Skin and soft tissue infections (SSTIs) caused by community-associated (CA)-methicillin-resistant Staphylococcus aureus (MRSA) have become a worldwide concern. An otherwise healthy 16-month-old Korean girl was admitted because of skin abscess on the left chest wall with a history of recurrent SSTIs since the age of 6 months. Immunologic evaluation including serum immunoglobulin level and nitroblue-tetrazolium (NBT) test were normal. Pus and nasal swab cultures revealed CA-MRSA ST714-SCCmec type IV with the Panton-Valentine leukocidin (PVL) genes, which was initially reported in the Netherlands in 2006 and has not been previously reported in Korea. The skin abscesses were successfully treated by needle aspiration and the use of antibiotics. In addition, nasal mupirocin was applied as a decolonization method. No more episodes of SSTI were observed over a follow-up period of 10 months.
Abscess ; Anti-Bacterial Agents ; Child* ; Female ; Follow-Up Studies ; Humans ; Immunoglobulins ; Infant ; Korea* ; Leukocidins ; Mupirocin ; Needles ; Netherlands ; Skin* ; Soft Tissue Infections* ; Staphylococcus aureus ; Suppuration ; Thoracic Wall

PURPOSE: We investigated trends in antibiotic pressure and the antibiotic susceptibility of gram negative bacteria isolated from Korean children over 10 consecutive years. METHODS: From January 2004 to December 2013, the antibiotic susceptibility of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii blood isolates obtained from children <18 years of age was determined according to the 2009 Clinical and Laboratory Standards Institute guidelines. Antibiotic consumption data were also analyzed. RESULTS: The prevalence of K. pneumoniae, E. coli, P. aeruginosa, and A. baumannii bacteremia was 4.6, 3.5, 3.4, and 2.2 cases/1,000 blood cultures/year, respectively. In K. pneumoniae, resistance to the third and fourth cephalosporin did not increase significantly. However, carbapenem-resistant K. pneumoniae first appeared in 2010, and the resistance rate increased to 9% between 2012 and 2013. Resistance to 3rd and 4th cephalosporin increased from 10% to 50% in E. coli, and resistance to carbapenem rose abruptly from 11% to 71% in A. baumannii (P for trend <0.01). However, such an increase of resistance was not observed in P. aeruginosa. There is a positive correlation between the resistance rate of cefepime in E. coli and the consumption of cefepime (r=0.900, P=0.037). CONCLUSION: The significant burden of antibiotic consumption and the high prevalence of antibiotic resistance to gram negative pathogen isolated from bacteremic children were observed. Empirical antibiotics should be wisely selected, and continued efforts to decrease the overall antibiotic pressure are mandatory, especially in highly resistant situations.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Bacteremia ; Child* ; Drug Resistance, Microbial ; Escherichia coli ; Gram-Negative Bacteria* ; Humans ; Klebsiella pneumoniae ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa

PURPOSE: Transient tachypnea of the newborn (TTN) is a disorder caused by the delayed clearance of fetal alveolar fluid. beta-adrenergic agonists such as albuterol (salbutamol) are known to catalyze lung fluid absorption. This study examined whether inhalational salbutamol therapy could improve clinical symptoms in TTN. Additional endpoints included the diagnostic and therapeutic efficacy of salbutamol as well as its overall safety. METHODS: From January 2010 through December 2010, we conducted a prospective study of 40 newborns hospitalized with TTN in the neonatal intensive care unit. Patients were given either inhalational salbutamol (28 patients) or placebo (12 patients), and clinical indices were compared. RESULTS: The duration of tachypnea was shorter in patients receiving inhalational salbutamol therapy, although this difference was not statistically significant. The duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment were significantly shorter in the salbutamol-treated group. No adverse effects were observed in either treatment group. CONCLUSIONS: Inhalational salbutamol therapy reduced the duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment, with no adverse effects. However, the time between salbutamol therapy and clinical improvement was too long to allow definitive conclusions to be drawn. Further studies examining a larger number of patients with strict control over dosage and frequency of salbutamol inhalations are necessary to better direct the treatment of TTN.
Absorption ; Adrenergic beta-Agonists ; Albuterol* ; Humans ; Infant, Newborn ; Inhalation ; Intensive Care, Neonatal ; Lung ; Methods ; Oxygen ; Prospective Studies ; Tachypnea ; Transient Tachypnea of the Newborn*

