Comparison of Plasma Metabolites From Patients With Non-Small Cell Lung Cancer by Erlotinib Treatment and Skin Rash.

Erlotinib is a necessary anticancer treatment for non-small cell lung cancer (NSCLC) patients yet it causes severe side effects such as skin rash. In this study, researchers compared the untargeted compound profiles before and after erlotinib administration to observe changes in blood metabolites in NSCLC patients. The levels of 1005 substances changed after taking erlotinib. The levels of 306 and 699 metabolites were found to have increased and decreased, respectively. We found 5539 substances with peak area differences based on the presence of skin rash. Carbohydrate, amino acid, and vitamin metabolic pathways were altered in response to the onset of erlotinib-induced skin rash. Finally, this study proposed using plasma metabolites to identify biomarker(s) induced by erlotinib, as well as target molecule(s), for the treatment of dermatological toxic effects.

Exogenous Transforming Growth Factor-ß in Brain-Induced Symptoms of Central Fatigue and Suppressed Dopamine Production in Mice.

Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is one of the most refractory diseases in humans and is characterized by severe central fatigue accompanied with various symptoms that affect daily life, such as impaired memory, depression, and somatic pain. However, the etiology and pathophysiological mechanisms of CFS remain unknown. To investigate the pathophysiological role of transforming growth factor (TGF)-ß1, we injected a cytokine into the lateral ventricle of a C57BL/6 mouse. The intracranial injection of TGF-ß1 increased the immobility duration in a forced swimming test (FST) and time spent at the closed arm in elevated plus maze (EPM) analysis. The mice injected with TGF-ß1 into their brain showed increased sensitivity to pain in a von Frey test, and had a decreased retention time on rotarod and latency time in a bright box in a passive avoidance test. In addition, the serum levels of muscle fatigue biomarkers, lactate dehydrogenase (LDH) and creatine kinase (CK), were significantly increased after administration of TGF-ß1. Intracranial injection of TGF-ß1 significantly reduced the production of tyrosine hydroxylase (TH) in the ventral tegmental area, accompanied by a decreased level of dopamine in the striatum. The suppression of TH expression by TGF-ß1 was confirmed in the human neuroblastoma cell line, SH-SY5Y. These results, which show that TGF-ß1 induced fatigue-like behaviors by suppressing dopamine production, suggest that TGF-ß1 plays a critical role in the development of central fatigue and is, therefore, a potential therapeutic target of the disease.

Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolates from a Korean hospital that carry blaOXA-23.

To elucidate the epidemicity of carbapenem-resistant Acinetobacter baumannii (CRAB), we investigated the antimicrobial susceptibility, the genetic basis of antimicrobial resistance, and the ability to form biofilms of 147 CRAB isolates collected between 2013 and 2015 from a Korean hospital based on sequence types (STs). Six different STs were identified: ST191 (n=47) and ST208 (n=36) were clones that had already been identified in the study hospital, whereas ST229 (n=28), ST369 (n=18), ST357 (n=17), and ST552 (n=1) were previously unknown. All the CRAB isolates exhibited an extensively drug-resistance. Twelve isolates, including ST191 and ST208, were resistant to tigecycline, and two were resistant to colistin. All the isolates carried ISAbaI-blaOXA-23 structures. The presence of the armA gene and/or a combination of aminoglycoside-modifying enzyme genes (aacC1, aadA1, aacA4, aphA1, and aphA6) was responsible for high-level resistance to aminoglycosides (minimal inhibitory concentrations≥256mg/L). All the ST229 isolates carried the blaPER-1 gene, whereas all the ST357 and ST369 isolates carried both aacA4 and aadA1. The ST229 isolates exhibited the greatest tendency to form biofilms, whereas the ST369 isolates exhibited significantly less tendency to form biofilms than other isolates. In conclusion, we discovered clonal diversity in the CRAB isolates from the study hospital. The resistant gene profiles and biofilm formation capabilities of the emerging CRAB STs differed from those of the circulating STs. The potential relationship between these genotypic and phenotypic traits and the epidemic capacity of CRAB STs requires further investigation.

Molecular epidemiology and antimicrobial susceptibility of Clostridium difficile isolates from two Korean hospitals.

