Multicenter Surgical Site Infections Surveillance System Report, 2007: In Total Hip and Total Knee Arthroplasties and Gastrectomies / 병원감염관리

BACKGROUND: A prospective multicenter study was performed to make a surgical site infections (SSI) surveillance system for hip (HRA) and knee (KRA) replacement arthroplasties and gastrectomies (GAST) in Korea. The rates, risk factors, and clinical characteristics of SSI were evaluated. METHODS: Demographic data, clinical and operative risk factors for SSI, and information of prophylactic antibiotic uses for the patients who took HRA/KRA and GAST in 7 and 5 hospitals, respectively were collected during July through December of 2007. SSI surveillance for HRA/KRA and GAST was done for 1 year and 1 month after operations, respectively. RESULTS: A total of 1,294 cases (HRA, 342; KRA, 453; GAST, 499) were monitored for SSI. The SSI rates of HRA, KRA, and GAST were 1.75 (6/342), 1.10 (5/453), and 4.41 (22/499) per 100 operations, respectively. Diabetes mellitus (DM) was more frequently accompanied and the dates of hospitalization before operations were longer in the infected group than the non-infected group of HRA. DM was more frequently found in the infected groups of KRA and GAST. Reoperation, emergent operation, and transfusion were more frequent in the infected group of GAST. Prophylactic antibiotics were used in 1,279 operations (99%) and started within 60 minutes before skin incision in 93% (1,190/1,279). The most frequently used antibiotics were 1st generation cephalosporins. Prophylactic antibiotics were used in combination in 33 operations (3%) and the median duration of antibiotic use was 4 days (0-89). CONCLUSION: The SSI rates of HRA, KRA, and GAST in this SSI surveillance system were 1.75, 1.10, and 4.41 per 100 operations, respectively.

Multicenter Surgical Site Infection Surveillance Study about Prosthetic Joint Replacement Surgery in 2006 / 병원감염관리

BACKGROUND: Surgical site infection (SSI) is generally considered second or third most important infection type in nosocomial infections. However, there are only a few national surveillances about surgical site infection and prophylactic antibiotics use. We performed the surveillance of surgical site infections and antibiotic use in joint replacement operation, which is difficult and costly to treat. METHODS: The surveillance study of the hip joint (HRA) and knee joint replacement surgery (KRA) was performed in four university hospitals from July 2006 to December 2006. The Clinical variables, operative risk factors for SSI, and information of prophylactic antibiotics uses were evaluated. SSI surveillance was done in 2 weeks, 1 month, 3 month, 6 month, and 1 year after surgery. RESULTS: A total of 436 cases (HRA, 227; KRA, 209) were enrolled for SSI surveillance. The SSI rates of HRA and KRA were 1.32 (3/227), and 1.44 (3/209) per 100 operations, respectively. The most of operation site was clean wound (97.9%). Staphylococcus aureus was observed in 19.8% before operation and among S. aureus infections about 20% was methicillin-resistant strain. The 1st generation cephalosporins were most frequently used for prophyaxis occupying 65.1%. The median duration of antibiotic use was 12 days (1-79 days). Any other specific risk factors were not correlated with SSI development. CONCLUSION: The multicenter surveillance study of SSI was first performed in Korea. The SSI rate was comparable with SSI reported in other country. We need to analyze the risk factors of SSI after collecting the data through further studies.

Pseudooutbreak of Acinetobacter spp. Bacteriuria Confirmed by 16S rRNA Gene Sequence Analysis

BACKGROUND: Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. MATERIALS AND METHODS: Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. RESULTS: All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. CONCLUSION: This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms

Pseudooutbreak of Acinetobacter spp. Bacteriuria Confirmed by 16S rRNA Gene Sequence Analysis

BACKGROUND: Acinetobacter spp. is increasingly implicated in hospital-acquired infections. We experienced a pseudooutbreak of Bordetella bronchiseptica bacteriuria identified with biochemical tests, that was later identified as Acinetobacter spp. by using 16S rRNA gene sequence analysis. MATERIALS AND METHODS: Five in-ward patients were found to have B. bronchiseptica bacteriuria without symptoms of urinary tract infection between September 23 and 26 of 2005. We conducted pulsed field gel electrophoresis (PFGE) of the bacteria and epidemiological investigation of this pseudooutbreak. In addition, 16S rRNA gene sequence analysis was performed for the verification of the strains. RESULTS: All 5 isolates were identified as B. bronchiseptica with similar antibiogram by VITEK system. There was no evidence of any symptom or sign of urinary tract infection. The source of this pseudooutbreak was not detected even after performing environmental culture and interviews with healthcare workers. We could not get the appropriate results from the first PFGE with XbaI restriction enzyme. B. bronchiseptica is an unusual organism in human so we conducted 16S rRNA gene sequence analysis for verification. The analysis of 16S rRNA gene sequence with 5 isolates demonstrated 99-100% similarity to a sequence of Acinetobacter spp. (AU1523). According to the results of 16S rRNA gene sequence analysis, we performed the second PFGE with SmaI restriction enzyme, which showed indistinguishable pattern among the all 5 isolates. CONCLUSION: This investigation suggests that the combined method of 16s rRNA gene sequence analysis and PFGE would be helpful for investigation of outbreak caused by unusual organisms

A Case of Incidentaloma Compromising of Pheochromocytoma and Adrenocortical Adenoma in an Infant / 대한소아혈액종양학회지

Pheochromacytoma, although occasionally present with adrenal cortical hyperfunction, is rarely associated with nonfunctioning adrenal cortical tumor. To our knowledge, eight cases of phemchromocytoma associated with adrenocortical adenoma have been reported in the literature, including a case in a Korean adult female. An adrenal mass is considered an incidentaloma when there is no history or physical findings suggesting an adrenal functional disorder or tumor. The majority of adrenal masses are nonfunctioning adrenocortical adenomas. In our case, left adrenal mass was found incidentally by ultrasonography after birth, done because of mother's oligohydroamnios. Abdomial CT study revealed an adrenal tumor, and a surgical resection was performed. The specimen showed a coincident pheochromocytoma and adrenocortical adenoma. The patient seems to be the first case of coexistence of nonfunctioning pheochromocytoma and adrenocortical adenoma in one adrenal tumor. We report this case with the review of literatures.