강정옥
Ann Clin Microbiol 1998 September, 1(1): 1-3. Published on 20 September 1998.
Helicobacterpylori(H. pylori) 감염이 소화성 궤양의 중요한 유발인자로 밝혀지면서 소화성 궤양의 치료에 일대 혁신이 생기게 되었다. 위산분비를 억제시키는 전통적인 소화성 궤양의 치료 일년 후 재발율은 약 90%에 이르나 H. pylori를 박멸시키는 항균제로 치료하면 일년 후의 재발율은 20% 미만이라고 보고되었다. 1994년 미국의 NIH는 H. pylori로 감염된 모든 소화성 궤양환자는 항균제로 치료하도록 권장하였으며 현재 가장 널리 사용되는 치료법은 bismuth, metronidazole, amoxicillin의 삼제요법(triple therapy)으로 박멸률이 91%에 이르나, metronidazole에 내성인 균주에 의한 감염일 경우에 삼제요법의 박멸률이 65%로 떨어진다고 한다. 그러므로 metronidazole에 내성인 균주에 감염된 경우에는 metronidazole 대신 clarithromycin이 권장된다.
필자는 3년여 H. pylori를 배양하고 metronidazole과 clarithromycin에 대한 항균제 감수성검사를 시행해 오고 있는데, 그동안 미생물분야에 경험이 많지 않은 임상병리전문의들과 소화기내과의사들로부터 H. pylori의 배양과 항균제 감수성검사에 대한 문의를 여러 차례 받은 바 있다. H. pylori에 관심이 많은 소화기내과의사들이 중심이 되어 H. pylori 연구회도 발족되었고(1997년), 한국에서 분리된 H. pylori 균주는 주치료제인 metronidazole에 대한 내성률이 46.2%로 높으므로 향후 H. pylori의 배양 및 항균제 감수성검사에 대한 요구는 점차 증가되리라 추정된다. 그러므로 아직 이를 실시하고 있지 않은 임상병리과에서는 H. pylori의 배양과 항균제 감수성검사에 대한 준비를 해 둘 필요가 있다고 생각된다. 이에 연자는 이 균의 배양과 항균제 감수성검사에 초점을 맞추어 실제 업무에 도움이 되기를 바라며 연자의 경험을 나누고자 한다.
[in Korean]
이환종
Ann Clin Microbiol 1998 September, 1(1): 4-10. Published on 20 September 1998.
바이러스 감염증의 진단은 다음의 몇 가지 이유에서 근래에 그 중요성이 새로이 인식되고 있다. 첫째, 선천성 감염증, 뇌염, 면역억제환자 등의 바이러스 감염증에서 그 원인을 밝힘으로써 환자의 예후를 추측할 수 있다. 둘째, 항바이러스 제제의 사용, 병원감염의 방지, 임신 초기 풍진에 감염시 유산을 시키는 것과 같이 감염을 일으킨 바이러스에 따라서는 적극적인 처치를 해야하는 경우가 많다. 셋째, 호흡기 감염, 뇌막염 등에서는 바이러스 감염이 증명됨으로써 불필요한 검사, 입원, 항생제 투여 등을 중지함으로써 경제적으로 도움을 얻을 수 있다. 넷째, 인플루엔자, 일본뇌염 등의 진단은 보건정책 수립에 영향을 미칠 수 있다. 다섯째, 환자를 진료하는 사람들이 진단 가능한 바이러스 질환에 대해 더 잘 알게 됨으로써 이후에 비슷한 환자의 진료에 도움을 줄 수 있다.
[in Korean]
Joon Haeng Rhee, M.D.
Ann Clin Microbiol 1998 September, 1(1): 11-13. Published on 20 September 1998.
Vibrio vulnificus is a halophilic estuarine bacterium that causes fatal primary septicemia and necrotizing wound infections. The gram negative bacterium was first identified in 1976 and clinical syndromes associated with the organism were described in 1980. In Korea, clinical cases were first reported in 1979 and the bacterium was first isolated in 1982. The primary septicemia occurs following ingestion of raw seafood. V. vulnificus preferentially affects subjects with hepatic diseases, heavy alcohol drinking habit, diabetes mellitus, hemochromatosis, and immunosuppression from corticosteroid therapy, AIDS, and malignancy. The primary septicemia progresses very rapidly and results in high fatality, 50 to 80% in a day or two.
