BACKGROUND: A rapid and sensitive surveillance culture has a pivotal role in infection control of methicillinresistant Staphylococcus aureus (MRSA). This study was aimed to compare the performance of MRSASelect (Bio-Rad, France) to that of mannitol salt agar containing 6 microgram/mL of oxacillin (MSA-OX) for detecting MRSA in surveillance cultures. METHOD: From May to June 2006, 86 nasal swabs and 21 sputum specimens were enrolled. All specimens were inoculated onto MRSASelect and MSA-OX, which were incubated for 2 days and 3 days, respectively, and colonies were read daily by a technologist. Pink colonies on MRSASelect and yellow colonies on MSA-OX were examined with Gram stain, Pastorex(R) Staph-plus (Bio-Rad) and mecA-PCR. After the final reading, both media were re-examined by a superviser. RESULTS: Of the 107 specimens cultured, 32 (29.9%) were positive for MRSA. Of these, 27 were detected by both media, one by MSA-OX only, and 4 by re-examination. The day-1 and day-2 sensitivities/specificities of MRSASelect were 78.1%/97.3% and 84.4%/97.3%, respectively, while those of MSA-OX were 53.1%/100% and 78.1%/92.1%, respectively. With MRSASelect, two more positives were detected at day 2, but their incubation was less than 18 hour at day 1. There were six false positive organisms detected: three Enterobacter spp., one Acinectobacter spp., and two coagulase-negative staphylococci (CNS). But, the two CNS grew on MSA-OX only. CONCLUSION: MRSASelect with 1-day incubation showed a sensitivity equivalent to and a specificity better than MSA-OX with 2-day incubation. MRSASelect should be a useful medium for MRSA surveillance when it is read after an incubation of 18-28 hours with the confirmatory Gram stain of screen-positives.
Agar ; Enterobacter ; Infection Control ; Mannitol ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Oxacillin ; Sensitivity and Specificity ; Sputum ; Staphylococcus aureus

BACKGROUND: Procedures for rapid identification and susceptibility testing by direct inoculation (DI) from positive blood culture bottles into an automated system have not been standardized. This study was purposed to evaluate DI from BACTEC 9240 blood culture system (BD, USA) into MicroScan (Dade Behring, USA) or Phoenix (BD, USA). METHODS: From May to June 2006, bacterial pellets from positive aerobic bottles showing gram-positive cocci (GPC) or gram-negative rods (GNR) of single morphology were directly inoculated to MicroScan PosCombo1A and NegCombo32 and to Phoenix PMIC/ID-107 and NMIC/ID-53. In addition, the automated instruments were also inoculated from subcultures (standard inoculations, SI). Species identification and susceptibilities were compared between DI and SI and between MicroScan and Phoenix. RESULTS: A total of 108, 104, and 78 specimens were tested with MicroScan, Phoenix, and both, respectively. When DI and SI were matched, 94.8% of GPC were correctly identified with MicroScan, compared to 80.7% with Phoenix, and 93.9% of GNR were correctly identified with MicroScan, compared to 95.7% with Phoenix. DI with MicroScan and Phoenix showed correct susceptibilities in 94.6% of 1,150 and 96.5% of 660 tests (with very major error [VME] of 1.1% and 1.1%), respectively, among GPC and in 94.4% of 942 and 96.3% of 781 tests (with VME of 0.6% and 0%), respectively, of GNR. Correlation of identification/susceptibilities between MicroScan and Phoenix using DI were 81.8%/98.0% for Staphylococcus aureus and 100.0%/95.6% for Escherichia coli. CONCLUSIONS: DI warrants a reliable method for identification and susceptibility testing of both GPC and GNR in MicroScan, and those of only GNR in Phoenix.
Automation ; Bacterial Typing Techniques/instrumentation/*methods ; Culture Media ; Gram-Negative Bacteria/*classification/drug effects/isolation & purification ; Gram-Negative Bacterial Infections/blood/*microbiology ; Gram-Positive Bacterial Infections/blood/*microbiology ; Gram-Positive Cocci/*classification/drug effects/isolation & purification ; Humans ; Microbial Sensitivity Tests/instrumentation/*methods ; Reagent Kits, Diagnostic ; Sensitivity and Specificity

