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1.
Article in English | WPRIM | ID: wpr-915759

ABSTRACT

Fecal microbiota transplantation (FMT) is a highly efficacious and safe modality for the treatment of recurrent or refractory Clostridioides difficile infection (CDI), with overall success rates of 90%. Thus, FMT has been widely used for 10 years. The incidence and clinical characteristics of CDI, the main indication for FMT, differ between countries. To date, several guidelines have been published. However, most of them were published in Western countries and therefore cannot represent the Korean national healthcare systems. One of the barriers to performing FMT is a lack of national guidelines. Accordingly, multidisciplinary experts in this field have developed practical guidelines for FMT. The purpose of these guidelines is to aid physicians performing FMT, which can be adapted to treat CDI and other conditions.

2.
Article in English | WPRIM | ID: wpr-925414

ABSTRACT

Background@#A variety of clinically important pathogens have developed multidrug resistance (MDR), which threatens global public health. This study aimed to determine the incidence, patterns, and trends of MDR of gram-negative bacterial isolates in clinical specimens in the Tamale Teaching Hospital, Ghana. @*Methods@#This retrospective study analyzed gram-negative bacterial isolates and antimicrobial susceptibility test (AST) results of patients who visited the Tamale Teaching Hospital laboratory between 2017 and 2019. @*Results@#A total of 2,779 gram-negative bacterial isolates and their phenotypic AST results were analyzed. From these, 1,297 gram-negative bacteria (46.7%) were isolated from urine samples, while the rest were isolated from sputum (20.9%), wound (14.3%), and swabs (11.7%) samples, etc. Escherichia coli (23.8%) was the most common gram-negative pathogen found predominantly in the urine samples (33.2%). All gram-negative bacteria isolated between 2017 and 2019 showed high MDR. Klebsiella pneumonia gradually increased its MDR from 84.0% in 2017, 89.5% in 2018, to 95.1% in 2019. On the other hand, the MDR rates in Pseudomonas aeruginosa were approximately 65.8%, varying from 59.5% in 2017 to 78.7% in 2019. Among tested antimicrobials, amikacin was the most effective. Resistance to amikacin in Enterobacter spp., E. coli, and K. pneumoniae in vitro were 16.2%, 11.8%, and 17.7%, respectively. @*Conclusion@#The study has shown that the high levels of MDR in gram-negative bacteria isolated may be associated with the infections recorded at the Tamale Teaching Hospital.The major gram-negative pathogens isolated have resistance to penicillins, cephalosporins, and fluoroquinolones. Aminoglycosides can offer high antibiotic activity to overcome gramnegative bacterial resistance. Further studies will be needed to decide policy direction on infection prevention and control, and antimicrobial stewardship programs

3.
Article in English | WPRIM | ID: wpr-874146

ABSTRACT

Fecal microbiota transplantation (FMT) is a widely accepted alternative therapy for Clostridioides difficile infection and other gastrointestinal disorders. Thorough donor screening is required as a safety control measure to minimize transmission of infectious agents in FMT. We report the donor screening process and outcomes at a fecal microbiota bank in Korea. From August 2017 to June 2020, the qualification of 62 individuals as FMT donors was evaluated using clinical assessment and laboratory tests. Forty-six (74%) candidates were excluded after clinical assessment; high body mass index ( > 25) was the most common reason for exclusion, followed by atopy, asthma, and allergy history. Four of the remaining 16 (25%) candidates failed to meet laboratory test criteria, resulting in a 19% qualification rate. FMT donor re-qualification was conducted monthly as an additional safety control measure, and only three (5%) candidates were eligible for repeated donation. As high prevalence of multidrug-resistant organisms (55%) and Helicobacter pylori (44%) were detected in qualified donors during the screening, a urea breath test was added to the existing protocol. The present results emphasize the importance of implementing a donor re-qualification system to minimize risk factors not identified during initial donor screening.

