failure and the appearance of resistant strains. Furthermore, antibiotic therapy results in recurrence rates of at least 20%. Fecal transplantation may be a feasible treatment option for recurrent <I>C. difficile</I> infection; moreover, it may be an early treatment option for severe <I>C. difficile</I> infection. We report a case of severe <I>C. difficile</I> infection treated with fecal transplantation using a nasoenteric tube during an initial episode. This is the first reported case of fecal transplantation using a nasoenteric tube during an initial episode of <I>C. difficile</I> infection in Korea.</P>

Comparative microbiome analysis of <i>Dermatophagoides farinae</i>, <i>Dermatophagoides pteronyssinus</i>, and <i>Tyrophagus putrescentiae</i>

Lee, Jinyoung,Kim, Ju Yeong,Yi, Myung-hee,Hwang, Younjee,Lee, In-Yong,Nam, Sung-Hyun,Yong, Dongeun,Yong, Tai-Soon Elsevier 2019 The journal of allergy and clinical immunology Vol.143 No.4

Microbiome of Haemaphysalis longicornis Tick in Korea

Myungjun Kim,Ju Yeong Kim,Myung-hee Yi,In-Yong Lee,Dongeun Yong,Bo-Young Jeon,Tai-Soon Yong 대한기생충학열대의학회 2021 The Korean Journal of Parasitology Vol.59 No.5

Comparative Microbiome Analysis of Three Species of Laboratory-Reared Periplaneta Cockroaches

Seogwon Lee,Ju Yeong Kim,Myung-hee Yi,In-Yong Lee,Won-Ja Lee,Hye Su Moon,Dongeun Yong,Tai-Soon Yong 대한기생충학열대의학회 2020 The Korean Journal of Parasitology Vol.58 No.5

골반과 척추부위의 농양을 동반한 파종성 콕시디오이데스 진균증 1예

박준철,김준형,구남수,이근호,최유경,이용호,김영근,김명수,송영구,신소연,김연아,박윤선,조상호,김창기,용동은,최준용,김준명 대한감염학회 2006 감염과 화학요법 Vol.38 No.5

Coccidioidomycosis results from inhaling the spores (arthroconidia) of Coccidioides species (Coccidioides immitis or Coccidioides posadasii), and is endemic in the southern United States. An even smaller proportion of all infections result in illnesses related to extrapulmonary infection. We report a case of coccidioidomycosis manifested as pelvic bone and paravertebral abscess in a Korean who has visited LA. Culture and pathology from the pelvic bone and paravertebral mass revealed Coccidioides immitis, and a diagnosis of disseminated coccidioidomycosis was made. 콕시디오이데스 진균증은 미국 남서부 지역의 풍토병으로 알려져 있고 우리나라는 유행지역이 아니기 때문에 진단에 혼선 및 지연을 초래할 수 있다. 그러나 해외여행자의 증가와 함께 다른 지역에서의 발병 사례가 증가하고 있으므로 임상양상과 진단이 맞지 않는 경우 환자의 유행지역의 여행력 여부에 대한 문진이 필수적이라 하겠다. 본 저자들은 콕시디오이데스 진균증의 토착지역인 미국 LA지역을 방문한 후 발생한 골반과 척추부위를 침범한 콕시디오이데스 진균증 1예를 경험하고 항진균제 사용과 함께 수술적 치료를 병행하여 치료하여 이를 보고하는 바이다.

국내 5개 종합병원에서 분리된 주요 원내감염 세균에 대한 Cefepime의 시험관내 항균력

용동은,김현숙,박연준,홍석일,구선회,이경원,정윤섭 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.3

