Cardiovascular disease (CVD) is the leading cause of death in renal allograft recipients with functioning graft. Our study aimed to determine the incidence and the risk factors of cardiovascular disease after renal transplantation in Korea. We retrospectively analyzed 430 adult recipients who underwent kidney transplantation between January 1997 and February 2007. CVD was defined as a composite outcome of ischemic heart disease, cerebrovascular accident and peripheral vascular disease. Mean age of recipients was 40.0+/-11.8 yr. Mean duration of follow-up was 72+/-39 months. The cumulative incidence of CVD after renal transplantation was 2.4% at 5 yr, 5.4% at 10 yr and 11.4% at 12 yr. Multivariate analysis revealed that recipient's age, diabetes mellitus and duration of dialysis before transplantation were associated with post-transplant CVD (hazard ratio 1.843 [95% CI, 1.005-3.381], 3.846 [95% CI, 1.025-14.432] and 3.394 [95% CI, 1.728-6.665] respectively). In conclusion, old age, duration of dialysis and diabetes mellitus are important risk factors for post-transplant CVD, although the incidence of post-renal transplant CVD is lower in Korea than that in western countries.
Adult ; Age Factors ; Cardiovascular Diseases/*epidemiology/etiology ; Diabetes Complications ; Female ; Humans ; Incidence ; *Kidney Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Renal Dialysis ; Republic of Korea ; Retrospective Studies ; Risk Factors

Chronic renal allograft dysfunction (CRAD) has been the rnost frequent cause of graft failure for last decade. Even in cycloporine era the incidence of CRAD has not changed. From Jan 1992 to Dec 1994 118 kidney transplants performed in Seoul National University Hospital had been entered into our database. All patients had been followed for at least 1 year. CRAD is defined if there had been progressive deterioration of renal function that was not explained by other causes and finally serum creatinine (Scr) had doubled from basal Scr after transplantation and has been maintained. Analyzed factors as follows; HLA misrnatch, living or cadaver transplant, ABO mismatch, acute rejecton (AR), frequency and timing of AR, donor age, recipient age, cold ischmic time, delayed graft function, proteinuria, infection. A CRAD has developed in 27 (23%) patients. The incidence of CRAD with time was analyzed by Kaplan-Meier survival analysis and compared with log-rank test. We concluded that in univariate anlaysis the risk factors are acute rejection, frequency of AR, AR after 3 months after tranplantation, age of recipient<15 and cold ischmic time> 40rnin for living transplants. Although HLAMM=0 significantly decreased the risk of CRAD (P<0.05), there was no difference in renal survival between groups of HLAMM>1. AR and HLAMM (HLAMM=O vs. HLAMM>1) were related each other (P=0.02).
Allografts* ; Cadaver ; Creatinine ; Delayed Graft Function ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Proteinuria ; Risk Factors* ; Seoul ; Tissue Donors ; Transplants

