BACKGROUND: The aim of this study was to evaluate the sensitivity of a clinicians' self-report method for the detection of nosocomial infections (NIs) in comparison with a total surveillance method in a neonatal intensive care unit (NICU). METHODS: Two surveillance methods were concurrently performed in the NICU of a university hospital during 5 months in 2003. Clinicians' self-report surveillance (CSRS) was based on the retrospective verification of monthly reports of positive bacteriologic results by NICU clinicians. Total surveillance (TS) was done prospectively by an infection control nurse based on chart review and laboratory data. RESULTS: One hundred fifty nine patients accounting to 2759 patient-days were included in the study. Twenty-seven NIs among 26 patients were identified by TS. The sensitivity of CSRS compared to TS was 14.8% (4 of 27 NIs). The specificity was 98.5% (131 of 133 non-NIs). Kappa measures of agreement were -0.309. CONCLUSIONS: Our results confirm that the retrospective review of charts and laboratory data by clinicians lacks sensitivity and agreement for the surveillance of nosocomial infections.
Cross Infection* ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal* ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND/AIMS: The purpose of this study was to evaluate the value of initial C-reactive protein (CRP) as a predictor of clinical outcome and to investigate whether follow-up CRP measurement is useful for the prediction of the clinical outcome of bloodstream infections in patients with liver cirrhosis (LC), whose CRP production in response to infection may be attenuated. METHODS: A retrospective, observational study including 202 LC patients with Escherichia coli or Klebsiella pneumoniae bacteremia was conducted to assess the usefulness of serial CRP measurements in predicting clinical outcome in LC patients. The CRP ratio was defined as the ratio of the follow-up CRP level to the initial CRP level. RESULTS: The overall 30-day mortality rate of the study population was 23.8% (48/202). In the multivariate analysis, advanced age (> or = 70 years), healthcare-associated or nosocomial infections, model for end-stage liver disease (MELD) score of > or = 30, and initial body temperature of < 37degrees C were significant factors associated with mortality (all p < 0.05). No association between initial CRP level and mortality was found. In a further analysis including 87 evaluable cases who had repeated CRP measurements at day 4 and/or 5, a CRP ratio of > or = 0.7 was found to be a significant factor associated with mortality (odds ratio, 19.12; 95% confidence interval, 1.32 to 276.86; p = 0.043) after adjusting for other confounding variables. CONCLUSIONS: Initial CRP level did not predict mortality of sepsis in LC patients. However, serial CRP measurements during the first week of antimicrobial therapy may be useful as a prognostic factor for mortality in LC patients.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Infective Agents/therapeutic use ; Bacteremia/drug therapy/*immunology/microbiology/mortality ; Biological Markers/blood ; C-Reactive Protein/*metabolism ; Chi-Square Distribution ; Escherichia coli Infections/drug therapy/*immunology/microbiology/mortality ; Female ; Humans ; Klebsiella Infections/drug therapy/*immunology/microbiology/mortality ; Klebsiella pneumoniae/*isolation & purification ; Liver Cirrhosis/complications/*immunology/mortality ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Predictive Value of Tests ; Republic of Korea ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND: Although heart transplantation is the only therapeutic modality for patients with end-stage heart disease, immunosuppressive therapy to reduce organ rejection may increase the risk of infection in transplant patients. Little is known regarding infectious complications in heart transplant recipients in Korea. Thus, this study was performed to evaluate the clinical features and outcome of infectious complications in patients receiving heart transplantation. MATERIALS AND METHODS: A retrospective cohort study was performed by reviewing medical records of patients who underwent heart transplantation from December 1996 to October 2008 in Samsung Medical Center, Seoul, Korea. RESULTS: A total of 72 cardiac allograft recipients were included in the analysis. Median follow-up duration was 417 (range, 2-3995) days. During the follow-up period, 75 infectious complications occurred in 39 (54.2%) recipients, of which 31 cases (41.3%) were caused by bacteria, 28 (37.3%) by viruses, 10 (13.3%) by fungi, 4 (5.4%) by Pneumocystis jirovecii, and 2 (2.7%) by Mycobacterium tuberculosis. Median onset time of bacterial, viral and fungal infection were 153, 106 and 68 days, respectively. The most common site of infection was lung (n=26, 34.7%), followed by gastrointestinal tract (n=11, 14.7%) and oral cavity (n=9, 12%). All patients were sero-positive for cytomegalovirus (CMV)-specific IgG before transplantation and received preemptive therapy of CMV infection. After heart transplantation, 44 (63.8%) patients experienced CMV reactivation identified by CMV antigenemia and 9 (13%) patients had organ-specific CMV diseases. The overall mortality rate was 33.3% (24/72). Infectious complications were the most common cause of death (n=10, 41.7%). The operative risk factors for death were lung infection, fungal infection and bloodstream infection. CONCLUSIONS: In the current study, the lung was the most common site of infection and bacteria were the most frequent etiologic pathogens among heart transplant recipients. Infectious complications, especially fungal infections were the most common causes of death. Prevention strategies against fungal infections should be evaluated in the future studies.
Bacteria ; Cause of Death ; Cohort Studies ; Cytomegalovirus ; Follow-Up Studies ; Fungi ; Gastrointestinal Tract ; Heart ; Heart Diseases ; Heart Transplantation ; Humans ; Immunoglobulin G ; Korea ; Lung ; Medical Records ; Mouth ; Mycobacterium tuberculosis ; Pneumocystis jirovecii ; Rejection (Psychology) ; Retrospective Studies ; Risk Factors ; Transplantation, Homologous ; Transplants

