감염 ; 비결핵항산균에 의한 피부, 연부조직 감염 9예

김효훈 ( Hyo Hoon Kim ),김신우 ( Shin Woo Kim ),장현하 ( Hyun Ha Chang ),김혜인 ( Hye In Kim ),정주영 ( Ju Young Jeong ),진선 ( Sun Jin ),박정화 ( Jung Wha Park ),정혜진 ( Hye Jin Jung ),김민혜 ( Min Hye Kim ),이종명 ( Jong Myung 대한내과학회 2014 대한내과학회지 Vol.87 No.3

Background/Aims: Non-tuberculous Mycobacterium (NTM) infections usually result in chronic disease, and making a diagnosis is often difficult. Skin and soft tissue infections due to NTM are not common and are usually diagnosed relatively late. We investigated the clinical characteristics of nine cases of skin and soft tissue infections with NTM. Methods: Nine patients with an NTM infection who were confirmed consecutively by skin and soft tissue and/or adjacent bone cultures at a teaching hospital between August 2006 and July 2013 were enrolled in this study. The demographics, clinical characteristics, underlying diseases, treatment, and prognosis between different NTM species were reviewed retrospectively. Results: The most common NTM species causing a soft tissue infection was Mycobacterium abscessus (five patients, 55.6%). Common sites of infection were the knee and lumbar spine. Five patients (55.6%) had underlying diseases. Six patients (77.8%) were treated with combined surgical treatment (incision and drainage) plus antibiotics. The duration from symptom onset to diagnosis was long (77.7 ± 44.6 days) due to inadequate microbiological evaluation and disregard for the clinical significance of the NTM culture. All patients were cured with treatment; however, the treatment duration was long (181.7 ± 140.0 days). Procedure and cosmetic surgery were the most important risk factors for infection. Conclusions: The diagnosis of NTM skin and soft tissue infections tends to be delayed in a clinical setting. Therefore, a high index of suspicion for NTM infection in chronic localized soft tissue infections is essential for diagnosis. Mycobacterium abscessus appears to be the most common NTM species causing soft tissue infections. (Korean J Med 2014;87:311-317)

A study of causative bacteria and antibiotic susceptibility in bacterial skin infection

( Jae Ho Lee ),( Ji-an Uh ),( Joong-ho Kim ),( Ho-young Kim ),( Soo Kyung Lee ),( Myoung Shin Kim ),( Un Ha Lee ) 대한피부과학회 2020 대한피부과학회 학술발표대회집 Vol.72 No.1

Background: Bacterial skin soft tissue infection is the most common clinical manifestation of community acquired methicillin resistant Staphylococcus aureus (MRSA) infection. And, treating bacterial skin soft tissue infection can be sometimes challenging because of the resistance to antibiotics. Objectives: To investigate the characteristics of bacterial skin infections and contributing factors of the treatment response. Methods: We retrospectively reviewed the chart from January 2010 to December 2019. Patients whom had taken ordinary bacterial skin culture at skin soft tissue infection site were included. Results: A total of 927 patients were diagnosed as skin soft tissue infections; Finally, 731 patents (78.9%) showed response and 196 patients (21.1%) showed no response at after initial treatment. The patients who showed no response (little improvement after the initial treatment and the treatment had to be changed.) in initial treatment had significantly older age (p=0.003), less crusted lesion (p=0.025), more results of gram negative bacteria in skin culture (<p=0.001), and more initial treatments with systemic or topical glucocorticosteroid (p=0.027). Conclusion: Patients who had older age and skin infections caused by gram negative bacteria can be easily suffered from initial treatment failure and should be treated with more attention.

The Efficacy and Safety of Arbekacin and Vancomycin for the Treatment in Skin and Soft Tissue MRSA Infection: Preliminary Study

