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Journal of clinical microbiology 43건

  1. [해외논문]   Assessment of a Novel Automatic Real-Time PCR Assay on the Cobas 4800 Analyzer as a Screening Platform for Hepatitis C Virus Genotyping in Clinical Practice: Comparison with Massive Sequencing   SCI SCIE

    Nieto-Aponte, Leonardo (Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ) , Quer, Josep (Centro de Investigaciòón Biomòóédica en Red de Enfermedades Hepòóéáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain ) , Ruiz-Ripa, Alicia (Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ) , Tabernero, David (Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ) , Gonzalez, Carolina (Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron (HUVH), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain ) , Gregori, Josep (Centro de Investigaciòón Biomòóédica en R) , Vila, Marta , Asensio, Miriam , Garcia-Cehic, Damir , Ruiz, Gerardo , Chen, Qian , Ordeig, Laura , Llorens, Meritxell , Saez, Montserrat , Esteban, Juan I. , Esteban, Rafael , Buti, Maria , Pumarola, Tomas , Rodriguez-Frias, Francisco
    Journal of clinical microbiology v.55 no.2 ,pp. 504 - 509 , 2017 , 0095-1137 ,

    초록

    The unequivocal identification of hepatitis C virus (HCV) subtypes 1a/1b and genotypes 2 to 6 is required for optimizing the effectiveness of interferon-free, direct-acting antiviral therapies. We compared the performance of a new real-time HCV genotyping assay used on the Cobas 4800 system (C4800) with that of high-resolution HCV subtyping (HRCS). In total, 502 samples were used, including 184 samples from chronic HCV patients (from routine laboratory activity during April 2016), 5 stored samples with double HCV genotype infections for testing the limitations of the method, and 313 samples from a screening protocol implemented in our hospital (from May to August 2016) based on the new method to further determine its genotyping accuracy. A total of 282 samples, including 171 from April 2016 (the 13 remaining had too low of a viral load for HRCS), 5 selected with double infections, and 106 from screening, were analyzed by both methods, and 220 were analyzed only by the C4800. The C4800 correctly subtyped 125 of 126 1a/1b samples, and the 1 remaining sample was reported as genotype 1. The C4800 correctly genotyped 38 of 45 non-1a/1b samples (classified by HRCS), and it reported the remaining 7 samples as indeterminate. One hundred two of 106 non-1a/1b genotype samples that were identified using the C4800 for screening were confirmed by HRCS. In the 4 remaining samples, 3 were correctly reported as genotype 1 (without defining the subtype) and 1 was reported as indeterminate. None of the samples were misgenotyped. Four of 7 samples with double HCV infections were correctly genotyped by the C4800. Excluding the 5 selected double-infected samples, the C4800 showed 95.7% concordant results for genotyping HCVs 2 to 6 and 1a/1b subtyping, and 99.2% concordance for subtyping 1a/1b single infections in clinical samples. To improve laboratory workflow, we propose using the C4800 as a first-line test for HCV genotyping and 1a/1b classification, followed by transferring non-1a/1b samples to a center where HRCS is available, if further characterization is needed.

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  2. [해외논문]   Comparative Evaluation of Four Phenotypic Tests for Detection of Carbapenemase-Producing Gram-Negative Bacteria   SCI SCIE

    Noel, Audrey , Huang, Te-Din , Berhin, Catherine , Hoebeke, Martin , Bouchahrouf, Warda , Yunus, Sami , Bogaerts, Pierre , Glupczynski, Youri
    Journal of clinical microbiology v.55 no.2 ,pp. 510 - 518 , 2017 , 0095-1137 ,

