Analysis of a COVID-19 Prescreening Process in an Outpatient Clinic at a University Hospital during the COVID-19 Pandemic

Background@#To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. @*Methods@#All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. @*Results@#During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44–2.10] vs. 0.59 [CI, 0.52–0.65], respectively) (P < 0.001). @*Conclusion@#Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.

Activities of an infection control surveillance-working group for the infection control and prevention of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is unlikely to end soon, and hospitals face a high risk of exposure to COVID-19 and nosocomial infections. Therefore, strengthened infection control and prevention (ICP) strategies are crucial. Here, we share our experience of activities implemented by an infection control surveillance-working group (ICS-WG) and the introduction of a hospital emergency code for patients requiring screening for COVID-19, which were established at a university-affiliated hospital. This hospital applies multi-step processes to identify patients who must visit the outdoor screening clinic for COVID-19 testing, instead of entering the hospital building. However, some of these patients inevitably end up inside the hospital building. To solve this issue, we implemented a process to announce the emergency code (“code apple”) and have the medical personnel escort such patients to the outdoor screening clinic. This process was useful in protecting the hospital from unnecessary exposure to COVID-19. The ICS-WG was assigned to conduct the surveillance of ICP practices, patrol the hospital, and recommend improvements for any practices that did not adhere to the guidelines. The ICS-WG also developed a checklist as a monitoring tool for ICP practices. The checklists were distributed to the infection control coordinators who were assigned to monitor their team’s ICP practices and report to the ICS-WG. Overall, we believe that code apple and the ICS-WG are effective strategies in improving ICP practices of COVID-19 at hospitals.

Perceptions of Medical Personnel toward Burnout using Q Methodology / 간호행정학회지

PURPOSE: This exploratory study was done to categorize medical personnel's perceptions of burnout and analyzed the characteristics. METHODS: Q methodology was applied using a 45 Q-sample categorized on an 11-point scale which was completed by nurses and doctors working at a university hospital in Seoul, Korea. Collected data were analyzed using the PC-QUANL program. RESULTS: Medical personnel's perceptions of burnout were categorized into three types; 33.83% of the total variance was explained. The first type was 'functionally deteriorating pressure' the second type was 'daily powerlessness' and the third was 'achievement-oriented re-energization'. CONCLUSION: There is a need to establish and apply intervention strategies for each type to alleviate medical personnel burnout and increase work efficiency to qualitatively improve medical services.

A Study on Adolescents' Smoking Behavior and the Status and Need of Smoking Prevention Education for Adolescents

PURPOSE: This study was to identify adolescents' smoking behavior and the status and need of smoking prevention education for adolescents. METHOD: The subjects were 375 students selected through convenient sampling from three middle schools and three high schools in Jeonbuk. Data were collected through a questionnaire survey and analyzed using SPSS 10.1. RESULT: The smoking rate was 20.8% and 83.7% the students experienced smoking prevention education. Students were educated by a special instructor (39.8%) or a health teacher (26.8%). Among the teaching methods, lecture was 69.4%, but some students (30.7%) wanted anti-smoking school. Among the students, 85.0% answered they want smoking prevention education and 46.7% said that it should be covered in regular curriculum. CONCLUSION: High interest and continuity are emphasized for the success of smoking prevention education. In addition, various teaching methods need to be developed including anti-smoking school, lectures, counselling and long term education program. Moreover, smoking prevention education programs need to be covered in regular curriculum.

Development of a Nursing Professional Values Scale / 간호학회지

PURPOSE: The purpose of this study was to develop an instrument to measure nursing professional values. METHOD: Forty preliminary items were selected by classifying 223 basic items extracted via a literature study and in-depth interviews of subjects and testing the relevance of their contents. In order to verify the reliability and relevance of the preliminary instrument, data was collected from 504 nurses in 3 general hospitals. RESULT: As a result of the item analysis, 29 items were selected from a total of 40 items. Five factors were extracted by factor analysis, and the total variance was 51.5%. For the explanation of variances by factors, the 1st factor, 'self-concept of the profession' accounted for 14.8%, the 2nd factor, 'social awareness' 12.1%, the 3rd factor, 'professionalism of nursing' 9.8%, the 4th factor, 'the roles of nursing service' 9.1%, and the 5th factor, 'originality of nursing', 5.6%. Cronbach's Alpha of those 29 items was .9168, which was high. CONCLUSION: This paper is meaningful in a way that it developed a tool capable of measuring nursing professional values, which reflects the characteristics of our country. In order to re-verify the relevance and stability of this tool, it is necessary that comparative studies should be conducted.