4.
Article in English | WPRIM | ID: wpr-896722

ABSTRACT

Background@#Although urine culture is considered a reference standard for the diagnosis of urinary tract infection (UTI), it is time-consuming, labor-intensive, and expensive. Here, we evaluated the performance of five recent automated urine analyzers for UTI diagnosis. @*Methods@#For the 510 specimens analyzed, the criterion for ‘significant bacteriuria’ was defined as ≥ 104 CFU/mL in the inoculated plate for all specimens or ≥ 103 CFU/mL for specimens from patients using a Foley catheter or with urinary symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UTI were analyzed using indicators individually, in different combinations, or with various cut-off values. @*Results@#Seventy-one specimens (13.9%) exhibited ‘significant bacteriuria’. In the eceiver operating characteristics curve analysis, UF-5000 (Sysmex Corp., Japan) showed the highest area under the curve values for both males and females (0.876 and 0.846, respectively). The PPVs for specimens from males with all indicators positive increased up to 100% after adjusting the cut-off values. NPVs for specimens with all indicators negative were 94.3%– 98.2% in males and 78.1%–93.8% in females after adjusting the cut-off values. @*Conclusion@#As a rapid and accurate diagnostic tool, urine sediment analyzers can be valuable for UTI diagnosis by reducing unnecessary culture and can help clinicians determine a treatment plan.

5.
Article in English | WPRIM | ID: wpr-919316

ABSTRACT

Ticks can transmit pathogenic bacteria, protozoa, and viruses to humans and animals. In this study, we investigated the microbiomes of Haemaphysalis longicornis according to sex and life stages. The Shannon index was significantly higher for nymphs than adult ticks. Principal coordinates analysis showed that the microbiome composition of female adult and male adult ticks were different. Notably, Coxiella-like bacterium (AB001519), known as a tick symbiont, was found in all nymphs and female adult ticks, but only one out of 4 male adult ticks had Coxiella-like bacterium (AB001519). In addition, Rickettsia rickettsii, Coxiella burnetii, and Anaplasma bovis were detected in this study.

6.
Article in English | WPRIM | ID: wpr-913381

ABSTRACT

Background@#Environmental sanitation plays a significant role on the prevalence of enteropathogenic bacteria. This study aimed to determine the trends in the prevalence and antimicrobial resistance profiles of enteropathogenic bacteria from 2011 to 2019. @*Methods@#A retrospective analysis was performed using data from stool cultures of Salmonella spp., Shigella spp., Plesiomonas shigelloides , Yersinia spp., Vibrio spp., and Campylobacter spp. Samples were obtained between 2011 and 2019 from Severance Hospital. Antimicrobial susceptibility profile was determined using the disk diffusion method for nontyphoidal Salmonella (NTS) and Campylobacterspp., following the Clinical and Laboratory Standards Institute (CLSI) guidelines. @*Results@#The number of specimens obtained for stool culture increased significantly from 13,412 during the period of 1969–1978, to 48,476 over the past nine years (2011–2019), whereas the ratio of positive specimens decreased significantly from 1,732 (12.9%) to 449 (0.9%). The proportion of samples positive for Salmonella Typhi decreased from 472 (93.6%, 1969–1978) to 4 (1.5%, 2011–2019), whereas the proportion of NTS increased from 14 (2.8%, 1969–1978) to 261 (96.7%, 2011–2019). Among all the enteropathogenic bacteria isolated, Shigella spp. accounted for 60.0% (1,039) isolates from 1969 to 1978, but only 1.6% (7) from 2011 to 2019. Campylobacter was the second most prevalent enteropathogenic bacteria, accounting for 29.4% isolates (132). Among the NTS strains isolated from 2016 to 2019, their susceptibility rates to ampicillin and sulfamethoxazole-trimethoprim were 51.1% and 85.2%, respectively. Additionally, the susceptibility rate of Campylobacter to ciprofloxacin was 15.8%. @*Conclusion@#The prevalence of Salmonella Typhi and Shigella spp. significantly decreased, whereas those of NTS and Campylobacter spp. increased. Therefore, continuous monitoring of ciprofloxacin-resistant Campylobacter spp. is of vital importance.

7.
Article in English | WPRIM | ID: wpr-889018

ABSTRACT

Background@#Although urine culture is considered a reference standard for the diagnosis of urinary tract infection (UTI), it is time-consuming, labor-intensive, and expensive. Here, we evaluated the performance of five recent automated urine analyzers for UTI diagnosis. @*Methods@#For the 510 specimens analyzed, the criterion for ‘significant bacteriuria’ was defined as ≥ 104 CFU/mL in the inoculated plate for all specimens or ≥ 103 CFU/mL for specimens from patients using a Foley catheter or with urinary symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UTI were analyzed using indicators individually, in different combinations, or with various cut-off values. @*Results@#Seventy-one specimens (13.9%) exhibited ‘significant bacteriuria’. In the eceiver operating characteristics curve analysis, UF-5000 (Sysmex Corp., Japan) showed the highest area under the curve values for both males and females (0.876 and 0.846, respectively). The PPVs for specimens from males with all indicators positive increased up to 100% after adjusting the cut-off values. NPVs for specimens with all indicators negative were 94.3%– 98.2% in males and 78.1%–93.8% in females after adjusting the cut-off values. @*Conclusion@#As a rapid and accurate diagnostic tool, urine sediment analyzers can be valuable for UTI diagnosis by reducing unnecessary culture and can help clinicians determine a treatment plan.

