Impact of Early Positive Culture Results on the Short-term Outcomes of Liver Transplants / 대한이식학회지

BACKGROUND: Infection is a major cause of morbidity and mortality following liver transplants. We evaluated the risk factors of mortality within 1 month of liver transplantation caused by post-transplant infections. METHODS: We retrospectively reviewed the medical records of 199 patients who underwent liver transplants from September 2005 to August 2010. We divided the enrolled patients into 3 groups. The first group, the Culture(-) group, was defined as those who had no significant culture results. The second group, the Culture(+)/survival group, was defined as those who tested positive for culture but survived longer than 1 month after transplantation. The third group, the Culture(+)/mortality group, was defined as those who died within 1 month of the transplant with positive culture test results. RESULTS: The culture(+)/mortality group consisted of more deceased donor liver transplants than other groups. Also, the Culture(+)/mortality group showed more evidence of pre-transplant infections, intensive care unit (ICU) admission, continuous post-transplant renal replacement therapy (CRRT), and a higher MELD score than other groups. The risk factors of early mortality combined with infection 1 month after liver transplantation are hospitalization in ICU before transplantation (HR=16.3, CI=2.6~102.3, P=0.003) and the positive results of culture within 7 days of the operation (HR=38.7, CI=4.1~368.8, P=0.001). CONCLUSIONS: Hospitalization in ICU before transplantation and an early positive culture result can be an early clinical indicator of a good prognosis after liver transplantation.

Impact of Early Positive Culture Results on the Short-term Outcomes of Liver Transplants / 대한이식학회지

BACKGROUND: Infection is a major cause of morbidity and mortality following liver transplants. We evaluated the risk factors of mortality within 1 month of liver transplantation caused by post-transplant infections. METHODS: We retrospectively reviewed the medical records of 199 patients who underwent liver transplants from September 2005 to August 2010. We divided the enrolled patients into 3 groups. The first group, the Culture(-) group, was defined as those who had no significant culture results. The second group, the Culture(+)/survival group, was defined as those who tested positive for culture but survived longer than 1 month after transplantation. The third group, the Culture(+)/mortality group, was defined as those who died within 1 month of the transplant with positive culture test results. RESULTS: The culture(+)/mortality group consisted of more deceased donor liver transplants than other groups. Also, the Culture(+)/mortality group showed more evidence of pre-transplant infections, intensive care unit (ICU) admission, continuous post-transplant renal replacement therapy (CRRT), and a higher MELD score than other groups. The risk factors of early mortality combined with infection 1 month after liver transplantation are hospitalization in ICU before transplantation (HR=16.3, CI=2.6~102.3, P=0.003) and the positive results of culture within 7 days of the operation (HR=38.7, CI=4.1~368.8, P=0.001). CONCLUSIONS: Hospitalization in ICU before transplantation and an early positive culture result can be an early clinical indicator of a good prognosis after liver transplantation.

Serotype and Antimicrobial Susceptibility of Streptococcus pneumoniae / 감염과화학요법

BACKGROUND: Pneumococcus is the most common cause of acute otitis media, community acquired pneumonia and invasive bacterial diseases in children. Ninety serotypes have been identified, and the distribution differs according to geographic area and ages. The 7 valent pneumococcal protein conjugate vaccine is used widely. To evaluate the efficacy of the vaccine, it is essential to investigate the distribution of the pneumococcal serotypes. MATERIALS AND METHODS: The serotypes and antibiotic resistance of the pneumococcus isolated from 308 patients at Shinchon Severance hospital from September of 2001 to July of 2005 were analyzed. RESULTS: The pneumococcci were isolated mostly from sputum and blood, and ear discharge in the descending order. Serotyping was possible in 265 cases, and the distribution of serotypes were 19F (16.2%), 19A (12.8%), 23F (8.7%), 6B (7.9%), and 6A (7.2%). Fifty two cases were isolated from those patients less than 16 years of age and the distribution of serotypes was 19F, 19A, 23F, 14, 6B, 6A and 4. Resistance to penicillin was 64.6% in all cases and 67.3% in children. The more common serotype showed the higher rate of penicillin resistance. Multi-drug resistance was demonstrated in 64.7%. Forty three percent of the total identified serotypes were included in the 7 valent pneumococcal conjugate vaccine. And 61.5% of the serotypes identified in children were included in the vaccine. CONCLUSION: The 7 valent vaccine may be used effetively in Korea. But, further study is needed to address serotype switching after the use of the protein conjugated vaccine, which has been reported in other countries.