Radiation recall phenomenon is an inflammatory reaction which occurs at a previously irradiated area after the administration of causative agents, especially anticancer drugs. Radiation recall mostly involves skin and rarely affects internal organs. We, hereby, report a rare case of radiation recall myositis. A 51-years-old man visited the hospital due to pain and weakness of the left thigh. He had been diagnosed with a skin metastasis of pancreatic adenocarcinoma, at the left thigh and treated with radiotherapy and subsequent combination chemotherapy of 5-FU and cisplatin. After the 5th cycle of chemotherapy, the patient developed pain and weakness localized at the previous radiation field. An MRI revealed myositis of left gluteus medius muscle. Muscle biopsy showed no malignant cells or signs of infection. He was diagnosed as having radiation recall myositis and treated with steroid and NSAID. Soon after, pain and weakness gradually improved. Although rare, a possibility of radiation recall myositis should be considered when a patient with history of radiotherapy has a myopathy.
Adenocarcinoma ; Biopsy ; Cisplatin ; Drug Therapy, Combination ; Fluorouracil ; Humans ; Muscles ; Muscular Diseases ; Myositis ; Neoplasm Metastasis ; Skin ; Thigh

OBJECTIVE: This study was conducted to evaluate the relationship between job stress and quality of life for hospital workers by type of employment. METHODS: Data were obtained for 361 workers in a large hospital 172 of whom were categorized as typical workers defined by permanent employee and 189 of whom were categorized as atypical workers defined by fixed-term contraction. Job stress was assessed using the Korean Occupational Stress Scale-Short Form and the World Health Organization Quality of Life-BREF Questionnaire RESULTS: Atypical workers had significantly higher scores for job-related stress in the domains of insufficient control, over work, job insecurity, and lack of reward in the workplace compared with typical workers, who had higher scores for stress in the domains of job demands and occupational climate. Test scores also indicated that typical workers had a significantly better quality of life than atypical workers, especially in terms of mental health, social relationships and environment. CONCLUSION: These findings suggested that factors contributing to job-related stress were different between typical and atypical hospital and typical workers are likely to have a better quality of life.
Climate ; Contracts ; Employment ; Mental Health ; Quality of Life ; Reward ; World Health Organization

BACKGROUND/AIMS: The individual course of Crohn's disease is diverse, and some patients may require bowel resection. The aims of this study were to determine the early surgery rate of Crohn's disease and to identify risk factors associated with early surgery in Korea. METHODS: Ninety six patients with Crohn's disease (68 men; median age at the time of diagnosis: 25 years), who had been followed up more than a year, were retrospectively analyzed. Early surgery was defined as a bowel operation for Crohn's disease or its complications occurring within 3 years from diagnosis. Early surgery rate and risk factors for early surgery were identified. RESULTS: Fifteen patients (15.6%) underwent early surgery. The cumulative surgery rate was 8.6% after 6 months, 11.9% after 12 months, 14.1% after 18 months, and 16.7% after 24 to 36 months. Multivariate analysis revealed penetrating or stricturing behavior to be an independent risk factor for early surgery (p<0.001, Exp (B)=2.97 CI 1.39-6.37). CONCLUSIONS: The cumulative early surgery rate in Korean patients seems to be lower than Western patients. Penetrating or stricturing behavior is significantly associated with early surgery, requiring early aggressive medical treatments.
Adolescent ; Adult ; Aged ; Constriction, Pathologic ; Crohn Disease/*surgery ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Sex Factors ; Time Factors

Pericardial effusions can be developed by any form of pericarditis; infective pericarditis such as viral or bacterial infection and non-infective, inflammatory pericarditis related with generalized disease such as end-stage renal disease or connective tissue disease and irradiation, postpericardiectomy syndrome, drugs and non-inflammatory pericarditis by malignancy, hypothyroidism, trauma on chest. In children, pericardial effusions are usually related with viral infection, generalized disease or cardiac surgery. We experienced three unusual cases of pericadial effusion by Mycoplasma pneumonia infection, Rickettsia tsutsugamushi infection and post-thoracotomy effusive constrictive pericarditis.
Bacterial Infections ; Child ; Connective Tissue Diseases ; Humans ; Hypothyroidism ; Kidney Failure, Chronic ; Pericardial Effusion ; Pericarditis ; Pericarditis, Constrictive ; Pneumonia, Mycoplasma ; Rickettsia Infections ; Thoracic Surgery ; Thorax

There are many variant forms in Turner's syndrome which is characterized by female phenotype, short height, primary amenorrhea, infertility, abnormal secondary sexual development, and mental retardation. Among these 45,XO/46,XX/47,XXX form is known as rare variant of Turner's syndrome. 45,XO/46,XX/47,XXX mosaicism is characterized by normal height, possibility of normal sexual development, menstrual/pregnancy history and normal intelligence. We report a cse of 45,XO/46,XX/47,XXX Turner's syndrome associated with primary amenorrhea in 17-year old Korean female.
Adolescent ; Amenorrhea* ; Female ; Humans ; Infertility ; Intellectual Disability ; Intelligence ; Mosaicism* ; Phenotype ; Sexual Development ; Turner Syndrome

