Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recently, community-associated MRSA has emerged, manifesting as skin and soft tissue infections in patients without any prior healthcare contact. Vancomycin, a glycopeptide in clinical use for more than 50 years, still remains an acceptable treatment option. However, significant concerns have been raised regarding the decreasing susceptibility of S. aureus to this agent. The growing awareness of the limitations of vancomycin has served as an impetus for development of newer agents. There has been an increase in the number of agents available to treat MRSA infections. Linezolid, daptomycin, telavancin, and ceftaroline have received regulatory approval in the last decade for the treatment of MRSA. Although these drugs do have certain differentiating attributes and may offer some advantages over vancomycin, they also have significant limitations.
Daptomycin ; Delivery of Health Care ; Humans ; Linezolid ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Skin ; Soft Tissue Infections ; Vancomycin

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of health care-associated infections. Vancomycin remains an acceptable treatment option. There has been a welcome increase in the number of agents available for the treatment of MRSA infection. These drugs have certain differentiating attributes and may offer some advantages over vancomycin, but they also have significant limitations. These agents provide some alternative when no other options are available.
Bacteremia* ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Vancomycin

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recently, community-associated MRSA has emerged, manifesting as skin and soft tissue infections in patients without any prior healthcare contact. Vancomycin, a glycopeptide in clinical use for more than 50 years, still remains an acceptable treatment option. However, significant concerns have been raised regarding the decreasing susceptibility of S. aureus to this agent. The growing awareness of the limitations of vancomycin has served as an impetus for development of newer agents. There has been an increase in the number of agents available to treat MRSA infections. Linezolid, daptomycin, telavancin, and ceftaroline have received regulatory approval in the last decade for the treatment of MRSA. Although these drugs do have certain differentiating attributes and may offer some advantages over vancomycin, they also have significant limitations.

No abstract available.
Seoul*

No abstract available.
Cross Infection* ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus*

BACKGROUND: Despite advances in microbiological diagnosis and effective antifungal treatment, invasive pulmonary aspergillosis (IPA) is a still major cause of mortality in immunocompromised patients. OBJECTIVE: The aim of this study is to analyze clinical characteristics, treatment outcome and prognostic factors for IPA. METHODS: Between May 2003 and March 2011, we retrospectively studied all patients with IPA in our facility. RESULTS: A total 37 cases were identified. Hematologic malignancies were the leading underlying disease for 27 (27/37, 73.0%) patients. Neutropenic period between the onset of neutropenia and the diagnosis of IPA was 15.0 days. The most common symptom was fever (35/37, 94.6%). The principal findings of chest computed tomography (CT) were segmental or air space consolidation (17/37, 45.9%) followed by halo sign (13/37, 35.1%), and ground-glass attenuation (11/37, 29.7%). Amphotericin B was the initial treatment for 36 (36/37, 97.3%) patients. Voriconazole was subsequently substituted for Amphotericin B in 25 (35/36, 97.2%) patients. The 30-day mortality rate was 24.3% (9/37). The 30-day mortality rate was associated with a failure to recover from neutropenia (p=0.048) or persistent fever during treatment (p=0.003). Two patients were lost to follow-up. Overall mortality was 62.9% (22/35). CONCLUSION: IPA remains a serious condition with failure to recover from neutropenia or persistent fever during treatment associated with a high 30-day mortality rate.
Amphotericin B ; Fever ; Hematologic Neoplasms ; Humans ; Invasive Pulmonary Aspergillosis ; Lost to Follow-Up ; Neutropenia ; Pyrimidines ; Retrospective Studies ; Thorax ; Treatment Outcome ; Triazoles

BACKGROUND: Currently, the incidence of hepatitis A is on the increase in Korea. Although there is emphasis on contact precautions, the nosocomial outbreak of hepatitis A virus (HAV) in healthcare personnel has increased within endemic areas because these workers inevitably come in close contact with patients and work under suboptimal hygiene conditions. In this study, we evaluated the necessity of immunization against HAV for healthcare personnel. METHODS: We investigated the seropositivity of serum immunoglobulin G (IgG) anti-HAV antibody (Ab) in 672 healthcare personnel on the basis of their age-group, sex, and occupation in Soon Chun Hyang University Hospital and Soon Chun Hyang University Bucheon Hospital. RESULTS: The subjects were divided into 6 groups on the basis of their ages to identify differences among the various age groups in the number of cases with HAV Ab seropositivity. Significant intergroup differences were noted in this respect: 21-25 years, 2/152 (1.3%); 26-30 years, 33/245 (13.5%); 31-35 years, 70/148 (47.3%); 36-40 years, 52/79 (65.8%); >40 years, 44/48 (91.7%). CONCLUSION: The number of seropositive cases was low among young healthy personnel: low seropositivity is an emerging risk for vulnerable population. With the increase in the incidence of hepatitis A, healthcare personnel have become a risk population for hepatitis A, as are community residents. Therefore, for healthcare personnel working in hospitals, immunization against HAV should be recommended for personnel younger than 30 years, and serological testing for older personnel.
Delivery of Health Care ; Hepatitis ; Hepatitis A ; Hepatitis A Antibodies ; Hepatitis A Vaccines ; Hepatitis A virus ; Humans ; Hygiene ; Immunization ; Immunoglobulin G ; Incidence ; Korea ; Occupations ; Serologic Tests ; Vulnerable Populations

