• 한국동물위생학회지
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• 제37권1호
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• pp.19-27
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• 2014

This study was conducted to investigate the antimicrobial resistance, presence of ${\beta}$-lactamase genes and integrons in 83 ESBL-producing Escherichia coli isolated from Nakdong river and Geumho river in Daegu. Among the ${\beta}$-lactam antimicrobials, all isolates were resistant to ampicillin, cephalothin, cefamandole and cefotaxime, followed by piperacillin (98.8%), ampicillin/sulbactam (86.7%), aztreonam (60.2%) and cefepime (59.0%), whereas resistance to piperacillin/tazobacram, ticarcillin/clavulanic acid and cefoxitin was less than 30%. Many of the ESBL-producing Escherichia coli were also resistant to non-${\beta}$-lactams antimicrobials such as nalidixic acid (83.1%), sulfonamides (72.3%), ciprofloxacin (62.7%) and gentamicin (38.6%). All isolates showed resistance to seven or more antimicrobial agents. The most frequently detected gene was $bla_{TEM+CTX-M}$ (49.4%), followed by $bla_{CTX-M}$ (27.7%), $bla_{TEM}$ (6.0%) and $bla_{OXA}$ (1.2%). But $bla_{SHV}$ was not found. Class 1 integrons were found in 61.4% (51 isolates) of isolates, however, class 2 and 3 integrons were not detected. The results showed water from Nakdong river and Geumho river is contaminated with ESBL-producing E. coli isolates. These results suggest the need for further investigation of antibiotic resistant bacteria to prevent public health impacts in the water environment.

• 한국동물위생학회지
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• 제42권1호
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• pp.17-24
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• 2019

The aim of this study was to investigate the prevalence and characterization of plasmid-mediated quinolone resistance (PMQR) gene in 79 Enterobacteriaceae isolated from dogs and cats. Of 79 isolates, PMQR genes were found in 10 (12.7%) isolates, including aac(6')-lb-cr, qnrB, qnrS and qnrA detected alone or in combination in 8 (10.1%), 4 (5.1%), 2 (2.5%) and 1 (1.3%) isolates, respectively. Interestingly, two qnrS genes were detected in nalidixic acid and ciprofloxacin susceptible isolates. Extended-spectrum ${\beta}$-lactamase (ESBL) was detected in 90% (9 isolates) of PMQR positives isolates. Among ESBL genes, CTX-M, TEM and SHV were detected in 9, 8 and 3 isolates, respectively. Almost all PMQR genes were detected in co-existence with ESBL genes. All PMQR positives isolates were multidrug resistance (i.e. resistant to five or more antibiotics). qepA, OXA and CMY-2 genes were not found. The six transconjugants were obtained by conjugation experiment. The aac(6')-lb-cr, qnrB and qnrS were co-transferred with CTX-M, TEM and/or SHV, whereas qnrA was not observed among transconugants. This is the first report of the presence of aac(6')-lb-cr and qnrA gene among Enterobacteriaceae isolates from dogs in Korea. The prudent use of antimicrobials and continuous monitoring for companion animals are required.

• Infection and chemotherapy
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• 제50권4호
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• pp.357-361
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• 2018

While carbapenems are the drug of choice to treat extended-spectrum-${\beta}$-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient's clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.

• Childhood Kidney Diseases
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• 제25권1호
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• pp.22-28
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• 2021

Purpose: The purpose of this study was to investigate the clinical outcomes of non-carbapenem treatment for urinary tract infections (UTIs) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) in young children. Methods: We retrospectively reviewed the medical records of children under 2 years of age who were diagnosed and treated for UTIs caused by ESBL-producing E. coli from September 2014 to March 2020. Results: Forty-three children under 2 years of age were treated with non-carbapenem antimicrobials for UTIs caused by ESBL-producing E. coli without bloodstream infections. The overall clinical and microbiological success rates for empirical antimicrobial treatment were 90.7% and 97.7%. Three of the patients (7.0%) experienced a relapse of UTI within a month. An in vitro susceptibility test showed that two patients were sensitive and one was resistant to the antimicrobial treatments. Furthermore, there were no significant differences in the time to defervescence, clinical success, microbiological success, and relapse rate between the susceptible (n=13) and non-susceptible groups (n=30). Conclusion: In this study, the overall relapse rate of patients treated with non-carbapenem antimicrobials was 7.0%. The patients showed high success rates in the clinical and microbiological responses to the non-carbapenems regardless of the results of the in vitro antimicrobial susceptibility test. These results provide evidence that non-carbapenems may be viable alternative treatments for UTIs caused by ESBL-producing E. coli.

