No abstract available.
Mass Screening* ; Tissue Transplantation* ; Transplants*

BACKGROUND: Serratia marcescens proliferates well in a humid environment or soil and is recently considered as an important pathogen for the severe nosocomial infections. this organism is spreads easily by hand-to-hand transmission, and contaminates medical equipment used for invasive procedures, working environment, medications, and soap. METHODS: We investigated the source of an outbreak of bloodstream infections by S. marcescens isolated that occurred during the period from July to December, 2004, at a university hospital in Gyeonggi Province and attempted to intervene in the outbreak and control it. RESULTS: From July to December, 2004, S. marcescens grew from 296 blood culture from 283 patients. The medical charts of the patients were reviewed, and surveillance cultures were taken to identify the outbreak of nosocomial infections and risk factors. Only four cases of infection were identified and all remaining positive blood cultures were due to contamination. Nine isolates randomly selected from the 296 S. marcescens showed an identical pulsed-field gel electrophoresis pattern. To identify the source of infection, environmental culture and hand cultures of the related medical workers were carried out, but S. marcescens was not isolated. CONCLUSION: As the result of aggressive infection control activities, such as re-education on environmental management methods, hand washing techniques, and blood culture sampling techniques, no more S. marcescens had been grown in blood culture since January, 2005.
Cross Infection ; Electrophoresis, Gel, Pulsed-Field ; Gyeonggi-do ; Hand ; Hand Disinfection ; Humans ; Infection Control ; Risk Factors ; Serratia marcescens ; Serratia* ; Soaps ; Soil

Since the World Health Organization has officially declared a global influenza pandemic, the number of human cases of pandemic influenza A (H1N1) in 2009 has been increasing in many countries. Especially from mid-October, the number of domestic cases of influenza A (H1N1) has been exponentially increasing, with the number of confirmed cases reaching over 100,000. The clinical symptoms of novel influenza A (H1N1) include fever, cough, sore throat, runny nose, myalgia, headache, chills and fatigue. Nucleic acid amplification tests, including real time RT-PCR assay specific for 2009 novel influenza A (H1N1) can be used in the patients with suspected influenza. Antiviral treatment by using neuraminidase inhibitors (oseltamivir, zanamivir) is recommended by Centers for Disease Control and Prevention for treatment of novel influenza A (H1N1) disease. Personal and public efforts to control the outbreak of novel influenza A (H1N1) disease are required. Vaccination against pandemic H1N1 is important for personal health, but also to build community-level immunity to novel influenza A.
Centers for Disease Control and Prevention (U.S.) ; Chills ; Cough ; Fatigue ; Fever ; Headache ; Humans ; Influenza, Human ; Neuraminidase ; Nose ; Nucleic Acid Amplification Techniques ; Oseltamivir ; Pandemics ; Pharyngitis ; Vaccination ; World Health Organization ; Zanamivir

The great increase in the numbers of the elderly people is one of the important challenges that our health care systems have to face and prepare. Many infectious diseases are more frequent in elderly persons, because of their decreased immune and physiologic functions. Elderly patients above the age of 65 are known to be at high risk for urinary tract infection. Urinary tract infection is the most common infection and also the first cause of bacteremia in the elderly. Most urinary tract infections in the elderly are either asymptomatic or mild and are easily managed. If left untreated, however, these infections can develop into severe and potentially life-threatening sepsis. Asymptomatic bacteriuria is neither the cause of morbidity nor associated with a higher mortality rate and thus treatment is not recommended. Older persons may not complain of typical urinary symptoms and usually have complicating factors including functional or structural abnormalities of the genitourinary tract. The epidemiology, pathogenesis, diagnosis and management of urinary tract infections in the elderly patients are discussed in this review according to their underlying diseases, sex, symptoms, and infection sites.
Aged ; Bacteremia ; Bacteriuria ; Catheters, Indwelling ; Communicable Diseases ; Cystitis ; Delivery of Health Care ; Humans ; Pyelonephritis ; Sepsis ; Urinary Tract ; Urinary Tract Infections

