BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.
Ampicillin ; Anti-Infective Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Epidemiology* ; Hospitalization ; Humans ; Imipenem ; Incidence ; Klebsiella pneumoniae ; Klebsiella* ; Outpatients ; Pneumonia ; Research Personnel

BACKGROUND: In recent years, the incidence of extended-spectrum beta-lactamase (ESBL) producing Klebsiella has been steadily increased, and the newer species K. planticola and K terrigena, formerly regarded as nonpathogen, have been reported with astonishing frequency from human infectious processes by some investigators. The aim of this study is to elucidate the isolation rate and antimicrobial susceptibility of recent clinical Klebsiella isolates. METHOD: For the clinical Klebsiella isolates during the period of June 1999 to May 2000, isolation frequency of Klebsiella species by specimen, departments, age, and sex were analyzed. And antimicrobial susceptibilities were also analyzed. RESULT: Isolation rate of Klebsiella in order of decreasing frequency were K. pneumoniae (74:7%), K. oxytoca (12.1%), K. ozaenae(1.7%), K. planticola(1.0%), K. terngena(0.9%), and K, ornithinolytica (0.7%), respectively. K. rhinoscleromatis was not isolated. Compared with outpatients, increase of resistance rates of inpatients's Klebsiella isolates were 10% in ciprofloxacin, 15% in cefoperazone/sulbactam, and the others were ranged from 24% to 31%. Isolation rate of ESBL producing K. pneumoniae by double disk (DD) synergy test was 41%, and detection rates by antimicrobial agents were as follows: cefotaxime (95%), aztreonam (58%), and ceftriaxone (37%). Antimicrobial susceptibility rate with the exception of ampicillin and imipenem decreased from the range of 81%-96% on admission day to 29-62% after one week on admission. CONCLUSION: The isolation rates of K. planticola and K. terrigena were less than 1%. The proportion of ESBL producing K. pneumoniae was 41 %. And the vast majority of multidrug resistant Klebsiella including ESBL producing strains are acquired by hospitalization.
Ampicillin ; Anti-Infective Agents ; Aztreonam ; beta-Lactamases ; Cefotaxime ; Ceftriaxone ; Ciprofloxacin ; Epidemiology* ; Hospitalization ; Humans ; Imipenem ; Incidence ; Klebsiella pneumoniae ; Klebsiella* ; Outpatients ; Pneumonia ; Research Personnel

Emergency endoacopy was performed in 315 patients for recent four years The source of upper GI bleeding in these 315 caaes were as follows: Esophageal varix(93), gastric ca(39), Mallory-weiss syndrome(14), gastric ca(38), Duodenal ulces(21), Erosive gastritis(14), Marginal ulcer(2), Combined case(24) Unknown cases(10), Essentiall Tx was not performed in 4 died case because of poor general conditions, After check up BP, Heart, Pluae rate, that examination was performed during drip infusion to be 'safety of cireulatary system. No compication were encountered. To confirm the source of bleeding at earlier stage, was useful to decid which way, that is conservative of surgical therapy in which better for the Management. The results are as follows: 1) The sex incidence of upper GI bleeding showed Male predominance c a ratio 4. 6: 1 and peak age groups were 4th & 5th decade. 2) Endoscopic diagnosis of npper GI bleeding in the studied case were in the order of Esophageal varix bleeding(29%), Gastric ulcer (23. 5%), Mallory weiss syndrome(12. 4%) Duodenal ulcer(6.7%) Erosive gastritis(4.4%) We could not find the bleedi site in 3.2% of the studied case. 3) The cause of emergeney endoseopy are Melena(19%), Hemstenesis(22.0%) and ccenbined (58. 4%) 4) Among the 315 cases of upper GI bleeding, 70. 1% of the cases revealed moderste degree of bleeding. 5) Among the 315 cases of apper BI bleeding, 28. 1% of the cases were confirmed of inducing factor. 6) Among the 315 cases of upper BI bleeding, 69% of the cases received an endcrscopic examination within 72 hr after initial episode of bleeding. (continue...)
Diagnosis ; Emergencies* ; Endoscopy* ; Esophageal and Gastric Varices ; Heart ; Hemorrhage* ; Humans ; Incidence ; Infusions, Intravenous ; Male ; Stomach Ulcer

