BACKGROUND: Workers in the microbiology laboratories are continuously exposed to the risk of laboratory-associated infections. Tuberculosis (TB) is a frequent laboratory-acquired infection owing to production of cough-generated aerosols with ease and high infectivity of Mycobacterium tuberculosis. This study aims to investigate the current situation of biosafety in Korean TB laboratories. METHODS: We conducted a nationwide survey of laboratories in hospitals conducting TB tests using questionnaires about their facility and management standards. RESULTS: We analyzed data from 52 hospitals nationwide that have a capacity of 100–2,000 beds, of which only two laboratories conduct high risk drug-susceptibility testing on cultured isolates among other test items, whereas six laboratories perform only direct sputum-smear microscopy. The remaining laboratories performed moderate-risk activities/tests, like sample processing for culture. In the majority of these laboratories, there are laboratory medicine specialists who are fully in charge of health checkup programs for laboratorians. The facility and management standards vary widely according to the size of the hospital and risk of TB tests. CONCLUSIONS: Our survey results about the current situation of TB laboratories could be useful as baseline data for preparing biosafety guidelines for all TB laboratories in Korea.
Aerosols ; Korea* ; Microscopy ; Mycobacterium tuberculosis ; Specialization ; Tuberculosis*

PURPOSE: Pancreatoduodenectomy is a common procedure for periampullary cancer, but pancreatic leakage is the most dreaded complication after pancreatoduodenectomy. The aim of our study was to evaluate the correlation between the level of amylase in the drain fluid and the level of development of the complications that are related to pancreatic leakage after pancreatoduodenectomy. METHODS: Fifty-one consecutive patients who underwent pancreatoduodenectomy and pancreaticojejunostomy by two surgeons between January 1998 and August 2002 were evaluated retrospectively. A pancreaticojeunotomy was performed by intussuscepting end-to-end anastomosis with an internal stent. Amylase level of the drain fluid was checked every 2 days (postoperative 1, 3, 5, 7 day). Synthetic somatostatin was infused postoperatively for 7 days. RESULTS: The mean age of the 51 patients was 64.8 years, and the male to female ratio was 1.4: 1. The classification by pathologic diagnoses were 20 cases of common bile duct cancer (39%), 19 cases of pancreas head cancer (38%), 6 cases of chronic pancreatitis (12%), 4 cases of ampullar of Vater cancer (8%), and 2 cases of duodenal cancer (4%). There were 24 (47%) postoperative complications. Of these complications, the most occurring complication was the 5 (10%) cases of delayed gastric emptying. The other complications were 4 (8%) cases of pancreaticojejunostomy leakage, 4 (8%) cases of intraabdominal abscess, wound infection, and pulmonary complications. The patients were divided into a complication group related to pancreatic leakage and a non-complication group. There were 14 cases allocated to the complication group, and 37 cases were allocated to the non-complication group. The level of amylase in the drain fluid was higher in the complication group (P<0.05). Four cases of pancreaticojejunostomy leakage developed after pancreatoduodenectomy. All cases had symptoms of high fever, leukocytosis, and abdominal tenderness. CONCLUSION: The occurrence of complications related to pancreaticojejunostomy leakage is suspected if the level of amylase in the drain fluid is higher than the normal serum amylase level after 5 days post operation, and fever, leukocytosis, or abdominal tenderness were the typical complication symptoms.
Abscess ; Amylases* ; Classification ; Common Bile Duct ; Diagnosis* ; Duodenal Neoplasms ; Female ; Fever ; Gastric Emptying ; Head and Neck Neoplasms ; Humans ; Leukocytosis ; Male ; Pancreas ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy ; Pancreatitis, Chronic ; Postoperative Complications ; Retrospective Studies ; Somatostatin ; Stents ; Wound Infection

