BACKGROUND: The Clinical and Laboratory Standards Institute (CLSI) recommends testing for inducible clindamycin resistance in clindamycin non-resistant and erythromycin resistant (CNR-ER) staphylococci by using a D-zone test. Recently, the VITEK2 system was developed to detect inducible clindamycin resistance in staphylococci. We evaluated the performance of the VITEK2 system by comparing it with a D-zone test. METHODS: In detecting inducible clindamycin resistance, a total of 142 clinical isolates of staphylococci were tested by using the VITEK2 Antimicrobial Susceptibility Test (AST)-P601 card (bioMerieux, Marcy l'Etoile, France) and the D-zone test. Of the 142 isolates of staphylococci tested, 114 were CNR-ER staphylococci [40 coagulase-negative staphylococci (CoNS), 74 Staphylococcus aureus] and 28 were staphylococci, either resistant or susceptible to clindamycin and erythromycin (1 CoNS and 27 S. aureus). RESULTS: Of the 114 CNR-ER staphylococci, 98.6% (73/74) of S. aureus and 32.5% (13/40) of CoNS were inducible clindamycin resistant according to the Dzone test. Overall sensitivity and specificity of the VITEK2 system were 98.8% (85/86) and 98.2% (55/56) respectively, and the agreement between the VITEK2 system and the D-zone test was 98.6% (140/142). CONCLUSION: The VITEK2 system shows high concordance with a D-zone test. The inducible clindamycin resistance in staphylococci can be detected easily and conveniently by the VITEK2 system.
Clindamycin ; Erythromycin ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

BACKGROUND: Blood culture bottles with an antimicrobial removal system have been developed for patients treated with antibiotics. This study compared the ability of BACTEC Plus Aerobic/F bottles (Becton Dickinson, USA, BACTEC Plus) and BacT/Alert FA bottles (bio-Merieux Vitek, France) to effectively remove antimicrobials. METHODS: BACTEC Plus and BacT/Alert FA bottles were spiked with 5 mL human blood, peak therapeutic concentrations of 9 antimicrobials and 7 type strains. Three rounds of duplicate testing were completed per antimicrobial/strain combination and growth control without antimicrobials. The time to detection (TTD) and recovery rates for bacteria were compared for both systems. RESULTS: Overall, the BACTEC Plus and BacT/Alert FA recovered 76% (128/168) and 34% (57/168) of strains from test bottles, respectively. BACTEC Plus detected all of gram-positive bacteria except S. pneumoniae with ampicillin and ceftriaxone, but BacT/Alert FA detected 0~50% of gram-positive bacteria except E. faecalis with vancomycin and methicillin-resistant S. aureus with oxacillin. In presence of cefepime, cefotaxime, cefoxitin and ceftriaxone, BACTEC Plus detected 33~100% of gram-negative bacteria, but BacT/ Alert FA did not detect gram-negative bacteria at all. In presence of ciprofloxacin, BacT/Alert FA detected 100% of E. coli and K. pneumoniae compared with 33% of those for BACTEC Plus. Overall, TTD of BACTEC Plus was shorter than that of BacT/Alert FA except in detecting gram-negative bacteria with ciprofloxacin (P<0.05). CONCLUSION: BACTEC Plus Aerobic/F media containing peak therapeutic levels of antimicrobials are more effective and faster detection of bacteria than BacT/Alert FA media.
Ampicillin ; Anti-Bacterial Agents ; Bacteria ; Cefotaxime ; Cefoxitin ; Ceftriaxone ; Cephalosporins ; Ciprofloxacin ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Methicillin Resistance ; Oxacillin ; Pneumonia ; Vancomycin