Eui-Chong Kim, M.D.
Ann Clin Microbiol 1998 September, 1(1): 14-14. Published on 20 September 1998.
Several molecular techniques has been introduced recently for the differentiation of microbial isolates: plasmid profiles, restriction fragment length polymorphism of chromosomal DNA or plasmids, ribotyping, arbitrarily primed PCR, pulsed-field gel electrophoresis(PFGE), and phylogenetic analysis. Molecular strain typing became an essential tool for epidemiological investigation. And conventional serotyping or phage typing methods are so time-consuming and labor-intensive that molecular fingerprinting methods are used as a substitute. Clinical microbiology laboratory cannot help doing strain typing for infection prevention and control, and should make a good choice among them in respect of efficiency and cost effectiveness.
Sook Jin Jang, M.D.
Ann Clin Microbiol 1998 September, 1(1): 15-21. Published on 20 September 1998.
Recently, two groups reported independently on the isolation of new positive-trand RNA viruses, designated hepatitis G virus (HGV) & GB virus C (GBV-C). Sequence analysis revealed that both genomes are different isolates of the same virus & represent a new genus of Flaviviridae.
The prevalence of HGV ranges from 0.9 to 10% among blood donors throughout the world. A high prevalence of HGV RNA has been found in subjects with frequent parenteral exposure, including intravenous drug users, patients on hemodialysis, patients with hemophilia and patients with anemia.
HGV is a blood borne virus that is parenterally transmitted. Vertical transmission has also been reported. HGV commonly occurs as a coinfection with another hepatitis virus such as HCV or HBV. However, HGV coinfection usually does not alter the clinical course or level of biochemical marker and the response to antiviral therapy of chronic hepatitis B or C in these patients. Acute HGV infection rarely causes acute hepatitis and is unlikely to be a major cause of chronic non-A-E hepatitis or fulminant viral hepatitis.
HGV infection can be diagnosed by PCR assay to detect the viral RNA in serum. An enzyme-linked immunosorbent assay (ELISA) for detection of antibodies to recombinant HGV putative envelope protein E2 was recently available. But antibodies to E2 appears to be a serological marker for diagnosing recovery from HGV infection. Since the role of HGV as a etiologic agent of liver disease is unclear, therapy is not recommended at this point.
[in Korean]
Won Kil Lee, M.D.
Ann Clin Microbiol 1998 September, 1(1): 22-23. Published on 20 September 1998.
모든 새로운 항균제를 임상 치료에 사용하면 그 효능에 대하여 내성균이 생기게 마련이지만, 반코마이신 내성 황색 포도구균이 보고된 일은 아직 없었으며, 단지 중등도의 내성을 나타내는 vancomycin-intermediate S. aureus(VISA), 즉 반코마이신의 MIC(최소억제농도)가 8-16 ug/mL인 중등도 내성 황색 포도구균에 의한 감염이 최근 미국에서 보고[1,2]되어 관심을 끌게 되었다. 1 병원 감염이나 사회 감염의 가장 흔한 원인균 중 하나이며, 특히 MRSA 감염 치료에 반코마이신을 많이 사용하므로써 VRE(vancomycin-resistant enterococci) 분리가 많아 졌고, 또 CNS는 반코마이신에 대한 내성이 증가하고 있다. 반코마이신 중등도 내성 CNS의 감염 이들 균주들은 테이코프라닌에도 동시에 중등도 내성을 나타내어 이들을 glycopetide-intermediate S. aureus(GISA)[3]라고 명명하고 있다. 이들에서 장구균이 갖고 있는 van A, B, C 유전자는 발견되지 않아 다른 내성 기전임을 추측케한다.
메티실린 내성 황색 포도구균(MRSA)을 치료하는데 사용되는 반코마이신과 테이코프라닌은 glycopeptides 계통의 대표적인 제품이다. 이 중 반코마이신은 현재 미국에서 사용되는 유일한 제품이며, 테이코프라닌은 임상시험을 하고 있다[4]고 한다. 반코마이신은 원래 페니실린에 내성인 포도구균에 대한 효과로 소개되었으며, 황색 포도구균 중에도 특히, MRSA를 치료하거나, 페니실린이나 세팔로스포린 계열에 알러지가 있는 환자에서 사용된다. 작용기전은 세포벽의 전구물질인 D-alanyl-D-alanine과 복합체를 만들므로써, 세균의 세포막에서 펩티도글라이칸의 합성을 억제하는 것이다.
