Incidence and Risk Factors for Surgical Site Infection after Gastric Surgery: A Multicenter Prospective Cohort Study / 감염과화학요법

BACKGROUND: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. While gastrointestinal surgery is relatively common in Korea, few studies have evaluated SSI in the context of gastric surgery. Thus, we performed a prospective cohort study to determine the incidence and risk factors of SSI in Korean patients undergoing gastric surgery. MATERIALS AND METHODS: A prospective cohort study of 2,091 patients who underwent gastric surgery was performed in 10 hospitals with more than 500 beds (nine tertiary hospitals and one secondary hospital). Patients were recruited from an SSI surveillance program between June 1, 2010, and August 31, 2011 and followed up for 1 month after the operation. The criteria used to define SSI and a patient's risk index category were established according to the Centers for Disease Control and Prevention and the National Nosocomial Infection Surveillance System. We collected demographic data and potential perioperative risk factors including type and duration of the operation and physical status score in patients who developed SSIs based on a previous study protocol. RESULTS: A total of 71 SSIs (3.3%) were identified, with hospital rates varying from 0.0 - 15.7%. The results of multivariate analyses indicated that prolonged operation time (P = 0.002), use of a razor for preoperative hair removal (P = 0.010), and absence of laminar flow in the operating room (P = 0.024) were independent risk factors for SSI after gastric surgery. CONCLUSIONS: Longer operation times, razor use, and absence of laminar flow in operating rooms were independently associated with significant increased SSI risk after gastric surgery.

A Prediction Rule to Identify Severe Cases among Adult Patients Hospitalized with Pandemic Influenza A (H1N1) 2009

The purpose of this study was to establish a prediction rule for severe illness in adult patients hospitalized with pandemic influenza A (H1N1) 2009. At the time of initial presentation, the baseline characteristics of those with severe illness (i.e., admission to intensive care unit, mechanical ventilation, or death) were compared to those of patients with non-severe illnesses. A total of 709 adults hospitalized with pandemic influenza A (H1N1) 2009 were included: 75 severe and 634 non-severe cases. The multivariate analysis demonstrated that altered mental status, hypoxia (PaO2/FiO2 or = 65 yr) were independent risk factors for severe cases (all P or = 2 risk factors had a higher sensitivity, specificity, positive predictive value and negative predictive value than an APACHE II score of > or = 13. As a prediction rule, the presence of > or = 2 these risk factors is a powerful and easy-to-use predictor of the severity in adult patients hospitalized with pandemic influenza A (H1N1) 2009.

Clinical Features of Hospitalized Adult Patients with Pneumonia in Novel Influenza A (H1N1) Infection / 결핵및호흡기질환

BACKGROUND: A novel 2009 influenza A (H1N1) virus emerged and disseminated to all over the world. There are few reports on the clinical characteristics of patients with complications. We describe the clinical features of pneumonia in adult patients hospitalized, who have novel influenza infection. METHODS: There were 43 adult patients enrolled into the study with pneumonia of 528 hospitalized patients confirmed influenza A (H1N1) virus infection by real-time reverse transcriptase polymerase chain reaction testing, between 24 August 2009 and 31 January 2010. The clinical data of patients with pneumonia were collected retrospectively. RESULTS: There were 22 of 43 (51.2%) influenza patients with pneumonia that had higher risk factors for complications. Compared to 28 patients with influenza A (H1N1) viral pneumonia and 15 patients, who had isolated bacteria from cultures, those with mixed viral and bacterial pneumonia were significantly more likely to have unilobar consolidations on chest radiographs (53.3 vs. 10.7%, p<0.01) and higher scores of pneumonia severity index (PSI; 90 [66~100] vs. 53 [28~90], p=0.04). Six patients required mechanical ventilation support in an Intensive Care Unit and were more likely to have dyspnea (83.3 vs. 29.3%, p=0.02) and low levels of PaO2 (48.3 [37.0~70.5] vs 64.0 [60.0~74.5] mm Hg, p=0.02) and high levels of pneumonia severity index (PSI) score (108.0 [74.5~142.8] vs. 56.0 [40.5~91.0], p=0.03). CONCLUSION: The majority of pneumonia patients infected with novel influenza improved. Chest radiographic findings of unilobar consolidations suggest that mixed pneumonia is more likely. Initial dyspnea, hypoxemia, and high levels of PSI score are associated with undergoing mechanical ventilation support.

