• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.168-174
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• 2015

Drug-resistant tuberculosis (TB) is still a major threat worldwide. However, recent scientific advances in diagnostic and therapeutic tools have improved the management of drug-resistant TB. The development of rapid molecular testing methods allows for the early detection of drug resistance and prompt initiation of an appropriate treatment. In addition, there has been growing supportive evidence for shorter treatment regimens in multidrug-resistant TB; and for the first time in over 50 years, new anti-TB drugs have been developed. The World Health Organization has recently revised their guidelines, primarily based on evidence from a meta-analysis of individual patient data (n=9,153) derived from 32 observational studies, and outlined the recommended combination and correct use of available anti-TB drugs. This review summarizes the updated guidelines with a focus on the medical management of drug-resistant TB.

• Clinical and Experimental Pediatrics
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• v.52 no.5
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• pp.529-537
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• 2009

Drug-resistant tuberculosis in children has important implications for both the patients and tuberculosis control programs. In Korea, among all new patients, the isoniazid resistance rate was 9.9% and multidrug-resistant tuberculosis rate was 2.7% in 2004 (in patients aged 10-19 yr, the multidrug-resistant tuberculosis rate reached 2.1%). Tuberculosis in pediatric patients is difficult to diagnose because many children have nonspecific clinical signs and the detection rates of acid-fast bacilli smears and cultures are low. Therefore, every effort should be made to identify adult sources and obtain information on drug susceptibility because symptomatic adult patients have a higher chance of culture positivity and drug-susceptibility patterns are the same in most adult-child pair patients. Korean children are at significant risk of drug-resistant tuberculosis. As the isoniazid resistance rate is greater than 4% among the new cases in Korea, a four-drug regimen should be considered for initial treatment of children with active tuberculosis, unless drug-susceptibility test results are available. Treatment of drug-resistant tuberculosis in children is challenging and there are only few available data. Tuberculosis control programs should be continuous with specific focus on pediatric populations because they can serve as reservoirs for future active cases. Further studies are needed regarding treatment of drug-resistant tuberculosis in children.

• Tuberculosis and Respiratory Diseases
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• v.85 no.3
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• pp.256-263
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• 2022

Background: Mycobacterium tuberculosis (Mtb) is resistant to the β-lactam antibiotics due to a non-classical transpeptidase in the cell wall with β-lactamase activity. A recent study showed that meropenem combined with clavulanate, a β-lactamase inhibitor, was effective in multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). However, in Korea, clavulanate can only be used as drugs containing amoxicillin. In this study, we investigated the susceptibility and genetic mutations of drug-resistant Mtb isolates to amoxicillin-clavulanate and meropenem-clavulanate to improve the diagnosis and treatment of drug-resistant TB patients. Methods: The minimum inhibitory concentration (MIC) of amoxicillin-clavulanate and meropenem-clavulanate was examined by resazurin microtiter assay. We used 82 MDR and 40 XDR strains isolated in Korea and two reference laboratory strains. Mutations of drug targets blaC, blaI, ldtA, ldtB, dacB2, and crfA were analyzed by polymerase chain reaction and DNA sequencing. Results: The MIC₉₀ values of amoxicillin/clavulanate and meropenem/clavulanate in drug-resistant Mtb isolates were 64/2.5 and 16/2.5 mg/L, respectively. Gene mutations related to amoxicillin/clavulanate and meropenem/clavulanate resistance could not be identified, but T448G mutation was found in the blaC gene related to β-lactam antibiotics' high susceptibility. Conclusion: Our results provide clinical consideration of β-lactams in treating drug-resistant TB and potential molecular markers of amoxicillin-clavulanate and meropenem-clavulanate susceptibility.

• The Journal of the Korean life insurance medical association
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• v.28 no.1_2
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• pp.15-18
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• 2009

Background: Recent emergence of drug-resistant tuberculosis such as multidrug-resistant tuberculosis(MDR-TB) or extensively drug-resistant tuberculosis(XDR-TB) has become important health care problems. It has also became grave issues for insurance industries in determining medical risks. We have therefore strived to analyze the comparative mortality rates for drug-resistant tuberculosis through utilization of results from previous articles. Methods: Comparative mortality was calculated from source articles using mortality analysis methods. Results: Mortality ratio of MDR-TB was estimate to 1200%, and excess death rate was 110 per 1,000. Comparative mortality between MDR-TB and XDR-TB by Korean $study^{(1)}$ were 1750, 382, 405, 443, 1025, and 357%, for each 10 months study intervals, respectively. Total mortality ratio was 594% and total excess death rate was 60 per 1,000person. It was determined that the risk of XDR-TB was much greater than MDR-TB. Discussion; Pending the development of a novel anti-tuberculosis drug, it would be prudent to steer clear insuring XDR-TB during underwriting phase due to high medical cost that it creates.