BACKGROUND: Coagulase is produced by all strains of Staphylococcus aureus. The 3' coding region of the coagulase (coa) gene contains varying numbers of 81 bp tandem repeats. S. aureus produces a variety of extracellular protein toxins. Here, we typed S. aureus strains isolated from blood by coa gene restriction fragment length polymorphism (RFLP) patterns and toxin gene profiles. METHODS: A total of 120 strains of S. aureus were isolated from blood cultures during 2003-2006 at Kangdong Sacred Heart Hospital. The isolates were typed by PCR RFLP analysis of the coa gene and by multiplex PCR for detection of genes encoding enterotoxins (sea, seb, sec, sed, and see), toxic shock syndrome toxin-1 (tst), exfoliative toxins (eta and etb), mecA and femA. RESULTS: All the S. aureus strains were classified into 16 types on the basis of coa gene RFLP and could be further differentiated into 34 types according to the combined patterns of coa gene RFLP and toxin gene profiles. Of 85 methicillin-resistant S. aureus (MRSA) strains, 43 (50.6%) and 36 (42.4%) belonged to the RFLP pattern L5 and pattern L1, respectively. MRSA strains belonging to pattern L5 frequently carried tst (93.0%) or sec gene (81.4%), and strains belonging to pattern L1 frequently carried sea (88.9%) or see gene (44.4%). The rate of the pattern L5 in MRSA strains increased over the past few years and was higher in intensive care unit than in other wards. CONCLUSIONS: We typed S. aureus strains isolated from blood on the basis of coa gene RFLP and toxin genes. The strains belonging to coa gene RFLP pattern L5 and L1 appeared to be the major types of MRSA isolasted from bacteremia and revealed specific toxin gene profiles according to the coa gene RFLP patterns.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacterial Proteins/genetics ; Bacterial Typing Techniques ; Child ; Child, Preschool ; Coagulase/*genetics ; Female ; Humans ; Infant ; Male ; Methicillin Resistance/genetics ; Middle Aged ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Staphylococcal Infections/*diagnosis/genetics/microbiology ; Staphylococcus aureus/*classification/genetics/isolation & purification ; Toxins, Biological/*genetics ; Young Adult

BACKGROUND: The MicroScan MICroSTREP plus panel for susceptibility testing of various streptococci, including Streptococcus pneumoniae, has recently been introduced in Korea. The current study evaluated the usefulness of MicroScan MICroSTREP plus panel for antimicrobial susceptibility test of S. pneumoniae. METHODS: A total of 75 clinical isolates of S. pneumoniae were tested for antimicrobial susceptibility to penicillin, cefotaxime, ceftriaxone, meropenem, vancomycin, clindamycin, erythromycin, and levofloxacin with the MicroScan MICroSTREP plus panel and clinical and laboratory standard institute (CLSI) reference broth microdilution method. For 46 of 75 isolates, additional susceptibility tests to penicillin and cefotaxime were performed with Etest. RESULTS: The overall essential agreement of MICs (within one dilution of MICs) defined by the MicroScan MICroSTREP plus panel and reference method was 93.0%. Overall there were 11.7% minor, 0.7% major, and 0.7% very major interpretative category errors observed. The results of antibiotic susceptibility testing by Etest were similar to those obtained by the MicroScan MICroSTREP plus panel. CONCLUSION: The MicroScan MICroSTREP plus panel, a commercial broth microdilution method, has a comparable accuracy to CLSI broth microdilution method for the resistance testing of S. pneumonia. This panel can be used for determining susceptibilities of S. pneumoniae to a wide variety of antimicrobial agents in clinical microbiology laboratories.
Anti-Infective Agents ; Cefotaxime ; Ceftriaxone ; Clindamycin ; Erythromycin ; Korea ; Ofloxacin ; Penicillins ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae ; Thienamycins ; Vancomycin

BACKGROUND: Although a growing number of guidelines and clinical researches are available for immunosuppressive treatment of post-transplantation, there is no clinical practice guideline for the care of kidney transplant recipients in Korea. Selection of a researchable question is the most important step in conducting qualified guideline development. Thus, we aimed to formulate key questions for Korean guideline to aid clinical decision-making for immunosuppressive treatment. METHODS: Based on previous published guidelines review, a first survey was constructed with 29 questions in the range of immunosuppressive treatments. The experts were asked to rate the clinical importance of the question using a 5-point Likert scale. The questions reached 60% or more from the first survey and additional new questions were included in the second survey. In analyzing the responses to items rated on the 9-point scale, consensus agreement on each question was defined as 75% or more of experts rating 7 to 9. RESULTS: In the first survey, 50 experts were included. Among the 29 questions, 27 were derived to get 60% or more importance and 3 new questions were additionally identified. Through the second survey, 9 questions were selected that experts reached consensus on 75% and over of the options. Finally, we developed key questions using PICO (patient, intervention, comparison, and outcome) methodology. CONCLUSION: The experts reached a high level of consensus on many of key questions in the survey. Final key questions provide direction for developing clinical practice guideline in the immunosuppressive treatment of transplantation.
Clinical Decision-Making ; Consensus ; Kidney Transplantation ; Kidney ; Korea ; Transplant Recipients