Clinical Features of Hospitalized Adult Patients with Pneumonia in Novel Influenza A (H1N1) Infection / 결핵및호흡기질환

BACKGROUND: A novel 2009 influenza A (H1N1) virus emerged and disseminated to all over the world. There are few reports on the clinical characteristics of patients with complications. We describe the clinical features of pneumonia in adult patients hospitalized, who have novel influenza infection. METHODS: There were 43 adult patients enrolled into the study with pneumonia of 528 hospitalized patients confirmed influenza A (H1N1) virus infection by real-time reverse transcriptase polymerase chain reaction testing, between 24 August 2009 and 31 January 2010. The clinical data of patients with pneumonia were collected retrospectively. RESULTS: There were 22 of 43 (51.2%) influenza patients with pneumonia that had higher risk factors for complications. Compared to 28 patients with influenza A (H1N1) viral pneumonia and 15 patients, who had isolated bacteria from cultures, those with mixed viral and bacterial pneumonia were significantly more likely to have unilobar consolidations on chest radiographs (53.3 vs. 10.7%, p<0.01) and higher scores of pneumonia severity index (PSI; 90 [66~100] vs. 53 [28~90], p=0.04). Six patients required mechanical ventilation support in an Intensive Care Unit and were more likely to have dyspnea (83.3 vs. 29.3%, p=0.02) and low levels of PaO2 (48.3 [37.0~70.5] vs 64.0 [60.0~74.5] mm Hg, p=0.02) and high levels of pneumonia severity index (PSI) score (108.0 [74.5~142.8] vs. 56.0 [40.5~91.0], p=0.03). CONCLUSION: The majority of pneumonia patients infected with novel influenza improved. Chest radiographic findings of unilobar consolidations suggest that mixed pneumonia is more likely. Initial dyspnea, hypoxemia, and high levels of PSI score are associated with undergoing mechanical ventilation support.

Prognosis Factors of Clostridium difficile Associated Diarrhea / 감염과화학요법

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. MATERIALS AND METHODS: A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. RESULTS: Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P< 0.001) as the independent poor prognostic factors. CONCLUSION: Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

A Case of Brucellar Spondylitis with Multiple Spine Involvement / 감염과화학요법

Brucellosis, a zoonosis with world wide distribution, is a systemic infection that affects several organs and has protean presentation. Although spondylitis is universally the most common complication of brucellosis and difficult to treat, there is no consensus on the preferred combination of antibiotics use. The authors report a case of a 58-year-old male patient with brucellar spondylitis involving several vertebrae. Diagnosis was made by positive blood culture and magnetic resonance imaging. The authors use a combination method of doxycycline, ciprofloxacin and streptomycin for a period of 3 months. The systemic symptoms were improved after treatment.

Therapeutic Response of HAART and Analysis of Related Factors in Korean HIV-infected Persons / 감염과화학요법