BACKGROUND: Rotavirus is the most common cause of childhood gastroenteritis during winter season. Rapid, accurate diagnosis is essential for preventing severe complications of rotaviral gastroenteritis. The sensitivity and specificity of five detection test kits for rotavirus including latex agglutination (LAT), enzyme immunoassay (EIA) and three immunochromatographic methods (ICG) were evaluated in this study. METHODS: A total of 95 stool samples collected from patients with acute gastroenteritis were studied. The test kits were as follows: LAT (Slidex latex, bioMerieux Vitek, France); three kinds of ICG (Dipstick ROTA, Eiken, Japan; SAS Rota Test, SA Scientific, Inc., USA; and ASAN Easy Test Rota strip, ASAN Pharmaceutical., Korea); and EIA (VIDAS Rotavirus, bioMerieux Vitek). The samples showing discordant results were reevaluated by reverse-transcription (RT) PCR and clinical manifestations. RESULTS: Of a total of 95 cases, 56 (58.9%) were positive and 39 (41.1%) were negative. Thirteen cases showed discordant results. Sensitivity and specificity were, respectively, 85.7% and 100% for LAT, 100% and 95% for both of Dipstick ROTA and SAS Rota, 86.7% and 87.5% for ASAN Rota strip and 98.1% and 97.3% for EIA. CONCLUSIONS: LAT was rapid and easy to perform and showed the lowest sensitivity among the five test kits. ICG showed a good agreement with EIA and RT-PCR. EIA was the best in respect of sensitivity and specificity, but difficulty in interpretations of equivocal results and time-consuming procedures were limitations. In conclusion, ICG, which is easy to perform at a low cost, may be an optimal method in place of LAT for the detection of rotavirus.
Antigens, Viral/*analysis ; Chromatography/*methods ; Enzyme-Linked Immunosorbent Assay/*methods ; Gastroenteritis/virology ; Humans ; Latex Fixation Tests/*methods ; Reagent Kits, Diagnostic ; Reverse Transcriptase Polymerase Chain Reaction ; Rotavirus/immunology/*isolation & purification ; Rotavirus Infections/*diagnosis ; Sensitivity and Specificity

Epiglottitis is an uncommon but potentially life threatening infectious disease in young children. And it is rapidly progressing cellulitis of the epiglottis and adjacent structures that has the potential for causing abrupt, complete airway obstruction. The most common cause of acute epiglottitis is Haemophilius influenzae type b(Hib), therefore in USA, the acute epiglottitis is seen less commonly since the wide spread use of immunization against Hib. In Korea, there has been no report of acute epiglottitis caused by known bacterial organism, and a little investigation of the effects of the immunization against Hib, or Hib related respiratory diseases. In this report, we describe two cases of acute epiglottitis caused by Hib, occurred in non-immunized young-male children admitted to Ajou University Hospital. They had visited to the emergency center of Ajou University hospital with the complaints of acute fever, drooling, dysphagia and severe respiratory difficulties. In both cases, we observed the cherry-red colored, severely swollen epiglottis by the direct laryngoscopic examination. Hib was cultured in blood samples from both two cases, and the patients treated successfully by the 3 days of endotracheal intubation and proper antibiotics therapy without any complications such as pneumonia, meningitis, osteomyelitis, or pericarditis.
Airway Obstruction ; Anti-Bacterial Agents ; Cellulitis ; Child ; Communicable Diseases ; Deglutition Disorders ; Emergencies ; Epiglottis ; Epiglottitis* ; Fever ; Haemophilus influenzae type b* ; Haemophilus influenzae* ; Haemophilus* ; Humans ; Immunization ; Influenza, Human ; Intubation, Intratracheal ; Korea ; Meningitis ; Osteomyelitis ; Pericarditis ; Pneumonia ; Sialorrhea

OBJECTIVES: This study investigated the relationship between depression, attachment and addiction problems in runaway youths. METHODS: We sent a questionnaire package to 187 runaway youths in 18 adolescent shelters. The questionnaire package collected their sociodemographic data and included the Patient Health Questionnaire-9, Inventory of Parent Attachment (IPA), Korean Internet Addiction Self-Scale (K-Scale), Korean version of Alcohol Use Disorders Identification Test, and Korean version of the Fagerström Test for Nicotine Dependence. RESULTS: The percentage of youth with depression was 28.8% (N=54). In the depression group, there were significantly more problematic alcohol users (53.06%, p=.0199) and significantly lower IPA scores (p=.0064). There was a significant negative correlation between depression and a IPA, and significant positive correlation between depression and the K-Scale. CONCLUSION: These results suggest that runaway youths with depression have more problematic alcohol drinking and attachment problems.
Adolescent* ; Alcohol Drinking ; Child ; Depression* ; Homeless Youth* ; Humans ; Internet ; Parents ; Tobacco Use Disorder