• Urogenital Tract Infection
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• 제13권3호
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• pp.72-78
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• 2018

Purpose: This retrospective study was undertaken to investigate whether increasing amikacin dosage for ciprofloxacin prophylaxis in patients with fluoroquinolone (FQ)-resistant rectal flora reduce infectious complications after transrectal ultrasound-guided prostate biopsy (TRUSPB). Materials and Methods: A total of 430 patients with FQ-resistant rectal flora based on rectal swab cultures were divided into two groups. Patients in both groups were administered ciprofloxacin (400 mg, intravenous [IV], twice daily) on the same day as TRUSPB and one day after biopsy. However, whereas group 1 patients (n=202) were administered a single injection of amikacin (1 g, IV) one hour before TRUSPB, patients in group 2 (n=228) were administered two injections of amikacin (1 g, IV) before one hour TRUSPB and again on the day after TRUSPB. Results: Of the 430 study subjects, 129 (30.0%) showed extended-spectrum beta-lactamase (ESBL) positivity. The overall incidence rate of infectious complications was 2.8% (12/430). Infectious complication rates were 4.0% (8/202) in group 1 and 1.3% (3/228) in group 2 (p=0.075). Urinary tract infection and acute prostatitis were more frequent in group 1 (3.5% vs. 0.4%, p=0.029). Infectious complication rates in ESBL negative patients were 3.4% (5/145) in group 1 and 1.3% (2/156) in group 2, whereas those in ESBL positive patients were 7.0% (4/57) in group 1 and 1.4% (1/72) in group 2. Conclusions: Increasing the dosage of amikacin for ciprofloxacin prophylaxis reduce infectious complications in patients with FQ-resistant rectal flora and to be more effective in ESBL positive patients with FQ-resistant rectal flora.

• 한국동물위생학회지
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• 제37권4호
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• pp.225-231
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• 2014

In this study, 185 cefotaxime-resistant Escherichia coli were isolated from different stages of a wastewater treatment plant (WWTP) in Daegu in Korea. Among them, 99.5% (184 isolates) originated from raw sewage and 0.5% (1 isolates) from the final effluent. Cefotaxime-resistant E. coli were high resistant to ampicillin, piperacillin, cefazolin, cephalothin, cefachlor and cefamandole (99.5~100%). About 93% of the cefotaxime-resistant E. coli were extended-spectrum ${\beta}$-lactamases (ESBL)-producing E. coli. The $bla_{TEM+CTX}$ gene was the most predominant of the ESBL genes (72.5%), followed by $bla_{CTX-M}$ (16.2%), $bla_{TEM}$ (8.7%), $bla_{TEM+CTX+SHV}$ (1.1%), $bla_{TEM+SHV}$, $bla_{TEM+OXA}$, and $bla_{TEM+CTX+SHV}$ (respectvely 0.5%). Class 1 and 2 integron were found in 49.7% and class 3 integron was not found. All of integron positive isolates were multiresistant (i.e. resistant to four or more antibiotics). Our findings showed WWTP is contaminated with antibiotic resistant bacteria with resistance genes.

• Clinical and Experimental Pediatrics
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• 제60권7호
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• pp.221-226
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• 2017

Purpose: Escherichia coli sequence type (ST) 131, a multidrug-resistant clone causing extraintestinal infections, has rapidly become prevalent worldwide. However, the epidemiological and clinical features of pediatric infections are poorly understood. We aimed to explore the characteristics of ST131 Escherichia coli isolated from Korean children with urinary tract infections. Methods: We examined 114 uropathogenic E. coli (UPEC) isolates from children hospitalized at Chung-Ang University Hospital between 2011 and 2014. Bacterial strains were classified into STs by partial sequencing of seven housekeeping genes (adk, fumC, gyrB, icd, mdh, purA, and recA). Clinical characteristics and antimicrobial susceptibility were compared between ST131 and non-ST131 UPEC isolates. Results: Sixteen UPEC isolates (14.0%) were extended-spectrum ${\beta}-lactamase$ (ESBL)-producers; 50.0% of ESBL-producers were ST131 isolates. Of all the isolates tested, 13.2% (15 of 114) were classified as ST131. There were no statistically significant associations between ST131 and age, sex, or clinical characteristics, including fever, white blood cell counts in urine and serum, C-reactive protein, radiologic abnormalities, and clinical outcome. However, ST131 isolates showed significantly lower rates of susceptibility to cefazolin (26.7%), cefotaxime (40.0%), cefepime (40.0%), and ciprofloxacin (53.3%) than non-ST131 isolates (65.7%, 91.9%, 92.9%, and 87.9%, respectively; P<0.001 for all). ESBL was more frequently produced in ST131 (53.3%) than in non-ST131 (8.1%) isolates (P<0.01). Conclusion: ST131 E. coli isolates were prevalent uropathogens in children at a single medical center in Korea between 2011 and 2014. Although ST131 isolates showed higher rates of antimicrobial resistance, clinical presentation and outcomes of patients were similar to those of patients infected with non-ST131 isolates.

