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

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: The urea breath test (UBT) is regarded as a highly reliable, noninvasive tool for diagnosing Helicobacter pylori infection. We compared a recently developed low-dose 38 mg 13C-urea capsule, which is able to eliminate oral urease effects and does not require positional changes during the test, with the conventionally used 100 mg 13C-urea tablet method. METHODS: Thirty-nine volunteers were tested under informed consent with both 13C-UBT methods, Helifinder(R) and UBiT-IR300(R), with a minimum 2-week washout period. The pre-ingestion and 20-minute post-ingestion breath samples were analyzed with an isotope ratio mass spectrometer for Helifinder, and a nondispersive isotope-selective infrared spectrophotometer for UBiT samples. RESULTS: Helifinder method showed excellent agreement with UBiT among 19 positive and 20 negative cases (weighted kappa value, 1.0). Helifinder results (y) showed good agreement but with a proportional bias compared to UBiT results (x) by Passing and Bablok method (y=0.551 X -0.255, r=0.74, P<0.0001). CONCLUSIONS: Since the low-dose 38 mg 13C-urea capsule (Helifinder) test, which is more convenient and economic, showed comparable results with the conventional UBiT method, it can be used as an alternative for the diagnosis of H. pylori infection.
Bias (Epidemiology) ; Breath Tests ; Diagnosis ; Helicobacter pylori* ; Helicobacter* ; Informed Consent ; Urea* ; Urease ; Volunteers

BACKGROUND: Antimicrobial resistance to third-generation cephalosporins in gram-negative bacteria, especially Enterobacter, Citrobacter, and Serratia spp., is increasing. The resistance mechanism of these organisms are hyperproduction of AmpC beta-lactamase and plasmid-mediated extended-spectrum beta-lactamase (ESBL). This study was to determine the occurrence of AmpC hyperproduction and ESBLs in E. cloacae, C. freundii, and S. marcescens over a 3-month period in 2002. METHODS: We tested total of 619 consecutive, nonduplicate isolates (229 E. cloacae, 183 C. freundii, 207 S. marcescens) from 12 university hospitals and a commercial laboratory in Korea. Antimicrobial susceptibilities were tested using the disk diffusion method. AmpC hyperproduction was defined as nonsusceptible to cefotaxime or ceftazidime for E. cloacae and C. freundii and as nonsusceptible to cefotaxime for S. marcescens. ESBL production was determined by the double disk synergy test. RESULTS: Among the E. cloacae, C. freundii and S. marcescens derepressed strains were 20.5%, 30.1%, and 31.4% and ESBL producers were 23.6%, 10.9%, and 15.5%, respectively. The AmpC derepressed strains and ESBL producers revealed lower susceptibility rates for ciprofloxacin, piperacillin, piperacillin-tazobactam and aminoglycosides. CONCLUSIONS: These data reveal that the occurrence of AmpC derepressants and ESBL producers among E. cloacae, C. freundii and S. marcescens is relatively high. Continued nationwide surveillance is necessary to provide information on the spread of these important mechanisms of resistance to beta-lactams.
Aminoglycosides ; beta-Lactamases ; beta-Lactams ; Cefotaxime ; Ceftazidime ; Cephalosporins ; Ciprofloxacin ; Citrobacter ; Citrobacter freundii* ; Cloaca ; Diffusion ; Enterobacter ; Enterobacter cloacae* ; Gram-Negative Bacteria ; Hospitals, University ; Korea ; Piperacillin ; Serratia ; Serratia marcescens*