BACKGROUND: Despite the diagnostic utility of immunophenotyping for myelodysplastic syndromes (MDS), it has not been widely performed, and reports on this are absent in Korea. We aimed to evaluate the immunophenotypic features of non-blastic granulocytes, monocytes, and blasts in patients with MDS and non-clonal disorders using routine flow cytometry (FCM). Moreover, we evaluated the phenotypic abnormalities of mature cells in leukemic patients. METHODS: Marrow aspirates from 60 patients, including 18 with MDS, 18 with leukemia, and 24 with non-clonal disorders (control group), were analyzed using FCM. Blasts, non-blast myeloid cells, and monocytes were gated based on CD45 expression and side scatter (SSC). The phenotypes were then compared among the 3 groups. RESULTS: Compared to non-clonal disorders, the granulocytic lineages of MDS showed decreased SSC (P=0.005), increased CD45 intensity (P=0.020), decreased CD10-positive granulocytes (P= 0.030), and a higher CD56-positive rate (P=0.005). It is noteworthy that similar results were obtained in the leukemia group, and these findings were not related to the phenotypes of the leukemic cells. Using blast and monocytic gating, useful parameters for generating a differential diagnosis were not found. CONCLUSIONS: Gating the granulocytic region is a relatively easy method for MDS immunophenotyping. Among the parameters studied, SSC, CD10, and CD56 were the most useful for differentiating MDS from non-clonal disorders. While immunophenotypic changes in MDS appear to be useful for differentiating MDS from non-clonal disorders, these changes were also noted in the mature cells of leukemic patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antigens, CD45/metabolism ; Antigens, CD56/metabolism ; Bone Marrow Cells/cytology ; Cell Lineage ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Flow Cytometry ; Granulocytes/*classification ; Humans ; *Immunophenotyping ; Leukemia/diagnosis/pathology ; Male ; Middle Aged ; Monocytes/*classification ; Myelodysplastic Syndromes/*diagnosis ; Neprilysin/metabolism ; Phenotype

OBJECTIVES: Firefighters frequently experience traumatic events, high-tension situations and shift work. Therefore, the prevalence of insomnia of firefighters is higher than one of general population. Not only does the quality of sleep affect the satisfaction of personal life, but it also influences their performance for the public's safety. We investigated which factors affect the quality of sleep of firefighters. METHODS: After personally delivering 120 questionnaires to 3 fire stations, the survey was conducted when the consents were signed. It inquired about alcohol use, smoking, shift work, sleep quality, depression, anxiety, and experience of traumatic events. We then divided the firefighting officers in two groups according to the quality of sleep and compared the variables examined to conduct the logistic regression analyses according to the results. RESULTS: The poor sleeper group reported a higher level of current alcohol consumption, depression, anxiety and experience of traumatic events. Logistic regression analyses showed that the current alcohol intake (Crude odds ratio=3.707, 95% confidence interval=1.288–10.672, p=0.015 ; Adjusted odds ratio=3.288, 95% confidence interval=1.011–10.694, p=0.048) has a significant effect on sleep quality. CONCLUSIONS: Current alcohol consumption, depression, anxiety and experience of traumatic events were respectively associated with sleep quality of firefighters. When all significant factors considered, the current alcohol use was the only statistically significant. To improve the quality of sleep for firefighters, it will be necessary to evaluate alcohol intake, educate the poor sleep quality caused by alcohol, and provide specific interventions to reduce consumption.
Alcohol Drinking ; Anxiety ; Depression ; Firefighters ; Fires ; Humans ; Logistic Models ; Prevalence ; Sleep Initiation and Maintenance Disorders ; Smoke ; Smoking

BACKGROUND: Morning blood pressure surge affects to cardiovascular disease risk. Short time to first cigarette (TTFC) after waking can enhance morning blood pressure surge, and accelerate atherosclerosis METHODS: We investigated that the relationship between TTFC and blood pressure. The study subjects included male current smokers (n=211) who had health check-up in Hallym University Sacred Heart Hospital from July to September, 2014. We categorized the subjects into 2 groups according to TTFC; early TTFC (TTFC <30 minutes) and late TTFC (TTFC > or =30 minutes), and the subjects who were taking antihypertensive medications or had a high blood pressure (>140 mm Hg or 90 mm Hg) were defined as hypertensive group. Multivariate logistic regression was performed to estimate the odds ratio and 95% confidence interval to investigate the association between TTFC and hypertensive group. RESULTS: Compared with late TTFC, early TTFC had higher odds (odds ratio [OR], 3.87; 95% confidence interval [CI], 1.89-7.94) for hypertensive group. After adjusting confounding factors, early TTFC was significantly associated with an increased risk of hypertension (OR, 4.43; 95% CI, 1.84-10.70). CONCLUSION: early TTFC after waking is associated with hypertension. It suggests delaying TTFC might help to control of blood pressure among the current smokers who are not ready to immediately quit smoking.
Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Heart ; Humans ; Hypertension* ; Logistic Models ; Male* ; Metabolic Syndrome X ; Odds Ratio ; Smoke ; Smoking ; Tobacco Products*