황지희,이주형,문미경,김주신,원경숙,이창섭 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.1

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has become a one of the most important causes of nosocomial infections, and use of vancomycin for the treatment of MRSA infection has increased. Unfortunately, vancomycin-resistant enterococcus have been reported, as well as vancomycin-resistant S. aureus . Arbekacin is an antibacterial agent and belongs to the aminoglycoside family of antibiotics. It was introduced to treat MRSA infection. We studied the clinical and bacteriological efficacy and safety of arbekacin compared to vancomycin in the treatment of infections caused by MRSA. Materials and Methods: This was a retrospective case-control study of patients who were admitted to tertiary Hospital from January 1st, 2009 to December 31st, 2010, and received the antibiotics arbekacin or vancomycin. All the skin and soft tissue MRSA infected patients who received arbekacin or vancomycin were enrolled during the study period. The bacteriological efficacy response (BER) was classified with improved and failure. The improved BER was defined as no growth of MRSA, where failure was defined as growth of MRSA, culture at the end of therapy or during treatment. Clinical efficacy response (CER) was classified as improved and failure. Improved CER was defined as resolution or reduction of the majority of signs and symptoms related to the original infection. Failure was defined as no resolution and no reduction of majority of the signs and symptoms, or worsening of one or more signs and symptoms, or new symptoms or signs associated with the original infection or a new infection Results: Totally, 122 patients (63/99 in arbekacin, 59/168 in vancomycin group) with skin and soft tissue infection who recieved arbekacin or vancomcyin at least 4 days were enrolled and analysed. The bacteriological efficacy response [improved, arbekacin vs vancomycin; 73.0% (46/63), 95% confidence interval (CI) 60.3 to 83.4% vs 83.1% (49/59), 95% CI 71.0 to 91.6%] and clinical efficacy response [improved, arbekacin vs vancomycin; 67.2% (41/61), 95% CI 52.0 to 76.7 % vs 78.0% (46/59), 95%CI 65.3 to 87.7%] were similar between the two groups (P=0.264, 0.265). The complication rate was significantly higher in the vancomycin group [29/59(49.2%), 95% CI 35.9 to 62.5%] than arbekacin [10/63(15.9%), 95% CI 8.4 to 29.0%] (P <0.001). Conclusions: Arbekacin could be considered as an alternative antibiotics for vancomycin in skin and soft tissue infection with MRSA. However, further prospective randomized trials are needed to confirm this finding.

Dual-Toehold-Probe-Mediated Exonuclease-III-Assisted Signal Recycles Integrated with CHA for Detection of mecA Gene Using a Personal Glucose Meter in Skin and Soft Tissue Infection

Su Jiaguang,Zheng Wenjun 한국미생물·생명공학회 2023 Journal of microbiology and biotechnology Vol.33 No.12

Staphylococcus aureus integrated with mecA gene, which codes for penicillin-binding protein 2a, is resistant to all penicillins and other beta-lactam antibiotics, resulting in poor treatment expectations in skin and soft tissue infections. The development of a simple, sensitive and portable biosensor for mecA gene analysis in S. aureus is urgently needed. Herein, we propose a dual-toehold-probe (sensing probe)-mediated exonuclease-III (Exo-III)-assisted signal recycling for portable detection of the mecA gene in S. aureus. When the target mecA gene is present, it hybridizes with the sensing probe, initiating Exo III-assisted dual signal recycles, which in turn release numerous “3” sequences. The released “3” sequences initiate catalytic hairpin amplification, resulting in the fixation of a sucrase-labeled H2 probe on the surface of magnetic beads (MBs). After magnet-based enrichment of an MB-H1-H2-sucrase complex and removal of a liquid supernatant containing free sucrase, the complex is then used to catalyze sucrose to glucose, which can be quantitatively detected by a personal glucose meter. With a limit of detection of 4.36 fM for mecA gene, the developed strategy exhibits high sensitivity. In addition, good selectivity and anti-interference capability were also attained with this method, making it promising for antibiotic tolerance analysis at the point-of-care.

Allosteric Probe-Based Colorimetric Assay for Direct Identification and Sensitive Analysis of Methicillin Resistance of Staphylococcus aureus

Juan Chu,Xiaoqin Zhao The Korean Society for Microbiology and Biotechnol 2024 Journal of microbiology and biotechnology Vol.34 No.3

The accurate and rapid detection of methicillin-resistance of Staphylococcus aureus (SA) holds significant clinical importance. However, the methicillin-resistance detection strategies commonly require complicated cell lysis and gene extraction. Herein, we devised a novel colorimetric approach for the sensitive and accurate identification of methicillin-resistance of SA by combining allosteric probe-based target recognition with self-primer elongation-based target recycling. The PBP2a aptamer in the allosteric probe successfully identified the target MRSA, leading to the initiation of self-primer elongation based-cascade signal amplification. The peroxidase-like hemin/G-quadruplex undergo an isothermal autonomous process that effectively catalyzes the oxidation of ABTS2- and produces a distinct blue color, enabling the visual identification of MRSA at low concentrations. The method offers a shorter duration for bacteria cultivation compared to traditional susceptibility testing methods, as well as simplified manual procedures for gene analysis. The overall amplification time for this test is 60 min, and it has a detection limit of 3 CFU/ml. In addition, the approach has exceptional selectivity and reproducibility, demonstrating commendable performance when tested with real samples. Due to its advantages, this colorimetric assay exhibits considerable potential for integration into a sensor kit, thereby offering a viable and convenient alternative for the prompt and on-site detection of MRSA in patients with skin and soft tissue infections.

