Mortality of Community-Acquired Pneumonia in Korea: Assessed with the Pneumonia Severity Index and the CURB-65 Score

The pneumonia severity index (PSI) and CURB-65 are widely used tools for the prediction of community-acquired pneumonia (CAP). This study was conducted to evaluate validation of severity scoring system including the PSI and CURB-65 scores of Korean CAP patients. In the prospective CAP cohort (participated in by 14 hospitals in Korea from January 2009 to September 2011), 883 patients aged over 18 yr were studied. The 30-day mortalities of all patients were calculated with their PSI index classes and CURB scores. The overall mortality rate was 4.5% (40/883). The mortality rates per CURB-65 score were as follows: score 0, 2.3% (6/260); score 1, 4.0% (12/300); score 2, 6.0% (13/216); score 3, 5.7% (5/88); score 4, 23.5% (4/17); and score 5, 0% (0/2). Mortality rate with PSI risk class were as follows: I, 2.3% (4/174); II, 2.7% (5/182); III, 2.3% (5/213); IV, 4.5% (11/245); and V, 21.7% (15/69). The subgroup mortality rate of Korean CAP patients varies based on the severity scores and CURB-65 is more valid for the lower scores, and PSI, for the higher scores. Thus, these variations must be considered when using PSI and CURB-65 for CAP in Korean patients.

Trends of Mortality and Cause of Death among HIV-Infected Patients in Korea, 1990-2011

Although a decrease in acquired immunodeficiency syndrome (AIDS)-related mortality has been documented in highly active antiretroviral therapy (HAART) era, there are no published data comparing specific causes of death between pre-HAART and HAART era in Korea. Mortality and cause of death were analyzed in three treatment periods; pre-HAART (1990-1997), early-HAART (1998-2001), and late-HAART period (2002-2011). The patients were retrospectively classified according to the treatment period in which they were recruited. Although mortality rate per 100 person-year declined from 8.7 in pre-HAART to 4.9 in late-HAART period, the proportion of deaths within 3 months of initial visit to study hospital significantly increased from 15.9% in pre-HAART to 55.1% in late-HAART period (P < 0.001). Overall, 59% of deaths were attributable to AIDS-related conditions, and Pneumocystis pneumonia (PCP) was the most common cause of death (20.3%). The proportion of PCP as cause of death significantly increased from 8.7% in pre-HAART to 31.8% in late-HAART period (P < 0.001). Despite of significant improvement of survival, there was still a high risk of early death in patients presenting in HAART era, mainly due to late human immunodeficiency virus (HIV) diagnosis and late presentation to care.

Pandemic Influenza (H1N1 2009) among Pregnant Korean Women / 감염과화학요법

BACKGROUND: Pregnant women are at an increased risk for severe illness and complications associated with pandemic (H1N1) 2009. This study was conducted to identify the severity of pandemic (H1N1) 2009 in pregnant Korean women. MATERIALS AND METHODS: The demographic and clinical data from pregnant women with laboratory confirmed pandemic (H1N1) 2009 during September to December 2009 were retrospectively collected from 8 hospitals in Korea. RESULTS: A total of 150 pregnant women with pandemic (H1N1) 2009 were identified. The median age was 30 years (range: 22-39 years), and the median gestational age (n=114) was 20 weeks (range: 1-39 weeks). All but one patient with secondary bacterial pneumonia had influenza without complication. Although 12 pregnant women needed hospitalization, there were no patients who needed admission to the intensive care unit or who died. Only one hospitalized patient had elective cesarean section because of oligohydamnios. No maternal or fetal complications directly related to the pandemic (H1N1) 2009 were identified among the 67 pregnant women who were followed up for 1 to 185 days after their influenza illness, including 6 women who delivered during the study period. CONCLUSIONS: In contrast with the reports from Western countries, pandemic (H1N1) 2009 among pregnant Korean women was mild.

