VIM- and IMP-Type Metallo-[beta]-lactamase--producing Pseudomonas spp. and Acinetobacter spp. in Korean hospitals. (Dispatches).We determined the occurrence of acquired metallo-[beta]-lactamase (MBL MBL Mobile MBL Marine Biological Laboratory MBL Macquarie Bank Limited MBL Mannose-Binding Lectin MBL Marine Boundary Layer MBL Member Business Lending (credit unions) MBL Movimiento Bolivia Libre )--producing bacteria in Korean hospitals. Among the isolates nonsusceptible to imipenem that were collected from 28 hospitals from 2000 to 2001, 44 (11.4%) of 387 Pseudomonas Pseudomonas A genus of gram-negative, nonsporeforming, rod-shaped bacteria. Motile species possess polar flagella. They are strictly aerobic, but some members do respire anaerobically in the presence of nitrate. spp. and 38 (14.2%) of 267 Acinetobacter spp Acinetobacter spp Bacteriology A widely distributed bacterium found in moist hospital environments, which may establish itself in the respiratory flora and on the skin of Pts with prolonged hospitalization, often via contaminated medical instruments–eg, . produced MBL and had alleles of [bla.sub.VIM-2] or [bla.sub.IMP-1]. MBL-producing isolates were detected in 60.7% of the hospitals. ********** Carbapenems are often used as a last resort for treating serious infections attributable to multidrug-resistant gram-negative bacilli bacilli /ba·cil·li/ (bah-sil´i) plural of bacillus. bacilli see bacillus. because these drugs are stable even to extended-spectrum and AmpC [beta]-lactamases. However, gram-negative bacilli with acquired metallo-[beta]-lactamase (MBL), IMP-1, emerged and spread during the early 1990s in Japan (1). IMP-1 and its variants were then detected in other countries (2). Another type of acquired MBL, VIM-l, was first reported in Pseudomonas aeruginosa Pseudomonas aeruginosa A normal soil inhabitant and human saprophyte that may contaminate various solutions in a hospital, causing opportunistic infection in weakened Pts Clinical Infective endocarditis in IVDAs, RTIs, UTIs, bacteremia, meningitis, 'malignant' in Italy (3), followed by reports of VIM-2 in France and Greece. VIM-2 was detected in P. aeruginosa in a Korean hospital isolated as early as 1995 (4). The occurrence of the VIM (Vendor Independent Messaging Interface) A programming interface developed by Lotus, Novell, IBM and others. In order to enable an application to send and receive mail over a VIM-compliant messaging system such as cc:Mail, programmers write to the VIM interface. enzyme has continued to evolve: VIM-3 was reported in Taiwan (5), and VIM-4 in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. (6). The [bla.sub.IMP (Interface Message Processor) The first router used in the ARPAnet. It was a Honeywell 516 minicomputer with special interfaces and software written by BBN. Imp of the Perverse perversity as motive for men’s actions. [Am. Lit. ] and [bla.sub.VIM] genes are horizontally transferable because they are inserted in integrons, and some of these integrons are located on conjugative plasmids (7). Because of its ability to spread, carbapenem resistance related to IMP and VIM [beta]-lactamase production has become a serious concern (8). Laboratory personnel and physicians must consider the therapeutic and infection-control implications of not detecting carbapenemase-producing bacteria (9). A large number of VIM-2-producing Pseudomonas spp. have been detected in a Korean hospital since 1995 (4), but the occurrence of MBL-producing isolates has not been studied at other Korean hospitals, despite the high prevalence of carbapenem-resistant P aeruginosa and Acinetobacter spp. (10). The aim of our study was to determine the occurrence of acquired MBL-producing P. aeruginosa and Acinetobacter spp. among isolates collected by Korean Nationwide Surveillance of Antimicrobial antimicrobial /an·ti·mi·cro·bi·al/ (-mi-kro´be-al) 1. killing microorganisms or suppressing their multiplication or growth. 