BACKGROUND: Concerns regarding increasing microbial resistance to vancomycin have resulted in recommendations for a higher trough serum vancomycin concentration. This study aimed to assess the dosage guidelines targeting vancomycin trough concentrations of 15-20 mg/L. METHODS: About 216 adult patients (age, >60 yr) were treated with intravenous vancomycin. The patients were divided into 2 groups according to their target vancomycin trough concentrations: the previous guideline group (n=108) treated with targeted vancomycin trough concentrations of 5-15 mg/L from Jan 2009 through April 2011 and the new guideline group (n=108) treated with targeted concentrations of 15-20 mg/L from November 2011 through July 2012. RESULTS: The 2 groups were not significantly different with respect to age, weight, initial serum creatinine, initial creatinine clearance, predictive trough levels, doses, serum drug concentrations, and area under the curve/minimal inhibitory concentrations. Regarding the proportions of vancomycin trough concentrations, the target range was achieved in 50% in the previous guideline group and in 16% in the new guideline group. In the previous and new guideline groups, the trough concentrations of 10-20 mg/dL were observed in 32.4% and 52.8% patients, respectively, and those of <10 mg/L were observed in 45.4% and 29.6%, respectively. CONCLUSIONS: Compared to the previous guideline group, the new guideline group showed higher proportions in the therapeutic range of 10-20 mg/L and lower proportions in trough concentrations <10 mg/L. The strictly managed vancomycin therapeutic drug monitoring in the new guideline group was assessed as more effective.
Aged ; *Drug Monitoring ; Female ; Gram-Positive Bacterial Infections/drug therapy ; Guidelines as Topic ; Half-Life ; Humans ; Injections, Intravenous ; Male ; Middle Aged ; Vancomycin/*blood/pharmacokinetics/therapeutic use

BACKGROUND: This study examined the differences in factors associated with albuminuria according to gender and comorbidities of hypertension (HTN) and diabetes mellitus (DM). METHODS: We included 3,859 participants aged 20 to 79 years (55% female) from the 5th Korea National Health and Nutrition Examination Survey. Participants were excluded if they took antihypertensive or anti-diabetic medication, had chronic renal failure, had malignant tumor, were pregnant or menstruating during the health examination, or had missing urine albumin data. Albuminuria was defined by the participant's urine albumin-creatinine ratio (uACR). Relationships between dependent and independent variables were analyzed using the Pearson's correlation test and simple linear regression. Due to possible muticollinearity, multiple linear regression analysis was used to determine whether the association between the dependent and independent variables of interest remained significant after adjustment for other potentially confounding independent variables. RESULTS: The variables significantly correlated with uACR were different between the genders and between subjects with HTN or DM as a comorbidity. In the multiple linear regression models, hemoglobin A1c (P=0.01) was positively associated with uACR in men without HTN and DM. In men with HTN or DM, systolic blood pressure and fasting glucose (P<0.01) were positively associated with uACR. In women with HTN or DM, waist circumference (P=0.011) and gamma-glutamyl transpeptidase (P<0.001) were positively correlated with uACR (P<0.05) and glucose level (P=0.019) was negatively correlated with uACR. CONCLUSION: The study suggested factors correlated with albuminuria were different for men and women according to comorbidities such as HTN and DM.
Albuminuria* ; Blood Pressure ; Comorbidity* ; Diabetes Mellitus ; Fasting ; Female ; gamma-Glutamyltransferase ; Gender Identity ; Glucose ; Humans ; Hypertension* ; Kidney Failure, Chronic ; Korea ; Linear Models ; Male ; Nutrition Surveys ; Waist Circumference