    초록

    Four screening assays aimed for rapid detection of carbapenemase production from Gram-negative bacterial isolates, i.e., the Neo-Rapid Carb kit (Rosco Diagnostica A/S), the Rapidec Carba NP test (bioMérieux SA), the β Carba test (Bio-Rad Laboratories N.V.), and a homemade electrochemical assay (BYG Carba test) were evaluated against a panel comprising 328 clinical isolates ( Enterobacteriaceae [ n = 198] and nonfermentative Gram-negative bacilli [ n = 130]) with previously characterized resistance mechanisms to carbapenems. Among Enterobacteriaceae isolates, the BYG Carba test and the β Carba test showed excellent sensitivities (respectively, 100% and 97.3%) and specificities (respectively, 98.9% and 97.7%). The two other assays yielded poorer performances with sensitivity and specificity of 91.9% and 83.9% for the Rapidec Carba NP test and of 89.2% and 89.7% for the Neo-Rapid Carb kit, respectively. Among Pseudomonas spp., sensitivities and specificities ranged, respectively, from 87.3% to 92.7% and from 88.2% to 94.1%. Finally, all tests performed poorly against Acinetobacter spp., with sensitivities and specificities, respectively, ranging from 27.3% to 75.8% and from 75 to 100%. Among commercially available assays, the β Carba test appeared to be the most convenient for routine use and showed the best overall performances, especially against OXA-48-like producers. The excellent performance of the BYG Carba test against Enterobacteriaceae was confirmed (100% sensitivity and 98.9% specificity).

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  3. [해외논문]   Clinical Evaluation and Cost Analysis of Great Basin Shiga Toxin Direct Molecular Assay for Detection of Shiga Toxin-Producing Escherichia coli in Diarrheal Stool Specimens   SCI SCIE

    Faron, Matthew L. (The Medical College of Wisconsin, Milwaukee, Wisconsin, USA ) , Ledeboer, Nathan A. (The Medical College of Wisconsin, Milwaukee, Wisconsin, USA ) , Connolly, Jessica (The Medical College of Wisconsin, Milwaukee, Wisconsin, USA ) , Granato, Paul A. (Laboratory Alliance of Central New York, Syracuse, New York, USA ) , Alkins, Brenda R. (Laboratory Alliance of Central New York, Syracuse, New York, USA ) , Dien Bard, Jennifer (Childrens Hospital of Los Angeles, Los Angeles, California, USA ) , Daly, Judy A. (University of Utah Primary Children's Hospital, Salt Lake City, Utah, USA ) , Young, Stephen (TriCore Laboratories, Albuquerque, New Mexico, USA ) , Buchan, Blake W. (The Medical College of Wisconsin, Milwaukee, Wisconsin, USA)
    Journal of clinical microbiology v.55 no.2 ,pp. 519 - 525 , 2017 , 0095-1137 ,

    초록

    The Shiga Toxin Direct molecular assay (ST Direct) relies on nucleic acid amplification and solid array-based amplicon detection to identify Shiga toxin-producing Escherichia coli (STEC) in preserved stool specimens. Genes encoding Shiga toxin ( stx 1 and stx 2 ), as well as the E. coli serotype O:157-specific marker rfbE , are simultaneously detected within 2 h. ST Direct was evaluated using 1,084 prospectively collected preserved stool specimens across five clinical centers. An additional 55 retrospectively collected, frozen specimens were included to increase the number of positive specimens evaluated. Results were compared to results from routine culture and an enzyme immunoassay (EIA) specific for the recovery and identification of STEC. ST Direct was found to be 93.2% sensitive and 99.3% specific for detection of stx 1 and stx 2 and 95.7% sensitive and 99.3% specific for detection of E. coli serotype O:157. All specimens with false-positive results were found to contain stx 1 or stx 2 or were found to be positive for serotype O:157 when analyzed using alternative molecular methods. All 4 false-negative stx 1 or stx 2 results were reported for frozen, retrospectively tested specimens. In all cases, the specimens tested positive for stx by an alternative FDA-cleared nucleic acid amplification test (NAAT) but were negative for stx 1 and stx 2 following nucleic acid sequence analysis. Based on these data, culture and EIA-based methods for detection of STEC are only 33% sensitive compared to molecular tests. A retrospective cost analysis demonstrated 59% of the cost of routine stool culture to be attributable to the identification of STEC. Taken together, these data suggest that ST Direct may provide a cost-effective, rapid molecular alternative to routine culture for the identification of STEC in preserved stool specimens.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  4. [해외논문]   Field Validation of SYBR Green- and TaqMan-Based Real-Time PCR Using Biopsy and Swab Samples To Diagnose American Tegumentary Leishmaniasis in an Area Where Leishmania (Viannia) braziliensis Is Endemic   SCI SCIE

