Clostridium difficile-associated diarrhea (CDAD) is common among hospital-acquired bacterial diarrhea, its mortality and morbidity show an increasing trend in recent years. Improper antimicrobial drug use is one of the key reasons. Adequate hand hygiene of healthcare workers, thorough disinfection of hospital environment, and appropriate isolation of patients are effective measures to prevent the outbreak of hospital-aquired CDAD.
Clostridium difficile ; physiology ; Cross Infection ; microbiology ; mortality ; prevention & control ; Diarrhea ; microbiology ; mortality ; prevention & control ; Enterocolitis, Pseudomembranous ; microbiology ; mortality ; prevention & control ; Humans ; Infection Control

PURPOSE: Despite advances in infection control practices, Surgical Site Infections (SSIs) remain a substantial cause of morbidity and mortality among hospitalized patients. This study was undertaken to determine prospectively the incidence of postoperative wound infections in surgical patients and to identify the risk factors associated with the development of wound infections. METHODS: Prospective data on 761 surgical operation patients in the department of surgery at Ewha Womans University Mokdong Hospital were collected over a 7 month-period from May 1, to December 31, 2001. The Centers for Disease Control and Prevention (CDC)'s definitions of surgical wound infections were used. RESULTS: A total of 761 patients were observed over 30 days. The overall incidence of wound infection was 2%. SSIs were significantly associated with the degree of wound contamination (P=0.0004). The infection rate increased as the degree of wound contamination increased from clean (1.4%) through clean-contaminated (1.8%) and contaminated (1.8%), to dirty- infected wound (12.7%). The infection rate was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.00153). There were no SSIs from laparoscopic surgery. The duration of operation was not associated with an increase in wound infections. Enterococcus faecium and Staphylococcus aureus were the most frequently isolated organisms. Three out of the five (60%) cases of E. faecium were vancomycin-resistant enterococci (VRE) and all of three cases of S. aureus were methicillin- resistant Staphylococcus aureus (MRSA). CONCLUSION: This study confirms that the degree of wound contamination is a significant preoperative risk factor for SSI. Many antibiotic-resistant bacteria such as MRSA and VRE were isolated. Accordingly, infection control practitioners need to consider this risk factor in the design of effective infection control strategies. There should be another safe and feasible option available for the treatment of selective patients.
Bacteria ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Enterococcus faecium ; Female ; Humans ; Incidence ; Infection Control ; Infection Control Practitioners ; Laparoscopy ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Prospective Studies* ; Risk Factors ; Staphylococcus aureus ; Surgical Wound Infection* ; Wound Infection ; Wounds and Injuries

During the second half of the 19th century many operations were developed after anesthesia was introduced but advances were limited for many years because of the high rate of infection and the high mortality rate that followed infections. After the introduction of the principle of antisepsis, postoperative infectious morbidity decreased substantially. With the introduction of antibiotic therapy in the middle of the 20th century, a new adjunctive method to treat and prevent surgical infections was discovered. However, not only have postoperative wound and hospital required infections continued, but widespread antibiotic therapy has often made prevention and control of surgical infections more difficult. Based on National Nosocomial Infection Surveillance (NNIS) system reports, SSIs (Surgical Site Infections) are the third most common nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients. It is also a significant source of postoperative morbidity, resulting in increased hospital length of stay and increased cost. Determination of risk factors for the development of SSI has been a major focus of surgical research. To reduce the rate of SSIs we have to eliminate risk factors of SSIs and keep a continuous surveillance with feedback of information to surgeons and other relevant staff. A successful SSI surveillance program includes standardized definition of infection, effective surveillance method, and stratification of the SSIs rates according to risk factors. Because SSIs may be the most preventable of nosocomial infections, health care facilities should make special efforts to reduce the risk of development of these surgical complications. The evaluation of infection control programs and the development of more effective infection control strategies should be established and surgeons should be more concern about SSI control.
Anesthesia ; Antisepsis ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Length of Stay ; Mortality ; Risk Factors ; Wounds and Injuries

