Clinical characteristics and risk factors for staphylococcal infections in neonatal intensive care unit / 소아과

PURPOSE: The importance of staphylococcal infections in NICU has been emphasized in terms of increased resistant strains and increased incidence of morbidity and mortality. In this study, we inrestignted the clinical characteristics and risk factors for staphylococcal infections, and looked into sensitivity trends of antibiotics in the era of a high rate of methicillin-resistant staphylococcus aureus (MRSA) in our society. METHODS: This study included 240 neonates with positive blood, urine and other sites cultures for staphylococci who were admitted to NICU of Hanil General Hospital and Kyunghee University Hospital from January 2000 to December 2004. The analyses included clinical characteristics of staphylococcal infections and the relationship of incidence rate among various factors, including invasive procedures. RESULTS: For 5 years, 3,593 patients were hospitalized in the NICU and 7,481 specimens were cultured from blood, urine, and other sites. During the study period, staphylococci were isolated from 240 patients, of whom 88 patients had MRSA, 41 patients methcillin sensitive staphylococcus aureus (MSSA), 63 patients S. epidermidis, 48 patients coagulase-negative staphylococcus (CNS) except S. epidermidis infections. The risk factors associated with staphylococcal infections were less than 37 weeks of gestational age, less than 7 on a 5 minutes Apgar score, receiving TPN, applied mechanical ventilation, use of central venous catheters and other tubes. The sensitivity to vancomycin was 100 percent. A relatively high sensitivity against teicoplanin, trimethoprim-sulfamethoxazole, chloramphenicol, clindamycin and low sensitivity against gentamicin and erythromycin were shown. CONCLUSION: To reduce staphylococcal infections in NICU, we need to monitor and manage premature neonates from the beginning of the birth process and to avoid as many invasive procedures as possible in NICU. Considering MRSA, control of preceding factors and early use of appropriate antibiotics is expected to reduce the morbidity and mortality caused by MRSA infections.

A case of intestinal tuberculosis complicated by miliary tuberculosis / 소아과

Intestinal tuberculosis presents with nonspecific and variable clinical manifestations. It is rarely seen in current clinical practice and the diagnosis may be missed or confused with many other disorders such as Crohns disease and intestinal neoplasms. The route of infection by tuberculous enteritis is variable and the treatment regimens used for treating pulmonary tuberculosis are generally effective for tuberculous enteritis as well. Uncomplicated tuberculous enteritis can be managed with a nine to 12- month course of antituberculous chemotherapy. If not treated early, the prognosis for intestinal tuberculosis is poor, with an overall mortality of between 19 percent and 38 percent. However, 90 percent of patients will respond to medical therapy alone if started early. Therefore, early detection and treatment is essential. Here we report a case of intestinal tuberculosis secondary to miliary tuberculosis.

The Safety and Immunogenicity of a Trivalent, Live, Attenuated MMR Vaccine, Priorix (TM) / 소아과

PURPOSE: This multi-center, open-label, clinical study was designed to evaluate the safety and immunogenicity of a trivalent, live, attenuated measles-mumps-rubella (MMR) vaccine, Priorix (TM) in Korean children. METHODS: From July 2002 to February 2003, a total of 252 children, aged 12-15 months or 4-6 years, received Priorix (TM) at four centers: Han-il General Hospital, Kyunghee University Hospital, St. Paul's Hospital at the Catholic Medical College in Seoul, and Korea University Hospital in Ansan, Korea. Only subjects who fully met protocol requirements were included in the final analysis. The occurrence of local and systemic adverse events after vaccination was evaluated from diary cards and physical examination for 42 days after vaccination. Serum antibody levels were measured prior to and 42 days post-vaccination using IgG ELISA assays at GlaxoSmithKline Biologicals (GSK) in Belgium. RESULTS: Of the 252 enrolled subjects, a total of 199 were included in the safety analysis, including 103 from the 12-15 month age group and 96 from the 4-6 year age group. The occurrence of local reactions related to the study drug was 10.1 percent, and the occurrence of systemic reactions was 6.5 percent. There were no episodes of aseptic meningitis or febrile convulsions, nor any other serious adverse reaction. In immunogenicity analysis, the seroconversion rate of previously seronegative subjects was 99 percent for measles, 93 percent for mumps and 100 percent for rubella. Both age groups showed similar seroconversion rates. The geometric mean titers achieved, 42 days post- vaccination, were: For measles, in the age group 12-15 months, 3, 838.6 mIU/mL [3, 304.47, 4, 458.91]; in the age group 4-6 years, 1, 886.2 mIU/mL [825.83, 4, 308.26]. For mumps, in the age group 12-15 months, 956.3 U/mL [821.81, 1, 112.71]; in the age group 4-6 years, 2, 473.8 U/mL [1, 518.94, 4, 028.92]. For rubella, in the age group 12-15 months, 94.5 IU/mL [79.56, 112.28]; in the age group 4-6 years, 168.9 IU/mL [108.96, 261.90]. CONCLUSION: When Korean children in the age groups of 12-15 months or 4-6 years were vaccinated with GlaxoSmithKline Biologicals' live attenuated MMR vaccine (Priorix (TM) ), adverse events were limited to those generally expected with any live vaccine. Priorix (TM) demonstrated excellent immunogenicity in this population.