BACKGROUND: Enterococci have become increasingly predominant as causative agents of nosocomial infections. Infections due to multi-drug resistant enterococci have drawn increasing attention during the past two decades. The purpose of the present study was to evaluate the occurrence of virulence factors and antimicrobial resistance in enterococci isolated from patients with bacteremia or urinary tract infection. METHODS: A total of 209 strains of enterococi (102 Enterococcus faecalis and 107 E. facium) isolated during 8 months of 2005 were collected from 10 university hospitals in Korea. Disk diffusion susceptibility tests were performed using Mueller-Hinton agar. The antimicrobial resistance genes and virulence factors were determined using PCR. RESULTS: In E. faecalis, the rate of resistance to ciprofloxacin, tetracycline, and quinupristindalfopristin was 27.4%, 83.3%, and 85.2%, respectively; no isolates were resistant to ampicillin, vancomycin, teicoplanin, or linezolid. In E. faecium, the rate of resistance to ampicillin, ciprofloxacin, tetracycline, vancomycin, and teicoplanin was 86.9%, 87.9%, 8.4%, 19.6%, and 6.5%, respectively; no strains were resistant to quinupristin-dalfopristin or linezolid. All the E. faecalis strains tested were found to harbor multiple virulence factors, but E. faecium strains were generally without virulence factors except esp. The prevalence of the esp gene was significantly higher in enterococci isolated from urinary tract infection than in those from bacteremia. CONCLUSION: A similar pattern of resistance to antimicrobial agents and prevalence of virulence factors was observed in both the enterococci isolated from bacteremia and urinary tract infection. Our study indicates that host factors are more likely than bacterial properties to influence the development of bacteremia.
Agar ; Ampicillin ; Anti-Infective Agents ; Bacteremia* ; Ciprofloxacin ; Cross Infection ; Diffusion ; Enterococcus faecalis ; Hospitals, University ; Humans ; Korea ; Polymerase Chain Reaction ; Prevalence ; Teicoplanin ; Tetracycline ; Urinary Tract Infections* ; Urinary Tract* ; Vancomycin ; Virulence Factors* ; Virulence* ; Linezolid

BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) may manifest paraneoplastic syndromes such as hypercholesterolemia, hypoglycemia, hypercalcemia and erythrocytosis. This study was aimed at evaluating the incidence and clinical significance of paraneoplastic syndromes in Korean HCC patients. METHODS: The medical records of 165 HCC patients who were diagnosed and died in the Kyung Hee University Hospital, were reviewed retrospectively. The following variables were analyzed: age, gender, hepatitis markers, platelet, liver function test, alpha-fetoprotein (AFP), Child-Pugh score, tumor features, and the duration of their survival. RESULTS: In total, paraneoplastic syndromes were presented in 43.6% of the HCC patients during the course of their disease. Hypercholesterolemia was solely presented in 14.5%, hypoglycemia in 12.7% and hypercalcemia in 7.8%. The patients who presented with more than 2 syndromes were 8.5%. While 80% of erythrocytosis (4/5) and 51.6% of hypercholesterolemia (16/31) was presented at the time of HCC diagnosis, hypoglycemia and hypercalcemia mainly occurred as terminal events. The patients with paraneoplastic syndromes were younger and had higher rates of portal vein thrombosis, bi-lobar tumor involvement and tumor more of more than 10 cm in diameter, compared to those patients without them. The proportion of patients with a serum AFP more than 400 ng/mL tended to be higher in the patients with paraneoplastic syndromes. The HCC patients with paraneoplastic syndromes, except for erythrocytosis, had a shorter survival than those patients without them. CONCLUSIONS: Paraneoplastic syndromes are not infrequently presented in HCC patients, especially at an advanced stage, and the survival of these patients is relatively shorter.
Aged ; Carcinoma, Hepatocellular/*complications/mortality ; English Abstract ; Female ; Humans ; Liver Neoplasms/*complications/mortality ; Male ; Middle Aged ; Paraneoplastic Syndromes/complications/diagnosis

BACKGROUND: The spectrum of clinical presentations of extrapulmonary tuberculosis (EPT) is so diverse that it may mimic other systemic diseases and often leads physicians to misdiagnosis. Since its diagnosis is largely depended on physician's suspicion of the disease, it would be worthwhile to scrutinize the clinical characteristics of EPT. We retrospectively evaluated clinical manifestations of 312 patients who were diagnosed as EPT in a tertiary referral hospital. METHODS: The medical records of 312 patients, diagnosed as having EPT at Youngdong Severance hospital from January 1997 to December 1999, were reviewed retrospectively. RESULTS: Total 312 patients, 149 (47.8%) men and 163 (52.2%) women with age ranged from 13 years to 87 years, were included in this study. The most common site of the involvement was pleura (35.6%). Patients complained of localized symptoms (72.4%) more frequently than systemic symptoms (52.2%). The most common symptom was pain on infected site (48.1%). Leukocytosis, anemia, and elevated ESR and CRP were found in 12.8%, 50.3%, 79.3%, and 63.1% of the patients, respectively. Twenty-four percent of patients had underlying medical illnesses such as old age over 60 years, diabetes mellitus or liver cirrhosis. In 67.3% of patients, tuberculosis was suspected at initial visit. However, tuberculosis was microbiologically proven in only 23.7% of patients. Histopathological diagnosis of EPT was made in 48.7% of patients. The time interval from symptom onset to diagnosis varied, and mean duration was 96 days. Pulmonary parenchymal abnormal lesions were found in 133 patients (42.6%) on chest radiographs. CONCLUSION: Although EPT had a wide spectrum of clinical manifestations and its diagnostic methods were lack, high index of suspicion could be obtained from chest radiograph, localized or systemic symptoms, and several laboratory parameters reviewed in this descriptive study. In case of doubt, early treatment instead of awaiting microbiological result may be necessary to avoid the devastating complications.
Anemia ; Diabetes Mellitus ; Diagnosis* ; Diagnostic Errors ; Female ; Humans ; Leukocytosis ; Liver Cirrhosis ; Male ; Medical Records ; Pleura ; Radiography, Thoracic ; Retrospective Studies ; Tertiary Care Centers ; Tuberculosis