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Efficacy of Panipenem versus Imipenem against Clinical Isolate of Pseudomonas aeruginosa in a Two-Compartment Artificial Capillary Model.

Dong Gun LEE ; Hye Sun CHUN ; Su Mi CHOI ; Jung Hyun CHOI ; Jin Hong YOO ; Wan Shik SHIN

Infection and Chemotherapy.2004;36(4):227-233.

BACKGROUND: Panipenem (PAPM) is a new carbapenem which has an enhanced broad spectrum activity against both gram-positive and negative organisms. However, its activities in vitro against Pseudomonas aeruginosa are still under controversy. The aim of this study was to compare the activity of PAPM with those of imipenem (IMPM) against clinical isolates of P. aeruginosa using in vitro kinetic model and to evaluate the differences according to the quantity of basic amino acid in media. MATERIALS AND METHODS: Using a clinical isolate of P. aeruginosa (SGP14) from blood, an in vitro 2-compartment artificial capillary model based on a dialyzer unit was prepared. Antibiotics were given as a bolus q12 hrs for 48 hrs. Simulated doses and frequencies of PAPM and IMPM were 500 mg q12 hrs as approved by Korea Food and Drug Administration. Muller-Hinton broth (MHB) and minimal broth Davis (MBD) were used as culture media and we divided the experiments into 4 groups [PAPM (MHB), PAPM (MBD), IMPM (MHB), IMPM (MBD)]. At 0, 1, 2, 4, 6, 8, 12, 24, 32, and 48 h, samples were removed from peripheral compartment and viable bacterial counts were measured. RESULTS: The susceptibility of PAPM and IMPM for SGP14 were 64 and 2 ug/mL in MHB and 4 and 2 ug/mL in MBD, respectively. Up until 12 hours, changes in bacterial colony counts were not significantly different (P=0.073) for each group. However among the four groups, PAPM (MHB) showed the least changes compared with PMPM (MBD), IMPM (MBD). The largest decrement of colony during 48 hours was observed with PMPM (MBD), followed by IMPM (MHB) or IMPM (MBD), and PAPM (MHB) in decreasing order (P=0.00). There were no differences between IMPM (MHB) and IMPM (MBD) as for the change in colony counts. CONCLUSIONS: The bactericidal activities of panipenem against the clinical isolate of P. aeruginosa was similar (at 12 h) or superior (at 48 h) to that of imipenem in an in vitro 2-compartment artificial capillary model using minimal broth to simulate human serum drug concentrations.
Amino Acids, Basic ; Anti-Bacterial Agents ; Bacterial Load ; Capillaries* ; Culture Media ; Humans ; Imipenem* ; Korea ; Pseudomonas aeruginosa* ; Pseudomonas* ; United States Food and Drug Administration

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Risk Factors for the Development of Nosocomial Candidemia among Patients in Intensive Care Unit.

You Hyun LEE ; Hee Jung CHOI ; Mi Ae LEE

Infection and Chemotherapy.2004;36(4):219-226.

BACKGROUND: Nosocomial candidemia is one of the most important disease entity in hospital not only because of increasing incidence but also because of its high fatality rate. The purpose of this study is to identify risk factors predicting the development of nosocomial candidemia and to evaluate its clinical outcome of nosocomial candidemia in the intensive care unit (ICU) patients. MATERIALS & METHODS: We conducted a retrospective, matched case-control study in adult patients admitted to ICU from January 1998 through December 2002 in Ewha Womans University Mokdong hospital. Sixty cases with candidemia were retrospectively identified from the records of the Department of Clinical Microbiology. The possible risk factors for the development of nosocomial candidemia were compared between 60 patients and 120 control subjects. RESULTS: Candida albicans was the most commonly isolated organism. In the multivariate analysis, number of concomitant bacteremia (OR=17.3), number of candida infection in other site (OR=20.6), number of antibiotics used (OR=4.2), duration of indwelling central venous catheter (OR=16.1), and insertion of arterial line for more than 8 days (OR=6.9) were identified as significant risk factors for development of candidemia. Crude mortality rate was higher in candidemia patients compared with control subjects (P=0.004). CONCLUSION: The best predictors of development of candidemia in ICU patients were concomitant bacteremia, candida colonization in other site, combined use of antibiotics, and long-indwelling arterial and central venous catheter. For the ICU patients with high risk factors of candidemia, we could consider the intervention to prevent emergence of candidemia.
Adult ; Anti-Bacterial Agents ; Bacteremia ; Candida ; Candida albicans ; Candidemia* ; Case-Control Studies ; Central Venous Catheters ; Colon ; Critical Care* ; Female ; Humans ; Incidence ; Intensive Care Units* ; Mortality ; Multivariate Analysis ; Retrospective Studies ; Risk Factors* ; Vascular Access Devices

