Antimicrobial Resistance in Bacterial Isolates Recovered from Nursing Hospitals between 2014 and 2017 / 대한임상미생물학회지

BACKGROUND: Antimicrobial resistance (AMR) is an issue not only with regard to public health, but also in terms of economic impact. AMR surveillance has mainly been carried out in general hospitals, and not in nursing hospitals. This study was conducted to investigate the AMR rate for bacterial strains isolated from nursing hospital samples.METHODS: Antimicrobial susceptibility testing (AST) results from a total of 23,518 bacterial isolates recovered from clinical specimens taken in 61 nursing hosals were analyzed. AST was conducted using Vitek 2 with AST cards specific for the bacterial strains.RESULTS: A total of 19,357 Gram-negative and 4,161 Gram-positive bacterial strains were isolated. Pseudomonas aeruginosa (n=6,384) and Escherichia coli (n=5,468) were the most prevalent bacterial species and, among Gram-positive bacteria, Staphylococcus aureus (n=1,565) was common. The AMR rate was high for the following strains: cefotaxime-resistant Klebsiella pneumoniae, 77.4%; cefotaxime-resistant E. coli, 70.6%; imipenem-resistant Acinetobacter baumannii, 90.3%; imipenem-resistant P. aeruginosa, 49.3%; oxacillin-resistant S. aureus, 81.1%, penicillin-resistant Enterococcus faecalis, 44.8%, and vancomycin-resistant Enterococcus faecium, 53.5%. AMR rate change varied by bacterial species and antimicrobial drug.CONCLUSION: AMR rates of major pathogens from nursing hospitals were higher than those from general hospitals with the exception of imipenem-resistant A. baumannii. Continuous monitoring and infection control strategies are needed.

Surgical impact on serum anti-Mullerian hormone in women with benign ovarian cyst: A prospective study

OBJECTIVE: The aim of this study was to evaluate the surgical impact of benign ovarian mass on ovarian reserve as measured by serum follicle stimulating hormone (FSH), estradiol (E2) and anti-Mullerian hormone (AMH) levels, antral follicle count (AFC) and ovarian volumes. In addition, the differences in ovarian reserve impairment between endometrioma cystectomy and non-endometrioma cystectomy were investigated. METHODS: In this prospective study, 22 patients of reproductive age (range, 18.35 years) with benign ovarian masses were enrolled to undergo laparoscopic cystectomy. Of whom 12 had endometriomas and 10 had non-endometriomas. On early follicular phase (day 3) of the cycle preceding the operation and three months after the laparoscopic cystectomy, serum levels of FSH, E2 and AMH, AFC and ovarian volumes were measured in all patients. Data were analyzed with Mann-Whitney U-test and Wilcoxon rank test using SPSS ver. 12.0 for statistic analysis. RESULTS: Median level of serum AMH was significantly decreased from 5.48 ng/mL (interquartile range [IQR], 2.80-7.47) before cystectomy to 2.56 ng/mL (IQR, 1.74-4.32) 3 months postoperation (P<0.05). On the other hand, no significant differences in FSH, E2, AFC and ovarian volumes were found between the preoperative and three months postoperative levels. In a subgroup analysis of the pathologic type of the ovarian cyst, postoperative serum AMH levels were significantly decreased in the endometrioma group, but not in the non-endometrioma group. CONCLUSION: Serum AMH levels were significantly decreased after laparoscopic cystectomy without any changes of other ovarian reserve tests.

Antimicrobial Resistance among Clinical Isolates of Pseudomonas aeruginosa from Non-tertiary Care Hospitals in Korea, 2002-2004 / 감염과화학요법