• Korean Journal of Veterinary Research
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• v.21 no.1
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• pp.25-31
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• 1981

A total of 250 enteric bacteria (148 Escherichia coli, 41 Klebsiella pneumoniae, 46 Enterobacter spp. and 15 Proteus spp.) isolated from bovine udder infections in 1979 through 1980 were examined for drug resistance and prevalence of R. plasmids. The drug tested were streptomycin (SM), kanamycin (KM), ampicillin (AP), chloramphenicol (CP), tetracycline (TC), gentamicin (GM), oxolinic acid (OA) and nalidixic acid (NA). The detection of R. plasmids was performed with Escherichia coli ML 1410 NAr as the recipient. Of the 148 Escherichia coli isolated, 68(45.9%) were found to be resistant to one or more drugs tested, and about 50% of the resistant strains were multiply resistant. of the 68 drugresistant strains, 13(19.1%) were found to carry R. plasmids which were capable of performing a conjugal transfer. CP resistance was transfered together with the other resistance. Of 41 strains of Klebsiella pneumoniae isolated, 90.2% were resistant to the drugs, alone or in combination thereof. Strains resistant to AP and TC were 63.4%, and 48.8%, respectively. R. plasmids were detected in 78.4% of the drug-resistant strains, and these strains transfered all or a part of their drug resistance pattern. AP and CP resistance were transfered in 100% of AP and CP-resistant strains. Eleven (37.9%) of 29 R. plasmids showed a thermosensitive transfer. Of the 46 strains of Enterobacter spp. isolated, 37(80.4%) were resistant to the drugs tested. A high percentage of resistance was noted for AP(65.2%). All strains resistant to four or more drugs transferred their resistances to Escherichia coli ML 1410, but strains resistant to three or fewer drugs did not transfer the resistances. All of the 15 Proteus strains isolated were resistant to more than two drugs. of them, 6 were quadruple resistance to SM, KM, CP and TC, and 9 were double one to AP and TC. Three (20.0%) of the drug-resistant isolates had R.plasmids conferring AP and TC resistance. GM, OA and NA of the drugs tested were very active to all of 250 Gram-negative enteric bacteria isolated from bovine udder infections.

• Journal of Microbiology and Biotechnology
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• v.33 no.10
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• pp.1281-1291
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• 2023

Infectious diseases caused by drug-resistant Escherichia coli (E. coli) pose a critical concern for medical institutions as they can lead to high morbidity and mortality rates. In this study, amygdalin exhibited anti-inflammatory and antioxidant activities, as well as other potentials. However, whether it could influence the drug-resistant E. coli-infected cells remained unanswered. Amygdalin was therefore tested in a cellular model in which human macrophages were exposed to resistant E. coli. Apoptosis was measured by flow cytometry and the lactate dehydrogenase (LDH) assay. Western immunoblotting and quantitative reverse-transcription polymerase chain reaction (qRT-PCR) were used to quantify interleukin-18 (IL-18), interleukin-1β (IL-1β), and interleukin-6 (IL-6). The production of reactive oxygen species (ROS) in macrophages was detected by ROS kit. The expression of pan-apoptotic proteins in macrophages was measured by qRT-PCR and Western immunoblotting. Drug-Resistant E. coli inhibited cell viability and enhanced apoptosis in the cellular model. In cells treated with amygdalin, this compound can inhibit cell apoptosis and reduce the expression of pro - inflammatory cytokines such as IL-1β, IL-18 and IL-6. Additionally, it decreases the production of PANoptosis proteins, Furthermore, amygdalin lowered the levels of reactive oxygen species induced by drug-resistant E. coli, in cells, demonstrating its antioxidant effects. Amygdalin, a drug with a protective role, alleviated cell damage caused by drug-resistant E. coli in human macrophages by inhibiting the PANoptosis signaling pathway.

• The Journal of the Korean Society for Microbiology
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• v.15 no.1
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• pp.19-32
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• 1980