2. an agent with such effects. Resistance Group hospitals. The MBL types produced and the sources of the MBL-positive isolates were also investigated. In addition, pulsed-field gel electrophoresis gel electrophoresis n. Electrophoresis performed in a gel composed of agarose, polyacrylamide, or starch. (PFGE PFGE Pulsed-Field Gel Electrophoresis ) patterns were compared to determine intra- and inter-hospital spread of resistant strains. The Study Nonduplicate, imipenem-resistant isolates of 387 Pseudomonas spp. and 267 Acinetobacter spp. were collected from 2000 to 2001 from 28 hospitals in the Korean Nationwide Surveillance of Antimicrobial Resistance Group hospitals located in six cities or provinces. The identification of the species and the imipenem susceptibility were confirmed at the coordinating laboratory by using conventional tests (11) or ATB ATB Antibiotic ATB All The Best ATB Ability to Benefit ATB André Tanneberger (musician) ATB Across the Board ATB Active Time Battle (roleplaying game) ATB All Terrain Bike ATB Alberta Treasury Branches 32 GN system (bioMerieux, Marcy-l'Etoile, France) and by using the disk diffusion test (12), respectively. MBL production was screened by using the Hodge test and the imipenem-EDTA double disk synergy test (13). The [bla.sub.IMP-1] and [bla.sub.VIM-2] alleles were detected by polymerase chain reaction polymerase chain reaction (pŏl`ĭmərās') (PCR), laboratory process in which a particular DNA segment from a mixture of DNA chains is rapidly replicated, producing a large, readily analyzed sample of a piece of DNA; the process is (PCR PCR polymerase chain reaction. PCR abbr. polymerase chain reaction Polymerase chain reaction (PCR) ), and three of the positive isolates were confirmed by sequencing, as described previously (4). XbaI-digested genomic DNA genomic DNA n. The full complement of DNA contained in the genome of a cell or organism. of P. aeruginosa isolates was separated by PFGE using the CHEF-DR-II system (Bio-Rad Laboratories, Hercules, CA) (4). The pattern was analyzed visually and by using UVIBand and Map software (UVItec Ltd., Cambridge, UK). Some of the Pseudomonas and Acinetobacter isolates collected were not fully resistant to imipenem but showed intermediate resistance when retested. Among the isolates not susceptible to imipenem, 44 (11.4%) of 387 Pseudomonas spp. (42 P. aeruginosa and 2 P. putida) and 38 (14.2%) of 267 Acinetobacter spp. were considered MBL producers on the basis of positive results by the Hodge test and imipenem-EDTA double disk synergy test (Table 1). MBL-producing Pseudomonas spp. and Acinetobacter spp. were detected in 11 (52.4%) of 21 and 10 (41.7%) of 24 hospitals that were located in four of five and five of six cities or provinces, respectively. We detected the [bla.sub.VIM] allele allele (əlēl`): see genetics. allele Any one of two or more alternative forms of a gene that may occur alternatively at a given site on a chromosome. by PCR from all 42 isolates of MBL-producing P. aeruginosa and 2 isolates of P putida. The [bla.sub.VIM-2] and [bla.sub.IMP-1] alleles were detected in 27 (71.1%) and 11 (28.9%) of 38 Acinetobacter isolates, respectively (Table 2). Nucleotide sequencing for three representative PCR-positive isolates confirmed the presence of the [bla.sub.VIM-2] gene in one isolate each of P. aeruginosa and Acinetobacter spp., and the [bla.sub.IMP-1] gene in one isolate of Acinetobacter spp. The MBL-producing strains were isolated mainly from intensive-care unit patients (31.7%) and other inpatients (50.0%); five (6.1%) were from emergency service and other outpatients (Table 3). Overall, MBL-producing isolates were mainly obtained from specimens of sputum sputum /spu·tum/ (spu´tum) [L.] expectoration; matter ejected from the trachea, bronchi, and lungs through the mouth. sputum cruen´tum bloody sputum. (50.0%) and urine (29.3%). However, the proportion of MBL-producing isolates was relatively higher among urine isolates: 17.3% for Pseudomonas spp. and 29.2% for Acinetobacter spp. We obtained one MBL-producing Acinetobacter isolate from each of the following specimen types: blood, spinal fluid spinal fluid n. See cerebrospinal fluid. , pleural fluid pleural fluid n. The thin film of serous fluid between the visceral and parietal pleurae. , and venous catheter tip (Table 4). The PFGE of the XbaI-digested genomic DNA of 39 isolates of P. aeruginosa showed 22 patterns (data not shown). Six isolates from one hospital had an identical pattern. Thirteen isolates (33.3%) belonged to another identical pattern--six from one hospital, two from each of two hospitals, and one from each of three hospitals, which were located in a city and two provinces. Conclusions In this study, > 10% of all imipenem-nonsusceptible isolates of Pseudomonas spp. and Acinetobacter spp. were attributable to MBL production (Table 1), and these MBL-producing isolates were detected in 62.5% of the participating hospitals. Our finding indicates that MBL-producing P. aeruginosa is more prevalent in Korea than in other countries (2) and that MBL-producing Acinetobacter spp. is increasing. The percentage of hospitals with MBL-producing isolates might have been higher if a larger number of imipenem-nonsusceptible isolates had been collected for this study. VIM-2 was the only type of acquired MBL identified initially in Korea. VIM-2-producing P. aeruginosa was isolated at almost the same time in Europe (7) and Korea (4). However, IMP-1-producing isolates were rare until 2000 in Korea. Only one and three IMP-1-positive P. aeruginosa and Acinetobacter spp., respectively, have been isolated at the coordinating laboratory (4, unpub. data). In our study, 11 (28.9%) of 38 MBL-positive isolates of Acinetobacter spp. were IMP producers (Table 2). This increase suggests the possible introduction of IMP-producing strains of Acinetobacter spp. from Japan, where 28 isolates of [bla.sub.IMP-1]-positive Acinetobacter baumannii Acinetobacter baumannii is a species of pathogenic bacteria which forms opportunistic infections.[1] There have been many reports of drug-resistant A. baumannii infections among American soldiers wounded in Iraq. were reported in a hospital as early as 1994 to 1996 (14). Rasmussen and Bush (15) predicted that an increase of MBL-producing organisms was inevitable, given the more frequent use of carbapenems. Imipenem has been used for only 9 years in Korea, but the imipenem-resistance rate of P. aeruginosa has rapidly risen from 6% in 1996 to 19% in 2001. A study by the Korean Nationwide Surveillance of Antimicrobial Resistance Group showed that the mean imipenem-resistance rates of P. aeruginosa in 1997 did not differ substantially depending on hospital size, (i.e., 17% in medium hospitals [<1,000 beds] and 18% in large hospitals [[greater than or equal to] 1,000 beds]). The mean resistance rates to imipenem were not lower than those to ceftazidime in 2000, i.e., 21% versus 18% in large hospitals and 20% versus 19% in medium hospitals (data not shown). Acinetobacter spp. are also common nosocomial nosocomial /noso·co·mi·al/ (nos?o-ko´me-il) pertaining to or originating in a hospital. nos·o·co·mi·al adj. 1. Of or relating to a hospital. 2. pathogens with multidrug resistance multidrug resistance, n the adaptation of tumor cells or infectious agents to resist chemotherapeutic agents. . The imipenem resistance rate of this organism isolated in Korea was found to be much lower than that of P. aeruginosa, but its resistance rate rose from 4% in the first quarter to 20% in the third quarter of 2002 at the coordinating laboratory (data not shown). In our study, MBL-producing Pseudomonas spp. and Acinetobacter spp. were isolated mainly from sputum and urine specimens, and most (81.7%) isolates were from inpatients and