BACKGROUND: Patients with prolonged empirical broad spectrum antibiotics for febrile neutropenia (FN) with cancer, inevitably have increased risk of invasive fungal infections owing to the altered endogenous microbial environment. OBJECTIVE: The purpose of this study is to evaluate the impact of empirical antifungal therapy on occurrence of invasive fungal infections (IFIs) during FN with cancer. METHODS: We retrospectively reviewed medical records of patients with FN after cytotoxic chemotherapy due to cancer from July, 2003 to June, 2007. RESULTS: We identified 91 patients with FN after cytotoxic chemotherapy. Most common underlying conditions were lymphoma (20/91, 22%) and leukemia (20/91, 22%). IFIs occurred in 10% (9/91). In a comparison of patients with empirical antifungal therapy with no antifungal therapy, the duration of neutropenia was significantly increased with IFIs (p=0.09). The mortality of IFIs was 55.5% (5/9). CONCLUSION: We found that the duration of FN than empirical antifungal therapy affected occurrence of IFIs.
Anti-Bacterial Agents ; Antifungal Agents ; Humans ; Leukemia ; Lymphoma ; Medical Records ; Neutropenia ; Retrospective Studies

BACKGROUND: Infections are the second leading cause of morbidity and mortality in hemodialysis patients. Vascular access is a major risk factor for infection-related hospitalization and mortality. This study aimed to characterize the presenting features and outcome of vascular access infection in hemodialysis patients. MATERIALS AND METHODS: Between May 2003 and March 2010, 224 patients admitted to a 750 bed tertiary care hospital for treatment of vascular access infection were retrospectively analyzed. Vascular access infections were defined by local infection signs (pus or redness) at the vascular access site or by a positive blood culture with no known source other than the vascular access. RESULTS: Of the 224 patients, 179 (79.7%) had an arteriovenous (AV) graft, 28 (12.5%) had a tunneled cuffed catheter, 12 (5.4%) had AV fistulas, and five (2.2%) had a temporary central catheter. The mean+/-SD time between the creation of each type of vascular access and onset of infection were as follows: temporary central catheter 46.6+/-36.9 days, tunneled cuffed catheter 180.3+/-168.8 days, AV fistulas 928.6+/-1,299.7 days, and AV graft 1,066.3+/-1321.1 days (P value=0.006). The most common causative organism was Staphylococcus aureus (62.5%; methicillin-susceptible 35.2%, methicillin-resistant 27.3%) followed by coagulase negative staphylococci (17.0%) and gram negative bacilli (15.9%). The involved vascular accesses in infected cases were: temporary central catheter (4/5, 80%), tunneled cuffed catheter (13/27, 48%), AV graft (68/179, 38%) and AV fistulas (4/12, 33%). The complications of vascular access infection included septic pulmonary embolism (n=9, 4%), pneumonia (n=9, 4%), endocarditis (n=6, 2.7%), osteomyelitis (n=3, 1.3%) and abdominal abscess (n=2, 0.9%). A multivariable analysis showed that Staphylococcus aureus was a risk factor of septic pulmonary embolism and osteomyelitis. The all-cause mortality was 8.4%, 30-day mortality was 2.2% and infection-related mortality was 5.4%. CONCLUSIONS: Staphylococcus was responsible for 79.5% of infections, with methicillin-susceptible S. aureus being the most commonly implicated strain. Temporary accesses have the potential to become infected earlier. Septic pulmonary embolism and pneumonia were common complications. Efforts should be focused on prevention and early detection of VA infection with pulmonary complications.
Abdominal Abscess ; Catheter-Related Infections ; Catheters ; Coagulase ; Endocarditis ; Fistula ; Hospitalization ; Humans ; Methicillin Resistance ; Osteomyelitis ; Pneumonia ; Pulmonary Embolism ; Renal Dialysis ; Retrospective Studies ; Risk Factors ; Sprains and Strains ; Staphylococcus ; Staphylococcus aureus ; Tertiary Healthcare ; Transplants

Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures. It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis, and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge, this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.
Biopsy ; Ceftazidime ; Cephalosporins ; Debridement ; Diagnosis, Differential ; Fasciitis ; Fasciitis, Necrotizing ; Hydrazines ; Korea ; Osteitis ; Osteomyelitis ; Parturition ; Pregnancy ; Pseudomonas aeruginosa ; Pubic Symphysis ; Sports