BACKGROUND: The recovery of bacteria from blood can be affected by many factors. Standardization of blood culture methods is important for reliability. Herein, we aimed to investigate blood culture protocols in Korea. METHODS: We performed a multicenter survey with a questionnaire about blood culture practices, which was sent by email to directors and clinical physicians in charge of clinical microbiology laboratories in May 2014. Total data from 18 participating hospitals were analyzed to be used as current baseline data, which is necessary to optimize blood culture protocols. RESULTS: Many laboratories included recommended blood volume, which is a major factor for bacteria recovery rate. This varied across participating laboratories. For adults, blood sampling of 10 mL was recommended by 10 laboratories and 20 mL was recommended by 5 laboratories. For children who weighed 14-36 kg and less than 14 kg, blood sampling of 10 mL (n=8) and 5 mL (n=7) was recommended, respectively. For neonates, less than 1 mL was recommended by 12 laboratories. CONCLUSION: Substantial variations in blood culture protocols were seen across participating clinical microbiology laboratories. Efforts to standardize this protocol should be undertaken.
Adult ; Bacteria ; Blood Volume ; Child ; Electronic Mail ; Humans ; Infant, Newborn ; Korea* ; Sepsis

BACKGROUND: Cladosporium spp. are dematiaceous fungi that are commonly isolated from indoor and outdoor environments, including hospital air. This fungus is rarely pathogenic to humans, but has been reported to cause infections of the skin and toenails, as well as sinusitis and pulmonary infections. The monitoring of culture results was conducted to identify the outbreak of an unknown black fungal infection between January and March 2006 in a University hospital, and infection control activity was performed to identify the cause of the outbreak. METHODS: An epidemiological investigation of 22 patients with infections caused by an unknown black fungus was conducted. Microscopic examination and molecular analysis on the internal transcript spacer (ITS) region was performed to identify the black fungus. To detect the source of contamination, a culture of environmental specimens was performed, and then, disinfection of the laboratory was implemented. RESULTS: The patients with black fungi belonged to various departments and wards. No symptoms of fungal infection were recognized on the basis of the survey. The black fungus was identified as Cladosporium spp. on the basis of morphological features and ITS region sequencing. Culturing of environmental specimens was performed in the laboratory. Black fungi were isolated from a specimen from a rack and had the same morphological features with Cladosporium spp. from clinical specimens. After the rack was autoclaved, Cladosporium spp. from clinical specimens was no longer isolated. CONCLUSION: Epidemiological investigation, microscopic examination, and molecular analysis revealed that the sudden increase in the isolation rate of Cladosporium spp. from clinical specimens was the result of a pseudo-outbreak caused by the contamination of a rack. To our knowledge, this is the first report of a pseudo-outbreak of Cladosporium spp. Continuous monitoring of culture results is important to avoid unnecessary labor for nosocomial infection control.
Cladosporium ; Cross Infection ; Disinfection ; Fungi ; Humans ; Infection Control ; Nails ; Sinusitis ; Skin

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, with its accuracy and speed, is widely used for bacterial identification. The ASTA MicroIDSys system (ASTA, Korea) was recently developed for species identification. We compared its performance with that of Bruker Biotyper (Bruker Daltonics, Germany). Microbes were recovered from sputum, urine, and pus samples from patients admitted to a tertiary care hospital in Korea from January to April 2016. Matrix solution (α-cyano-4-hydroxycinnamic acid) was used, and the peptide profiles acquired from the Microflex LT (Bruker Daltonics) and Tinkerbell LT (ASTA) were analyzed by using their respective software. From 5,322 isolates, Bruker Biotyper identified 163 species; fifty species from 4,919 isolates were identified more than 10 times, including Klebsiella pneumoniae (n=571), Acinetobacter baumannii (n=436), Pseudomonas aeruginosa (n=358), Escherichia coli (n=372), Staphylococcus aureus (n=511), S. epidermidis (n=444), Enterococcus faecium (n=262), E. faecalis (n=220), and Candida albicans (n=248). Identical results, confidence scores (≥ 2.0 for Bruker Biotyper), and acceptable scores (≥140 for ASTA MicroIDSys) were obtained for 86.1% of isolates. Of 4,267 isolates, 99.2% showed acceptable scores in both systems. Results from the ASTA MicroIDSys showed good agreement with those from the Bruker Biotyper. The ASTA MicroIDSys could reliably identify clinically important microorganisms.
Acinetobacter baumannii ; Candida albicans ; Enterococcus faecium ; Escherichia coli ; Humans ; Klebsiella pneumoniae ; Korea ; Mass Spectrometry* ; Pseudomonas aeruginosa ; Sputum ; Staphylococcus aureus ; Suppuration ; Tertiary Healthcare

