Effects of subinhibitory concentrations of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus.

BACKGROUND: The effects of subinhibitory concentrations (sub-MICs) of antibacterial agents on the biofilm-forming ability of Staphylococcus aureus require further study. AIM: To investigate the effects of sub-MICs of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates. METHODS: MRSA isolates were collected from patients with bloodstream infections at a tertiary care hospital. The basal level of biofilm formation and biofilm induction by sub-MICs of chlorhexidine and mupirocin were evaluated by measuring biofilm mass stained with Crystal Violet. FINDINGS: Of the 112 MRSA isolates tested, 63 (56.3%) and 44 (39.3%) belonged to sequence type (ST)5 and ST72 lineages, respectively, which are the predominant healthcare- and community-associated clones in South Korea. ST5 isolates were more likely to have chlorhexidine MIC ≥4 (73.0% vs 29.5%), resistance to mupirocin (23.8% vs 0%), agr dysfunction (73.0% vs 9.1%), and qacA/B gene (58.7% vs 2.3%) compared to ST72 isolates. The basal level of biofilm formation ability was frequently stronger in ST72 isolates compared to ST5 isolates (77.3% vs 12.7%). Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in 56.3% and 53.6%, respectively, of all isolates. Biofilm induction was more prevalent in ST5 isolates (85.7% for chlorhexidine, 69.8% for mupirocin) than in ST72 isolates (15.9% for chlorhexidine, 27.3% for mupirocin). CONCLUSION: Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in half of the clinical MRSA isolates. Our results suggest that ST5 MRSA biofilm can be induced together with some other bacterial virulent factors following exposure to chlorhexidine, which might confer a survival advantage to this clone in the healthcare environment.

Police Officers' Knowledge and Attitudes Toward Brain Death and Organ Donation in Korea.

BACKGROUND: Administrative processing by the police may affect the process involved in organ donation in the event of an accidental brain injury. The purpose of this study was to evaluate the knowledge and attitude of police toward brain-dead donors and organ donation. METHODS: This was a descriptive research study using a 41-item questionnaire. As of July 19, 2017, 11 police stations in Seoul had collected questionnaires completed by 115 police officers. Data were analyzed using SAS (version 9.4) software. RESULTS: There were statistically significant differences in the scores on knowledge about brain death/donation according to religion (P = .022). Attitude was significantly positively correlated with the knowledge about brain-death organ donation (P = .029). CONCLUSION: It is necessary to understand and cooperate with the police when processing brain death organs from accidents. Education about organ donation can enhance the information and knowledge of the police and can also help to establish a positive attitude about organ donation.

Severe fever with thrombocytopenia syndrome-associated encephalopathy/encephalitis.

OBJECTIVES: Severe fever with thrombocytopenia syndrome (SFTS) virus has a variety of central nervous system (CNS) manifestations. However, there are limited data regarding SFTS-associated encephalopathy/encephalitis (SFTSAE) and its mechanism. METHODS: All patients with confirmed SFTS who underwent cerebrospinal fluid (CSF) examination due to suspected acute encephalopathy were enrolled in three referral hospitals between January 2013 and October 2016. Real-time RT-PCR for SFTS virus and chemokine/cytokines levels from blood and CSF were analysed. RESULTS: Of 41 patients with confirmed SFTS by RT-PCR for SFTS virus using blood samples, 14 (34%) underwent CSF examination due to suspected SFTSAE. All 14 patients with SFTSE revealed normal protein and glucose levels in CSF, and CSF pleocytosis was uncommon (29%, 4/14). Of the eight patients whose CSF was available for further analysis, six (75%) yielded positive results for SFTS virus. Monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) level in CSF were significantly higher than those in serum (geometric mean 1889 pg/mL in CSF versus 264 pg/mL in serum for MCP-1, p = 0.01, and geometric mean 340 pg/mL in CSF versus 71 pg/mL in serum for IL-8, p = 0.004). CONCLUSIONS: The CNS manifestation of SFTS as acute encephalopathy/encephalitis is a common complication of SFTS. Although meningeal inflammation was infrequent in patients with SFTSAE, SFTS virus was frequently detected in CSF with elevated MCP-1 and IL-8. These findings indicate that possible direct invasion of the CNS by SFTS virus with the associated elevated cytokine levels in CSF may play an important role in the pathogenesis of SFTSAE.

Late paradoxical lymph node enlargement during and after anti-tuberculosis treatment in non-HIV-infected patients.