8.
Article in English | WPRIM | ID: wpr-785399

ABSTRACT

BACKGROUND: As the spread of carbapenemase-producing Enterobacteriaceae poses a critical threat to public health, rapid detection of carbapenemase genes is urgently required for prompt initiation of appropriate antimicrobial therapy and infection control. We evaluated the performance of Xpert Carba-R v.2 (Cepheid, USA) compared with that of culture-based conventional PCR.METHODS: Using the results of 5,479 consecutive clinical rectal swabs, discrepant analysis (enriched culture followed by PCR) was performed for all discordant samples (N=100), which were Carba-R v.2-positive and culture-negative.RESULTS: Among the samples, 206 carbapenemase genes (3.6%) were detected by Carba-R v.2. The sensitivity and specificity were 95.0% and 98.1%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 49.0% and 99.9%, respectively. Following discrepant analysis, the PPV increased to 73.5% and the low PPV (8.1%) of the 86 non-KPC improved to 48.8%. Among the 105 discrepancies, NDM was the most frequently observed (N=56), followed by KPC (N=26), VIM (N=10), IMP (N=8), OXA-48 (N=5). The threshold cycle values between discordant vs. concordant and resolved groups were significantly different (P<0.001).CONCLUSIONS: Carba-R v.2 is a rapid and sensitive method for detecting carbapenemase-encoding genes compared with culture-based conventional PCR. Most of our discrepant results were non-KPC genes. Thus, the clinical significance of the non-KPC positive cases detected by Carba-R v.2 should be investigated. This assay would be useful for deciding whether to isolate pre-exposed patients in hospital settings, based on the high specificity and NPV.


Subject(s)
Enterobacteriaceae , Humans , Infection Control , Korea , Methods , Polymerase Chain Reaction , Public Health , Sensitivity and Specificity
9.
Article in English | WPRIM | ID: wpr-762459

ABSTRACT

BACKGROUND: The existing modified carbapenem inactivation methods (mCIMs) recommended by the CLSI for detecting carbapenemase production have not been applicable for Acinetobacter baumannii. We evaluated the influence of matrices used in mCIMs and CIMTris on the stability of the disks for detecting carbapenemase producers and suggested optimal mCIM conditions for detecting carbapenemase-producing A. baumannii. METHODS: Seventy-three A. baumannii isolates characterized for antimicrobial susceptibility and carbapenemase encoding genes were tested for carbapenemase production using mCIM and CIMTris. The influence of the matrices (Tryptic soy broth [TSB] and Tris-HCl) used in these methods on the stability of the meropenem (MEM) disk was also evaluated. The mCIM conditions were adjusted to enhance screening sensitivity and specificity for detecting carbapenemase-producing A. baumannii. RESULTS: The matrices had an impact on the stability of the MEM disk after the incubation period (two or four hrs). TSB nutrient broth is an appropriate matrix for mCIM compared with Tris-HCl pH 7.6, which leads to the loss of MEM activity in CIMTris. The sensitivity and the specificity of the optimal mCIM were both 100%. CONCLUSIONS: We established optimal mCIM conditions for simple, accurate, and reproducible detection of carbapenemase-producing A. baumannii.


Subject(s)
Acinetobacter baumannii , Acinetobacter , Hydrogen-Ion Concentration , Mass Screening , Methods , Sensitivity and Specificity
10.
Article in English | WPRIM | ID: wpr-899728

ABSTRACT

Hospitals need to find a safe and rapid method for respiratory specimen collection as the number of patients suspicious for coronavirus disease -2019 (COVID-19) rapidly grows. Applied with significant infection control and prevention measures, a respiratory specimen collection booth was newly designed. The new respiratory specimen collection booth not only increased COVID-19 testing cases but also decreased personal protective equipment consumption.

11.
Article in English | WPRIM | ID: wpr-899702

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 not yet has established its treatment, but convalescent plasma has been expected to increase survival rates as in the case with other emerging viral infections. We describe two cases of COVID-19 treated with convalescent plasma infusion. Both patients presented severe pneumonia with acute respiratory distress syndrome and showed a favorable outcome after the use of convalescent plasma in addition to systemic corticosteroid. To our knowledge, this is the first report of the use of convalescent plasma therapy for COVID-19 in Korea.