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Factors Influencing Decision Regarding Influenza Vaccination: A Survey of Healthcare Workers in One Hospital.

Hee Jin CHEONG ; Jang Wook SOHN ; Sun Ju CHOI ; Joong Sik EOM ; Heung Jeong WOO ; Byong Chull CHUN ; Woo Joo KIM ; Seung Chull PARK

Infection and Chemotherapy.2004;36(4):213-218.

BACKGROUND: In spite of yearly recalls, influenza immunization rate among healthcare workers (HCWs) remained low in Korea University Guro Hospital. This study was conducted to identify the causes of non-compliance against influenza immunization and to analyze the barrier factors for the immunization. MATERIALS & METHODS: Questionnaires were distributed in March of 2000 at Korea University Guro Hospital. We evaluated factors associated with acceptance of influenza vaccination and opinions regarding influenza prevention (knowledge about influenza vaccination efficacy, que to action in vaccinee, perceptible benefit, barrier to vaccination). RESULTS: 309 completed questionnaires from HCWs were returned. Mean age and mean duration of work in hospital were higher and longer among vaccinee than non-vaccinee. Even though the necessity of influenza vaccination among HCWs were accepted well in vaccinee compared to non- vaccinee, the accurate reasons for vaccination were not quite understood among HCWs regardless of compliance. Vaccine campaign (30.8%) and advise from doctors (24.7%) were important for the promotion of vaccination among vaccinee. However, major reason for non-compliance among nursing staff and was mis-confidence that their bodies' self defense mechanisms would ward off infection (33.5%) and 'too busy to get injection' for doctors (65%). CONCLUSION: We conclude that regular education about perceptible benefits and wrong concerns about influenza vaccination among HCW's and easy accessibility to vaccination were important determinants to improve the influenza vaccination. On-site availability of a vaccination-nurse also proved to be important.
Compliance ; Defense Mechanisms ; Delivery of Health Care* ; Education ; Humans ; Immunization ; Influenza, Human* ; Korea ; Nursing Staff ; Vaccination* ; Surveys and Questionnaires

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Efficacy of Influenza Vaccination among Chronic Ill Patients: Retrospective Case Control Study.

Seung Chull PARK ; Hee Jin CHOENG ; Jang Wook SOHN ; Sun Ju CHOI ; Joong Sik EOM ; Heung Jeong WOO ; Byong Chull CHUN ; Woo Joo KIM

Infection and Chemotherapy.2004;36(4):207-212.