BACKGROUND: The influenza is a contagious respiratory illness caused by influenza viruses. The primary target groups recommended for annual vaccination are healthcare workers and households which have frequent contact with persons at high risk and can transmit influenza to those persons at high risk. Members of these groups should be vaccinated against the flu so that they can avoid getting infected with continuously mutating influenza viruses. We assessed healthcare workers' knowledge and attitudes regarding influenza vaccination in order to help promote the vaccination rate. METHODS: This survey was carried out in two hospitals affiliated with the Catholic University School of Medicine, from December 2004 to January 2005. Of the 3,023 questionnaires distributed, 2,023 could be evaluated. RESULTS: The most frequently cited reason for receiving influenza vaccine was self-protection against influenza (55.4%). The most common reasons for not receiving influenza vaccine are personal health problems such as concurrent flu, pregnancy or breast-feeding (29.2%). There is no significant difference in the frequency of side effect between two groups receiving and not receiving vaccine. The most frequent side effect of influenza vaccination is flu-like syndrome; People receiving vaccine have more significant knowledge than those people not receiving vaccine about efficacy of flu vaccination, risk of influenza infection of healthcare workers and their need of flu vaccination. CONCLUSION: In order to promote the vaccination rate, education targeting people at high risk need to keep continuous and facilitate access to vaccination.
Delivery of Health Care* ; Education ; Family Characteristics ; Humans ; Influenza Vaccines ; Influenza, Human* ; Orthomyxoviridae ; Pregnancy ; Vaccination* ; Surveys and Questionnaires

No abstract available.
Bacteremia/*microbiology ; Cross Infection/*microbiology ; Enterobacteriaceae Infections/*microbiology ; Female ; Humans ; Male ; Providencia/*isolation & purification ; *Tertiary Care Centers

Foreign bodies in the stomach are usually ingested by children under the age of 5 years, persons with dentures and alcoholics or mentally disturbed individuals. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metal, fish bones and etc. A toothpick in the stomach has been rarely reported in an alert adult. Here, we present a case of a patient with toothpick stuck in the stomach, that she did not realize she had swallowed. It was removed by an endoscopy without any complications. A 57 year-old woman was admitted to Uijoagbu St. Mary's hospital because of epigastric pain for 10 days. The pain persisted constantly in the epigastrium and aggravated after meals. Sbe had an episode of vomiting during these days. A yellowish white, thin, stiff material 1.5 cm long was found by an endoscopic examination stuck at the less curvature of the antrum. It was removed by the endoscopic biopsy forceps and was proved to be an wooden toothpick, sharp at both ends, with a length of 6.6cm and a diameter of 0.2 cm. There was a small ulcer at the site of the removed toothpick and mild bleeding from the ulcer. The epigastric pain was relieved after the removal of the toothpick. She did not realize she had swallowed the toothpick. Four days later, a follow-up endoscopic examination revealed closed ulcer and no bleeding. She was discharged without complications.
Adult ; Alcoholics ; Biopsy ; Child ; Dentures ; Endoscopy ; Female ; Follow-Up Studies ; Foreign Bodies ; Hemorrhage ; Humans ; Meals ; Middle Aged ; Numismatics ; Parents ; Stomach* ; Surgical Instruments ; Ulcer ; Vomiting

Tuberculous bronchoesophageal fistula is a rare disease. We experienced a case of the tuberculous bronchoesophageal fistula, which was found by endoscopy and surgically confirmed. A sixty seven years old female patient complained of foreign body sensation in the throat and frequent aspiration, especially after liquid meal. Esophagoscopic ex- aminatian showed the orifice of the fistula in the midesophagus at the level of 28 cm from the incisors. Esophagogram showed bronchoesophageal fistula between midesophagus and the right intermediate bronchus. A bronchoscopy visualized fistulous tract with granulation in the right intermediate bronchus. Biopsy specimens obtained from the bronchus revealed the esophageal tissue with granulation and multinucleated giant cells. Fistulectomy with wrapping procedure was performed successfully. Surgical pathologic findings confirmed a small focal granuloma and chronic inflammations, compatible with tuberculosis. There was no evidence of malignancy at the specimens. She was treated with anti-tuberculous agents and became well.
Biopsy ; Bronchi ; Bronchoscopy ; Endoscopy ; Female ; Fistula* ; Foreign Bodies ; Giant Cells ; Granuloma ; Humans ; Incisor ; Inflammation ; Meals ; Pharynx ; Rare Diseases ; Sensation ; Tuberculosis