12.
Article in English | WPRIM | ID: wpr-892024

ABSTRACT

Hospitals need to find a safe and rapid method for respiratory specimen collection as the number of patients suspicious for coronavirus disease -2019 (COVID-19) rapidly grows. Applied with significant infection control and prevention measures, a respiratory specimen collection booth was newly designed. The new respiratory specimen collection booth not only increased COVID-19 testing cases but also decreased personal protective equipment consumption.

13.
Article in English | WPRIM | ID: wpr-891998

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 not yet has established its treatment, but convalescent plasma has been expected to increase survival rates as in the case with other emerging viral infections. We describe two cases of COVID-19 treated with convalescent plasma infusion. Both patients presented severe pneumonia with acute respiratory distress syndrome and showed a favorable outcome after the use of convalescent plasma in addition to systemic corticosteroid. To our knowledge, this is the first report of the use of convalescent plasma therapy for COVID-19 in Korea.

14.
Laboratory Medicine Online ; : 221-226, 2020.
Article | WPRIM | ID: wpr-836921

ABSTRACT

Background@#Intestinal protozoan infection is one of the main causes of gastrointestinal diseases. Protozoa are usually detected by direct smear microscopy, concentration techniques, or special stains; however, these techniques are labor-intensive and require well-trained technicians. Therefore, molecular techniques involving polymerase chain reaction (PCR) have been developed to satisfy the need for unbiased and rapid analytical methods with high sensitivity and specificity. In this study, the BD MAXTM Enteric Parasite Panel (EPP) (Becton, Dickinson and Company, USA), designed to detect Cryptosporidium parvum and/or hominis, Giardia lamblia, and Entamoeba histolytica, and the AllplexTM Gastrointestinal Parasite Assays (AGPA) (Seegene Inc., Korea), designed to detect Cryptosporidium species, G. lamblia, E. histolytica, Blastocystis hominis, Dientamoeba fragilis, and Cyclospora cayetanensis were compared to determine whether any of these assays could become a useful tool for detecting intestinal protozoan infections in Korea. @*Methods@#We investigated 295 fecal samples using EPP and AGPA. Then we confirmed the positive results with the conventional and nested PCR. Consistent detection by conventional PCR, nested PCR, and one of the multiplex panels was considered “true positive.” @*Results@#Out of 295 samples, 17 were true positives for B. hominis and 2 were true positives for E. histolytica. EPP detected parasites in only two samples owing to its design; however, its true positive detection rate was 100% (2/2). AGPA detected parasites in 24 samples with 79.2% (19/24) true positives. @*Conclusions@#The incidence of protozoan, especially B. hominis, infection may be more prevalent than expected. AGPA could be an effective tool for screening protozoan infections.

15.
Article | WPRIM | ID: wpr-833820

ABSTRACT

Cockroaches inhabit various habitats, which will influence their microbiome. Although the microbiome can be influenced by the diet and environmental factors, it can also differ between species. Therefore, we conducted 16S rDNAtargeted high-throughput sequencing to evaluate the overall bacterial composition of the microbiomes of 3 cockroach species, Periplaneta americana, P. japonica, and P. fuliginosa, raised in laboratory for several generations under the same conditions. The experiments were conducted using male adult cockroaches. The number of operational taxonomic units (OTUs) was not significantly different among the 3 species. With regard to the Shannon and Pielou indexes, higher microbiome values were noted in P. americana than in P. japonica and P. fuliginosa. Microbiome composition was also evaluated, with endosymbionts accounting for over half of all OTUs in P. japonica and P. fuliginosa. Beta diversity analysis further showed that P. japonica and P. fuliginosa had similar microbiome composition, which differed from that of P. americana. However, we also identified that P. japonica and P. fuliginosa host distinct OTUs. Thus, although microbiome compositions may vary based on multiple conditions, it is possible to identify distinct microbiome compositions among different Periplaneta cockroach species, even when the individuals are reared under the same conditions.