BACKGROUND: Increasing numbers of resistant and multidrug resistant (MDR) isolates of Pseudomonas aeruginosa have become a worldwide problem. This report provides the trend of antimicrobial resistance, the proportions of MDR and metallo-beta-lactamase-producing isolates among clinical isolates of P. aeruginosa in Korea. MATERIALS AND METHODS: Clinical isolates of P. aeruginosa were collected from two representative reference laboratories during 2002-2004. Clinical information regarding specimens and type of hospital for isolates was investigated. Antimicrobial susceptibility against 11 antibiotics was tested by disk diffusion according to NCCLS criteria. MDR was assessed as resistance to > or =3 of the core drugs (ceftazidime, ciprofloxacin, gentamicin, imipenem and piperacillin). PCR assays and sequencing for detection of blaVIM-2 and blaIMP-1 gene were carried out. RESULTS: Of 1,748 P. aeruginosa isolates, 179 isolates were collected from primary care hospitals and 1,569 isolates were recovered from outpatients and inpatients in secondary care hospitals. From 2002 to 2004, rates of resistance to ceftazidime and imipenem increased from 10% to 12.3% and from 14.8% to 15.9%, respectively. Rates of resistance to amikacin (from 26.2% to 31.0%) and ciprofloxacin (from 35.6% to 46.2%) increased annually. In the period 2002-2004, decreasing of susceptibility to meropenem (from 83.4% to 76.8%) was observed, but meropenem was the most potent agent against P. aeruginosa isolates studied. During the 3-year period, MDR P. aeruginosa accounted for 26.4-33.5% of clinical isolates and the most common MDR phenotype was concurrent resistance to piperacillin, gentamicin and ciprofloxacin. The prevalence of VIM-2-producing isolates obviously increased from 1.7% in 2002 to 6.3% in 2004. CONCLUSIONS: These results suggested that MDR P. aeruginosa was already prevalent in one third of clinical isolates and VIM-2-producing P. aeruginosa isolates disseminated in non-tertiary care hospitals in Korea.

Antimicrobial Resistance among Clinical Isolates of Pseudomonas aeruginosa from Non-tertiary Care Hospitals in Korea, 2002-2004 / 감염과화학요법

BACKGROUND: Increasing numbers of resistant and multidrug resistant (MDR) isolates of Pseudomonas aeruginosa have become a worldwide problem. This report provides the trend of antimicrobial resistance, the proportions of MDR and metallo-beta-lactamase-producing isolates among clinical isolates of P. aeruginosa in Korea. MATERIALS AND METHODS: Clinical isolates of P. aeruginosa were collected from two representative reference laboratories during 2002-2004. Clinical information regarding specimens and type of hospital for isolates was investigated. Antimicrobial susceptibility against 11 antibiotics was tested by disk diffusion according to NCCLS criteria. MDR was assessed as resistance to > or =3 of the core drugs (ceftazidime, ciprofloxacin, gentamicin, imipenem and piperacillin). PCR assays and sequencing for detection of blaVIM-2 and blaIMP-1 gene were carried out. RESULTS: Of 1,748 P. aeruginosa isolates, 179 isolates were collected from primary care hospitals and 1,569 isolates were recovered from outpatients and inpatients in secondary care hospitals. From 2002 to 2004, rates of resistance to ceftazidime and imipenem increased from 10% to 12.3% and from 14.8% to 15.9%, respectively. Rates of resistance to amikacin (from 26.2% to 31.0%) and ciprofloxacin (from 35.6% to 46.2%) increased annually. In the period 2002-2004, decreasing of susceptibility to meropenem (from 83.4% to 76.8%) was observed, but meropenem was the most potent agent against P. aeruginosa isolates studied. During the 3-year period, MDR P. aeruginosa accounted for 26.4-33.5% of clinical isolates and the most common MDR phenotype was concurrent resistance to piperacillin, gentamicin and ciprofloxacin. The prevalence of VIM-2-producing isolates obviously increased from 1.7% in 2002 to 6.3% in 2004. CONCLUSIONS: These results suggested that MDR P. aeruginosa was already prevalent in one third of clinical isolates and VIM-2-producing P. aeruginosa isolates disseminated in non-tertiary care hospitals in Korea.