황색 포도구균과 CNS(코아귤라제 음성 포도구균)는 병원 감염이나 사회 감염의 가장 흔한 원인균 중 하나이며, 특히 MRSA 감염 치료에 반코마이신을 많이 사용하므로써 VRE(vancomycin-resistant enterococci) 분리가 많아 졌고, 또 CNS는 반코마이신에 대한 내성이 증가하고 있다.
[in Korean]
Tae Youn Choi, M.D.
Ann Clin Microbiol 1998 September, 1(1): 24-32. Published on 20 September 1998.
매년 여름철이 되어 집중적으로 냉방장치가 가동되면 냉각탑수의 Legionella 균 오염이 예견됨에 따라 국내 매스컴들은 레지오넬라증의 발생우려를 대대적으로 보도하여 국민들을 일시적으로 불안감에 휩싸이게 한다. 레지오넬라증의 원인인 Legionella 균은 오염된 환경수 내에서 외부 기온이 높아짐에 따라 증식하며 에어로졸 형태로 냉방기계, 샤워물 등을 통하여 확산되어 감염을 유발할 수 있다.
레지오넬라증은 세계 도처에서 집단 발생으로 문제가 되고 있을 뿐만 아니라 면역기능저하 환자에서 발생하는 원내 폐렴의 주요 원인으로 인지되고 있고, 또한 지역적인 차이가 있으나 과거 10년 동안 원인균을 규명할 수 없는 지역사회 폐렴의 주요 원인균으로 대두되고 있다[1-4].
국내에서도 이미 집단 발생 사례를 비롯하여 증례가 종종 보고되고 있으며[5-12], 여름철 대형건물의 냉각탑수가 Legionella 균에 상당히 오염되어 있는 점을 고려할 때[13] 아직 레지오넬라증의 진단이 체계적으로 이루어지지 않는 국내 여건 하에서 그 발생 가능성이 심각하게 부각되고 있는 주요 감염증의 하나이다.
그러므로 지금까지 알려진 레지오넬라증의 역학, 세균학, 진단 및 치료, 환경감시 등에 대하여 기술하고자 한다.
[in Korean]
Wee Gyo Lee, M.D.
Ann Clin Microbiol 1998 September, 1(1): 33-36. Published on 20 September 1998.
최근 vancomycin 내성 장구균(vancomycin-resistant enterococci：VRE)의 급증으로 인하여 감염 질환 분야에서는 새로운 도전에 직면하고 있다. 장구균은 지난 수년간 병원감염의 주원인균이었고 또한 VRE의 경우는 대부분 다약제 내성을 나타내므로 치료에 어려움이 따르며[1-3], 아직 실험실내에서만 증명된 바 있으나 내성이 Staphylococcus aureus등에 전달될 수 있다는 문제가 있다[4]. 이러한 심각성으로 인하여 Hospital Infection Control Practice Advisory Committee(HICPAC)에서는 1995년 vancomycin 내성 전파 방지를 위한 권장 지침을 발표한 바 있다[5]. 병원내 VRE 전파를 예방하기 위해서는 빠르고 정확하게 VRE를 동정하고 내성형을 결정하여 VRE 발생원을 찾아내고 전파를 방지하여야 한다. 이에 저자는 분자생물학적 방법을 이용한 VRE 내성 유전자형 결정법에 관하여 알아보고, 신속하고 간단하게 미생물 검사실에서 적용할 수 있는 방법을 소개하고자 한다.
[in Korean]
Jong Hee Shin, M.D.
Ann Clin Microbiol 1998 September, 1(1): 37-43. Published on 20 September 1998.
In the past decades there has been a dramatic increase in the number of opportunistic fungal infections. Establishing the diagnosis of opportunistic fungal infections in compromised patients is not simple. The laboratory diagnostic tests include microscopic examination, culture and serological tests. Although the most reliable method is the histologic examination, various opportunistic fungal agents can reveal similar histologic morphology. Culture should be attempted, however, the isolation of these organisms from cultures must be interpretated with caution, because the causing agents for opportunistic fungal infections are common laboratory contaminants. Serology for fungal infections has limited value except cryptococcal antigen: the usefulness of detection of antigenemia in invasive candidiasis and invasive aspergillosis has been limited by the rapid clearance of Candida mannan and Aspergillus galactomann from serum, which results in only moderate sensitivity for the disease. Therefore, it should be appreciated that every laboratory test, for the diagnosis of opportunistic infections, has its limitations and should be interpreted with caution.