SETTINGS: A tertiary referral centre in South Korea. OBJECTIVE: To investigate the incidence, clinical characteristics and outcomes of late paradoxical response (>4 months after the initiation of anti-tuberculosis treatment) during and after anti-tuberculosis treatment in non-human immunodeficiency virus (HIV) infected patients with lymph node tuberculosis (TB). DESIGN: We retrospectively reviewed the medical records of non-HIV-infected patients with lymph node TB between 1997 and 2007, and prospectively enrolled patients with newly diagnosed lymph node TB between 2008 and 2013. RESULTS: Of 467 patients with confirmed and probable lymph node TB, 83 (18%) displayed a paradoxical response: 57 of these (69%) were classified as early and 26 (31%) as late paradoxical response. Patients with late paradoxical response (median 12 months) received more prolonged anti-tuberculosis treatment than those with early (median 9 months, P < 0.001) or no paradoxical response (median 9 months, P < 0.001). The frequency of post-treatment lymph node enlargement increased progressively from those without any paradoxical response (6%), through those with an early response (12%) to those with a late response (23%). CONCLUSIONS: Paradoxical response presents late in about one third of non-HIV-infected patients with lymph node TB who experience a response. Although anti-tuberculosis treatment is commonly prolonged in patients with late paradoxical response, post-treatment lymph node enlargement is more frequent in these patients.

Satisfaction with the organ donation process of brain dead donors' families in Korea.

PURPOSE: The purpose of this study was to investigate the satisfaction of the families of brain dead donors with regard to donation processes as well as their emotions after the donation. METHOD: A cross-sectional survey study was performed that included 45 families of brain-dead donors in 1 hospital-based organ procurement organization (HOPO) in Korea between February 2007 and April 2011. RESULTS: Donor willingness and desire in life was the most frequent reason organs were donated (34.5%), followed by the advice of family members or friends (31.0%). Satisfaction with the organ donation processes was 4.04 of 6 points. In each category, the satisfaction with the decision of donation was the highest (4.96 points) and the satisfaction with the procedure of donation was the lowest (3.07 points); of each question, the satisfaction of "information and help on funeral arrangements was enough" and "the process of preparing the relevant documents was cumbersome" was the lowest. "Missing" the dead person and "pride" were the most common emotions experienced after organ donation (69.0% and 62.1%, respectively), followed by "grief," "family coherence," and "guilt." Religious practices were observed to be most helpful for psychological stress relief after donation, followed by spending time with family and friends. Moreover, 24.1% responded that they had not yet overcome their suffering. CONCLUSION: Because donors' own willingness is the most common reason that families choose donation, it is necessary to remind the public of the importance of organ donation through education and public relations using mass communication approaches. Additionally, because the families felt grief and guilt as well as missing their loved ones and pride regarding their dead loved ones after organ donation, continuous and systematic supports are needed to promote their psychological stability.

Enterococcus avium bacteremia: a 12-year clinical experience with 53 patients.

Because Enterococcus avium is rarely isolated from blood cultures, little is known about the clinical features and outcomes of bacteremia caused by this organism, formerly called "group Q streptococcus". We retrospectively evaluated the clinical features and outcomes of patients with clinically significant bacteremia caused by E. avium presenting at a tertiary-care hospital in Korea between February 1997 and February 2009. We identified 53 patients over the 12-year period; of these, 27 (50.9%) had biliary and 13 (24.5%) had intra-abdominal E. avium infections. Thirty-six (67.9%) of the episodes were polymicrobial. Thirty-three (62.3%) episodes were nosocomial bloodstream infections and resistance to vancomycin was not observed. The crude mortality rate was 24.5% (13/53), and the E. avium bacteremia-related mortality rate was 11.3% (6/53). Multivariate analysis showed that underlying rapidly fatal or ultimately fatal disease (adjusted odds ratio [AOR], 6.92; 95% confidence interval [CI], 1.56-30.65; P = 0.011) and inadequate antimicrobial therapy (AOR, 7.29; CI, 1.27-41.93; P = 0.026) were independent risk factors for mortality. In summary, bacteremia due to E. avium was commonly of biliary or intraabdominal origin and was often associated with polymicrobial bacteremia. The crude mortality rate was considerable. Severe underlying conditions and inadequate antimicrobial therapy were significant and independent risk factors for crude patient mortality.

Polypyrimidine tract-binding protein interacts with HnRNP L.

Polypyrimidine tract-binding protein (PTB) is involved in pre-mRNA splicing and internal ribosomal entry site (IRES)-dependent translation. In order to identify cellular protein(s) interacting with PTB, we performed a yeast two-hybrid screening. Heterogeneous nuclear ribonucleoprotein L (hnRNP L) was identified as a PTB-binding protein. The interaction between PTB and hnRNP L was confirmed in an in vitro binding assay. Both PTB and hnRNP L were found to localize in the nucleoplasm, excepting the nucleoli, in HeLa cells by the green fluorescent protein (GFP)-fused protein detection method. The N-terminal half of PTB (aa 1-329) and most of hnRNP L (aa 141-558) is required for the interaction between PTB and hnRNP L.