intensive-care unit patients. Therefore, proper treatment of respiratory secretions and urine from intensive-care unit patients is considered an important aspect of preventing the spread of MBL-producing organisms. The presence of P. aeruginosa isolates with identical PFGE patterns among those collected not only from certain hospitals but also from different hospitals suggests that clonal spread is at least a part of the cause of intra- and inter-hospital dissemination of MBL-producing isolates. The presence of VIM-2-producing Serratia marcescens Serratia marcescens Microbiology The type-species of the gram-negative Serratia, widely present in the environment, and occasional cause of hospital-acquired infections Asssociations Contaminated fluids, equipment, cleaning solutions, hands, ↓ , Enterobacter cloacae Enterobacter cloacae is a clinically significant Gram-negative, facultatively-anaerobic, rod-shaped bacterium. , and Achromobacter xylosoxidans subsp, denitrificans (unpub. data) in other hospitals also suggests horizontal transfer of the resistance determinants. Cornaglia et al. reported that five of seven patients infected with MBL-producing P. aeruginosa died, although the cause of death was difficult to establish with certainty (16). Clinical studies on the infection are rare because isolation of MBL-producing gram-negative bacilli increased only recently. We anticipate difficulties in treating patients infected with MBL-producing gram-negative bacilli, which can hydrolyze hydrolyze to performance hydrolysis. , in vitro in vitro /in vi·tro/ (in ve´tro) [L.] within a glass; observable in a test tube; in an artificial environment. in vi·tro adj. In an artificial environment outside a living organism. , all available [beta]-lactams, except aztreonam for which clinical efficacy is unknown. Our study indicates the urgent need for action to prevent further spread of MBL-producing organisms. Previous experiences with penicillin-nonsusceptible pneumococci, methicillin-resistant Staphylococcus aureus methicillin-resistant Staphylococcus aureus Methicillin-aminoglycoside resistant Staphylococcus aureus, MRSA An organism with multiple antibiotic resistances–eg, aminoglycosides, chloramphenicol, clindamycin, erythromycin, rifampin, tetracycline, , vancomycin-resistant Enterococcus vancomycin-resistant enterococcus Infectious disease An enterococcus, primarily Enterococcus faecium, resistant to most antibiotics, including aminoglycosides and vancomycin, once a 'last-resort' agent; VRE is primarily nosocomial, in long faecium, and extended-spectrum [beta]-lactamase--producing Klebsiella pneumoniae Klebsiella pneu·mo·ni·ae n. Friedlander's bacillus. indicate that once resistant bacteria can become widespread they cannot be controlled (10). Our first task is to detect MBL producers among clinical isolates (9). Although the National Committee for Clinical Laboratory Standards document (12) does not contain procedures for detection, simple procedures are available (13). The prevalence of [bla.sub.VIM-2] allele-positive P. aeruginosa and [bla.sub.IMP-1] allele-positive Acinetobacter spp. is increasing possibly because of clonal and horizontal spread Horizontal Spread An options strategy involving the simultaneous purchase and sale of two options of the same type, having the same strike price, but different expiration dates. of the resistance determinant in Korean hospitals. Sputum and urine from inpatients and intensive-care unit patients were found to be the main sources of MBL-producing isolates. Laboratories not only in Korea but also in other countries with carbapenem-resistant organisms must be prepared to screen MBL-producing isolates to determine the clinical impact and prevent further spread of MBL-producing organisms.
Table 1. Detection of metallo-[beta]-lactamase-producing isolates among
imipenem-nonsusceptible isolates of Pseudomonas spp. and Acinetobacter
spp.