OBJECTIVES: The Personality Belief Questionnaire-Short Form (PBQ-SF) is a self-report instrument for assessment of dysfunctional beliefs based on Beck's cognitive formulations of personality disorders. The aims of this study was to examine the reliability and validity of the Korean version of PBQ-SF in clinical samples. METHODS: The Korean version of PBQ-SF was examined in 115 participants (50 patients with personality disorder and 65 patients without personality disorder). All participants were assessed for personality disorder using the semi-structured clinical interview of the Personality Assessment Schedule. The construction validity was examined by correlation with Beck Depression Inventory, Spielberger State-Trait Anxiety Inventory, and Neuroticism-Extraversion-Openness Five-Factor Inventory neuroticism scales. Twenty four randomly sampled patients were examined for the test-retest reliability. RESULTS: The Korean version of PBQ-SF showed good internal consistency [Cronbach's alpha=0.73 (schizoid)-0.92 (paranoid)] and test-retest reliability [r=0.74 (narcissistic)-0.92 (paranoid)]. The PBQ-SF was correlated with depression, anxiety, and neuroticism. The overall subscales of PBQ-SF were correlated with Diagnostic and Statistical Manual of Mental Disorders based diagnosis of personality disorders. CONCLUSION: Consistent with previous findings using the Korean full version of PBQ as well as the English version of PBQ-SF, our results support that the Korean version of PBQ-SF is a reliable and valid instrument for assessment of dysfunctional beliefs associated with personality pathology.
Anxiety ; Appointments and Schedules ; Depression ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Pathology ; Personality Assessment ; Personality Disorders ; Reproducibility of Results ; Weights and Measures

The authers performed long coloaofiherscopy with barium enema study on 134 cases, of coloreatal diseasea, who had been admitted to the department of Internal Medicine, Kwangiu Christian Hospital from July 1984 to Aupist 1986, The results were following: 1) Among 134 cases of colonoacopy, abnormal findings were 70 cases (52.2%) and normal findings 64 cases (47.8%). 2) among 70 cases of colonoscopic abnormal findings, nonspecific inflammatory colitis were 27 cases, colon tuberculosis 15 cases, colon and rectal cancer 14 cases, colon polyps 8 cases, ulcerative colitis 3 cases, internal hemorrhoid 2 cases, sigmoid diverticular 1 case. 3) The cases in which the findings of barium contrast enema were compatible with those of colonoscopy were 84 cases (62.7%), not compatible 50 cases(37.3%). There were not compatible with findings in 4 cases of colon cancer (10 cases), 7 cases of colon tuberculosis (15 cases), 4 cases of colon polyps (8 cases), 1 case of ulcerative colitis (3 cases). 4) The insertion ratio to ileocecal valve was 79.1%. The rate of correct approach by a colonoscopy to the lesion site shown at barium contrast enema was 94.1%
Barium ; Colitis ; Colitis, Ulcerative ; Colon ; Colon, Sigmoid ; Colonic Neoplasms ; Colonoscopes* ; Colonoscopy ; Enema ; Hemorrhoids ; Ileocecal Valve ; Internal Medicine ; Polyps ; Rectal Neoplasms ; Tuberculosis

No abstract available.
Epidemiologic Studies*

BACKGROUND: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. METHODS: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician's log and newly devised protocols recorded by paramedics or nurses. RESULTS: 1) Male to female ratio was 1:0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6+/-1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients. 4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment, performance of treatment, and adequate treatment were as follows: oxygen supply, 38.1/41.6/93.8; wound dressing, 19.3/71.8/92.9; immobilization of the cervical spine, 15.8/56.3/92.9; application of a spinal board, 12.9/42.3/72.7; application of a splint, 9.9/50.0/60.0; manual maintenance of an airway, 9.9/55.0/63.6; and CPR, 4.5/66.7/0.5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG, intubation medical administration, defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3%; endotracheal intubation, 8.9%; medical administration, 8.9%; defibrillation, 3.5%; and pacing, 1.5%. CONCLUSION: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.
Allied Health Personnel ; Ambulances ; Bandages ; Cardiopulmonary Resuscitation ; Electrocardiography ; Emergencies ; Emergency Medical Technicians ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Humans ; Immobilization ; Intubation ; Intubation, Intratracheal ; Male ; Oxygen ; Prospective Studies ; Spine ; Splints ; Triage* ; Wounds and Injuries

