Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a major problem of public health. By various resistance mechanisms including carbapenemase, there are few antibiotics to treat CRE infection. Therefore, an infection caused by CRE is associated with a higher mortality rate than those caused by other causative agents. By horizontal transmission of the carbapenemase-producing gene, resistance to carbapenem spreads to other organisms and multi-drug resistance could be induced. The incidence of CRE has increased, and many countries have been troubled with CRE outbreaks. The best way to manage and treat CRE is infection control and prevention against CRE. The aim of this paper is to describe the current status of CRE and clinical implication of CRE infection in Korea. The mechanism which induces resistance to carbapenem as well as carbapenemase-producing gene (a gene that could be transferred to other organisms and then induces resistance to carbapenem) make it difficult to treat CRE infection.
Anti-Bacterial Agents ; Disease Outbreaks ; Drug Resistance, Multiple ; Enterobacteriaceae* ; Epidemiology ; Incidence ; Infection Control ; Korea* ; Mortality ; Public Health

Blood transfusion is an essential medical procedure that can save a patient's life. But, in the near future, it is anticipated that blood transfusion products will be lacking in Korea. Patient Blood Management (PBM) is an evidence-based, mult-idisciplinary approach to optimizing the care of patients who might need transfusion. This goal is fulfilled by clinically managing or preserving the patient's own blood instead of imprudently resorting to allogeneic blood. It can be said that Korea just begun the journey toward the PBM implementation. However, strong support from the government and endeavors from professional societies will make rapid and substantial success in implementation of PBM in Korea.
Blood Transfusion ; Health Resorts ; Humans ; Korea*

Obstetricians and gynecologists frequently deal with hemorrhage so they should be familiar with management of patient blood management (PBM). We will review to summarize the alternative measures and interventions used in bloodless surgery in the field of obstetrics and gynecology. In the obstetric field, PBM has been developed as an evolving evidence-based approach with a number of key goals: (i) to identify, evaluate, and manage anemia; (ii) reduce iatrogenic blood loss; (iii) optimize hemostasis; and (iv) establish decision thresholds for transfusion. Transfusion, mechanical method including balloon tamponade and uterine artery embolization, and intraoperative cell salvage were introduced for PBM. In the gynecologic field, PBM is not significantly different from that in the obstetric field. Preoperative managements include iron supplement, erythropoietin administration, autologous blood donation, and uterine artery embolization. Meticulous hemostasis, short operative time, hypotensive anesthetic techniques, hemodilution during operation, blood salvage and pharmacological agents were introduced to intraoperative management. Postoperative measures include meticulous postoperative monitoring of the patient, early detection of blood loss, reduction of blood sampling, appropriate use of hemopoiesis, normalization of cardio-pulmonary function and minimization of oxygen consumption. In conclusion, each obstetrician and gynecologist should be aware about the appropriate method for blood conservation and use in practice. A comprehensive approach to coordinating all members of the bloodless agent and surgical team is essential.
Anemia ; Balloon Occlusion ; Blood Donors ; Bloodless Medical and Surgical Procedures ; Erythropoietin ; Gynecology ; Hemodilution ; Hemorrhage ; Hemostasis ; Humans ; Iron ; Methods ; Obstetrics ; Operative Time ; Oxygen Consumption ; Uterine Artery Embolization

Despite improved perioperative management and surgical techniques, patients undergoing hepatobiliary and pancreatic (HBP) surgery often need to be transfused. Although disadvantages of transfusion and advantages of patient blood management (PBM) have been recognized, study results of the effects of PBM in HBP surgery are rare. The aim of this article was to review the current status of PBM in Korea in patients having HBP surgery. PBM in HBP surgery consists of increasing preoperative hemoglobin level, preoperative blood conservation, and preoperative autologous blood donation. The main intraoperative modalities used to conserve blood in recent studies were autologous techniques of acute normovolemic hemodilution and intraoperative cell salvage (Cell Saver®). In postoperative PBM, blood augmentation with erythropoietin and iron are also used depending on the postoperative hemoglobin level. Advances in surgical, anesthesiologic and pharmacologic strategies have contributed to a reduction of blood loss during HBP surgery in all patients.
Blood Donors ; Erythropoietin ; Hemodilution ; Humans ; Iron ; Korea

Preoperative anemia should be diagnosed and treated before surgery, because anemia is associated with increased postoperative mortality and morbidity. Even if iron deficiency is not detected, the possibility of functional iron deficiency should be considered. During surgery, patients should be managed to avoid hypothermia, acidosis, and hypocalcemia, while maintaining adequate blood pressure and preventing dilutional coagulopathy. It is currently recommended to start transfusion when hemoglobin is under 7–8 g/dL in patients without cardiac problems, using restrictive strategy rather than liberal, due to dangers of complications from transfusion. For those who refuse transfusion, or when transfusion is difficult due to multiple antibodies, or when attempting to reduce allogeneic transfusion, preoperative autologous blood donation (PAD), intraoperative acute normovolemic hemodilution (ANH), intraoperative blood salvage, or postoperative blood salvage can be used. For patients with trauma or massive bleeding, damage control resuscitation of permissive hypotension, restriction of crystalloid infusion, transfusion of blood product in a ratio similar to whole blood (1:1:1 of FFP, platelets, PRBC) must be actively carried out.
Acidosis ; Anemia ; Antibodies ; Blood Donors ; Blood Pressure ; Blood Transfusion ; Hemodilution ; Hemorrhage ; Humans ; Hypocalcemia ; Hypotension ; Hypothermia ; Iron ; Mortality ; Operative Blood Salvage ; Resuscitation