BACKGROUND/AIMS: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. METHODS: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. RESULTS: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). CONCLUSIONS: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low.
Administration, Intravenous ; Aged ; Anti-Bacterial Agents/administration & dosage/adverse effects/*therapeutic use ; Cefuroxime/administration & dosage/adverse effects/*therapeutic use ; Community-Acquired Infections/diagnosis/*drug therapy/microbiology/urine ; Databases, Factual ; *Drug Resistance, Bacterial ; Escherichia coli/*drug effects/isolation & purification ; Escherichia coli Infections/diagnosis/*drug therapy/microbiology/urine ; Female ; Hospitalization ; Humans ; Microbial Sensitivity Tests ; Middle Aged ; Pyelonephritis/diagnosis/*drug therapy/microbiology/urine ; Remission Induction ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Urinalysis ; Urinary Tract Infections/diagnosis/*drug therapy/microbiology/urine ; Urine/microbiology

BACKGROUND: ESBL-producing Klebsiella spp. are increasing worldwide, and infections with ESBL-producing organisms are usually hospital-acquired and common infections with ESBL-producing organisms include urinary tract infections, peritonitis, cholangitis, intraabdominal abscesses and nosocomial pneumonia. We studied the phenotypic and genotypic characteristics of ESBL-producing K. pneumoniae, which were isolated from the patients in St. Vincent Hospital. METHODS: Susceptibility to antibiotic was determined by standard disk diffusion and agar dilution methods for all 22 strains of K. pneumoniae. PCR amplifications were performed with primers specific for TEM. SHY, and CMY-1 genes, and the DNA of the amplified products were sequenced. Total DNA was extracted from the isolates restricted with XbaI, and fingerprinted using pulsed-field gel electrophoresis. Crude preparations of beta-lactamase were obtained by sonications and used for characterization of beta-lactamase by isoelectric focusing. RESULTS: The MIC90 values for ceftazidime and aztreonam were 128 microgram/mL and 64 microgram/mL, respectively. The MIC90 values for cefotaxime and sulperazon were 8 microgram/mL and 4microgram/mL, respectively, and that for cefoxitin was 1.0 microgram/mL, which is much lower than the value for third-generation cephalosporins. The MICs for ciprofloxacin. cefepime, and imipenem were less than 1 microgram/mL for all organisms, which is within the susceptible range. Isoelectric focusing studies demonstrated three beta-lactamases with pls of 5.. (TEM-1), 7.6 (SHV-2a), and 8.2 (SHV-12). The presence of blaSHV and blaTEM genes was confirmed by specific PCRs and DNA sequencing analysis. but blaCMY-1 genes were not found. According to DNA sequencing analysis, 21 K. pneumoniae strains produced SHV-12 ESBL and one strain produced SHV-2a ESBL. CONCLUSIONS: Our results suggest that the resistance of K. pneumoniae from clinical isolates to extended spectrum beta-lactam antibiotics may be due to the production of SHY-type ESBL. This approach in detecting and characterizing ESBL will be valuable for the control of infection and antibiotics use in medical institution.
Abscess ; Agar ; Anti-Bacterial Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Cefoxitin ; Ceftazidime ; Cephalosporins ; Cholangitis ; Ciprofloxacin ; Dermatoglyphics ; Diffusion ; DNA ; Electrophoresis, Gel, Pulsed-Field ; Humans ; Imipenem ; Isoelectric Focusing ; Klebsiella pneumoniae* ; Klebsiella* ; Peritonitis ; Pneumonia ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Sonication ; Urinary Tract Infections