ABSTRACT
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. METHODS: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. RESULTS: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. CONCLUSIONS: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Subject(s)
Aged , Humans , Male , Clinical Coding , Critical Care , Diffusion , Disease Outbreaks , Drug Resistance, Bacterial , Electrophoresis, Gel, Pulsed-Field , Enterobacteriaceae , Hand , Infection Control , Intensive Care Units , Klebsiella pneumoniae , Klebsiella , Korea , Methods , Mortality , Pneumonia , Polymerase Chain Reaction , SputumABSTRACT
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported. METHODS: Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame. RESULTS: During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions. CONCLUSIONS: This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.
Subject(s)
Aged , Humans , Male , Clinical Coding , Critical Care , Diffusion , Disease Outbreaks , Drug Resistance, Bacterial , Electrophoresis, Gel, Pulsed-Field , Enterobacteriaceae , Hand , Infection Control , Intensive Care Units , Klebsiella pneumoniae , Klebsiella , Korea , Methods , Mortality , Pneumonia , Polymerase Chain Reaction , SputumABSTRACT
PURPOSE: The increasing prevalence and global spread of carbapenem-resistant Acinetobacter baumannii (A. baumannii) has become a serious problem. The aim of this study was to investigate molecular and epidemiological characteristics of carbapenem-resistant A. baumannii isolates collected from Korean non-tertiary hospitals. MATERIALS AND METHODS: Thirty six non-duplicated carbapenem-resistant A. baumannii isolates were collected from 17 non-tertiary hospitals in Korea between 2004 and 2006. Isolates were typed by multilocus sequence typing and repetitive-sequence-based PCR (rep-PCR). Detection of genes encoding OXA carbapenemase and their relationship with ISAba1 was performed by PCR. RESULTS: Two clones were prevalent among 36 isolates: ST69 (17 isolates, 47.2%) and ST92 (19 isolates, 52.8%). Rep-PCR patterns were diverse and revealed that all isolates were clustered into eight band patterns. The ISAba1-activated blaOXA-23-like and ISAba1-activated blaOXA-51-like genes were prevalent among the carbapenem-resistant A. baumannii isolates. CONCLUSION: The class D beta-lactamase genes of A. baumannii were distributed nationwide in non-tertiary Korean hospitals.
Subject(s)
Humans , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/classification , Anti-Bacterial Agents/therapeutic use , Bacterial Typing Techniques , Carbapenems/therapeutic use , DNA, Bacterial/analysis , Drug Resistance, Bacterial , Hospitals , Microbial Sensitivity Tests , Molecular Epidemiology , Multilocus Sequence Typing , Polymerase Chain Reaction , Prevalence , Republic of Korea , beta-Lactamases/geneticsABSTRACT
PURPOSE: In Korea, vivax malaria re-emerged in 1993 and the outbreak continued in several areas near the DMZ until now. This study was conducted to define the epidemiologic pattern of malaria in Korea and to examine the changes comparing to the one in 1999. METHODS: We collected information about civilian, veteran patients through the National malaria surveillance system and soldier from the Ministry of National Defense. We analyze epidemiological characteristics of malaria by groups (civilian, veteran, soldier). RESULTS: The reported cases of malaria in 2000 were 4,142 that number is an increase of 14% in numbers compared with those of 1999's. Most of cases occured in 17 counties nearby DMZ and from May to October(98.7%) seasonally. The incidence rates (per 100,000) in 2000 by residence were 17.0 in Gangwon-Do, 15.5 in Incheon Metropolitan city, 10.3 in Gyeonggi-Do was dereased. The risk area in 2000 were 17 counties located nearly DMZ and the high risk area were 5 counties where the incidence rate greater than 100. In case of civilian and veteran, the time required to diagnosis from onset of symptom was 8.1 days on the average. CONCLUSION: Epidemiologic pattern of malaria in 2000 did not differ from the one in 1999. Et showed regional spread (increasing risk area) but incidence rate was lowered in the high risk area of 1999. And it is necessary that we pay more attention to Gangwon-Do and Incheon metrocity to reduce the incidence rate in 2001.