    Gomes, Ciro Martins (Division of Dermatology, Department of Medical Clinics, Ribeirááão Preto Medical School, University of Sááãão Paulo, Ribeirááããão Preto, Sááãããão Paulo State, Brazil ) , Cesetti, Mariana Vicente (Division of Dermatology, Department of Medical Clinics, University of Brasááããããília, Brasááããããíília, Federal District, Brazil ) , de Paula, Natá (Laboratory of Dermatology, University Hospital of Ribeirááããããííão Preto Medical School, University of Sááããããííãão Paulo, Ribeirááããããííããão Preto, Sááããããííãããão Paulo State,) , lia Aparecida , Vernal, Sebastiá , á , n , Gupta, Gaurav , Sampaio, Raimunda Nonata Ribeiro , Roselino, Ana Maria
    Journal of clinical microbiology v.55 no.2 ,pp. 526 - 534 , 2017 , 0095-1137 ,

    초록

    The precise diagnosis of American tegumentary leishmaniasis (ATL) is an essential task due to the disease's associated morbidity. A noninvasive, extremely sensitive, and highly specific exam is critical, particularly for mucosal leishmaniasis (ML), in which a low parasite quantity is expected. We aimed to compare the diagnostic accuracy of swab and biopsy sample analysis using SYBR Green- and TaqMan-based real-time PCR (qPCR) assays with that of a composite reference standard consisting of the Montenegro skin test, serology, histopathology, smears, culture, and conventional PCR. In total, 55 patients with ATL (ML, 18 patients; cutaneous leishmaniasis [CL], 37 patients) and 36 patients without ATL were studied. qPCR analysis of swabs was more accurate when using SYBR Green (87.88%; 95% confidence interval [CI], 77.86 to 93.73 patients) than when using TaqMan (78.79%; 95% CI, 67.49 to 86.92%) ( P = 0.031). SYBR Green (84.72%; 95% CI, 74.68 to 91.25%) was also more accurate than TaqMan (73.61%; 95% CI, 62.42 to 82.41%) for biopsy samples ( P = 0.008). All qPCR methods were 100% specific. Swabs and biopsy specimens had similar sensitivity when using the same chemistry ( P = 0.125 for SYBR Green and P = 0.625 for TaqMan). Moreover, qPCR achieved better performance than most existing techniques used for the diagnosis of ATL and also detected the Leishmania parasite in a greater proportion of patients than the associated histopathology, smear, culture, and conventional PCR techniques did. Swabs therefore represent a useful diagnostic tool because they not only are noninvasive but also can achieve an accuracy similar to that of biopsy samples. The high accuracy of SYBR Green-based qPCR may also reduce the requirement for associated parasitological tests for ATL diagnosis.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  5. [해외논문]   Zika Virus Testing Considerations: Lessons Learned from the First 80 Real-Time Reverse Transcription-PCR-Positive Cases Diagnosed in New York State   SCI SCIE

    St. George, Kirsten (Wadsworth Center, New York State Department of Health, Albany, New York, USA ) , Sohi, Inderbir S. (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Dufort, Elizabeth M. (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Dean, Amy B. (Wadsworth Center, New York State Department of Health, Albany, New York, USA ) , White, Jennifer L. (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Limberger, Ronald (Wadsworth Center, New York State Department of Health, Albany, New York, USA ) , Sommer, Jamie N. (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Ostrowski, Stephanie (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Wong, Susan J. (Wadsworth Center, New York State Department of Health, Albany, New York, USA ) , Backenson, P. Bryon (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Kuhles, Daniel (Division of Epidemiology, New York State Department of Health, Albany, New York, USA ) , Blog, Debra (Division of Epidemiology, New York State Department of Health, Albany, New) , Taylor, Jill , Hutton, Brad , Zucker, Howard A.
    Journal of clinical microbiology v.55 no.2 ,pp. 535 - 544 , 2017 , 0095-1137 ,

