Susceptibility of Escherichia coli from Community-Acquired Urinary Tract Infection to Fosfomycin, Nitrofurantoin, and Temocillin in Korea

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.

Susceptibility of Escherichia coli from Community-Acquired Urinary Tract Infection to Fosfomycin, Nitrofurantoin, and Temocillin in Korea

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.

Is it Acceptable to Select Antibiotics for the Treatment of Community-acquired Acute Cystitis Based on the Antibiotics Susceptibility Results for Uropathogens from Community-acquired Acute Pyelonephritis in Korea?

BACKGROUND: Uncomplicated acute cystitis (CA-UAC) is one of the most common infections treated with antibiotics in the community. However, few data on etiology of CA-UAC and its susceptibility to antibiotics are available, primarily because, in Korea, insurance does not allow reimbursement for microbiological evaluation of CA-UAC. However, microbiologic data on community-acquired uncomplicated acute pyelonephritis (CA-UAPN) are available. The objective of the study was to evaluate the question of whether microbiologic data on CA-UAPN can be used for treatment of CA-UAC; therefore, etiology and antimicrobial susceptibility were compared between pathogens of CA-UAC and those of CA-UAPN. MATERIALS AND METHODS: During 2008, 538 CA-UACs and 1,265 CA-UAPNs were recruited retrospectively from 14 hospitals (UTI research group). Microbiologic data on etiology and susceptibility to antibiotics were collected retrospectively. RESULTS: Urine culture was positive in 131 CA-UACs (131/469, 27.9%) and 719 CA-UAPNs (719/1249, 57.6%). Escherichia coli was the most common pathogen in both groups [83.2% (109/131) in CA-UAC vs. 91.9% (661/719) in CA-UAPN]. Susceptibility to common UTI regimens, such as ciprofloxacin, extended-spectrum cephalosporins, and trimethoprim/sulfamethoxazole did not differ between urinary pathogens of CA-UACs and CA-UAPNs, however, a significant difference was observed in rates of resistance to ampicillin/sulbactam (16.5% vs. 42.9%, P<0.001, respectively). CONCLUSIONS: Rates of resistance of E. coli from CA-UAC and CA-UAPN to most antibiotics did not differ. For proper treatment, further microbiological evaluation for CA-UAC is mandatory.

Korean Surgical Site Infection Surveillance System Report: Data Summary from July 2010 through June 2011 / 병원감염관리

BACKGROUND: A web-based surveillance of surgical-site infections (SSIs) in Korean Nosocomial Infections Surveillance System (KONIS) was performed to determine the incidence of SSIs after 15 operative procedures. METHODS: Forty-three hospitals participated in the surveillance system for 15 operative procedures. A year-round observation was carried out, and the duration of participation was shortened for 3 months unit. All data were collected using a real-time web-based reporting system. RESULTS: From July 2010 through June 2011, SSI surveillance data of 18,644 cases were collected from 43 hospitals. SSIs were found to occur in 2.10% of the total cases. The SSI rates after various surgeries were as follows: 4.49%, rectal surgery; 4.41%, colon surgery; 3.50%, gastric surgery; 3.12%, craniotomy; 1.25%, abdominal hysterectomy; 0.93%, laminectomy; 0.63%, cesarean section; 0.62%, gallbladder surgery; and 0.54%, vaginal hysterectomy. The interim results of implant-related surgery are given below as SSI rates: 3.78%, ventricular shunt operation; 3.23%, coronary artery bypass graft; 2.20%, cardiac surgery; 1.31%, spinal fusion; 0.96%, knee prosthesis; and 0.88%, hip prosthesis. CONCLUSION: The SSI rate was found to be 2.10% by the KONIS 2010. The maintenance of a surveillance system for SSI is very important, as it will help in decreasing SSIs via feedback to the involved surgeons and infection-control personnel.

Effect of Coronary Angioplasty on QT and JT Dispersion

BACKGROUND: QT dispersion, reflecting inhomogenous ventricular repolarization, increases in myocardial ischemia. In addition, Many studies reported that prolonged QT dispersion reduced to normal after reperfusion treatment. We have carried out this study to evaluate the QT and JT dispersion before and after the angioplasty in patients with coronary artery diseases. METHOD AND MATERIALS: Seventy-two patients (55 men and 17 women:18 acute myocardial infarction, 9 unstable angina and 45 stable angina) who underwent percutaneous transluminal coronary angioplasty were evaluated. Standard 12-lead electrocardiograms were recorded 24 hours before and 24 hours after angioplasty at a paper speed of 25 mm/sec. RESULTS: There was no significant change in heart rate or the maximum or minimum QT interval after angioplasty. QT dispersion significantly decreased after angioplasty (p<0.05). And QTc dispersion (QTcd) also similary reduced (p<0.01). JT dispersion (JTc) and JTc dispersion (JTcd) were not changed significantly. There were significant reduction in QTd and QTcd in the group of patients without acute myocardial infarction (p=0.005, 0.004, respectively) but not in JTd and JTcd. However, in patients with acute myocardial infarction, all four dispersion were not reduced significantly. And in patients with multivessel angioplasty, there were significant reduction of QTd, QTcd, JTd and JTcd (p=0.016, 0.014, 0.036, 0.030, respectively). CONCLUSIONS: As changes in QT and JT dispersion reflect successful reperfusion by angioplasty, they can be accepted as promising test for assessing the effectiveness of angioplasty clinically. However the methodology still has several unresolved issues and larger, prospective clinical studies are needed.