Rebamipide Protects TNBS Induced Colonic Damage Through Down-regulation of NF-kappaB Activation and Induction of Heme Oxygenase -1 Expression / 대한해부학회지

Crohn 's disease is characterized by a chronic relapsing inflammation of the bowel in which pro-inflammatory cytokines play an important role. Rebamipide is an anti-gastric ulcer drug with anti-inflammatory properties in vivo and in vitro. The effects of rebamipide on Crohn 's disease have not been carefully evaluated. This study investigated the potential of rebamipide to protect Crohn 's disease using a murine model of colitis induced by trinitrobenzene sulfonic acid (TNBS). Rebamipide dramatically improved histopathological symptom involving myeloperoxidase (MPO)activation and increase of microscopic damage score in TNBS induced colitis. Rebamipide suppressed IL-8 secretion, ICAM-1 induction and nuclear factor-kappaB (NF-kappaB) activation by TNF-alpha and induced heme oxygenase-1(HO-1)in HT-29 cells. HO-1 inducer cobalt protoporphyrin IX (CoPPIX)suppressed NF-kappaB activation by TNF-alpha in HT-29 cells like rebamipide, and mimicked the protective effects of rebamipide on TNBS induced colitis. This suggests that rebamipide exerts anti-inflammatory effects by down-regulating NF-kappaB activity via inducting HO-1 expression. In conclusion, this study suggests that rebamipide represents a potential therapeutic agent and HO-1 is an important therapeutic target for the treatment of Crohn's disease.

Heme Oxygenase-1 is Involved in the Down-regulation of Nuclear Transcription Factor kappa B Activation in the Colonic Epithelium During Inflammation / 대한해부학회지

Heme oxygenase-1 (HO-1) is a stress-inducible enzyme with anti-inflammatory activity, but the mechanisms underlying this activity are incompletely understood. Nuclear transcription factor kappa B (NF-kappa B) activation is an important factor in the pathogenesis of inflammatory bowel disease (IBD). We investigated the suppressive effects of HO-1 on the activation of NF-kappa B by pro-inflammatory cytokines in cultured colonic epithelial cells and by trinitrobenzene sulfonic acid (TNBS) in the colon of mice. The expression level of HO-1 in the colonic epithelium of a patient with inflammatory bowel disease and pseudo-membranous colitis was lower than that in a healthy control subject. In cultured human colonic epithelial HT-29 cells, pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha ) and IL-1 beta down-regulate HO-1 expression. The HO-1 inducer, cobalt protoporphyrin IX (CoPPIX), dramatically down-regulated NF-kappa B activation in HT-29 cells by TNF-alpha. In addition, bilirubin-a product of heme catabolism by HO-1-and the carbon monoxide donor tricarbonyldichlororuthenium (II) dimer also suppressed NF-kappa B activation by TNF-alpha. However, iron, another heme metabolite, did not suppress NF-kappa B activation by TNF-alpha. Furthermore, CoPPIX diminished the macroscopic and histopathological symptoms of TNBS-induced colitis and down-regulated NF-kappa B activation in mice. In conclusion, this study suggests that HO-1 plays an important role in the down-regulation of NF-kappa B activation, which is a key factor in the pathogenesis of IBD and is thus an excellent therapeutic target for the treatment of IBD.

Impaired DNA Synthesis by Copper Cytotoxicity in LEC Mutant Rat / 대한해부학회지

Long-Evans Cinnamon (LEC) mutant rat, which spontaneously develops a necrotizing hepatic injury at 4 ~5 months of age, reveals an excess hepatic copper accumulation and is a good model for studying the detail mechanism of cellular copper toxicity. We have observed the effects of copper toxicity on DNA synthesis upon growth stimulation by treating primary-cultured hepatocytes of LEC rat with epidermal growth factor (EGF) and insulin. DNA synthesis measured by [ 3 H]-thymidine incorporation and DNA synthesis S-phase cells in LEC rat significantly decreased when compared to those of normal F344 rat. Since DNA synthesis was impaired in LEC rat, we examined the detail mechanism by determining the histone content, which are involved in DNA stability, and the phosphorylation of nuclear protein. However, the histone contents and phosphorylated nuclear protein upon growth stimulation was intact in LEC rat. These results suggest that a cellular event other than protein phosphorylation required for the initiation of DNA synthesis upon growth stimulation is impaired by copper cytotoxicity in LEC rat.