    초록

    The performance and interpretation of laboratory tests for Zika virus (ZKV) continue to be evaluated. Serology is cross-reactive, laborious, and frequently difficult to interpret, and serum was initially solely recommended for molecular diagnosis. ZKV testing was initiated in January 2016 in New York State for symptomatic patients, pregnant women, their infants, and patients with Guillain-Barré syndrome who had traveled to areas with ZKV transmission. Subsequently, eligibility was expanded to pregnant women with sexual partners with similar travel histories. Serum and urine collected within 4 weeks of symptom onset or within 6 weeks of travel were tested with real-time reverse transcription-PCR (RT-PCR) assays targeting the ZKV envelope and NS2B genes. In this review of lessons learned from the first 80 positive cases in NYS, ZKV RNA was detected in urine only in 50 patients, in serum only in 19 patients, and in both samples concurrently in 11 patients, with average viral loads in urine a log higher than those in serum. Among 93 positive samples from the 80 patients, 41 were positive on both gene assays, 52 were positive on the envelope only, and none were positive on the NS2B only. Of the 80 infected patients, test results for 74 (93%) would have defined their infection status as not detected or equivocal if the requirement for positive results from two assay targets (two-target-positive requirement) in the initial federal guidance to public health laboratories was enforced, if urine was not tested, or if the extended eligibility time for molecular testing was not implemented. These changes facilitated more extensive molecular diagnosis of ZKV, reducing reliance on time-consuming and potentially inconclusive serology.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  6. [해외논문]   Validation of Autoclave Protocols for Successful Decontamination of Category A Medical Waste Generated from Care of Patients with Serious Communicable Diseases   SCI SCIE

    Garibaldi, Brian T. (Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Reimers, Mallory (Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Ernst, Neysa (Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Bova, Gregory (Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Nowakowski, Elaine (Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Bukowski, James (Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Ellis, Brandon C. (Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Smith, Chris (Johns Hopkins Hospital, Baltimore, Maryland, USA ) , Sauer, Lauren (Johns Hopkins Office of Critical Event Preparedness and Response, Baltimore, Maryland, USA ) , Dionne, Kim (Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Carroll, Karen C. (Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Maragakis, Lisa L. (Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA ) , Parrish, Nicole M. (Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, U)
    Journal of clinical microbiology v.55 no.2 ,pp. 545 - 551 , 2017 , 0095-1137 ,

    초록

    In response to the Ebola outbreak in 2014, many hospitals designated specific areas to care for patients with Ebola and other highly infectious diseases. The safe handling of category A infectious substances is a unique challenge in this environment. One solution is on-site waste treatment with a steam sterilizer or autoclave. The Johns Hopkins Hospital (JHH) installed two pass-through autoclaves in its biocontainment unit (BCU). The JHH BCU and The Johns Hopkins biosafety level 3 (BSL-3) clinical microbiology laboratory designed and validated waste-handling protocols with simulated patient trash to ensure adequate sterilization. The results of the validation process revealed that autoclave factory default settings are potentially ineffective for certain types of medical waste and highlighted the critical role of waste packaging in successful sterilization. The lessons learned from the JHH validation process can inform the design of waste management protocols to ensure effective treatment of highly infectious medical waste.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  7. [해외논문]   Coelomycetous Fungi in the Clinical Setting: Morphological Convergence and Cryptic Diversity   SCI SCIE

    Valenzuela-Lopez, Nicomedes (Unitat de Micologia, Facultat de Medicina i Ciééències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Spain ) , Sutton, Deanna A. (Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, Texas, USA ) , Cano-Lira, José (Unitat de Micologia, Facultat de Medicina i Ciééències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Spain ) , F. (Unitat de Micologia, Facultat de Medicina i Ciééències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Spain ) , Paredes, Katihuska (Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, Texas, USA ) , Wiederhold, Nathan (Unitat de Micologia, Facultat de Medicina i Ciééències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Spain ) , Guarro, Josep (Unitat de Micologia, Facultat de Medicina i Ciééències de la Salut and IISPV, Universitat Rovira i Virgili, Reus, Spain) , Stchigel, Alberto M.
    Journal of clinical microbiology v.55 no.2 ,pp. 552 - 567 , 2017 , 0095-1137 ,

    초록

    Human infections by coelomycetous fungi are becoming more frequent and range from superficial to systemic dissemination. Traumatic implantation of contaminated plant material is the most common cause. The typical morphological feature of these fungi is the production of asexual spores (conidia) within fruiting bodies called conidiomata. This study aimed to determine the distribution of the coelomycetes in clinical samples by a phenotypic and molecular study of a large set of isolates received from a U.S. reference mycological institution and by obtaining the in vitro antifungal susceptibility pattern of nine antifungals against a selected group of isolates. A total of 230 isolates were identified by sequencing the D1 and D2 domains of the large subunit (LSU) nuclear ribosomal RNA (nrRNA) gene and by morphological characterization. Eleven orders of the phylum Ascomycota were identified: Pleosporales (the largest group; 66.1%), Botryosphaeriales (19.57%), Glomerellales (4.35%), Diaporthales (3.48%), Xylariales (2.17%), Hysteriales and Valsariales (0.87%), and Capnodiales , Helotiales , Hypocreales and Magnaporthales (0.43% each). The most prevalent species were Neoscytalidium dimidiatum , Paraconiothyrium spp., Phoma herbarum , Didymella heteroderae , and Epicoccum sorghinum . The most common anatomical site of isolation was superficial tissue (66.5%), followed by the respiratory tract (17.4%). Most of the isolates tested were susceptible to the majority of antifungals, and only flucytosine showed poor antifungal activity.

