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Background: Enterococci have become increasingly predominant as causative agents of nosocomial infections. Infections due to multi-drug resistant enterococci have drawn increasing attention during the past two decades. The purpose of the present study was to evaluate the occurrence of virulence factors and antimicrobial resistance in enterococci isolated from patients with bacteremia or urinary tract infection. Methods: A total of 209 strains of enterococi (102 Enterococcus faecalis and 107 E. facium) isolated during 8 months of 2005 were collected from 10 university hospitals in Korea. Disk diffusion susceptibility tests were performed using Mueller-Hinton agar. The antimicrobial resistance genes and virulence factors were determined using PCR. Results: In E. faecalis, the rate of resistance to ciprofloxacin, tetracycline, and quinupristindalfopristin was 27.4%, 83.3%, and 85.2%, respectively; no isolates were resistant to ampicillin, vancomycin, teicoplanin, or linezolid. In E. faecium, the rate of resistance to ampicillin, ciprofloxacin, tetracycline, vancomycin, and teicoplanin was 86.9%, 87.9%, 8.4%, 19.6%, and 6.5%, respectively; no strains were resistant to quinupristin-dalfopristin or linezolid. All the E. faecalis strains tested were found to harbor multiple virulence factors, but E. faecium strains were generally without virulence factors except esp. The prevalence of the esp gene was significantly higher in enterococci isolated from urinary tract infection than in those from bacteremia. Conclusion: A similar pattern of resistance to antimicrobial agents and prevalence of virulence factors was observed in both the enterococci isolated from bacteremia and urinary tract infection. Our study indicates that host factors are more likely than bacterial properties to influence the development of bacteremia. 배경: 장구균은 병원감염을 흔히 일으키는 중요한 세균으로, 최근 20년간 다제 내성 장구균에 의한 감염의 증가로 인하여 심각한 문제가 되고 있다. 본 연구의 목적은 균혈증과 요로 감염에서 분리된 장구균을 대상으로 항균제 내성 및 병독성 인자 검출 양상을 분석하는데 있다. 방법:2005년 3월부터 10월 사이에 전국 10개 대학병원 환자의 혈액과 소변에서 분리된 장구균 (209균주; Enterococcus faecalis, 102; E. faecium, 107)을 수집하였다. 항균제 감수성 검사는 디스크 확산법으로 실시하였고, 항균제 내성 유전자와 병독성 인자는 중합효소 연쇄 반응법으로 검출하였다. 결과:항균제 내성율은 E. faecalis의 경우 ciprofloxacin 27.4%, tetracycline 83.3%, 및 quinupristindalfopristin 85.2%였고, ampicillin, vancomycin, teicoplanin 및 linezolid에 내성인 균주는 검출되지 않았다. E. faecium의 경우 ampicillin 86.9%, ciprofloxacin 87.9%, tetracycline 8.4%, vancomycin 19.6% 및 teicoplanin 6.5%였고 quinupristin-dalfopristin과 linezolid에 내성인 균주는 검출되지 않았다. esp를 제외한 병독성 인자는 E. faecalis에서 양성율이 높았고, esp의 경우는 E. faecium에서 높은 양성율을 보였으나 통계적으로 유의하지는 않았다. 혈액 및 소변 분리주간 esp 보유율은 소변 분리주에서 유의하게 높았고, 나머지 병독성 인자 양성율의 차이는 없었다. 결론:항균제 내성율 및 병독성 인자 보유 양상은 혈액 분리주와 요로 감염 분리주간 유의한 차이는 보이지 않아, 균혈증 야기는 세균의 성상보다는 숙주의 환경에 영향을 받는 것으로 생각되었다.
