BACKGROUND: For an optimum treatment of infections, appropriate antimicrobials should be selected according to the results of antibiotic susceptibility test (AST). However, the present AST does not take into account of antimicrobial concentrations in tissues, although different tissues have different distribution of antimicrobials. Thereby we intended to evaluate the usefulness of interpreting antimicrobial susceptibility depending on tissue concentrations of antimicrobials. METHODS: Gram-negative bacilli isolated from clinical specimens at Yeungnam University Hospital during the period from January to July, 2006 were evaluated retrospectively. The data on blood concentration, half life and tissue distribution of antimicrobials with variable administration route and dosage were collected and arranged in the forms of previous reports. The diameters of the zone of inhibition from the disc diffusion method were converted to minimum inhibitory concentration (MIC) and the organism was regarded as resistant if the converted concentration was higher than the expected concentration in the tissue. RESULTS: Among the data reported as susceptible, antimicrobial concentrations in peritoneal fluid and bile showed a relatively good relationship with AST. But, aminoglycosides and carbenicllin concentrations in wounds and respiratory tissues were shown to be inadequate, thus resulting in a low bacteriologic cure. In cerebrospinal fluid, ciprofloxacin was less effective regardless of dosage. CONCLUSION: Antimicrobial concentration is variable in different tissues and more information on antimicrobial tissue distribution is needed for the appropriate treatment of infections. Reporting of MIC rather than AST with breakpoints should be considered for selection of antimicrobials. Therefore, an interpretation of AST in consideration of the tissue concentration would be more helpful for prevention of major errors and control of infections.
Aminoglycosides ; Ascitic Fluid ; Bile ; Cerebrospinal Fluid ; Ciprofloxacin ; Diffusion ; Half-Life ; Microbial Sensitivity Tests ; Retrospective Studies ; Tissue Distribution ; Wounds and Injuries

Phialemonium keratitis is a very rare case and we encountered a case of keratitis caused by Phialemonium obovatum (P. obovatum) after penetrating injury to the cornea. This is the first case report in the existing literature. A 54-year-old male was referred to us after a penetration injury, and prompt primary closure was performed. Two weeks after surgery, an epithelial defect and stromal melting were observed near the laceration site. P. obovatum was identified, and then identified again on repeated cultures. Subsequently, Natacin was administered every two hours. Amniotic membrane transplantation was performed due to a persistent epithelial defect and impending corneal perforation. Three weeks after amniotic membrane transplantation, the epithelial defect had completely healed, but the cornea had turned opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained opaque. Six months after amniotic membrane transplantation, visual acuity was light perception only, and corneal thinning and diffuse corneal opacification remained.
Cornea/*injuries/microbiology/pathology ; Diagnosis, Differential ; Eye Infections, Fungal/diagnosis/etiology/*microbiology ; Eye Injuries, Penetrating/*complications/diagnosis ; Follow-Up Studies ; Fungi/isolation & purification ; Humans ; Keratitis/diagnosis/etiology/*microbiology ; Male ; Middle Aged

Salmonella enteritica serovar Senftenberg is a rare pathogen in osteomyelitis, and is not usually encountered in healthy individuals. Here we report radiological and microbiological findings of a case of Brodie's abscess caused by S. enteritica serovar Senftenberg in the left tibia of an otherwise healthy child.
Abscess ; Child ; Humans ; Osteomyelitis ; Salmonella ; Tibia

Gonococcal conjunctivitis is rare in adults and, if not treated properly, can cause corneal perforation. Gonococcal conjunctivitis typically presents with a severe mucopurulent discharge, similar to that associated with viral conjunctivitis. Here, we describe a case of monocular gonococcal conjunctivitis, including its clinical characteristics and slit-lamp images, which was initially misdiagnosed as epidemic conjunctivitis. A 20-year-old man was referred to our hospital with no improvement in monocular infection and purulent ocular discharge after 2-wk treatment using antibiotic and 0.1% fluorometholone eye drops at the local ophthalmic clinic. Initially, 0.5% loteprednol eye drops were used since we suspected viral conjunctivitis. Following this treatment, conjunctival infection worsened and a yellow-white ocular discharge covered the conjunctiva and cornea surface. Additional history taking revealed that the patient had sexual contact with a prostitute 1 wk prior to symptom presentation and, after the encounter, he took antibiotics for genital discharge at the local urology clinic, but self-discontinued treatment. A Gram staining showed gram-negative diplococci and culture of collected ocular discharge from the palpebral conjunctiva revealed growth of Neisseria gonorrhoeae, confirming gonococcal conjunctivitis. Following this, the patient was systemically treated with 3rd generation cephalosporin antibiotics. After 3-d treatment, conjunctival infection and purulent ocular discharge had significantly improved. When clinical symptoms are aggravated following steroid eye drop treatment for suspected monocular viral conjunctivitis, gonococcal conjunctivitis must be considered as a differential diagnosis
Adult* ; Anti-Bacterial Agents ; Cephalosporins ; Conjunctiva ; Conjunctivitis* ; Conjunctivitis, Viral ; Cornea ; Corneal Perforation ; Diagnosis, Differential ; Fluorometholone ; Humans ; Loteprednol Etabonate ; Male* ; Neisseria gonorrhoeae ; Ophthalmic Solutions ; Sex Workers ; Urology ; Young Adult

