PURPOSE: The purpose of this research was to describe clonorchis sinensis infection experience in high risk populations living in riverside areas. The research question was "How do local residents perceive Clonorchiasis and how are they infected with the parasite". METHODS: Qualitative data were collected by focus group interviews with 16 participants from January to February, 2009. All the interviews were tape-recorded, transcribed, and analyzed by the content analysis method. RESULTS: Five main categories were conceptualized, which were "lacking in understanding of Clonorchiasis," "culture of the rural community," "life style," "recovering experience from infection" and "change of health behavior." CONCLUSION: The result of this study indicates that residents are infected with Clonorchiasis through interaction between individual and group risky factors. Therefore, it is important to develop effective health education programs on both individual and group levels to prevent infection with Clonorchiasis.
Clonorchiasis ; Clonorchis sinensis* ; Focus Groups ; Health Education ; Parasites ; Qualitative Research

Chryseobacterium hominis is non-fermenting Gram-negative rod that was first identified as a novel species in 2007. Here, we report the first clinical case of C. hominis bacteremia, which was confirmed by MALDI-TOF MS and 16S rRNA gene sequencing. A 16-year-old boy diagnosed with acute lymphoblastic leukemia was hospitalized for three months. Two sets of blood culture test through a peripherally inserted central catheter (PICC), which was inserted a month ago, was performed when his white blood cell count declined and he had a high fever. Colonies of medium sizes that looked round, mucoid, sticky, and grayish on blood and chocolate agar plates were observed. Identification of bacteria using the VITEK MALDI-TOF MS system (BioMérieux, France) was not successful and the VITEK 2 system (BioMérieux, USA) indicated Sphingomonas paucimobilis, with a questionable level of confidence (92%). However, Microflex LT Biotyper (Bruker Daltonics, Germany) showed C. homins (log score: 1.81) and sequence of 16S rRNA showed a 100% identity with C. hominis. Piperacillin-tazobactam was administered since the isolate was susceptible to piperacillin-tazobactam but C. hominis showed growth in the next four follow-up culture of blood drawn through PICC. The fever subsided only after PICC was changed. The clinical prognosis and antimicrobial susceptibility test of C. hominis should be further studied.
Adolescent ; Agar ; Bacteremia ; Bacteria ; Cacao ; Catheters ; Chryseobacterium ; Fever ; Follow-Up Studies ; Genes, rRNA ; Humans ; Leukocyte Count ; Male ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prognosis ; Sphingomonas

Objective: PD-1 inhibitors have demonstrated improved health outcomes in cancer patients. PD-1 inhibitors are well-tolerated and associated with immune-related adverse events. The objectives of this study are to analyze use patterns of PD-1 inhibitors in patients with cancer and to investigate the incidence of thyroid-related adverse reactions in patients treated with PD-1 inhibitors. Methods: The study included patients who had been administered PD-1 inhibitors (either nivolumab or pembrolizumab) at the Samsung Medical Center between October 1, 2016 and June 30, 2017. Data was collected from electronic medical records and tested using Mann-Whitney tests and Chi-Square tests for statistical significance. Associations between PD-1 inhibitors and incidence of adverse events were tested using Cox regression for age, gender, BMI, ECOG PS and medication. Results: Two hundred fifteen patients were identified as eligible for analyses. Thyroid-related adverse events occurred in 20% of patients (n=43). Thyroid function tests (TFTs) was performed in 109 patients (50.7%). Positive results of PD-L1 testing were found in 53.2% of the 94 patients who had the test. Approved doses of nivolumab (3 m/kg) and pembrolizumab (200 mg) were administered in 70.4% and 53% of patients, respectively. The analysis of risk factor of thyroid-related adverse reaction did not show statistically significant differences (Cox regression). Conclusion Thyroid-related adverse events are common in patients treated with PD-1 inhibitors and hypothyroidism is the most frequent adverse reaction. Routine TFTs monitoring is strongly recommended to evaluate thyroid function in real-world clinical practice.