BACKGROUND: Influenza is one of the preventable respiratory disease by annual vaccination. Elderly people and patients with chronic medical disease are the primary target for influenza vaccination according to ACIP (Advisory Committee on Immunization). This study was done to determine whether influenza vaccination affects hospitalization due to influenza like illness or it's related complications among chronic ill patients. MATERIALS AND METHODS: Retrospective, case-control study was conducted for 5 months (Nov. 1999-Mar. 2000). Physicians from two-university hospitals in Korea were instructed to collect clinical data, sera from subjects presenting with a flu-like illness or flu-related exacerbation in patients with chronic underlying diseases. We compared the vaccination history of case patients with control. Logistic regression analysis was used to calculate the odd ratio and efficacy of influenza vaccination. RESULTS: Hospitalization due to ILI (influenza like illness) or it's related complications were observed more frequently in patients with chronic lung disease (25.3%) and chronic cardiac disease (31.3%) compared to others. Influenza vaccination resulted in fewer hospitalization with ILI or ILI-related acute exacerbation of underlying disease in chronic ill patients (adjusted odd ratio, 0.328 [CI, 0.14 to 0.73]) during influenza seasons. CONCLUSION: For patients with chronic disease, influenza vaccination is associated with substantial health benefit including fewer hospitalization. Health care providers should take advantage of all opportunities to immunize these high-risk patients.
Aged ; Case-Control Studies* ; Chronic Disease ; Health Personnel ; Heart Diseases ; Hospitalization ; Humans ; Influenza, Human* ; Insurance Benefits ; Korea ; Logistic Models ; Lung Diseases ; Retrospective Studies* ; Seasons ; Vaccination*

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Metabolic Complications in Korean HIV/AIDS Patients Receiving Highly Active Anti-retroviral Therapy.

Young Ju CHOE ; Sang Won PARK ; Hong Bin KIM ; Wan Bum PARK ; Ki Deok LEE ; Myoung Don OH ; Kang Won CHOE

Infection and Chemotherapy.2004;36(4):197-206.

BACKGROUND: Since the introduction of HAART (Highly Active Anti-Retroviral Therapy), metabolic com- plications have been reported with varying prevalence. We performed a retrospective study to evaluate the incidence and risk factors of metabolic complications arising in Korean HIV/AIDS patients. MATERIALS AND METHODS: 66 HIV positive patients on combination therapy between 1998 June to 2002 June with at least 1 protease inhibitor (PI) or/and Non-nucleoside reverse transcriptase inhibitors (NNRTI) were reviewed. Hyperglycemia was defined as serum glucose >140 mg/dL on 2 or more occasions; diabetes as any random serum glucose >200 mg/dl; hypercholesterolemia as serum cholesterol >240 mg/dL; hypertriglyceridemia as serum triglyceride >200 mg/dL. We used SPSS version 9.0 for statistical analysis. One way ANOVA was used to compare the treatment groups. Multinominal logistic regression analysis was used for risk factor analysis. RESULTS: 66 patients were analyzed and total duration of follow up was 138 patient-years. The incidence of metabolic complication was 20.3%. Incidence of hypertriglyceridemia, hypercholesterolemia, hyperglycemia, and diabetes were 12.3%, 5.8%. 1.4%, 4.3% respectively. On risk factor analysis, factors contributing to the development of metabolic complication were age>35 years (P= 0.020) and baseline serum triglyceride >140 mg/dL (P=0.001). Baseline CD4 count <170/mm3 (P= 0.054) and use of stavudine >6 months (P=0.055) were associated with development of metabolic complications with borderline significance. CONCLUSION: The incidence of metabolic complication among Korean HIV/AIDS patients receiving HAART is 20.3%. Older age and high baseline triglyceride were risk factors for development of metabolic complications.
Antiretroviral Therapy, Highly Active ; Blood Glucose ; CD4 Lymphocyte Count ; Cholesterol ; Follow-Up Studies ; HIV ; Humans ; Hypercholesterolemia ; Hyperglycemia ; Hypertriglyceridemia ; Incidence ; Logistic Models ; Prevalence ; Protease Inhibitors ; Retrospective Studies ; Reverse Transcriptase Inhibitors ; Risk Factors ; Stavudine ; Triglycerides

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Generation of NS1-mutant Live attenuated Human Influenza vaccine candidate.

Hee Jin CHEONG ; Sa XIAO ; Peter PALESE

Infection and Chemotherapy.2004;36(4):189-196.