Subject(s)
Humans , Diagnosis , Epidemiology , Incidence , Korea , Malaria , Malaria, Vivax , Military Personnel , Seasons , VeteransABSTRACT
Surveillance for Vibrio vulnificus infections was performed by Korea National Institute of Health to investigate the epidemiological characteristics of recent occurence and to provide basic information for V. vulificus infection control. In 1998, a total of 44 cases of V. vulnificus infections were confirmed bacteriologically. The age groups of the patients ranged from thirties to seventies and 13 (29.5%) patients were in their fifties. Thirty-six (81.8%) patients had chronic liver diseases. Twenty-five (56.8%) had drinking habits. Eating uncooked seafood (fish, shrimp, and small octopus) produced in tideland was the main suspected source of infections and 32 (72.8%) cases were associated with raw seafood consumption. Two cases were associated with contaminated chopping board and 5 were infected through the wound. The incubation period ranged from less than 1 day to 7 days (median 2 days). The case fatality rate was 48%. In conclusion, V. vulnificus infection, a highly fatal disease, is not rare in Korea. Therefore, attention should be given to prevent V. vulnificus infections.
Subject(s)
Humans , Drinking , Eating , Infection Control , Korea , Liver Diseases , Mortality , Seafood , Vibrio vulnificus , Vibrio , Wounds and InjuriesABSTRACT
Eight strains of multidrug-resistant (MDR) Salmonella typhi were isolated from Kyonggi area during January-February,1997. They were resistant to ampiciUin, amoxicillin, carbeniciillin, tetracycline, chloramphenicol, trimethoprim/sulfamethoxazole, trimethoprim. Eight strains had one plasmid respectively which size was approximately M.W 220 kb and showed same restriction pattern by endonuclease HindIII. The plasmid was similar to the plasmid in size that was related to multidrug resistant S. typhi isolated from southeast Asia. It were transferred by conjugation to recipient E, coli K-12 in frequency of 2.43 x10-4 - 1.73 x 10-2 and transconjugant showed same drug-resistant pattem with donor cells. All of 8 strains produced B-lactamase that was assummed to TEM-1 type by isoelectric focusing and PCR.
Subject(s)
Humans , Amoxicillin , Asia, Southeastern , Chloramphenicol , Deoxyribonuclease HindIII , Isoelectric Focusing , Korea , Plasmids , Polymerase Chain Reaction , Salmonella typhi , Salmonella , Tetracycline , Tissue Donors , TrimethoprimABSTRACT
BACKGROUND: During the period from April to June 1996, an outbreak of typhoid fever occurred in SuYoung-Ku, Pusan city. We performed the molecular epidemiological analysis and drug susceptibility test for 48 isolates of Salmonella typhi from the outbreak. METHODS: Chromosomal DNA of S. typhi was digested with the restriction endonuclease Spe I and the resulting restriction polymorphism was observed on pulsed field gel electrophoresis (PFGE). Phage typing was performed using Vi-phages, and antimicrobial susceptibility test was done by Disc diffusion method. RESULTS: On phage typing, 2 isolates were M1 phage type, 2 E1 phage type and 44 untypable. The PFGE analysis on 14 to 16 chromosomal DNA restriction fragments ranged from 50 Kb to 1000kb showed 2 different patterns of restriction fragments, divided into group A and B. Forty-seven isolates belonged to group A that were allocated into A1 (42 strains), A2 (1 strain), A3 (3 strains), A4 (1 strain), and one strain was grouped into group B. In the F-value of genetic similarity of the epidemic S. typhi strains, there was low similarity (F value:0.2-0.258) between group A strains and group B strains. However, the subgroup strains (A1-A4) showed high similarity (F value:0.8-0.897) each other. The drug susceptibility test showed susceptibility to ampicillin, carbenicillin, cephalothin, chloramphenicol, tobramycin, gentamicin, kanamycin, nalidixic acid, neomycin, polymyxin B, streptomycin, tetracycline, trimethoprim-sulfamethoxazole, ciprofloxacin and norfloxacin. CONCLUSION: This study showed that phage typing and PFGE were very useful as a tool to investigate molecular analyses of epidemic S. typhi strains this study.