Prevalence of Complement-Mediated Cell Lysis-like Gene (sicG) in Streptococcus dysgalactiae subsp. equisimilis Isolates From Japan (2014–2016)

Takashi Takahashi,Tomohiro Fujita,Akiyoshi Shibayama,Yuzo Tsuyuki,Haruno Yoshida 대한진단검사의학회 2017 Annals of Laboratory Medicine Vol.37 No.4

Background: Streptococcus dysgalactiae subsp. equisimilis (SDSE; a β-hemolytic streptococcus of human or animal origin) infections are emerging worldwide. We evaluated the clonal distribution of complement-mediated cell lysis-like gene (sicG) among SDSE isolates from three central prefectures of Japan. Methods: Group G/C β-hemolytic streptococci were collected from three institutions from April 2014 to March 2016. Fifty-five strains (52 from humans and three from animals) were identified as SDSE on the basis of 16S rRNA sequencing data.; they were obtained from 25 sterile (blood, joint fluid, and cerebrospinal fluid) and 30 non-sterile (skin-, respiratory tract-, and genitourinary tract-origin) samples. emm genotyping, multilocus sequence typing, sicG amplification/sequencing, and random amplified polymorphic DNA (RAPD) analysis of sicG-positive strains were performed. Results: sicG was detected in 30.9% of the isolates (16 human and one canine) and the genes from the 16 human samples (blood, 10; open pus, 3; sputum, 2; throat swab, 1) and one canine sample (open pus) showed the same sequence pattern. All sicG-harboring isolates belonged to clonal complex (CC) 17, and the most prevalent emm type was stG6792 (82.4%). There was a significant association between sicG presence and the development of skin/soft tissue infections. CC17 isolates with sicG could be divided into three subtypes by RAPD analysis. Conclusions: CC17 SDSE harboring sicG might have spread into three closely-related prefectures in central Japan during 2014–2016. Clonal analysis of isolates from other areas might be needed to monitor potentially virulent strains in humans and animals.

Necrotizing Fasciitis in Three University Hospitals in Korea: A Change in Causative Microorganisms and Risk Factors of Mortality During the Last Decade

유시내,김태형,이은정,추은주,전민혁,정영규,김태진,문인기,이지성 대한감염학회 2013 Infection and Chemotherapy Vol.45 No.4

Background: Necrotizing fasciitis is a life-threatening infectious disease with rapidly progressive involvement of the affected site. Because of the high mortality rate of this disease, early diagnosis, surgical exploration, and administration of appropriate antibioticsare necessary. The present study aimed to further review the changes in the clinical and microbiological characteristics of necrotizingfasciitis using patients’ medical records from consecutive databases of 3 hospitals in Korea. Materials and Methods: In this study, we retrospectively reviewed the medical records of patients with necrotizing fasciitis who wereclinically diagnosed between May 2001 and February 2012 in 3 university hospitals in Korea. In total, the data of 83 patients wereanalyzed, including those of 20 patients from our previous study in 2006. An organism found in a blood culture or surgical specimenwas regarded as a causative organism. Results: Of the 83 patients, 68(81.9%) had community-acquired infections. Ninety microorganism species were indentifed byculture. Streptococcus was the most commonly identified pathogen. Non-fermentative gram-negative bacteria and Candida specieshave recently emerged, especially in immunocompromised hosts. Conclusions: Gram-positive organisms are still the most common pathogens of necrotizing fasciitis. However in our study, variousgram-negative bacteria with different levels of susceptibility to antibiotics, as well as Candida species, were responsible forthe necrotizing fasciitis. Initial empirical antimicrobial agents for necrotizing fasciitis should be considered depending on theindividual patient’s condition.

P103 Microbiological characteristics of pathogens associated with skin and soft tissue infections during 5 years

( Seung Pil Ham ),( Cheong Ha Woo ),( Ho Yeol Lee ),( Sik Haw ),( Hai-jin Park ),( Mira Choi ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Skin and soft tissue infections (SSTIs) are frequently seen in dermatology department. Microbiologic characteristics of the pathogens may affect the treatment and outcome. Objectives: The objective of this study is to evaluate the recent microbiological characteristics of SSTI and to compare inpatient and outpatient in a single study center. Methods: We retrospectively reviewed the clinical data of 202 patients with SSTI from 2011 to 2015 in a secondary medical center. Results: Among 202 cases, 172 were outpatients and 30 were inpatients. Mean age was significantly older in inpatient (61.5 vs 44.1 years, p=0.001). Most common infection site was the face in outpatients (25.5%) and leg in inpatients (33.3%). In 65/202 cases (32.1%), no bacterial species was identified. Major isolated pathogen was Staphylococcus aureus (25.7%), followed by coagulase negative staphylococcus (CNS) (23.3%) and Pseudomonas aeruginosa (5.4%). CNS was the most frequently isolated from leg (26.0%), but S.aureus was the most common pathogen from the face (30.6%). The susceptibility rates of S. aureus to the methicillin was 35.2%, and hospitalization was a significant factor to the methicillin resistance (p=0.002). Conclusion: As various organisms can cause SSTI and 32.1% were no growth in this study, close monitoring of the microbiologic characteristics of pathogen is important and unnecessary administration of antibiotics should be avoided.