[in Korean]
Mi Ae Lee, M.D. and Jung Won Huh, M.D.
Ann Clin Microbiol 1998 September, 1(1): 44-50. Published on 20 September 1998.
Backgrounds: Helicobacter pylori infection is now recognized as a cause of chronic gastritis, peptic ulcer disease, gastric carcinoma and lymphoma. Several diagnostic methods of H. pylori infection, such as histopathology, culture, rapid urease test, urea breath test, serologic test and polymerase chain reaction (PCR) have been used. This study aimed to compare different diagnostic methods of H. pylori infection and determined the appropriate cut-off value of IgG anti-H. pylori antibody using receiver operating characteristic (ROC) curve.
Methods: We compared sensitivities, specificities and efficiencies of histology, CLO test, culture, IgG anti-H. pylori Ab and PCR using the ureC gene in gastric biopsy specimens from 112 H. pylori patients and 140 control group.
Results: The sensitivities of histology, CLO test, culture, IgG anti-H. pylori Ab and PCR were 72%, 91%, 86%, 82% and 94%, respectively and the specificities of histology, CLO test, culture, IgG anti-H. pylori Ab and PCR were 96%, 99%, 100%, 73% and 99%, respectively. The efficiencies of histology, CLO test, culture, IgG anti-H. pylori Ab and PCR were 88%, 96%, 89%, 77% and 97%, respectively. From the ROC curve, the cut-off value of the anti-H. pylori Ab determined 10U/mL in which sensitivity was 82% and specificity was 82%.
Conclusions: These findings suggest that the PCR assay in gastric biopsy is the most sensitive and efficient diagnostic method of H. pylori infection and the cut-off value of the anti-H. pylori Ab determines 10U/mL showing highest efficiency.
[in Korean]
Chul Hun Chang, M.D., Jeong Whan Shin, M.D., Han Chul Son, M.D., Chul Min Kim, M.D. and Ju Hyun Lee, M.D.
Ann Clin Microbiol 1998 September, 1(1): 51-56. Published on 20 September 1998.
Background: In the year 1996, there were some outbreaks of Salmonella typhi infection in Pusan and therefore, the incidence of S. typhi infection was markedly increased in comparison with the previous year. To differentiate the isolates epidemiologically, a random amplified polymorphic DNA (RAPD) fingerprinting method has been developed.
Methods: A total of 9 arbitrary primers were screened with S. typhi strains isolated in Pusan, 1996. This allowed selection of a panel of primers capable of detecting DNA polymorphisms among S. typhi isolates. This panel was used to examine 54 strains of S. typhi, which had been isolated in Pusan including the cases of outbreaks that was previously characterized by phage typing.
Results: Four single primers and one combination of two primers were selected to discriminate the S. typhi isolates. RAPD analysis resolved the 54 strains into 20 different subtypes. At least two outbreaks were found by RAPD analysis. The isolates of E1 phage type, which are the most common in Korea, were perfectly differentiated with each other, except the strains isolated within the outbreaks.
Conclusion: The RAPD approach is the useful epidemiologic tool to S. typhi subtyping, which is providing high discriminatory power. There were at least two outbreaks when the epidemic Salmonella infections of Pusan in 1996 had been occurred. The primers or their combination capable to discriminate the S. typhi isolates were described.
[in Korean]
Eun Gyung Ko, M.D., Chang Jung Kim, M.D., Key Earn Lee, M.D., Jihyun Cho, M.D., and Young Hoe Moon, M.D.
Ann Clin Microbiol 1998 September, 1(1): 57-62. Published on 20 September 1998.
Background: In developed countries, food-borne diseases have decreased and hospital laboratory have taken more simple method rather than complex enrichment-selective methods. But detection rate of pathogenic bacteria in stool culture was not so high.
Methods: We mixed 4 pathogenic bacteria (S. typhi, S. flexneri, V. cholerae and Y. enterocolitica) with 3 stool specimens from healthy persons (for Y. enterocolitica, 5 specimens) and inoculated directly or after enrichment (10^5 bacteria/plate). After proper incubation, we counted suspected colonies and calculated true positive rate after identification of each colonies.
