BACKGROUND: Healthcare-associated infections (HAIs) are among the most important threats to patient safety. When hospitalized children face these threats, there is morbidity, mortality, prolonged hospitalization, and increased healthcare costs. Research on local healthcare epidemiology is necessary to enhance collective knowledge and evidence formanaging this problem. METHODS: We performed a retrospective analysis of databases of patients who were diagnosed with HAIs at Chung-Ang University Hospital (CAUH) from 2007 through 2011. Cases were selected from the microbiology registry databases. The data on prevalence of HAIs in various wards and its annual trends were compared to previously reported nationwide data. Moreover, we analyzed the patterns of antibiotic susceptibility results for HAI pathogens. RESULTS: A total of 181 HAIs were identified in 122 patients. The HAI rate among pediatric patients at CAUH was 2.4/1,000 person-hospital days. Urinary tract infections (UTIs) (53 episodes, 29.3%) were the most common, followed by pneumonia (33 episodes, 18.2%). Staphylococcus aureus was found to be the most common gram-positive organism, whereas Escherichia coli was the most common gram-negative organism. Methicillin-resistant S. aureus (MRSA) comprised 84% of the S. aureus infections. Imipenem resistance was detected in 58.8% and 55.0% of Acinetobacter baumannii and Pseudomonas aeruginosa isolates, respectively. CONCLUSION: Between 2007 and 2011, UTIs were the most common type of HAIs, and MRSA was the most common pediatric HAI pathogen, both in the general ward and intensive care unit at the CAUH. Further research on the epidemiology and pathogenesis of HAIs is necessary and prevention measures should be implemented to prevent HAIs in children.
Acinetobacter baumannii ; Child ; Child, Hospitalized ; Delivery of Health Care ; Escherichia coli ; Health Care Costs ; Hospitalization ; Humans ; Imipenem ; Intensive Care Units ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Microbial Sensitivity Tests ; Patient Safety ; Patients' Rooms ; Pneumonia ; Prevalence ; Pseudomonas aeruginosa ; Retrospective Studies ; Staphylococcus aureus ; Urinary Tract Infections

Lateral malleolar bursitis rarely progresses to septic arthritis. In our case, the 27 year old man visited due to progressive left ankle pain, despite the antibiotics treatment of lateral malleolar bursitis. 8 years ago, modified Brostrom procedure was performed owing to chronic ankle instability. Previous surgery altered anatomical structure of lateral ankle bursa, so it may cause the infection to spread to the ankle joint. We reported rare case of secondary septic arthritis caused by lateral malleolar bursitis.
Adult ; Ankle ; Ankle Joint ; Anti-Bacterial Agents ; Arthritis, Infectious* ; Bursitis* ; Humans

OBJECTIVES: The incidence of hepatitis A infections among young adults has recently increased in South Korea. Although universal vaccination has often been suggested to mitigate the problem, its rationale has not been well-understood. Estimating the societal costs of hepatitis A infections might support the development of intervention strategies. METHODS: We classified hepatitis A infections into eight clinical pathways and estimated the number of occurrences and cost per case for each clinical pathway using claim data from National Health Insurance and several national surveys as well as assumptions based on previous studies. To determine the total costs of a hepatitis A infection, both direct and indirect costs were estimated. Indirect costs were estimated using the human-capital approach. All costs are adjusted to the year 2008. RESULTS: There were 30,240 identified cases of hepatitis A infections in 2008 for a total cost of 80,873 million won (2.7 million won per case). Direct and indirect costs constituted 56.2% and 43.8% of the total costs, respectively. People aged 20-39 accounted for 71.3% of total cases and 74.6% of total costs. Medical costs per capita were the lowest in the 0-4 age group and highest in the 20-29 age group. CONCLUSIONS: This study could provide evidence for development of cost-effective interventions to control hepatitis A infections. But the true costs including uncaptured and intangible costs of hepatitis A infections might be higher than our results indicate.
Cost of Illness ; Critical Pathways ; Hepatitis A* ; Humans ; Incidence ; Korea ; National Health Programs ; Republic of Korea ; Vaccination ; Young Adult