BACKGROUND: Doctors' white coats and neckties can become contaminated with potentially pathogenic bacteria and have a possibility of causing cross infections. Our objective was to determine the level of bacterial contamination and detect methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and Clostridium difficile present on the white coats and neckties of residents. METHODS: We sampled 28 long-sleeved white coats and 14 neckties worn by residents. The tested sites for white coats were the cuffs and lower front surfaces, and for neckties, the lower surfaces. Impressions of these sites were taken with the plates containing blood agar (BAP), mannitol salt agar supplemented with oxacillin (6microgram/mL), enterococcus screening agar supplemented with vancomycin (6microgram/mL) and phenyl ethanol agar. The colonies grown on each plate were Gram stained and identified by standard microbiological methods. RESULTS: Of the 28 white coats, 7 (25.0%) carried MRSA, and of the 14 neckties, 1 (7.1%) carried MRSA. The majority of white coats (96.4%) and all neckties (100.0%) carried methicillin-resistant coagulase negative staphylococci (MRCNS). None of the white coats and neckties carried VRE or C. difficile. CONCLUSION: Our results showed that white coats and neckties worn by residents were contaminated with MRSA and MRCNS. The preventive measures for clothing-borne cross contamination should be considered, especially when performing invasive procedures or having close contact with patients.
Agar ; Bacteria ; Clostridium difficile ; Coagulase ; Cross Infection ; Enterococcus ; Ethanol ; European Continental Ancestry Group ; Humans ; Mannitol ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Vancomycin

BACKGROUND: It is now recognized that screening for methicillin-resistant Staphylococcus aureus (MRSA) in hospital is an effective infection control measure, and selective media-based methods have been commonly used. MRSASelect (MRSAS; Bio-Rad, Hercules, CA, USA) is MRSA selective agar incorporating chromogenic enzymatic substrates, and have been found to be more sensitive and specific than other selective media. The aim of present study was to evaluate MRSAS for discrimination of MRSA from other staphylococci by comparison with mannitol-salt agar with oxacillin (MSO) which is widely used as a MRSA selective medium. METHODS: Ninety-eight staphylococcal strains which were isolated from blood culture specimen, representing 16 MRSA, 6 methicillin-susceptible S. aureus, 59 methicillin-resistant coagulase- negative staphylococci (MRCNS), and 17 methicillin-susceptible coagulase-negative staphylococci were tested. The isolated colonies from pure culture were directly inoculated onto MSO and MRSAS respectively. On MRSAS any growth appearing pink after 24 hours incubation, and on MSO any growth appearing yellow after 48 hours incubation was interpreted as positive for the presence of MRSA. RESULTS: Sensitivities of MRSAS and MSO for MRSA detection were equal (93.8%). Specificities for MRSA discrimination from other staphylococci were 98.8% and 89.0%, and especially from MRCNS were 100% and 84.7%, for MRSAS and MSO, respectively. CONCLUSIONS: The MRSAS showed equal sensitivity compared with MSO for the detection of MRSA. MRSAS showed higher specificity than MSO in discrimination MRSA from MRCNS. It was suggested that the implementation of MRSAS in MRSA screening could decrease the work needed for MRCNS identification.
Agar ; Discrimination (Psychology) ; Infection Control ; Mass Screening ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Oxacillin ; Sensitivity and Specificity