Annual Report on External Quality Assessment in Therapeutic Drug Monitoring in Korea (2005) / 임상검사와정도관리

Two trials of external quality assessment for Therapeutic Drug Monitoring (TDM) subcommittee of Korean Association of Quality Assurance for Clinical Pathology (KAQACP) were performed in 2005. The number of participating laboratories were increased to 95, by 6.7% comparing with the previous year. Response rates were 100.0% for both trials just like the two previous years. Two kinds of control materials were requested to be tested in each trial so that each institution could know the possible systematic error. In both trials, 20 test items were responded at least from one laboratory. The average drug item was 6.7 per institution, which was elevated slightly from 6.5 in recent 5 years. The most common test items were digoxin, valproic acid, carbamazepine, theophylline, phenytoin, and phenobarbital which were peformed in more than 65% of participating laboratories, followed by cyclosporine, lithium, vancomycin, tacrolimus, methotrexate, amikacin, gentamycin, tobramycin, salicylate, primidone, acetaminophen, free phenytoin, amitryptyline, and ethosuximide. The most widely used TDM analyzer was Abbott TDx/TDxFLx (41.7%), followed by Abbott AxSym (23.3%), and Roche Cobas Integra (19.2%). The inter-laboratory coefficients of variations were not much improved comparing with previous years. We also determined cyclosporine with reference method using liquid chromatography-tandem mass spectrometry. In conclusion, the TDM external quality assessment of 2005 showed grossly similar pattern comparing with those of previous year with increasing participating laboratories.

Annual Report on External Quality Assessment in Therapeutic Drug Monitoring in Korea (2004) / 임상검사와정도관리

Two trials of external quality assessment for Therapeutic Drug Monitoring (TDM) Subcommittee of Korean Association of Quality Assurance for Clinical Pathology (KAQACP) were performed in 2004. Number of participating laboratories were increased to 89, by 11.3% increase comparing with the previous year. Response rates were 100.0% for both trials just like the previous year. Two kinds of control materials were requested to be tested in each trial so that each institution could know the possible systematic error. In both trials, 20 test items were responded at least from one laboratory. The average drug item was 6.8 per institution, which was elevated slightly from 6.5 in recent 5 years. The most common test items were valproic acid, digoxin, phenytoin, carbamazepine, theophylline, and phenobarbital which were peformed in more than 71% of participating laboratories, followed by cyclosporine, lithium, tacrolimus, vancomycin, methotrexate, amikacin, gentamycin, salicylate, tobramycin, acetaminophen, primidone, free phenytoin, and amitryptyline. The most widely used TDM analyzer was Abbott TDx/TDxFLx (41.6%), followed by Roche Cobas Integra (21.3%), and Abbott AxSym (20.2%). The inter-laboratory coefficients of variations were not greatly improved comparing with previous years. We also determined cyclosporine and tacrolimus with reference method using liquid chromatography-tandem mass spectrometry. In conclusion, the TDM external quality assessment of 2004 showed grossly similar pattern comparing with those of previous year, except the 11.3% increase of participating laboratories.

Usefulness of Maternal Serum Amyloid A as a Predictor of Tocolytic Failure in Preterm Delivery / 대한산부인과학회잡지

OBJECTIVE: This study is directed to determine whether the concentrations of serum amyloid A (SAA) in maternal serum could be used to predict a tocolytic failure in preterm delivery, by comparing with other factors associated with inflammation. METHODS: A total of 100 pregnant women from September, 2000 to August, 2001 received continuous prenatal care and underwent delivery in our hospital was enrolled in the study. Gestational age was ranged between 20 and 37 weeks. Subjects were divided into four groups (group I, no preterm labor and no premature rupture of membranes [n=38]; group II, premature rupture of membranes and no preterm labor [n=12]; group III, preterm labor and no premature rupture of membranes [n=34]; Group IV, preterm labor and premature rupture of membranes [n=16]). The levels of SAA, CRP, ESR, and WBC count were measured in maternal serum. RESULTS: SAA levles, CRP levels, and WBC count in patients with tocolytic failure were significantly higher than those in patients without tocolytic failure. SAA and CRP appeared to be significant factors by logistic regression analysis. From the ROC curve analysis of maternal SAA for the prediction of tocolytic failure, we set 6 mg/L as a cut-off value in this study. Sensitivity, specificity, positive predictive value, and negative predictive value were 76%, 72%, 47.5%, and 90%, respectively. As for CRP, 0.59 mg/dL was set as a cut-off value, and sensitivity, specificity, positive predictive value, and negative predictive value were 72%, 81.3%, 56.3%, and 89.7%, respectively. When cut-off values for both SAA and CRP were applied at the same time, sensitivity, specificity, positive predictive value, and negative predictive value were 60%, 92%, 71.4%, and 87.3%, respectively. CONCLUSION: This study showed that the measurement of maternal serum amyloid A may be a fast, non-invasive diagnostic method in the prediction of tocolytic failure in preterm delivery.