Clostridium difficile is one of the main etiological agents causing antibiotic-associated diarrhea. This study investigated the genetic diversity of 70 toxigenic C. difficile isolates from two Korean hospitals by employing toxinotyping, ribotyping, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE). Toxin gene amplification resulted in 68 A⁺B⁺ and two A-B+ isolates. Most isolates (95.7-100%) were susceptible to daptomycin, metronidazole, and vancomycin. Seventy C. difficile isolates were classified into five toxinotypes, 19 ribotypes, 16 sequence types (STs), and 33 arbitrary pulsotypes. All C. difficile isolates of ribotype 018 (n = 38) were classified into ST17, which was the most prevalent ST in both hospitals. However, C. difficile isolates of ST17 (ribotype 018) exhibited pulsotypes that differed by hospital. ST2 (ribotype 014/020), 8 (ribotypes 002), 17 (ribotype 018), and 35 (ribotypes 015) were detected in both hospitals, whereas other STs were unique to each hospital. Statistical comparison of the different typing methods revealed that ribotyping and PFGE were highly predictive of STs. In conclusion, our epidemiological study indicates that C. difficile infections in both hospitals are associated with the persistence of endemic clones coupled with the emergence of many unique clones. A combination of MLST with PFGE or ribotyping could be useful for monitoring epidemic C. difficile strains and the emergence of new clones in hospitals.

Assessment of collagen antibody-induced arthritis in BALB/c mice using bioimaging analysis and histopathological examination.

The aim of this study was to examine the therapeutic potential of sulfasalazine and prednisolone in a mouse collagen antibody-induced arthritis (CAIA) model. Twenty-five male BALB/c mice were randomly divided into five groups: group 1 (G1): control, group 2 (G2): probe control, group 3 (G3): CAIA, group 4 (G4): CAIA+sulfasalazine (10 mg/kg, oral), and group 5 (G5): CAIA+prednisolone (100 mg/kg, oral). Fluorescence bioimaging was performed in vivo 24 and 48 h after treatment with a fluorescence probe (OsteoSense® 680 EX), and all mice were sacrificed. The hind knee joints were fixed in 10% neutral phosphate-buffered formalin, and micro-computed tomography (micro-CT) and histopathological analyses were performed. The paw thickness increased in a time-dependent manner in G3 mice, but trended toward a decrease in both G4 and G5 mice. Fluorescence intensity increased in G3 mice at 24 and 48 h after fluorescence probe treatment, but the fluorescence intensity in G4 and G5 mice was lower than that in G3. Micro-CT analyses showed that the joint surfaces of G3 mice had a rough and irregular articular appearance, but the occurrence of these irregularities was lower in G4 and G5. Hematoxylin and eosin and Safranin O-fast green staining confirmed that destruction of the cartilage and bony structures, synovial hyperplasia, and inflammatory cell infiltration all occurred in G3, and that the occurrence of these phenomena was lower in G4 and G5 than in G3. Taken together, these results suggest that sulfasalazine and prednisolone can reduce acute rheumatoid arthritis in mice.

Two Cases of Bacteremia Due to Roseomonas mucosa.

Roseomonas is a genus of pink-pigmented nonfermentative bacilli. These slow-growing, gram-negative cocobacilli form pink-colored colonies on sheep blood agar. They differ from other pink-pigmented nonfermenters, including Methylobacterium, in morphology, biochemical characteristics, and DNA sequence. Roseomonas strains are rarely isolated in clinical laboratories; therefore, we report two cases in order to improve our ability to identify these pathogens. We isolated two strains of Roseomonas mucosa from the venous blood cultures of two patients, an 84-yr-old woman with common bile duct obstruction and a 17-yr-old male with acute myeloid leukemia who had an indwelling central-venous catheter for chemotherapy. The isolated strains were confirmed as R. mucosa by 16S rRNA sequencing.

Complete genome of the multidrug-resistant Acinetobacter baumannii strain KBN10P02143 isolated from Korea.

Acinetobacter baumannii, a strictly aerobic, non-fermentative, Gram-negative coccobacillary rod-shaped bacterium, is an opportunistic pathogen in humans. We recently isolated a multidrug-resistant A. baumannii strain KBN10P02143 from the pus sample drawn from a surgical patient in South Korea. We report the complete genome of this strain, which consists of 4,139,396 bp (G + C content, 39.08%) with 3,868 protein-coding genes, 73 tRNAs and six rRNA operons. Identification of the genes related to multidrug resistance from this genome and the discovery of a novel conjugative plasmid will increase our understanding of the pathogenicity associated with this species.

