Kocuria spp. are members of the Micrococcaceae family that are frequently found in the environment and on human skin. Few human infections have been reported. We describe what appear to be the first two cases of Kocuria marina peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. CASE REPORTS Case 1.A 57-year-old man was admitted to the emergency department because of turbid dialysis effluent for 1 day. He had end-stage renal disease as a result of diabetic nephropathy and had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for 6 years. Upon physical examination, he was afebrile, with a normal-appearing catheter exit site. However, the peritoneal dialysate fluid was straw colored and cloudy, with a total leukocyte count of 0.78 ϫ 10 9 leukocytes/ liter and a neutrophil count of 90%. No microorganisms were seen on a Gram stain. In the peripheral blood, the hemoglobin concentration was 10.1 g/dl, the white blood cell (WBC) count was 7.40 ϫ 10 9 cells/liter, and the platelet count was 171 ϫ 10 9 platelets/liter. The C-reactive protein concentration was 2.76 mg/dl (reference concentration, Ͻ0.5 mg/dl), and the serum urea and creatinine concentrations were 53 mg/dl and 11.2 mg/dl, respectively. Intraperitoneal administration of netilmicin and narrow-spectrum cephalosporin (ceftezole) was started for empirical treatment of CAPD peritonitis, which was changed to intraperitoneal ceftazidime and clindamycin when there was no response. Culture of the dialysate yielded a pure culture of grampositive cocci in pairs or clusters (strain M07-0128). After 48 h of incubation at 35°C in 5% CO 2 on sheep blood agar, the 1-to 2-mm colonies were nonhemolytic and yellow. The isolate was identified as Kocuria varians/Kocuria kristinae with a 50.28%/49.72% probability, respectively, by a Vitek 2 system (bioMérieux, St. Louis, MO) and as K. kristinae (code number 6714014) with a 99.3% probability by an API Staph system (bioMérieux, Marcy l'Etoile, France). We performed 16S rRNA gene sequencing as previously described (5) and compared the obtained sequence with sequences similar to those of the type strains using BLAST and EzTaxon (4). The result showed 99.86% homology with Kocuria marina; the second closest match was Kocuria carniphila, with 98.30% homology. This isolate was finally identified as K. marina by 16S rRNA gene sequence analysis. In spite of the start of administration of intravenous vancomycin on day 10, the response remained unsatisfactory. The Tenckhoff catheter in his abdomen was removed on day 17, and he was switched to hemodialysis with the placement of an arteriovenous shunt. The patient improved with antibiotic therapy for 7 days after catheter removal and was discharged.We performed antimicrobial susceptibility testing on the isolate using the agar dilution method, according to the Clinical and Laboratory Standards Institute (CLSI) guidelines for Staphylococcus (4a). The isolate was susceptible to penicillin, ampicillin, ampicillin-sulbactam, gentamicin, cephalothin (cefaloti...

The sodA, tuf, and 16S rRNA genes were very useful for CoNS identification. Each has its own characteristics of similarity, discriminative power, and inclusion in databases.

BackgroundWe investigated the prevalence of plasmid-mediated quinolone resistance and its association with extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase in Enterobacteriaceae.MethodsA total of 347 non-duplicated isolates of Enterobacteriaceae were collected between August and October 2006 from 2 hospitals. Qnr determinant screening was conducted using PCR amplification, and all positive results were confirmed by direct sequencing. Qnr-positive strains were determined on the basis of the presence of ESBL and AmpC beta-lactamase genes.ResultsThe qnr gene was detected in 47 of 347 clinical Enterobacteriaceae isolates. Among the 47 qnr-positive strains, Klebsiella pneumoniae (N=29) was the most common, followed by Escherichia coli (N=6), Enterobacter cloacae (N=6), Citrobacter freundii (N=5), and Enterobacter aerogenes (N=1). These isolates were identified as qnrA1 (N=6), 8 qnrB subtypes (N=40), and qnrS1 (N=1). At least 1 ESBL was detected in 38 of the 47 qnr-positive strains. Qnr-positive strains also showed high positive rates of ESBL or AmpC beta-lactamase, such as TEM, SHV, CTX-M, and DHA. DHA-1 was detected in 23 of 47 qnr-positive strains, and this was co-produced with 1 qnrA1 and 22 qnrB4. Strains harboring MIR-1T and CMY were also detected among the qnr-positive strains. Antimicrobial-resistance rates of qnr-positive strains to ciprofloxacin, levofloxacin, norfloxacin, nalidixic acid, and moxifloxacin were 51.1%, 46.8%, 46.8%, 74.5%, and 53.2%, respectively.ConclusionsThe qnr genes were highly prevalent in Enterobacteriaceae, primarily the qnrB subtypes. They were closely associated with EBSL and AmpC beta-lactamase.

Background The aims of this study were to compare several DNA extraction methods and 16S rDNA primers and to evaluate the clinical utility of broad-range PCR in continuous ambulatory peritoneal dialysis (CAPD) culture fluids. Methods Six type strains were used as model organisms in dilutions from 10 8 to 10 0 colony-forming units (CFU)/mL for the evaluation of 5 DNA extraction methods and 5 PCR primer pairs. Broad-range PCR was applied to 100 CAPD culture fluids, and the results were compared with conventional culture results. Results There were some differences between the various DNA extraction methods and primer sets with regard to the detection limits. The InstaGene Matrix (Bio-Rad Laboratories, USA) and Exgene Clinic SV kits (GeneAll Biotechnology Co. Ltd, Korea) seem to have higher sensitivities than the others. The results of broad-range PCR were concordant with the results from culture in 97% of all cases (97/100). Two culture-positive cases that were broad-range PCR-negative were identified as Candida albicans , and 1 PCR-positive but culture-negative sample was identified as Bacillus circulans by sequencing. Two samples among 54 broad-range PCR-positive products could not be sequenced. Conclusions There were differences in the analytical sensitivity of various DNA extraction methods and primers for broad-range PCR. The broad-range PCR assay can be used to detect bacterial pathogens in CAPD culture fluid as a supplement to culture methods.

We report the first detection of PMQR in Salmonella isolates from Korea. It is essential to continue surveillance and to watch for the spread of PMQR in Salmonella for public health control.