In vitro antimicrobial activity of cefditoren against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates / 대한내과학회지

BACKGROUND: The aim of this study was to determine the in vitro activity of cefditoren, an oral third-generation aminothiazolyl cephalosporin, against Streptococcus pneumoniae and Haemophilus influenzae clinical isolates in a tertiary hospital. METHODS: We have studied the in vitro activities of cefditoren and other oral antibiotics against 120 S. pneumoniae isolates, including 80 penicillin non-susceptible isolates and 80 H. influenzae isolates from clinical specimens of patients at the Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by the agar dilution method. RESULTS: All S. pneumoniae strains tested were inhibited by 1 g/mL of cefditoren (MIC50/MIC90 0.25/1 microgram/mL; range 0.015~1 microgram/mL). The MICs were lower for penicillin-susceptible S. pneumoniae (MIC90 0.015 g/mL) as compared to penicillin-intermediate resistant (MIC90 0.5 g/mL) or penicillin- resistant strains (MIC90 1 microgram/mL). Cefditoren was active against all tested H. influenzae strains (MIC50/MIC90 0.015/0.03 microgram/mL; range <0.008~0.03 g/mL) and its activity was comparable to levofloxacin and cefixime. CONCLUSIONS: Cefditoren had an excellent activity against S. pneumoniae and H. influenzae irrespective of penicillin or ampicillin resistance, respectively. The results of this study suggest that cefditoren is a good choice of an antibiotic to use for empirical oral treatment of community-acquired respiratory tract infections.

A case of pyelonephritis caused by Candida kefyr / 대한내과학회지

We report a case of pyelonephritis caused by Candida kefyr, which has been previously described as C. pseudotropicalis. The patient who had been having multiple intrarenal stones and ureteral stones for ten years was admitted for fever, left flank pain, and dysuria. In the blood culture, C. kefyr was isolated. These symptoms and signs were successfully resolved with a new antifungal agent, voriconazole. After the resolution of symptoms and signs, the patient took extracorporeal shock wave lithotripsy for intrarenal stones and ureteral stones.

In vitro Antimicrobial Activity of Cefcapene against Clinical Isolates / 감염과화학요법

BACKGROUND: Cefcapene pivoxil hydrochloride is a new oral cephem which has a broad-spectrum activity with expanded potency against Gram-positive bacteria, including Staphylococcus aureus and Streptococcus, as well as Gram-negative bacteria. In this study, we examined the in vitro activity of cefcapene against recently isolated clinical specimens from patients in a tertiary hospital. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of cefcapene and other cephalosporins against 450 clinical isolates from of patients in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by agar dilution method according to the recommendations of National Committee for Clinical Laboratory Standards. RESULTS: Compared with other cephalosporins (cefaclor, cefpodoxime, and cefixime), cefcapene had lower MIC distributions for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and methicillin-susceptible S. aureus. Cefcapene had variable activity against Enterobateriaceae. CONCLUSION: Cefcapene had excellent in vitro antimicrobial activities against common typical bacterial respiratory tract pathogens and methicillin-susceptible S. aureus. Cefcapene appears to be a promising agent for treatment of community-acquired respiratory tract infections and infections caused by methicillin-susceptible S. aureus.

Clinical Features and Prognostic Factors of Aeromonas Bacteremia / 감염과화학요법

BACKGROUND: Aeromonas is not a common cause of bacteremia, but can result in a grave outcome when present. In this study, clinical characteristics and prognostic factors of Aeromonas bacteremia were analysed. We also compared the clinical characteristics of community-acquired and nosocomial Aeromonas bacteremia. MATERIALS AND METHODS: We retrospectively reviewed 182 cases of Aeromonas bacteremia at Asan Medical Center from 1991 to 2000. RESULTS: Male patients predominated (67.0%) and the majority of cases occurred in the warmer months of the year. Almost all the patients (97.8%) had underlying conditions; liver disease (48.9%), biliary disease (30.2%), hematologic malignancy (10.9%), diabetes mellitus (10.9%), congestive heart failure (10.9%), and solid tumor (7.1%). An accompanying infection focus was found in 112 (61.5%) cases and the biliary tract was the most common site of infection. Compared to nosocomial bacteremia, patients with community-acquired Aeromonas bacteremia were more likely to have liver cirrhosis and complications (septic shock, altered consciousness). Nosocomial bacteremia occurred more often in patients with hematologic malignancy. Mortality directly related to Aeromonas bacteremia was 24.1%. Mortality was significantly associated with old age (> or =65 years), skin and soft tissue infection, septic shock, and altered consciousness by univariate analysis. Multivariate analysis revealed septic shock and altered consciousness as independent prognostic factors. CONCLUSION: Aeromonas bacteremia usually occurred in patients with hepatobiliary disease or malignancy and heralded a poor prognosis, especially when associated with complications (septic shock or altered consciousness).

