CTX-M형 ESBL 생성 비장티푸스성 살모넬라의 특성

박순호,서일혜,안정열,박필환,김경희,송영희,김정은 대한감염학회 2010 감염과 화학요법 Vol.42 No.1

Background: Extended-spectrum ß-lactamase (ESBL)-producing Salmonella have been increasingly reported worldwide. ESBL-producing Salmonella is of particular concern since children cannot be treated with quinolones. This study was conducted to determine the phenotypic and genetic characteristics of ESBL-producing Salmonella in a tertiary hospital. Materials and Methods: Four clinical ESBL-producing isolates of non-typhoidal Salmonella were collected during 2001 to 2009. Antimicrobial susceptibility was determined by disk diffusion test and VITEK-II system. ESBL production was tested by ESBL phenotypic confirmatory test. TEM, SHV, CTX-M1, CTX-M2, CTX-M8, and CTX-M9 type ESBL genes were detected by PCR amplification, and PCR products were subjected to direct sequencing Results: Phenotypic confirmatory test showed that 4 of the 300 non-typhoidal Salmonella isolates were ESBL-producing: 3 S. Enteritidis and 1 S. Typhimurium. All 4 isolates were recovered during the past 1 year period. All 3 S. Enteritidis harbored CTX-M-15, while the S. Typhimurium harbored CTX-M-14. All CTX-M-15-producing S. Enteritidis isolates showed resistance both to cefotaxime and ceftazidime, while the CTX-M-14-producing S. Enteritidis were resistant only to cefotaxime. Conclusions: ESBL-producing nontyphoidal Salmonella has emerged recently and the type of ESBL has switched from TEM and SHV to CTX-M.

16S rRNA 유전자 염기서열 분석에 의해 확인된 Acinetobacter spp. 가성요로감염 유행

김수연,김진용,강지혜,박신영,이희승,박윤수,서일혜,조용균 대한감염학회 2007 감염과 화학요법 Vol.39 No.4

목적 : 본 연구는 일개 대학병원의 한 병동에서 16SrRNA 유전자 염기서열 분석을 통해 확인된 Acinetobacter spp. 가성요로감염 집단 발생에 대한 조사이다. 재료 및 방법 : 일개 대학병원의 일반병동에서 2005년 9월 23일부터 26일까지 5명의 환자에서 Bordetelta bronchiseptica 세균뇨가 동시에 분리되었다. 해당 환자들에 대한 입원 진료 기록을 확인하고, 이학적 검사를 시행하였고, 의료진 면담 등의 역학적 조사와 의심되는 전파원의 환경 감시배양을 시행하였다. 또한 다섯 균주들의 상동성 확인을 위해 pulsed field gel electrophoresis (PFGE)를 하였고, 정확한 균 동정을 위해 16S rRNA 유전자 염기서열 분석을 하였다. 결과 : VITEK system에 의해 B. bronchiseptica로 보고된 다섯 균주들은 거의 유사한 항생제 감수성을 가지고 있었다. 유행조사에서 요로감염의 증상이나 균혈증을 보인 환자는 없었고, 환경 감시배양에서 공통의 전파원은 증명되지 않았다. 또한 PFGE와 16S rRNA 유전자 염기서열분석에서 상동성을 가진 동일 Acinetobacter spp.로 확인되어 이에 의한 가성요로감염의 유행으로 결론지었다. 결론 : 역학적 조사와 함께 PFGE와 16s rRNA 유전자염기서열 분석과 같은 분자생물학적인 조사를 시행하는 것은 희귀한 균에 의한 병원감염 유행조사에 도움이 될 것이다. Background : Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. Materials and Methods : Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. Results : All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. Conclusion : This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms.