No. hospitals (%)
Organism City/province Tested Positive
Pseudomonas spp. Seoul 11 (a) 4 (36.4)
Kyungki 2 2 (100)
Kangwon 2 1 (50.0)
Chulla 4 4 (100)
Kyungsang 2 0 (0)
Total 21 11 (52.4)
Acinetobacter spp. Seoul 11 (a) 4 (36.4)
Kyungki 3 0 (0)
Kangwon 3 2 (25.0)
Chulla 3 1 (12.5)
Kyungsang 2 1 (50.0)
Chungchung 2 2 (100)
Total 24 10 (41.7)
No. isolates (%)
Organism City/province Tested Positive
Pseudomonas spp. Seoul 144 12 (8.3)
Kyungki 40 6 (15.0)
Kangwon 57 2 (3.5)
Chulla 108 24 (22.2)
Kyungsang 38 0 (0)
Total 387 44 (11.4)
Acinetobacter spp. Seoul 107 12 (11.2)
Kyungki 29 0 (0)
Kangwon 41 8 (19.5)
Chulla 25 13 (52.0)
Kyungsang 53 1 (1.9)
Chungchung 12 4 (33.3)
Total 267 38 (14.2)
(a) Four were tertiary-care hospitals.
Table 2. Detection of [bla.sub.VIM-2] and [bla.sub.IMP-1] allele from
metallo-[beta]-lactamase-producing Pseudomonas spp. and Acinetobacter
spp. by polymerase chain reaction
No. isolates (%)
[bla.sub.VIM-2] [bla.sub.IMP-1
Organism Tested positive positive
Pseudomonas aeruginosa 42 42 (100) 0 (0)
P. putida 2 2 (100) 0 (0)
Acinetobacter spp. 38 27 (71.1) 11 (28.9)
Total 82 71 (86.6) 11 (13.4)
Table 3. [bla.sub.VIM-2] and [bla.sub.IMP-1] allele-positive
Pseudomonas spp. and Acinetobacter spp. isolated by service
No. isolates (%)
Organism Outpatient Inpatient Intensive-care unit
Pseudomonas spp. 3 (6.8) (a) 26 (59.1) 11 (25.0)
Acinetobacter spp. 2 (5.2) (b) 15 (39.5) 15 (39.5)
Total 5 (6.1) 41 (50.0) 26 (31.7)
Organism Others Total
Pseudomonas spp. 4 (9.1) 44 (100)
Acinetobacter spp. 6 (15.8) 38 (100)
Total 10 (12.2) 82 (100)
(a) Two were emergency service patients, and one was a urology patient.
(b) One was an emergency service patient, and one was a pediatric
patient.
Table 4. [bla.sub.VIM-2] and [bla.sub.IMP-1] allele-positive
Pseudomonas spp. and Acinetobacter spp. isolated by source
No. (%) of isolates with metallo-a-lactamase
Pseudomonas spp. Acinetobacter spp.
Source Tested Positive Tested Positive
Sputum 200 22 (11.0) 143 19 (13.3)
Urine 98 17 (17.3) 24 7 (29.2)
Wound 49 2 (4.1) 71 7 (9.9)
Other (a) 18 3 (16.7) 29 5 (17.2)
Total 387 44 (11.4) 267 38 (14.2)
Total % positive by
Source Tested Positive source
Sputum 343 41 (12.0) 50.0
Urine 122 24 (19.7) 29.3
Wound 120 9 (7.5) 10.9
Other (a) 47 8 (17.0) 9.8
Total 654 82 (12.5) 100
(a) Others included one Acinetobacter isolate of specimens from blood,
spinal fluid, pleural fluid, and a venous catheter tip.