Using a Microwave Oven to Disinfect Intermittent-Use Catheters / 병원감염관리

BACKGROUND: Clean intermittent catheterization is one of the management of the neurogenic bladder caused by such disease as spinal injury. The purpose of this study is to assess the amount of time in a microwave oven required to eliminate seven pathogens isolated from urine of the patients, and to evaluate the effect of repeated use of a microwave oven on the patency and pliability of silicon catheter. METHODS: Seven microorganisms isolated from urine of patients were used as inoculating pathogens. These included Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, Enterococcus faecium, Staphylococcus aureus, Candida albicans. The silicon catheter was divided into six pieces (4 cm) and sterilized by ethylene oxide gas, Each piece of catheter was incubated for 60 minutes in a suspension of microorganisms, and placed in a plastic container. The piece was microwaved for 0 (control catheters) to 15 minutes a dose of 1,000 watts. Two methods were used. First method was a water-free method that was microwaved after removing water from the catheter. Second method was a water-added method that was microwaved after adding 5 mL of sterile water around the catheter. Then, that was placed in 15 mL sterile phosphate buffer in a conical tube. The fluid was cultured. Using a new silicon catheter, the microwave procedure was repeated until the catheter was no longer patent or pliable. RESULTS: Using a water-free method, E, coli, C. albicans were eliminated at 5 minutes, P. aeruginosa was at 8 minutes, K. pneumoniae, E. faecalis was at 12 minutes, but S. aureus was remained until 15 minutes, Using a water-added method, all strains were eliminated at 8 minutes. The characteristics of the silicon catheter after repeated procedures were not changed in patency or pliability until 100 times. CONCLUSION: The disinfection of silicon catheters using a microwave oven after adding water around the catheter was able to sterilize the frequent pathogens including C. albicans within 8 minutes. It was clinically useful to sterilize repeatedly the catheter using microwave oven without distorting the characteristics of the silicon catheter.

A Case of Aortitis Associated with Primary Streptococcus pneumoniae Bacteremia / 감염과화학요법

Bacterial aortitis is rare and without surgical intervention, it usually leads to uncontrolled sepsis or catastrophic hemorrhage, ultimately, resulting in death. In the postantibiotic era, the dominant infecting organisms are Staphylococcus aureus and Salmonella spp.. In spite of frequent pneumococcal bacteremia, vascular seeding is rare and there is only one published report in Korea. We describe a 77-year-old female with primary pneumococcal bacteremia followed by aortitis of the descending aorta, which was successfully treated by aneurysmectomy, wide excision of periaortic tissue, aortobiiliac bypass via prosthetic graft, and antibiotic therapy.

In vitro Antimicrobial Activity of Cefcapene against Clinical Isolates / 감염과화학요법

BACKGROUND: Cefcapene pivoxil hydrochloride is a new oral cephem which has a broad-spectrum activity with expanded potency against Gram-positive bacteria, including Staphylococcus aureus and Streptococcus, as well as Gram-negative bacteria. In this study, we examined the in vitro activity of cefcapene against recently isolated clinical specimens from patients in a tertiary hospital. MATERIALS AND METHODS: We tested the in vitro antimicrobial activities of cefcapene and other cephalosporins against 450 clinical isolates from of patients in Asan Medical Center. Minimal inhibitory concentrations (MICs) were determined by agar dilution method according to the recommendations of National Committee for Clinical Laboratory Standards. RESULTS: Compared with other cephalosporins (cefaclor, cefpodoxime, and cefixime), cefcapene had lower MIC distributions for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and methicillin-susceptible S. aureus. Cefcapene had variable activity against Enterobateriaceae. CONCLUSION: Cefcapene had excellent in vitro antimicrobial activities against common typical bacterial respiratory tract pathogens and methicillin-susceptible S. aureus. Cefcapene appears to be a promising agent for treatment of community-acquired respiratory tract infections and infections caused by methicillin-susceptible S. aureus.