Erythromycin 내성 포도알균의 유도형 Macrolide-Lincosamide-Streptogramin B (MLS_(B)) 내성 표현형 빈도

김경희,박순호,박필환,안정열,서일혜 대한감염학회 2010 감염과 화학요법 Vol.42 No.3

Background: Inducible MLS_(B) (macrolide-lincosamide-streptogramin B) resistance in staphylococci is not detected by standard susceptibility test methods. Failure to identify inducible MLS_(B) resistance may lead to clinical failure during clindamycin therapy. We determined the prevalence of inducible MLS_(B) resistance in erythromycin-resistant staphylococcal isolates. Materials and Methods: We evaluated all 2,792 non-duplicate staphylococcal strains: 1,402 Staphylococcus aureus and 1,390 coagulase-negative staphylococci (CoNS) isolated from May 2008-June 2009 at one-unoversity hospital. Testing for inducible MLS_(B) was accomplished by the disk approximation test (D-test) in accordance with the recommendations of the Clinical and Laboratory Standards Institute (CLSI). Results: Of the 2,792 staphylococcal isolates, 892 S. aureus isolates and 740 CoNS isolates were resistant to erythromycin. Among the 892 erythromycin-resistant S. aureus isolates, the overall prevalence of inducible MLS_(B) was 21.3% (16.2% of MRSA and 76.3% of methicillin-susceptible S. aureus). Among the 740 erythromycinresistant CoNS isolates, the overall prevalence of inducible MLS_(B) was 16.5% (16.0% of methicillin-resistant CoNS and 18.7% of methicillin-susceptible CoNS). The D-test was positive in 88.8% of S. aureus and 28.4% of CoNS isolates, which were erythromycin-resistant and clindamycin-susceptible. Conclusions: There are some variations in the prevalence of inducible MLS_(B) resistance in clinical staphylococcal isolates. It is important that clinical laboratories report inducible MLS_(B) resistance for erythromycin-resistant and clindamycinsusceptible staphylococcal isolates.

중합효소연쇄반응을 이용한 Chlamydia trachomatis의 검출

서일혜(Yiel Hea Seo),최태열(Tae Yeal Choi) 大韓微生物學會 1995 大韓微生物學會誌 Vol.30 No.2

중합효소연쇄반응을 이용한 결핵성 림프절염의 진단

서일혜,김완,최태열 대한감염학회 1997 감염 Vol.29 No.3

목적: 결핵성 림프절염은 가장 흔한 폐외결핵질환 중의 하나이다. 진단은 임상소견 및 림프절 생검을 통한 항산성 도말염색, 결핵균 배양, 병리소견등으로 이루어지나 이들의 민감도가 낮아 진단에 어려움이 있다. 이에 저자는 림프절 세침흡인 검체를 이용해 중합효소연쇄반응을 시행하여, 결핵성 림프절염의 진단에 대한 이의 유용성을 평가해 보고자 하였다. 방법: 경부종물을 주소로 내원한 환자중 결핵성림프절염이 의심되었던 환자 50여명과 대조군으로 결핵성 림프절염이 배제되었던 10명을 대상으로 하였다. 림프절 세침흡인을 시행하여 검체를 얻었으며, phenol/chloroform법으로 DNA를 분리하였다. 그 다음 IS6110에 대한 시발체를 이용해 중합효소연쇄반응을 시행하였으며, 증폭산물은 겔 전기영동하에서 Ethidium bromide로 염색하여 관찰하였다. 결과: 임상적으로 결핵성 림프절염이 의심되었던 환자 50명중 45명에서 양성으로 나타났으며, 결핵성림프절염이 배제되었던 10명의 대조군중 1명에서 양성으로 나타났다. 따라서 중합효소연쇄반응의 민감도는 90%, 특이도도 90%로 나타났다. 중합효소연쇄반응의 검사 민감도는 결핵균 DNA 10fg까지 검출할 수 있었으며 이는 결핵균 약 2개에 해당하는 양이다. 결론: 림프절 세침흡인검체로 시행한 중합효소연쇄반응은 결핵성 림프절염의 진단에 매우 유용하게 이용될 수 있으리라 생각된다. Background: Tuberculous lymphadenitis is the commonest form of extrapulmonary tuberculosis. The laboratory diagnosis of tuberculous lymphadenitis is based on the traditional method of the acid-fast stain and culture of discharge or lymph node. However, acid-fast strain lack sensitivity and specificity, and culture is time-consuming. Polymerase chain reaction is a rapid, sensitive and specific DNA amplification technique for the detection of Mycobacterium tuberculosis in sputum, pleural fluid, cerebrospinal fluid, or others. We evaluate the sensitivity and specificity of the polymerase chain reaction assay for the rapid diagnosis of tuberculous lymphadenitis. Methods: the study included 50 patient with clinically suspected tuberculous lymphadenitis. We performed fine needle aspiration biopsies(FNAB) on head and neck lymph node. The DNA of the sample was purified by phenol/chloroform method. The nested PCR was performed with TB-CR kit(Bioneer, Korea), which a amplified a insertion sequence IS 6110 sequences. The PCR product was analysed by agarose gel electrophoresis in the presence of ethidium bromide. Results: Forty-five of the 50 clinically suspected specimens were PCR-positive, 5 specimens were negative. And one of the 10 negative specimens was positive. The sensitivity and specificity of the PCR was 90% and 90%, respectively. Conclusion: The polymerase chain reaction is a very sensitive and rapid method for rapid detection of M. tuberculosis in patient with tuberculous lymphadenitis.

