OBJECTIVETo describe a hospital outbreak of severe acute respiratory syndrome (SARS) and summarize its clinical features and therapeutic approaches.

METHODSThe outbreak started with a SARS patient from the community, and a total of 96 people (76 women and 20 men, mean age (29.5 +/- 10.3) years, 93.8% of whom were health care workers) who had exposure to this source patient became infected in a short time. Clinical data in this cohort were collected prospectively as they were identified.

RESULTS(1) The incubation period ranged from 1 to 20 (mean: 5.9 +/- 3.5) days. The duration of hospitalization was (17.2 +/- 8.0) days. (2) The initial temperature was (38.3 +/- 0.6) degrees C, while the highest was (39.2 +/- 0.6) degrees C (P < 0.001), with fever duration of (9.0 +/- 4.2) days. (3) Other most common symptoms included fatigue (93.8%), cough (85.4%), mild sputum production (66.7%), chills (55.2%), headache (39.6%), general malaise (35.4%) and myalgia (21.9%). (4) The radiographic changes were predominantly bilateral in the middle or lower lung zones. The number of affected lung fields was 1.2 +/- 0.8 on presentation, which increased to 2.9 +/- 1.4 after admission (P < 0.001). The interval from the beginning of fever to the onset of abnormal chest radiographs was (3.5 +/- 2.3) days, which increased in size, extent, and severity to the maximum (6.7 +/- 3.5) days later. The time before the lung opacities were basically absorbed was (14.9 +/- 7.8) days. (5) Leukopenia was observed in 67.7% of this cohort. The time between the onset of fever and leukopenia was (4.4 +/- 2.3) days, with the lowest white blood cell count of (2.80 +/- 0.72) x 10(9)/L. (6) The lowest arterial oxygen saturation was (94.8 +/- 3.1)% with supplementary oxygen. (7) Antibiotical therapies included tetracyclines (91.0%), aminoglycosides (83.3%), quinolones (79.2%); 18.8% of the patients received a combination of tetracyclines and aminoglycosides, while 11.5% received a combination of tetracyclines and quinolones, and 63.5% received a combination of tetracyclines, aminoglycosides and quinolones. Vancomycin was used in 13.5% of the patients. (8) 68.8% of the patients were treated with methylprednisolones for a mean interval of (4.9 +/- 2.4) days. The initial dose was (67.3 +/- 28.2) mg/d and the maximal dose was (82.4 +/- 30.5) mg/d. (9) Human gamma-globulin, interferon-alpha, antiviral drugs (oral ribavirin or oseltamivir) were used respectively in 68.6%, 46.9% and 92.7% of the patients. (10) Ninety-five patients (99.0%) had a complete clinical recovery, and only 1 patient (1.0%) died.

CONCLUSIONSSARS appears to be quickly infectious and potentially lethal among health care workers, characterized by acute onset and rapid progression, and mostly bilateral lung involvement on chest radiographs. Proper administration of glucocorticosteroids seems to be of some benefits. Antibiotics, human gamma-globulin, interferon-alpha, and antiviral drugs, although empirically, might be useful to shorten the clinical course.

Adult ; China ; epidemiology ; Cross Infection ; diagnosis ; epidemiology ; therapy ; Disease Outbreaks ; Female ; Humans ; Male ; Severe Acute Respiratory Syndrome ; diagnosis ; epidemiology ; therapy