BACKGROUND: Recently, 2.1 persons per day are reported to be HIV infected and totally more than 4,500 HIV infected persons have been officially reported until 2006 in Korea. We started highly active antiretroviral therapy (HAART) for HIV patients from 1997. Data on the efficacy of antiretroviral therapy are limited in Korea. MATERIALS AND METHODS: HIV infected patients treated with HAART for more than 1 year were included. We studied the therapeutic response of antiretroviral therapy in patients with AIDS and without previous antiretroviral therapy who were treated until Dec 2005 in Severance hospital. RESULTS: More than 450 were diagnosed as HIV infected in Severance hospital. Among these HIV infected patients, 141 patients including 14 females were included. 121 of the 141 patients (85.8%) were treated with PI based regimen, and 20(14.2%) were treated with NNRTI based regimen. The initial mean CD4 T cell count was 207/mm3 (IQR 73-299) and the mean HIV RNA level was 70,800 copies/mL. After 6 months of HAART, 103 patients (73%) had fewer than 400 copies of HIV RNA copies/mL. After 12 months of HAART, 90 patients (63.8%) had fewer than 50 copies of HIV RNA copies/mL. The mean increase in the CD4 T cell count from baseline to 12 months was 143 cells/mm3. After 12 months, 96 patients (68.1%) had increased more than 100 cells/mm3. CONCLUSION: This report the therapeutic response of HAART in Korea which the prevalence of HIV infection is now increasing. Overall, the outcomes are similar to those in other developed countries. Further large scale prospective cohort study is needed.

Epidemiology of HIV/AIDS in East Asia / 감염과화학요법

BACKGROUND: Recent predictions of catastrophic epidemic surge of HIV infection in East Asia concern experts and governmental organizations. As in many other areas, countries in East Asia show diversities in their HIV epidemics, both geographically and temporally. However, they have similar regional, cultural and racial characteristics which allow them to have certain common factors. Having a clear picture of the current extent and feature of HIV/AIDS in this region is a very difficult task largely due to the fast pacing of expending epidemic and difficulty in data-sharing among countries in the region. Hence, we decided to study the epidemiologic feature of HIV/AIDS in East Asia through East Asia Network on HIV (EAN-HIV). MATERIALS AND METHODS: The epidemiological patterns of HIV/AIDS in East Asian countries were investigated by collecting data through EAN-HIV. RESULTS: The HIV/AIDS epidemic in East Asia started relatively late at mid 1980s. Since then, the number of newly infected HIV/AIDS cases has been steadily increasing with stiffer escalation in recent years. In China and Taiwan, IDU plays an important part in the swiftly growing HIV epidemics; however, in other regions like Korea, Japan, and Hong Kong, MSM (men who have sex with men) seems to be more of a problem. The major subtypes of HIV in East Asia are subtype B, C, and CRF01_AE, and rapidly evolving circulating recombinant forms (CRF) between subtypes such as CRF07_BC give dynamic change to the current status. CONCLUSION: The incidence of HIV/AIDS is rapidly increasing in East Asia. The epidemic pattern has undergone dynamic changes over time. China seems to be the leading source of HIV/AIDS epidemic in East Asia due to its large population and rapidly growing epidemics.

Prognosis Factors of Clostridium difficile Associated Diarrhea / 감염과화학요법

BACKGROUND: Clostridium difficile associated diarrhea (CDAD) has a wide range of clinical manifestations. The prognostic factors of CDAD are not fully understood. MATERIALS AND METHODS: A retrospective cohort study of 115 patients with CDAD from Aug. 2002 to Dec. 2003 was conducted to evaluate prognostic factors of CDAD. Bacteriologic factors were determined by detecting the binary toxin gene, tcd A, tcd A rep and tcd B gene. Poor prognosis was defined as diarrhea more than 10 days even with classic treatment, recurrence, death, and moribund discharge. RESULTS: Approximately 79% of isolated strains were toxin A+/B+ strains and 21% were toxin A-/B+ strains. There was no difference in prognosis between toxin A+ and toxin A- strains. 39 (33.9%) cases showed poor prognosis and 76 (66.1%) cases showed good prognosis. Univariate analyses revealed that the poor prognostic factors were old age over 70 years old, male, the number of antibiotics used after onset of symptom, the administration of carbapenems, aminoglycosides, glycopeptides after onset of symptom, history of DM and stroke, and high Charlson comorbidity index. Multiple logistic regression analysis identified old age over 70 years old (odds ratio=3.378, P=0.009) and the administration of carbapenems after onset of symptom (odds ratio 7.210, P< 0.001) as the independent poor prognostic factors. CONCLUSION: Old age over 70 and the administration of carbapenems after onset of symptom were the poor prognostic factors for CDAD caused by none-binary toxin producing strains.