BACKGROUND:Influenza virus reverse genetics has reached a level of sophistication where one can confidently generate virus entirely form cloned cDNA. This system makes it possible to generate attenuated live virus vaccine candidate. We tried to generate human influenza A viruses encoding altered viral NS1 proteins in various available cell lines. MATERIALS AND METHODS:Eight (HA, NA, NP, M, NS, PBI, PB2, PA) viral and four (PB1, PB2, PA, NP) expression plasmids were generated from A/T exas/ 36/91 influenza virus by RT-PCR and cloning with POL-I and pGEM-T vector. Two NS1 mutant cDNA (NS1-126delta, NS1-99delta) were also generated. We transfected these plasmids into the 293T/MDCK, 293, CEF and Vero cells and incubated with culture media for 2-3 days. And then, we inoculated cell soups into the embryonated eggs. After 3-4 days of incubation, we harvested allantoic fluid and checked viral titer by HA assay. Finally we did RT-PCR and sequencing to confirm the virus. RESULTS:Finally we got the NS1 mutant A/Texas influenza viruses from 293T/MDCK cells, but not from FDA approved cells. However, whereas 293 cells are capable of being transfected and of growing the NS1 mutant viruses with low titer, CEF cells are only capable of growing this mutant viruses. CONCLUSION:293 and CEF cells could not be used alone for acquiring NS1 mutant A/Texas influenza viruses. However, 293/CEF co-culture seems to be a resonable next step for NS1 mutant virus rescue for human using.
Cell Line ; Clone Cells ; Cloning, Organism ; Coculture Techniques ; Culture Media ; DNA, Complementary ; Eggs ; Humans* ; Influenza, Human* ; Orthomyxoviridae ; Ovum ; Plasmids ; Reverse Genetics ; Vero Cells

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A Case of Kikuchi's disease accompanied by Hemophagocytic Lymphohistiocytosis.

Jun Hyok OH ; Ju Hyun PARK ; Sang Youn HWANG ; Sun Hee LEE ; Sung ll KIM ; Ji Yoen KIM ; Chang Hun LEE ; Joo Seop CHUNG ; Eun Yup LEE ; Kun Je CHO

Infection and Chemotherapy.2004;36(3):185-188.

Kikuchi's disease usually occurs in young women and is characterized by localized lymphadenitis (mostly cervical) usually associated with fever. It is considered a self-limited disease and most patients recover spontaneously within a few weeks to 6 months without any serious sequelae. However, patients with Kikuchi's disease require a systemic survey and regular follow-up for several years because it may be associated with other diseases such as systemic lupus erythematosus. To our knowledge, there are very few reports of Kikuchi's disease accompanied by hemophagocytic lymphohistiocytosis. Biopsy of a right cervical lymph node in a 35-year-old female who presented with fever and masses in the right cervical region showed necrotizing lymphadenitis and a diagnosis of Kikuchi's disease was reached. She was started on methylprednisolone pulse therapy (500 mg for 3 days) but developed generalized rash and fever. Laboratory data showed pancytopenia, elevation of serum transaminase and ferritin levels. Bone marrow and liver biopsy showed proliferation of histiocytes and Kupffer's cells engulfing lymphocytes, platelets and red blood cells, respectively. We report a case of Kikuchi's disease accompanied by hemophagocytic lymphohistiocytosis.
Adult ; Biopsy ; Bone Marrow ; Diagnosis ; Erythrocytes ; Exanthema ; Female ; Ferritins ; Fever ; Follow-Up Studies ; Histiocytes ; Histiocytic Necrotizing Lymphadenitis* ; Humans ; Liver ; Lupus Erythematosus, Systemic ; Lymph Nodes ; Lymphadenitis ; Lymphocytes ; Lymphohistiocytosis, Hemophagocytic* ; Methylprednisolone ; Pancytopenia

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A Case of Cerebral Toxoplasmosis in a Patient with Acquired Immune Defeciency Syndrome.

Bo Hyun KIM ; Sung Ik LEE ; Chang Hun LEE ; Sung Heun CHA ; Tae Hong LEE ; Sun Hee LEE ; Joo Seop CHUNG ; Goon Jae CHO

Infection and Chemotherapy.2004;36(3):181-184.

