Serotype Distribution and Antimicrobial Resistance of Invasive and Noninvasive Streptococcus pneumoniae Isolates in Korea between 2014 and 2016

BACKGROUND: Several factors contribute to differences in Streptococcus pneumoniae serotype distribution. We investigated the serotype distribution and antimicrobial resistance of S. pneumoniae isolated between 2014 and 2016 in Korea. METHODS: We collected a total of 1,855 S. pneumoniae isolates from 44 hospitals between May 2014 and May 2016, and analyzed the serotypes by sequential multiplex PCR. We investigated the distribution of each serotype by patient age, source of the clinical specimen, and antimicrobial resistance pattern. RESULTS: The most common serotypes were 11A (10.1%), followed by 19A (8.8%), 3 (8.5%), 34 (8.1%), 23A (7.3%), and 35B (6.2%). The major invasive serotypes were 3 (12.6%), 19A (7.8%), 34 (7.8%), 10A (6.8%), and 11A (6.8%). Serotypes 10A, 15B, 19A, and 12F were more common in patients ≤5 years old, while serotype 3 was more common in patients ≥65 years old compared with the other age groups. The coverage rates of pneumococcal conjugate vaccine (PCV)7, PCV10, PCV13, and pneumococcal polysaccharide vaccine 23 were 11.8%, 12.12%, 33.3%, and 53.6%, respectively. Of the 1,855 isolates, 857 (46.2%) were multi-drug resistant (MDR), with serotypes 11A and 19A predominant among the MDR strains. The resistance rates against penicillin, cefotaxime, and levofloxacin were 22.8%, 12.5%, and 9.4%, respectively. CONCLUSIONS: There were significant changes in the major S. pneumoniae serotypes in the community. Non-PCV13 serotypes increased in patients ≤5 years old following the introduction of national immunization programs with the 10- and 13-polyvalent vaccines.

A Case of Catabacter hongkongensis and Alistipes indistinctus Isolated from Blood Cultures of a Patient with Acute Appendicitis

Catabacter hongkongensis is an anaerobic gram-positive coccobacillus that was first isolated in Hong Kong. It is infectious and causes high mortality in patients with rare but underlying diseases. Alistipes indistinctus is an anaerobic gram-negative coccobacillus. This bacterium is a common member of the human intestinal microbiota. We report a case of C. hongkongensis and A. indistinctus isolated from blood cultures of a patient with acute appendicitis. A 35-year-old female patient with no specific medical history was admitted to the hospital due to abdominal pain, vomiting, nausea, and diarrhea experienced on the day before admission. On admission, laboratory tests revealed leukocytosis, neutropenia, and elevated C–reactive protein and procalcitonin levels. Following an abdominal computed tomography showing acute appendicitis with suspected perforation, emergency surgery was performed. Growth was observed in two anaerobic blood culture bottles after four days. After further culturing of the bacteria on Brucella Blood Agar, two types of bacteria were obtained. The two bacterial isolates, one gram-positive and one gram-negative, were unable to be identified using matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Thus, 16S rRNA gene sequence analysis was performed, resulting in identification of the bacteria as C. hongkongensis and A. indistinctus. The patient was administered antibiotics and discharged two days after surgery. Although MALDI-TOF MS enables fast and accurate identification of bacteria, C. hongkongensis and A. indistinctus were not listed in the spectral library, and 16S rRNA gene sequence analysis was useful for identifying the two bacteria.

Performance Evaluation of Two Immunochromatographic Assays for Rotavirus Detection in Stool Specimens

