Aims: This study was aimed to identify the risk factors for the acquisition of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae on non-ventilator hospital-acquired pneumonia (NV-HAP) patients in a tertiary care hospital in Indonesia. Methodology and results: A case-control study was performed between March 31, 2018, and August 31, 2019. Twenty-eight ESBL-producing E. coli and K. pneumoniae isolates and 28 susceptible strains of E. coli and K. pneumoniae obtained from NV-HAP patients were included in this study. Phenotypic screening for ESBL production was performed by the Vitek2 system and subsequently confirmed by double-disk synergy tests. The use of 3rd generation cephalosporin as initial antibiotic therapy for more than three days was the significant risk factor for the acquisition of ESBL-producing E. coli and K. pneumoniae among NV-HAP patients (odds ratio [OR] 41.827; p=0.001). The length of stay of patients with NV-HAP acquiring the ESBL strains was longer than 10 days (OR 17.334; p=0.001). Conclusion, significance and impact of study The use of 3rd generation cephalosporin as the initial antibiotic for NV-HAP should be restricted to prevent the emergence of ESBL-producing strains. Infection prevention measures are required to control the acquisition of ESBL-producing E. coli and K. pneumoniae in NV-HAP patients.
beta-Lactamases ; Escherichia coli ; Klebsiella pneumoniae ; Cross Infection ; Healthcare-Associated Pneumonia ; Tertiary Care Centers

healthcare worker (HCW) is important for preventing transmission in the hospital. We evaluated the seroprevalence of mumps in HCWs in a tertiary care hospital in Republic of Korea. A total of 6,055 HCWs born between 1950 and 1995 underwent antibody testing. The overall seropositivity rate of mumps was 87% (95% confidence interval, 86%–87%). Our data indicates that, in Korean HCWs, testing for mumps antibody followed by mumps vaccination is more appropriate than routine mumps vaccination without testing for mumps antibody.]]>
Delivery of Health Care ; Health Personnel ; Humans ; Korea ; Measles-Mumps-Rubella Vaccine ; Mumps ; Republic of Korea ; Seroepidemiologic Studies ; Tertiary Healthcare ; Vaccination

tertiary care hospital in the ROK between 2017 and 2018 were evaluated.RESULTS: Out of 37 patients with hvKP liver abscess, 11 patients were noted to have K. pneumoniae isolated from stool samples and were enrolled for analysis. The median age was 71 years. For hvKP isolates from the liver aspirate samples, the most common serotype was K1 (72.7%) followed by K2 (27.3%). For K. pneumoniae isolates from the stool sample, the majority was non-K1/K2 serotype (72.7%). Among non-K1/K2 serotype isolates, high variability of sequence type (ST; ST15, ST307, ST37, ST273, ST2622, and ST42) with high rate of presence of extended-spectrum beta-lactamase (100.0%) was noted. The concordance rate of the K. pneumoniae isolates between the liver aspirate samples and the stool samples from the primary hvKP liver abscess was low (27.3%).CONCLUSION: This study suggests that significant heterogeneity of K. pneumoniae colonizing intestinal tract of the hvKP liver abscess patients. Further studies involving a larger number of hvKP liver abscess patients with continuing surveillance are needed to define the changing epidemiology and the role of gastrointestinal K. pneumoniae in the hvKP liver abscess patients in the ROK.]]>
beta-Lactamases ; Colon ; Epidemiology ; Far East ; Humans ; Klebsiella pneumoniae ; Klebsiella ; Liver Abscess ; Liver ; Pneumonia ; Population Characteristics ; Republic of Korea ; Serogroup ; Tertiary Healthcare

PURPOSE: While there is an urgent need for diagnosis and therapeutic intervention in patients with primary immunodeficiency diseases (PIDs), current genetic tests have drawbacks. We retrospectively reviewed the usefulness of flow cytometry (FCM) as a quick tool for immunophenotyping and functional assays in patients suspected to have PIDs at a single tertiary care institute.METHODS: Between January 2001 and June 2018, patients suspected of having PIDs were subjected to FCM tests, including lymphocyte subset analysis, detection of surface- or intracellular-target proteins, and functional analysis of immune cells, at Samsung Medical Center, Seoul, Korea. The genetic diagnosis was performed using Sanger or diagnostic exome sequencing.RESULTS: Of 60 patients diagnosed with definite or probable PID according to the European Society of Immune Deficiencies criteria, 24 patients were provided with useful information about immunological dysfunction after initial FCM testing. In 10 patients, the PID diagnosis was based on abnormal findings in FCM testing without genetic tests. The FCM findings provided strong evidence for the diagnosis of severe combined immunodeficiency (n = 6), X-linked chronic granulomatous diseases (CGD) (n = 6), leukocyte adhesion deficiency type 1 (n = 3), X-linked agammaglobulinemia (n = 11), autoimmune lymphoproliferative syndrome-FASLG (n = 1), and familial hemophagocytic lymphohistiocytosis type 2 (n = 1), and probable evidence for autosomal recessive-CGD (n = 2), autosomal dominant-hyper-immunoglobulin E (IgE)-syndrome (n = 1), and STAT1 gain-of-function mutation (n = 1). In PIDs derived from PIK3CD (n = 2), LRBA (n = 2), and CTLA4 mutations (n = 3), the FCM test provided useful evidence of immune abnormalities and a tool for treatment monitoring.CONCLUSIONS: The initial application of FCM, particularly with known protein targets on immune cells, would facilitate the timely diagnosis of PIDs and thus would support clinical decisions and improve the clinical outcome.
Agammaglobulinemia ; Diagnosis ; Exome ; Flow Cytometry ; Genetic Testing ; Granulomatous Disease, Chronic ; Humans ; Immunophenotyping ; Korea ; Leukocytes ; Lymphocyte Subsets ; Lymphohistiocytosis, Hemophagocytic ; Phenotype ; Retrospective Studies ; Seoul ; Severe Combined Immunodeficiency ; Tertiary Healthcare