Puerperal sepsis is one of the leading causes of maternal morbidity and mortality worldwide. Postpartum pelvic infections can cause various complications, including wound infections and necrotizing fasciitis. Several microorganisms are known to cause such infections; however, no study has reported on Staphylococcus caprae, a coagulase-negative staphylococcus that is isolated frequently from animals and infrequently from human specimens, as a causative agent. Here, we report a rare case of septic shock complicated by necrotizing fasciitis after a cesarean section. This is the first report of a human isolate of S. caprae in association with puerperal sepsis and necrotizing fasciitis.
Animals ; Cesarean Section ; Escherichia coli ; Escherichia ; Fasciitis, Necrotizing ; Female ; Goats ; Humans ; Mortality ; Pelvic Infection ; Postpartum Period ; Pregnancy ; Puerperal Infection ; Sepsis ; Shock, Septic ; Staphylococcus ; Wound Infection

BACKGROUND: Lymphocytopenia is a common finding in critically ill patients while lymphocyte depletion in critically ill patients is presumed to have little clinical significance. However, a total lymphocyte count has been reported to provide prognostic information in surgical patients. The aim of this study was to evaluate the association of a total lymphocyte count (TLC) with a prognostic criterion in critically ill patients. METHODS: The patients were divided into three groups according to their TLC on admission to intensive care unit (ICU) (Group 1: TLC > 1.0 x 10(9)/L, Group 2: 0.7 x 10(9)/L < TLC < 1.0 x 10(9)/L, and Group 3: TLC <0.7 x 10(9)/L). Outcomes examined were patients' in-hospital mortality, length of hospital stay and incidence of infection. RESULTS: Patients with a TLC less than 0.7 x 10(9)/L (Group 3) had an infection twice (32% VS 15%) as often as those with a TLC more than 0.7 109/L (Group 1 2). But, in the hospital stay and mortality, there was no significant difference among the groups. CONCLUSIONS: TLC is very useful indicator in critically ill patients with a high risk of hospital infection on ICU admission.
Critical Illness* ; Cross Infection* ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Lymphocyte Count* ; Lymphocyte Depletion ; Lymphopenia ; Mortality

Clinical analysis was performed on 660 cases of the intussusception treated at the Masan Fatima Hospital from January 1981 to December 1995. Also the frequency of the intussusception in the central area of Kyung Nam province from January 1991 to December 1995 was studied. The results were as follows. 1) The intusssusception was most commonly occured between 6 months to 9 months of age(28.6%). Male to female ratio was 2.06 : 1. 2) The frequent symptoms and signs were abdominal pain(80.9%), bloody stool(68.3%), vomiting(63.9%), and palpable abdominal mass(43.6%). 3) The incidence of types of intussusception were ileo-colic(50.0%), ileo-ileo-colic(41.2%), ileo-cecal(6.3%), colo-colic(2.1%) and ileo-ileal(0.4%) in order. 4) The chance of intestinal resection was increased in the case of symptom duration over 24 hours(P<0.01). 5) Barium reduction was attempted in 660 cases(100%) and achieved successful reduction in 364 cases(55.2%). Operative treatment was performed in 296 cases(44.8%), of which manual reduction was carried out in 267 cases(90.2%), intestinal resection in 17 cases(5.8%) and spontaneous reduction was noted in 12 cases(4.0%). 6) Wound infection developed in 12 cases(4.0%) was the most commonly observed postoperative complication. 7) The recurrent rates of the barium enema and operation were 9.1% and 7.1%, resepctively. 8) The operative mortality was 0.2%. 9) The incidence of intussusception in Kyung Nam central area from 1991 to 1995 were as followings : 5.55/1000 live birth in 1991, 5.65/1000 live birth in 1992, 5.03/1000 live birth in 1993, 5.00/1000 live birth in 1994 and 4.03/1000 live birth in 1995.
Barium ; Child* ; Enema ; Female ; Humans ; Incidence* ; Infant* ; Intussusception* ; Live Birth ; Male ; Mortality ; Postoperative Complications ; Wound Infection

BACKGROUND: Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. MATERIAL AND METHOD: From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. RESULT: There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. CONCLUSION: Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.
Follow-Up Studies ; Humans ; Intubation, Intratracheal ; Mortality ; Tracheal Stenosis* ; Vocal Cord Paralysis ; Wound Infection