Complete genome of the multidrug-resistant Acinetobacter baumannii strain KBN10P02143 isolated from Korea

Acinetobacter baumannii, a strictly aerobic, non-fermentative, Gram-negative coccobacillary rod-shaped bacterium, is an opportunistic pathogen in humans. We recently isolated a multidrug-resistant A. baumannii strain KBN10P02143 from the pus sample drawn from a surgical patient in South Korea. We report the complete genome of this strain, which consists of 4,139,396 bp (G + C content, 39.08%) with 3,868 protein-coding genes, 73 tRNAs and six rRNA operons. Identification of the genes related to multidrug resistance from this genome and the discovery of a novel conjugative plasmid will increase our understanding of the pathogenicity associated with this species.

Modulation of Apoptosis and Differentiation by the Treatment of Sulfasalazine in Rabbit Articular Chondrocytes.

This study was conducted to examine the cellular regulatory mechanisms of sulfasalazine (SSZ) in rabbit articular chondrocytes treated with sodium nitroprusside (SNP). Cell phenotype was determined, and the MTT assay, Western blot analysis and immunofluorescence staining of type II collagen was performed in control, SNP-treated and SNP plus SSZ (50~200 µg/mL) rabbit articular chondrocytes. Cellular proliferation was decreased significantly in the SNP-treated group compared with that in the control (p < 0.01). SSZ treatment clearly increased the SNP-reduced proliferation levels in a concentration-dependent manner (p < 0.01). SNP treatment induced significant dedifferentiation and inflammation compared with control chondrocytes (p < 0.01). Type II collagen expression levels increased in a concentration-dependent manner in response to SSZ treatment but were unaltered in SNP-treated chondrocytes (p < 0.05 and < 0.01, respectively). Cylooxygenase-2 (COX-2) expression increased in a concentration-dependent manner in response to SSZ treatment but was unaltered in SNP-treated chondrocytes (p < 0.05). Immunofluorescence staining showed that SSZ treatment increased type II collagen expression compared with that in SNP-treated chondrocytes. Furthermore, phosphorylated extracellular regulated kinase (pERK) expression levels were decreased significantly in the SNP-treated group compared with those in control chondrocytes (p < 0.01). Expression levels of pERK increased in a concentration-dependent manner by SSZ but were unaltered in SNP-treated chondrocytes. pp38 kinase expression levels increased in a concentration-dependent manner by SSZ but were unaltered in control chondrocytes (p < 0.01). In summary, SSZ significantly inhibited nitric oxide-induced cell death and dedifferentiation, and regulated extracellular regulated kinases 1 and 2 and p38 kinase in rabbit articular chondrocytes.

Dermabacter jinjuensis sp. nov., a novel species of the genus Dermabacter isolated from a clinical specimen.

A Gram-stain-positive, catalase-positive, facultatively anaerobic, non-motile, coryneform bacterium, designated strain 32T, was isolated from a closed pus sample from a patient having finger necrosis in Korea. Strain 32T was considered as representing a novel species according to its initial identification by matrix-assisted laser desorption/ionization-time-of-flight MS. Phylogenetic analysis based on 16S rRNA gene sequences revealed that strain 32T belonged to the genus Dermabacter and was closely related to Dermabacter hominis DSM 7083T (=ATCC 49369T) (98.34 % similarity). Optimal growth was observed at 30-40 °C and pH 7. Growth occurred in the presence of 0-6 % (w/v) NaCl. Menaquinones MK-8, MK-7 and MK-9 were the major respiratory quinones. The major polar lipids were phosphatidylethanolamine, phosphatidylcholine, glycolipid and two unknown lipids. The major cellular fatty acids were anteiso-C17 : 0, anteiso-C15 : 0, iso-C16 : 0 and iso-C15 : 0. The DNA G+C content of strain 32T was 62.58 mol%, and the mean level of DNA-DNA relatedness between strain 32T and D. hominis ATCC 49369T was 49±1.6 %. Based on the phenotypic and genotypic characteristics, strain 32T is confirmed to represent a novel species of the genus Dermabacter, for which the name Dermabacter jinjuensis sp. nov. is proposed. The type strain is 32T (=NCCP 16133T=DSM 101003T).