Serotype and Antimicrobial Susceptibility of Streptococcus pneumoniae / 감염과화학요법

BACKGROUND: Pneumococcus is the most common cause of acute otitis media, community acquired pneumonia and invasive bacterial diseases in children. Ninety serotypes have been identified, and the distribution differs according to geographic area and ages. The 7 valent pneumococcal protein conjugate vaccine is used widely. To evaluate the efficacy of the vaccine, it is essential to investigate the distribution of the pneumococcal serotypes. MATERIALS AND METHODS: The serotypes and antibiotic resistance of the pneumococcus isolated from 308 patients at Shinchon Severance hospital from September of 2001 to July of 2005 were analyzed. RESULTS: The pneumococcci were isolated mostly from sputum and blood, and ear discharge in the descending order. Serotyping was possible in 265 cases, and the distribution of serotypes were 19F (16.2%), 19A (12.8%), 23F (8.7%), 6B (7.9%), and 6A (7.2%). Fifty two cases were isolated from those patients less than 16 years of age and the distribution of serotypes was 19F, 19A, 23F, 14, 6B, 6A and 4. Resistance to penicillin was 64.6% in all cases and 67.3% in children. The more common serotype showed the higher rate of penicillin resistance. Multi-drug resistance was demonstrated in 64.7%. Forty three percent of the total identified serotypes were included in the 7 valent pneumococcal conjugate vaccine. And 61.5% of the serotypes identified in children were included in the vaccine. CONCLUSION: The 7 valent vaccine may be used effetively in Korea. But, further study is needed to address serotype switching after the use of the protein conjugated vaccine, which has been reported in other countries.

Listeria monocytogenes Bacteremia in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

We report a 43-year old woman of Listeria monocytogenes bacteremia associated with systemic lupus erythematosus (SLE). She had been treated with glucocorticoid pulse therapies and a cyclophosphamide pulse therapy for relapsed lupus nephritis class IV. After the immunosuppressive treatment, she complained of fever, vomiting, diarrhea, and abdominal pain. Diffuse edematous thickening of bowel wall was seen on abdominal CT scan and Listeria monocytogenes was identified on blood culture study. After antibiotic therapy that lasted for more than 4 weeks, her presenting symptoms were resolved and no more Listeria monocytogenes was identified on follow-up culture studies. Infection with Listeria monocytogenes, a rare food-borne illness, can be life-threatening with high fatality rates and is known to occur more frequently in immunocompromised patients, including those receiving high-dose glucocorticoid or immunosuppressive therapy for collagen vascular disease. In Korea, a case of Listeria meningitis was reported, but a case of bacteremia caused by Listeria monocytogenes enteritis has never been reported in SLE patients. Thus, we report a case of Listeria monocytogenes bacteremia that occurred due to food poisoning after aggressive immunosuppressive treatment in a patient with SLE.

Dissemination of CTX-M Type Extended-Spectrum beta-Lactamases and Emergence of CTX-M-12 in Escherichia coli / 대한진단검사의학회지