BACKGROUND: Rotavirus is a major pathogen causing enteritis worldwide in children under five years of age. In recent years, immunochromatographic assay (ICA) has been widely used as a diagnostic test for rotavirus detection. This study aimed to compare and evaluate the performance of ICA-based rotavirus rapid test kits from two manufacturers. METHODS: Residual stool samples from a total of 130 children with acute enterocolitis from November 2017 to January 2018 were used. We compared the results of the two immunochromatographic methods (SD BIOLINE Rotavirus kit and GENEDIA Rotavirus Ag Rapid Test) with those of the currently used enzyme immunoassay method. RESULTS: Positive agreement, negative agreement, and total agreement rates between the SD BIOLINE rotavirus kit and the enzyme immunoassay were 98.0%, 100%, and 99.2%, respectively. Positive agreement, negative agreement, and total agreement rates between the GENEDIA Rotavirus Ag Rapid Test and the enzyme immunoassay were 96.0%, 100%, and 98.4%, respectively. CONCLUSIONS: Both rotavirus rapid test kits showed very good agreement with the conventional enzyme immunoassay. Therefore, it could be a useful test to detect rotavirus directly from stool samples in a short time.

Association between Sleep Duration and Prevalence of Dyslipidemia in Korean Adults: The Sixth Korean National Health and Nutrition Examination Survey

BACKGROUND: This study was performed to evaluate the correlation between sleep duration and the prevalence of dyslipidemia in Korean adults.METHODS: Among the 18,034 adults who participated in the 6th Korean National Health and Nutrition Examination Survey, 3,020 adults with missing values were excluded, and 15,014 adults were enrolled in our study. The association between sleep duration and the prevalence of dyslipidemia was analyzed by multiple logistic regression. We controlled for factors including sex, age, body mass index, smoking, drinking, diabetes mellitus, hypertension, walking exercise, muscular exercise, and stress.RESULTS: After adjusting for sex, age, body mass index, smoking, drinking, diabetes mellitus, hypertension, walking, muscular exercise, and stress in a multiple logistic regression analysis, sleep duration was associated with the prevalence of dyslipidemia. The group who slept for less than 7 hours per night had a higher prevalence of dyslipidemia than the group who slept for between 7 and 9 hours per night.CONCLUSION: In this study, a shorter sleep duration was associated with a higher prevalence of dyslipidemia.

Five Cases of the Gram Variable Bacterium Paenibacillus urinalis Isolated from Clinical Specimens and its Clinical Significance

Paenibacillus urinalis was first isolated from the urine of a woman in 2008, and was reported to be a contaminant. Here, we report 5 cases of P. urinalis isolated over 5 months at a tertiary hospital. Using an API kit, 4 cases were classified as Cellulomonas species. Owing to the low reliability of API kit results and Gram stain results indicating gram variable bacilli for few specimens, MALDI-TOF MS and 16S rRNA gene sequencing were performed for identification. The last case showed Gram variable bacilli, and therefore, based on previous experience, 16S rRNA gene base sequence analysis was carried out without an additional API kit. All isolated strains were confirmed to be P. urinalis, and were judged to be contaminants. As for Gram variable bacteria, the use of current biochemical identification systems may lead to misidentification as other bacteria, which may cause unnecessary or improper use of antibiotics. Moreover, whereas most of the Paenibacillus species are reported to be contaminants, some of them are being reported as sources of infection. Therefore, more accurate identification will be necessary in the future. Accordingly, it is expected that accurate identification of this genus will help clinical physicians make decisions regarding appropriate treatment and use of antibiotics.

An Effective Method of RNA Extraction from Mycobacterium tuberculosis / 대한임상미생물학회지

In the RNA-based study, it is important to extract high-quality RNA. However, RNA extraction from Mycobacterium tuberculosis is problematic due to its thick, waxy cell wall rich in mycolic acid, which renders the cells resistant to lysis. Using TRIzol reagent and several powerful bead-beating steps, a high quantity of RNA was obtained.

Peritonitis Caused by Internal Migration of the Percutaneous Transhepatic Biliary Drainage Catheter / 대한췌담도학회지

Percutaneous transhepatic biliary drainage (PTBD) is a modality that is used to decompress obstructive jaundice due to impacted stones, benign stricture or cancer. The PTBD catheter is removed percutaneously after the restoration of internal biliary drainage. We experienced a case of a 62-year-old man with peritonitis due to the migration of the PTBD catheter into the peritoneal cavity; we successfully removed it using peroral endoscopy. Although rare, the PTBD catheter may migrate into the peritoneal cavity during the removal of it. In these cases, clinicians should consider the peroral endoscopic removal of the PTBD catheter.