Objective: PD-1 inhibitors have demonstrated improved health outcomes in cancer patients. PD-1 inhibitors are well-tolerated and associated with immune-related adverse events. The objectives of this study are to analyze use patterns of PD-1 inhibitors in patients with cancer and to investigate the incidence of thyroid-related adverse reactions in patients treated with PD-1 inhibitors. Methods: The study included patients who had been administered PD-1 inhibitors (either nivolumab or pembrolizumab) at the Samsung Medical Center between October 1, 2016 and June 30, 2017. Data was collected from electronic medical records and tested using Mann-Whitney tests and Chi-Square tests for statistical significance. Associations between PD-1 inhibitors and incidence of adverse events were tested using Cox regression for age, gender, BMI, ECOG PS and medication. Results: Two hundred fifteen patients were identified as eligible for analyses. Thyroid-related adverse events occurred in 20% of patients (n=43). Thyroid function tests (TFTs) was performed in 109 patients (50.7%). Positive results of PD-L1 testing were found in 53.2% of the 94 patients who had the test. Approved doses of nivolumab (3 m/kg) and pembrolizumab (200 mg) were administered in 70.4% and 53% of patients, respectively. The analysis of risk factor of thyroid-related adverse reaction did not show statistically significant differences (Cox regression). Conclusion Thyroid-related adverse events are common in patients treated with PD-1 inhibitors and hypothyroidism is the most frequent adverse reaction. Routine TFTs monitoring is strongly recommended to evaluate thyroid function in real-world clinical practice.

We evaluated the new C. DIFF QUIK CHEK COMPLETE (CD COMPLETE; TechLab, USA), which is a rapid membrane enzyme immunoassay that uses a combination of glutamate dehydrogenase (GDH) antigen and toxin A and B detection. A total of 608 consecutive loose stool specimens collected from the patients with suspected Clostridium difficile infection (CDI) from August to December 2012 were subjected to the CD COMPLETE and VIDAS Clostridium difficile A & B (VIDAS CDAB; bioMerieux, France). Their performances were compared with a toxigenic culture as a reference. Stool specimens that were culture-negative and CD COMPLETE- or VIDAS CDAB-positive were analyzed by using an enrichment procedure. In comparison to the toxigenic cultures, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were 63.6%, 98.0%, 76.1%, and 96.4%, respectively, for the CD COMPLETE-toxin and 75.5%, 97.4%, 72.5%, and 97.8%, respectively, for the VIDAS CDAB. In comparison to the enriched C. difficile cultures, the sensitivity, specificity, PPV, and NPV for the CD COMPLETE-GDH were 91.0%, 92.4%, 70.5%, and 98.1%, respectively. The CD COMPLETE is a reliable method for the diagnosis of CDI and provides greater sensitivity than toxin enzyme immunoassay alone. Furthermore, the CD COMPLETE-GDH has advantages over direct culture in detecting C. difficile.
Bacterial Proteins/*analysis ; Bacterial Toxins/*analysis ; Clostridium Infections/*diagnosis/microbiology ; Clostridium difficile/enzymology/*isolation & purification/metabolism ; Enterotoxins/*analysis ; Feces/microbiology ; Glutamate Dehydrogenase/*analysis ; Humans ; *Immunoenzyme Techniques ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

BACKGROUND: Rapid species identification of enterococci is necessary for optimal treatment of infected patients as they are frequently resistant to various antimicrobial agents. Minimal identification scheme is necessary to cut the laboratory cost. In this study, a minimal identification system was modified to expand the identifiable species. METHODS: Performance of MGP test was compared to that of MIO motility test. Colonies on blood agar were used to inoculate primary identification media: SFA, BEAA, mannitol agar, tellurite agar, sorbose agar and MGP agar, which were prepared in biplates. Pigment production was tested when necessary using colonies on a blood agar. Isolates, which were not identifiable by the primary test, were inoculated to secondary test media: ADH, and arabinose-, raffinose- and sucrose-containing CTA. Vitek GPI cards were used to test isolates with a doubtful identification or no identification. RESULTS: MGP test was selected for the modified scheme, as it was more rapid and accurate than motility test. Among the 879 clinical isolates of enterococci, 462 (52.6%) and 3 (0.3%) were identified as E. faecalis and E. casseliflavus, respectively, by the primary test only. With the additional secondary tests, 379 (43.1%) isolates were identified as E. faecium. Vitek test showed the identification of 4 isolates with atypical test results and 5 isolates of rare species by modified scheme were correct. Nine isolates (1.0 %) were not identifiable by the modified scheme. CONCLUSIONS: The modified minimal identification scheme which included MGP test identified most E. faecalis isolates rapidly and accurately. Most of E. faecium isolates were identified with the additional secondary tests. In conclusion, the system is useful for the identification of commonly isolated species of enterococci.
Agar ; Anti-Infective Agents ; Humans ; Mannitol ; Sorbose