PURPOSE: To investigate the association between necrotizing enterocolitis (NEC) and red blood cell transfusions in very low birth weight (VLBW) preterm infants. METHODS: We studied were 180 VLBW preterm infants who were admitted to the neonatal intensive care unit of CHA Gangnam Hospital from January of 2006 to December of 2009. The subjects were divided into 2 groups: an NEC group (greater than stage II on the modified Bell's criteria) and a control group (less than stage II on the modified Bell's critieria). We defined red blood cell transfusion before NEC diagnosis as the frequency of transfusion until NEC diagnosis (mean day at NEC diagnosis, day 18) in the NEC group and the frequency of transfusion until 18 days after birth in the control group. RESULTS: Of the 180 subjects, 18 (10%) belonged to the NEC group, and 14 (78%) of these 18 patients had a history of transfusion before NEC diagnosis. The NEC group received 3.1+/-2.9 transfusions, and the control group received 1.0+/-1.1 transfusions before the NEC diagnosis (P=0.005). In a multivariate logistic regression corrected for gestational age, Apgar score at 1 minute, the presence of respiratory distress syndrome, patent ductus arteriosus, premature rupture of membrane, disseminated intravascular coagulopathy and death were confounding factors. The risk of NEC increased 1.63 times (95% confidence interval, 1.145 to 2.305; P=0.007) with transfusion before the NEC diagnosis. CONCLUSION: The risk for NEC increased significantly with increased transfusion frequency before the NEC diagnosis.
Apgar Score ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Erythrocyte Transfusion ; Erythrocytes ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care, Neonatal ; Logistic Models ; Membranes ; Parturition ; Rupture

Behcet's disease (BD) is a rare, multisystemic disorder characterized by vasculitis. Although renal involvement rarely coexists with BD, several types of renal involvements have been reported: amyloidosis, glomerulonephritis and vascular involvement. Herein, we report a rare case of BD complicated with IgA nephropathy (IgAN). A 42-year-old woman visited the hospital due to joint pains and painful subcutaneous nodules. Based on her medical history of recurrent orogenital ulcers, arthritis, enteral ulcers, erythema nodosum-like skin lesions, and a positive pathergy test, we diagnosed her with BD. To evaluate proteinuria, we performed a renal biopsy. The patient was diagnosed with BD complicated with IgAN, and treated with a low dosage of steroid, colchicine, as well as angiotensin II type I receptor blockers. Although renal involvement in BD is rare, it is important to periodically perform renal function assessments in patients with BD involving abnormal urine results.
Adult ; Angiotensin II Type 1 Receptor Blockers ; Arthralgia ; Arthritis ; Biopsy ; Colchicine ; Erythema Nodosum ; Female ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Immunoglobulin A ; Proteinuria ; Skin ; Ulcer ; Vasculitis

BACKGROUND: We evaluated the BD Phoenix Automated Microbiology System (Phoenix) for its ability to detect methicillin resistant Staphylococcus aureus (MRSA) and compared the results to those obtained by the Clinical and Laboratory Standards Institute (CLSI) agar dilution method, a mecA gene PCR method, and the MicroScan WalkAway 96 System (MicroScan). METHODS: One hundred seventy S. aureus strains (Group I) isolated from blood and urine cultures were collected from eight university hospitals and 58 strains (Group II) including 20 blood isolates among Group I and 38 isolates from skin lesions of atopic patients were collected from Asan Medical Center. All 208 isolates were tested with Phoenix using PMIC/ID-53 panels, and the tests were repeated when the results were indeterminate. The results by Phoenix were compared to the susceptibility results obtained by reference methods: the CLSI method for oxacillin MIC for Group I strains, and a PCR assay method for detection of the mecA gene and MicroScan tests for oxacillin susceptibility for Group II strains. RESULTS: One hundred strains (58.8%) in Group I were MRSA and 28 strains (48.3%) were mecA positive in Group II. Compared to the CLSI method, Phoenix showed the sensitivity and specificity of 100% and MIC agreement of 99.4% for Group I strains. The level of agreement between Phoenix and MicroScan for oxacillin MIC and their interpretation were 98.3% and 100%, respectively, for Group II strains. Both MicroScan and Phenix failed to detect one mecA-positive strain: its MIC was shown as 2 microgram/mL twice by MicroScan and 2 microgram/mL twice and > 2 microgram/mL once by Phoenix. The frequency of the indeterminate results was 5.5% and the mean time to completion of the tests was 12.8 (10.2-16) hours in Phoenix. CONCLUSION: Phoenix showed a high level of sensitivity and specificity for the detection of MRSA with an excellent correlation with MicroScan. Further evaluation is required for detection of heterogeneous MRSA.
Agar ; Chungcheongnam-do ; Hospitals, University ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Skin ; Staphylococcus aureus* ; Staphylococcus*