A Case of Brucellar Spondylitis with Multiple Spine Involvement / 감염과화학요법

Brucellosis, a zoonosis with world wide distribution, is a systemic infection that affects several organs and has protean presentation. Although spondylitis is universally the most common complication of brucellosis and difficult to treat, there is no consensus on the preferred combination of antibiotics use. The authors report a case of a 58-year-old male patient with brucellar spondylitis involving several vertebrae. Diagnosis was made by positive blood culture and magnetic resonance imaging. The authors use a combination method of doxycycline, ciprofloxacin and streptomycin for a period of 3 months. The systemic symptoms were improved after treatment.

Therapeutic Response of HAART and Analysis of Related Factors in Korean HIV-infected Persons / 감염과화학요법

BACKGROUND: Recently, 2.1 persons per day are reported to be HIV infected and totally more than 4,500 HIV infected persons have been officially reported until 2006 in Korea. We started highly active antiretroviral therapy (HAART) for HIV patients from 1997. Data on the efficacy of antiretroviral therapy are limited in Korea. MATERIALS AND METHODS: HIV infected patients treated with HAART for more than 1 year were included. We studied the therapeutic response of antiretroviral therapy in patients with AIDS and without previous antiretroviral therapy who were treated until Dec 2005 in Severance hospital. RESULTS: More than 450 were diagnosed as HIV infected in Severance hospital. Among these HIV infected patients, 141 patients including 14 females were included. 121 of the 141 patients (85.8%) were treated with PI based regimen, and 20(14.2%) were treated with NNRTI based regimen. The initial mean CD4 T cell count was 207/mm3 (IQR 73-299) and the mean HIV RNA level was 70,800 copies/mL. After 6 months of HAART, 103 patients (73%) had fewer than 400 copies of HIV RNA copies/mL. After 12 months of HAART, 90 patients (63.8%) had fewer than 50 copies of HIV RNA copies/mL. The mean increase in the CD4 T cell count from baseline to 12 months was 143 cells/mm3. After 12 months, 96 patients (68.1%) had increased more than 100 cells/mm3. CONCLUSION: This report the therapeutic response of HAART in Korea which the prevalence of HIV infection is now increasing. Overall, the outcomes are similar to those in other developed countries. Further large scale prospective cohort study is needed.

Epidemiology of HIV/AIDS in East Asia / 감염과화학요법

BACKGROUND: Recent predictions of catastrophic epidemic surge of HIV infection in East Asia concern experts and governmental organizations. As in many other areas, countries in East Asia show diversities in their HIV epidemics, both geographically and temporally. However, they have similar regional, cultural and racial characteristics which allow them to have certain common factors. Having a clear picture of the current extent and feature of HIV/AIDS in this region is a very difficult task largely due to the fast pacing of expending epidemic and difficulty in data-sharing among countries in the region. Hence, we decided to study the epidemiologic feature of HIV/AIDS in East Asia through East Asia Network on HIV (EAN-HIV). MATERIALS AND METHODS: The epidemiological patterns of HIV/AIDS in East Asian countries were investigated by collecting data through EAN-HIV. RESULTS: The HIV/AIDS epidemic in East Asia started relatively late at mid 1980s. Since then, the number of newly infected HIV/AIDS cases has been steadily increasing with stiffer escalation in recent years. In China and Taiwan, IDU plays an important part in the swiftly growing HIV epidemics; however, in other regions like Korea, Japan, and Hong Kong, MSM (men who have sex with men) seems to be more of a problem. The major subtypes of HIV in East Asia are subtype B, C, and CRF01_AE, and rapidly evolving circulating recombinant forms (CRF) between subtypes such as CRF07_BC give dynamic change to the current status. CONCLUSION: The incidence of HIV/AIDS is rapidly increasing in East Asia. The epidemic pattern has undergone dynamic changes over time. China seems to be the leading source of HIV/AIDS epidemic in East Asia due to its large population and rapidly growing epidemics.