Annual Report on External Quality Assessment in Therapeutic Drug Monitoring in Korea (2003) / 임상검사와정도관리

Two trials of external quality assessment for Therapeutic Drug Monitoring (TDM) subcommittee of Korean Association of Quality Assurance for Clinical Pathology (KAQACP) were performed in 2003. Number of participating laboratories were 80 which is similar to those of the previous year. Response rates were elevated to 100.0% for both trials. Two kinds of control materials were requested to be tested in each trial so that each institution could know the possible systematic error. In both trials, 20 test items were responded at least from one laboratory. The average drug item was 7.0 per institution, which was elevated slightly from 6.5 in recent 5 years. The most common test items were valproic acid, digoxin, phenytoin, carbamazepine, theophylline, and phenobarbital, which were peformed in more than 75% of participating laboratories, followed by cyclosporine, lithium, methotrexate, tacrolimus, vancomycin, amikacin, gentamycin, salicylate, tobramycin, acetaminophen, primidone, free phenytoin, and amitryptyline. The most widely used TDM analyzer was Abbott TDx/TDxFLx (52%), but its proportion were decreased slightly comparing with the previous years. The interlaboratory coefficients of variations were not greatly improved comparing with previous years. In conclusion, the TDM external quality assessment of 2003 showed grossly similar pattern comparing with those of previous year, except that the response rate was elevated to 100% and two levels of control material were used in each trials.

Annual Report on External Quality Assessment in Therapeutic Drug Monitoring in Korea (2002) / 임상검사와정도관리

Three trials of external quality assessment for Therapeutic Drug Monitoring (TDM) subcommittee of Korean Association of Quality Assurance for Clinical Pathology (KAQACP) were performed in 2002. Participating laboratories were 79 similar to the previous year. Response rates were 96.3% for 1st, 2nd, and third trials. In the first trial, 20 test items among 27 ones were responded from as least from one laboratory as follows: acetaminophen, amikacin, amitriptyline, carbamazepine, cyclosporine, digoxin, free phenytoin, gentamicin, lithium, methotrexate, phenobarbital, phenytoin, primidone, quinidine, salicylate, tacrolimus (FK-506), theophylline, tobramycin, valproic acid and vancomycin. In the second and third trial, the test items were same with those of 1st trial except the exclusion of quinidine. We included tacrolimus with a whole blood control material in addition to cyclosporine from the first trial. The most common test items were valproic acid, digoxin, phenytoin, carbamazepine, theophylline, and phenobarbital which were peformed in more than 77% of participating laboratories. The most widely used TDM analyzer was Abbott TDx/TDxFLx (56%), but its proportion were decreased slightly comparing with the previous years. In conclusion, we added tacrolimus from the year of TDM proficiency testing in 2002 and found grossly similar pattern comparing with those of previous years.

The Effects of Korean Red Ginseng and Irbesartan on Inhibition of Diabetic Nephropathy / 대한소아내분비학회지

PURPOSE: Ginseng has been reported to reduce blood glucose levels in diabetic animals and patients, and it is also reported to slow the aging process by acting as an anti-atherosclerotic agent or as an anti-oxidant. This study was designed to investigate whether ginseng and irbesartan can prevent the development of diabetic nephropathy in streptozotocin-induced diabetic rats. METHODS: Diabetes was induced in 7 week-old male Sprague-Dawley rats by intravenous injection of 60 mg/kg streptozotocin. Ginseng(1 g/kg/day) or irbesartan (20 mg/kg/day) was given to diabetic rats for 25 weeks. Blood glucose and body weight were checked weekly and urinary albumin excretion was evaluated every 6 weeks. At the end of the experiment, the kidneys were weighed and sliced for microscopic examination. Glomerular size and hyaline deposition were measured on light microscopy(on Masson' trichrome stain and PAS stain) and thickness of glomerular basement membrane(GBM) on electron microscopy. Renal histologic findings of ginseng or irbesartan treated rats were compared with those of normal control and diabetic control groups. RESULTS: The weight gain in diabetic rats was significantly reduced, and the final body weight of diabetic rats was lower than that of normal control rats. There was no significant difference in body weights between the diabetic control, ginseng, and irbesartan treated groups. Mean levels of blood glucose were significantly increased in diabetic rats compared to normal rats, but there was no significant difference in blood glucose among the three groups of diabetic rats. Urinary albumin excretion was increased in the diabetic groups compared to the normal control group, and it was significantly decreased in the irbesartan treated group compared to the diabetic control group at 13th week of treatment. At the end of the experiment, the kindeys of the diabetic rats were examined and showed significantly enlarged than those of the normal rats, and the ratio of kidney weight to body weight was decreased in the ginseng treated group compared to the diabetic control and irbesartan treated group. There was no significant difference in the size of glomerulus, the thickness of GBM, and glomerular hyaline deposition among the three diabetic groups. CONCLUSION: There was no significant hypoglycemic effect of ginseng in streptozotocin-induced diabetic rats. Renal hypertrophy was relatively milder in the ginseng-treated group, but there was no difference in findings of renal histology between the treatment groups.