Clinical Features and Prognostic Factors of Aeromonas Bacteremia / 감염과화학요법

BACKGROUND: Aeromonas is not a common cause of bacteremia, but can result in a grave outcome when present. In this study, clinical characteristics and prognostic factors of Aeromonas bacteremia were analysed. We also compared the clinical characteristics of community-acquired and nosocomial Aeromonas bacteremia. MATERIALS AND METHODS: We retrospectively reviewed 182 cases of Aeromonas bacteremia at Asan Medical Center from 1991 to 2000. RESULTS: Male patients predominated (67.0%) and the majority of cases occurred in the warmer months of the year. Almost all the patients (97.8%) had underlying conditions; liver disease (48.9%), biliary disease (30.2%), hematologic malignancy (10.9%), diabetes mellitus (10.9%), congestive heart failure (10.9%), and solid tumor (7.1%). An accompanying infection focus was found in 112 (61.5%) cases and the biliary tract was the most common site of infection. Compared to nosocomial bacteremia, patients with community-acquired Aeromonas bacteremia were more likely to have liver cirrhosis and complications (septic shock, altered consciousness). Nosocomial bacteremia occurred more often in patients with hematologic malignancy. Mortality directly related to Aeromonas bacteremia was 24.1%. Mortality was significantly associated with old age (> or =65 years), skin and soft tissue infection, septic shock, and altered consciousness by univariate analysis. Multivariate analysis revealed septic shock and altered consciousness as independent prognostic factors. CONCLUSION: Aeromonas bacteremia usually occurred in patients with hepatobiliary disease or malignancy and heralded a poor prognosis, especially when associated with complications (septic shock or altered consciousness).

A Case of Aortitis Associated with Primary Streptococcus pneumoniae Bacteremia / 감염과화학요법

Bacterial aortitis is rare and without surgical intervention, it usually leads to uncontrolled sepsis or catastrophic hemorrhage, ultimately, resulting in death. In the postantibiotic era, the dominant infecting organisms are Staphylococcus aureus and Salmonella spp.. In spite of frequent pneumococcal bacteremia, vascular seeding is rare and there is only one published report in Korea. We describe a 77-year-old female with primary pneumococcal bacteremia followed by aortitis of the descending aorta, which was successfully treated by aneurysmectomy, wide excision of periaortic tissue, aortobiiliac bypass via prosthetic graft, and antibiotic therapy.

The Close Relationship between Ciprofloxacin Resistance and Extended-Spectrum beta-Lactamase Production:Analysis of 154 Consecutive Nosocomially-Acquired Klebsiella pneumoniae Bacteremia / 감염과화학요법

BACKGROUND: Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. MATERIALS AND METHODS: Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. RESULTS: The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3rd- generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). CONCLUSION: The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

A Case of Recurrent Campylobacter fetus Endocarditis in a Healthy Person / 감염과화학요법

Campylobacter fetus is a rare cause of endocarditis. To date, only about 30 cases of C. fetus endocarditis have been reported mainly in the elderly with chronic underlying illnesses. Most cases showed tendency to involve aortic valve. This report describes a case of native tricuspid valve infective endocarditis in a 69-year-old man without any underlying disease. Despite adequate antibiotic therapy for 4-weeks, endocarditis recurred and leading to surgical valve replacement.

A Case of Septicemia and Septic Pneumonia due to Burkholderia pseudomallei / 감염과화학요법

Melioidosis is an infectious disease caused by a gram-negative saprophyte bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It mostly infects adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ. The spectrum of melioidois in human varies from subclinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. We report herein a case of septicemia and septic pneumonia due to Burkholderia pseudomallei in 47-year-old man with diabetes mellitus who has history of traveling to Malaysia. This is the first report of melioidosis in Korea.