A Case of Gastrogastric Fistula as a Complication of Benign Gastric Ulcer / 대한소화기내시경학회지

Gastrogastric fistula is an extremely rare complication of benign gastric ulcer. We report a case of gastrogastric fistula in a 67-year-old male who presented with symptoms of dyspnea on exertion, pretibial pitting edema, and dyspepsia. He suffered from a peptic ulcer 9 years ago and from a gastric outlet obstruction 5 years ago. A gastrogastric fistula was observed by endoscopy, and the biopsy forceps were passed through the fistulous tract. The patient was treated with proton pump inhibitors, and H. pylori was eradicated. Gastrogastric fistula, unlike other types of gastric fistulas, can be cured using non-surgical therapy as long as complications such as peritonitis, gastric outlet obstruction, and bleeding do not occur.

Comparison of Efficacy of Cefoperazone/Sulbactam and Imipenem/Cilastatin for Treatment of Acinetobacter Bacteremia

Multiple antibiotic reisistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/ cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/ sulbactam group and imipenem/ cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.

Lack of Toll-like Receptor 4 and 2 Polymorphisms in Korean Patients with Bacteremia

Toll-like receptors (TLRs) are pattern-recognition receptors that are important in innate immune responses to bacterial infection. The purpose of this study is to describe the prevalence of TLRs genetic variations in the bacteremic patients in Korea. A total of 154 patients with bacteremia and 179 healthy volunteers were included. The Asp299Gly and Thr399Ile allele of the TLR4 gene and Arg753Gln and Arg677Trp allele of the TLR2 gene were tested by PCR-RFLP. The DNA sequences were determined to confirm the PCR-RFLP results. Contrary to the expectation, no genetic polymorphisms were detected in both groups of this study, suggesting that it is very rare in Korean.

Lack of Toll-like Receptor 4 and 2 Polymorphisms in Korean Patients with Bacteremia

Toll-like receptors (TLRs) are pattern-recognition receptors that are important in innate immune responses to bacterial infection. The purpose of this study is to describe the prevalence of TLRs genetic variations in the bacteremic patients in Korea. A total of 154 patients with bacteremia and 179 healthy volunteers were included. The Asp299Gly and Thr399Ile allele of the TLR4 gene and Arg753Gln and Arg677Trp allele of the TLR2 gene were tested by PCR-RFLP. The DNA sequences were determined to confirm the PCR-RFLP results. Contrary to the expectation, no genetic polymorphisms were detected in both groups of this study, suggesting that it is very rare in Korean.

Clinical Characteristics of Pyogenic Liver Abscess with Klebsiella pneumoniae or Non-Klebsiella pneumoniae and Its Prognosis Associated with Diabetes Mellitus / 감염과화학요법

BACKGROUND: Although the most common pathogen of liver abscess was Escherichia coli in the past, there has been an increasing number of reports on liver abscess caused by Klebsiella pneumoniae, especially in Asia and its more frequent occurrence in diabetes mellitus. Our study was to clarify the different clinical characteristics and prognostic factors of K. pneumoniae and non-K. pneumoniae liver abscess in patients with or without diabetes. MATERIALS AND METHODS: We reviewed medical records of pyogenic liver abscess diagnosed by defined criteria at 7 different tertiary care hospitals in Seoul and Gyeonggi Province from January 2000 to December 2003 retrospectively. RESULTS: Of the 248 cases, 86 cases (34.7%) of patients were diabetic. Cryptogenic cause (73.4%) was the most frequent portal of entry in liver abscess and 58 cases (23.4%) were the secondary following biliary disease. There were no differences in portal of entry between DM group and non- DM group. The most common organism was K. pneumoniae (70.2%) followed by E. coli (11.5%) and alpha-hemolytic streptococcus (5.2%). There were no significant differences in causative organism of liver abscess between DM group and non-DM group as K. pneumoniae was dominant pathogen [76.6% in DM group vs 66.2% in non-DM group (P=0.11)]. The metastatic complication occurred in 15 cases (8.6%) and found more frequently in DM group (P=0.042). All of the metastatic abscesses were found in liver abscess caused by K. pneumoniae (P=0.007). Ten patients died and the overall mortality rate was 4.1%. The factors associated with mortality were level of serum creatinine, past history of intra-abdominal surgery and underlying biliary malignancy. CONCLUSION: The most commom pathogen of the pyogenic liver abscess is K. pneumoniae and the metastatic complications are usually found in liver abscess caused by K. pneumoniae, especially more frequently in patients with diabetes than in patients without diabetes.