Trend in Age Distribution of Visitors to Flu-Clinics during the Pandemic Influenza (H1N1 2009) / 감염과화학요법

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

Clinical characteristics and prevalence of toxoplasma infection in human immunodeficiency virus-infected patients in South Korea / 대한내과학회지

BACKGROUND/AIMS: Toxoplasmic encephalitis (TE) is one of the most common causes of focal brain lesions, which complicate the course of acquired immunodeficiency syndrome (AIDS). There is wide geographic variation in the prevalence of toxoplasma infection. This study was performed to characterize toxoplasma infection in human immunodeficiency virus (HIV)-infected patients in South Korea. METHODS: We retrospectively examined the incidence and clinical characteristics of TE in 683 HIV-infected patients who were enrolled between 1990 and 2008 at four university hospitals in Busan, Korea. We also assessed the seroprevalence of IgG antibodies to Toxoplasma gondii, risk factors for toxoplasma seropositivity, and seroconversion rates during the course of HIV infection. RESULTS: Among 683 HIV-infected patients, six (0.9%) patients were diagnosed with TE. The incidence of TE was 0.34 per 100 person-years (py) during the study period. Of the 414 patients who had undergone serological examinations for Toxoplasma gondii, 35 (8.5%) patients were seropositive. Univariate analysis showed that the risk factors associated with toxoplasma seropositivity included increased age, heterosexual transmission, marriage, and a history of overseas residence (p<0.05). Of these factors, a history of overseas residence was a significant risk factor in a multivariate analysis (p<0.05). A total of 95 patients who were seronegative on their initial screen showed serial toxoplasma IgG antibodies (mean duration of follow-up, 2.1 years). Among these patients, only two (2.1%) acquired IgG antibodies to Toxoplasma gondii during the follow-up period. CONCLUSIONS: The seroprevalence of anti-toxoplasma IgG antibodies in HIV-infected patients in Korea was 8.5%. A history of overseas residence was a significant risk factor for toxoplasma seropositivity. The incidence of TE was 0.34/100 py, which is lower than that reported in other countries. Toxoplasma seroconversion was also uncommon (2.1%).

Trends in cancer risk among South Korean patients infected with Human Immunodeficiency Virus / 대한내과학회지

BACKGROUND/AIMS: The prevalence of malignancies associated with human immunodeficiency virus (HIV) is rapidly increasing. The aim of the present study was to identify clinical features associated with malignancies in South Korean patients infected with HIV. METHODS: From January 1990 to June 2007, we reviewed an electronic database containing pathological reports obtained from HIV-infected patients and then retrospectively analyzed a total of 27 malignancy cases treated at four different institutions. RESULTS: Among 683 patients infected with HIV, malignant diseases were diagnosed in 27 cases (4.0%). Twenty-five of these patients were male, and the median age was 48 (range; 24-76). At the time of diagnosis, the median CD4+ lymphocyte count was 42/uL (range 3-339). Acquired immune deficiency syndrome (AIDS)-defining malignancies were diagnosed in 13 patients (48%) and non-AIDS-defining malignancies were diagnosed in 14 patients (52%). Two patients each were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the pre-highly active anti-retroviral therapy (HARRT) period. In contrast, 11 patients (48%) and 12 patients (52%) were diagnosed with AIDS-defining and non-AIDS-defining malignancies during the HARRT period, respectively. Among AIDS-defining malignancies, non-Hodgkins lymphoma was the most frequently observed (9/13), followed by Kaposi's sarcoma (4/13). Among the 9 patients with non-Hodgkins lymphoma, diffuse large B-cell lymphoma was most common (5/9), followed by primary CNS lymphoma (3/9) and Burkitt's lymphoma (1/9). Gastrointestinal (GI) malignancies [i.e., gastric cancer (3/14), rectal cancer (3/14), and esophageal cancer (1/14)] and hepatocellular carcinoma (3/14) were the most commonly observed among the non-AIDS-defining malignancies. Other observed non-AIDS-defining malignancies were thyroid cancer (1/14), tonsillar cancer (1/14), angiosarcoma (1/14), and eccrine cancer (1/14). Finally, median CD4+ lymphocyte counts at the time of diagnosis were significantly different (18 vs. 114/uL, p=0.001) between AIDS-defining malignancies and non-AIDS-defining malignancies. CONCLUSIONS: Malignancies were diagnosed in 4.0% of patients infected with HIV. This study showed similar rates of incidence between AIDS-defining and non-AIDS-defining malignancies. Non-Hodgkins lymphoma was the most frequently observed malignancy, whereas GI malignancies and hepatocellular carcinoma were common among non-AIDS-defining malignancies.

