• Childhood Kidney Diseases
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• 제21권2호
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• pp.121-127
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• 2017

Purpose: The aim of this study was to determine the prevalence of antibiotic susceptibility and resistance of Escherichia coli in urinary tract infections (UTIs) in children. Methods: We retrospectively reviewed the clinical records of 212 inpatients aged 18 years or younger with UTIs treated at the Pediatric Department of Dongguk University Gyeongju Hospital between January 2008 and December 2016. For comparison, patients were divided into three groups according to age as follows: group 1, ${\leq}1$ month; group 2, >1 month to ${\leq}12$ months; and group 3, ${\geq}13$ months. The antibiotic resistance rates from January 2008 to December 2012 (study period 1) and from January 2013 to December 2016 (study period 2) were analyzed statistically by group. Results: As the patient age increased, the antibiotic resistance rate to ampicillin (P=0.013), levofloxacin (P=0.050), piperacillin/tazobactam (TZP) (P<0.001), and trimethoprim/sulfamethoxazole (P=0.002) increased. The frequency of extended spectrum beta-lactamase producing E. coli showed a significant difference from 5 cases (4.6%) in study period 1 and 16 cases (15.8%) in study period 2 (P=0.007). The antibiotic resistance rate of E. coli was compared between the two time periods and we found that the antibiotic resistance rate to cefotaxime was significantly increased from 5.4% to 16.8% (P=0.008) and that to TZP was significantly decreased from 40.5% to 7.9% (P<0.001). Conclusion: Over the past 9 years, the resistance rate to cefotaxime has increased but the resistance rate to TZP has decreased. Thus, it is important to continue to investigate the antibiotic resistance rates of bacteria in the community.

• 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.

• Journal of Microbiology and Biotechnology
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• 제28권7호
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• pp.1178-1184
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• 2018

The spread of antibiotic-resistant Enterobacteriaceae in the community is one of the main challenges for antibiotic treatment of community-onset infections. We evaluated the microbiological and molecular characteristics of stool samples from adults with comprehensive health examinations. Of 109 fecal samples, bacterial growth was observed in 86 samples and 61 gram-negative bacterial isolates were identified, of which 45 were Escherichia coli isolates (73.8%). Two isolates of Raoultella showed imipenem resistance, and both E. coli and Citrobacter freundii showed intermediate resistance to imipenem. Colistin resistance was identified in isolates of Klebsiella variicola and Salmonella subterranean, but no isolates carried mcr-1. As for E. coli genotypes, 35 sequence types were identified. $bla_{TEM-1}$, $bla_{TEM-30}$, and $bla_{CTX-M}$ were identified in 15, 1, and 4 E. coli isolates, respectively. In addition, all four Klebsiella pneumoniae isolates carried $bla_{SHV}$. Many genotypes that have been identified in isolates causing human infections were found in isolates in this study. There is a need to control the rise and spread of antibiotic-resistant pathogens by fecal carriage.

• 한국식품위생안전성학회지
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• 제29권1호
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• pp.47-52
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• 2014

This study was performed to evaluate antimicrobial resistance of food-borne pathogens isolated from retail meat in Korea. A total of 157 samples of beef, pork, and chicken were collected and analyzed for E. coli, Salmonella, Campylobacter. Resistances to tetracycline were declined in accord with reduced usage of tetracycline in live stock production. E. coli stains from chicken meat had higher multi-drug resistance ratio than strains from other meat. One extended spectrum beta lactamase (ESBL) producing E. coli and two ESBL producing Salmonella were identified in this study. ESBL producing Salmonella strains were confirmed to carry CTX-M-1 type genes.

• Journal of Yeungnam Medical Science
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• 제35권1호
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• pp.84-88
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• 2018

A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature $38.7^{\circ}C$, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.

• 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.

• Childhood Kidney Diseases
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• 제23권1호
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• pp.29-35
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• 2019

Purpose: We aimed to determine characteristics of host, causative organisms, and antibiotic susceptibility of bacteria in pediatric patients with UTI living in metropolitan area of Korea. Methods: Retrospective investigation was done for the causative organisms of UTI in 683 pediatric cases treated at Ajou University Hospital from 2012 to 2017. Patients were classified into Escherichia coli and non-E. coli group, where E. coli group was subdivided into ESBL(+) and ESBL(-) groups based on whether the bacteria could produce extended spectrum beta-lactamase (ESBL). Antibiotic susceptibility of the causative organism was also determined. Results: A total of 683 UTIs occurred in 550 patients, of which 463 (67.8%) were first-time infection and 87 (32.2%) were recurrent ones (2-7 recurrences, 2.52 average), and 64.9% were male and 35.1% were female. The most common causative organism was E. coli (77.2%) and ESBL(+) E. coli was found in 126 cases. The susceptibility of E. coli to 3rd or 4th generation cephalosporin was relatively higher than that to ampicillin or amoxicillin/clavulanic acid. ESBL(+) E. coli showed higher resistance rate to 3rd or 4th generation cephalosporin than ESBL(-) E. coli. Conclusion: New treatment guideline should be considered due to the incidence of ESBL(+) E. coli increased up to one quarter of UTI cases.