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    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  8. [해외논문]   Stability Study of Cervical Specimens Collected by Swab and Stored Dry Followed by Human Papillomavirus DNA Detection Using the cobas 4800 Test   SCI SCIE

    Lin, Chun-Qing (Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China ) , Zeng, Xi (Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China ) , Cui, Jian-Feng (Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China ) , Liao, Guang-Dong (Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China ) , Wu, Ze-Ni (Department of Cancer Epidemiology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China ) , Gao, Qian-Qian (Department of Gynecology and Obstetrics, West China Second University Hospit) , Zhang, Xun , Yu, Xiu-Zhang , Chen, Wen , Xi, Ming-Rong , Qiao, You-Lin
    Journal of clinical microbiology v.55 no.2 ,pp. 568 - 573 , 2017 , 0095-1137 ,

    초록

    Safer, more convenient methods for cervical sample collection and storage are necessary to facilitate human papillomavirus (HPV) DNA testing in low-resource settings. Our study aimed to evaluate the stability of cervical specimens collected with dry swabs and stored dry, compared to liquid-based cytology (LBC) samples, as detected by HPV DNA testing. Women with abnormal cytological findings or HPV-positive results at colposcopy were recruited from the West China Second University Hospital, Sichuan University, between October 2013 and March 2014. From each woman, physicians collected cervical specimens with a swab placed into a Sarstedt tube and a CytoBrush placed into LBC medium. Samples were randomly assigned to be stored at uncontrolled ambient temperature for 2, 7, 14, or 28 days and then were tested for 14 high-risk HPV (HR-HPV) types using the cobas HPV test. The rates of agreement between dry swab and LBC samples for any HR-HPV type, HPV16, HPV18, and the 12 pooled HR-HPV types were 93.8%, 97.8%, 99.4%, and 93.2%, respectively, with kappa values of 0.87 (95% confidence interval [CI], 0.83 to 0.91), 0.94 (95% CI, 0.91 to 0.97), 0.94 (95% CI, 0.87 to 1.00), and 0.86 (95% CI, 0.82 to 0.90). The performance of swab samples for detection of cervical precancerous lesions by means of cobas HPV testing was equal to that of LBC samples, even with stratification by storage time. Dry storage of swab-collected cervical samples can last for 1 month without loss of test performance by cobas HPV testing, compared to LBC samples, which may offer a simple inexpensive approach for cervical cancer screening in low-resource settings.

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  9. [해외논문]   Emergence of mmpT5 Variants during Bedaquiline Treatment of Mycobacterium intracellulare Lung Disease   SCI SCIE

    Alexander, David C. (University of Regina, Department of Biology, Regina, Saskatchewan, Canada ) , Vasireddy, Ravikiran (The Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center at Tyler, Tyler, Texas, USA ) , Vasireddy, Sruthi (The Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center at Tyler, Tyler, Texas, USA ) , Philley, Julie V. (The Mycobacteria/Nocardia Research Laboratory, Department of Medicine, University of Texas Health Science Center at Tyler, Tyler, Texas, USA ) , Brown-Elliott, Barbara A. (The Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center at Tyler, Tyler, Texas, USA ) , Perry, Benjamin J. (University of Regina, Department of Biology, Regina, Saskatchewan, Canada ) , Griffith, David E. (The Mycobacteria/Nocardia Research Laboratory, Department of Medicine, University of Texas Health Science Center at Tyler, Tyler, Texas, USA ) , Benwill, Jeana L. (The Mycobacteria/Nocardia Research Laboratory, Department of Microbiology, University of Texas Health Science Center at T) , Cameron, Andrew D. S. , Wallace Jr., Richard J.
    Journal of clinical microbiology v.55 no.2 ,pp. 574 - 584 , 2017 , 0095-1137 ,