목적 : Enterobacter, Citrobacter, Serratia, A. baumannii 및 P. aeruginosa 등의 원내 감염균은 AmpC β-lactamase 과량 생산으로 인하여 여러 가지 β-lactamase 항균제에 내성인 균주가 많다. Cefepime은 제 4세대 cephalosporin으로 AmpC β-lactamase 과량 생산균에 대한 항균력이 우수하고, oxacillin 감수성 포도구균과 penicillin 내성 S. pneumoniae에도 항균력 있는 것으로 알려져 있다. 그러나 국내분리균주에서 cefepime의 항균력은 시험된 바 적다. 본 연구에서는 우리나라 병원에서 분리되는 원내감염 세균에 대한 cefepime의 항균력을 다른 광범위 β-lactamase 항균제의 항균력과 비교하고자 하였다. 방법 : 1999년 전국 5개 병원에서 분리한 원내 감염세균에 대한 항균제 감수성을 각각의 병원에서 Etest strip (AB Biodisk, Solna, Sweden)으로 시험하였다. 시험 균주는 균종별로 약 10주씩이었고, 대상균종은 E. coli, Klebsiella spp., C. freundii, Enterobacter spp., Serratia spp., Indole-positive Proteeae, Acinetobacter spp., P. aeruginosa, oxacillin-suspectible S. aureus, and oxacillin-suspectible coagulase-negative Staphylococcus이었다. 시험 항균제는 cefepime, cefpirome, ceftazidime, ceftriaxone, imipenem, oxacillin 그리고 piperacillin-tazobactam이었다. 결과 : 총 407주 그람음성 간균에서 cefepime의 MIC_(90)는 E. coli에 대하여 0.75㎍/mL, Klebsiella spp. 12㎍/mL, C. freundii 2㎍/mL 및 E. cloacae 48㎍/mL로서 imipenem을 제외한 다른 시험항균제의 MIC_(90)보다 낮았다. 전체 균종의 감수성율은 imipenem 89%, cefepime 78%, cefpirome 74%, ceftazidime 66%, piperacillin-tazobactam 65% 및 ceftriaxone 51%이었다. Oxacilin 감수성 포도구균의 감수성율은 cefepime, cefpirome 및 imipenem에 대해 100%이었다. 결론 : Cefepime의 원내감염 세균에 대한 시험관내 항균력은 imipenem을 제외한 다른 광범위 항균제보다 우수하여, 이 항균제는 원내감염증 환자의 치료에 유용할 것으로 판단되었다. Background : Common nosocomial pathogens such as Pseudomonas aeruginosa, Acinetobacter baumannii, and species of Enterobacter, Citrobacter, and Serratia, are often resistant to various β-lactam antibiotics by Amp C β-lactamase hyperproduction. Cefepime, a fourth generation cephalosporin, has been reported to have higher activity against AmpC β-lactamase-producing strains. It is also reported to be active against oxacillin-susceptible S. aureus, and penicillin-resistant S. pneumoniae. However, few studies were reported with Korean isolates. The purpose of this study was to compare the in vitro activities of cefepime and other broad-spectrum β-lactam antibiotics against nosocomial pathogens isolated in Korean Hospitals. Methods: In 1999, each of five participating hospitals in Korea tested the antimicrobial susceptibility for nosocomial pathogens using Etest strip. The number of isolates tested were about ten per species, which were E. coli, Klebsiella spp., C. freundii, Enterobacter spp., Serratia spp., Indole-positive Proteeae, Acinetobacter spp., P. aeruginosa, oxacillin-susceptible S. aureus, and oxacillin-susceptible coagulase-negative Staphylococcus. Antimicrobials used were cefepime, cefpirome, ceftazidime, ceftriaxone, imipenem, oxacillin and piperacillin-tazobactam. Results: A total of 407 isolates were tested. The MIC_(90s) of cefepime were 0.75 ㎍/mL for E. coli, 12 ㎍/mL for Klebsiella spp., 2 ㎍/mL for C. freundii, and 48 ㎍/mL for Enterobacter spp., which were generally lower than those of other antibiotics except imipenem. The following were the susceptibility rates of gram-negative bacilli to various antimicrobials, respectively: imipenem, 89%; cefepime, 78%; cefpirome, 74%; ceftazidime, 66%; piperacillin-tazobactam, 65% and ceftriaxone, 51%. To cefepime, cefpirome and imipenem, 100% of oxacillin-susceptible S. aureus were susceptible. Conclusion: The higher in vitro activities of cefepime than other broad-spectrum β-lactam antibiotics except imipenem suggests cefepime is useful for the treatment of patients with nosocomial infections.

국내 대학병원 환자의 호흡기 검체에서 분리된 세균에 대한 Gatifloxacin의 시험관내 항균력

용동은,김명숙,김신영,이경원,김성규,정윤섭,이일섭 대한감염학회 2004 감염과 화학요법 Vol.36 No.2

목적 : 새로 개발된 8-methoxyquinolone인 gatifloxacin은 호흡기 감염균을 포함한 광범위 세균에 항균력을 보인다. 본 연구에서 저자들은 gatifloxacin과 비교약제의 시험관내 항균력을 최근 우리나라 환자의 호흡기에서 분리된 세균에 대하여 시험하였다. 방법 : 본 저자들은 2000-2001년에 국내 8개 대학병원에서 만성 하부기도 감염증이 급성 악화된 환자의 호흡기 검체에서 분리된 세균 49주와 연세의대 병원 환자의 호흡기 검체에서 분리된 병원균 108균주를 대상으로 하였다. 항균제 최소억제 농도는 NCCLS 한천희석법으로 시험하였다. 결과 : Streptococcus pneumoniae에 대한 gatifloxacin의 MIC_(90)는 1㎍/mL로서 ciprofloxacin과 levofloxacin의 MIC_(90)보다 각각 8배와 2배 낮았다. Haemophilus influenzae와 Moraxella (Branhamella) catarrhalis는 각각 gatifloxacin ≤0.06㎍/mL와 ≤0.25㎍/mL에서 억제되었고 시험한 fluoroquinolones제에 모두 감수성이었다. Klebsiella pneumoniae에 대한 gatifloxacin의 MIC_(90)는 0.06㎍/mL으로 levofloxacin과 moxifloxacin의 MIC_(90)보다 2배 낮았다. 결론 : Gatifloxacin은 국내 환자의 호흡기병원에서 분리된 세균인 S. pneumoniae, H. influenzae 및 M. (B.) catarhalis에 대한 시험관내 항균력이 우수하였다. Background : Gatifloxacin, a new 8-methoxyquinolone, has a broad-spectrum activity with expanded potency against respiratory pathogens. In this study, we examined the in vitro activity of gatifloxacin and comparators against recently isolated bacteria from respiratory specimens of patients in Korean hospitals. Methods : Forty-nine isolates were from respiratory specimens of patients with acute exacerbations of chronic lower respiratory infections in eight university hospitals and 108 isolates were from respiratory specimens from patients of Yonsei University Hospital. Minimum inhibitory concentrations (MICs) were determined by NCCLS agar dilution method. Results : MIC_(90) of gatifloxacin for Streptococcus pneumoniae was 1 ㎍/mL, which was 8-fold and 2-fold lower than those of ciprofloxacin and levofloxacin, respectively. All strains of Haemophilus influenzae and Moraxella (Branhamella) catarrhalis were inhibited by ≤0.06 ㎍/mL and ≤0.25 ㎍/mL of gatifloxacin, respectively, and were susceptible to all fluoroquinolones tested. MIC_(90) of gatifloxacin for Klebsiella pneumoniae was 0.06 ㎍/mL, which was 2-fold lower than those of levofloxacin and moxifloxacin. Conclusion : Gatifloxacin is highly active against S. pneumoniae, H. influenzae and M. (B.) catarrhalis isolated from respiratory specimens of patients of university hospitals in Korea.