BACKGROUND: Clinical isolates of Escherichia coli were evaluated to determine the prevalence and genotypes of Ambler class A extended-spectrum beta -lactamases (ESBLs). METHODS: Clinical isolates of E. coli were collected from 12 hospitals from February through July, 2004. Antimicrobial susceptibility was tested by disk diffusion and agar dilution methods, and ESBLproduction was determined by double-disk synergy test. TEM, SHV, CTX-M, PER-1, VEB, IBC, GES, and TLA type ESBL genes were detected by PCR amplifications, and the PCR products were subjected to direct sequencing. RESULTS: The double-disk synergy test was positive in 90.9% (149 in 164) of the ceftazidime- or cefotaxime-resistant E. coli isolates. The most prevalent types of Ambler class A ESBLs in E. coliisolates were CTX-M-15 (n=53). CTX-M-14 (n=24), CTX-M-3 (n=9), CTX-M-9 (n=3), CTX-M-12 (n=3), SHV-2a (n=1), SHV-12 (n=5) and TEM-52 (n=3) were also found. CTX-M-12 ESBL had never been reported before in Korea. CONCLUSIONS: CTX-M type ESBL-producing E. coli isolates are spreading and CTX-M-12 is emerging in Korea.

Annual Report on External Quality Assessment of Clinical Microbiology Laboratory in Korea (2003) / 임상검사와정도관리

Three trials of external quality assessment for clinical microbiology laboratory and two workshops were performed in 2003. A total of 19 specimens were distributed. Six specimens were distributed to 241 laboratories with 231 returns in Trial I, Five specimens to 241 laboratories with 225 returns in Trial II, and seven specimens to 245 laboratories with 220 returns in Trial III. The percentages of fully correct results of E. coli, E. faecalis, S. aureus, P. aeruginosa, K. pneumoniae, Candida albicans, P. aeruginosa, S. aureus, E. faecalis, K. pneumoniae, E. coli, and Candida tropicalis were 99%, 83%, 99%, 89%, 97%, 92%, 90%, 98%, 83%, 90%, 99%, and 63%, respectively. The standard deviation (SD) of inhibition zone diameter against each antibiotic was calculated. The within-one-SD percentages on disk diffusion test against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0301) were 86%, 78%, 86%, 91%, and 76%, respectively. Those against vancomycin and teicoplanin of E. faecalis (M0302) were 77% and 95%, respectively. Those against vancomycin, oxacillin, penicillin G, clindamycin, erythromycin, ciprofloxacin, gentamicin and teicoplanin of S. aureus (M0303) were 82%, 80%, 81%, 81%, 79%, 80%, 88%, and 90%, respectively. Those against ciprofloxacin, gentamicin, imipenem, ceftazidime, and piperacillin of P. aeruginosa (M0304) were 73%, 88%, 85%, 83%, and 78%, respectively. Those against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0305) were 89%, 89%, 87%, 81% and 86%, respectively. Thirty-five laboratories on Trial I and Trial II had reported the both results of disk diffusion and MIC methods. Seven laboratories use disk diffusion method or MIC method according to the bacterial species. The performance on the automated or E-test susceptibility tests was generally good. In conclusion, it is necessary that the quality assurance of the individual laboratories should be improved in the identification of Candida tropicalis and Enterococcus spp., and in susceptibility tests against oxacillin, erythromycin and ciprofloxacin of S. aureus, and cephalothin and imipenem of E. coli and vancomycin of E. faecalis in case of disk diffusion method.

Evaluation of a Spectrophotometric Broth Microdilution Method for Determining Fluconazole Susceptibility of Candida albicans: Influence of RPMI and RPMI-2% Glucose on the Selection of Endpoint Criteria / 대한진단검사의학회지

