Klebsiella pneumoniae ST11 Producing GES-5 Carbapenemase Isolated from Tertiary-Care Hospital.

BACKGROUND: The emergence of carbapenem-resistant Klebsiella pneumoniae has become a major problem among healthcare-associated infections with relatively few therapeutic options. In particular, the infection of carbapen-emase-producing Enterobacteriaceae (CPE) can be related to the widespread nosocomial transmission. In this study, we isolated carbapenem-resistant K. pneumoniae producing carbapenemase from a tertiary-care hospital and investigated the antimicrobial resistance and molecular and epidemiological features of these isolates. METHODS: A total of 16 carbapenemase-producing K. pneumoniae strains were isolated from a tertiary-care hospital. Antimicrobial susceptibility tests were performed. Carbapenemase production was assessed using the phenotypic and genotypic tests. Molecular characteristics were determined using polymerase chain reaction to detect blaKPC, blaIMP-1, blaVIM, blaNDM, blaOXA48, and blaGES. For phylogenetic analyses, multilocus sequence typing (MLST) was performed. RESULTS: All of the isolates were found to be resistant to ertapenem (MIC range 2.0 - 8.0 g/mL), among which only two (12.5%) isolates were susceptible to imipenem. All isolates were resistant to ampicillin, azithromycin, cefazolin, cefepime, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin. Three isolates (18.8%) were resistant to gentamicin, and two isolates (12.5%) were resistant to amikacin. Only two isolates were identified as carbapenemase producers using the phenotypic tests. All isolates produced GES-5 carbapenemases. MLST analysis revealed four sequence types (STs): ST11 (n = 12), ST789 (n = 2), ST392 (n = 1), and an unidentified ST (n = 1). CONCLUSIONS: ST11 K. pneumoniae producing GES-5 carbapenemase was the most common sequence type. Systematic and broad range screening tests in the early stages are required to identify the carbapenemase producers, which may help to prevent healthcare-associated transmission.

Comparative Evaluation of the Modified Carbapenem Inactivation Method for Phenotypic Detection of Guiana Extended-Spectrum ß-Lactamase-Type Carbapenemases in Enterobacterales.

OBJECTIVE: We comparatively evaluated the performance of 3 phenotypic tests for the detection of carbapenemase production. MATERIALS AND METHODS: Carbapenemase production was evaluated using the modified Hodge test (MHT), the modified carbapenemase inhibition method (mCIM), and the Rapidec Carba NP test (RCNP). RESULTS: Among the 170 isolates, 79 were CP-CRE and 91 were non-CP-CRE. The CP-CRE isolates produced GES-5 (n = 66), KPC (n = 4), NDM (n = 7), NDM and OXA-48 (n = 1), and VIM (n = 1). For KPC producers, all 3 methods showed a sensitivity of 75%. The sensitivities of MHT, mCIM, and RCNP were 14.3%, 100%, and 71.4%, respectively, for NDM producers, and 1.5%, 12.1%, and 18.2% for GES-5 producers, respectively. CONCLUSION: The performance of the phenotypic tests varied depending on the type of carbapenemase. For intensive infection control, phenotypic and molecular tests are required for the detection of common and rare types of carbapenemases.

Generation of transgenic chickens that produce bioactive human granulocyte-colony stimulating factor.

We report here the generation of transgenic chickens that produce human granulocyte-colony stimulating factor (hG-CSF) using replication-defective Moloney murine leukemia virus (MoMLV)-based vectors packaged with vesicular stomatitis virus G glycoprotein (VSV-G). The recombinant retrovirus was injected beneath the blastoderm of nonincubated chicken embryos (stage X). Out of 140 injected eggs, 17 chicks hatched after 21 days of incubation and all hatched chicks were found to express vector-encoded hG-GSF gene. The biological activity of the recombinant hG-CSF was significantly higher than its commercially derived E. coli-derived counterpart. Successful germline transmission of the transgene was also confirmed in G(1) transgenic chicks produced from the cross of Go transgenic roosters with nontransgenic hens, but most of the G(1) progeny were dead within 1 month of hatching.

Gastric cancer detection using gastric juice pepsinogen and melanoma-associated gene RNA.

