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.

A Diabetic Patient with Fungal Arthritis due to Hansenula anomala / 감염

Hansenula anomala is a normal or transient flora of the throat and alimentary tract, and has been reported as an organism causing opportunistic or nosocomial infections in immunocompromised patients, but rarely in immunocompetent hosts. From the review of the literatures, there is no published report on arthritis caused by H. anomala. We experienced a case of H. anomala arthritis in a 59-year old man who had diabetes mellitus and right knee joint swelling with deformity. The findings of magnetic resonance image were consistent with septic arthritis which had bony destruction in distal femur and proximal tibia, abscess formation in joint space, and joint effusion with synovial hypertrophy. A fungus was isolated from a couple of blood cultures and knee joint aspiration fluid, and later identified as H. anomala by yeast biochemical cards. He was successfully treated with extensive debridement and fluconazole for 8 weeks.

Two cases of posttransplantation lymphoproliferative disorders in recipients of liver transplantation / 대한내과학회지

The posttransplantation lymphoproliferative disorders (PTLD) are not rare complications of solid organ transplants. The incidence varies with the type of transplantation and the nature and intensity of the immunosuppressive regimens. PTLDs are unique in that they have a predilection for extranodal sites, a strong and probably causal association with Ebstein-Barr virus infection, and a poor response to the cytolytic chemotherapeutic or irradiation regimens used for treatment of malignant lymphoma. The outcomes of treatment have been disappointing, with mortality from PTLD or related complications of over 50% of patients. We experienced two cases of PTLDs in liver transplant recipients presenting with liver mass and intraabdominal lymphadenopathy. PTLDs were diagnosed by autopsy and a liver biopsy. In the case diagnosed by a liver biopsy, EBV was detected by in situ hybridization. Despite reduction of immunosuppression and conservative management, both patients died.

A Study on Modes of Transmission and Role of Nasal Carriage to Subsequent Infection with Methicillin-Resistant Staphylococcus aureus in Medical ICU Using PFGE / 병원감염관리

BACKGROUND: In Korea, methicillin-resistant Staphylococcus aureus (MRSA) is the most common nosocomial pathogen, which is particularly prevalent in ICU. We performed this study to investigate the modes of transmission of MRSA and the role of nasal carriage of11RSA to subsequent MRSA infections in medical ICU. METHODS: All patients admitted to the medical lCU during 10 months were studied prospectively. Nasal swabs were done in all patients within 24 hours of admission and weekly thereafter. For patients who developed MRSA infections, additional cultures were done before start of antibiotics. Surveillance cultures of nostril, hands of health care workers and environment were done once at the end of the study. Bacterial typing was performed with pulsed-field gel electrophoresis (PFGE) using Smal. RESULTS: Among 138 patients enrolled, 24 patients (17.4 %) were nasal colonizers, and 9 patients (6.5%) were already infected with MRSA prior to admission. New nasal colonization among patients, in whom follow up nasal cultures were done at the interval of 3 days or more, developed at 36.2 % (21/58 patients). New infections of MRSA in patients who were admitted for more than 3 days, developed at 11.7 % (13/111 patients). Patients in isolation room were infected with MRSA less frequently (P <0.05). No other risk factors for nasal colonization of MRSA or MRSA infections were found. There were no significant differences between nasal colonizers and non-colonizers in the incidence of MRSA infections. PFGE analysis of MRSA isolates from patients showed several major patterns, which were similar in both MRSA isolates obtained prior to admission and those acquired after admission. PFGE patterns of MRSA isolates from health care workers and environment were different from those of patients. CONCLUSION: Patients who were infected or colonized with MRSA seemed to be a major source for transmission of MRSA in medical ICU. In medical lCU, where MRSA were prevalent, nasal colonization was not related to the increased incidence of MRSA infections.