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

Purpose: This study aimed to identify the influence of knowledge of personal information protection law and nursing patient advocacy on practice of personal information protection among nurses. Methods: The subjects were 130 nurses who have worked for six months or more in the ward of the tertiary or general hospitals. Data were collected from February 20 to March 3, 2023. Results: Factors influencing practice of personal information protection were acting as an advocate (β=.32, p=.004), environmental and educational influences (β=.21, p=.040), knowledge of personal information protection law (β=.19, p=.013) and clinical experience for five years or more but less than ten years (β=.17, p=.036). The regression model showed an explanatory power of 34.0%. Conclusion Acting as an advocate has the most effect on practice of personal information protection. To promote practice of personal information protection for nurses, it is necessary to provide education related to privacy protection and encourage nursing patient advocacy.

Background: Intestinal protozoan infection is one of the main causes of gastrointestinal diseases. Protozoa are usually detected by direct smear microscopy, concentration techniques, or special stains; however, these techniques are labor-intensive and require well-trained technicians. Therefore, molecular techniques involving polymerase chain reaction (PCR) have been developed to satisfy the need for unbiased and rapid analytical methods with high sensitivity and specificity. In this study, the BD MAXTM Enteric Parasite Panel (EPP) (Becton, Dickinson and Company, USA), designed to detect Cryptosporidium parvum and/or hominis, Giardia lamblia, and Entamoeba histolytica, and the AllplexTM Gastrointestinal Parasite Assays (AGPA) (Seegene Inc., Korea), designed to detect Cryptosporidium species, G. lamblia, E. histolytica, Blastocystis hominis, Dientamoeba fragilis, and Cyclospora cayetanensis were compared to determine whether any of these assays could become a useful tool for detecting intestinal protozoan infections in Korea. Methods: We investigated 295 fecal samples using EPP and AGPA. Then we confirmed the positive results with the conventional and nested PCR. Consistent detection by conventional PCR, nested PCR, and one of the multiplex panels was considered “true positive.” Results: Out of 295 samples, 17 were true positives for B. hominis and 2 were true positives for E. histolytica. EPP detected parasites in only two samples owing to its design; however, its true positive detection rate was 100% (2/2). AGPA detected parasites in 24 samples with 79.2% (19/24) true positives. Conclusions The incidence of protozoan, especially B. hominis, infection may be more prevalent than expected. AGPA could be an effective tool for screening protozoan infections.

PURPOSE: Hospital-acquired Burkholderia cepacia (B. cepacia) infection are not commonly recorded in patients without underlying lung disease, such as cystic fibrosis and chronic granulomatous disease. However, in 2014, B. cepacia appeared more frequently in pediatric blood samples than in any other year. In order to access this situation, we analyzed the clinical characteristics of B. cepacia infections in pediatric patients at our hospital. MATERIALS AND METHODS: We conducted a retrospective study of blood isolates of B. cepacia taken at our hospital between January 2004 and December 2014. Patient clinical data were obtained by retrospective review of electronic medical records. We constructed a dendrogram for B. cepacia isolates from two children and five adult patients. RESULTS: A total of 14 pediatric patients and 69 adult patients were identified as having B. cepacia bacteremia. In 2014, higher rates of B. cepacia bacteremia were observed in children. Most of them required Intensive Care Unit (ICU) care (12/14). In eleven children, sputum cultures were examined, and five of these children had the same strain of B. cepacia that grew out from their blood samples. Antibiotics were administered based on antibiotic sensitivity results. Four children expired despite treatment. Compared to children, there were no demonstrative differences in adults, except for history of ICU care. CONCLUSION: Although there were not many pediatric cases at our hospital, awareness of colonization through hospital-acquired infection and effective therapy for infection of B. cepacia is needed, as it can cause mortality and morbidity.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/drug therapy/*epidemiology ; Burkholderia Infections/blood/drug therapy/*epidemiology ; Burkholderia cepacia/drug effects/*isolation & purification ; Child ; Child, Preschool ; Cross Infection/blood/*diagnosis/drug therapy/mortality ; Disease Outbreaks ; Female ; Humans ; Incidence ; Infant ; *Intensive Care Units ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Treatment Outcome ; Young Adult

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