Toxoplasmosis is one of the most common opportunistic infection of the central nervous system in patients with acquired immunodeficiency syndrome(AIDS). There have been few reports of cerebral toxoplasmosis in patients with AIDS in Korea. In most cases, the diagnosis was assisted by serology and neuroradiologic findings. Making a reliable diagnosis of acute cerebral toxoplasmosis is difficult in patients with AIDS because of the lack of specificity of serologic data and neuroradiological findings. We report a case of 32-year-old man who presented with decreased mentality and fever. Brain MRI showed multiple ill-defined mass-like lesions in both basal ganglia and right thalamus. Stereotatic brain biopsy revealed small parasitic cysts which were filled with toxoplasmic bradyzoites in inflammatory brain tissue.
Adult ; Basal Ganglia ; Biopsy ; Brain ; Central Nervous System ; Diagnosis ; Fever ; Humans ; Korea ; Magnetic Resonance Imaging ; Opportunistic Infections ; Sensitivity and Specificity ; Thalamus ; Toxoplasmosis ; Toxoplasmosis, Cerebral*

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A Case of Concomitant Disseminated Gonococcal Infection with Acute Viral Hepatitis C.

Gi Chang KIM ; Chung Hwon LEE ; Jin Su LEE ; Moon Hyun CHUNG ; Ji Ho CHOI ; Yeon sook MOON

Infection and Chemotherapy.2004;36(3):175-180.

Gonorrhea is endemic in developing countries. Frequent sexual contacts are common among travellers to endemic countries and the risk of sexually transmitted disease as gonorrhea is believed to be high. Disseminated gonococcal infection (DGI) results from blood dissemination of Neisseria gonorrhoeae from the primary mucosal infection and is a common cause of infective arthritis in sexually active adults in the USA. The usual manifestations of DGI are dermatitis, tenosynovitis, and septic arthritis. We experienced a case of DGI concomitant with acute viral hepatitis C, probably acquired by sexual contacts in Philippines. A 40-year-old man took a trip to Philippines and stayed for a week. During his stay in Philippines, a hemorrhagic bulla and several pustules developed on his extrimities. Subsequently he suffered from high fever and arthralgia of several joints, including both knee joints. Neisseria gonorrhoeae was identified by culture of an aspirate from the right knee joint and he was managed with ceftriaxone for 3 weeks under the diagnosis of DGI and gonococcal arthritis. During the follow-up at the outpatient clinic, alanine aminotransferase and aspartate aminotransferase levels began to rise and an anti-HCV antibody became positive. Because HCV viral loads were surging up from 56,703 copies/mL to 538,292 copies/mL during the next 4 weeks, interferon-alpha 2b was administered for 6 months with resultant normal liver function tests and undetectable HCV viral loads.
Adult ; Alanine Transaminase ; Ambulatory Care Facilities ; Arthralgia ; Arthritis ; Arthritis, Infectious ; Aspartate Aminotransferases ; Ceftriaxone ; Dermatitis ; Developing Countries ; Diagnosis ; Fever ; Follow-Up Studies ; Gonorrhea ; Hepacivirus ; Hepatitis C* ; Hepatitis* ; Humans ; Interferon-alpha ; Joints ; Knee Joint ; Liver Function Tests ; Neisseria gonorrhoeae ; Philippines ; Sexually Transmitted Diseases ; Tenosynovitis ; Viral Load

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A Case of Human Brucellosis Who had No Contact with Infected Animal: Sero-epidemiology Study on Market, by-product, Stock-raising.

Sung Joo JUNG ; Sung Bum KIM ; Bae Won PARK ; Hye Won JEONG ; Sae Yoon KEE ; Jung Ah KWON ; Man Suck PARK ; Mi Yeoun PARK ; Hee Jin CHEONG ; Woo Joo KIM

Infection and Chemotherapy.2004;36(3):170-174.

Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.
Animals* ; Brucellosis* ; Doxycycline ; Epistaxis ; Fever ; Humans* ; Korea ; Polymerase Chain Reaction ; Rifampin ; Zoonoses

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