No abstract available.
Communicable Diseases

No abstract available.

No abstract available.
Asian Continental Ancestry Group ; Humans

Group A streptococci (GAS) cause diverse diseases ranging from mild to severe illnesses, and the global burden of GAS infections is enormous. Serological typing has been replaced by emm genotyping for the epidemiological study of GAS. Acute bacterial pharyngitis is a common illness, which requires either throat culture or rapid Ag test for diagnosis. Moreover, molecular point-of-care tests have been introduced owing to their higher sensitivity. Optimal diagnosis of bacterial pharyngitis is necessary for the adequate use of antibiotics. Although antimicrobial resistance (AMR) to erythromycin or clindamycin does not seem serious in Korea, it is very high in China, being reported at over 90%. Antibiotic surveillance and relevant education are necessary for primary clinical physicians and pediatricians. It is necessary to monitor AMR and develop a system for reporting the appearance of highly virulent diseases, such as necrotizing fasciitis or streptococcal toxic-shock syndrome, to the government authority.

BACKGROUND: The pre-storage condition of blood culture bottles prior to entering the automated blood culture system may affect the time to detection (TTD) of microorganisms and the final report days. METHODS: We compared the TTD and final report days according to the pre-incubation conditions after laboratory operating hours: room temperature (RT) vs. a BacT/Alert unit (BioMerieux Inc.) for 3 months respectively. All bottles were inserted into the main BacT/Alert system the next morning. RESULTS: TTD was significantly reduced by pre-incubating bottles in a BacT/Alert unit (median, 8.4 h) compared to pre-storage at RT (median, 12.4 h) (P< 0.001). The final report of bacterial identification and drug susceptibility within 2 days was available for 24.4% of bottles pre-incubated in a BacT/Alert unit compared to 14.9% of those incubated at RT. The false positive results were significantly higher for pre-incubation in a BacT/Alert unit (0.81%) than for that (0.29%) at RT (P<0.001). CONCLUSION: If a clinical microbiology laboratory is not operational for 24 hours, an automated blood culture unit might be a good alternative to reduce TTD and allow the submission of a faster final report compared to pre-storage at RT. However, false positive readings increased more than two-fold by pre-incubation in a BacT/Alert unit.
Reading

BACKGROUND: Reducing skin contamination rate and improving the positive rate in blood culture is essential for the correct diagnosis and management of sepsis. Chlorhexidine-alcohol was compared with povidone-iodine for the efficiency of disinfection. Positive rates were compared between the collection of 10 mL and 20 mL of blood per sample. METHODS: The study population included adult patients > or = 18 years old requested for blood culture in the Emergency Department. Povidone-iodine (10%) was used for antiseptic skin preparation from March to June 2011, and 0.5% chlorhexidine-alcohol from July to October 2011. The standard for blood collection was 10 mL in the first period and 20 mL in the second period. The dedicated phlebotomists had been educated on the optimal skin preparation and sample collection. RESULTS: After 10% povidone-iodine application, 31 of 2,755 samples (1.1%) were considered to be contaminated; whereas, a total of 60 of 3,064 samples (2.0%) were contaminated (P=0.011) after application of 0.5% chlorhexidine-alcohol. The positive rate of blood culture was 12.5% (345/2,755) in the first period versus 17.1% (524/3,064) in the second period (P<0.001). CONCLUSION: Both disinfectants appeared acceptable for skin preparation for blood culture collection, although chlorhexidine-alcohol had a higher contamination rate than povidone-iodine. The positive rate of blood culture was in accordance with the amount of sample collected. Continuous education and monitoring are needed for the proper collection and management of blood culture.
Adult ; Antisepsis ; Blood Volume ; Disinfectants ; Disinfection ; Emergencies ; Humans ; Povidone-Iodine ; Sepsis ; Skin

Background: Blood volume is the most important parameter for an optimal blood culture; however, the effect of blood volume on blood culture is not clearly understood from patients with sepsis. Methods: Blood cultures were obtained from 1,049 patients (≥ 15 years old) who visited the emergency department (ED). Two sets of 20 mL each was collected from each patient, 12 mL of which was transferred to 2 and 10 mL FA Plus (aerobic) bottles (bioMérieux, USA) and the remaining into an FN Plus (anaerobic) bottle. Medical records were reviewed to confirm the diagnosis and clinical significance of the blood culture isolates. The positive rate and time-todetection (TTD) were compared between the 2 and 10 mL groups. Results: Among the 2,098 sets collected, 612 sets (29.2%) were excluded due to inadequate (either too much or too little) blood volume. The positive rate of clinically significant pathogens was lower in the 2 mL group (6.1%) than in the 10 mL group (7.5%) (P = 0.003) among the 1,486 sets. However, there was no significant difference in the positive rate (11.0% vs. 12.5%, P= 0.152) and TTD (15.7 hours vs. 14.2 hours, P = 0.299) among the 585 (39.4%) patients with sepsis. Conclusion The positive rate and TTD were similar between the 2 and 10 mL groups from patients with sepsis who visited the ED, suggesting a high concentration of bacteremia in this group. Therefore, a smaller blood volume should be carefully considered in patients with sepsis in the ED.