Results: For S. typhi, in the case of direct innoculation on the MacConkey, XLD and SS agar, positive rate of selected colonies were below 36.6%. After enrichment in SF broth for 8 hours, the rate were 80.0%, 83.0% and 70.0% respectively. For S. flexneri, the rates were 86.7%, 100%, 93.3% in direct innoculation, and were highest after enrichment in GN broth for two hours (93.3% in MacConkey and 100.0% in both XLD and SS agar). For V. cholerae, inspite of screening by catalase and oxidase tests, positive rate of selected colonies were 0% (0/7 colonies) in direct innoculation on the MacConkey. After enrichment in APW about 1 day and on TCBS agar, the rate were 100%. For Y. enterocolitica, after incubation at room temperature for 2 days, most selected colonies were Y. enterocolitica on CIN media.
Conclusion: For more efficient detection of pathogenic bacteria in stool culture, combination of direct innoculation on MacConkey agar and on one or two selective media after proper enrichment process, should be considered.
[in Korean]
Yong Kohn Cho, M.D., Dal Sik Kim, M.D., Sam Im Choi M.D., and Hye Soo Lee, M.D.
Ann Clin Microbiol 1998 September, 1(1): 63-67. Published on 20 September 1998.
Background：Blood culture has been used for finding the etiology of bacteremia. The results of its susceptibility test can be an important tool for deciding the direction of treatment. However, the rate of positive blood culture is very low; it, most of all, is because of the abuse of antimicrobials. Especially under the condition which allows anyone to get antimicrobials at any pharmacies and hospitals without antimicrobial susceptibility test as in Korea, the abuse of antimicrobials be brought about, but there is no concrete information about it.
Methods：The rate of antimicrobial abuse and the serum antimicrobial activities of 106 patients, whose blood was requested for diagnosis of bacteremia, were investigated, and the results were compared with blood culture results. Thirteen mililiters of blood was aseptically extracted; 10 ml out of it was used for blood culture and the serum separated from 3ml of blood was used for serum antibacterial activities. For the test of serum antimicrobial activities, standard strain of bacteria, Staphylococcus aureus ATCC 25923, which are susceptible to every antibiotics was used. And for the blood culture, blood samples were inoculated to aerobic and anaerobic culture broth, and incubated in the automated blood culture system. The abuse of antimicrobials were investigated by the interview with patients and the medical records at admission.
Results：The antimicrobial abuse rate was 78.3%(83/106), and the rate of positive blood culture was as low as 6.6%(7/106). The rate of positive serum antibacterial activity was 47.2%(50/106). The rate of positive blood culture in the group of positive serum antimicrobial activity was only 4%(2/50) and that in the group of negative serum antimicrobial activity was 8.9%(5/56). And in the group of positive blood culture, the rate of positive serum antimicrobial activity was 28.6%(2/7) and the rate of negative activity was 71.4%(5/7).
Conclusions：The antimicrobial abuse rate in Korea was considerably high, and the rate of positive blood culture was very low. The rate of positive blood culture in the group of positive serum antibacterial activity was conspicuously lower than that in the group of negative ones. According to these results, the use of antimicrobials before blood culture should be carefully considered for the diagnosis and treatment of bacterial infection.
[in Korean]
Jeong Hwan Shin, M.D., Chul Hun Chang, M.D., Han Chul Son, M.D., and Kwang Ok Park, M.D.
Ann Clin Microbiol 1998 September, 1(1): 68-74. Published on 20 September 1998.
Background：Several risk factors related with vancomycin-resistant Enterococcus (VRE) colonization are well known, but the direct relatedness of the use of glycopeptides with VRE colonization is not confirmed yet. So we evaluated the influence of the use of glycopeptides and other variables, as risk factors on intestinal colonization with VRE.
Methods：In glycopeptide-administered inpatients group, multiple stool specimens were collected on the day of glycopeptides administration, and weekly after that, until VRE were detected. In the inpatients and outpatients control groups, stool were obtained with point survey. The specimens were inoculated on m-enterococcus agar with 6mg/L vancomycin. The phenotypes and genotypes of resistance of the VRE isolates were confirmed by disk diffusion and agar dilution tests, and polymerase chain reaction.
Results：Of the 361 patients(530 specimens), twelve VRE(3.3%) were isolated. The rates of intestinal colonizations were not significantly differed between the inpatients groups with or without glycopeptides administration, which are 5.1 and 4.1%, respectively. The colonization rates were significantly higher in the patients with 30 or more hospital stay, and in those with three or more antimicrobial administrations. vanA and vanC genes were amplified in the isolates.