OBJECTIVES: To estimate mumps incidence during the study period and to evaluate the completeness of case reporting. METHODS: Capture-recapture methods, originally developed for counting wildlife animals, were used. The data sources were 1) the National Notifiable Communicable Disease Reporting System (NNCDRS; 848 cases), 2) the School Health Reporting System, temporarily administered by the Division of Education (SHRS; 1,026 cases), and 3) a survey of students (785 cases). We estimated the number of unobserved mumps cases by matching the three data sources and fitting loglinear models to the data. We then determined the estimated total number of mumps cases by adding this to the number of observed cases. Completeness was defined as the proportion of observed cases from each source to the total of estimated cases. RESULTS: The total number of observed cases was 1,844 and the total number of estimated cases was 1,935 (95% CI: 1,878-2,070). The overall completeness was 43.8% of the NNCDRS, 53.0% of the SHRS, and 40.6% of the survey. However, completeness varied by area and age. CONCLUSION: Although the completeness of NNCDRS data appeared higher than in the past, it is difficult to generalize this result. In Korea, it is possible to estimate the size of health hazards relatively cheaply and quickly, by applying capture-recapture methods to various data using a multiple data collection system.
Animals ; Communicable Diseases ; Information Storage and Retrieval ; Education ; Humans ; Incidence ; Jeju-do* ; Korea ; Mumps* ; School Health Services

BACKGROUND: Vancomycin-resistant enterococci (VRE) were first recovered from clinical isolates in Korea in 1992, and the incidence has been steadily increasing. Alternatives to vancomycin are few because VRE are frequently resistant to commonly used antimicrobial agents. The present study was designed to assess the in-vitro activity of fosfomycin to clinical isolates of VRE. METHODS: For 199 VRE isolates from 1995 to 2000, and 91 enterococcal isolates that were consecutively isolated during the January of 2001 at Wonju Christian Hospital, fosfomycin (200 microgram) disk diffusion test was done by NCCLS method. The number of enterococcal isolates tested for fosfomycin were as follows:58 E. faecalis (42 vancomycin susceptible isolates, 16 vancomycin resistant isolates, and 1 vancomycin intermediate resistance isolate); 210 E. faecium (185 vancomycin resistant and 25 vancomycin susceptible isolates); 15 E. gallinarum, and 6 E. casseliflavus isolates. RESULTS: Among the VRE isolates, the resistance rates of fosfomycin according to enterococcal species were 6.3% in E. faecalis, 4.9% in E. faecium, 0% in E. casseliflavus, and 16.7% in E. gallinarum. CONCLUSION: Fosfomycin could be a potentially useful drug for the treatment of infections caused by VRE.
Anti-Infective Agents ; Diffusion ; Enterococcus faecalis ; Enterococcus faecium ; Fosfomycin* ; Gangwon-do ; Incidence ; Korea ; Vancomycin*

BACKGROUND: Accurate detection of organisms producing extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase is very important for treatment of patients. However, unlike the ESBL confirmatory test, there are no guidelines for detection of organisms producing AmpC beta-lactamase. We evaluated a detection method using boronic acid (BA) for ESBL and AmpC beta-lactamase. METHODS: Clinical isolates of Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, and Proteus mirabilis showing intermediate resistance or resistance to cefoxitin (FOX) or positive for ESBL were tested. A > or =5 mm increase in zone diameter of ceftazidime/clavulanic acid/BA (CAZ/CA/BA) and/or cefotaxime/clavulanic acid/BA (CTX/CA/BA) versus CAZ/BA and/or CTX /BA was considered positive for ESBL. Likewise, a > or =5 mm increase in zone diameter of FOX/BA and/or cefotetan/BA (CTT/BA) versus FOX and/or CTT alone was considered positive for AmpC beta-lactamase. RESULTS: Among 622 clinical isolates, ESBL positive rates by the CLSI ESBL confirmatory test or by the BA method were 18.1% or 18.4% for E. coli, 38.3% or 40.4% for K. pneumoniae, 8.7% or 8.7% for K. oxytoca, and 14.8% or 14.8% for P. mirabilis, respectively. AmpC beta-lactamase positive rates using the BA method were 3.7% for E. coli, 33.3% for K. pneumoniae, 0% for K. oxytoca, and 7.4% for P. mirabilis. The detection rates of coproducing ESBL and AmpC beta-lactamase were 2.4% in E. coli 27.1% in K. pneumoniae, and 3.7% in P. mirabilis. CONCLUSION: The ESBL confirmatory method using BA was found to enhance the detection of ESBLs, even when potentially masked by AmpC beta-lactamase.
Bacterial Proteins ; beta-Lactamases ; Boron ; Cefoxitin ; Escherichia ; Escherichia coli ; Humans ; Klebsiella ; Klebsiella oxytoca ; Klebsiella pneumoniae ; Masks ; Mirabilis ; Penicillinase ; Pneumonia ; Proteus ; Proteus mirabilis