Background: Blood volume is the most important parameter for an optimal blood culture; however, the effect of blood volume on blood culture is not clearly understood from patients with sepsis. Methods: Blood cultures were obtained from 1,049 patients (≥ 15 years old) who visited the emergency department (ED). Two sets of 20 mL each was collected from each patient, 12 mL of which was transferred to 2 and 10 mL FA Plus (aerobic) bottles (bioMérieux, USA) and the remaining into an FN Plus (anaerobic) bottle. Medical records were reviewed to confirm the diagnosis and clinical significance of the blood culture isolates. The positive rate and time-todetection (TTD) were compared between the 2 and 10 mL groups. Results: Among the 2,098 sets collected, 612 sets (29.2%) were excluded due to inadequate (either too much or too little) blood volume. The positive rate of clinically significant pathogens was lower in the 2 mL group (6.1%) than in the 10 mL group (7.5%) (P = 0.003) among the 1,486 sets. However, there was no significant difference in the positive rate (11.0% vs. 12.5%, P= 0.152) and TTD (15.7 hours vs. 14.2 hours, P = 0.299) among the 585 (39.4%) patients with sepsis. Conclusion The positive rate and TTD were similar between the 2 and 10 mL groups from patients with sepsis who visited the ED, suggesting a high concentration of bacteremia in this group. Therefore, a smaller blood volume should be carefully considered in patients with sepsis in the ED.

Pharyngitis is a prevalent disease of the upper respiratory tract that requires treatment with an antibiotic. Group A streptococci (GAS) are the most frequent etiologic agents of bacterial pharyngitis. Because GAS are susceptible to penicillin, routine antibiotic susceptibility testing is not needed. Generally, patients with bacterial pharyngitis have high fever, cervical lymphadenopathy and tenderness, and tonsillar exudative discharge without symptoms of the common cold (e.g., cough, rhinorrhea, and sneezing). However, differentiating bacterial pharyngitis from viral pharyngitis based only on their clinical manifestations is problematic. Therefore, a bacterial culture or a rapid antigen detection test (RADT) is required for the diagnosis of bacterial pharyngitis. Although bacterial culture is the gold standard for diagnosis of bacterial pharyngitis, its accuracy is affected by the technical expertise of the technician, and there is a delay of 1–2 days before the results become available. In contrast, the sensitivity of RADT has increased to over 90%, making them suitable for screening purposes. The result of a RADT is available within 5–10 minutes, obviating the need for a second visit to obtain the results of culture. Use of a RADT would enable the optimal antibiotic to be administered earlier, reducing the overuse of antibiotics.
Anti-Bacterial Agents ; Common Cold ; Cough ; Diagnosis ; Drug Resistance ; Fever ; Humans ; Immunologic Tests ; Lymphatic Diseases ; Mass Screening ; Penicillins ; Pharyngitis ; Professional Competence ; Respiratory System

Pharyngitis is a prevalent disease of the upper respiratory tract that requires treatment with an antibiotic. Group A streptococci (GAS) are the most frequent etiologic agents of bacterial pharyngitis. Because GAS are susceptible to penicillin, routine antibiotic susceptibility testing is not needed. Generally, patients with bacterial pharyngitis have high fever, cervical lymphadenopathy and tenderness, and tonsillar exudative discharge without symptoms of the common cold (e.g., cough, rhinorrhea, and sneezing). However, differentiating bacterial pharyngitis from viral pharyngitis based only on their clinical manifestations is problematic. Therefore, a bacterial culture or a rapid antigen detection test (RADT) is required for the diagnosis of bacterial pharyngitis. Although bacterial culture is the gold standard for diagnosis of bacterial pharyngitis, its accuracy is affected by the technical expertise of the technician, and there is a delay of 1–2 days before the results become available. In contrast, the sensitivity of RADT has increased to over 90%, making them suitable for screening purposes. The result of a RADT is available within 5–10 minutes, obviating the need for a second visit to obtain the results of culture. Use of a RADT would enable the optimal antibiotic to be administered earlier, reducing the overuse of antibiotics.