Catheter-related infections (CRIs) are one of the most frequent healthcare-associated infections and are costly, morbid, and potentially lethal. A series of studies has confirmed that a comprehensive bundle approach based on known guidelines was successful in reducing catheter-related bloodstream infections in intensive care units. In this review, I'll summarize the previous recommendations made in 2002 on preventing CRIs and highlight recent advances and the evidences supporting novel methods of CRIs prevention published in research articles.
Catheter-Related Infections ; Intensive Care Units

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Twin pregnancies represent a high risk obstetric population with perinatal morbidity and mortality much greater than that of singleton pregnancies. A retrospective dinical evaluation was attempted to analyse 211 cases of twin pregnancies in Chunchon Sacred Heart Hospital of Hallym University from Jan. l. 1988 to Dec. 31. 1997. The results were as follows. 1) The incidence of twin pregnancy was 1 in 93.9 deliveries. 2) The age of mother ranged from 19 to 42 years and predominant age group was 26-30 which covers 43.1% of all. 3) Nullipara was 61.1% and multipara was 38.9%. 4) The predominant gestational age group at delivery was 36-37 weeks, 33.2%. 5) In presentation, both cephalic combination was 46.4%, cephalic-breech was 26.1%. 6) The birth weight was less than 2500gm in 64.9% of the 1st babies and 70.6% of the 2nd babies, respectively. 7) The rate of cesarean section was 89.0%. The indications of cesarean section were malpresention (48.9%), elective cesarean section(38.8%), and toxemia(9.0%). 8) In 23 cases of vaginal delivery, the average duration of labor was 7.0 hours and 43.5% of 2nd baby was delivered within 5 min after 1st baby delivery, 9) The most frequent maternal complications during pregnancy were anemia(36.0%), preterm labor(34.6%) and preeclamsia(17.5%). 10) The perinatal mortality rate of the first and second twins was 10.4% and 12.3%, respectively. The main causes of perinatal death were prematurity(52.1%) and stillborn(22.9%). 11) Both female was 43.6%, both male was 39.3%, and opposite sex was 17.1% in infant.
Birth Weight ; Cesarean Section ; Female ; Gangwon-do ; Gestational Age ; Heart ; Humans ; Incidence ; Infant ; Male ; Mortality ; Mothers ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin* ; Retrospective Studies

BACKGROUND: Urinary tract infections (UTIs) are the most frequent nosocomial infections and are frequently associated with indwelling urinary catheters. It is known that adherence to standard infection control measures for urinary catheters can reduce UTIs in hospitals. This study was performed to evaluate the effect of education in reducing catheter-related UTIs (CR-UTIs) in intensive care units (ICUs) of a university hospital. METHODS: CR-UTIs were prospectively monitored for all patients with indwelling urinary catheters in ICUs from July 2006 through December 2007. Recommendations based on previously known guidelines for catheter insertion, catheter management, and specimen collection to prevent CR-UTIs were formulated and educated in March 2007. Knowledge and adherence level were evaluated before and after educating healthcare workers about the recommendations using questionnaire. Changes in knowledge and adherence level before and after education were compared by Chi-square test. Changes in the rate of CR-UTIs and urinary catheter utilization ratios were also analyzed by Fisher's exact test. RESULTS: After education, knowledge level of and adherence level to most of the recommendations were improved significantly. The rate of CR-UTIs significantly decreased by 48% from 7.43/1,000 catheter-days before intervention to 3.87/1,000 catheter-days after intervention (P=0.02). CONCLUSION: Surveillance for nosocomial infections and education for standard infection control measures are very important in preventing CR-UTIs in ICUs.
Catheters ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Critical Care ; Intensive Care Units ; Prospective Studies ; Specimen Handling ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Surveys and Questionnaires

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nasocomial pathogen. The active surveillance of MRSA is essential to limit its transmission. The BD GeneOhm MRSA real-time PCR assay (Becton Dickinson Diagnostics, San Diego, USA) has been recently developed and used for same-day MRSA detection directly from nasal swab specimens. The authors of the present study compared GeneOhm MRSA PCR with culture methods to evaluate its diagnostic performance for MRSA active surveillance. METHODS: The present study was conducted on patients admitted to the ICU for six months. A total of 371 nasal swab specimens were obtained from patients at admission day and at the seven-day follow-up. The swab was streaked onto culture media, and presumptive S. aureus colonies were confirmed as MRSA using the BD Phoenix automated microbiology system (Becton Dickinson Diagnostic Systems, Sparks, USA). In addition, GeneOhm MRSA PCR was performed. For discrepant results between Gene-Ohm MRSA PCR and culture, the enrichment broth culture method was performed. RESULTS: There were 34 samples with discrepant results between the GeneOhm MRSA PCR and culture. The overall agreement was 90.7%. For the detection of MRSA, the GeneOhm MRSA PCR was 96.8% sensitive and 86.3% specific, with positive and negative predictive values of 83.9% and 97.3%, respectively. CONCLUSION: Identification of MRSA-colonized patients was achieved in as little as two hours, and the high negative predictive value of GeneOhm MRSA PCR suggests that the assay is a rapid method for the identification of persons who are not colonized with MRSA. However, due to the low positive predictive value, GeneOhm MRSA PCR combined with enrichment culture in cases of positive GeneOhm MRSA PCR is potentially useful for active MRSA surveillance activities.
Colon ; Culture Media ; Follow-Up Studies ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction

BACKGROUND: We compared the LightCycler MRSA advanced test (Roche Diagnostics, Germany) with enrichment culture methods to evaluate the relative diagnostic performance of the LightCycler MRSA advanced test for active surveillance in a high-prevalence setting. METHODS: A total of 342 nasal swab specimens were obtained from patients in the intensive care unit at admission and on the seventh day for follow-up. The results of LightCycler MRSA advanced test were compared to those of the enrichment culture. For discrepant results, mecA gene PCR was performed. RESULTS: For the detection of methicillin-resistant Staphylococcus aureus (MRSA), the LightCycler MRSA advanced test showed 98.5% sensitivity and 78.6% specificity and had positive and negative predictive values of 75.0% and 98.8%, respectively. A total of 46 samples had discrepant results between the LightCycler MRSA advanced test and enrichment culture. Of the 44 specimens that were positive in the LightCycler MRSA advanced test but negative by enrichment culture, mecA genes were detected in 37 specimens. In addition, of the original 44 cases, 21 patients had a history of MRSA colonization or infection within the last month; of those 21 specimens, 20 were positive for mecA gene as shown by PCR. Seven mecA-negative discrepant specimens comprised 3 methicillin-sensitive S. aureus-culture positive and only 2 patients had MRSA infections. CONCLUSIONS: Despite its low specificity and positive predictive value, the LightCycler MRSA advanced test could serve as a rapid test for patients colonized with MRSA.

The quinolone class of antimicrobial agents is one of most widely used classes of antimicrobial agents in outpatient and inpatient treatment. However, quinolone resistance in gram-positive and gram-negative bacteria has emerged and increased globally. This resistance limits the usefulness of quinolones in clinical practice. The review summarizes mechanisms of quinolone resistance and its epidemiology and implications in the most common clinical settings, urinary tract infections, respiratory tract infections, intraabdominal infections, skin and skin structure infections, and sexually transmitted diseases.
Anti-Infective Agents ; Drug Resistance ; Epidemiology* ; Gram-Negative Bacteria ; Humans ; Inpatients ; Intraabdominal Infections ; Outpatients ; Quinolones ; Respiratory Tract Infections ; Sexually Transmitted Diseases ; Skin ; Urinary Tract Infections

Acetabular fracture can result in severe limitation of the motion of the hip joint, which supports totalweight of human body. Beause of different methods of surgical approach a ccording to fracture type, preciseinterpretation of X-ray films of acetabular fracture is required. We reviewed 38 cases of simple X-ray filmsshowing acetabular fracture. The results were as follows: 1. Almomst 60% of the cases-were in their 2nd and 3rddecades. 2. Twenty cases were male, and 18 cases were female. 3. The most common cause of the injury was trafficaccident(33 cases, 86.8%), followed by fall down (4 ases, 10.5%) and slip down(1 case, 2.7%). 4. Elementaryfractures were 21 cases(55.3%) and associated fractures were 17 cases(44.7%). 5. Among elementary fractures,posterior wall fractures were 9 cases(23.7%), followed by anterior column fractures(8 ases, 21.1%), anterior wallfractures(4 cases, 10.5%). 6. Among associated fractures, T-shaped fractures were 8 cases(21.1%), followed by bothcolumn fractures(6 cases, 15.8%), anterior and hemitransverse fractures(3 cases, 7.8%). 7. Other pelvic bonefractures associated with the acetabular fracture were as follows: farcture of contralateral pubic rami(6 ases,15.8%) contralateral iliac bone (1 case, 2.6%) and ipsilateral iliac bone (1 case, 2.6%). 8. Injuries of otherorgans adjacent to the acetabulum were as follows: rupture of the bladder (3 cases, 7.9%), urethra(2 cases, 5.3%)and uterus (1 cases, 2.6%).
Acetabulum ; Female ; Hip Joint ; Human Body ; Humans ; Male ; Rupture ; Urinary Bladder ; Uterus ; X-Ray Film