BACKGROUND: The purpose of this study was to compare a 1% chlorhexidine gluconate/6l% ethanol (CHG/Ethanol) emollient and 7.5% povidone-iodine (PVI) scrub for antibacterial efficacy and effect on skin condition. METHODS: Twelve healthy newly employed nurses were recruited for this clinical study to evaluate the two hand cleansing agents. The CHG/Ethanol emollient hand preparation was applied without scrubbing and 7.5% PVI was applied using a scrub brush in 5-minute surgical scrubbing. Subjects used one method for 5 days and switched to the other method for another 5 days. Samples were taken for bacterial counts using the glove juice technique before and one minute after hand cleansing and again at the end of surgical operation on Day 1, 2, and 5. The VSS (Visual Scoring of Skin condition) scores and HSA (Hand Subject Assessment) scales were used to evaluate skin condition. RESULTS: Log reduction in bacterial counts by CHG/Ethanol emollient was greater than by PVI immediately after hand cleasing (log3.73 vs log1.66) and at the end of surgical operation (log3.49 vs log1.93) on Day 1. But there were no significant difference on Day 2 and 5. CHG/Ethanol emollient caused fewer skin problems than PVI; the VSS scores of the CHG/Ethanol emollient were better than those of PVI on Day 2, 3, 4, and 5 (P<0.05), and also HSA scale for change from baseline to the end of Day 5 was significantly better for the CHG/Ethanol emollient (22.5-->24.5 vs 23.0-->19.3). CONCLUSION: Compared to PVI, the CHG/Ethanol emollient hand preparation was shown to be more antibacterial and less irritation to skin. The results showed the possibility of using the waterless, scrubless agent for surgical hand scrub in Korea.
Bacterial Load ; Chlorhexidine ; Detergents ; Ethanol ; Hand ; Hand Disinfection ; Korea ; Povidone-Iodine* ; Skin ; Weights and Measures

BACKGROUND: Sequence type 131 (ST131) O25b serogroup Escherichia coli, producing CTX-M type extended-spectrum β-lactamase (ESBL), is a major clone involved in worldwide pandemic spread in both community- and healthcare-associated infections. Recently, matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has become a routine tool for the identification of bacteria in many laboratories. This study aimed to assess the performance of MALDI-TOF MS for the screening of ESBL-producing E. coli ST131 in a rapid, inexpensive, and simple way. METHODS: A total 26 clinical E. coli, isolated from blood between 2013 and 2014, were used. The characteristics are ST131-O25b ESBL producers (n=6), ST131-O16 ESBL producers (n=4), non-ST131 ESBL producers (n=11), and non-ST131 non-ESBL producers (n=5). Specific biomarker peaks to distinguish the ST131 clonal group from others were investigated by MicroIDSys (ASTA, South Korea) and ASTA Tinkerbell 2.0 software. RESULTS: A peak at 9,713 m/z peak is useful to screen for ST131 E. coli, regardless of serogroup O25 or O16, showing a sensitivity of 100%, specificity of 56.2%, positive predictive value of 58.8%, and negative predictive value of 100% when using a relative intensity cutoff of 15%. CONCLUSION: We can screen for ST131 E. coli using MicroIDSys (ASTA), MALDI-TOF MS in a rapid, inexpensive, and simple way. However, other confirmatory tests are needed to confirm ST131 E. coli due to the low specificity of this method.
Bacteria ; Clone Cells ; Escherichia coli* ; Escherichia* ; Mass Screening ; Mass Spectrometry* ; Methods ; Pandemics ; Sensitivity and Specificity ; Serogroup

BACKGROUND: Patients infected with vancomycin-resistant enterococci (VRE) are kept in isolation to prevent the spread of VRE in medical facilities. However, decision-making regarding isolation can be challenging at the time of re-admission of previously VRE-colonized or infected patients who have not been examined for VRE infections for a long time. This study focused on providing guidelines for isolating VRE patients based on the analysis of risk factors for prolonged carriage and reacquisition of VRE. METHODS: A retrospective review was performed on medical records of patients who were diagnosed with VRE infections at a university hospital in 2009. Durations of colonization and negative conversion of VRE were estimated by Kaplan-Meier methods. Prolonged duration of VRE infections and risk factors for reacquisition were analyzed using Cox's proportional hazard model. RESULTS: Among 220 VRE-colonized patients, 132 were cleared, and 30 reacquired after negative conversion of VRE. The median duration of colonization was 33.1 weeks, and the median clearance period was 19.4 weeks. Patients who were admitted via the emergency department and treated with glycopeptides tended to have prolonged duration of VRE colonization. Prolonged hospitalization and metronidazole therapy increased the risk of reacquisition more rapidly. CONCLUSION: Treatment with glycopeptides, metronidazole antibiotic therapy, history of admission via the emergency department, and prolonged hospitalization can affect to prolonged carriage and reacquisition of VRE. Consider carefully the release of isolation of VRE patients with these risk factors.
Colon ; Emergency Service, Hospital ; Enterococcus ; Glycopeptides ; Hospitalization ; Humans ; Medical Records ; Metronidazole ; Patient Isolation ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors* ; Vancomycin Resistance