Correlational Study on Health Behaviors, Menopausal Symptoms and Sexual Satisfaction in Korean Middle-aged Women / 성인간호학회지

PURPOSE: The purpose of this study was to identity the relationships among self reported health behaviors, menopausal symptoms, and sexual satisfaction in middle-aged women. METHOD: The subjects of this study were 155 women from 40 to 60 years. The data was analyzed using SPSS program for frequency, percentage, mean, t-test, ANOVA, Duncan and Pearson's correlation coefficients. RESULTS: 1. The mean score of health behaviors was 3.10 out of maximum 4. 2. The mean score of self-reported menopausal symptoms was 1.73 out of maximum 2. 3. The mean score of sexual satisfaction was 2.73 out of maximum 4. 4. Women's degree of menopausal symptoms had negative correlations with the degree of health behaviors(r=-0.437, p<.001) and the degree of sexual satisfaction(r=-0.439, p<.001). The degree of health behaviors had a positive correlation with the degree of sexual satisfaction (r=0.470, p<.001). CONCLUSION: In conclusion, menopausal symptoms-based complaints by middle-aged women were negatively correlated to health behavior and sexual satisfaction. Therefore, health behavior should be considered when developing nursing strategies for middle- aged women, especially when dealing with menopausal symptoms and sexual satisfaction.

A Q-methodological Study on Nursing Students' Attitudes toward Nursing Ethics / 간호학회지

PURPOSE: Professional nursing ethics is a living, dynamic set of standards for nurses'professional moral behavior. Furthermore, in daily clinical nursing training, nursing students are constantly confronted with decisionmaking that is moral in nature. The aim of this study was to identify the perceived ethical attitudes in the clinical training process of senior nursing students using Q-methodology to offer basic strategies for nursing ethics education and thereby improve patients'care. METHODS: Q-methodology provides a scientific method for identifying perception structures that exist within certain individuals or groups. Thirty-seven participants in a university rated 38 selected Q-statements on a scale of 1-9. The collected data were analyzed using pc-QUNAL software. RESULTS: Principal component analysis identified 3 types of ethical attitudes in nursing students in Korea. The categories were labeled Sacred-life, Science-realistic and Humane-life. Sacred-life individuals think that a life belongs to an absolute power (God), not a man, and a human life is a high and noble thing. Science-realistic individuals disagreed that allowing an induced abortion or embryo (human) duplication is unethical behavior that provokes a trend, which takes the value of a life lightly; most of them took a utilitarian position with respect to ethical decisions. Humane-life individuals exhibit a tendency toward human-centered thought with respect to ethical attitudes. CONCLUSION: This study will be of interest to educators of students of nursing and hospital nursing administrators. Also, the findings may provide the basis for the development of more appropriate strategies to improve nursing ethics education programs.

CoPPIX Protects against TNBS Induced Colitis Through HO-1 Induction / 대한해부학회지

Crohn`s disease is a severe chronic inflammation that is treated mainly by immunosuppression, which often has serious side effects. There is a need to develop new drugs for treating this disease that have few side effects. Heme oxygenase-1 (HO-1) has immunosuppressive properties, but the mechanism of its anti-inflammatory actions is unclear. We investigated the protective effects of HO-1 on trinitrobenzene sulfonic acid (TNBS)-induced colitis in mice. An HO-1 inducer, cobalt protoporphyrin IX (CoPPIX), dramatically improved the clinical and histopathological symptoms in TNBS-induced colitis. CoPPIX suppressed tumor necrosis factor-alpha and interleukin-1beta expression and down-regulated the nuclear transcription factor kappa B activity caused by TNBS. The vehicle copper protoporphyrin IX (CuPPIX) failed to duplicate the protective effects seen with CoPPIX. Moreover, an inhibitor of HO-1 activity-zinc protoporphyrin IX-reversed the protective effects of CoPPIX on TNBS-induced colitis. In conclusion CoPPIX protects against TNBS-induced colonic damage by inducing HO-1, which might be an important target in the treatment of Crohn`s disease.