• 미생물학회지
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• 제43권2호
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• pp.116-123
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• 2007

본 연구는 부산지역 하천에서 plasmid 매개성 광범위 ${\beta}-lactam$ 분해효소(extended spectrum ${\beta}-lactamase;\;ESBL$)를 생성하는 세균을 분리하여 생성된 광범위 ${\beta}-lactam$ 분해효소를 유형별로 분류하기 위함이다. Escherichia coli 6균주와 Klebsiella pneumoniae 15균주가 피전달균주인 Escherichia coli J53 $Azid^{R}$에 plasmid 매개성 광범위 ${\beta}-lactam$ 분해효소 생성 인자를 전달하였다. PCR 후 얻은 유전인자를 plasmid로 매개된 광범위 ${\beta}-lactam$ 분해효소 유전자의 염기서열 분석결과, E. coli와 K. pneumoniae 유전자를 BCM Search Launcher 및 GenBank nucleotide database를 통하여 검색한 결과 ESBL 유형은 TEM-52형과 SHV-12형이었다. TEM-52는 E. coli와 K. pneumoniae 양쪽에서 분리되었다. 그러나 SHV-12는 K. pneumoniae에서만 분리되었다. 이상의 결과로부터 plasmid 매개성 광범위 ${\beta}-lactam$ 분해효소를 생성하는 세균이 한국에서는 이미 임상범위를 넘어 자연계까지 확산되었음을 알 수 있었다.

• Journal of Microbiology and Biotechnology
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• 제24권3호
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• pp.421-426
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• 2014

To characterize the extended-spectrum beta-lactamases (ESBLs) in diarrheagenic Escherichia coli from Korea in 2008-2011, we screened seven enterotoxigenic E. coli (ETEC) and one enteroaggregative E. coli (EAEC) that produce ESBLs from a nationwide survey. All eight isolates produced CTX-M-type ESBLs, including CTX-M-12 (n = 4), CTX-M-14 (n = 2), and CTX-M-15 (n = 2). PCR-based replicon typing indicated that the $bla_{CTX-M-12}$ genes of four ETEC isolates were carried on a conjugative IncF plasmid, whereas the $bla_{CTX-M-14}$ of one EAEC was located on an IncK plasmid. This is the first report of the occurrence of $bla_{CTX-M}$ genes in clinical isolates of EAEC in Korea. The ESBL-producing isolates were shown to be different based on pulsed-field gel electrophoresis and multilocus sequence typing, whereas the four isolates with CTX-M-12 were clonally related. These observations raise an alarm for the spread of plasmid-mediated resistance to ESBL among diarrheagenic E. coli.

• 미생물학회지
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• 제42권2호
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• pp.125-130
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• 2006

본 연구에서는 도축장과 도축물에서 plasmid 매개성 광범위 ${\beta}$-lactam (extended spectrum ${\beta}$-lactamase) 분해효소를 생성하는 Klebsiella pneumoniae와Escherichia coli가 분리됨으로서 한국에서는 이들 균주가 임상범위를 넘어 자연계까지 확산되었음을 확인하였다. 디스크 확산 시험, 등전점 수치, 접합시험 등을 통하여 돼지의 분변으로부터 최종 10균주의 접합자를 얻었고 이들의 형별결정은 아미노산서열분석과 기준주와 대조등을 BCM Search Laucncher 및 NCBI blast를 통해 이루어졌다. 광범위 ${\beta}$-lactam 유형은 Klebsiella pneumoniae 8균주가 TEM-52형이었고 2균주 Escherichia coli가 SHV-12형이었다. CMY-1형은 본 연구에서 분리되지 않았다.