목적 : VRE의 출현으로 인하여 내성 균주에 의한 감염시 치료 요법 선택에 어려움이 예상되며 여러 약제의 병합 요법이 강구되고 있다. 본 연구의 목적은 VanA, B, 및 C형 내성 균주에 대하여 vancomycin, penicillin 및 gentamicin의 병용에 의한 살균 효과를 알아보고자 하였다. 방법 : VRE 9 균주와 vancomycin 감수성 2균주를 대상으로 하였고 MIC는 한천 희석법을 시행하였다. 시험 약제는 vancomycin 8㎍/mL, penicillin 2㎍/mL, 및 gentamicin 1㎍/mL 였고 병용에 의한 상승 효과는 24시간 후 균수가 2log_(10) CFU/mL 이상 감소시 유효하다고 판정하였다. 결과 : VanA와 VanB 균주는 Vancomycin-penicillin-gentamicin 및 vancomycin-penicillin 병용에 대하여 억제 효과를 보였고 VanC 균주는 어떠한 약제 병용에도 저항성이었다. 결론 : 3 약제 병합 요법과 vancomycin-penicillin 병용 요법은 VanA와 VanB 균주에 치료효과가 기대되며 VanC 균주에 대한 치료 방법에 대해서는 새로운 모색이 필요하다고 사료된다. Background : Because of the resistance that enterococci already exhibit to a 2a riety of antimicrobial agents, the emergence of vancomycin resistance is troublesome. The combined regimen mag offer a treatment for patients infected with vancomycin-resistant enterococci. We examined the antibiotic synergistic killing of clinical isolates of vancomycm-resistant enterococci belonging to genotypic resistance classes A, B, and C. Methods : Nine strains of vancomycin-resistant enterococcl and 2 strains of vancomycin-susceptible enterococci were utilized in this study. MICs were determined by agar dilution method. Synergistic inhibition of growth was assessed by addition vancomycin(8 ㎍/mL), peniciilin( 2 ㎍/mL), gentamicin( 1 ㎍/mL), or combinations of these antibiotics to cultures in the early logarithmic phase of growth. Synergy was defined as a decrease in CFU/mL by at least 2 log10 after 24 h compared with the effect of the most active single agent. Results : Vancomycin-penicillin-gentamicin, and vancomycin-penicillin resulted in 2 or more logs of killing above that the most effective single agent for all VanA and VanB strains. All VanC strains were resistant to any antibiotics combination. Conclusion : Triple combination therapy and vancomycin plus penicillin regimen may be effective for the treatment of infections caused by vancomycin-resistant enterococci belong to genotypic classes VanA and VanB, Futher studies are needed for the new therapeutic regimen agaist VanC strains.
Background: Salmonella infections in human present a spectrum of clinical syndromes that include enteric fever, acute gastroenteritis, bacteremia, localized infections, asymptomatic intestinal infections and transient, convalescent and chronic intestinal carrier states. Recently the incidence of reported nontyphoidal Salmonella cases has increased. Among them, group B Salmonella is an important enteric pathogen and increased incidence of bacteremia in infants is also reported. We performed a retrospective analysis to evaluate the incidence of group B Salmonella infection, the clinical manifestation, the laboratory findings and the pattern of susceptibility to commonly used antibiotics. Methods: The serogroups of Salmonella strains isolated from stool and blood from June 1994 to September 1995 were typed and the antimicrobial susceptibility was tested by agar diffusion method. We reviewed clinical records of patients who had positive culture for group B Salmonella. The age, sex, body temperature, white blood cell count and Widal test results of those patients were analyzed. Results: 1. Among 124 strains, group B Salmonella was 58(48.8%). 2. About 57% of patients were infants and early childhood and most of cases(77.6%) occurred between May and October, 3. Two patients(4.7%) were associated with bacteremia. 4. The resistance to Tetracycline, Ampicillin, Trimethoprim-Sulfamethoxazole (TMP-SXT), cefamandole and ceftriaxone for group B was 62%, 32.7%, 8.6%, 1.7% and 0% respectively. Multiple resistant strains were 7(12.1%). Conclusion: Most patients with acute gastroenteritis due to group B Salmonella are under two years old and the resistant strains to first line antibiotics have increased. Young infants are at particular risk for bacteremia, so if group B Salmonellosis is suspected in infants, blood culture should be obtained and proper antibiotic therapy should be given.
In July 2010, we identified an outbreak of vancomycin-resistant enterococci (VRE) in our 26-bed neonatal intensive care unit. We performed an epidemiological investigation after clinical cultures of 2 neonates were positive for VRE. Identification, susceptibility testing, and molecular characterization were performed. Cultures of 3 surveillance stool samples of inpatients and 5 environmental samples were positive for VRE. All isolates were identified as Enterococcus faecium containing the vanA gene. Two distinct clones were identified by performing pulsed-field gel electrophoresis. The 2 clones exhibited different pulsotypes, but they represented identical Tn1546 types. Two sequence types, ST18 and ST192, were identified among all of the isolates with multilocus sequence typing. Our investigation determined that the outbreak in the neonatal intensive care unit was caused by 2 genetically different clones. The outbreak may have occurred through clonal spread and horizontal transfer of the van gene.