POEMS Syndrome with IgG-λ/IgA-κ Biclonal Gammopathy and Abnormal Serum Free Light Chain Ratio: a Case Report.

BACKGROUND: POEMS syndrome is a rare paraneoplastic disorder with atypical plasma cell proliferation. Cases of POEMS syndrome presented with either biclonal gammopathy or an abnormal serum free light chain ratio are considered uncommon. The present authors encountered a case of POEMS syndrome with IgG-λ/IgA-κ biclonal gammopathy with dominant κ free light chain and abnormal serum free light chain ratio. CASE: A 56-year-old man with a history of Castleman disease was suspected with POEMS syndrome and admitted for further evaluation for B-cell proliferative disease to rule out multiple myeloma. He also had a sustained tingling sensation on both feet and gait disturbance, which were compatible with diffuse peripheral sensorimotor polyneuropathy with demyelinating features. His laboratory findings revealed hyperlipidemia and hypothyroidism, and he had hypertrichosis. The results of the serum and urine protein electrophoresis seemed normal, except a very weak band at the end of the serum gamma region. Serum immunofixation electrophoresis confirmed IgG-λ and IgA-κ biclonal gammopathy, with an increased serum IgA concentration and normal levels of IgG, IgM, and IgD. Both serum free light chain κ and λ values were increased, and the κ/λ ratio was higher than normal. CONCLUSIONS: The finding of IgG-λ/IgA-κ biclonal gammopathy and abnormal serum free light chain ratio with dominant κ clonality in our case was definitely rare. However, a primary pathogenic role of the different paraproteinemia in POEMS syndrome remains unclear. Further studies to identify better management modalities for POEMS syndrome is needed.

Gallotannin causes differentiation and inflammation via ERK­1/­2 and p38 kinase pathways in rabbit articular chondrocytes.

Gallotannin (GT) is a type of tannic acid, derived from plant polyphenols, that is an agonist of plant defense mechanisms. Tannins have two types of structure; condensed tannins are a polymer of flavonoid units, while hydrolysable tannins are carbohydrates. GT is used in medical agents for its anti­viral, anti­bacterial and anti­parasitic effects. The present study investigated the effects of GT on differentiation and inflammation in rabbit articular chondrocytes. GT caused differentiation and inflammatory responses in the rabbit articular chondrocytes. GT treatment induced the expression of type Ⅱ collagen and sulfated proteoglycan, as determined by western blot analysis and alcian blue staining, respectively, in a dose­ and time­dependent manner. Additionally, treatment with GT increased the expression of cyclooxygenase­2 (COX­2) and the production of prostaglandin E2 (PGE2), as determined by western blot analysis and PGE2 assay. GT was confirmed to cause phosphorylation of ERK­1/­2 and p38 kinase. Inhibition of pERK with PD98059 promoted GT­induced type Ⅱ collagen expression. However, the inhibition of p38 with SB203580 suppressed GT­induced COX­2 expression and PGE2 production. In summary, the results demonstrated that GT­induced ERK­1/­2 and p38 kinase have opposite effects on differentiation and inflammation in rabbit articular chondrocytes.

Clinical value of whole-blood interferon-gamma assay in patients with suspected pulmonary tuberculosis and AFB smear- and polymerase chain reaction-negative bronchial aspirates.

Combining a polymerase chain reaction (PCR) test with bronchoscopy is frequently performed to allow a rapid diagnosis of smear-negative pulmonary tuberculosis (PTB). However, limited data are available concerning clinical judgment in patients with suspected PTB and AFB smear- and PCR-negative bronchial aspirates (BA). The present study evaluated the usefulness of whole-blood QuantiFERON-TB Gold In-Tube (QFT) testing in these patients. Of 166 patients with suspected PTB who had undergone bronchoscopy because of smear-negative sputum or inadequate sputum production, 93 (56%) were diagnosed with culture-positive PTB. Seventy-four patients were either AFB smear- or PCR-positive. In the 75 patients whose BA AFB smear and PCR results were both negative, 19 were finally diagnosed with PTB by culture. The QFT test had a negative predictive value of 91% for PTB. The QFT test may be useful for excluding PTB in patients with suspected PTB whose BA AFB smear and PCR results are both negative.

[Novel influenza A (H1N1) infection in immunocompromised patients].

