No abstract available.
Acute Kidney Injury* ; Cholesterol* ; Coronary Angiography* ; Embolism, Cholesterol*

Tsutsugamushi disease is an acute febrile illness caused by infection with Orientia tsutsugamushi transmitted by the bite of larval trombiculid mites and characterized by fever, myalgia, lymphadenopathy, rash and eschar. O. tsutsugamushi has been known to cause diffuse vasculitis of small blood vessels. Disseminated intravascular coagulation associated with endothelial cellular injury by O. tsutsugamushi has been occasionally reported. However, in our knowledge, splenic infarction-associated scrub typhus has not been previously reported. We experienced two cases of tsutsugamushi disease with splenic infarction, which were improved after doxycycline treatment finished.
Blood Vessels ; Disseminated Intravascular Coagulation ; Doxycycline ; Exanthema ; Fever ; Lymphatic Diseases ; Myalgia ; Orientia tsutsugamushi ; Scrub Typhus* ; Splenic Infarction* ; Trombiculidae ; Vasculitis

The most serious problem after splenectomy is the increased risk of life-threatening infections caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis. Purpura fulminans, which is commonly associated with meningococcal sepsis, is characterized by disseminated intravascular coagulation and rapidly progressive purpuric skin lesions. Purpura fulminans can also develop in invasive pneumococcal infection especially after splenectomy, however, there has been no report in Korea. We report a case of overwhelming pneumococcal sepsis manifested as purpura fulminans in a splenectomized patient.
Bacteria ; Disseminated Intravascular Coagulation ; Haemophilus influenzae ; Humans ; Korea ; Neisseria meningitidis ; Pneumococcal Infections ; Purpura Fulminans* ; Purpura* ; Sepsis ; Skin ; Splenectomy ; Streptococcus pneumoniae* ; Streptococcus*

Clostridium sordellii is a gram-positive spore forming anaerobic bacillus, rarely encountered in human infection. It produces several exotoxins which contribute to myonecrosis, pulmonary infection, obstetric infection and bacteremia. C. sordellii bacteremia is very rare and has been reported in few patients with malignancy or immunosuppression. To date, there has been no report in Korea. Mortality is high when deep site infection exists regardless of underlying pathology and immune status. In contrast, superficial skin and subcutaneous tissue infection has a favorable prognosis. We present a case of C. sordellii bacteremia in a patient with osteosarcoma. The patient was admitted for the treatment of the infection at the ulcerative osteosarcoma lesions of the leg, and C. sordellii bacteremia was demonstrated. He was successfully treated with intravenous ampicillin/sulbactam for two weeks.
Bacillus ; Bacteremia* ; Clostridium sordellii* ; Clostridium* ; Exotoxins ; Humans ; Immunosuppression ; Korea ; Leg ; Mortality ; Osteosarcoma* ; Pathology ; Prognosis ; Skin ; Spores ; Subcutaneous Tissue ; Ulcer

Clostridium sordellii is a gram-positive spore forming anaerobic bacillus, rarely encountered in human infection. It produces several exotoxins which contribute to myonecrosis, pulmonary infection, obstetric infection and bacteremia. C. sordellii bacteremia is very rare and has been reported in few patients with malignancy or immunosuppression. To date, there has been no report in Korea. Mortality is high when deep site infection exists regardless of underlying pathology and immune status. In contrast, superficial skin and subcutaneous tissue infection has a favorable prognosis. We present a case of C. sordellii bacteremia in a patient with osteosarcoma. The patient was admitted for the treatment of the infection at the ulcerative osteosarcoma lesions of the leg, and C. sordellii bacteremia was demonstrated. He was successfully treated with intravenous ampicillin/sulbactam for two weeks.
Bacillus ; Bacteremia* ; Clostridium sordellii* ; Clostridium* ; Exotoxins ; Humans ; Immunosuppression ; Korea ; Leg ; Mortality ; Osteosarcoma* ; Pathology ; Prognosis ; Skin ; Spores ; Subcutaneous Tissue ; Ulcer

Methcillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of community-acquired infections, which has been recently designated as community-associated (CA) MRSA. Panton-Valentine leukocidin (PVL)-negative multilocus sequence type 72 (ST72)-staphylococcal cassette chromosome mec (SCCmec) type IV has been reported as the predominat CA-MRSA strain in Korea and is commonly associated with skin and soft tissue infections in addition to healthcare-associated pneumonia. However, community-acquired pneumonia (CAP) for this strain has not yet been reported. We hereby report two cases of CAP caused by PVL-negative ST72-SCCmec type IV strain in patients who had no risk factors for MRSA acquisition. While CA-MRSA infections are not yet prevalent in Korea, our cases suggest that CA-MRSA should be considered in cases of severe CAP, especially for cases associated with necrotizing pneumonia.
Bacterial Toxins ; Community-Acquired Infections ; Exotoxins ; Humans ; Korea ; Leukocidins ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Risk Factors ; Skin ; Soft Tissue Infections ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus

Rhizobium species, aerobic Gram-negative rods found in soils worldwide, are well-known tumor-inducing pathogens in plants. Since 1980, when the first case of prosthetic valve endocarditis caused by Rhizobium radiobacter was reported, R. radiobacter has been recognized as an opportunistic human pathogen. In Korea, three cases of infection by this organism have been reported. Recently, we experienced a case of R. radiobacter bacteremia in a patient who underwent chemotherapy for lymphoma. Here, we report the case with a review of the literature.
Agrobacterium tumefaciens ; Bacteremia ; Endocarditis ; Humans ; Korea ; Lymphoma ; Rhizobium ; Soil

BACKGROUND/AIMS: As bacterial resistance to antimicrobial agents has grown due to the increasing use of antimicrobial agents, we sought to evaluate the suitability of ceftriaxone usage (representative of third generation cephalosporins) at 10 university hospitals in Korea. METHODS: We prospectively evaluated the appropriateness of antibiotic usage in 400 adult patients who received ceftriaxone between February 1, 2006 and June 30, 2006. Drug utilization evaluation (DUE) methods were based on standards set forth by the American Society of Hospital Pharmacists. The DUE criteria used in this study were modified to be more suitable in our hospital setting: justification of drug use, critical and process indications, complications, and outcome measures. RESULTS: The average patient age was 64.4 years. The utilization of ceftriaxone was appropriate in 262 cases (65.5%) for the justification of use, while inappropriate use was observed in 138 cases (34.5%). Common reasons for inappropriate use of ceftriaxone included continued empiric use for presumed infections, prophylactic perioperative injection, and empiric therapy for fever. Most of the critical indications showed a high rate of suitability (66.5-98.5%). Complications occurred in 37 cases (9.3%). With respect to outcome measures, clinical responses were observed in 60.7% of cases, while only 15.7% of cases showed evidence of infection eradication via negative cultures. CONCLUSIONS: Appropriate use (65.5%) of ceftriaxone was higher than inappropriate use (34.5%) at university hospitals in Korea. Inappropriate utilization, however, including continued empiric use for presumed infections and prophylactic perioperative injection remained high. Intensification of educational programs and antibiotic control systems for ceftriaxone is needed to improve the suitability of antimicrobial use.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/*therapeutic use ; Ceftriaxone/adverse effects/*therapeutic use ; Child ; Child, Preschool ; *Drug Utilization Review ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Treatment Outcome

BACKGROUND: To evaluate the appropriateness of intravenous (IV) ciprofloxacin usage in university hospitals in Korea. MATERIALS AND METHODS: We prospectively evaluated the appropriateness of drug usage in 290 consecutive adult patients who received IV ciprofloxacin in eight teaching hospitals during the period from September 25, 2003 to November 15, 2003. Drug use evaluation (DUE) in this study was based on the modified standard by the American Society of Hospital Pharmacy with regard to the justification of drug use, critical and process indications, complications, and outcome measures. RESULTS: Average age of the patients was 54 years. The use of IV ciprofloxacin was appropriate only in 33 cases (26.9%). Common reasons for inappropriate use of IV ciprofloxacin include perioperative uses or prophylactic injection before urologic procedures, and empirical therapy for febrile episodes. Most of the "critical indications" and "process indications" showed high rate of appropriateness (82.4-100%). However, the rate of taking culture and sensitivity test before (73.8%) and during ciprofloxacin use (68.6%) were low. Complications with ciprofloxacin use were rare. In 93.3% of cases, ciprofloxacin treatment was clinically effective. CONCLUSION: Use of intravenous ciprofloxacin is frequently inappropriate in tertiary care hospitals in Korea. Implementation of education program and antibiotic control system is critical in improving the appropriateness of antimicrobial use.
Adult ; Ciprofloxacin* ; Education ; Hospitals, Teaching ; Hospitals, University* ; Humans ; Korea* ; Outcome Assessment (Health Care) ; Pharmacy ; Prospective Studies ; Tertiary Healthcare

BACKGROUND: To evaluate the appropriateness of intravenous (IV) ciprofloxacin usage in university hospitals in Korea. MATERIALS AND METHODS: We prospectively evaluated the appropriateness of drug usage in 290 consecutive adult patients who received IV ciprofloxacin in eight teaching hospitals during the period from September 25, 2003 to November 15, 2003. Drug use evaluation (DUE) in this study was based on the modified standard by the American Society of Hospital Pharmacy with regard to the justification of drug use, critical and process indications, complications, and outcome measures. RESULTS: Average age of the patients was 54 years. The use of IV ciprofloxacin was appropriate only in 33 cases (26.9%). Common reasons for inappropriate use of IV ciprofloxacin include perioperative uses or prophylactic injection before urologic procedures, and empirical therapy for febrile episodes. Most of the "critical indications" and "process indications" showed high rate of appropriateness (82.4-100%). However, the rate of taking culture and sensitivity test before (73.8%) and during ciprofloxacin use (68.6%) were low. Complications with ciprofloxacin use were rare. In 93.3% of cases, ciprofloxacin treatment was clinically effective. CONCLUSION: Use of intravenous ciprofloxacin is frequently inappropriate in tertiary care hospitals in Korea. Implementation of education program and antibiotic control system is critical in improving the appropriateness of antimicrobial use.
Adult ; Ciprofloxacin* ; Education ; Hospitals, Teaching ; Hospitals, University* ; Humans ; Korea* ; Outcome Assessment (Health Care) ; Pharmacy ; Prospective Studies ; Tertiary Healthcare