Besides the benefits of antimicrobial agents in the control of various infectious diseases, widespread and prolonged use of particular antimicrobial agents has brought about the increase of drug-resistant strains in a community and the profound changes in the pattern of infectious diseases. In Korea, there are some remote villages where no clinics and drug stores are available and the residents in those areas are assumed to have fewer chances to contact with antimicrobial agents. In the present study, the differences in susceptibilities to 14 antimicrobial agents between the isolates from rural areas(R) and Seoul National University Hospital(SNUH, H) were studied. The isolates and their numbers were Staphylococcus aureus, R;55, H;68), Enterococci(R;28, H;30), Escherichia coli(R;40, H;40), Enterobacter aerogenes(R;25, H;21) and Klebsiella pneunoniae(R;58, H;67). Minimal inhibitory concentrations(MIC's) of penicillin, ampicillin, carbenicillin, cephalexin, tetracycline, oxytetracyline, doxycycline, minocycline, gentamicin, kanamycin, streptomycin, erythromycin, troleandomycin and co-trimoxazole were determined by agar dilution method. I. Comparison of MIC's and resistant strain proportions between isolates from SNUH and rural areas. MIC's and/or resistant strain proportions of the isolates from SNUH were significantly higher than those of the isolates from rural areas in the cases of 1. S. aureus to doxycycline, streptomycin and kanamycin. 2. E. coli to penicillin, ampicillin, carbenicillin, tetracycline, oxytetracycline, doxycycline, minocycline, streptomycin, kanamycin, erythromycin and co-trimoxazole. 3. E. aerogences to carbenicillin, tetracycline, oxytetracycline, doxycycline, minocycline, streptomycin, kanamycin, genaamicin and co-trimoxazole. 4. K pneunoniae to penicillin, ampicillin, tetracycline, oxytetracycline, doxycycline, monocycline, streptomycin, kanamycine, gentamicin and co-trimoxazole. However, the mean MIC and resistant strain proportion of S. aureus to tetracycline were higher in isolates from rural areas than in those from SNUH and Enterococci showed no differences in susceptibilities to the antimicrobial agents between isolates from rural areas and from SNUH. Therefore, in general, differenes in susceptibility to these antimicrobial agents between the isolates from rural areas and SNUH were remarkably greater and broader in gram negative enteric bacteria. II. Multiple drug resistance pattern. Patterns and incidences of multiple drug resistance were studied with penicillin, ampicillin, tetracycline, cephalexin, gentamicin, streptomcin, kanamycin and co-trimoxazole in Enterococci, E. coli, E. aeroges and K. pneumoniae. There appeared significant differences in the incidence of multiply drug-resistant strains and multiple drug resistance patterns between the isolates from SNUH and rural areas in Enterococci, E. coli, E. aerogenes and K. pneumoniae. However, there was no difference in the incidence of multiply drug-resistant strains between isolates of S. aureus from SNUH and rural areas but the pattern of multiple resistance of the SNUH strains of S. aureus was diverse, while that of the rural strains was predominantly confined to penicillin-tetracycline combination. The incidence of multigly drug-resistant strains and diversity of their patterns were the highest in E. coli strains isolated from SNUH and there were no multiply drug resistant strrains in Enterococci and K. pneumoniae strains isolated from rural areas. The number of drug-resistance determinants was also different between the isolates from rural areas and SNUH. Most of the multiply drug-resistant strains of E. coli, E. aerogenes and K. pneumoniae isolated from SNUH were resistant to more than 3 kinds of antimicrobial agents, most frequently to ampicillin, tetracycline and streptomycin, while multiply drug-resistant strains from rural areas were resistant to 2 kinds of antimicrobial agents among ampicillin, tetracycline and streptomycin. With drug-resistant E. coli strains, resistance to tetracycline which was used most widely since 1951 was most frequently involved as a part of mutliple drug-resistance, followed by resistance to ampicillin and streptomycin. This strongly suggests that emergence of drug-restant strains in a community is directly dependent on the selective pressure exerted by the antimicrobial agent used. III. Cross resistance. Cross resistance of bacteria was studied among tetracycline penicillin, aminoglycoside and macrolide derivatives by analyzing correlation coefficients of sucseptibilities using the least square method. In this study, there were high correlations among the susceptibilities to related derivatives. It appears that the relatively low correlations in susceptibilities present in some cases are due to intrinsic resistance of E. aerogenes to penicillin, Enterococci to aminoglycoside and E. coli E. aerogenes and K. pneumoniae to macrolide derivatives.

• The Journal of the Korean Society for Microbiology
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• v.19 no.1
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• pp.11-24
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• 1984