Idiopathic Charcot-like Arthropathy: A case report

The causes of Charcot joint gradually has grown since Charcot's original description of syphilitic neuropathic joint disease in 1868. Recently, diabetic mellitus is the commonest condition associated with neuropathic bone and joint disease. But trauma can precipitate the development of the typical neuropathic Charcot joint. It has been suggested that the altered mechanics of walking throws an abnormal stress on the sensory deprived joint so that arthropathy develops. This paper is reporting a case of developed idiopathic Charcot-like arthropathy in both knee and elbow joints. Intra-articular steroid injection and repeated trauma caused the patient to develop idiopathic Charcot-like arthropathy. The purpose of this paper is to emphasize that early recognition and conservative treatment may alter the course of certain neuropathic joints.

The Experience of Decision Making to Donate Organs / 성인간호학회지

PURPOSE: The aim of this study was to identify the process of experience toward decision making to donate organs. METHOD: Eleven subjects who registered at the Association for Organ Sharing in Korea were recruited. Using in-depth interviews and tape-recordings, data was collected from Jun. 2001 to Feb. 2002 and the contents of these were analyzed by Glaser's grounded theory analysis method. RESULT: Basic Social- Psychological Problem(BSPP) of subjects were 'attachment to body' and the core theme, that is Basic Socialization Progress(BSP) were discovered to 'find out what is the meaning of life'. Also it consisted of four steps: 1st 'hesitate', 2nd 'look into self', 3rd 'realize the tie up to self' and last 're-find the meaning of life'. CONCLUSION: These findings indicate the Korean's Basic Socialization Progress of decision making regarding organ donation, so possible development of promoting decision making is necessary strategies for people who is having his/her potential of organ donation in mind.

Subjectivity on Organ Donation and Transplantation / 간호학회지

This study was designed to identify the attitudes of the people on organ donation and transplantation. The purpose of this study was to provide data to help inspire organ donation, and promote registration yield so donor candidates will have more favorable recipients through Q-methodology. A Q-sample was developed through a review of the literature and interviews. Thirty-three statements made up the final Q-sample. The P-sample consisted of twenty-eight subjects, excluding chronic organic disorder. The Q-sorts by each subject were coded and analyzed with the QUNAL computer program. The results were as follows: This study discovered five different types of organ donation and transplantation of twenty- eight subjects. Type I is 'utilitarian.' The people of this type consider human life very valuable and they recognize that organ transplantation is an affirmative medicine that should be performed to extend human life. They believe that are saving others' lives by donating organs. Type II is 'sardonist.' The people of this type approve of organ transplantation usefulness, but they have no intention of participating in the program because of it may trample on human rights. Type III is 'individualist.' The people of this type consider it proper for the activation of organ transplantation by the legal system. They believe that organ donation a valuable too, but needs support through social benefits to donors. Yet, they have not intention of doing what they propose. Type IV is 'familist.' The people of this type have strong attachments to life but they think that organ donation and transplantation should be done between within a family. Type IV is disposition of family intensive consideration rather than altruistic and utilitarianism. Type V is 'deontologist.' The people of this type recognize the benefits of transplantation, but have a negative opinion of activation. They worry about ethical and social problems occurring in the development of modern medicine. They believe that death is the only natural end to life, so they have strong negative opinions of euthanasia and brain death compared to other types. They regard transplantation to be a non-human behavior, because it involves a removing organs and breaking the boundary of death. The findings of this study are only preliminary and serve as a baseline to understanding the subjectivity of individuals on organ donation and transplantation. Therefore, the subjectivity of the five types will be applied to formulate the educational programs and public relations strategies for organ donation because the public's awareness toward organ donation is closely related to their values, beliefs, and attitudes.