Nephrotic syndrome associated with early neurosyphilis / 대한내과학회지

Nephrotic syndrome, hepatitis, and CNS involvement resulting from secondary syphilis are well-documented complications of neurosyphilis. However, the simultaneous occurrence of these complications is rare. The present report describes a 49-year-old male with early neurosyphilis who presented with features of nephritic syndrome and hepatitis. A diagnosis of neurosyphilis was made by CSF study and serologic tests. After the diagnosis of neurosyphilis, nephrotic syndrome and hepatitis were suspected to be factors of the neurosyphilis. A kidney biopsy revealed membranous nephropathy characterized by subepithelial electron dense deposits and diffuse effacement of foot processes. Abdominal ultrasonography showed hepatitis. The patient was treated with intravenous potassium penicillin G, 4 million units for 2 weeks, and the symptoms and signs resolved after the penicillin therapy. In conclusion, complications experienced by patients with a history of syphilis or syphilis lesions need to be minimized through careful observations and multi-organ treatments.

Nephrotic syndrome associated with early neurosyphilis / 대한내과학회지

Nephrotic syndrome, hepatitis, and CNS involvement resulting from secondary syphilis are well-documented complications of neurosyphilis. However, the simultaneous occurrence of these complications is rare. The present report describes a 49-year-old male with early neurosyphilis who presented with features of nephritic syndrome and hepatitis. A diagnosis of neurosyphilis was made by CSF study and serologic tests. After the diagnosis of neurosyphilis, nephrotic syndrome and hepatitis were suspected to be factors of the neurosyphilis. A kidney biopsy revealed membranous nephropathy characterized by subepithelial electron dense deposits and diffuse effacement of foot processes. Abdominal ultrasonography showed hepatitis. The patient was treated with intravenous potassium penicillin G, 4 million units for 2 weeks, and the symptoms and signs resolved after the penicillin therapy. In conclusion, complications experienced by patients with a history of syphilis or syphilis lesions need to be minimized through careful observations and multi-organ treatments.

Evaluation of Ceftriaxone Utilization at Multicenter Study

BACKGROUND/AIMS: As bacterial resistance to antimicrobial agents has grown due to the increasing use of antimicrobial agents, we sought to evaluate the suitability of ceftriaxone usage (representative of third generation cephalosporins) at 10 university hospitals in Korea. METHODS: We prospectively evaluated the appropriateness of antibiotic usage in 400 adult patients who received ceftriaxone between February 1, 2006 and June 30, 2006. Drug utilization evaluation (DUE) methods were based on standards set forth by the American Society of Hospital Pharmacists. The DUE criteria used in this study were modified to be more suitable in our hospital setting: justification of drug use, critical and process indications, complications, and outcome measures. RESULTS: The average patient age was 64.4 years. The utilization of ceftriaxone was appropriate in 262 cases (65.5%) for the justification of use, while inappropriate use was observed in 138 cases (34.5%). Common reasons for inappropriate use of ceftriaxone included continued empiric use for presumed infections, prophylactic perioperative injection, and empiric therapy for fever. Most of the critical indications showed a high rate of suitability (66.5-98.5%). Complications occurred in 37 cases (9.3%). With respect to outcome measures, clinical responses were observed in 60.7% of cases, while only 15.7% of cases showed evidence of infection eradication via negative cultures. CONCLUSIONS: Appropriate use (65.5%) of ceftriaxone was higher than inappropriate use (34.5%) at university hospitals in Korea. Inappropriate utilization, however, including continued empiric use for presumed infections and prophylactic perioperative injection remained high. Intensification of educational programs and antibiotic control systems for ceftriaxone is needed to improve the suitability of antimicrobial use.

