Endodontic Drainage in Delayed Replantation after Prolonged Extra-alveolar Period of the Avulsed Teeth: Report of a Case

Penicillin-resistant Aerococcus viridans Bacteremia Associated with Granulocytopenia

Aerococcus viridans, a catalase-negative gram-positive coccus rarely causing bacteremia, was isolated from blood cultures of a 52-yr-old man under the gran-ulocytopenic condition. The isolate showed the typical characteristics of A. viridans, i.e., tetrad arrangements in gram stain, positive pyrrolidonyl aminopeptidase (PYR) and negative leucine aminopeptidase (LAP) reactions, and no growth at 45 degrees C.The isolate was revealed to be highly resistant to penicillin, erythromycin, clindamycin, and ceftriaxone, although most strains of A. viridans isolated from the previously reported patients were susceptible to penicillin and other commonly used antibiotics. Even though A. viridans is rarely associated with human infections, it could be a potential causative agent of bacteremia, especially in immunocompromised patients.

Identification Results of Aerobic Gram-positive Bacteria Isolated from Blood Cultures Using BBL Crystal GP ID System / 대한임상미생물학회지

BACKGROUND: Although most of aerobic gram-positive bacilli have been considered to be contaminants, gram-positive bacilli should be identified to the species level if they are isolated from sterile body sites such as blood, and from adequately collected clinical specimens if they are the predominant organisms. However, identification of gram-positive bacilli are difficult due to the enormous diversity of these organisms and the small number of readily available commercial identification systems in clinical laboratories. Gram-positive bacilli and coccorods isolated from blood cultures were tested with BBL Crystal Gram-Positive (GP) Identification (ID) system in order to evaluate the system's usefulness of identifying these bacteria. METHODS: Thirty-seven stock strains of aerobic gram-positive bacteria isolated from blood cultures between October 1998 and November 1999 at Wonju Christian Hospital were simultaneously tested by BBL Crystal GP ID system and API system. Three kinds of API system (API Coryne, API 50 CHB, and API 20 Strep) were tested according to gram stain results. Gram-positive bacilli or gram-positive coccorods consecutively isolated from blood cultures from May to November in 2000 were identified by BBL Crystal GP ID system. RESULTS: Among the 37 stock strains of aerobic gram-positive bacteria, agreement rate of identification between Crystal GP ID system and API system were 88% to the genus level and 63% to the species level in Bacillus species, and 90% to the genus level in Corynebacterium species. The isolation rate of gram-positive bacteria from blood cultures from May to November in 2000 to the genus level were: Bacillus; 41.9%(18/43), Corynebacterium; 37.2%(16/43), and the other grampositive coccorods; 20.9%(9/43). CONCLUSIONS: Crystal GP ID system is a useful identification system which, when combined with basic microbiological tests, should lead to satisfactory identification results for gram-positive bacteria isolated from blood cultures.

Identificatiion,Antimicrobial Susceptibility an Epidemiology of Klebsiella species Isolated from Clinical Specimen / 대한임상미생물학회지

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.

Identificatiion,Antimicrobial Susceptibility an Epidemiology of Klebsiella species Isolated from Clinical Specimen / 대한임상미생물학회지

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.

Microplate Identification System of Enterobacteriaceae / 대한임상미생물학회지

BACKGROUND: To access the accuracy and clinical usefulness of microplate identification (ID) system for the identification of Enterobacteriaceae, we compared microplate ID system with API 20E(bioMerieux, Etoile, France). METHODS: Ninety-two cultures of Enterobacteriaceae and one isolate of Aeromonas species were simultaneously identified by microplate ID system and the API 20E. Twenty biochemical tests used in microplate ID system were lactose, sucrose, and H2S in Kligler's iron agar media; indole, sucrose, raffinose, arabinose, trehalose, adonitol, dulcitol, sorbitol, cellibiose, methy-red, phenylalanine deaminase, ornithine decarboxylase, lysine decarboxylase, arginine dihydrolase, urease, and citrate in microplate; and oxidase test. The identification was obtained by considering percent likelihood(% ID), modal frequency and ID score method. RESULTS: Among the 92 cultures of Enterobacteriaceae and one isolate of Aeromonas species, agreement rate of identification according to the % ID between microplate ID system and API 20E were 90.3% to the species level and 97.8% to the genus level. CONCLUSIONS: For the identification of clinical Enterobacteriaceae isolates, the microplate ID system compares favorably with API 20E in identification accuracy and have the advantage of costsaving and easy to use.