Patient blood management (PBM) is an evidence-based, patient-focused approach to optimize the management of patient and blood transfusion. While PBM is relatively well established in perioperative care, it is not as well established in the medical field. Since anemia in medical patients is heterogeneous and complex in its pathogenesis, the evidence for the threshold of hemoglobin for red blood cell (RBC) transfusion and the use of erythropoiesis-stimulating agents (ESAs) is not strong. While anemia seems to be an adverse risk factor for mortality, it is uncertain if rapid correction of anemia through RBC transfusion can reverse the negative impact of anemia on clinical outcomes. The introduction of ESA is a breakthrough in reducing RBC transfusion and managing anemic patients with renal disease and cancer. Despite promising results from early trials, the United States Food and Drug Administration issued a black box warning for ESAs in 2007 because of concerns about higher mortality, serious cardiovascular and thromboembolic events, and tumor progression. Therefore, the individualized approach to each patient with anemia is recommended in various medical conditions such as acute coronary syndrome, heart failure, chronic kidney disease, and malignancies.
Acute Coronary Syndrome ; Anemia ; Blood Transfusion ; Drug Labeling ; Erythrocytes ; Erythropoietin ; Heart Failure ; Humans ; Iron ; Mortality ; Perioperative Care ; Renal Insufficiency, Chronic ; Risk Factors ; United States Food and Drug Administration

Increasingly, autologous blood transfusion has been arousing concern owing to awareness of adverse effects of allogenic blood transfusion, blood shortage and patients, having religious or personal issues. With the development of medicine, Cell Salvage and Acute normovolemic hemodilution (ANH) has been proposed as an alternative to allogenic blood transfusion. This review looked at the use of ANH and cell salvage and evaluated the benefits and usefulness based on the strengths and indications. Although not consistent with all cases of ANH, there were benefits in the amount of hemorrhage and transfusion, and no supplementary plasma or platelet transfusion was needed after surgery when employing ANH. But, it showed a cutoff value only for massive bleeding surgery (at least 500 mL). In the case of cell salvage, the amount of blood transfusion was reduced in most cases and platelet or plasma transfusion was not required in most cases. When the Leukoreduction filter (LDF) was utilized, it showed the effect of removing bacterial infection or tumor cells. Nonetheless, the effectiveness and benefits for patients in certain condition of cell salvage and ANH is ambiguous with discrepancies among studies or patients. Therefore, the aim of this study is to provide clinical knowledge relative to the procedure, measure the efficacy and usefulness of peri-operative blood management mentioned above and discuss the forthcoming prospects and challenges.
Bacterial Infections ; Blood Platelets ; Blood Transfusion ; Blood Transfusion, Autologous ; Hemodilution ; Hemorrhage ; Humans ; Operative Blood Salvage ; Plasma ; Platelet Transfusion

Allogeneic blood transfusion is often restricted due to its adverse effects, a lack of blood supply, and religious or cultural constraints. As a result, patient blood management (PBM) has been gaining attention. PBM is an evidence-based, patient-centered bundle of technologies that manages perioperative anemia and reduces bleeding during surgery. PBM improves the postoperative prognoses. Perioperative anemia is the main concern in PBM; therefore, to diagnose and treat it is important. This review focuses on the perioperative use of oral or intravenous iron and erythropoietin (EPO), in relevant fields such as cardiac surgery, orthopedics, and neurosurgery. IV administration of iron has been controversial due to safety concerns, such as increased risk of infection. However, using IV iron appropriately is beneficial in most surgical settings. Although recombinant human EPO may increase thromboembolic risks, this can be mitigated through various methods including limiting the target Hb level, using it in combination with IV iron, or prophylaxis for deep venous thrombosis. EPO is recommended in patients undergoing cardiac or orthopedic surgery. As PBM becomes globally implemented, the blood management methods, including tranexamic acid, hemostatic agents, and cell salvage have become more variable as well. Among them, administration of iron and EPO would be the most common pharmacologic choices based on current practice. However, controversy still exists. Therefore, further studies on iron and EPO are needed to ensure better and safer patient care.
Anemia ; Blood Transfusion ; Bloodless Medical and Surgical Procedures ; Erythropoietin* ; Hemorrhage ; Humans ; Iron* ; Neurosurgery ; Orthopedics ; Patient Care ; Perioperative Care ; Prognosis ; Thoracic Surgery ; Tranexamic Acid ; Venous Thrombosis

Ever since mankind has had blood, efforts to stop bleeding have never ceased and so numerous methods for hemostasis have been developed. In recent decades, minimally invasive surgical techniques have led patients to less-bleeding surgery but, hemostatic agents, devices and techniques still play an important role in medical side. A number of hemostatic agents and devices have been developed and they can be classified by their mechanism of action. That classification of the coagulants includes mechanisms with physical, caustic, bio-physical, biologic actions. Hemostatic devices are divided into categories such as dressings, glue, clips, electrocoagulations and so on. Based on the concept of minimally invasive surgical procedures, variously developed surgical techniques are divided by the number of ports used and auxiliary instruments. However, there are advantages and disadvantages to each of the hemostatic agents and minimally invasive methods, and the belief in the classical method also prevents the application of new hemostatic methods. The knowledge and understanding of the benefits and costs of these newly developed hemostatic methods will make it easier for medical personnel to manage patient's blood.
Adhesives ; Bandages ; Bloodless Medical and Surgical Procedures* ; Classification ; Coagulants ; Cost-Benefit Analysis ; Electrocoagulation ; Hemorrhage ; Hemostasis ; Humans ; Methods ; Minimally Invasive Surgical Procedures

No abstract available.
Humans