Pseudo-outbreak of Klebsiella oxytoca fromBronchial Washing Specimens / 대한임상미생물학회지

BACKGROUND: We noticed a sudden increase in the isolation of Klebsiella oxytoca from bronchial washing specimens during May to June 2006. An epidemiological investigation was conducted to identify the cause of the outbreak and to implement appropriate infection control measures. METHODS: A total of 18 isolates of K. oxytoca were found. The 14 bronchial washing specimens that yielded K. oxytoca were taken in the outpatient bronchoscopy suite, and the other 4 specimens were obtained by a portable bronchoscopy. The medical records and microbiologic findings of these patients were reviewed. Environmental samples from two bronchoscopes and the bronchoscopy suite were cultured. The relations between the available 10 isolates from bronchial washing fluid were investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: No patients were judged to have had true infections attributable to K. oxytoca either before or after bronchoscopy. Cultures of samples from two bronchoscopes and related environment did not grow K. oxytoca. The PFGE analysis showed that 8 of 10 isolates had a similar pattern of DNA fragments. An infection control strategy was implemented, including adequately cleaning and disinfecting the bronchoscopes, and a sharp reduction in the incidence of K. oxytoca from bronchial washing samples followed. CONCLUSION: The sudden increase of K. oxytoca from bronchial washing specimens was a pseudo-outbreak. We presumed that the bronchoscopes became contaminated during a procedure in a patient colonized with K. oxytoca in the upper-respiratory tract.

Clinical Characteristics of Primary Epstein-Barr Virus Infections in Korea / 감염과화학요법

In this study, the clinical features of 264 patients of primary Epstein-Barr virus (EBV) infection between the years of 2002-2006 were evaluated retrospectively. The median age of the patients was 6 years old (0-69), and the hospitalization rate was 78.0%. Fever (83.3%) and sore throat (50.4%) were the most common symptoms. Cervical lymphadenopathy (71.2%), tonsillitis (51.1%), splenomegaly (26.1 %), hepatomegaly (25.8%), rash (10.2%) and jaundice (1.5%) were observed. Cervical lymphadenopathy was less frequent in older age groups. The annual number of primary EBV infections according to the age group during the study period did not change significantly in this study.

Clinical Characteristics of Primary Epstein-Barr Virus Infections in Korea / 감염과화학요법

In this study, the clinical features of 264 patients of primary Epstein-Barr virus (EBV) infection between the years of 2002-2006 were evaluated retrospectively. The median age of the patients was 6 years old (0-69), and the hospitalization rate was 78.0%. Fever (83.3%) and sore throat (50.4%) were the most common symptoms. Cervical lymphadenopathy (71.2%), tonsillitis (51.1%), splenomegaly (26.1 %), hepatomegaly (25.8%), rash (10.2%) and jaundice (1.5%) were observed. Cervical lymphadenopathy was less frequent in older age groups. The annual number of primary EBV infections according to the age group during the study period did not change significantly in this study.

Synergy of Arbekacin-based Combinations Against Vancomycin Hetero-intermediate Staphylococcus aureus

This study was undertaken to evaluate the in vitro activities of arbekacin-based combination regimens against vancomycin hetero-intermediate Staphylococcus aureus (hetero-VISA). Combinations of arbekacin with vancomycin, rifampin, ampicillin-sulbactam, teicoplanin, or quinipristin-dalfopristin against seven hetero-VISA strains and two methicillin-resistant S. aureus strains were evaluated by the time-kill assay. The combinations of arbekacin with vancomycin, teicoplanin, or ampicillinsulbactam showed the synergistic interaction against hetero-VISA strains. Data suggest that these arbekacin-based combination regimens may be useful candidates for treatment options of hetero-VISA infections.

Urinary Tract Infections in Renal Transplant Recipients / 감염과화학요법

BACKGROUND: To evaluate urinary tract infections (UTI) in renal transplant recipients in setting where TMP-SMX resistance is quite common. MATERIALS AND METHODS: All patients underwent renal transplantation at Samsung Medical Center from January 1998 to August 2002 were included with the completion of 2 year-follow-up. TMP- SMX was prophylactically administered during 12 months after renal transplantation. Their medical records and microbiologic data were reviewed, retrospectively. RESULTS: A total of 336 patients were enrolled (male to female ratio, 191:145; mean age, 39+/-10 years). 146 episodes of UTI were observed in 104 patients (31.0%) within 2 years after renal transplantation. 52 episodes (35.6%) developed during post-transplantation 30 days, and 87 episodes (59.6%) within post-transplantation 6 months. There was no difference in the incidence of UTI with regard to the type of immunosuppressants (P=0.371) or graft rejections (P=0.291). Among the isolated strains, Escherichia coli (E. coli) (51.4%) was the most common, followed by Enterococcus species (12.3%), Pseudomonas species (6.8%), Enterobacter species (6.1%), Coagulase-negative staphylococci (5.5%), and Klebsiella species (5.5%). Among 75 E. coli isolates, rates of resistance to TMP-SMX, ciprofloxacin, ampicillin-sulbactam and ceftriaxone were 62.7%, 34.7%, 33.3%, and 1.0%, respectively. There was no difference in mortality rate related with the occurrence of UTI (P= 0.754). CONCLUSION: Despite high prevalence of TMP-SMX resistance, post-transplantation UTI is usually mild and does not seem to predispose to increase graft rejection or patient mortality. Nevertheless, because most common episodes of UTI occur within 1 or 6 months of transplantation, further studies are warranted to evaluate if additional preventive strategies during early period are needed.