Members of the genus Acinetobacter are recognized as newer pathogens of the nosocomial infection with an increasing frequency in recent years. Strains that belonged to A. calcoaceticus-A. baumannii complex (genomic species 1, 2, 3, and 13TU) were major groups associated with nosocomial infection. Phenotypic identification was unreliable and laborious method to classify Acinetobacter strains into 19 genomic species. Rapid and reliable identification of clinical isolates is essential to diagnosis and epidemiology of Acinetobacter. We investigated the suitability of amplified ribosomal DNA restriction analysis (ARDRA) to identify genomic species of 131 Acinetobacter isolates. The 16S rRNA genes (ribosomal DNA) were enzymatically amplified and the amplified PCR products were restricted independently with the enzymes, AluI, CfoI, and MboI. Genomic species of Acinetobacter was classified by the combinations of restriction patterns. The analysis was showed that restriction profiles were characteristic for each genomic species. One hundred fourteen isolates were identified as A. baumannii, twelve were identified as genomic species 13TU, and one was identified as genomic species 3. Four isolates were found to be unknown organisms. All of the isolates which were identified to A. baumannii by phenotypic tests were completely discriminated into A. baumannii and genomic species 13TU by ARDRA. This study demonstrates that ARDRA is a rapid and simple techniques for the identification of Acinetobacter species according to the genomic species.
Acinetobacter baumannii* ; Acinetobacter calcoaceticus* ; Acinetobacter* ; Cross Infection ; Diagnosis ; DNA, Ribosomal* ; Epidemiology ; Genes, rRNA ; Polymerase Chain Reaction

INTRODUCTIONCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged worldwide. In contrast to healthcare-associated MRSA (HA-MRSA), CA-MRSA isolates are usually susceptible to multiple non-beta-lactam antibiotics and cause a distinct spectrum of infections in epidemiologically disparate populations - in particular, cutaneous abscesses, necrotising fasciitis and necrotising pneumonia. They arise from a broader genetic background, and possess differing virulence genes. We aim to describe the distribution of different molecular subtypes of CA-MRSA among various regions and discuss briefly the implications of CA-MRSA from a local perspective.

METHODSLiterature review of articles on CA-MRSA, focusing mainly on reports where the genetic background of isolates had been analysed using multi-locus sequence typing (MLST). Singapore data were obtained from the local CA-MRSA database.

RESULTSMLST analysis demonstrated the presence of epidemic subtypes of CA-MRSA within most geographic areas. In parts of the United States, community MRSA infections currently exceed those caused by their methicillin-susceptible counterparts. In Singapore, CA-MRSA infections are increasing, predominantly as a result of the spread of ST30 clones.

CONCLUSIONAvailable evidence suggests that the emergence of MRSA from the community is not going to be a transient phenomenon. Local guidelines for dealing with this phenomenon at both therapeutic and preventive levels are needed prior to the potential development of a situation mirroring that of meso-endemic HA-MRSA in local hospitals or CA-MRSA epidemics in parts of USA.

Bacterial Typing Techniques ; Community-Acquired Infections ; epidemiology ; microbiology ; Cross Infection ; diagnosis ; microbiology ; Humans ; Methicillin Resistance ; Risk Factors ; Singapore ; epidemiology ; Staphylococcal Infections ; epidemiology ; microbiology ; Staphylococcus aureus ; classification ; drug effects

OBJECTIVETo understand the risk factors of measles among babies under 8-months-old and people ≥15 years old, in Gansu province.

METHODSLaboratory-confirmed measles cases were divided into two groups among children below 8-months-old and those ≥15 year olds. Descriptive epidemiology and 1:3 case control study were conducted to find out those related risk factors as:hospital exposure, contact with measles cases, vaccination, history of measles etc. so as to determine the risk factors and appropriate control measures.

RESULTSHistories of hospital exposure, contact with measles cases and travelling to other cities were risk factors for measles among babies younger than 8-months and people ≥15 year olds. Vaccination appeared a protective factor for people ≥15 years of age. From 42 cases and 126 controls, through multivariate analysis, results showed that hospital exposure was the only significant factor ( OR = 29.23, 95%CI:2.82-302.89)for those babies younger than 8-months. Factors as hospital exposure and travelling among cities for 7-21 days before being infected, were with significant importance ( OR = 5.15, 95% CI:2.28-11.63; OR = 5.48, 95%CI:1.38-21.69)for people ≥15 years of age, according to the observation from 74 cases and 222 controls.

CONCLUSIONIn order to reduce the incidence of measles among babies under 8-month-old and people ≥15 years old, efforts on control of nosocomial infection should be strengthened, while the routine immunization coverage need to be increased for the children at higher risks, to reduce the source of infection.