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.
Serratia Infections/*epidemiology/*prevention & control/transmission ; Risk Factors ; Risk Assessment/*methods ; Population Surveillance ; Neurosurgery/*statistics & numerical data ; Middle Aged ; Male ; Korea/epidemiology ; Intensive Care Units/*statistics & numerical data ; Infection Control/methods/statistics & numerical data ; Incidence ; Humans ; Follow-Up Studies ; Female ; Disease Transmission, Horizontal/prevention & control/statistics & numerical data ; Disease Outbreaks/prevention & control/statistics & numerical data ; Case-Control Studies ; Bacteriuria/*epidemiology/*prevention & control

We report on the investigations and interventions conducted to contain an extended outbreak of Serratia marcescens bacteriuria that lasted for years in a neurosurgical intensive care unit (NSICU). A case-control study was performed to identify the risk factors for S. marcescens acquisition in urine. In case patients, urine sampling for tests and central venous catheterization were performed more frequently before the isolation of S. marcescens. Case patients were more frequently prescribed third-generation cephalosporins. Adherence to hand antisepsis was encouraged through in-service educational meetings and infection control measures, especially concerning the manipulation of indwelling urinary catheters, were intensified. The outbreak persisted despite the reinforcement of infection control measures. However, no patient has newly acquired the organism in the NSICU since December 2004. Multiple factors, including inadequate infection control practices and inappropriate antimicrobial usage, possibly contributed to the persistence of this S. marcescens outbreak. Healthcare workers should consistently follow infection control policies to ensure quality care.
Serratia Infections/*epidemiology/*prevention & control/transmission ; Risk Factors ; Risk Assessment/*methods ; Population Surveillance ; Neurosurgery/*statistics & numerical data ; Middle Aged ; Male ; Korea/epidemiology ; Intensive Care Units/*statistics & numerical data ; Infection Control/methods/statistics & numerical data ; Incidence ; Humans ; Follow-Up Studies ; Female ; Disease Transmission, Horizontal/prevention & control/statistics & numerical data ; Disease Outbreaks/prevention & control/statistics & numerical data ; Case-Control Studies ; Bacteriuria/*epidemiology/*prevention & control

BACKGROUND: With the emergence of antimicrobial resistance among Streptococcus pneumoniae, a more accurate and automated antimicrobial susceptibility testing method is essential. We evaluated the BD Phoenix Automated Microbiology System (Becton Dickinson Diagnostic Systems, USA) SMIC/ID-2 panel for antimicrobial susceptibility testing of S. pneumoniae. METHODS: A total of 113 clinical strains of S. pneumoniae (88 penicillin susceptible strains, 8 intermediate strains, and 17 resistant strains by 2008 CLSI criteria) were tested. Minimum inhibitory concentrations (MICs) for penicillin, cefotaxime, clindamycin, erythromycin, levofloxacin, trimethoprim/ sulfamethoxazole, tetracycline, and vancomycin were determined by Etest (AB Biodisk, Sweden) and Phoenix System. The results obtained by Phoenix system were compared to those obtained by Etest. RESULTS: The overall essential agreement of MICs (within one dilution of MICs) defined by the Phoenix and Etest was 92.3%. Neither very major errors nor major errors were produced, and minor errors were 6.5%. Minor errors were frequently observed in susceptibility testings for penicillin (22.1%), cefotaxime (12.4%), and trimethoprim/sulfamethoxazole (11.5%). CONCLUSIONS: The Phoenix SMIC/ID-2 panel provided a simple and rapid susceptibility testing for S. pneumoniae, and the results were in a good agreement with those of Etest. The Phoenix system appears to be an effective automated system in clinical microbiology laboratories.
Anti-Bacterial Agents/pharmacology ; Bacterial Typing Techniques/instrumentation/methods ; Drug Resistance, Bacterial ; Microbial Sensitivity Tests/*methods ; Reagent Kits, Diagnostic ; Streptococcus pneumoniae/*drug effects/growth & development/isolation & purification

Chronic neutrophilic leukemia (CNL) is a rare myeloproliferative neoplasm (MPN) characterized by persistent peripheral blood neutorphilia, bone marrow hypercellularity of neutrophilic granulocyte proliferation and hepatosplenomegaly. Acquired somatic mutation, JAK2 V617F, is the only molecular marker known to have association with classic BCR-ABL1 negative MPNs. However, JAK2 V617F has been detected occasionally in other MPNs such as CNL or other disease entities. We experienced a case of CNL with JAK2 V617F mutation. The patient was diagnosed according to the 2008 WHO classification criteria, and developed AML 9 months after the diagnosis of CNL. The JAK2 V617F was detected in the bone marrow throughout the clinical course. More cases are needed to establish the role of JAK2 V617F in the pathogenesis, prognosis and disease course of CNL.
Bone Marrow ; Granulocytes ; Humans ; Leukemia, Myeloid, Acute ; Leukemia, Neutrophilic, Chronic ; Neutrophils ; Prognosis

Cowden's syndrome is a harmatomatous polyposis syndrome with characteristic mucocutaneous lesions and among the spectra of clinical disorders that has been attributed to germline mutations in the PTEN gene. Although Cowden's syndrome has rarely been reported, immunologic studies have revealed that patients with this syndrome have humoral and/or cellular immune abnormalities. We recently identified a 21-year-old woman with Cowden's syndrome who was diagnosed with candida esophagitis without a history of diabetes, carcinoma, or steroid therapy. We report the immunologic status of this patient and the relationship with candida esophagitis on the basis of a literature review.
Candida ; Esophagitis ; Female ; Germ-Line Mutation ; Hamartoma Syndrome, Multiple ; Humans ; Young Adult

No abstract available.
Brain* ; Child* ; Humans ; Nervous System Diseases*