BACKGROUND: Minimum inhibitory concentration (MIC) endpoint determination is the major varia-tion source for the fluconazole susceptibility test, especially for Candida albicans. In this study, we evaluated spectrophotometric broth microdilution methods using RPMI 1640 and RPMI supple-mented with 18 g of glucose per liter (RPMI-2% glucose) for determining fluconazole susceptibility of C. albicans. METHODS: A total of 129 clinical isolates of C. albicans were tested by the broth microdilution method using RPMI and RPMI-2% glucose. The MIC endpoint was calculated objectively with the spectrophotometer set at 405 nm. These results were compared to those by the National Commit-tee for Clinical Laboratory Standards (NCCLS) macrodilution method and the agar dilution method. RESULTS: The mean absorbances in the drug-free wells in RPMI and RPMI-2% glucose were 0.208 +/- 0.014 and 0.316 +/- 0.061, respectively, at 24 h and 0.339 +/- 0.094 and 0.530 +/- 0.104, respectively, at 48 h (P < 0.01). The agreement of the microdilution method with the RPMI within two doubling dilutions of the macrodilution reference were 91.5% (118/129) at 24 h and 76.7% (99/129) at 48 h. The percentage of agreement in the microdilution method with the RPMI-2% glucose were significantly higher: 100% (129/129) at 24 h and 99.2% (128/129) at 48 h (P < 0.01). In addition, the MIC endpoints were easier to detect in RPMI-2% glucose, because of the greater difference in absorbance in between grown wells and fluconazole-inhibited wells (P < 0.01). CONCLUSIONS: The spectrophotometric microdilution method with RPMI-2% glucose may have an excellent agreement with the NCCLS broth macrodilution method and may provide more easily determined MIC endpoints for fluconazole susceptibility testing for C. albicans.

Evaluation of the TSH, Free Triiodothyronine, Free Thyroxine and Estradiol Test of the Vitros ECi(R) Immunodiagnostic System / 대한임상병리학회지

BACKGROUND: The analytical performance of the Vitros ECi(R) Immunodiagnostic System on the thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4) and estradiol (E2) assays, which are based on electrochemical luminescence to replace the radioimmunoassay was evaluated. METHODS: The precision as measured by the NCCLS protocol and a comparison of the method were done for each TSH, FT3, FT4, and E2 assay. The functional sensitivity and linearity tests were performed for both TSH and E2. The free hormone validity test was performed for both the FT3 and FT4. RESULTS: All four analytes showed an acceptable precision. The functional sensitivities of TSH and E2 were 0.007 mIU/L, and 87 pmol/L, respectively. TSH and E2 showed excellent linearity up to 78 mIU/mL, and up to 7,700 pmol/L, respectively. The free hormone validity test showed acceptable results demonstrating accurate free hormone determination. The E2 showed a significant proportion-al bias requiring an adjustment of the reference range, However, the other analytes showed good agreement with a slight proportional bias. CONCLUSIONS: The TSH, FT3, FT4, and E2 assay by Vitros ECi(R) exhibited excellent performance overcoming the drawbacks of a conventional radioimmunoassay.

In vitro Activity of Gemifloxacin Against Recent Clinical Isolates of Bacteria in Korea

Gemifloxacin is an enhanced-affinity fluoroquinolone with broad-spectrum antibacterial activity. In Korea, resistant bacteria are relatively more prevalent than in other industrialized countries. In this study, we studied the in vitro activities of gemifloxacin, gatifloxacin, moxifloxacin, levofloxacin, ciprofloxacin, and other commonly used antimicrobial agents against 1,689 bacterial strains isolated at four Korean university hospitals during 1999-2000. Minimum inhibitory concentrations (MICs) were determined using the agar dilution method of National Committee for Clinical Laboratory Standards. Gemifloxacin had the lowest MICs for the respiratory pathogens: 90% of Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae were inhibited by 0.06, 0.03, and 0.03 mg/L, respectively. Gemifloxacin was more active than the other fluoroquinolones against methicillin-susceptible Staphylococcus aureus, coagulase-negative staphylococci, streptococci, and Enterococcus faecalis. The MIC90s of gemifloxacin for Klebsiella oxytoca, Proteus vulgaris, and nontyphoidal Salmonella spp. were 0.25, 1.0, and 0.12 mg/L, respectively, while those for other Gram-negative bacilli were 4-64 mg/L. In conclusion, gemifloxacin was the most active among the comparative agents against Gram-positive species, including respiratory pathogens isolated in Korea.