A Clinic study was made on 140 cases of acute appendicitis in children under the age of 15 which were treated at National Seoul Hospital during the past 10 years from Jan. 1971 to dec. 1980. The following results were obtained. 1) The disease is relatively uncommon under the age of 6, and showed a progressive increase from 6 to 15 years old. The ratio between male and female was within 1.5:1 and there was no significant difference in the seasonal distribution. 2) The duration from onset to admission was within 24 hours in imperforated group and within 48 hours in a perforated one. 3) The over-all perforation rate was 13.6%. 4) The average leukocyte count was 10,000~15,000/mm and leukocytosis was noted in 70.7%. In 56.7% of cases neutrophil count was above 75%. 5) The complications occurred mainly in a perforated group and they were wound infection. 6) The average hospital days were 5.3days in an imperforated group and 10.2 days in a perforated one. 7) There was no mortality.
Adolescent ; Appendicitis* ; Child* ; Female ; Humans ; Leukocyte Count ; Leukocytosis ; Male ; Mortality ; Neutrophils ; Seasons ; Seoul ; Wound Infection

PURPOSE: Malignant colorectal obstruction is a common emergency situation showing high morbidity and mortality because of the poor general condition of the patients, unprepared bowel and advanced diseases. Recently, the self-expandable colorectal stent has allowed an elective one-stage resection without the risk of an emergency operation and stoma formation. We evaluated the usefulness of the self-expandable metallic stent for a malignant colorectal obstruction in terms of the preoperative preparation of the patients. METHODS: Seventeen patients who underwent a surgical resection following self-expandable metallic stent insertion for a malignant colorectal obstruction were included in this study. The patients' characteristics, clinical courses, and complications after stent insertion, the changes in physical status of the patients, the operative method, and the postoperative complications were investigated. The APACHE II score was applied for evaluating the physical status of the patients. RESULTS: Obstructions were located at the transverse (n=1), the descending (n=3), and the sigmoid colon (n=6) and at the rectum (n=7). Stents were successfully inserted and obstructions were relieved in all patients. Preoperative evaluations were performed in all cases. Fourteen of the 17 patients (82.4%) showed abnormal laboratory findings on admission. The average APACHE II score was 10.6 on admission and decreased to 7.8 after stent insertion (P<0.05). Nine patients (52.9%) could resume oral feeding after stent insertion. There were 2 stent-related complications, one case of stent migration and one case of minor bleeding; both were managed conservatively. At an average of 9 days after the stent insertion, an elective radical resection was conducted in all cases. Laparoscopic resections were attempted in 7 (41.2%) patients and were successful in 6. In 15 cases (88.2%), resection with primary anastomosis was possible. Postoperatively, there were 3 cases of wound infections and a temporary ileus. The TNM stage was stage II in 9 patients (52.9%), III in 6 (35.3%), and IV in 2 (11.8%). The patients were discharged from the hospital at an average of 11 days postoperatively. CONCLUSIONS: Self-expandable colorectal stent insertion is a safe and effective treatment strategy and can change the emergency setting to permit an elective one-stage curative operation by allowing the general condition of a patient with malignant colorectal obstruction to recover.
APACHE ; Colon, Sigmoid ; Emergencies ; Hemorrhage ; Humans ; Ileus ; Mortality ; Postoperative Complications ; Rectum ; Stents* ; Wound Infection

The halophilic bacterium, Vibrio vulnificus, causes acute fulminating wound infections and septicemia in human. Especially the septicemia shows high mortality above 50%. In Korea, septicemia by V. vulnificus was reported at westem and southern coast in every year. Here, we try to isolate this V. vulnipcus at Kyoung-nam area and coast of Pusan during 1996. Purposed sites were Dadaepo, Songjung, Chungsapo and Mipo of Pusan and Kijang, Ilkuang, Juksoung, Dongam, Waljun and Chilam of southern sea. Total 40 strains of V. vulnipcus were isolated from sea samples. Biochemical characteristics of isolated V. vulnificus were almost same with reference strain V. vulnificus ATCC 27562 on Farmer's tests and on API 20E kit test. V. vulnificus isolates in 1996, fermented cellobiose and salicin but arabinose. and had resistance to 7% sodium chloride.
Arabinose ; Busan* ; Cellobiose ; Humans ; Korea* ; Mortality ; Sepsis ; Sodium Chloride ; Vibrio vulnificus* ; Vibrio* ; Wound Infection