No abstract available.
Female ; Humans ; Osteoporosis, Postmenopausal*

Inferior sinus venosus ASD (atrial septal defect) is a rare congenital cardiac deformity, that occurs on between the inferior vena cava and right atrium. Diagnosis of inferior sinus venosus ASD is difficult because of its infero-posterior location of the fossa ovalis. Therefor, exact anatomical diagnosis by preoperative and intraoperative transesophageal echocardiography is necessary at preoperation and during the operation. We present a case of residual ASD, which was diagnosed secundum ASD and repaired when the patient was 10 years old. Residual ASD was diagnosed by cardiac echocardiography in preparation of otorhinolaryngology operation. Therefore, reoperation of residual ASD was done when the patient was 24 years old. The patient had secundum ASD and inferior sinus venosus ASD, but in the prior operation, inferior sinus venosus ASD wasn't found and only secundum ASD was repaired. In reoperation, inferior sinus venosus ASD was reveled and patch closure was done.
Child ; Congenital Abnormalities ; Diagnosis ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Heart Septal Defects, Atrial* ; Humans ; Otolaryngology ; Reoperation* ; Vena Cava, Inferior ; Young Adult

PURPOSE: Peripheral artery disease (PAD) is thought one of the most serious complications caused by atherosclerosis, and the principal cause of death and disability in persons age 50 years or older. But, there is very little information on the prevalence of PAD in diabetic patients and relationship between risk factors and PAD in Korea. Thus, the authors conducted this study to find the risk factors for PAD in diabetic patients and help to improve patients' health. METHOD: A total of 149 Korean NIDDM patients were enrolled. All subject's systolic blood pressures in arm and ankle were measured with a Doppler ultrasonic instrument, from which ankle-brachial pressure index (ABPI) was derived. We also examined clinical and biochemical parameters in all patients. RESULT: Systolic pressure, total cholesterol, TG, LDL were higher and albumin were lower in diabetic patients with PAD than in diabetic patients without PAD (p value < 0.01). Logistic regression analysis showed that hypoalbuminemia and hypertriglyceridemia were independent risk factor of PAD. CONCLUSION: In the light of these results, it seems reasonable to suggest that hypoalbuminemia and hypertriglyceridemia in diabetic patients may play a role in the pathogenesis of PAD.
Ankle ; Arm ; Arteries ; Atherosclerosis ; Blood Pressure ; Cause of Death ; Cholesterol ; Diabetes Mellitus, Type 2 ; Humans ; Hypertriglyceridemia ; Hypoalbuminemia ; Korea ; Logistic Models ; Peripheral Arterial Disease* ; Prevalence ; Risk Factors* ; Ultrasonics

BACKGROUND: There are several active tuberculosis (TB) cases in Korean high schools each school year. The risk of transmission in schools is extremely high due to the considerable time spent in closed classrooms. We evaluated the control of latent tuberculosis infection in Korean high schools. METHODS: When a student was identified with active TB, tuberculin skin testing was performed on their classmates and on students in their same school grade. When a student had a positive tuberculin skin tests (TST), they underwent follow-up testing with QuantiFERON-TB Gold In-Tube (QFT). The manufacturer recommended a cut-off of 0.35 IU/mL to determine QFT positivity was applied. RESULTS: A total of 131 pulmonary tuberculosis (TB) patients were included based on the criteria for screening TB contacts in the National Tuberculosis Control Program. Seventy-five (57.2%) students tested smear positive. TST were performed on 7,109 students who were classmates of, or in the same grade as, a TB patient. Of the contacts, 1,231 students (17.3%) were TST positive and they were screened with QFT. Six hundred-sixty-six (55.0%) of the tested students returned a positive QFT result and the rate of positivity was significantly associated with the increasing size of TST indurations (p<0.0001). CONCLUSION: The use of QFT resulted in approximately 45% of TST positive students not being given chemoprophylaxis.
Chemoprevention ; Follow-Up Studies ; Humans ; Interferon-gamma ; Interferon-gamma Release Tests ; Latent Tuberculosis ; Mass Screening ; Skin ; Skin Tests ; Tuberculin ; Tuberculin Test ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: Cancer of the gallbladder, which is the eighth most common malignancy of the digestive system in Korea, is almost always associated with an unfavorable prognosis, and the clinical outcome has not improved much over the past couple of decades. This study was intended to examine our surgical experience and to evaluate the prognostic significance of the clinicopathological factors for a primary carcinoma of the gallbladder. METHODS: The data of 202 patients with gallbladder carcinomas operated on at our surgical department over a period of 10 years from May 1994 to Dec. 2003 were retrospectively reviewed. RESULTS: Overall, the 5-year survival was 46.8% with the median survival of 58.8 months. The histopathological type and grade, TNM stage, stage grouping, symptom, CA 19-9 level, and jaundice were significant prognostic factors. Among the 85 patients with T2 cancer, the outcome after a resection was better than that after simple cholecystectomy. CONCLUSION: A complete tumor resection and no lymph node involvement are associated with a good prognosis. The long-term survival may be achieved by an early diagnosis with a curative, radical resection. Additionally, a radical resection may be beneficial for patients with a T2 gallbladder carcinoma.
Cholecystectomy ; Digestive System ; Early Diagnosis ; Gallbladder Neoplasms ; Gallbladder* ; Humans ; Jaundice ; Korea ; Lymph Nodes ; Prognosis ; Retrospective Studies