Backgound: The aim of this study was to compare the levels of perception of and compliance with handwashing between the groups of direct patient contact and indirect contact in a tertiary-care university hospital. METHODS: A cross-sectional study was conducted in a university hospital with 4,500 employees. A questionnaire, containing questions on demographic data and the perception of and compliance with handwashing, was distributed to and collected from a total of 1,087 employees from June 25 to July 10, 2005. RESULTS: The study subjects washed their hands an average of 11.2 times (range, 1-100) per day: nurses washed their hands more frequently than others. The average duration of handwashing by employees was 18.8 seconds. Those in the direct patient contact group scored significantly higher points than did those in the indirect contact group in both perception (P<.021) of and compliance (P<.001) with handwashing. CONCLUSION: Education for handwashing is needed direction employees who have indirect contact with patients to improve their compliance with handwashing.
Compliance* ; Cross-Sectional Studies ; Education ; Hand ; Hand Disinfection* ; Humans ; Surveys and Questionnaires

This paper is presented to report the results of urinary quantitative culture and sensitivity tests of certain antibiotics. Studies were done on 331 cases from the Department of Urology. Woo Sok University Medical College Hospital during the period from May 1962 up to September 1970. 1) Urine specimens from 331 cases were cultured and, of these, 115 cases grew micro-organism while the remaining 216 cases showed no growth. Among the 115 cases, 84 cases(73%) revealed significant bacteriuria with counts over 10s/ml. colonies in urine while 31 cases(27%) were below 10(5)/ml. 2) Only 74 cases(88. 1%) among the 84 cases with significant bacteriuria could the bacteria be identified after centrifuging the specimens and doing a smear and Gram stain. 68 cases(81%) of the total 84 significant bacteriuria cases had shown urinary leukocyte count of more than 4/HPF while 16 cases(19%) were below 4/HPF. 3) 77 cases(92%) of the total 84 cases with significant bacteriuria had Gram negative bacilli while 4 cases had Gram positive cocci by direct smear. 4) There were no significant differences between male and female patients in colony counts except the female group revealed some preponderance of E. coli. 5) In the sensitivity testing if the cultured significant bacteriuria in the group with Gram negative bacilli, 36 cases(49.3%) were sensitive to Kanamycin and 22 cases(30.1%) were resistant, while all cases were resistant to leucomycin and only one case was sensitive to penicillin among the total 73 cases of Gram negative bacilli cultured.
Anti-Bacterial Agents ; Bacteria ; Bacteriuria ; Female ; Gram-Positive Cocci ; Humans ; Kanamycin ; Kitasamycin ; Leukocyte Count ; Male ; Penicillins ; Urology

OBJECTIVES: In the present study, we aimed to develop an oral examination smart chart application for tablet personal computers (PC). We evaluated the time required to perform an oral examination and assessed the degree of user's convenience by using this application. We determined to make our application cost and human resource effective by automatically computerizing the statistics to facilitate its application in oral health services such as national oral health research. The development of this application for tablet PCs was aimed at recording the results of oral examinations. METHODS: We produced flow charts and designed the program screen, which would replace the existing paper chart. To evaluate the efficiency of the application, 1 preventive dentistry professor and 6 dentistry students performed an oral examination on 41 subjects. We performed the oral examination in duplicate using a tablet PC and a paper chart. The data collected were analyzed using the SPSS 18.0 program. P-values less than 0.05 were considered statistically significant. RESULTS: The time required for oral examination by the study group (the group using the application) and the control group (the group using paper) were 131.93+/-10.14 and 151.85+/-7.77, respectively; the difference between these values was statistically significant (P-value=0.002). The oral examination could be performed faster in the study group (the group using the application) than in the control group; therefore, we noted that the time taken for oral examination was reduced by using the application. CONCLUSIONS: The tablet-based system has been shown to save time by omitting the step of entering the paper chart data into a computer. Further, the findings of this study can be used to establish an oral health index database with the help of additional resources. Moreover, it would facilitate creating awareness among the patients with regard to their oral health indices through the use of visual aids.
Audiovisual Aids ; Dentistry ; Diagnosis, Oral ; Humans ; Microcomputers ; Oral Health ; Preventive Dentistry