OBJECTIVE: To analyze the trends in demographics and outcomes of patients presenting with traumatic brain injury by performing a retrospective database review of the Illinois Department of Public Health (IDPH) Trauma Registry.METHODS: We utilized the IDPH Trauma Registry to retrieve data on patients treated for traumatic brain injuries at our large, tertiary care hospital from 2004 to 2012, inclusive. From this data, logistic regression models were used to analyze and compare basic demographics such as age, sex, and clinical outcome.RESULTS: Three thousand and thirty-nine patients were analyzed with a mean age of 43 (standard deviation, 24) and a median age of 41 (interquartile range, 23 to 60). Over the study period, patients’ age increased steadily from 32 to 49 years. The percentage of female patients increased, from 16.4% to 27.5% over the last 4 years. Overall mortality was greater for males than females (22.1% vs. 17.3%; odds ratio [OR], 1.36; 95% confidence interval [CI], 1.10 to 1.68). Mortality decreased over the period (OR, 0.88; 95% CI, 0.85 to 0.91), with a greater decrease in females (OR, 0.84; 95% CI, 0.78 to 0.90) than in males (OR, 0.90; 95% CI, 0.86 to 0.94).CONCLUSION: Although the age of patients presenting with traumatic brain injury is increasing substantially, the data suggests that overall mortality appears to be decreasing, and this decrease appears to be greater in females than in males. These changes in trends found in the IDPH Trauma Registry supports the importance for further analysis of other reliable public datasets to identify areas of future study.
Brain Injuries ; Dataset ; Demography ; Emergency Service, Hospital ; Female ; Humans ; Illinois ; Logistic Models ; Male ; Mortality ; Odds Ratio ; Patient Outcome Assessment ; Public Health ; Retrospective Studies ; Tertiary Healthcare

OBJECTIVE: This study aimed to examine the effect of vitrification on apoptosis and survival in human preantral follicles after thawing.METHODS: This experimental study was conducted at an acute tertiary care hospital from March 2012 to April 2013. Ovaries were sliced into 5×5×1-mm pieces and divided into the following three groups: preantral follicle isolation, ovarian tissue vitrification-warming followed by follicle isolation, and immunohistochemistry of fresh ovarian tissue. For statistical analyses, the Student t-test, chi-square test, Kruskal-Wallis test, and Kaplan-Meier survival analysis were used.RESULTS: A total of 161 preantral follicles (70% secondary) were collected from ovarian cortex tissue of six women between 30 and 37 years of age who underwent oophorectomy due to cervical cancer or breast cancer. There were no significant differences in the follicular morphology of fresh preantral follicles and vitrified follicles after thawing. The mean Fas ligand (FasL) mRNA expression level was 0.43±0.20 (relative to β-actin) in fresh preantral follicles versus 0.51±0.20 in vitrified follicles (p=0.22). The mean caspase-3 mRNA expression level in fresh preantral follicles was 0.56±0.49 vs. 0.27±0.21 in vitrified follicles (p=0.233). One vitrified-thawed secondary follicle grew and developed to an antral follicle within 6 days of culture.CONCLUSION: Vitrification did not affect preantral follicle morphology or mRNA expression of the apoptosis markers FasL and caspase-3. Further studies are required to establish whether vitrification affects the outcomes of in vitro culture and the maturation of preantral follicles.
Apoptosis ; Breast Neoplasms ; Caspase 3 ; Fas Ligand Protein ; Female ; Humans ; Immunohistochemistry ; In Vitro Techniques ; Ovariectomy ; Ovary ; RNA, Messenger ; Tertiary Healthcare ; Uterine Cervical Neoplasms ; Vitrification