Shigella remains to be an important enteric pathogen in this country for the present. Moreover, most of the isolates have become multiple resistant to various antibiotics which used to be drugs of choice for shigellosis. This study was made as an attempt to assess the present stage of antibiotic resistance and the incidence and transferability of R factors of Shigella. A total of one hundred and seventeen strains of Shigella isolated from patients in Seoul and provincial area between 1982 and 1983 were tested for their resistant to antimicrobial agents and transmission of R-plasmid. Antibiotic susceptibilities were determined by an agar dilution method. Muller hinton agar were used for the assay of drug resistance and tryptic soy broth were used for propagating medium for conjugation. Shigella isolated found to be one or more antibiotics were considered potential donor of R-plasmid. The following results were obtained. 1. Among 117 strains of Shigella isolated, 111 strains(94.9%) were found to be resistant to one or more drugs tested and 97.3% of these resistant strains were multiply resistant, indicating the multiply resistant strains were more than the single resistant strains. Only six strains were susceptible to all drugs tested. 2. Among 117 strains of Shigella isolated, 107 strains(91.5%) were resistant to Tetracyclin(Tc), 106 strains(90.6%) to Chloramphenicol(Cp) and Streptomycin(Sm), 97 strains(82.9%) to Ampicillin(Ap), 68 strains(58.1%) to Cephaloridine(Cr), 10 strains(8.5%) to Nalidixic acid(Na), 5 strains(4.3%) to Kanamycin(Km) and 2 strains(1.7%) to Rifampicin. No strain was resisfant to Amikacin(Ak) and Gentamicin(Gm). 3. All drug-resistant Shigella strains, except three, were multiply resistant to two or more drugs. Fifty eight strains were resistant to five drugs, followed by 26 strains resistant to dour drugs, 12 strains resistant to three drugs and 11 strains resistant to six drugs. 4. The 73% of multiply drug-resistant Shigella transferred their resistance to E. coli by conjugation and the resistance was considered to be mediated by R-plasmid. Resistance to Nalidixic acid and Rifampicin were not transferred by conjugation to recipient. As for the transferability of resistance to each seperate drug, Ap resistance was transferred with 73.2% frequence and Cm and Tc resistance were transferred with approximately 50-60% frequence whereas Sm and Cr resistance were transferred in 19.1-21.4% The other four drugs resistant failed to transfer their resistance to recipient. 5. As for the incidence and transferability of resistance to each seperate drug, the strains resistant to Tc and Cm were encountered most frequently with the rate of 91-92%, whereas transfer of Tc and Cm were low, 51-52%. The incidence of Sm resistance was very high(90.6%) but transferability of drugs resistance was much lower(25.4%). Though the incidence of Km reristance was much lower(4.3%) transferability of Km resistance was considerably higher(60%). 6. The greater the multiplicity of resistance, the greater was the likelihood that part of all of the resistance markers would be transferable.

• Tuberculosis and Respiratory Diseases
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• v.81 no.3
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• pp.222-227
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• 2018

Background: Rifampicin (RFP) is one of the principal first-line drugs used in combination chemotherapies against Mycobacterium tuberculosis, and its use has greatly shortened the duration of chemotherapy for the successful treatment of drug-susceptible tuberculosis. Compensatory mutations have been identified in rpoC that restore the fitness of RFP-resistant M. tuberculosis strains with mutations in rpoB. To investigate rpoC mutation patterns, we analyzed 93 clinical M. tuberculosis isolates from patients in South Korea. Methods: Drug-resistant mycobacterial isolates were cultured to determine their susceptibility to anti-tubercular agents. Mutations in rpoC were identified by sequencing and compared with the relevant wild-type DNA sequence. Results: In total, 93 M. tuberculosis clinical isolates were successfully cultured and tested for drug susceptibilities. They included 75 drug-resistant tuberculosis species, of which 66 were RFP-resistant strains. rpoC mutations were found in 24 of the 66 RFP-resistant isolates (36.4%). Fifteen different types of mutations, including single mutations (22/24, 91.7%) and multiple mutations (2/24, 8.3%), were identified, and 12 of these mutations are reported for the first time in this study. The most frequent mutation involved a substitution at codon 452 (nt 1356) resulting in amino acid change F452L. Conclusion: Fifteen different types of mutations were identified and were predominantly single-nucleotide substitutions (91.7%). Mutations were found only in dual isoniazid- and RFP-resistant isolates of M. tuberculosis. No mutations were identified in any of the drug-susceptible strains.

• Annals of Clinical Neurophysiology
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• v.19 no.1
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• pp.20-27
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• 2017

Background: We evaluated whether eye movements could reflect the efficacy of antiepileptic drugs in patients with epilepsy. Methods: Thirty patients with epilepsy of unknown cause as well as age- and sex-matched normal controls were enrolled in this study. We divided the patients into drug-controlled epilepsy (n = 22) and drug-resistant epilepsy (n = 8) groups according to their seizure controls. We analyzed the differences in the parameters of the eye movements in these two groups compared with normal controls using video-based electro-oculography. In addition, we investigated the differences in the cerebellar volumes of these two groups using whole-brain T1-weighted images. Results: The latency and accuracy of saccade in patients with epilepsy were significantly different from normal controls, but they were not different between patients with drug-controlled epilepsy and drug-resistant epilepsy. However, the gain of pursuit was significantly decreased in patients with drug-resistant epilepsy compared with normal controls (p = 0.0010), whereas it was not different between patients with drug-controlled epilepsy and normal controls (p = 0.9646). In addition, the patients with drug-resistant epilepsy had lower cerebellar volumes than normal controls (p = 0.0052), whereas the cerebellar volumes in patients with drug-controlled epilepsy were not different from normal controls (p = 0.5050). Conclusions: We demonstrated that pursuit eye movements could reflect the efficacy of antiepileptic drugs in patients with epilepsy, a finding that may be related to cerebellar dysfunction.