CIN배지를 이용하여 분리한 Yersinia Species 4예

서일혜,최태열 대한임상병리학회 1992 대한임상병리학회지 Vol.12 No.3

Nonspecific esterase 양성의 소과립성 급성 전골수구성 백혈병 1예

서일혜,정화순,김신규 大韓血液學會 1991 大韓血液學會誌 Vol.26 No.2

다중 중합효소연쇄반응 및 제한효소 RFLP를 이용한 마이코박테리아의 동정

서일혜,김완,안정열,금동극 대한감염학회 1999 감염 Vol.31 No.2

Polymerase Chain Reaction-Restriction Fragment Length Polymorphism법을 이용한 Chlamydia trachomatis의 혈청형 분석 : Restriction fragment Length Polymorphism Analysis

서일혜,박필환,김완,김덕언,최태열 대한임상병리학회 2000 대한임상병리학회지 Vol.20 No.5

Performance of Copeptin for Early Diagnosis of Acute Myocardial Infarction in an Emergency Department Setting

정지훈,Yiel Hea Seo,Jeong Yeal Ahn,Kyung Hee Kim,Ja Young Seo,Ka Yeong Chun,Yong Su Lim,Pil Whan Park 대한진단검사의학회 2020 Annals of Laboratory Medicine Vol.40 No.1

Background: Rapid and accurate diagnosis of acute myocardial infarction (AMI) is critical for initiating effective treatment and achieving better prognosis. We investigated the performance of copeptin for early diagnosis of AMI, in comparison with creatine kinase myocardial band (CK-MB) and troponin I (TnI). Methods: We prospectively enrolled 271 patients presenting with chest pain (within six hours of onset), suggestive of acute coronary syndrome, at an emergency department (ED). Serum CK-MB, TnI, and copeptin levels were measured. The diagnostic performance of CK-MB, TnI, and copeptin, alone and in combination, for AMI was assessed by ROC curve analysis by comparing the area under the curve (AUC). Sensitivity, specificity, negative predictive value, and positive predictive value of each marker were obtained, and the characteristics of each marker were analyzed. Results: The patients were diagnosed as having ST elevation myocardial infarction (STEMI; N=43), non-ST elevation myocardial infarction (NSTEMI; N=25), unstable angina (N=78), or other diseases (N=125). AUC comparisons showed copeptin had significantly better diagnostic performance than TnI in patients with chest pain within two hours of onset (AMI: P =0.022, ≤1 hour; STEMI: P =0.017, ≤1 hour and P =0.010, ≤2 hours). In addition, TnI and copeptin in combination exhibited significantly better diagnostic performance than CK-MB plus TnI in AMI and STEMI patients. Conclusions: The combination of TnI and copeptin improves AMI diagnostic performance in patients with early-onset chest pain in an ED setting.