Adolescent ; Case-Control Studies ; China ; epidemiology ; Cross Infection ; Humans ; Incidence ; Infant ; Measles ; diagnosis ; epidemiology ; prevention & control ; Measles Vaccine ; administration & dosage ; Risk Factors ; Vaccination ; utilization

Catheter-Related Infections ; diagnosis ; epidemiology ; Critical Care ; Cross Infection ; diagnosis ; epidemiology ; Electronic Health Records ; Hospitalization ; Hospitals ; Humans ; Intensive Care Units ; Length of Stay ; Singapore ; Urinary Catheterization ; adverse effects ; Urinary Tract Infections ; diagnosis ; epidemiology

OBJECTIVETo study the nosocomial fungal infections in the patient with severe hepatitis and analyze of risk factor.

METHODSAll 115 severe hepatitis with fungal infections inpatients was studied prospectively.

RESULTSWe identified 115 cases with fungal infections, the mean age of patients was 37.2+/-21.5 years, male: 49 cases, female 66 cases. Infection of abdominal cavity accounted for 40.9%, infectious rate in respiratory tract and digestive tract were 26.9%, 21.8%, respectively. Candida albicans accounted for 67.6%. Use of broad-spectrum antibiotic and corticosteroids, neutropenia, severity of liver disease, improper medical manipulations as significant risk factors for fungal infection. Death rate of study group and control group was 59.1%, 34.8%, respectively (x2=36.0). In multivariate analysis, neutropenia, disseminated infection and severity of liver diseases were independent prognostic factors.

CONCLUSIONIdentification of risk factors and predictors of a poor outcome in patients with severe hepatitis with fungal infections, it suggested that implications in prophylaxis of fungal infection, early diagnosis and appropriate therapy would be important for these patients.

Adult ; Candidiasis ; diagnosis ; epidemiology ; China ; epidemiology ; Cross Infection ; complications ; epidemiology ; Female ; Hepatitis, Viral, Human ; complications ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Mycoses ; epidemiology ; microbiology ; Prospective Studies ; Risk Factors ; Severity of Illness Index

The aim of this study was to determine candidemia incidence among patients in a medical intensive-care unit (MICU) and the associated mortality rate and to identify risk factors associated with candidemia. We retrospectively performed a 1:3 matched case-control study of MICU patients with candidemia. Controls were matched for sex, age, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Candidemia incidence was 9.1 per 1,000 admissions. The most common pathogen was Candida albicans. Crude mortality was 96% among candidemia patients and 52% among controls (P<0.001). Mortality differed significantly between the groups according to Kaplan-Meier survival analysis (P=0.024). Multivariate analysis identified the following independent risk factors for candidemia: central venous catheterization (odds ratio [OR] = 3.2, 95% confidence interval [CI]=1.2-9.0), previous steroid therapy (OR=4.7, 95% CI=1.8-12.1), blood transfusion during the same admission period (OR=6.3, 95% CI=2.4-16.7), and hepatic failure upon MICU admission (OR=6.9, 95% CI=1.7-28.4). In conclusion, we identify an additional independent risk factor for candidemia, the presence of hepatic failure on MICU admission. Therefore, increased awareness of risk factors, including hepatic failure, is necessary for the management of candidemia.
Candidiasis/*diagnosis/*epidemiology ; Cross Infection/*diagnosis/*epidemiology ; Female ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Intensive Care Units/*statistics & numerical data ; Korea/epidemiology ; Longitudinal Studies ; Male ; Middle Aged ; Pilot Projects ; Risk Assessment/methods ; Risk Factors

No abstract available.
Coronavirus Infections/*diagnosis/epidemiology/*prevention & control ; Cross Infection/*diagnosis/epidemiology/*prevention & control ; Disease Outbreaks/prevention & control/*statistics & numerical data ; Global Health/*trends ; Humans ; Incidence ; Population Surveillance/methods ; Republic of Korea/epidemiology