OBJECTIVES: To develop a new method for gastric cancer detection with gastric juice using melanoma-associated gene (MAGE) RNA and pepsinogen (PG). METHODS: In total, 183 gastric juice and paired serum specimens were obtained from 134 patients with gastric cancer and 49 healthy individuals. The gastric juice specimens were analyzed with MAGE A1 to A6 nested reverse transcription-polymerase chain reaction. The serum and gastric juice PG were measured with a PG I and II immunoassay. RESULTS: The gastric juice PG I and PG I/II ratios were more accurate than those of serum. The combination test using the gastric PG I/II ratio and MAGE was the most accurate, with a sensitivity of 77.6% and a specificity of 87.8%. The sensitivity was 78.8% for stage I gastric cancer and not influenced by cancer location or pathologic type. CONCLUSIONS: The combination test is potentially an additional tool for gastric cancer detection.

MAGE A1-A6 RT-PCR and MAGE A3 and p16 methylation analysis in induced sputum from patients with lung cancer and non-malignant lung diseases.

The melanoma antigen gene (MAGE) A1-A6 RT-PCR system was developed for the detection of lung cancer cells in the sputum. However, we identified MAGE expression in some patients with non-malignant lung diseases. To understand these patterns of MAGE expression, we performed MAGE A3 methylation-specific PCR (MSP) and p16 MSP. We collected 24 biopsy specimens of lung cancer tissue and performed MAGE A1-A6 RT-PCR, MAGE A3 MSP and p16 MSP. RNA and DNA were simultaneously extracted from induced sputum specimens of 133 patients with lung diseases and 30 random sputum specimens of healthy individuals and the 3 molecular analyses were performed. The patients were diagnosed as 65 cases of lung cancer and 68 of benign lung diseases. Positive rates of MAGE A1-A6 RT-PCR, MAGE A3 MSP and p16 MSP were as follows: in lung cancer tissue, 87.5, 58.3 and 70.8%; in the sputum of lung cancer patients, 50.8, 46.2 and 63.1%; benign lung diseases, 10.3, 30.9 and 39.7%; and healthy individuals, 3.3, 6.7 and 3.3%. Of the 40 MAGE-positive cases, 33 were diagnosed with lung cancer and 7 as having benign lung diseases. From the 7 cases of MAGE-positive benign lung diseases, 6 cases showed methylation abnormalities. The MAGE-positive group revealed significantly higher rates of methylation abnormalities. Of the 40 MAGE-positive cases, 39 cases were found to be lung cancer or benign lung diseases with abnormal methylation. Thus, MAGE expression in the sputum suggests the presence of lung cancer cells or pre-cancerous cells.

Inhibition of P-glycoprotein facilitated glycosaminoglycan accumulation during chondrogenesis of human bone marrow mesenchymal stem cells.

AIM: P-glycoprotein (P-gp) is an adenosine-5-triphosphate Binding Cassettes B 1 (ABCB1) transporter that exports various substrates on cellular membrane. Surface expression of P-gp was decreased during chondrogenesis of human bone marrow mesenchymal stem cells (BM-MSCs). We examined the role of P-gp in extracellular matrix deposition during chondrogenesis of human BM-MSCs. METHOD: BM-MSCs were isolated from 16 volunteers after informed consent and incubated for 28 days using three-dimensional culture methods in chondrogenic medium with and without P-gp inhibitor (verapamil, 10 µmol/L). RESULTS: Hematoxylin and eosin staining revealed a cartilaginous structure with chondrogenic cells in the lacunae after 2 weeks of culture. Total glycosaminoglycan (GAG) content was increased and rose during pellet culture. Hyaluronan (HA) content of the culture medium decreased with P-gp inhibitor. Type II collagen deposition decreased with P-gp inhibitor. CONCLUSION: Inhibition of P-gp facilitated GAG accumulation via HA export inhibition during chondrogenic differentiation of human BM-MSCs. Modulation of P-gp expression during chondrogenesis would be a possible therapeutic approach for articular cartilage regeneration.

A case of natural killer cell leukemia misdiagnosed as tuberculous lymphadenopathy.