Detection of Campylobacter jejuni by Multiplex PCR and Patterns of Pulsed-Field Gel Electrophoresis / 대한임상미생물학회지

BACKGROUND: Campylobacter is the most common bacterial cause of food-borne infection in developed countries, and handling or eating of contaminated poultry products was reported as the major cause of human campylobacteriosis in sporadic cases. This study was performed to investigate the prevalence of Campylobacter in patients with diarrhea and raw chickens of grocery, and identify the species by multiplex PCR and determine the genotypes of isolates by SmaI pulsedfield gel electrophoresis(PFGE) profiles. METHODS: Eight hundred and fifty six stool specimens obtained from 773 hospitalized patients with diarrhea and 16 raw chickens purchased from grocery were tested. Karmali's charcoal based selective medium and Campylobacter enrichment broth were used for isolation of Campylobacter from patients and chicken, respectively. And membrane filter method with sheep blood agar was also used in both two cases. Isolates were indentified with PCR, PCR-RFLP, and biochemical test. And genotypes were determined with SmaI PFGE profile analysis. RESULTS: A total of 13 Campylobacter strains(1.7%) were isolated from 856 stool specimens of 773 patients with diarrhea, nine isolates were C. jejuni and four were C. coli. All of 16 raw chickens were contaminated with Campylobacter spp., and both of C. jejuni and C. coli were detected from eight chickens. From the SmaI-digested PFGE profile analysis of nine C. jejuni strains and four C. coli strains isolated from patients, eight types and four types of PFGE profile were obtained, respectively. And 15 types and seven types of PFGE profile were obtained from 23 of C. jejuni and 11 of C. coli which strains were isolated from chicken samples, respectively. The several isolates showing the different PFGE patterns were detected in the same chicken. Three PFGE patterns of C. jejuni isolated from patients were observed in the chickens. One type of C. coli PFGE profiles of the patient's isolates were the same as that of chicken. CONCLUSIONS: The prevalence of Campylobacter infection is not high compared to the other countries, but most of raw chickens are contaminated with Campylobacter spp. Several genotypes of C. jejuni and C. coli are contaminated in the single chicken. The PFGE patterns of some human isolates are the same as those of chicken so that human infection may be originated from the chicken. But the reason of low infection rate in human in spite of the very high contamination rate of chicken should be clarified in the near future

Evaluation of Spectrophotometric Broth Microdilution Method to Determine the Fluconazole MIC of the Candida Species / 대한진단검사의학회지

BACKGROUND: Although the broth microdilution method has been recently established for antifungal susceptibility testing of the Candida species, there is still an argue in the interpretation of the trailing endpoint. We evaluated the spectrophotometric broth microdilution method (SBM) to determine the fluconazole MICs from five different Candida species. METHODS: A total of 252 clinical isolates of five Candida species (144 C. albicans, 42 C. tropicalis, 32 C. glabrata, 28 C. parapsilosis, and 6 C. krusei) were tested for fluconazole susceptibility with the broth microdilution method. The MICs were spectrophotometrically determined at 80% (Spec-80%) and 50% (Spec-50%) decrease in absorbance as compared with growth control, respectively. The results were compared with the fluconazole MICs tested by the National Committee for the Clinical Laboratory Standards (NCCLS) macrodilution method. RESULTS: When MICs were obtained by Spec-80%, the agreements of SBM and the NCCLS macro dilution method within two doubling dilutions were 92.4% (220/238) at 24 h and 78.6% (198/252) at 48 h for all Candida species. Using the Spec-50%, those were increased to 97.9% (233/238) at 24 h and 98.8% (249/252) at 48 h (P<0.01). Especially, for C. albicans and C. tropicalis, the agreement of the Spec-50% was significantly higher than those of the Spec-80% at 48 h; 97.9% vs. 75.0%, for C. albicans (P<0.01), and 100% vs. 57.1%, for C. tropicalis (P<0.01). CONCLUSIONS: These data suggest that the SBM using Spec-50% can provide a more precise and objective mean for fluconazole susceptibility testing, especially for C. albicans and C. tropicalis.