Clinical Manifestations of Posttransplantation Lymphoproliferative Disorder (PTLD) after Liver Transplantation / 감염과화학요법

BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly. MATERIALS AND METHODS: A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003. RESULTS: The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir. CONCLUSION: The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.

Association between Location of Eschar and Clothing in Scrub Typhus / 감염과화학요법

BACKGROUND: Wearing a long-sleeved shirt and tucking the pants legs into the socks is recommended to prevent scrub typhus. This study investigated associations between the location of eschar and the type of clothes and shoes to evaluate the efficacy of these protective measures. MATERIALS AND METHODS: One-hundred and fifty nine patients in whom scrub typhus was confirmed or suspected based on the typical clinical manifestations, presence of eschar, or positive results of serologic tests at 6 Korean hospitals from October to December 2005 were included in this study. We collected the information on the location of eschar, presumed exposure date to chiggers, and the clothes and shoes which they had worn. RESULTS: Serologic tests were positive in 99 patients. Eschars were observed in 142 patients and 6 of them exhibited more than 2 eschars. Eighty-two (60.3%) of 136 patients with a single eschar had an eschar on the lower half of the body. Of the 44 patients whose exposure date could be estimated, and who had only a single eschar, 5 of the 17 patients with eschars in the lower half of their bodies, and none of the 27 patients with eschars in the upper half of their bodies went barefoot or wore open footware (P=0.006). Only 4 patients tucked the pants into their socks, and an eschar was found in the lower half in one patient, and in the upper half of the body in the other 3 patients. Of 42 patients who wore long-sleeved shirts, eschars were found in their lower bodies in 16, and on their upper bodies in 26 (P=1.00). CONCLUSION: When the feet were not protected properly with shoes, eschars were found more frequently on the lower half of the body than on the upper half. Wearing a long-sleeved shirt or tucking the pants legs into the socks was not found to be significantly correlated to the location of eschars. Further studies involving larger samples are necessary for the development of practical guidelines of protective measures to prevent scrub typhus.

Urinary Tract Infections in Renal Transplant Recipients / 감염과화학요법

BACKGROUND: To evaluate urinary tract infections (UTI) in renal transplant recipients in setting where TMP-SMX resistance is quite common. MATERIALS AND METHODS: All patients underwent renal transplantation at Samsung Medical Center from January 1998 to August 2002 were included with the completion of 2 year-follow-up. TMP- SMX was prophylactically administered during 12 months after renal transplantation. Their medical records and microbiologic data were reviewed, retrospectively. RESULTS: A total of 336 patients were enrolled (male to female ratio, 191:145; mean age, 39+/-10 years). 146 episodes of UTI were observed in 104 patients (31.0%) within 2 years after renal transplantation. 52 episodes (35.6%) developed during post-transplantation 30 days, and 87 episodes (59.6%) within post-transplantation 6 months. There was no difference in the incidence of UTI with regard to the type of immunosuppressants (P=0.371) or graft rejections (P=0.291). Among the isolated strains, Escherichia coli (E. coli) (51.4%) was the most common, followed by Enterococcus species (12.3%), Pseudomonas species (6.8%), Enterobacter species (6.1%), Coagulase-negative staphylococci (5.5%), and Klebsiella species (5.5%). Among 75 E. coli isolates, rates of resistance to TMP-SMX, ciprofloxacin, ampicillin-sulbactam and ceftriaxone were 62.7%, 34.7%, 33.3%, and 1.0%, respectively. There was no difference in mortality rate related with the occurrence of UTI (P= 0.754). CONCLUSION: Despite high prevalence of TMP-SMX resistance, post-transplantation UTI is usually mild and does not seem to predispose to increase graft rejection or patient mortality. Nevertheless, because most common episodes of UTI occur within 1 or 6 months of transplantation, further studies are warranted to evaluate if additional preventive strategies during early period are needed.