Evaluation of Identification Rate of Enterobacteriaceae by Conventional Biochemical Tests / 대한임상병리학회지

BACKGROUND: One of major consideration of any identification (ID) system is the cost. Commercial kits, however, are too expensive. The aim of this study was to evaluate the clinical usefulness of the computerized ID system based on the conventional minimal biochemical tests for the identification of clinical isolates of Enterobacteriaceae. METHODS: During June 1996 to April 1997, Enterobacteriaceae were tested by triple sugar iron, motility, indole, ornithine decarboxylase, and citrate, and 2-4 biochemical tests were tested additionally according to the characteristics of colony on MacConkey agar. We also compared the conventional ID system with API Rapid 32E (ATB system, bioMrieux, France) to determine the accuracy of conventional ID system. RESULTS: Among the 3,652 strains of Enterobacteriaceae, 84.4% were identified by conventional tests. The identification rate of Enterobacteriaceae by conventional tests; K. pneumoniae, E. coli, P. stuartii, M. morganii, and P. mirabilis were more than 80%; K. oxytoca, Enterobacter, and S. marcescens were ranged from 70% to 80%; P. vulgaris, P. rettgeri, and C. freundii were less than 70%. Among the 133 isolates tested simultaneously by two ID systems, each of one strain of M. morganii, E. cloacae, and S. marcescens on conventional minimal biochemical tests were identified as E. coli, E. sakazakii, and S. liquefaciens by commercial kit. CONCLUSIONS: Our computerized ID system based on the minimal biochemical tests was found to offer simple, reliable and economic in the identification of clinical isolates of Enterobacteriaceae. And further studies are needed for the improvement of accuracy and identification rate.

Evaluation of 10 Tube System for the Identification of Enterobacteriaceae / 대한임상병리학회지

BACKGROUND: The selection of identification (ID) system of Enterobacteriaceae depends mainly on accuracy of identification system, cost of operation and convenience of testing. Commercial ID kits are easy to use but too expensive. Therefore, we designed a computerized ID system based on 10 tubes which were composed of 14 conventional biochemical tests to identify the Enterobacteriaceae and Vibrionaceae. The purpose of this present study was to assess the clinical usefulness of 10 tube system as an identification system for Enterobacteriaceae in clinical microbiology laboratories. METHODS: During the period of January 1998, 189 Enterobacteriaceae and 2 Aeromonas spp. consecutively isolated from clinical specimens were simultaneously identified by 10 tube system and the API rapid ID 32 E. Fourteen conventional biochemical tests used in 10 tube system were lactose, sucrose, and H2S in Kligler's iron agar media; motility, indole, and ornithine decarboxylase in motility-indole-ornithine decarboxylase agar media; citrate, urease, lysine decarboxylase, phenylalanine deaminase, arginine dihydrolase, arabinose, trehalose, and adonitol. Identification program used in 10 tube system were % ID method and ID score method. RESULTS: Among the 191 isolates, agreement rate of identification between 10 tube system and API rapid ID 32 E were 96.0% to the species level and 99.4% to the genus level. And identification accuracy of 10 tube system was 90.6% to the species level and 93.2% to the genus level. CONCLUSIONS: 10 tube system has been shown to be an accurate, cost-effective alternative to the use of commercial kit systems for identification of Enterobacteriaceae.

Isolation Rate and Biochemical Reaction of Enterobacteriaceae / 대한임상미생물학회지

BACKGROUND: In clinical microbiology the accurate and rapid identification of members of the family Enterobacteriaceae is essential for diagnostic and therapeutic purposes and for epidemiologic studies. Accuracy of identification system depends mainly on data base such as positive rate of biochemical reactions, relative frequency of occurrence of biotype, and isolation frequency of microorganisms. The purpose of this study was to analyze the isolation rate and biotype frequency of the family Enterobacteriaceae isolated from tertiary care hospital in Korea. METHODS: Isolation frequency of the family Enterobacteriaceae isolated from clinical specimens during the period of January 1998 to June 1998 were analyzed. And biochemical phenotypes of 2,022 isolates tested by 10 tube system consisting of 14 conventional biochemical tests were also analyzed. RESULTS: Isolation rate of the family Enterobacteriaceae to the genus level in order of decreasing frequency were Escherichia (37.0%), Serratia (15.9%), Klebsiella (14.9%), Enterobacter (11.1%), Providencia (8.1%), Citrobacter (2.8%), Proteus (2.5%), Morganella (2.4%), Salmonella (2.4%), and Cedecea (0.7%). Among the genus of the family Enterobacteriaceae, Budvicia, Edwardsiella, Ewingella, Hafnia, Kluyvera, Leminorella, Moellerella, Shigella, Tatumella, Xenorhabdus, Yersinia, and Yokenella were not isolated. The number of species and genus of the family Enterobacteriaceae by this study were 48 and 12, respectively. Over 95% of all clinical isolates belonged to only 25 species. CONCLUSIONS: Although these data about frequency of relative isolation rate and biotype patterns of the family Enterobacteriaceae is inadequate according to species and genus, yet these data will be utilized for the application and development of identification method of the family Enterobacteriaceae.