BACKGROUND: Gatifloxacin, a new 8-methoxyquinolone, has a broad-spectrum activity with expanded potency against respiratory pathogens. In this study, we examined the in vitro activity of gatifloxacin and comparators against recently isolated bacteria from respiratory specimens of patients in Korean hospitals. METHODS: Forty-nine isolates were from respiratory specimens of patients with acute exacerbations of chronic lower respiratory infections in eight university hospitals and 108 isolates were from respiratory specimens from patients of Yonsei University Hospital. Minimum inhibitory concentrations (MICs) were determined by NCCLS agar dilution method. RESULTS: MIC90 of gatifloxacin for Streptococcus pneumoniae was 1 g/mL, which was 8-fold and 2-fold lower than those of ciprofloxacin and levofloxacin, respectively. All strains of Haemophilus in fluenzae and Moraxella (Branhamella) catarrhalis were inhibited by < or =0.06 g/mL and < or =0.25 g/mL of gatifloxacin, respectively, and were susceptible to all fluoroquinolones tested. MIC90 of gatifloxacin for Klebsiella pneumoniae was 0.06 g/mL, which was 2-fold lower than those of levofloxacin and moxifloxacin. CONCLUSION: Gatifloxacin is highly active against S. pneumoniae, H. influenzae and M. (B.) catarrhalis isolated from respiratory specimens of patients of university hospitals in Korea.
Agar ; Bacteria* ; Ciprofloxacin ; Fluoroquinolones ; Haemophilus ; Hospitals, University* ; Humans ; Influenza, Human ; Klebsiella pneumoniae ; Korea* ; Levofloxacin ; Microbial Sensitivity Tests ; Moraxella (Branhamella) catarrhalis ; Pneumonia ; Respiratory Tract Infections ; Streptococcus pneumoniae

BACKGROUND: Gatifloxacin, a new 8-methoxyquinolone, has a broad-spectrum activity with expanded potency against respiratory pathogens. In this study, we examined the in vitro activity of gatifloxacin and comparators against recently isolated bacteria from respiratory specimens of patients in Korean hospitals. METHODS: Forty-nine isolates were from respiratory specimens of patients with acute exacerbations of chronic lower respiratory infections in eight university hospitals and 108 isolates were from respiratory specimens from patients of Yonsei University Hospital. Minimum inhibitory concentrations (MICs) were determined by NCCLS agar dilution method. RESULTS: MIC90 of gatifloxacin for Streptococcus pneumoniae was 1 g/mL, which was 8-fold and 2-fold lower than those of ciprofloxacin and levofloxacin, respectively. All strains of Haemophilus in fluenzae and Moraxella (Branhamella) catarrhalis were inhibited by < or =0.06 g/mL and < or =0.25 g/mL of gatifloxacin, respectively, and were susceptible to all fluoroquinolones tested. MIC90 of gatifloxacin for Klebsiella pneumoniae was 0.06 g/mL, which was 2-fold lower than those of levofloxacin and moxifloxacin. CONCLUSION: Gatifloxacin is highly active against S. pneumoniae, H. influenzae and M. (B.) catarrhalis isolated from respiratory specimens of patients of university hospitals in Korea.
Agar ; Bacteria* ; Ciprofloxacin ; Fluoroquinolones ; Haemophilus ; Hospitals, University* ; Humans ; Influenza, Human ; Klebsiella pneumoniae ; Korea* ; Levofloxacin ; Microbial Sensitivity Tests ; Moraxella (Branhamella) catarrhalis ; Pneumonia ; Respiratory Tract Infections ; Streptococcus pneumoniae