    초록

    Bedaquiline (BDQ), a diarylquinoline antibiotic that targets ATP synthase, is effective for the treatment of Mycobacterium tuberculosis infections that no longer respond to conventional drugs. While investigating the off-label use of BDQ as salvage therapy, seven of 13 patients with Mycobacterium intracellulare lung disease had an initial microbiological response and then relapsed. Whole-genome comparison of pretreatment and relapse isolates of M. intracellulare uncovered mutations in a previously uncharacterized locus, mmpT5 . Preliminary analysis suggested similarities between mmpT5 and the mmpR5 locus, which is associated with low-level BDQ resistance in M. tuberculosis . Both genes encode transcriptional regulators and are adjacent to orthologs of the mmpS5-mmpL5 drug efflux operon. However, MmpT5 belongs to the TetR superfamily, whereas MmpR5 is a MarR family protein. Targeted sequencing uncovered nonsynonymous mmpT5 mutations in isolates from all seven relapse cases, including two pretreatment isolates. In contrast, only two relapse patient isolates had nonsynonymous changes in ATP synthase subunit c ( atpE ), the primary target of BDQ. Susceptibility testing indicated that mmpT5 mutations are associated with modest 2- to 8-fold increases in MICs for BDQ and clofazimine, whereas one atpE mutant exhibited a 50-fold increase in MIC for BDQ. Bedaquiline shows potential for the treatment of M. intracellulare lung disease, but optimization of treatment regimens is required to prevent the emergence of mmpT5 variants and microbiological relapse.

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  10. [해외논문]   Clinical and Microbiological Aspects of β-Lactam Resistance in Staphylococcus lugdunensis   SCI SCIE

    McHardy, Ian H. (Medical Microbiology and Immunology, UC Davis, Davis, California, USA ) , Veltman, Jennifer (Detroit Medical Center, Wayne State University, Detroit, Michigan, USA ) , Hindler, Janet (Pathology and Laboratory Medicine, UCLA, Los Angeles, California, USA ) , Bruxvoort, Katia (Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom ) , Carvalho, Marissa M. (Pathology and Laboratory Medicine, UCLA, Los Angeles, California, USA ) , Humphries, Romney M. (Pathology and Laboratory Medicine, UCLA, Los Angeles, California, USA)
    Journal of clinical microbiology v.55 no.2 ,pp. 585 - 595 , 2017 , 0095-1137 ,

    초록

    Antimicrobial susceptibility results from broth microdilution MIC testing of 993 Staphylococcus lugdunensis isolates recovered from patients at a tertiary care medical center from 2008 to 2015 were reviewed. Ninety-two oxacillin-susceptible isolates were selected to assess the accuracy of penicillin MIC testing, the penicillin disk diffusion test, and three β-lactamase tests, including the cefoxitin-induced nitrocefin test, penicillin cloverleaf assay, and penicillin disk zone edge test. The results of all phenotypic tests were compared to the results of blaZ PCR. The medical records of 62 patients from whom S. lugdunensis was isolated, including 31 penicillin-susceptible and 31 penicillin-resistant strains, were retrospectively reviewed to evaluate the clinical significance of S. lugdunensis isolation, the antimicrobial agents prescribed, if any, and the clinical outcome. MIC testing revealed that 517/993 (52.1%) isolates were susceptible to penicillin and 946/993 (95.3%) were susceptible to oxacillin. The induced nitrocefin test was 100% sensitive and specific for the detection of β-lactamase compared to the blaZ PCR results, whereas the penicillin disk zone edge and cloverleaf tests showed sensitivities of 100% but specificities of only 9.1% and 89.1%, respectively. The penicillin MIC test had 100% categorical agreement with blaZ PCR, while penicillin disk diffusion yielded one major error. Only 3/31 patients with penicillin-susceptible isolates were treated with a penicillin family antimicrobial. The majority of cases were treated with other β-lactams, trimethoprim-sulfamethoxazole, or vancomycin. These data indicate that nearly all isolates of S. lugdunensis are susceptible to narrow-spectrum antimicrobial agents. Clinical laboratories in areas with resistance levels similar to those described here can help promote the use of these agents versus vancomycin by effectively designing their antimicrobial susceptibility reports to convey this message.

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