PURPOSE: This study aimed to test the validity and reliability of the Korean version of the Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) instrument developed by Saveman et al. METHODS: The 222 pediatric nurses' data were collected from 13 hospitals in South Korea and were analyzed using descriptive statistics, exploratory factor analysis, the Pearson correlation coefficient, and the Cronbach's α in SPSS software. The AMOS program was used to conduct confirmatory factor analysis of construct validity. RESULTS: Of the 26 initial items, 24 were ultimately selected after evaluating content validity, construct validity, and reliability. The following 6 factors were included in the Korean version of the Families' Importance in Nursing Care-Pediatric Nurses' Attitudes (KFINC-PNA): family as a ‘conversational partner’, ‘participant in care’, ‘supporter for the nurse’, ‘burden’, ‘recipient of empowerment’, and ‘its own resource’. CONCLUSION: The KFINC-PNA was partially modified to explain differences in language and culture, but its validity and reliability were verified. Pediatric nurses' attitudes can be assessed using the KFINC-PNA, and adjustments to the care of hospitalized children and their families can be made based on these items. We recommend developing and verifying intervention methods that will improve family-centered care for hospitalized children and their families.
Child ; Child, Hospitalized ; Humans ; Korea ; Nursing* ; Reproducibility of Results*

PURPOSE: This study aimed to seek agreement on the core components of an e-learning cultural competence program for Korean public health workers (PHWs) while prioritizing educational content areas. METHODS: A two-round Delphi study was performed with 16 Korean experts from five disciplines. Data were collected between August 30 and November 24, 2017. A questionnaire was developed from literature reviews and previous focus group interviews concerning PHWs. The panel members were asked to rate the importance and urgency of educational content areas and the effectiveness of teaching–learning methods and gave opinions on their appropriate frequency, duration, and target audience. Responses were analyzed using descriptive statistics. A median of 4.0 or greater or a rate of agreement of 75% or greater was considered a “consensus” for the purposes of this study. RESULTS: All consenting participants responded to two-round surveys. Participants reached consensus on thirty-one educational content areas. Of these, the highest priorities were “necessity of cultural competence of PHWs,” “health characteristics according to race and ethnicity,” and “establishing trusting relationships with migrants.” The most effective teaching–learning method was case-based learning, with seven to eight sessions of training and duration of fewer than 30 minutes per session. CONCLUSION: Multidisciplinary experts proposed 12 prioritized educational content areas and effective teaching–learning methods as well as their frequency, duration, and target audiences, reflecting Korea-specific multicultural phenomena and the nature of the work of PHWs. These findings can contribute to preparing PHWs to provide culturally competent services to migrants in their communities.
Consensus ; Continental Population Groups ; Cultural Competency ; Delphi Technique ; Education ; Focus Groups ; Health Personnel ; Humans ; Korea ; Learning ; Methods ; Public Health ; Transients and Migrants