BACKGROUND: Cinical and Laboratory Standards Institute (CLSI) recommends the use of cefoxitin disks instead of long-used oxacillin disks for screening methicillin-resistant isolates of staphylococci. The frequency of discrepant results and accuracy of the tests were evaluated by detecting mecA gene. METHODS: A total of 3,123 Stapylococci isolates from patients in Severance Hospital were tested during September 2005 to August 2006 by the CLSI-recommended test using both cefoxitin and oxacillin disks. The mecA gene was detected by PCR and the oxacillin minimum inhibitory concentration (MIC) was determined by using agar dilution method for the isolates with discrepant tests. RESULTS: Among 1,915 S. aureus islolates tested, one isolate was resistant to oxacillin disk but susceptible to cefoxitin disk; the isolate did not have mecA gene. Another isolate susceptible to oxacillin but resistant to cefoxitin had mecA gene. Among 1,208 coagulase-negative staphylococcal isolates, 15 isolates were resistant to oxacillin disk but susceptible to cefoxitin disk; the isolates did not have mecA genes. Two isolates susceptible to oxacillin disk but resistant to cefoxitin disk had mecA genes. Among the 16 Staphylococcus isolates that did not have mecA gene, 15 isolates had the oxacillin MICs of < or =2 microgram/mL and were considered as methicillin-susceptible, while 1 isolate with the MIC of 4 microgram/mL was considered as methicillin-resistant. CONCLUSIONS: Overall, 1.9% of staphylococcal isolates showed discrepant results when the screening tests were performed by using oxacillin and cefoxitin disks. None of the isolates resistant to oxacillin disk but susceptible to cefoxitin disk had mecA gene. In conclusion, the cefoxitin disk test is more reliable than oxacillin disk test in screening methicillin-resistant staphylococcal isolates.
Anti-Bacterial Agents/*pharmacology ; Bacterial Proteins/analysis/*genetics ; Cefoxitin/*pharmacology ; *Disk Diffusion Antimicrobial Tests ; Humans ; Methicillin/pharmacology ; Methicillin Resistance ; Oxacillin/*pharmacology ; Polymerase Chain Reaction ; Staphylococcal Infections/microbiology ; Staphylococcus aureus/*drug effects/isolation & purification

BACKGROUND: Cinical and Laboratory Standards Institute (CLSI) recommends the use of cefoxitin disks instead of long-used oxacillin disks for screening methicillin-resistant isolates of staphylococci. The frequency of discrepant results and accuracy of the tests were evaluated by detecting mecA gene. METHODS: A total of 3,123 Stapylococci isolates from patients in Severance Hospital were tested during September 2005 to August 2006 by the CLSI-recommended test using both cefoxitin and oxacillin disks. The mecA gene was detected by PCR and the oxacillin minimum inhibitory concentration (MIC) was determined by using agar dilution method for the isolates with discrepant tests. RESULTS: Among 1,915 S. aureus islolates tested, one isolate was resistant to oxacillin disk but susceptible to cefoxitin disk; the isolate did not have mecA gene. Another isolate susceptible to oxacillin but resistant to cefoxitin had mecA gene. Among 1,208 coagulase-negative staphylococcal isolates, 15 isolates were resistant to oxacillin disk but susceptible to cefoxitin disk; the isolates did not have mecA genes. Two isolates susceptible to oxacillin disk but resistant to cefoxitin disk had mecA genes. Among the 16 Staphylococcus isolates that did not have mecA gene, 15 isolates had the oxacillin MICs of < or =2 microgram/mL and were considered as methicillin-susceptible, while 1 isolate with the MIC of 4 microgram/mL was considered as methicillin-resistant. CONCLUSIONS: Overall, 1.9% of staphylococcal isolates showed discrepant results when the screening tests were performed by using oxacillin and cefoxitin disks. None of the isolates resistant to oxacillin disk but susceptible to cefoxitin disk had mecA gene. In conclusion, the cefoxitin disk test is more reliable than oxacillin disk test in screening methicillin-resistant staphylococcal isolates.
Anti-Bacterial Agents/*pharmacology ; Bacterial Proteins/analysis/*genetics ; Cefoxitin/*pharmacology ; *Disk Diffusion Antimicrobial Tests ; Humans ; Methicillin/pharmacology ; Methicillin Resistance ; Oxacillin/*pharmacology ; Polymerase Chain Reaction ; Staphylococcal Infections/microbiology ; Staphylococcus aureus/*drug effects/isolation & purification