A study on establishing a technical safety assessment system for the Korean telemedicine system

Telemedicine is a critical infrastructure that directly affects people's lives. In this vein, the government announcement of the introduction of a telemedicine service has caused controversy among the government and medical institutions over the safety of the service. Before the introduction of the telemedicine service, its technical safety and effectiveness should be validated. The telemedicine system should be supported by proper policies to ensure a secure, continuous service. To this end, we have conducted research to derive the security requirements from domestic and foreign standards and laws relating to telemedicine and information security. Based on the derived requirements, we have developed a security standard for telemedicine that facilitates the objective assessment of the security of the telemedicine service. Furthermore, we have analyzed the vulnerabilities of telemedicine devices through penetration tests. Finally, using a risk analysis method, we have created risk scenarios that might occur in the provision of telemedicine services, and have calculated risk levels and expected loss for each scenario. We expect that the results of this research will be a basis for ensuring a sufficient budget and staff for the safety of telemedicine, and for establishing relevant policies.

A Novel Case of Extreme Thrombocytosis in Acute Myeloid Leukemia Associated With Isochromosome 17q and Copy Neutral Loss of Heterozygosity

No abstract available.

Possibility of Frequent Detection of Invasive Cyberlindera fabianii Infection Using Molecular Method / 대한임상미생물학회지

A case of fungemia caused by Cyberlindera fabianii was reported in the September issue of Annals of Clinical Microbiology. The C. fabianii that causes rare invasive infection can easily be misidentified as Candida utilis by Vitek-2 YST ID (bioMerieux, USA) and as Candida pelliculosa by API kit (bioMerieux, USA) with high probability. Recently, we also experienced a case of fungemia caused by C. fabianii that was misidentified as C. pelliculosa using API 20C Aux (bioMerieux, USA). As molecular identification is becoming more widespread, cases of C. fabianii infection are expected to be more frequently identified.

Central Venous Catheter-Related Bloodstream Infection by Corynebacterium striatum Identified by 16S rRNA and rpoB Gene Sequencing

No abstract available.

Primary Anti-D Alloimmunization Induced by "Asian Type" RHD (c.1227G>A) DEL Red Cell Transfusion

No abstract available.

Disseminated Gonococcal Infection Presenting as Bacteremia and Liver Abscesses in a Healthy Adult

Herein, we describe a bacteremia caused by Neisseria gonorrhoeae that presented as liver abscesses. The patient had no risk factors for disseminated gonococcal infection. Periodic fever, skin rashes, and papules were present and the results of an abdominal computed tomography scan indicated the presence of small liver abscesses. The results of blood culture and 16S rRNA sequencing of the bacterial isolates confirmed the presence of N. gonorrhoeae. The patient improved with antibiotic therapy.

A Case of Ceftazidime-Nonsusceptible Burkholderia pseudomallei Infection

Melioidosis, which is an infectious disease caused by Burkholderia pseudomallei, is prevalent mostly in Southeast Asia and northern Australia; it can progress to abscess formation, pneumonia and sepsis, and ultimately cause death. A 66-yr-old male patient with diabetes mellitus was hospitalized for sepsis 3 months after coming back from Cambodia, and B. pseudomallei was identified from the blood culture. The B. pseudomallei strain was found to be susceptible to carbapenem, and non-susceptible to trimethoprim/sulfamethoxazole and ceftazidime. Although the patient was treated with carbapenem, to which the strain was susceptible, the bacteremia persisted, and progressed to septic shock and pneumonia, and eventually to acute respiratory distress syndrome (ARDS). The patient died on the 12th day of hospitalization. This study, which reports the first case of ceftazidime-nonsusceptible B. pseudomallei in Korea, indicates the importance of B. pseudomallei infection, which is highly likely to be imported to Korea, and discuss its clinical progress, which can lead to fatality.