• Clinical and Experimental Pediatrics
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• 제64권6호
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• pp.293-300
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• 2021

Background: Understanding the epidemiology and prevalence of febrile urinary tract infection (fUTI) in children is important for risk stratification and selecting appropriate urine sample collection candidates to aid in its diagnosis and treatment. Purpose: This study aimed to analyze the epidemiology, etiology, and changes in antibiotic susceptibility patterns of the first fUTI in children. Methods: This retrospective observational cohort study included children younger than 19 years of age who were diagnosed and treated for their first fUTI in 2006-2016. Electronic medical records were analyzed and radiologic images were evaluated. Results: A total of 359 patients (median age, 5.1 months; interquartile range, 3.0-10.5 months) fit the inclusion criteria; of them, 78.0% (n=280) were younger than 12 months old. The male to female ratio was 5.3:1 for patients aged 0-2 months, 2.1:1 for those 3-5 months, and 1.6:1 for those 6-11 months. Beyond 12 months of age, there was a female predominance. Escherichia coli was the leading cause (83.8%), followed by Enterococcus species (6.7%), and Klebsiella pneumoniae (3.6%). Significant yearly increases in the proportions of multidrug-resistant strains (P<0.001) and extended-spectrum beta-lactamase (ESBL) producers (P<0.001) were observed. In patients with vesicoureteral reflux (VUR), the overall recurrence rate was 53.6% (n=15). A significantly higher recurrence rate was observed when the fUTI was caused by an ESBL versus non-ESBL producer (75.0% vs. 30.0%, P=0.03). Conclusion: fUTI was most prevalent in children younger than 12 months of age and showed a female predominance in patients older than 12 months of age. The proportion of ESBL producers causing fUTI is increasing. Carbapenems, rather than noncarbapenems, should be considered for treating fUTI caused by ESBL-producing enteric gram-negative rods to reduce short-term recurrence rates in children with VUR.

• 한국융합학회논문지
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• 제6권5호
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• pp.77-84
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• 2015

본 연구는 항균제에 내성을 보이는 대장균의 특성을 알아보기 위해 설사환자에서 분리된 대장균에 대한 항균제 감수성 및 병원성 인자의 상관성을 분자융합적 기술을 통해 조사하였다. 분리한 대장균의 항균제 내성은 60주에서 ESBL(extendede spectrum ${\beta}$-lactamase) positive균주가 8주이고, negative균주는 52주였다. ESBL 양성 8주 중 2주는 병원성 유전자가 검출되지 않았으며, stb(3주), flich7(1주), flich7-eae(2주)로 나타났다. ESBL 음성 52주 중 26주는 병원성 유전자가 검출되지 않았고, stx1(3주), stb(10주), flich7 및 eae(각 2주), stx1-flich7(2주), stx1-stb(4주), flich7-stb(2주), flich7-stb-eae(1주)이었다. 결론적으로 항균제 내성이 증가하는 시대에 분자 융합적 관점에서 독력 유전자의 분포와 항균제 내성과의 관계는 적게 나타났으나, 향후 다양한 독력 유전자의 분석을 통한 융합기술연구가 이루어진다면 보다 정확한 병원성 인자를 추정할 수 있을 것으로 사료된다.

• Clinical and Experimental Pediatrics
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• 제49권8호
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• pp.882-888
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• 2006

목 적 : 소아 종양 환아 치료에서 감염은 사망까지 초래할 수 있어, 균혈증에 적절히 대처하는 것은 매우 중요하다. 이에 저자들은 현 시점에서 소아 암 환아에서 발생한 균혈증을 분석하여 앞으로의 치료에 참조하기 위해 이 연구를 시행하였다. 방 법 : 1998년 2월부터 2005년 5월 까지 계명대학교 동산의료원 소아과 병동에서 총 44명의 소아 종양 환아에서 발생되었던 62건의 균혈증을 후향적으로 분석하였다. 입원 당시 감염 소견이 있거나 입원 48시간 이내 발열이 있었던 환아들은 대상군에서 제외하였다. 결 과 : 그람양성균에 의한 균혈증은 30례, 그람음성균에 의한 균혈증은 24례, 진균혈증은 8례로 그람양성균의 빈도가 가장 높았다. 그람양성균 중에서는 Staphylococcus epidermidis 19례, Staphylococcus aureus 5례, alpha-hemolytic Streptococcus 5례의 순으로 빈도가 높았으며, 그람음성균에서는 Alcaligenes xylosoxidans 10례, Klebsiella pneumoniae 5례, Stenotrophomonas maltophilia 3례의 순으로 빈도가 높았다. 절대 호중구 수치가 $500/mm^3$ 이하인 경우는 모두 28례(45.2 %)였으며 그람양성균에서는 S. epidermidis가, 그람음성균에서는 K. pneumoniae가 가장 많았다. 항생제 감수성 검사를 시행하여서는 그람양성균 모두가 vancomycin과 teicoplanin에 감수성이 있었으나 methicillin에 내성을 보이는 경우가 S. epidermidis에서 61.5%(8/13), S. aureus에서 80%(4/5)이었다. 그람음성균에서의 감수성 결과, 대부분이 imipenem에 감수성을 보였다. K. pneumoniae는 모든 경우에서 extended-spectrum beta-lactamase(ESBL)가 양성이었고 K. pneumoniae에 감염된 환아 5례 중 4례가 패혈증과 관련되어 사망하였다. 결 론 : 본원에서도 다른 기관과 마찬가지로 균혈증의 원인으로 그람양성균이 많았다. 앞으로 주기적으로 균혈증의 원인균주를 분석하고 그 균주에 대한 항생제의 감수성을 참조하여 적절한 항생제를 선택할 수 있도록 하여야 할 것이다.