Treatment strategy for skin and soft tissue infections caused by nontuberculous mycobacteria following various procedures

배재영,윤인식,노태석,김영석 대한미용성형외과학회 2021 Archives of Aesthetic Plastic Surgery Vol.27 No.1

Background The early diagnosis and treatment of skin and soft tissue infections caused by nontuberculous mycobacteria (NTM) are important, especially as infections with rapidly growing mycobacteria (RGM) are rare and difficult to diagnose and treat. Recently, we identified 22 cases of NTM infections; in this study, we suggest treatment strategies by analyzing the demographic characteristics and treatment progress of these patients. Methods A retrospective study of patients with NTM infections from 2009 to 2019 was conducted. To identify NTM infections, acid-fast bacillus (AFB) staining, Gram staining, polymerase chain reaction (PCR), and cultures of mycobacteria were performed. Empirical treatment with a combination of antibiotics or surgery was performed; species identification and drug susceptibility tests were performed by the Korean National Tuberculosis Association. The final regimen was determined after obtaining the test results. Results The mean incubation time of NTM was 4.32±2.88 weeks. RGM were detected in mycobacterial cultures in 21 of the 22 NTM patients. The results of AFB staining were negative in all patients, although PCR was positive for NTM in one patient. Fourteen patients were hospitalized for treatment with intravenous antibiotics and surgery. Treatment with a combined regimen of oral antibiotics was maintained for a mean of 5.41±1.85 months. Conclusions The unusual clinical manifestations of skin and soft tissue infections caused by NTM make them difficult to diagnose. Suspicion of NTM based on clinical presentation and a detailed examination should be followed by proper treatment involving multiple antibiotics and surgery in these patients.

ST714-SCCmec type IV CA-MRSA에 의한 피부 연부조직 감염증으로 내원한 소아 증례

유리나 ( Reenar Yoo ),김서희 ( Seohee Kim ),이진아 ( Jina Lee ) 대한소아감염학회 2016 Pediatric Infection and Vaccine Vol.23 No.1

최근 전세계적으로 지역사회 기원 메티실린내성 황색포도알균(CA-MRSA)에 의한 피부연부조직 감염증이 증가하고 있다. 16개월의 한국 여아가 생후 6개월부터 시작된 반복되는 피부연부조직 감염증을 주소로 내원하였다. 환아의 가족들도 환아와 비슷한 시기에 피부연부조직 감염증의 병력이 있었다. 환아의 혈중 면역글로불린 및 NBT 검사는 정상이었고, 피부 병변 외에는 가족 모두 건강하였다. 환아의 감염증 부위의 고름 배양 및 비강 내 보균 검사시 모두 PVL genes을 생성하는 CA-MRSA ST714 SCCmec type IV가 확인되었고, 이는 ST30의 single locus variant로서 국내에서는 보고된 적이 없는 MRSA의 유전형이다. 환아와 함께, 환아의 균주와 동일 항생제 감수성 양상을 보이는 MRSA 보균자인 환아부에게 재발 방지를 위해서 비강내 mupirocin 5일 요법을 시행하였고 이후 10개월간 추가적인 재발은 없었다. Skin and soft tissue infections (SSTIs) caused by community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have become a worldwide concern. An otherwise healthy 16-month-old Korean girl was admitted because of skin abscess on the left chest wall with a history of recurrent SSTIs since the age of 6 months. Immunologic evaluation including serum immunoglobulin level and nitroblue-tetrazolium (NBT) test were normal. Pus and nasal swab cultures revealed CA-MRSA ST714-SCCmec type IV with the Panton-Valentine leukocidin (PVL) genes, which was initially reported in the Netherlands in 2006 and has not been previously reported in Korea. The skin abscesses were successfully treated by needle aspiration and the use of antibiotics. In addition, nasal mupirocin was applied as a decolonization method. No more episodes of SSTI were observed over a follow-up period of 10 months.