OBJECTIVES: This study assessed the antifungal effects of neutral electrolysis hydrogen water, an agent known for its oral anti-bacterial effects on the growth of C. albicans in vitro.METHODS: Hydrogen water, denture cleansing agent, and Listerine® were compared to a tap water control. We serially cultured C. albicans KCTC 27239 in SD media to analyze the inhibitory effect of each treatment on growth. We evaluated the data using repeated-measures ANOVA test and one-way ANOVA test, and a significant difference was defined as P < 0.05.RESULTS: Hydrogen water significantly inhibited the growth, but not the biofilm formation, of C. albicans compared to tap water control at 1-, 5-, and 10-minute time points (P < 0.05).CONCLUSIONS: The growth of C. albicans was slower in hydrogen water than in tap water, thereby suggesting an inhibitory effect of hydrogen water. Hydrogen water may, therefore, be utilized as an antibacterial and preventive agent without any harmful effect on denture and oral tissues.
Biofilms ; Candida albicans ; Candida ; Dentures ; Detergents ; Electrolysis ; Hydrogen ; In Vitro Techniques ; Water

OBJECTIVES: Rheumatoid arthritis (RA) has been associated with systemic diseases, such as periodontal diseases. Periodontal diseases and RA appear to share many pathologic features. The etiology of the two diseases may differ, but they share similar pathological characteristics. Therefore, the aim of this study was to evaluate the correlation between RA and periodontal diseases. METHODS: Data from the Fifth Korea National Health and Nutrition Examination Survey (KNHNES) were used to analyze periodontal status according to the presence of RA. Demographics and oral behaviors were analyzed using the complex chi-square test to compare participants with RA with those without RA. Complex logistic regression was used to analyze relationships of periodontal diseases with RA and other covariates. RESULTS: The odds ratio for periodontal diseases was 1.91 (95% confidence interval: 1.05-3.48) in participants with RA compared with participants without RA. CONCLUSIONS: The results of this study provide evidence of a significant association between periodontal diseases and RA.
Arthritis, Rheumatoid* ; Demography ; Korea ; Logistic Models ; Nutrition Surveys* ; Odds Ratio ; Periodontal Diseases*

BACKGROUND/AIMS: We evaluated the clinical features of ciprofloxacin-resistant Proteus mirabilis bacteremia and risk factors for ciprofloxacin resistance. METHODS: From October 2000 to July 2009, 37 patients with clinically significant P. mirabilis bacteremia were identified and data from patients with ciprofloxacin-resistant and ciprofloxacin-susceptible P. mirabilis bacteremia were compared. RESULTS: The most common underlying diseases were neurologic disease (37.8%) and solid tumors (29.7%). The most common site of infection was the urinary tract (35.1%). Ten of the 37 patients (27.0%) were infected with ciprofloxacin-resistant isolates, and univariate analysis revealed a significant relationship between ciprofloxacin-resistant P. mirabilis bacteremia and neurologic disease, recent operation, L-tube insertion, percutaneous tube use, and extended-spectrum beta-lactamase (ESBL) production (all p < 0.05). ESBL was detected in six of 10 (60%) ciprofloxacin-resistant isolates, while only three of 27 (11%) ciprofloxacin-susceptible isolates produced ESBL (p = 0.005). In a logistic regression analysis, ESBL production remained a significant factor associated with ciprofloxacin resistance, after adjusting for other variables. CONCLUSIONS: These data indicate a close association between ciprofloxacin resistance and ESBL-production in P. mirabilis bacteremia. This association is particularly troublesome because the therapeutic options for serious infections caused by ESBL-producing P. mirabilis are severely restricted.
Adult ; Aged ; Anti-Infective Agents/*pharmacology ; Bacteremia/*drug therapy ; Ciprofloxacin/*pharmacology ; Drug Resistance, Bacterial ; Female ; Humans ; Male ; Middle Aged ; Proteus Infections/*drug therapy ; Proteus mirabilis/*drug effects/enzymology ; Risk Factors ; beta-Lactamases/*biosynthesis

Chronic active Epstein-Barr virus (CAEBV) infection is characterized by persistent infectious mononucleosis-like symptoms, an unusual pattern of Epstein-Barr virus (EBV) antibodies, detection of the EBV genome in affected tissues or peripheral blood, and chronic illness that cannot be attributed to any other known disease. This is the first reported Korean case of an immunocompetent adult with CAEBV-associated interstitial pneumonitis. A 28-year-old female was admitted with a fever that persisted for 3 weeks. She had multiple lymphadenopathy, hepatosplenomegaly, pancytopenia, and elevated serum aminotransferase levels. Serology for antibodies was positive and chest computed tomography showed diffuse ground glass opacities in both lungs. Histopathology of the lung tissue showed lymphocyte infiltration, and EBV DNA was detected in those lymphocytes using in situ hybridization with an EBV-encoded RNA probe. After 1 month of hospitalization, she improved without specific treatment.
Adult ; Chronic Disease ; Epstein-Barr Virus Infections/complications/*pathology/radiography ; Female ; *Herpesvirus 4, Human ; Humans ; Immunocompetence ; Lung Diseases/etiology/pathology ; Lung Diseases, Interstitial/etiology/*pathology/radiography