Detection of 13 Enteric Bacteria and 5 Viruses Causing Acute Infectious Diarrhea Using Multiplex PCR from Direct Stool Specimens / 대한임상미생물학회지

BACKGROUND: We investigated the prevalence of various pathogens (13 enteric bacteria and 5 viruses) which cause diarrhea using multiplex PCR of stool specimens and compared two multiplex PCR methods for detecting diarrheagenic Escherichia coli. METHODS: A total of 405 stool specimens submitted between November 2010 to February 2011 for routine culture of enteric pathogens were included and screened for five viruses (astrovirus, Group A rotavirus, enteric adenovirus, norovirus G1/G2) and eight bacteria (Salmonella spp., Shigella spp., Campylobacter spp., Vibrio spp., C. difficile Toxin B, C. perfringens, Y. enterolytica, Aeromonas spp.) using the Seeplex(R) Diarrhea ACE detection kit (Seegene). In addition, virulence-associated genes of enteropathogenic E. coli, (EPEC), enterohemorrhagic E. coli (EHEC), enteroinvasive E. coli, (EIEC), enterotoxigenic E. coli (ETEC), and enteroaggressive E. coli (EAEC) were detected using 16-plex PCR and a commercial diarrheagenic E. coli detection (DEC) PCR kit (SSI Diagnostica). RESULTS: Overall, 138 (34.1%) of 405 samples was positive for pathogen. The positive rate for virus was 18.5%. norovirus G2, Group A rotavirus, enteric adenovirus, astrovirus and norovirus G1 were detected in 40, 23, 8, 3 and 1 samples, respectively. The positive rate for bacteria was 24.4% (99/405). C. difficile toxin B was the most frequently detected, followed by C. perfringens, EPEC, and EAEC. The agreements of the two multiplex PCR methods for detecting EPEC and EHEC were 99.3% and 100%, respectively. CONCLUSION: The detection rate was high (34.1%) including various diarrheagenic E. coli (6.2%) and C. perfringens (5.2%). Multiplex PCR is thus useful for detecting various pathogens.

Comparative Evaluation of Three Chromogenic Media Combined with Broth Enrichment and the Real-Time PCR-Based Xpert MRSA Assay for Screening of Methicillin-Resistant Staphylococcus aureus in Nasal Swabs

BACKGROUND: We evaluated the performance of three chromogenic media (Brilliance agar I [Oxoid, UK], Brilliance agar II [Oxoid], and ChromID MRSA [Biomerieux, France]) combined with broth enrichment and the Xpert MRSA assay for screening of methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We obtained 401 pairs of duplicate nasal swabs from 321 patients. One swab was suspended overnight in tryptic soy broth; 50-microL aliquots of suspension were inoculated on the three chromogenic media. Brilliance agar I and II were examined after 24 hr, and ChromID MRSA, after 24 and 48 hr. The paired swab was processed directly using real-time PCR-based Xpert MRSA assay. RESULTS: True positives, designated as MRSA growth in any of the culture media, were detected with the prevalence of 17% in our institution. We report the sensitivity, specificity, positive predictive value, and negative predictive value of MRSA growth as follows: 92.3%, 94.0%, 75.9%, and 98.4% in Brilliance agar I (24 hr); 92.7%, 97.9%, 90.0%, and 98.5% in Brilliance agar II (24 hr); 95.6%, 95.8%, 82.3%, and 99.1% in ChromID MRSA (24 hr); 100%, 92.5%, 73.1%, and 100% in ChromID MRSA (48 hr); 92.6%, 96.7%, 85.1%, and 98.5% in Xpert MRSA assay. The agreement between the enriched culture and Xpert MRSA assay was 96.0%. CONCLUSIONS: Three chromogenic culture media combined with enrichment and Xpert MRSA assay demonstrated similar capabilities in MRSA detection. The Xpert MRSA assay yielded results comparable to those of culture methods, saving 48-72 hr, thus facilitating earlier detection of MRSA in healthcare settings.

Latency Period after Preterm Premature Rupture of Membranes: A Comparison of Cefazolin with and without Erythromycin / 대한주산의학회잡지

No abstract available.

Chromosomal Abnormality of Spontaneous Abortus in Relation to Transvaginal Ultrasonographic Finding / 대한산부인과학회잡지

OBJECTIVE: To determine the clinical value of human papillomavirus deoxyribonucleic acid(HPV DNA) testing by polymerase chain reaction(PCR), specifically to examine whether HPV testing could identify the women with Pap smears read as mostly atypical squamous cells of undetermined significance(ASCUS) or more. METHODS: HPV DNA testing by PCR for 3 high-risk cancer associated genotypes(HPV 16, 18, 33), repeat Pap smears and colposcopically directed punch biopsies were performed concurrently on 169 women referred for cervical cancer screening test with a previous Pap smear read as ASCUS or more. RESULTS: HPV DNA testing positivity was significantly associated with abnormal cytology and high-grade squamous intraepithelial lesion(HSIL) and squamous cell carcinoma(SCC) in histology(P=0.034). The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) of Pap smear and HPV testing for identifying 38 cases of histologically confirmed HSIL and carcinoma by different triage protocols(HPV positive or HSIL or SCC) among 169 women were 65.8%(25/38), 85.5%(112/131), 56.8%(25/44) and 89.6%(112/125), respectively. Also sensitivity, specificity, PPV and NPV were varied by ages and more higher in older. CONCLUSION: HPV DNA testing by PCR appears to offer an effective means by which women whose cervical Pap smears have been read as ASCUS or more could be triaged for colposcopically directed biopsy. The sensitivity for HSIL could be maintained in high and specificity markedly improved by HPV genotypes 16, 18, 33.