Acknowledgments We thank Jong Noun 1. Jong - United States writer (born in 1942) Erica Jong Hwa Yum and Dongeun Yong for detecting the metallo-[beta]-lactamase genes and Yonghee Suh for screening the MBL producers. References (1.) Osano E, Arakawa Y, Wacharotayankun R, Ohta M, Horii T, Ito H, et al. Molecular characterization of an enterobacterial metallo-[beta]-lactamases found in a clinical isolates of Serratia marcescens that shows imipenem resistance. Antimicrob Agents Chemother 1994;38:71-8. (2.) Gibb AP, Tribuddharat C, Moore RA, Louie T J, Krulicki W, Livermore DM, et al. Nosocomial outbreak of carbapenem-resistant Pseudomonas aeruginosa with a new [bla.sub.IMP] allele, [bla.sub.IMP-7]. Antimicrob Agents Chemother 2002;46:255-8. (3.) Lauretti L, Riccio ML, Mazzariol A, Comaglia G, Amicosante G, Fontana R, et al. Cloning and characterization of [bla.sub.VIM], a new integron-borne metallo-[beta]-lactamase gene from a Pseudomonas aeruginosa clinical isolate. Antimicrob Agents Chemother 1999; 43:1584-90. (4.) Lee K, Lim JB, Yum JH, Yong D, Chong Y, Kim JM, et al. [bla.sub.VIM-2] cassette-containing novel integrons in metallo-[beta]-lactamase--producing Pseudomonas aeruginosa and Pseudomonas putida Pseudomonas putida is a gram-negative rod-shaped saprophytic soil bacterium. Based on 16S rRNA analysis, P. putida has been placed in the P. putida group, to which it lends its name[1]. isolates disseminated in a Korean hospital. Antimicrob Agents Chemother 2002;46:1053-8. (5.) Yan J-J, Hsueh P-R, Ko W-C, Luh E-T, Tsai S-H, Wu H-M, et al. Metallo-[beta]-lactamases in clinical Pseudomonas isolates in Taiwan and identification of VIM-3, a novel variant of the VIM-2 enzyme. Antimicrob Agents Chemother 2001 ;45:2224-8. (6.) Tolman MA, Rolston K, Jones RN, Walsh TR. Molecular characterization of VIM-4, a novel metallo-beta-lactamase isolated from Texas: report from the cancer surveillance program (2001). Proceedings of the 42nd Interscience ConfErence on Antimicrobial Agents and Chemotherapy Antimicrobial Agents and Chemotherapy (print-ISSN 0066-4804, CODEN AMACCQ; canceled ISSN 0074-9923, canceled CODEN AACHAX) is an academic journal published by the American Society for Microbiology. . Abstract C1-1851. San Diego, California “San Diego” redirects here. For other uses, see San Diego (disambiguation). San Diego is a coastal Southern California city located in the southwestern corner of the continental United States. As of 2006, the city has a population of 1,256,951. ; 2002. (7.) Poirel L, Naas T, Nicolas D, Collet L, Bellais S, Cavallo T-D, et al. Characterization of VIM-2, a carbapenem-hydrolyzing metallo-[beta]-lactamase and its plasmid- and integron borne gene from a Pseudomonas aeruginosa clinical isolate in France. Antimicrob Agents Chemother 2000;44:891-7. (8.) Richet HM, Mohammed J, McDonald LC, Jarvis WR, INSPEAR. Building communication networks: International Network for the Study and Prevention of Emerging Antimicrobial Resistance. Emerg Infect Dis 2001;7:319-22. (9.) Molland ES, Black JA, Ourada J, Reisbid MD, Hanson ND, Thomson KS. Occurrence of newer [Mactamases in Klebsiella pneumoniae isolates from 24 U.S. hospitals. Antimicrob Agents Chemother 2002;46:3837-42. (10.) Lee K, Lee HS, Jang SJ, Park AJ, Lee MH, Song WK, et al. Antimicrobial resistance surveillance of bacteria in 1999 in Korea with a special reference to resistance of enterococci enterococci bacteria in the genus Enterococcus. to vancomycin vancomycin (văn'kōmī`sĭn), antibiotic resembling penicillin in the way it acts. It is derived from the bacterium Streptomyces orientalis, which was isolated from soil of India and Indonesia. and gram-negative bacilli to third generation cephalosporin third generation cephalosporin Infectious disease A group of broad-spectrum antibiotics–eg, cefatoxime, ceftazidime, ceftriaxone and moxalactam that are structurally related to penicillins and used against penicillinase-producing bacteria; TGCs are more , imipenem, and fluoroquinolone fluoroquinolone /flu·o·ro·quin·o·lone/ (-kwin´o-lon) any of a subgroup of fluorine-substituted quinolones, having a broader spectrum of activity than nalidixic acid. fluor·o·quin·o·lone n. . J Korean Med Sci 2001;16:262-70. (11.) Kiska DL, Gilligan PH. Pseudomonas. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology Clinical microbiology The adaptation of microbiological techniques to the study of the etiological agents of infectious disease. Clinical microbiologists determine the nature of infectious disease and test the ability of various antibiotics to inhibit or kill , 7th ed. Washington: American Society for Microbiology The American Society for Microbiology (ASM) is a scientific organization, based in the United States although with over 43,000 members throughout the world. It is the largest single life science professional organization and its members include those whose interests encompass basic ; 1999. p. 517-25. (12.) National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility testing. Eleventh informational supplement. NCCLS NCCLS National Committee for Clinical Laboratory Standards document M100-S11. Wayne (PA): The Committee, 2001. (13.) Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. Modified Hodge test and EDTA-disk synergy tests to screen metallo-[beta]-lactamase--producing strains of Pseudomonas and Acinetobacter species. Clin Microbiol Infect 2001 ;7:88-91. (14.) Takahashi A, Yomoda S, Kobayashi I, Kubo T, Tsunoda M, Iyobe S. Detection of carbapenemase-producing Acinetobacter baumannii in a hospital. J Clin Microbiol 2000;38:526-9. (15.) Rasmussen BA, Bush K. Carbapenem-hydrolyzing [beta]-lactamases. Antimicrob Agents Chemother 1997;41:223-32. (16.) Cornaglia G, Mazzariol A, Lauretti L, Rossolini GM, Fontana R. Hospital outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-1, a novel transferable metallo-[beta]-lactamase. Clin Infect Dis 2000;31:1119-25. Address for correspondence: Yunsop Chong, Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University
Yonsei University (IPA: / College of Medicine, 134 Shinchon-dong Seodaemun-ku, Seoul, Korea 120-752; fax: 82-2-313-0908; email: whonetkor@yumc.yonsei.ac.kr Kyungwon Lee, * Wee Gyo Lee, ([dagger]) Young Uh, ([dagger]) Gyoung Yim Ha, ([section]) Jihyun Cho, ([paragraph]) Yunsop Chong, * and the Korean Nationwide Surveillance of Antimicrobial Resistance Group (1) * Yonsei University College of Medicine, Seoul, Korea; ([dagger]) Ajou University See also
n. A reference mark (  ) used in printing and writing. Also called diesis.Noun 1. ]) Yonsei University Wonju College of Medicine, Wonju, Korea; ([section]) College of Medicine of Dongguk University Dongguk University is a private, coeducational university in South Korea. It operates campuses in Seoul and in Gyeongju City, North Gyeongsang province. In addition, it operates two affiliated hospitals of Western medicine, and four of Oriental medicine a generic term which , Kyongju, Korea; and Wonkwang University College of Medicine, Iksan, Korea (1) In addition to the listed authors, this group includes the following: Jung Oak Kang, Moon Yeon Kim, Nam Yong Lee, Mi-Ne Kim, Myungshin Kim, Kyung Soon Song, Ki Sook Hong, In Ki Paik, Hye Soo Lee, Sook-Jin Jang, Ae Ja Park, Sung Ha Kang, Won Keun Song, Insoo Rheem, Eui-Chong Kim, Yeon Joon Park, Jong Hee Shin, Myungseo Kang, Young-Kyu Sun, Hee Joe Lee, Hwan-Sub Lim, Jong Week Lee, and Bo-Moon Shin. Dr. Lee is director of the Research Institute of Bacterial Resistance and a professor in the Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. He is the Korean coordinator in the World Health Organization/Centers for Disease Control and Prevention External Quality Assurance Scheme, and he is the organizer of the Korean Nationwide Surveillance of Antimicrobial Resistance Group. His research interests include antimicrobial resistance of bacteria and its mechanisms. |
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