Conclusions：It is demonstrated that the use of glycopeptides is not a direct risk factor of intestinal colonization of VRE in Pusan National University Hospital, in which the prescription of glycopeptides is rigidly controlled. But, a shortened stay in the hospital will diminish the intestinal colonization of VRE.
[in Korean]
Chang-Seok Ki, M.D., Seong Kyu Lee, M.D., Jang Ho Lee, M.T., and Nam Yong Lee, M.D.
Ann Clin Microbiol 1998 September, 1(1): 75-81. Published on 20 September 1998.
Background: We tried to evaluate the incidence and clinical significance of coagulase-negative staphylococci (CoNS) with reduced susceptibilities to glycopeptides. In addition, the ability of disk diffusion and Vitek system to detect CoNS with reduced susceptibilities to glycopeptides were compared with the standard agar dilution method.
Methods: One hundred and nineteen clinical isolates of CoNS were recovered at Samsung Medical Center from June to July 1998 and were examined for their susceptibilities to vancomycin and teicoplanin by disk diffusion method (30-µg disk), Vitek system with GPS-AA card, and agar dilution for the determination of MICs. The records of all patients, from whom CoNS with decreased susceptibility to glycopeptide was isolated, were reviewed.
Results: All CoNS showed uniform susceptibility to vancomycin by all three methods but 11 strains (9.2%) exhibited reduced susceptibilities to teicoplanin (MICs, 16 to 32 µg/mL). All but suspected colonized strains were nosocomially acquired and were isolated from 7 different wards. None were previously treated with teicoplanin. The concordance rates of disk diffusion method and Vitek system with agar dilution method were 94.1% and 84%, respectively. However, the sensitivity of disk diffusion method and Vitek system were only 50.0% and 62.5%, respectively.
Conclusions: This study demonstrates that CoNS with reduced susceptibilities to glycopeptides is not uncommon and may cause true infections in clinical settings. However, neither disk diffusion method nor Vitek system could differentiate these strains from more susceptible isolates.
[in Korean]
Young Uh, M.D., Jeong Seog Son, M.D., Gyu Yel Hwang, M.D., In Ho Jang, M.D., Kap Jun Yoon, M.D., and Dong Min Seo, M.D.
Ann Clin Microbiol 1998 September, 1(1): 82-96. Published on 20 September 1998.
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 Cedeca (1.0%). Among the genus of the family Enterobacteriaceae, Budvicia, Edwardsiella, Erwinia, Hafnia, Kluyvera, Leineriella, 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 frequency 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.
[in Korean]
Bo-Moon Shin M.D. and Seung-Ok Paik, M.T.
Ann Clin Microbiol 1998 September, 1(1): 97-103. Published on 20 September 1998.
Background : Continuous monitoring blood culture systems (CMBCS) reduce the time and false negative rates of bacterial growth compared with the traditional manual blood culture systems which have been used in many hospitals yet. The purpose of this study is to evaluate the terminal subcultures monitored by Vital system compared with the manual system and to determine the guideline of terminal subcultures.
Methods : A retrospective study was conducted over a period of one year (from January to December 1995) with manual blood culture system and and sixteen months (from February 1996 to May 1997) with Vital system. All of the positive and negative blood bottles were done Gram staining and subcultured aerobically and anaerobically with 7-day terminal subculture protocol. All of the isolates were identified with API systems or ATB systems.
Results : Among 3,344 cases with the manual system, 305 cases (9.1%) were declared positive and 424 cases (8.8%) out of 4,822 cases with Vital system were positive. The terminal subcultures detected 48 cases (1.44%) in manual system and 9 cases (0.19%) in Vital system according to 7-day protocol. No statistical differences were observed in results among 5 day, 7 day and terminal subcultures. Those of false negative organisms were gram positive cocci (22 cases), Enterobacteriaceae (13 cases), non-fermenters (12 cases) and gram positive rod (1 case) with the manual system and gram positive cocci (4 cases), Entrobacteriaceae (1 case), non-fermenter (1 case) and yeasts (3 cases) with Vital system.
Conclusions : These results suggest that terminal subculture of Vital system-negative blood culture bottles is not necessary except S. aureus and fungus bacteremia on the basis of clinical situation.