BACKGROUND: Since April 2009, novel influenza A (H1N1) infection is spreading throughout the world. This infection might be fatal for immunocompromised patients who are at a potentially high risk of developing infectious complications. We investigated the detection rate and features of H1N1 infection in immunocompromised patients. METHODS: Between August 2009 and February 2010, we examined 8,112 subjects, including 390 immunocompromised patients, for H1N1. Swab samples were taken from the nose and throat of the participants. Real-time PCR was performed to identify H1N1 viral genes. RESULTS: Positive results were obtained in 2,953/8,112 (36.4%) subjects and 46/390 (11.8%) immunocompromised patients. H1N1 was identified in 8.7% patients with solid cancer, 12.9% patients with hematologic malignancy, 16.7% patients with chronic renal disease, and 14.5% patients with kidney transplantation. The mean cycle threshold (Ct) value of PCR was significantly lower (P<0.05) in patients with hematologic malignancy as compared to that in patients with chronic renal disease and control subjects. Four patients died due to respiratory complications. CONCLUSIONS: The detection rate of H1N1 was significantly lower in immunocompromised patients than in other patients. The Ct value of patients with hematologic malignancy was significantly lower than that of other immunocompromised patients and control subjects.

[Reducing patient waiting time for the outpatient phlebotomy service using six sigma].

BACKGROUND: One of the challenging issues of the outpatient phlebotomy services at most hospitals is that patients have a long wait. The outpatient phlebotomy team of Kyungpook National University Hospital applied six sigma breakthrough methodologies to reduce the patient waiting time. METHODS: The DMAIC (Define, Measure, Analyze, Improve, and Control) model was employed to approach the project. Two hundred patients visiting the outpatient phlebotomy section were asked to answer the questionnaires at inception of the study to ascertain root causes. After correction, we surveyed 285 patients for same questionnaires again to follow-up the effects. RESULTS: A defect was defined as extending patient waiting time so long and at the beginning of the project, the performance level was 2.61 sigma. Using fishbone diagram, all the possible reasons for extending patient waiting time were captured, and among them, 16 causes were proven to be statistically significant. Improvement plans including a new receptionist, automatic specimen transport system, and adding one phlebotomist were put into practice. As a result, the number of patients waited more than 5 min significantly decreased, and the performance level reached 3.0 sigma in December 2007 and finally 3.35 sigma in July 2008. CONCLUSIONS: Applying the six sigma, the performance level of waiting times for blood drawing exceeding five minutes were improved from 2.61 sigma to 3.35 sigma.

Ectopic expression of cyclooxygenase-2-induced dedifferentiation in articular chondrocytes.

Cyclooxygenase-2 (COX-2) is known to modulate bone metabolism, including bone formation and resorption. Because cartilage serves as a template for endochondral bone formation and because cartilage development is initiated by the differentiation of mesenchymal cells into chondrocytes (Ahrens et al., 1977; Sandell and Adler, 1999; Solursh, 1989), it is of interest to know whether COX-2 expression affect chondrocyte differentiation. Therefore, we investigated the effects of COX-2 protein on differentiation in rabbit articular chondrocyte and chick limb bud mesenchymal cells. Overexpression of COX-2 protein was induced by the COX-2 cDNA transfection. Ectopic expression of COX-2 was sufficient to causes dedifferentiation in articular chondrocytes as determined by the expression of type II collagen via Alcian blue staining and Western blot. Also, COX-2 overexpression caused suppression of SOX-9 expression, a major transcription factor that regulates type II collagen expression, as indicated by the Western blot and RT-PCR. We further examined ectopic expression of COX-2 in chondrifying mesenchymal cells. As expected, COX-2 cDNA transfection blocked cartilage nodule formation as determined by Alcian blue staining. Our results collectively suggest that COX-2 overexpression causes dedifferentiation in articular chondrocytes and inhibits chondrogenic differentiation of mesenchymal cells.

ERK-1/-2 and p38 kinase oppositely regulate 15-deoxy-delta(12,14)-prostaglandinJ(2)-Induced PPAR-gamma activation that mediates dedifferentiation but not cyclooxygenase-2 expression in articular chondrocytes.