PURPOSE: Diagnosis of anaphylaxis depends on clinical manifestations and a high index of suspicion, and a misdiagnosis can lead to a preventable death. We aimed to investigate age group characteristics of clinical features and epinephrine use in children with anaphylaxis who visited the emergency department (ED).METHODS: We performed a retrospective chart review of 138 children who visited a tertiary care hospital ED from January through December 2018, and were discharged with anaphylaxis as the diagnosis. Anaphylaxis was defined according to the National Institutes of Allergy and Infectious Disease criteria. The children were divided into 4 age groups; infants (< 1 year), preschoolers (1–5 years), schoolers (6–11 years), and adolescents (12–18 years). Clinical features and epinephrine use were compared among the age groups.RESULTS: Of the 138 children with presumed anaphylaxis, 108 met the criteria. The most common cause was food (74%), followed by drugs (10.2%). Epinephrine was used in 82 children (75.9%). The infants and preschoolers reported less frequent cardiovascular symptoms (0%–3.6% vs. 26.5%, P = 0.020) and epinephrine use (33.3%–70.9% vs. 91.2%, P = 0.037) compared to the adolescents. The former 2 age groups reported food as triggers more frequent, and often reported food-associated and respiratory or gastrointestinal symptoms.CONCLUSION: Infants and preschoolers with anaphylaxis may undergo less frequent cardiovascular symptoms and epinephrine use compared to adolescents. This feature prompts to increased epinephrine use in the former age groups even without ageadjusted hypotension.
Academies and Institutes ; Adolescent ; Anaphylaxis ; Child ; Communicable Diseases ; Diagnosis ; Diagnostic Errors ; Emergencies ; Emergency Service, Hospital ; Epinephrine ; Hospitals ; Humans ; Hypersensitivity ; Hypotension ; Infant ; Retrospective Studies ; Tertiary Healthcare

STUDY DESIGN: Prospective clinical study. PURPOSE: We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. OVERVIEW OF LITERATURE: Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis. METHODS: Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis. RESULTS: Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated. CONCLUSIONS: Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum C-reactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.
Alkaline Phosphatase ; C-Reactive Protein ; Causality ; Clinical Study ; Comorbidity ; Diagnosis ; Discitis ; Follow-Up Studies ; Humans ; Low Back Pain ; Lumbar Vertebrae ; Phosphoric Monoester Hydrolases ; Prospective Studies ; Spine ; Staphylococcal Infections ; Staphylococcus aureus ; Tertiary Care Centers ; Tertiary Healthcare ; Visual Analog Scale

The susceptibility of Escherichia coli from community onset urinary tract infection (UTI) was evaluated by dividing community onset UTI into the simple community acquired-UTI (CA-UTI) and healthcare associated UTI (HCA-UTI) groups for a period of 10 years. The susceptibility of E. coli to most antibiotics, except amikacin and imipenem, continued to decrease. In the CA-UTI group, the susceptibility to cefotaxime was 88% in 2015, but rapidly decreased to 79.3% in 2017. The susceptibility to cefepime and piperacillin-tazobactam were 88.8% and 90.5% in 2017, respectively. In the HCA-UTI group, the susceptibility to most antibiotics markedly decreased to less than 60% by 2017. The incidence of ESBL-producing E. coli increased to 23.3% in the CA-UTI group in 2017.
Amikacin ; Anti-Bacterial Agents ; Cefotaxime ; Delivery of Health Care ; Escherichia coli ; Escherichia ; Imipenem ; Incidence ; Korea ; Tertiary Healthcare ; Urinary Tract Infections ; Urinary Tract

OBJECTIVE: Neurological symptoms in hospitalized patients are not rare, and neurological consultation for movement disorders is especially important in evaluating or managing those with various movement disorders. Therefore, we investigated a clinical pattern of in-hospital consultations for various movement disorders in a tertiary care university hospital. METHODS: Over two years, a total of 202 patients (70.7 ± 11.8 years of age) presenting with movement disorders referred to movement disorder specialists were investigated. RESULTS: The main symptoms referred by nonneurologists were tremor (56.9%), parkinsonism (16.8%), and gait disturbance (8.9%). The most frequent diagnostic category was toxic/metabolic-caused movement disorder (T/MCMD) (35%) with regard to medications, followed by Parkinson’s disease (PD) (16%). Regarding the mode of onset, T/MCMD was the leading cause for acute (68%) and subacute onset (46%), while PD was the leading disorder (31%) for chronic onset. CONCLUSION: The current study showed a characteristic pattern of inpatients presenting with movement disorders. Furthermore, our findings highlighted the clinical significance of drug use or metabolic problems for treating this patient population.
Dyskinesias ; Gait ; Humans ; Inpatients ; Movement Disorders ; Parkinsonian Disorders ; Referral and Consultation ; Specialization ; Tertiary Healthcare ; Tremor