AmpC-type beta-lactamases in Clinical Isolated of Cefoxitin-resistant E. coli and K. pneumoniae

To elucidate the role of plasmid-mediated AmpC-type B-lactamases in clinical practice, cefoxitin-resistant isolates of E. coli (19 strains) and K. pneumoniae (7 strains) from three hospitals in Korea were studied. All of the 26 isolates produced at least one j3-lactamase and 16 (62%) isolates produced AmpC-type B-lactamases poorly inhibited by clavulanic acid. In 16 such isolates, 4 kinds of AmpC enzymes were detected; the pI 8.0 AmpC enzyme in 11 isolates, the pI 8.9 in 3 isolates of E. coli, the pI 8.5 in 1 isolate of E. coli, and the pI 7.8 in 1 isolate of K pneumoniae. The pI 8.0 and 7.8 AmpC enzymes had an apparent molecular mass of 38 kDa and the pI 8.5 and 8.9 AmpC enzymes had a molecular mass of 35 kDa. Cefoxitin resistance was transmissible in six E. coli and three K pneumoniae strains due to a common AmpC-type B-lactamase with a pl of 8.0. This enzyme was confirmed to be CMY-1 B-lactamase by Southern blotting and PCR analysis. Four E. coli isolates produced large amounts of AmpC-type j3-1actamase. They were chromosomal AmpC hyperproducers carrying some alterations in the promoter and attenuator regions of the ampC chromosomal gene. The pI 7.8 AmpC enzyme is currently under study. In conclusion, this study showed that the CMY-1 plasmid-mediated cephamycinase play an important role in cephamycin resistance of K. pneumoniae and E. coli clinical isolates in Korea.

Analysis of the Nursing Interventions done by MICU and SICU nurses using NIC / 간호학회지

The purpose of this research was to identify nursing interventions performed by MICU and SICU nurses. For data collection this study used the taxonomy of the Nursing Interventions Classification(NIC: 433 nursing interventions) which was modified by McCloskey and Bulecheck(1996). Each of the 433 interventions were identified as used by MICU and SICU nurses. More than 50% of the ICU nurses performed 280 nursing interventions at least monthly. Rarely used interventions included 26 nursing interventions in the childbearing care class. Overall, both MICU and SICU nurses used interventions in the Physicological : Complex domain most often on a daily basis and the interventions in the Family domain least often. The most frequently reported interventions as being used daily in the MICU were chest physioterapy, airway suctioning and coughing enhancement and, in the SICU, documentation and airway suctioning. There were significant differences between MICU and SICU nurses differences interventions childbearing care, cognitive therapy, communication enhancement, coping assistance, elimination management, lifespan care, health system mediation, immobility management, medication management, neurologic management, patient education psychological comfort promotion, physical comfort program, respiratory management, risk management and information management. The SICU nurses performed there interventions more frequently than the MICU nurses. These findings will help in building of a standardized language for the MICU and SICU and enhance the quality of nursing care.

Analysis of extended-spectrum beta-lactamase TEM produced by Klebsiella Pneumoniae / 감염

BACKGROUND: The prevalence of extended-spectrum beta-lactamase(ESBL)-producing organisms has been increasing in Korea. We performed a study to characterize various TEM derivatives with clinical isolates of Klebsiella pneumoniae collected from 3 hospitals in Korea. METHODS: Fifty-seven isolates of ESBL-producing K. pneumoniae collected from 3 hospitals were screened by TEM-specific PCR for the carriage of TEM genes. Thirteen strains were found to have TEM-related genes. Eleven blaTEM genes were amplifed and sequenced. The transfer of resistance was tested by conjugation and isoelectric points of beta-lactamases were determined. MICs were measured to obtain a resistance pattern for each indivudual wild- type and transconjugant strain. The hydrolysis rate of TEM-52 was measured spectrophotometrically. RESULTS: Ten strains carried plasmid-mediated CTEM-52 gene, which sequence showed the substitution of 3 amino acids compared to that of TEM-1: 104 glutamic acid --> lysine (GAG --> AAG), 182 methionine --> threonine (ATG --> ACG), and 238 glycine --> serine (GGT --> AGT). MIC showed that TEM-52 mediated a resistance to ceftazidime and aztreonam at a lower level than to cefotaxime. TEM-52 enzyme hydrolyzed cefotaxime efficiently (Vmax, 340) and showed fairly weak activity for ceftazidime (Vmax, 15.1), but very weak activity for aztreonam. The gene of TEM-52 beta-lactamases was mediated by approximately 77-kb plasmids. CONCLUSION: From these results, we conclude that the TEM-52 beta-lactamase is a common TEM- type ESBL in K. pneumoniae in Korea.