Background: Postoperative nausea and vomiting (PONV) commonly occurs after spinal anesthesia; however, its incidence rate and predictors have been scarcely studied. Therefore, we aimed to investigate its incidence rate and potential predictors. Methods: The electronic medical records of 6,610 consecutive patients undergoing orthopedic surgery under spinal anesthesia were reviewed between January 2016 and December 2020. The primary outcome was PONV incidence within 24 h after spinal anesthesia. Along with its incidence rate, we investigated its predictors using multivariable logistic regression analysis. Results: Among the 5,691 patients included in the analysis, 1,298 (22.8%) experienced PONV within 24 h after spinal anesthesia. Female sex (odds ratio [OR]: 3.23, 95% CI [2.72, 3.83], P < 0.001), nonsmoker (OR: 2.12, 95% CI [1.46, 3.07], P < 0.001), history of PONV (OR: 1.52, 95% CI [1.26, 1.82], P < 0.001), prophylactic 5-hydroxytryptamine receptor antagonist use (OR: 0.35, 95% CI [0.24, 0.50], P < 0.001), prophylactic steroid use (OR: 0.53, 95% CI [0.44, 0.62], P < 0.001), baseline heart rate ≥ 60 beats/min (OR: 1.38, 95% CI [1.10, 1.72], P = 0.005), and postoperative opioid use (OR: 2.57, 95% CI [1.80, 3.67], P < 0.001), were significant predictors of the primary outcome. Conclusions Our study showed the common incidence of PONV after spinal anesthesia and its significant predictors. A better understanding of its predictors may provide important information for its management.

PURPOSE: The aim of this study was to investigate the prognostic factors for Pneumocystis jirovecii pneumonia (PCP) and to evaluate the influence of PCP prophylaxis in pediatric patients. METHODS: From January 2002 to April 2015, patients aged <18 years with a diagnosis of confirmed PCP at our institute were reviewed retrospectively. Clinical characteristics and outcomes were compared according to the groups with or without PCP prophylaxis. Risk factors associated with PCP-related death were analyzed by logistic regression analysis. RESULTS: During study period, a total of 24 patients were diagnosed with PCP by immunofluorescence assay and/or PCR. The median age of the patients was 5 years (range, 3 months-18 years) and 23 (96%) had immunocompromised conditions including hematologic disorders with or without hematopoietic stem cell transplantation (n=15), solid organ transplantation (n=4), and primary immune deficiency (n=4). Most common presenting symptoms were tachypnea and cough (92%, each). At the time of diagnosis, 79% (19/24) and 25% (6/24) suffered from respiratory failure and multi-organ dysfunction syndrome (MODS), respectively. Mechanical ventilation was required in 8 (33%) patients and 5 (21%) patients died of PCP. Multivariate analysis showed that MODS at initial presentation was an indicator of poor prognosis (OR, 17.1 [95% CI 1.13-257.67]; P=0.04). Compared to the patients without PCP prophylaxis, the frequency of MODS at diagnosis, need for mechanical ventilation and length of hospital days were significantly less common in the children who received PCP prophylaxis. CONCLUSIONS: MODS at presentation was a significant predictor for poor outcome and PCP prophylaxis could alleviate the clinical courses of pediatric PCP. Prospective study will be mandatory to determine the risk factors for development and deterioration of PCP in children.
Child* ; Cough ; Diagnosis ; Fluorescent Antibody Technique ; Hematopoietic Stem Cell Transplantation ; Humans ; Logistic Models ; Multiple Organ Failure ; Multivariate Analysis ; Organ Transplantation ; Pneumocystis jirovecii* ; Pneumocystis* ; Pneumonia* ; Polymerase Chain Reaction ; Prognosis ; Prospective Studies ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies ; Risk Factors ; Tachypnea ; Transplants

