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Choi, Kang, Lee, Chang, Tateda, Yamaguchi, Kim, and Kim: Antimicrobial Susceptibility Patterns of Legionella isolates in the Environment and in Patients
Original Article

Korean J Leg Med 2010;30(1):28-33.

Published online: 14 January 2010

DOI: https://doi.org/10.3343/kjlm.2010.30.1.28

Antimicrobial Susceptibility Patterns of Legionella isolates in the Environment and in Patients

Go Eun Choi1, Jeong Eun Kang, M.D.1, Eun Yup Lee, M.D.1, Chulhun L. Chang, M.D.1, Kazuhiro Tateda, M.D.2, Keizo Yamaguchi, M.D.2, Kyeong Hee Kim, M.D.3, Jeong Man Kim, M.D.3

1Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea

2Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan

3Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea

Corresponding author: Jeong-Man Kim, M.D. Department of Laboratory Medicine, Dong-A University College of Medicine, Dongdaesindong 3-ga, Seo-gu, Busan 602-714, Korea Tel: +82-51-240-5322, Fax: +82-51-255-9366 E-mail: jmkim@dau.ac.kr

      Revised 8 July 20094 September 2009       Accepted 2 December 2009

Copyright © 2010 Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Antimicrobial susceptibility of Legionella spp. has rarely been studied in Korea. Therefore, we aimed to determine the susceptibility of Legionella spp. to various antibiotics.

Methods:

We assessed the antimicrobial susceptibility of 66 environmental and clinical Legionella isolates collected between January 2001 and December 2008 from Korea and Japan. The minimum inhibitory concentrations (MICs) of 6 antibiotics, namely, azithromycin, ciprofloxacin, clarithromycin, clindamycin, gatifloxacin, and gemifloxacin were determined by the broth microdilution method using buffered starch yeast extract broth.

Results:

The MIC ranges of the 6 antibiotics used against the Legionella isolates were as follows: 0.004-0.062 μg/mL (azithromycin), 0.002-0.5 μg/mL (ciprofloxacin), 0.004-0.5 μg/mL (clarithromycin), 0.12-4 μg/mL (clindamycin), 0.002-0.12 μg/mL (gatifloxacin), and 0.008-1 μg/mL (gemifloxacin).

Conclusions:

Legionella spp. isolates from Korea and Japan were most susceptible to gatifloxacin. Azithromycin, clarithromycin, ciprofloxacin, and gemifloxacin were also effective for treating legionellosis.

Keywords: Legionella, Antimicrobial susceptibility, Buffered starch yeast extract broth

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Table 1.
Species and sources of the strains
Microorganisms Sources Number of tested strains∗
Legionella pneumophila Environment, Busan 12 (11)
Serogroup 1    
L. pneumophila Serogroup 5 Environment, Busan 9 (7)
L. pneumophila Serogroup 6 Environment, Busan 2 (2)
L. pneumophila Serogroup 10-14 Environment, Busan 9 (7)
L. pneumophila Serogroup 1 Clinical specimen, Busan 4 (4)
L. pneumophila Serogroup 1 Clinical specimen, Japan 16 (13)
L. pneumophila Serogroup 3 Clinical specimen, Japan 2 (1)
L. pneumophila Serogroup 5 Clinical specimen, Japan 4 (3)
L. pneumophila Serogroup 6 Clinical specimen, Japan 2 (2)
L. pneumophila Serogroup 9 Clinical specimen, Japan 2 (2)
L. longbeachae Clinical specimen, Japan 2 (2)
L. micdadei Clinical specimen, Japan 2 (2)
Total   66 (56)

∗ The numbers in parentheses indicate strains grown in buffered starch yeast extract media.

Table 2.
Minimum inhibitory concentrations (μg/mL) of antibiotics against Legionella spp. determined by 2 methods
Antimicrobial agents Broth microdilution by using BSYE (N=56) E-test by using BCYE-α (N=66)
MIC50 MIC90 Range MIC50 MIC90 Range
Azithromycin 0.016 0.062 0.004-0.062 0.31 0.12 0.016-1∗
Ciprofloxacin 0.031 0.25 0.002-0.5 0.25 1 0.062-2∗
Clarithromycin 0.031 0.25 0.004-0.5 0.062 1 0.016-1∗
Clindamycin 0.5 2 0.12-4 1 6 0.25-8∗
Gatifloxacin 0.008 0.12 0.002-0.12 0.062 0.25 0.031-0.5∗
Gemifloxacin 0.12 0.25 0.008-1 0.31 1 0.016-2∗

∗ Student's t-test was performed to compare the MIC values obtained by the 2 methods. P<0.01.

Abbreviations: BCYE-α, buffered charcoal yeast extract supplemented with α-ketoglutrate; BSYE, buffered starch yeast extract; MIC, minimum inhibitory concentration.

Table 3.
Minimum inhibitory concentration ranges (μg/mL) of antibiotics against environmental and clinical Legionella pneumophila isolates from Busan
Antimicrobial agents Environmental isolates (N=27) Clinical isolates (N=4)
MIC50 MIC90 Range MIC50 MIC90 Range
Azithromycin 0.016 0.062 0.004-0.062 0.016 0.062 0.008-0.062∗
Ciprofloxacin 0.016 0.031 0.004-0.12 0.12 0.25 0.12-0.25∗
Clarithromycin 0.008 0.031 0.004-0.031 0.25 0.5 0.12-0.5∗
Clindamycin 0.5 1 0.12-2 1 2 0.5-2∗
Gatifloxacin 0.016 0.031 0.002-0.031 0.008 0.12 0.004-0.12
Gemifloxacin 0.12 0.25 0.008-1 0.25 0.5 0.12-0.5†

∗ Minimum inhibitory concentration (MIC) values for clinical isolates were higher than those for environmental isolates (P<0.05);

† MIC values for environmental isolates were higher than those for clinical isolates (P<0.05).

Table 4.
Comparison of the minimum inhibitory concentration (μg/mL) for L. pneumophila serogroup 1 and non-serogroup 1 isolates from Busan
Antimicrobial agents L. pneumophila serogroup 1 (N=15) L. pneumophila non-serogroup 1 (N=16)
MIC50 MIC90 Ranges MIC50 MIC90 Ranges
Azithromycin 0.031 0.062 0.004-0.062 0.016 0.062 0.004-0.062
Ciprofloxacin 0.031 0.25 0.008-0.5 0.016 0.5 0.004-0.5∗
Clarithromycin 0.12 0.25 0.004-0.5 0.016 0.25 0.004-0.5∗
Clindamycin 1 2 0.12-4 0.5 2 0.12-4
Gatifloxacin 0.008 0.031 0.004-0.12 0.008 0.12 0.002-0.12
Gemifloxacin 0.12 0.25 0.008-1 0.12 0.5 0.016-0.5

∗ MIC values for L. pneumophila serogroup 1 were significantly higher than those for L. pneumophila non-serogroup 1 (P<0.01).

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