Characterization of Extended-spectrum Beta-lactamases in Klebsiella pneumoniae Isolated in Korea / 감염

BACKGROUND: Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated enzymes that confer resistance to oxyimino-beta-lactams such as cefotaxime, ceftazidime, and aztreonam, antibiotics that were designed to be effective against strains producing known plasmid-determined beta-lactamases. METHODS: Fifty-seven isolates of ESBL producing K. pneumoniae which were collected from 3 hospitals in Korea were characterized. They either transferred ceftazidime resistance or showed clavulanic acid enhancement of oxyimino-beta-lactam susceptibility. Beta-lactamase production by clinical isolates and transconjugants were characterized by isoelectric focusing and MIC values of oxyimino-beta-lactam were determined by agar dilution method. We performed PCR and RFLP for further characterization of TEM-type ESBLs. RESULTS: The results showed that SHV-type ESBLs, especially SHV-5 and SHV-2 predominated, but TEM-4 and plasmid- mediated AmpC beta-lactamases (pI 8.0 and pI 8.4) were present as well: SHV-5, 26; SHV-2, 12; TEM-4, 9; plasmid-mediated AmpC type beta-lactamase (pI 8.0), 4; plasmid-mediated AmpC type beta-lactamase (pI 8.4), 1. Two isolates produced both TEM-4 and SHV-5, which showed higher MIC50 of cefotaxime, ceftazidime and aztreonam than those in the isolates producing TEM-4 or SHV-5. Three isolates produced both plasmid-mediated AmpC type beta-lactamases and other ESBLs, each one of TEM-4, SHV-2 and SHV-5. All of the isolates showed high resistance to cefoxitin, cefotaxime, ceftazidime and aztreonam. CONCLUSION: With these results we conclude that SHV-type ESBLs outnumber and plasmid-mediated AmpC type beta-lactamases are present in high frequency in Korea.

Distribution of MIC Values of Various Antibiotics against Extended-spectrum Beta-lactamase (ESBL)-producing Klebsiella pneumoniae / 감염

BACKGROUND: Extended-spectrum beta-lactamases (ESBLs) confer resistance to extended-spectrum cephalosporin (e.g., cefotaxime, ceftazidime) and aztreonam. But the diversity of ESBLs results in various susceptibility profiles with different beta-lactams. To study the relative in vitro activities of various beta-lactams and non-beta-lactam antibiotics against the clinical isolates of ESBL-producing K. pneumoniae, we determined the MIC (minimum inhibitory concentration) of various antimicrobials. METHODS: Fifty-seven isolates of K. pneumoniae which produced ESBL and 63 isolates which did not produce ESBL from 3 university hospitals in Korea were tested. The MIC values of antimicrobials were determined by agar dilution method and detection of ESBL production was performed by double disk synergy test. RESULTS: The MIC values of beta-lactams against K. pneumoniae which produced ESBLs exhibited heterogeneous susceptability profiles. In differentiation of ESBL production, MIC value of 8 ug/mL (breakpoint of intermediate resistance) of ceftazidime was more sensitive and more specific than that of cefotaxime or aztreonam. MIC50 values of gentamicin, amikacin and ciprofloxacin against K. pneumoniae that produced ESBL were significantly higher than those against Non-ESBL producing isolates (P<0.001), suggesting that ESBL producing isolates are multi-drug resistant. CONCLUSION: The level of resistance to various beta-lactams of K. pneumoniae which produced ESBL was heterogeneous. ESBL-producing K. pneumoniae showed higher resistance to aminoglycoside and quinolone antibiotics. Ceftazidime was the most appropriate antibiotic to differentiate ESBL production.

CT and US Findings of the Multilocular Cystic Renal Cell Carcinoma

PURPOSE: To find the CT and US findings of multilocular cystic renal cell carcinoma. MATERIAL AND METHODS: We retrospectively analysed CT and US findings of five cases of the pathologically proven multilocular cystic renal cell carcinoma. We analysed CT and US with view points of tumor margin, growth pattern, renal contour change, echogenicity, attenuation on pre- and postcontrast scan, thickness and number of septum, and perirenal change. RESULTS: The CT findings of the multilocular cystic renal cell carcinoma were large well defined round encapsulated multiple fluid filled cystic mass with exophytic growing pattern. The capsule and septum were relatively well enhanced with contrast medium. The cystic space and septurn were variable in size and shape. US revealed large multiple fluid filled cystic mass separated by echogenic septum. CONCLUSION: The above CT and US findings of multilocular cystic renal cell carcinoma may be helpful in the diagnosis.