Clinical Manifestations of Posttransplantation Lymphoproliferative Disorder (PTLD) after Liver Transplantation / 감염과화학요법

BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly. MATERIALS AND METHODS: A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003. RESULTS: The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir. CONCLUSION: The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.

Association between Location of Eschar and Clothing in Scrub Typhus / 감염과화학요법

BACKGROUND: Wearing a long-sleeved shirt and tucking the pants legs into the socks is recommended to prevent scrub typhus. This study investigated associations between the location of eschar and the type of clothes and shoes to evaluate the efficacy of these protective measures. MATERIALS AND METHODS: One-hundred and fifty nine patients in whom scrub typhus was confirmed or suspected based on the typical clinical manifestations, presence of eschar, or positive results of serologic tests at 6 Korean hospitals from October to December 2005 were included in this study. We collected the information on the location of eschar, presumed exposure date to chiggers, and the clothes and shoes which they had worn. RESULTS: Serologic tests were positive in 99 patients. Eschars were observed in 142 patients and 6 of them exhibited more than 2 eschars. Eighty-two (60.3%) of 136 patients with a single eschar had an eschar on the lower half of the body. Of the 44 patients whose exposure date could be estimated, and who had only a single eschar, 5 of the 17 patients with eschars in the lower half of their bodies, and none of the 27 patients with eschars in the upper half of their bodies went barefoot or wore open footware (P=0.006). Only 4 patients tucked the pants into their socks, and an eschar was found in the lower half in one patient, and in the upper half of the body in the other 3 patients. Of 42 patients who wore long-sleeved shirts, eschars were found in their lower bodies in 16, and on their upper bodies in 26 (P=1.00). CONCLUSION: When the feet were not protected properly with shoes, eschars were found more frequently on the lower half of the body than on the upper half. Wearing a long-sleeved shirt or tucking the pants legs into the socks was not found to be significantly correlated to the location of eschars. Further studies involving larger samples are necessary for the development of practical guidelines of protective measures to prevent scrub typhus.

Etiology and Antimicrobial Susceptibility of Bacterial Pathogens Causing Community-Acquired Urinary Tract Infection at a Tertiary-care Hospital / 대한임상미생물학회지

BACKGROUND: Resistant organisms are now a growing and frequent problem in community-acquired infections. There is little information on the etiology and antimicrobial susceptibility patterns of community-acquired urinary tract infection (CA-UTI) at a tertiary-care hospital. METHODS: We evaluated the distribution of etiological organisms with their antimicrobial susceptibility patterns of CA-UTI in the patients visiting a tertiary-care hospital during the period of three years from 2001 through 2003. RESULTS: In total, 1,753 bacterial isolates yielded a significant growth as pathogens of CA-UTI in this study. The most common pathogen was Escherichia coli (38.3%), followed by Pseudomonas aeruginosa (10.8%), Enterococcus faecalis (7.3%), Klebsiella pneumoniae (6.4%), coagulase negative staphylococci (CoNS) (5.4%) and Staphylococcus aureus (5.2%). The prevalence of E. coli was significantly higher in females (P < 0.001), whereas P. aeruginosa, E. faecalis, and S. aureus were significantly more common in male group (P < 0.001). The susceptibility rate of E. coli was 26.0% to ampicillin, 65.8% to gentamicin, 51.3% to co-trimoxazole, and 62.5% to ciprofloxacin. The susceptibility patterns of Enterobacteriaceae other than E. coli were different from those of E. coli. Extended spectrum beta-lactamase was detected in 7.9% of E. coli and 15.6% of K. pneumoniae. CONCLUSION: This study demonstrates a diversity of etiological organisms and a high rate of resistance to commonly used antimicrobials of CA-UTI in patients visiting a tertiary-care hospital.