Evaluation of Performance Including Interference Tests of Diasys Reagents on Hitachi 747 Analyzer / 대한임상병리학회지

BACKGROUND: We evaluated the analytical performances of Diasys reagents manufactured by Diasys Diagnostic Systems (Holzheim, Germany) with Hitachi 747. METHODS: We evaluated AST, ALT, ALP, gamma-GT, calcium, and glucose. Only two tests were adapt-ed to different methods from the current ones: the photometric test using the arsenazo III for calci-um, the kinetic colorimetric test according to Szasz/Persijin using l-gamma-glutamyl-3-carboxy-4-nitranilide as a substrate for gamma-GT. Precision, interference, linearity, and method comparisons were evaluated by NCCLS guidelines. RESULTS: The coefficient of variation (CV) of total precision was less than 6.8% in all items. Preci-sions and linearities of all items were acceptable. Correlation coefficients were more than 0.9884 and all items showed excellent agreement compared to the current reagents in the reportable range. We could not find any significant interference for six test items up to 750 mg/dL triglyceride, 50 mg/dL hemoglobin, and 20 mg/dL bilirubin, except that the latter ALT showed a negative bias by more than 5 mg/dL of bilirubin. CONCLUSIONS: Diasys reagents showed high precision, linearity and correlation in comparison to the current reagents. So we conclude that these reagents are good for routine clinical use with Hitachi 747.

Troponin T and CK-MB by Electrochemiluminescense Assay in Acute Coronary Syndrome / 대한임상병리학회지

BACKGROUND: Early diagnosis and treatment of acute coronary syndrome(ACS) encompassing acute myocardial infarction(AMI) and unstable angina(UA) is very important. Cardiac troponin T(cTnT) is known to be more specific to myocardium, and the level increases early and persistently during the period of 7 to 14 days after the onset of symptoms. The aim of this study was to evaluate the usefulness of cTnT for the diagnosis of ACS comparing with other biochemical markers. METHODS: The precision, linearity, lower limit of detection and interferences for cTnT by electrochemiluminescence were evaluated. cTnT and other conventional cardiac markers were determined for 128 AMI, 96 UA and 72 stable angina(SA) patients. The medical records of these patients were reviewed. RESULTS: cTnT-positive rates in AMI patients were 87.5-100% in all periods. cTnT positive rate was maintained as 100% from 3 hours to 96 hours after heart attack. Although CK-MB positive rate was as high as 85.7% at 6 hours, it decreased after 61 hours. The positive rate of LD and LD isoenzyme were very low(33.8-75%). In UA patients, mean positive rates of cTnT and CK-MB were 22.6% and 22.9% respectively. For the diagnosis of ACS comparing with SA, the sensitivity and specificity of cTnT were 63% and 94%(cut-off, 0.1 microgram/ml), meanwhile these of CK-MB were 53% and 90%, respectively(cut-off, 5 microgram/ml). CONCLUSIONS: cTnT was more useful and sensitive than CK-MB, LD, or LD isoenzyme. ACS also could be diagnosed with cTnT and CK-MB with sufficiently high specificity. cTnT seemed to be slightly more specific than CK-MB for the diagnosis of ACS.