BK virus-associated nephropathy (BKVAN) is one of the major causes of allograft dysfunction in kidney transplant (KT) patients. We compared BKVAN combined with acute rejection (BKVAN/AR) with BKVAN alone in KT patients. We retrospectively analyzed biopsy-proven BKVAN in KT patients from 2000 to 2011 at Seoul National University Hospital. Among 414 biopsies from 951 patients, biopsy-proven BKVAN was found in 14 patients. Nine patients had BKVAN alone, while 5 patients had both BKVAN and acute cellular rejection. BKVAN in the BKVAN alone group was detected later than in BKVAN/AR group (21.77 vs 6.39 months after transplantation, P=0.03). Serum creatinine at diagnosis was similar (2.09 vs 2.00 mg/dL). Histological grade was more advanced in the BKVAN/AR group (P=0.034). Serum load of BKV, dose of immunosuppressants, and tacrolimus level showed a higher tendency in the BKVAN alone group; however it was not statistically significant. After anti-rejection therapy, immunosuppression was reduced in the BKVAN/AR group. Renal functional deterioration over 1 yr after BKVAN diagnosis was similar between the two groups (P=0.665). These findings suggest that the prognosis of BKVAN/AR after anti-rejection therapy followed by anti-BKV therapy might be similar to that of BKVAN alone after anti-BKV therapy.
Acute Disease ; Adult ; Antiviral Agents/therapeutic use ; BK Virus/*physiology ; Creatinine/blood ; Female ; *Graft Rejection/diagnosis/virology ; Humans ; Immunosuppressive Agents/administration & dosage ; Kidney/*virology ; Kidney Diseases/pathology/surgery/*virology ; *Kidney Transplantation ; Male ; Middle Aged ; Polyomavirus Infections/drug therapy/*etiology/pathology ; Retrospective Studies ; Tacrolimus/administration & dosage ; Time Factors ; Transplantation, Homologous/adverse effects ; Tumor Virus Infections/drug therapy/*etiology/pathology

A sixty-seven-year-old man was admitted to a hospital with symptoms of high fever and chill. Bacterial isolates were obtained from sputum and blood. These isolates were identified as Klebsiella terrigena by API 20E (BioMerieux, Marcy-l'Etoile, France). K. terrigena is very rarely isolated from humans and no case of K. terrigena bacteremia has been reported yet. We analyzed partial 16S rRNA gene sequences of these isolates. The 16S rRNA gene sequences were matched with that of Klebsiella pneumoniae (ATCC 13886). 16S rRNA gene sequencing has been recently introduced in clinical laboratories for unidentified organisms by conventional biochemical tests. For the precise identification of bacteria rarely causing clinical infection, it might be considered to use genotypic methods, such as 16S rRNA gene sequencing.
Bacteremia ; Bacteria ; Fever ; Genes, rRNA ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Sputum

BACKGROUND: We performed surveillance cultures of the surfaces of X-ray cassettes to assess contamination with methicillin-resistant Staphylococcus aureus (MRSA). METHODS: The surfaces of 37 X-ray cassettes stored in a radiology department were cultured using mannitol salt agar containing 6 microg/mL oxacillin. Suspected methicillin-resistant staphylococcal colonies were isolated and identified by biochemical testing. Pulsed-field gel electrophoresis (PFGE) analysis was performed to determine the clonal relationships of the contaminants. RESULTS: Six X-ray cassettes (16.2%) were contaminated with MRSA. During the isolation procedure, we also detected 19 X-ray cassettes (51.4%) contaminated with methicillin-resistant Staphylococcus haemolyticus (MRSH), identified as yellow colonies resembling MRSA on mannitol salt agar. PFGE analysis of the MRSA and MRSH isolates revealed that most isolates of each organism were identical or closely related to each other, suggesting a common source of contamination. CONCLUSIONS: X-ray cassettes, which are commonly in direct contact with patients, were contaminated with MRSA and MRSH. In hospital environments, contaminated X-ray cassettes may serve as fomites for methicillin-resistant staphylococci.
Anti-Bacterial Agents/pharmacology ; Diagnostic Equipment/*microbiology ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus/drug effects/*isolation & purification ; Microbial Sensitivity Tests ; Oxacillin/pharmacology ; Staphylococcus haemolyticus/drug effects/*isolation & purification