Perinatal Outcome with Active Expectant Management of Second-Trimester Rupture of Membranes / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate the perinatal outcomes in pregnancies complicated by preterm premature rupture of membranes (PROM) during the second trimester. METHODS: Thirty-two consecutive pregnancies with PROM at 20-28 weeks of gestation were studied retrospectively. The goals of management were to prolong the pregnancies to 32 weeks through active expectant management and to avoid fetal compromise through close monitoring and active intervention. All medical records of mothers and neonates were reviewed. RESULTS: Total 30 pregnant women with rupture of membranes at 20-28 weeks were included. Rupture of membranes occurred at 20-25 weeks(mean 24.2) in 14 women and at 26-28 weeks(mean 27.2) in 16 women. The median latency periods to delivery were 309 hours and 234 hours when rupture of membranes occurred at 20-25 weeks and at 26-28 weeks, respectively. Overall incidences of clinical and histologic chorioamnionitis were 10% and 72%. There were no fetal deaths and 8 neontal deaths. When rupture of membranes occurred at 20-25 weeks and at 26-28 weeks, the perinatal survival rates were 50% and 94%, respectively. CONCLUSION: Active expectant management of second-trimester PROM offers better perinatal survival than previously thought.

Changing pattern of serum leptin concentration in women undergoing clomiphene citrate challenge test or controlled ovarian hyperstimulation / 대한산부인과학회잡지

OBJECTIVE: To evaluate the changing pattern of serum leptin level and the correlation between estradiol level during the clomiphene citrate challenge test(CCCT) or controlled ovarian hyperstimulation(COH) cycle. METHODS: Twenty-seven women who underwent CCCT and fourteen women who underwent controlled ovarian hyperstimulation were recruited to measure the serum leptin level. After correction of serum concentration with body mass index(BMI), changes of leptin level and correlation with serum estradiol level during CCCT and COH cycle were analyzed. RESULTS: Circulating leptin levels were significantly correlated with BMI at each time point in CCCT cycle(P<0.01). In CCCT cycle, leptin/BMI level was significantly increased at midluteal phase compared to that of menstrual cycle day 3 and 10(p<0.05). In women with regular menstruation, leptin/BMI level at midluteal phase was significantly higher than that of menstrual day 3 and 10, but this difference was not seen in women with irregular menstruation. The leptin/BMI level in COH cycle showed increasing tendency throughout ovarian stimulation. But there was no significant correlation between leptin/BMI and estradiol level in CCCT and COH cycle. CONCLUSION: There is a significant correlation between BMI and circulating leptin level. Midluteal leptin level is significantly higher than that of follicular phase in CCCT cycle, and there is an increasing tendency in leptin level after ovarian stimulation in CCCT and COH cycle without statistical significance. These findings suggest that circulating estradiol concentration has no major influence on circulating leptin level.

Pregnancy Outcomes after Induction of Labor Versus Expectant Management in Cases with Sonographic Diagnosis of Fetal Macrosomia / 대한주산의학회잡지

OBJECTIVE: Macrosomia is associated with increased birth injury and neonatal morbidity as well as a higher rate of cesarean delivery. Our purpose was to determine whether induction of labor after sonographic diagnosis of fetal macrosomia could improve maternal and neonatal outcome. STUDY DESIGN: The hospital records of 180 patients who delivered of an inFant with birth weight over 4000 gm were reviewed. The subjects were divided into three groups based on obstetric management as follows.. expectant management after sonographic diagnosis of fetal macrosomia(group I), induction of labor(group lI), unexpected patients who were underestimated of fetal weight(estimated fetal weight<90th percentile) (groupIII), Patients who underwent elective cesarean delivery and complicated with diabetes were excluded. Outcome variables for comparison in three groups were mode of delivery, 5 minute Apgar score below 7, presence of cephalohematoma, clavicular fracture, brachial plexus injury, and intraventricular hemorrhage. RESULTS: One hundred eighty patients who eligible for the study, of whom 32 patients were included to group I, 57 patients to group lI, and 91 patients to group Ill, respectively. The cesarean rate within elective induction group was 49%, which was significant higher than the 16% rate in expectant management group and 19% in unexpected group(p<0.05). The observed rates of cephalohematoma, clavicular fracture and 5 min Apgar score below 7 were not significantly different in three groups. CONCLUSIONS: There was an significant increased cesarean delivery rate without improvement in neonatal outcomes or reduction in birth injury among pregnancies in which labor was electively induced after sonographic diagnosis of fetal macrosomia. Elective induction of labor should be discharged in cases with fetal macrosomia.