BACKGROUND: Compliance with hand hygiene protocols is one of the simplest ways to prevent healthcare-associated infections (HAIs). Hand hygiene is influenced by individual habits and beliefs, as well as by local organizational culture practices. This study was performed in order to increase the rate of compliance to hand hygiene through changes in the organizational culture. METHODS: From 2009 through 2011, this study was performed in a 2,000-bed tertiary-care university hospital with more than 6,000 employees. The program was implemented mainly by team activities, and the leadership and hand hygiene steering committee members supported them. Goals for planning, intervention, and evaluation of the compliance rate for hand hygiene were made annually in the hospital. RESULTS: The rate of compliance to hand hygiene increased significantly each year (43.8% in 2008, 75.3% in 2009, 80.7% in 2010, and 83.2% in 2011). The detection rate of vancomycin-resistant Enterococcus (VRE) and the incidence of healthcare-associated Staphylococcus aureus bacteremia decreased. CONCLUSION: The rate of compliance to hand hygiene was remarkably improved, and it continuously increased through systematic and continuous changes in the organizational culture. In addition, the detection rate of VRE and incidence of S. aureus bacteremia decreased. These results show that hand hygiene is an important factor for preventing HAIs.
Bacteremia ; Committee Membership ; Compliance ; Enterococcus ; Hand Hygiene ; Incidence ; Organizational Culture ; Staphylococcus aureus

BACKGROUND/AIMS: Risk factors for mortality resulting from anaerobic infection are incompletely defined. The clinical significance of a broad range of pathogenic obligate anaerobic organisms was examined, and factors independently associated with mortality were identified in patients with clinically significant anaerobic infections. METHODS: The medical records of 1,050 patients with anaerobic infections were retrospectively reviewed at Severance Hospital in Seoul, Korea. RESULTS: The mean age of the patients was 54.1+/-16.8 years, and 57.7% were men. Overall, 320 (30.5%) patients with case-defined illness experienced pain at the affected site, and 230 (21.9%) experienced pus flow from lesions. Ten (1.4%) patients presented with shock, and 80.3% of the clinically significant cases were polymicrobial anaerobic infections. The mean number of pathogens, including aerobic and anaerobic bacteria, was 3.7+/-1.0 (minimum 1, maximum 5), and the number of anaerobic organisms was 1.0+/-0.3 in each specimen. The major pathogens by rank were the Bacteroides fragilis group, which accounted for 41.8% of anaerobic infections, followed by Clostridium spp. (11.8%), Prevotella spp. (9.4%), and Peptostreptococcus spp. (8.4%). Escherichia coli (17.5%), Staphylococcus aureus (7.5%), and Klebsiella pneumoniae (7.5%) were common concomitant aerobic organisms. The overall crude mortality rate resulting from anaerobic infection was 29.7%. Among the determining factors associated with mortality, liver disease (p=0.003) and old age (p=0.005) were significant in multivariate analysis. CONCLUSIONS: Anaerobic infection is polymicrobial and has a significant role in morbidity and mortality. Underlying liver disease was associated with poor prognosis in anaerobic infection.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Bacteria, Anaerobic/*isolation & purification ; Bacterial Infections/*epidemiology/microbiology/therapy ; Drainage/methods ; Female ; Follow-Up Studies ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Morbidity/trends ; Prognosis ; Retrospective Studies ; Survival Rate/trends ; Time Factors ; Young Adult

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.