Peroxisome proliferator-activated receptor gamma (PPAR-gamma) is a ligand-activated transcription factor and plays an important role in growth, differentiation, and inflammation in different tissues. In this study, we investigated the effects of 15d-PGJ(2), a high-affinity ligand of PPAR-gamma, on dedifferentiation and on inflammatory responses such as COX-2 expression and PGE(2) production in rabbit articular chondrocytes with a focus on ERK-1/-2, p38 kinase, and PPAR-gamma activation. We report here that 15d-PGJ(2) induced dedifferentiation and/or COX-2 expression and subsequent PGE(2) production. 15d-PGJ(2) treatment stimulated activation of ERK-1/-2, p38 kinase, and PPAR-gamma. Inhibition of ERK-1/-2 with PD98059 recovered 15d-PGJ(2)-induced dedifferentiation and enhanced PPAR-gamma activation, whereas inhibition of p38 kinase with SB203580 potentiated dedifferentiation and partially blocked PPAR-gamma activation. Inhibition of ERK-1/-2 and p38 kinase abolished 15d-PGJ(2)-induced COX-2 expression and subsequent PGE(2) production. Our findings collectively suggest that ERK-1/-2 and p38 kinase oppositely regulate 15d-PGJ(2)-induced dedifferentiation through a PPAR-gamma-dependent mechanism, whereas COX-2 expression and PGE(2) production is regulated by ERK-1/-2 through a PPAR-gamma-independent mechanism but not p38 kinase in articular chondrocytes. Additionally, these data suggest that targeted modulation of the PPAR-gamma and mitogen-activated protein kinase pathway may offer a novel approach for therapeutic inhibition of joint tissue degradation.

15-deoxy-Delta 12,14-ProstaglandinJ2 regulates dedifferentiation through peroxisome proliferator-activated receptor-gamma-dependent pathway but not COX-2 expression in articular chondrocytes.

Peroxisome proliferator-activated receptors-gamma (PPAR-gamma) is critical for phenotype determination at early differentiation stages of mesenchymal cells, whereas its physiological role is unclear. Therefore, we investigated the role of 15-deoxy-Delta(12,14)-prostaglandinJ2 (15d-PGJ2), the natural receptor ligand for PPAR-gamma, on dedifferentiation and inflammatory responses, such as COX-2 expression and PGE2 production, in articular chondrocytes. Our data indicate that the 15d-PGJ2 caused a loss of differentiated chondrocyte phenotype as demonstrated by inhibition of type II collagen and proteoglycan synthesis. 15d-PGJ2 also induced COX-2 expression and PGE2 production. The 15d-PGJ2-induced dedifferentiation effect seems to be dependent on PPAR-gamma activation, as the PPRE luciferase activity increased and PPAR-gamma antagonist, BADGE, abolished type II collagen expression. However, BADGE did not block 15d-PGJ2-induced COX-2 expression. Collectively, our findings suggest that PPAR-gamma-dependent and -independent mechanisms of 15d-PGJ2-induced dedifferentiation and inflammatory responses in articular chondrocytes, respectively. Additionally, these data suggest that targeted modulation of the PPAR-gamma pathway may offer a novel approach for therapeutic inhibition of joint tissue degradation.

Molecular characterization of Pseudomonas aeruginosa isolates resistant to all antimicrobial agents, but susceptible to colistin, in Daegu, Korea.

Multi-drug resistant Pseudomonas aeruginosa has been implicated in a variety of serious therapeutic problems in clinical environments. Among the 968 P. aeruginosa isolates obtained from two hospitals in Daegu, Korea, we acquired 17 isolates that were resistant to all available tested antimicrobial agents, with the exception of colistin (colistin-only sensitive). We characterized the antimicrobial susceptibilities, metallo-beta-lactamases, and epidemiological relatedness among the colistin-only sensitive P. aeruginosa isolates. All colistin-only sensitive isolates were positive in the modified Hodge test and imipenem-EDTA synergy test, thereby indicating the production of metallo-beta-lactamases. 11 isolates from the secondary hospital and six isolates from the tertiary teaching hospital harbored blaVIM-2 and blaIMP-1, respectively. The pulsed-field gel electrophoretic analysis of the SpeI-digested DNA from P. aeruginosa isolates indicated that two different clones of colistin-only sensitive P. aeruginosa originated from each hospital, and had spread within the hospital environment. Overall, colistin-only sensitive P. aeruginosa was detected in Korea for the first time, but no pan-drug resistant bacteria were identified. Nationwide surveillance is required in order to monitor the emergence of colistin-only sensitive or pan-drug resistant bacteria.