BACKGROUND: There is a lack of basic epidemiological information on bacterial meningitis in children and adults in Korea. Therefore, more research is needed to investigate the causative organisms, clinical manifestations, and prognosis in Korean children and adults. METHODS: We analyzed retrospectively 148 medical records with final diagnosis of bacterial meningitis. The diagnosis of bacterial meningitis was based on culture-positive cases. RESULTS: Out of a total 148 patients, 71 were children and 77 were adults. In the children with community acquired meningitis, infection-related meningitis was the most common predisposing factor (23.3%). In adults, otitis media was the most common (21.7%). There were more frequent seizures in children than adults (38.1%, 17.1%, p<0.05). In community-acquired meningitis, Streptococcus pneumoniae was the most common type. However, in nosocomial meningitis, gram-negative bacilli was the most common type. The prognostic factors associated with mortality rate in adults were old age (>50 years), seizure (p<0.05), and mental change (p<0.001). CONCLUSIONS: Although a causative organism is not documented, we believe that our study will help to properly treat acute bacterial meningitis in children and adults regardless if it is community acquired or nosomial.
Adult ; Causality ; Child ; Cross Infection ; Diagnosis ; Epidemiology ; Humans ; Korea ; Medical Records ; Meningitis ; Meningitis, Bacterial* ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Prognosis* ; Retrospective Studies ; Seizures

Since May 20, 2015, when the first case of Middle East respiratory syndrome (MERS) in South Korea was confirmed, the cluster case in South Korea has grown to become the largest observed case following Saudi Arabia within the span of one month. Akin to what was observed in the Middle East, confirmed cases were infected through nosocomial transmission where the cluster is largely limited to patients, healthcare workers, and visitors to patients in healthcare facilities with confirmed cases. A major difference from the outbreaks in the Arabian Peninsula has been the large number of tertiary transmission cases in South Korea, which had reached forty cases by June 12. This observation may suggest that despite the lack of genetic mutation of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea, the virus may be behaving differently from that of the Middle East. The higher infectiousness of 'super-spreaders' in South Korea also suggests that this assertion should be under further investigation. Suggestions of inadequate triage in emergency rooms, particularly at Samsung Medical Center which accounts for the most nosocomial infection with 60 cases, have been made by several organizations as the basis for this rapid spread. This, however, does not account for the fact that triage was impossible to implement, since the presence of MERS-CoV in South Korea was unknown during the index patient's stay at the healthcare facilities. This paper aims to identify the key factors in the amplified spread of MERS-CoV in South Korea. The first is the initial failure to confirm diagnosis promptly and to isolate the index case after confirmation of MERS in hospital and the lack of detail in tracking potential exposures in the community of the index case before isolation. The second is the early inadequate measures the Korea Centers for Disease Control and Prevention took in categorizing close contacts. Due to inconsistencies in defining what constitutes close contact, a number of cases were neglected from quarantine and were not subjected to investigation. Finally, confirmed or potential MERS patients were admitted for treatment and observation at medical facilities without adequate disease control measures or rooms, such as ventilated single rooms or airborne precaution rooms. Due to the rigid position that MERS-CoV cannot be transmitted via airborne means, infection control measures has so far neglected evidence that smaller droplets (aerosol) containing the virus can act similar to airborne agents, which may account for the widespread and rapid transmission in a emergency room and a patient's room in hospital. Although the South Korean government expects newly confirmed cases to abate in the coming few weeks, without stringent implementation of clearly defined guidelines to control further transmissions, the cessation of the current trend may continue for an extended period. Additionally, due to the high infection rate of super-spreaders in South Korea, efforts to screen for potential super-spreaders and a thorough investigation of those confirmed to be super-spreaders should be done to quickly identify source of infection, to potentially lower the number of secondary, tertiary transmissions and prevent possible quaternary transmissions.
Centers for Disease Control and Prevention (U.S.) ; Communicable Diseases ; Coronavirus* ; Cross Infection ; Delivery of Health Care ; Diagnosis ; Disease Outbreaks ; Emergency Service, Hospital ; Epidemiology ; Humans ; Infection Control ; Korea ; Middle East* ; Public Health* ; Quarantine ; Saudi Arabia ; Temefos ; Triage ; Visitors to Patients