Effect of Coexistence of Antimicrobial-susceptible Gram-negative Bacilli on the Resistant Gram-negative Bacilliin the Absence of Antimicrobial Agents / 감염

BACKGROUND: Carrying antimicrobial resistance genes is a burden to bacteria. Therefore, in the absence of antimicrobial selective pressure, susceptible bacteria are expected to replace resistant ones. The cost was reported to decrease with time, but the effect of different species of susceptible bacteria on extended-spectrum -lactamase (ESBL)-, AmpC beta-lactamase-, and VIM-2 metallo-beta-lactamase-producing gram-negative bacilli are not known. The aim of this study was to determine the effect in vitro. METHODS: Antimicrobial-susceptible and -resistant strains of Escherichia coli, Enterobacter aerogenes, Klebsiella p neumoniae, and Acinetobacter baumannii were subcultured daily in glucose limited minimal salt medium at 30degrees C and 37degrees C, and the numbers of cells (CFU/mL) were determined by culturing on Mueller-Hinton agar and MacConkey agar plates. RESULTS: Continued incubation without subculture of both individual and mixed cultures at 37degrees C showed higher counts of a ESBL-producing K. p neumoniae than a susceptible E. coli. Daily subcultures of two strains in a tube showed the counts were : ESBL-producing K. pneumoniae >susceptible E. coli; susceptible E. aerogenes >ESBL-producing K. p neumoniae; susceptible E. aerogenes >VIM-2-beta-lactamase-producing Acinetobacter baumannii. The counts were similar for susceptible K. p neumoniae and AmpC beta-lactamasehyperproducing E. aerogenes. Initial low count of a susceptible E. coli and an ESBL-producing K. p neumoniae at 30degrees C gradually increased with continued subculture. CONCLUSION: Growth of not all resistant bacteria are slower and the growth improves with continued subculture. Coexistence of a susceptible bacteria with resistant bacteria in GLMS medium both at 30degrees C and 37degrees C does not reduce the number of resistant bacteria.

Isolation Trend of Enterobacter, Citrobacter, and Serratia for the Recent Five Years and Antimicrobial Susceptibility of Derepressed AmpC beta-lactamase Producing Strains / 감염

BACKGROUND: Derepressed AmpC beta-lactamase producing Enterobacter cloacae, Citrobacter f reundii, and Serratia marcescens are important nosocomial pathogens and the infections are difficult to treat, because they are multi-drug resistant. The aim of this study was to determine the isolation rate and trend, and antimicrobial susceptibility of derepressed strains isolated from clinical specimens. METHODS: E. cloacae, S. marcescens, and C. f reundii isolated from 1996 through 2000 were enrolled in the study. Antimicrobial susceptibility was tested by NCCLS disk diffusion method. Derepressed strain was defined as strain non-susceptible to third generation cephalosporin. The isolation patterns of important gram-negative bacilli with the derepressed strains were analyzed with respect to years, patient's locations and specimens. RESULTS: Among the clinical isolates, the derepressed strains of E. cloacae, S. marcescens, and C. f reundii were 65%, 70%, and 56%. The proportion of the derepressed strains : E. cloacae increased from 68% in 1996 to 71% in 1998, however, decreased to 59% in 2000, S. marcescens increased from 68% in 1996 to 73% in 2000, C. f reundii decreased from 69% in 1996 to 41% in 2000. The proportion of the derepressed strains were high among the isolates from blood and respiratory specimens of inpatient and intensive care patient. The resistance rates of the depressed strains were 47~62% to third generation cephalosporin and aztreonam, 15~85% to aminoglycoside, 68% to cotrimoxazole, and 31% to levofloxacin. CONCLUSION: Among the clinical isolates of E. cloacae, S. marcescens, and C. f reundii, the derepressed strains were as high as 56~70%, and they were commonly isolated from blood and sputum specimens of inpatient and intensive care patient, and showed high resistance rates to the most antimicrobial agents.