HIV-Specific Cellular Immune Responses Are Stimulated by Structured Treatment Interruption in Chronically HIV-1 Infected Koreans

We evaluated the enhancing effect of structured treatment interruptions (STIs) on HIV-specific immunity in chronically HIV-1 infected Korean patients. A prospective case-control study was done with a total of 10 subjects for a period of 26 weeks. Six subjects were on STIs and four subjects were on continuous HAART for comparison. The STI subjects underwent four periods of STIs. For those on STIs, HAART was stopped at week 0 for two weeks, and resumed thereafter for six weeks. Viral load and CD4+/CD8+ T cells were measured by HIV RNA RT-PCR and flow cytometry, and HIV-specific immunity was measured by an ELISPOT assay. HIV-specific cytotoxic T cell immunity was more pronounced in the STI subjects than in the continuous HAART subjects after 26 weeks (p = 0.011). The difference in cytotoxic T cell response in the STI group was more prominent than in the continuous HAART group (p = 0.011). Viral load after 26 weeks was higher in the STI subjects than in the continuous HAART subjects (p = 0.008). An HIV-specific cellular immune response can be stimulated by STIs in chronically HIV-infected Koreans. A larger study is warranted in order to further characterize viral and immunological parameters of treatment with STIs in cases of chronic HIV infection.

Papular-purpuric 'gloves and socks' syndrome / 대한내과학회지

No abstract available.

Clinical Manifestations of Febrile Neutropenic Patients with Solid Tumor and Risk Factors for Gram Positive Bacteremia / 감염과화학요법

BACKGROUNDS: Recently, there has been a rise of prevalence of gram positive infection among cancer patients with febrile neutropenia. The proportion of antibiotic-resistant gram positive infection has been growing lately, especially in Korea, where the rate of MRSA infection was over 70%. It brings to careful consideration of early glycopeptide treatment in febrile neutropenic patients if gram positive infection is suspected. Also until now, most studies concerning febrile neutropenic patients were mainly related to hematologic malignancy rather than solid tumor. MATERIALS AND METHODS: We evaluated clinical manifestations and risk factors for gram positive bacteremia in a cohort of 288 solid tumor patients who were more than 18 years old and had neutropenic fever after chemotherapy from January 2002 to December 2004 at the Department of Oncology, Yonsei Cancer Center, Seoul. RESULTS: We identified the cause of fever in 130 (45.1%) cases, of which 53 (18.4%) cases were blood stream infection. Gram positive organism was isolated in 27 cases which comprises 50.9% of blood stream infections, followed by gram negative organism (47.2%) and fungus (1.9%). A logistic regression analysis revealed that gram positive bacteremia was associated independently with central venous catheter (CVC) infection, oropharyngeal mucositis, skin and soft tissue infection in febrile neutropenic patients with solid tumor. CONCLUSIONS: Gram positive bacteremia was common among febrile neutropenic patients in solid tumor and was associated with CVC infection, oropharyngeal mucositis, skin and soft tissue infection. The early use of glycopeptide must be taken into account in such conditions.