PURPOSE: Kawasaki disease (KD) is a systemic vasculitis, a leading cause of pediatric acquired heart disease. Histopathological findings of coronary artery lesion (CAL) in KD indicate destruction of the coronary artery wall with diffuse vasculitis. Matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs) might play central roles in this process. Special attention to MMP-9 has recently been emerging. This study was performed to investigate the clinical significance of MMP-9 and its inhibitors, TIMP-1 and TIMP-2, in KD. METHODS: We compared 47 KD patients with 14 febrile controls. Serum MMP-9 and TIMP-1, TIMP-2 were measured by ELISA and compared according to clinical stages and coronary involvement. RESULTS: In acute stage, MMP-9 and TIMP-1 were significantly higher, whereas TIMP-2 was lower, in KD than those in febrile controls (p<0.05). The elevated MMP-9 levels in acute phase significantly decreased during the subacute and convalescent phases (p<0.05). During acute phase, the MMP-9, TIMP-1, and MMP-9/TIMP-2 levels in the CAL group were lower than those in the non-CAL group, but they increased significantly in the subacute phase (p<0.05). MMP-9 has a positive correlation with TIMP-1 in the acute and subacute phases, and negative correlation with TIMP-2 in the subacute and convalescent phases (p<0.05). CONCLUSION: These results suggest that MMP-9, TIMP-1, and the imbalance in MMP-9 and TIMP-2 might play important roles on the pathophysiology of KD and especially on the development of CAL. However, further larger studies are needed.
Coronary Vessels ; Enzyme-Linked Immunosorbent Assay ; Heart Diseases ; Humans ; Matrix Metalloproteinase 9 ; Matrix Metalloproteinases ; Mucocutaneous Lymph Node Syndrome ; Systemic Vasculitis ; Tissue Inhibitor of Metalloproteinase-1 ; Tissue Inhibitor of Metalloproteinase-2 ; Tissue Inhibitor of Metalloproteinases ; Vasculitis

BACKGROUND: Nuss procedure used in pectus excavatum repair is preferred, because of its excellent effect from the cosmetic point of view and improved pulmonary function, but it cause severe pain due to thoracic expansion after the operation. This study was designed to evaluate effective fentanyl dose using an intravenous patient-controlled analgesia (IV-PCA) pump for pain control following pectus excavatum repair in pediatric patients. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to received fentanyl 0.5microgram/kg/hr (Group I, n = 20), 0.7microgram/kg/hr (Group II, n = 20), and 1.0microgram/kg/hr (Group III, n = 20) via an IV-PCA pump (basal, 1 ml/h; bolus, 0.5 ml; lock out interval, 30 min) after operation. A blind observer evaluated each patient using the Children's Hospital of Eastern Ontario pain scale (CHEOPS) and the faces scale (FS). Incidences of side effects and pain control satisfaction were assessed at postoperative 48 hrs. RESULTS: There were no significant differences in CHEOPS or FS score between the groups the postoperative 48 hrs period. CHEOPS and FS scores at 4 and 8 hrs in groups II and III were significantly lower than in group I (P<0.05), but all groups showed lower CHEOPS and FS scores during the first postoperative 48 hrs. Satisfaction of pain control assessment by mothers was significantly higher in groups II and III than in group I (P<0.05). CHEOPS and FS scores were highly correlated with each other (P<0.001). CONCLUSIONS: We conclude that infusion of fentanyl at 0.5microgram/kg/hr using an IV-PCA pump is effective for pain control of 5 years of age or older after Nuss procedure.
Analgesia, Patient-Controlled* ; Fentanyl* ; Funnel Chest* ; Humans ; Incidence ; Mothers ; Ontario ; Thoracic Surgery