[in Korean]
Mi Yeon Choi, M.D., Seong Soo Jang, M.D., Jung Oak Kang, M.D., and Myung Ju Ahn, M.D.
Ann Clin Microbiol 1998 September, 1(1): 104-108. Published on 20 September 1998.
The major cause of pseudomembranous colitis is known to be Clostridium difficile (C. difficile). There are few reports that Clostridium species other than C. difficile has caused pseudomembranous colitis. We report a case of pseudomembranous colitis caused by Clostridium glycolicum (C. glycolicum).
A 47-year-old woman who had operational history for rectal cancer 3 months ago, was readmitted with diarrhea of 3 days duration. Seven weeks before admission, she had received ornidazole and ceftriaxone due to diarrhea and abdominal pain, and her symptoms were improved. She had received additional radiation therapy for rectal cancer during six weeks before the recent onset of diarrhea. On admission, she complained of watery diarrhea ten times a day and abdominal pain. She had tenderness on both lower abdomen. Pseudomembrane was observed by colonoscopic and histologic examination. VIDAS C. difficile toxin A II assay was positive and C. glycolicum was isolated in the stool. She recovered after receiving oral metronidazole treatment.
[in Korean]
Soo Youn Lee, M.D., Jung Soo Lee, M.D., Mi Ae Lee, M.D., Wha Soon Chung, M.D. and Seon Ju Kim, M.D.
Ann Clin Microbiol 1998 September, 1(1): 109-112. Published on 20 September 1998.
The group A streptococcus is capable of producing exotoxins that have been linked to a toxic shock-like syndrome. Streptococcal toxic shock syndrome is a rapidly progressive associated with injury to multiple organ systems and a 30-60% mortality rate. These cases are very rare in Korea. We present a case of 32-year-old pregnant woman who developed streptococcal toxic shock syndrome following intrauterine fetal death. She manifested hypotension, shock, increased level of creatinine, disseminated intravascular coagulopathy, liver impairment, renal failure, pulmonary edema and adult respiratory distress syndrome. Blood cultures yielded Streptococcus pyogenes. After 17 hours on admission, she died in spite of massive transfusion, antibiotics therapy and ventilatory support. Clinicians should be alert to the importance of early diagnosis and treatment of this lethal infection.
[in Korean]
Hyun Yong Hwang, M.D., Seok Hoon Jeong, M.D., Hark Rim, M.D., Mi Hyang Kim, M.D., Tae Jeon Jeong, M.T., Byeong Gil Choi, M.T.
Ann Clin Microbiol 1998 September, 1(1): 113-116. Published on 20 September 1998.
A 60-year-old male with continuous ambulatory peritoneal dialysis was admitted because of abdominal discomfort and turbid dialysate. He had a history of chronic renal failure due to diabetic nephropathy. His WBC count of peripheral blood was 8,500/mm³ (neutrophil 92%), and that of dialysate was 1,400/mm³ (polymorphonuclear leukocyte 69%, lymphocyte 31%). Pure growth of Leclercia adecarboxylata was isolated from dialysate. The L. adecarboxylata isolate was susceptible to ampicillin, ampicillin/sulbactam, cephalothin, cefoperazone, cefoxitin, cefotaxime, ceftazidime, aztreonam, imipenem, gentamicin, tobramycin, amikacin, tetracycline, trimethoprim-sulfamethoxazole and ciprofloxacin. Cephalothin & amikacin were added into dialysate, and his clinical symptoms and turbidity of dialysate were resolved. L. adecarboxylata has been rarely isolated from clinical specimens. To our knowledge, this is the first report of L. adecarboxylata isolated from clinical specimen in Korea. On review of the world literature, we found only 7 cases of L. adecarboxylata infections. This microorganism has been isolated from lower extremity wounds and sputum as part of a mixed flora in 3 cases and 1 case, respectively, but it was the only microorganism isolated from cultures of blood in 3 cases. These 3 patients with bacteremia due to L. adecarboxylata had severe underlying diseases, and clinical symptoms were developed after invasive procedures. All of the L. adecarboxylata isolates from clinical specimens were susceptible to antimicrobial agents tested, and the responses to antibiotic therapy were excellent. It is difficult to identify this organism because its biochemical reactions are similar to those of Escherichia coli, therefore careful identification is required. And additional studies are necessary to determine the pathogenic potential and route of infection of this organism.
[in Korean]
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