Natural killer (NK) cell neoplasms are a group of rare but highly malignant tumors. We report here one case of NK cell leukemia. A 54-yr-old woman presented with a 2-month history of progressive left neck mass. Based on the positive result of tissue PCR for Mycobacterium tuberculosis, she was at first diagnosed with tuberculous lymphadenopathy. After two weeks, she developed generalized lymphadenopathy, hepatosplenomegaly, fever and anemia. Subsequent evaluation was performed including bone marrow aspiration and biopsy. Peripheral blood smear showed leukoerythroblastic features with 31% blasts. Bone marrow was packed with agranular blastoid cells, which were periodic acid-Schiff (PAS) positive and myeloperoxidase (MPO) negative. Immunophenotyping showed that these cells were positive for CD45 and HLA-DR, whereas negative for CD3, CD5, CD7, CD10, CD13, CD14, CD19, CD20, CD22, CD33, CD34, and CD61. Because of the absence of the markers of T-cell, B-cell, and myeloid lineage-specific antigens, we added CD16/56 for the immunophenotyping and the blasts were positive (94%). The tumor cells of biopsied lymph node were only positive for CD56, consistent with NK cell lymphoma. Epstein-Barr virus (EBV) was not detected by RNA in situ hybridization. Culture for M. tuberculosis was negative. Thus this patient was diagnosed with blastic NK cell lymphoma/leukemia involving bone marrow and lymph node.

P-glycoprotein expression in extracellular matrix formation of chondrogenic differentiation of human adult stem cells.

Mesenchymal stem cell (MSC) has been known as a good source of progenitor for multiple connective tissue including cartilage, muscle, adipocyte, and bone. P-glycoproteins (P-gps) also known as ABCB1 that exports diverse substrates are the product of the multidrug resistance-1 (MDR-1) gene. P-gp expression has been reported in chondrosarcoma and hypertrophic chondrocyte in the human growth plate. This study was designed to investigate the expression of P-gp during chondrogenic differentiation of adult human stem cells. Bone marrow samples were obtained from nine human donors after informed consent. The isolated mononuclear cells (MNCs) were incubated as one pellet/tube and 0.5ml chondrogenic medium in the presence of 10ng/ml of TGF-beta 1 and TGF-beta 3 for 28 days. The expression of surface P-gps was analyzed by flow cytometry and quantitative RT-PCR was performed for the detection of mRNA expression of MDR-1 and type II collagen gene. Total collagen and glycosaminoglycan (GAG) contents of the pellets were measured. Surface P-gp expression of the MSCs was decreased during chondrogenic differentiation. MDR-1 gene was decreased 10-fold after the 2-week incubation whereas type II collagen gene was increased 491-fold after the 4-week incubation in chondrogenic medium. The total amount of collagen and GAG were increased during pellet culture. This study has demonstrated a decrease in expression of P-gp and down regulation of MDR-1 gene consistently by flow cytometry and quantitative RT-PCR, but an increased expression of type II collagen on MSC during chondrogenesis.

Molecular epidemiological profile of rotavirus in South Korea, July 2002 through June 2003: emergence of G4P[6] and G9P[8] strains.

To determine the distribution of rotavirus strain genotypes in South Korea, rotavirus-positive stool specimens were collected from July 2002 through June 2003 at 8 hospitals in the Korean Rotavirus Strain Surveillance Network, and they were genotyped by means of reverse-transcription polymerase chain reaction. The globally uncommon G4P[6] type was the most prevalent type identified among strains (27% of strains), the newly emerging G9P[8] strain accounted for 11% of strains, and the globally common genotypes (i.e., G1P[8], G2P[4], G3P[8], and G4P[8]) constituted 55% of the strains characterized. Ninety percent of G4P[6] strains were detected in specimens obtained from neonates. Common genotypes were responsible for the rotavirus epidemic that began in January 2003 and ended in May 2003; however, an early peak in infections with the G4P[6] strain occurred from August through October 2002, and infections with this strain were detected throughout the remaining study period. G4P[6] strains were most commonly identified at 6 urban health care centers, but they were absent from 2 rural health care centers. The newly emerging strain G9P[8] represented a relatively greater proportion of strains identified at a hospital in the central region of Korea and at 2 hospitals in the southern region. The identification of novel rotavirus genotypes in this laboratory-based surveillance study underscores the importance to public health of continued strain surveillance among children for whom prevention of rotavirus infection by vaccination might be considered.