Trends in Bloodstream Infections at a Korean University Hospital between 2008 and 2013 / 대한임상미생물학회지

BACKGROUND: Blood culture remains the definitive method for diagnosing bacteremia and fungemia. In this study, we investigated the incidence of bacterial and fungal infections along with the trends in antimicrobial susceptibility in blood cultures collected from 2008 to 2013. METHODS: We performed a retrospective analysis of blood cultures performed at Kyung Hee University Hospital, Seoul, South Korea, between 2008 and 2013 to determine the bacterial and fungal species isolated, and their antimicrobial susceptibilities. Additional analyses were performed comparing these results to that of a prior study examining blood cultures collected from 2003-2007. RESULTS: Of the 102,257 specimens collected, 8,452 (8.3%) were culture positive, with Staphylococcus epidermidis being the most common species isolated (17.3%), followed by Escherichia coli (16.9%), Staphylococcus aureus (8.1%), and Klebsiella pneumoniae (6.5%). Fungal species accounted for 3.7% of all isolates. Methicillin resistance was seen in 54.3% of S. aureus isolates. The frequencies of extended-spectrum beta-lactamase (ESBL)-producing E. coli and K. pneumoniae were 13.1% and 10.3%; imipenem resistance was seen in 19.5% of Pseudomonas aeruginosa isolates. CONCLUSION: Although the number of blood specimens analyzed increased steadily over the course of this study, the rate of positive blood cultures declined. The most common microorganisms isolated were coagulase-negative staphylococci, E. coli, S. aureus, and K. pneumoniae, consistent with our prior analysis. This analysis of blood culture isolate frequencies and antibiotic susceptibilities can be used to inform antibiotic therapy decisions.

Evaluation of a Chromogenic Culture Medium for the Detection of Clostridium difficile

PURPOSE: Clostridium difficile (C. difficile) is an important cause of nosocomial diarrhea. Diagnostic methods for detection of C. difficile infection (CDI) are shifting to molecular techniques, which are faster and more sensitive than conventional methods. Although recent advances in these methods have been made in terms of their cost-benefit, ease of use, and turnaround time, anaerobic culture remains an important method for detection of CDI. MATERIALS AND METHODS: In efforts to evaluate a novel chromogenic medium for the detection of C. difficile (chromID CD agar), 289 fecal specimens were analyzed using two other culture media of blood agar and cycloserine-cefoxitin-fructose-egg yolk agar while enzyme immunosorbent assay and polymerase chain reaction-based assay were used for toxin detection. RESULTS: ChromID showed the highest detection rate among the three culture media. Both positive rate and sensitivity were higher from chromID than other culture media. ChromID was better at detecting toxin producing C. difficile at 24 h and showed the highest detection rate at both 24 h and 48 h. CONCLUSION: Simultaneous use of toxin assay and anaerobic culture has been considered as the most accurate and sensitive diagnostic approach of CDI. Utilization of a more rapid and sensitive chromogenic medium will aid in the dianogsis of CDI.

A Study of Efflux Pump Genes in Mycobacterium tuberculosis Clinical Isolates / 대한임상미생물학회지

The efflux pump system has been suggested as an important mechanism in the drug resistance of Mycobacterium tuberculosis (MTB). In this study, molecular analysis of five genes in the efflux pump system of MTB isolates from Korean patients was performed in order to identify appropriate molecular targets. In this study, 35 culture-positive specimens were included. PCR was performed for five efflux genes, mmpL7, efpA, mmr, p55 and tap-like gene. In the 35 clinical isolates, molecular analysis of five kinds of efflux pump genes was performed. Only one clinical isolate showed negative PCR results for all five efflux pump genes. All the rest 34 isolates presented concurrent positive results for the five efflux pump genes. In the near future, gene expression study with quantitative PCR should be performed using these genes.

16S Ribosomal RNA Identification of Prevotella nigrescens from a Case of Cellulitis

No abstract available.

Plasma Cell Myeloma Initially Presenting as Lung Cancer

No abstract available.

The Utility of the Multiplex Reverse Transcriptase-Polymerase Chain Reaction Assay in the Detection of Hematologic Malignancies

No abstract available.