PURPOSE: There is a the great diagnostic challenge in pediatric tuberculosis especially in high burden setting. The purpose of this preliminary study is to evaluate the agreement between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) including T-SPOT®-TB and QuantiFERON®-TB Gold (QFT-G) in Korean children. METHOD: This retrospective study included children and adolescents who visited to Asan Medical Center to evaluate tuberculosis infection using at least two assays of TST, T-SPOT.TB and QFT-G, from January 2014 to April 2015. RESULTS: A total of 20 patients were included, whose median age was 13.3 years (range, 3.8-18.1 years), and all of them had history of BCG vaccination. Eleven patients had underlying diseases including 7 patients with immunosuppressant medication. The concordance rate between T-SPOT.TB and QFT-G was 90%. However, the concordance rate between TST and T-SPOT.TB was 50%, and between TST and QFT-G was 42.9%. Specificity for the diagnosis of tuberculosis infection of T-SPOT.TB, QFT-G, and TST was 93.3%, 86.7%, and 58.3%, respectively. CONCLUSIONS: Although there was a discrepancy between TST and IGRA to diagnose tuberculosis, agreement between T-SPOT.TB and QFT-G was relatively high. Further prospective study to validate the clinical usefulness of each assay for immunologic evidence of tuberculosis infection in Korean children will be mandatory.
Adolescent ; Child* ; Chungcheongnam-do ; Diagnosis* ; Humans ; Interferon-gamma Release Tests* ; Interferon-gamma* ; Latent Tuberculosis ; Mycobacterium bovis ; Prospective Studies ; Retrospective Studies ; Sensitivity and Specificity ; Skin Tests* ; Skin* ; Tuberculin* ; Tuberculosis* ; Vaccination

PURPOSE: The purpose of this paper was to describe the attributes of nursing with humor based on an integrative review and to present basic information for developing humor intervention programs for children. METHODS: Using combinations of the terms 'nursing' and 'humor' as key words, the researchers searched four electronic databases to relevant identify studies. Thirteen studies were selected through full text screening of related research published in academic journals from January 1993 to April 2013. RESULTS: Through in-depth discussion and investigation of the relevant literature, three components emerged; 1) using instruments of coping for stress relief, 2) symptoms relief through pleasant feeling, and 3) job satisfaction and work improvement of nurse using humor. CONCLUSION: The results of this study suggest that humor is valuable as a nursing intervention for children and the possibility of bringing about positive results in nursing care if nurses utilize the sense of humor as fully as they can. Therefore, it is critical for nurses to develop a diversity of humor interventions for children as well as measurements to test quality and quantity of humor used in clinical pediatric settings.
Child ; Humans ; Job Satisfaction ; Mass Screening ; Nursing Care ; Nursing*

It is important to use vancomycin in a proper manner to ensure optimal drug exposure. Despite extensive use of vancomycin in children, studies on its optimal trough concentration (C(trough)) in the pediatric population remained rare. This retrospective study included children < 18 years old with culture-confirmed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia who were hospitalized in our institute from January 2010 to April 2014. Clinical characteristics, initial vancomycin dose, Ctrough and clinical/microbiological outcomes were retrospectively collected from medical records. Forty-six MRSA bacteremia cases occurring to the patients with a mean age of 22.0 ± 46.9 months were included and all of them were healthcare-associated. Severe diseases requiring intensive care unit (ICU) stay, mechanical ventilation and/or resulting in death were observed in 57.8% (26/45); all-cause 30-day fatality was 11.1% (5/45). An initial C(trough) ≥ 15 μg/mL was achieved in only 4 (8.7%) cases with an average vancomycin dosage of 40.6 ± 7.9 mg/kg/day. Persistent bacteremia at 48 hours after initiation of vancomycin was observed more frequently in children with initial Ctrough < 10 μg/mL than in those with C(trough) < 10 μg/mL (P = 0.032). However, there was no statistically significant difference between the two groups in terms of 30-day mortality and recurrent bacteremia (P = 0.899, and P = 0.754, respectively). Although initial C(trough) may be a useful parameter for minimizing early microbiological failure, it does not predict 30-day fatality or recurrence in pediatric MRSA bacteremia. Further prospective data on vancomycin dosing are needed to find the optimal drug exposure and clarify its impact on clinical outcomes in pediatric populations.
Bacteremia* ; Child* ; Humans ; Intensive Care Units ; Korea ; Medical Records ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Mortality ; Prospective Studies ; Recurrence ; Respiration, Artificial ; Retrospective Studies ; Vancomycin*