16.
Article | WPRIM | ID: wpr-830355

ABSTRACT

Background@#The rapid antimicrobial susceptibility testing (AST) performed on urine samples would guide the adequate choice of antibiotics for obtaining better treatment outcomes in patients. Our study aimed to evaluate the performance of the modified-EUCAST (European Committee on Antimicrobial Susceptibility Testing) rapid direct AST on urine samples. @*Methods@#From >2,000 urine samples, a total of 128 urine samples containing bacterial counts of ≥2 × 10 4 CFU/mL with a uniform bacterial shape were initially included based on flow cytometry (Sysmex UF-1000i, Japan) and Gram staining, respectively. A total of 103 samples showing the presence of Enterobacteriaceae were finally selected in this study. The urine samples were directly inoculated on Mueller-Hinton agar, which was used in the current EUCAST rapid direct AST on blood samples. The size of the growth inhibition zones around antimicrobial disks was measured using a digital scanner (BIOMIC vision analyzer, Giles scientific, USA) and further confirmed by visualization with naked eyes after incubation for 4, 6, and 8 hours. The AST interpretations were compared to those of the conventional VITEK 2 AST system (bioMérieux, France) and the discrepancies between both tests were confirmed with the E-test. @*Results@#The antibiotics, namely ampicillin, cefazolin, aztreonam, ceftazidime, cefotaxime, cefoxitin, cefepime, gentamicin, ciprofloxacin, and cotrimoxazole showed excellent correlations with modified-EUCAST rapid direct test and conventional ASTs with >0.75 weighted kappa values. The categorical agreement of the rapid direct AST was 1,442 (93.3%), with 76 (4.9%) minor error, 9 (0.6%) major error and 18 (1.2%) very major error, implicating the reliability of this method for clinical application. @*Conclusion@#Performing the modified-EUCAST rapid direct AST on urine samples can predict reliable AST results within 8 hours. The rapid direct AST can help the physicians to initiate adequate antimicrobial treatment for urinary tract infections.

17.
Article in English | WPRIM | ID: wpr-811100

ABSTRACT

BACKGROUND: Colistin has become a last-resort antibiotic for the management of multidrug-resistant gram-negative bacteria. The disk diffusion test is cheap and easy to perform but may be unreliable for colistin susceptibility testing due to poor diffusion of the large colistin molecule. An improved agar diffusion test would increase the reliability of colistin susceptibility testing. This study aimed to modify Muller-Hinton agar (MHA) to improve colistin diffusion in agar.METHODS: MHA was modified by reducing the agar concentration from 100% to 30% and supplementing with protamine. We tested 60 gram-negative clinical isolates of Pseudomonas aeruginosa (N=27) and Acinetobacter calcoaceticus-baumannii complex (N=33). Disk diffusion test results were interpreted based on minimum inhibitory concentrations determined by broth microdilution.RESULTS: The modified MHA yielded the best performance metrics, including 94.7% sensitivity, 100% specificity, and an area under the curve of 0.995 (95% confidence interval, 0.982–1.000), P<0.001, at a cut-off point of 13 mm.CONCLUSIONS: A reduction of the agar concentration from 100% to 30% and the addition of protamine improved colistin diffusion in agar and allowed routine colistin susceptibility testing in a clinical microbiology laboratory, but should be handled with caution.

20.
Article in Korean | WPRIM | ID: wpr-816607

ABSTRACT

BACKGROUND: 16S rRNA gene-targeted next-generation sequencing (NGS) can detect microorganisms in a comprehensive reference database. To date, NGS has been successfully applied to samples such as urine, blood, and synovial fluid. However, there is no data for continuous ambulatory peritoneal dialysis (CAPD) fluid. The purpose of this study was to evaluate the clinical usefulness of microbiome analysis of CAPD fluids for the diagnosis of CAPD peritonitis.METHODS: We included 21 patients with high suspicion of CAPD peritonitis. Routine CAPD fluid culture was performed using a pellet of 50 mL CAPD fluid onto the chocolate and blood agar for two days, and thioglycollate broth for one week. 16S rRNA gene-targeted NGS of pellets, stored at −70℃ was performed with MiSeq (Illumina, USA).RESULTS: Many colonized or pathogenic bacteria were detected from CAPD fluids using NGS and the microbiomes were composed of 1 to 29 genera with a cut-off 1.0. Compared to the culture results, NGS detected the same pathogens in 6 of 18 valid results (three samples failed with low read count). Additionally, using NGS, anaerobes such as Bacteroides spp. and Prevotella spp. were detected in six patients. In two of five samples in which no bacterial growth was detected, possible pathogens were detected by NGS.CONCLUSION: To our knowledge, this is the first report about the application of 16S rRNA gene-targeted NGS for diagnosis of CAPD peritonitis. Etiology of culture-negative CAPD peritonitis can be better defined in NGS. Furthermore, it also helped the detection of anaerobic bacteria.


Subject(s)
Agar , Bacteria , Bacteria, Anaerobic , Bacteroides , Cacao , Colon , Diagnosis , Humans , Microbiota , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , Prevotella , Synovial Fluid
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