Detection of Vancomycin Heteroresistant Staphylococcus aureus Using Mu-3 Agar / 감염

BACKGROUND: The aim of the study was to determine prevalence of potential heterogeneous vancomycin-resistant Staphylococcus aureus (h-VRSA) among methicillin-resistant S. aureus (MRSA) isolated in Korea by using Mu-3 agar and to determine the effect of in vitro vancomycin exposure on the resistance. METHODS: MRSAs isolated in 1980-1999 were screened for the presence of VISA or h-VRSA using Mu-3 agar. MIC of vancomycin was tested by NCCLS agar dilution and broth microdilution tests. Suspected h-VRSA were selected by vancomycin-containing media and change of resistance was determined by population analysis. A strain with Mu50 type growth was serially exposed to 8 pg/ml of vancomycin containing media and change of the vancomycin resistance was determined. RESULTS: Among the 455 MRSA isolates, 18 (3.9 %) grew on selective brain heart infusion agar (BHIA), and 354 (77,8%) on Mu-3 agar, 66 (14.5%) with Mu3 type growth and 78 (17.1%) with Mu50 type growth. MIC of vancomycin was 11 pg/ml for some of the isolates when inocula were approximately 10' CFU, but VISA was not present when tested by NCCLS broth microdilution test. Exposure of the isolates to van-cornycin raised the MIC. Serial exposure once to 8 pg/ml of vancomycin resulted in significant decrease of cells susceptible to 8-12 pg/ml of vancomycin. CONCLUSION: VISA was not present among the test isolates, but 34.2% were suspected to be potential h-VRSAs, suggesting possible emergence of VISA if vancomycin was administered prolonged period. It is considered that suitable screening media are vancomycin containing BHIA for VISA and Mu-3 agar for h-VRSA. The isolates showing Mu50 type growth on Mu-3 agar are not always VISA, but rather h-VRSA.

Production and Assessment of Goat Antihuman Globulin Reagent / 대한수혈학회지

BACKGROUND: Since the 1960 s rabbit antihuman globulin reagent has been used widely. Recently most conjugate of enzyme immunoassay is produced from goat, and precise purification method is developed. Therefore we evaluated the commercial value of the goat antihuman globulin as a blood bank test reagent. METHODS: The human IgG was purified by protein-A gel, and injected into goat. The goat antihuman globulin was coupled by CNBr activated sepharose 4B-gel and purified by 0.2M glycine elution buffer. For verification of this reagent, commercial reagents(Ortho rabbit reagent & DiaMed Gel test) were used. RESULTS: The minimal concentration for detecting antibody of goat reagent was 9 ng/mL. The results of direct antiglobulin tests, with 400 samples collected from donated blood in CPDA-1, were all negative(false positive rate: 0%). With 613 samples collected from inpatients of Severance Hospital, the results were positive in 35 patients(positive rate:5.7%), and those results were in complete agreement with commercial reagent(concordance rate: Goat vs. Ortho :99.8%, Goat vs. DiaMed :98.4%). And with 30 samples of artificially prepared complement-coated RBC, the results were all negative. Indirect antiglobulin test showed higher agglutination score than commercial reagents. CONCLUSIONS: Goat reagent showed high sensitivity and specificity in comparison with rabbit reagent. Because false positive reaction was not observed in negative control samples, the heterophil agglutinin reaction, which was the major problem when the reagent was initially developed, might be excluded. In conclusion, goat reagent seems to be more economical than rabbit reagent because the former can be obtained in a large quantity and of high potency.

A case of autoimmune hemolytic anemia due to autoanti-Ce / 대한수혈학회지

A 12-year-old female with histiocytosis X accompanied by autoimmune hemolytic anemia. During the episode of hemolysis, the hemoglobin level fell to 5.2 g/dL. The direct antiglobulin test was weakly positive. The anti-C and anti-e were identified in her serum. The Rh subgroup of her family(father, mother and brother) including the patient, were all same as DCe. The antibodies which showed anti-C and anti-e specificity were confirmed autoanti-Ce(non-separable) using the serum absorbed with various known Rh phenotyped RBCs. Two packed RBCs phenotyped as DeE were transfused for correction of anemia. Acute and delayed hemolytic transfusion reactions were not noted after transfusion. Identification of blood group specific autoantibodies may be benificial in such case for blood transfusion.