The Close Relationship between Ciprofloxacin Resistance and Extended-Spectrum beta-Lactamase Production:Analysis of 154 Consecutive Nosocomially-Acquired Klebsiella pneumoniae Bacteremia / 감염과화학요법

BACKGROUND: Strains of ciprofloxacin-resistant Klebsiella pneumoniae have emerged worldwide. We investigated the epidemiology of ciprofloxacin resistance and its relationship to ESBL production in nosocomial K. pneumoniae bacteremia. MATERIALS AND METHODS: Using the computerized database of clinical microbiology, we identified all patients whose blood culture had yielded K. pneumoniae between January 2001 and December 2002 at a 2200-bed university-affiliated tertiary-care hospital. During the study period, total of 392 episodes of K. pneumoniae bacteremia were documented of which 163 episodes were acquired nosocomially. 9 cases of recurrent episodes were excluded. RESULTS: The resistance rates to ciprofloxacin was 28.6% (44/154). ESBL-production was significantly more common in ciprofloxacin-resistant isolates than in ciprofloxacin-susceptible isolates (95.9% [42/44] vs. 24.5% [27/110], P<0.001). In univariate analysis, following factors were significantly associated with resistance to ciprofloxacin: older age, male sex, ICU admission at the time of bacteremia, prior use of antibiotics within 1 month before bacteremia, solid tumor, hematological malignancy, or biliary disease as underlying disease, and ESBL-production. The prior use of 3rd- generation cephalosprins, metronidazole, fluroquinolone, or carbapenem were also risk factors. Independent risk factors for ciprofloxacin resistance were older age (adjusted odds ratio [AOR]; 1.04, 95% confidence interval [CI]; 1.01-1.06) and ESBL production (AOR; 81.35, 95% CI; 17.76-372.53). CONCLUSION: The close relationship between ciprofloxacin resistance and ESBL production was documented in nosocomial K. pneumoniae bacteremia. Further epidemiological and molecular studies to determine factors and mechanisms involved in the relationship are needed.

A Case of Recurrent Campylobacter fetus Endocarditis in a Healthy Person / 감염과화학요법

Campylobacter fetus is a rare cause of endocarditis. To date, only about 30 cases of C. fetus endocarditis have been reported mainly in the elderly with chronic underlying illnesses. Most cases showed tendency to involve aortic valve. This report describes a case of native tricuspid valve infective endocarditis in a 69-year-old man without any underlying disease. Despite adequate antibiotic therapy for 4-weeks, endocarditis recurred and leading to surgical valve replacement.

A Case of Septicemia and Septic Pneumonia due to Burkholderia pseudomallei / 감염과화학요법

Melioidosis is an infectious disease caused by a gram-negative saprophyte bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. It mostly infects adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ. The spectrum of melioidois in human varies from subclinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. We report herein a case of septicemia and septic pneumonia due to Burkholderia pseudomallei in 47-year-old man with diabetes mellitus who has history of traveling to Malaysia. This is the first report of melioidosis in Korea.

A case of dengue hemorrhagic fever imported from Philippines / 대한내과학회지

Dengue Hemorrhagic Fever/dengue shock syndrome (DHF/DSS) is an acute febrile illness characterized by decreased platelet counts and hypovolemic shock due to increased vascular permeability and plasma leakage in patients infected with any one of four serotypes of dengue virus. The disease is one of the principal causes of hospitalization and death among children in several Southeast Asia, Central and South Americas, and Africa. With increasing use of air or ship transport, more travelers and sailors to the tropics are returning within the incubation period of acute febrile infection. We experienced a case of a Korean traveler who had presented with fever, chills, nausea, loss of consciousness, gastrointestinal bleeding, and thrombocytopenia after returning from the Philippines and diagnosed his illness as Dengue Hemorrhagic Fever by serologic test (Indirect immunofluorescent : Dengue duo IgM and IgG rapid strip test).

A case of Salmonella enterica serovar Typhi endocarditis with multiple splenic infarctions / 대한내과학회지

Infective endocarditis is a very rare cardiac manifestation of salmonella infection, and splenic infarction is a rare noncardiac complication. We describe a case of Salmonella enterica serovar Typhi bacteremia which was complicated by infective endocarditis with multiple splenic infarctions in a previously healthy 47-year-old female. She didn't have any history of foreign travel. The isolate of Salmonella enterica serovar Typhi was susceptible to cephalosporins, aminoglycosides, quinolones but resistant to ampicillin. After 3 weeks of intravenous and oral therapy with ciprofloxacin, follow up transthoracic and transesophageal echocardiography showed no vegetation. In addition, follow up abdominal CT showed decreased size of splenic infarctions. The patient was treated with 2 weeks of intravenous and 4 weeks of oral ciprofloxacin, and was cured without sequelae or relapse for 6 months follow-up.

Clinical Efficacy and Safety with Arbekacin for Methicillin-Resistant Staphylococcus aureus (MRSA) Infections / 대한내과학회지

BACKGROUND: Arbekacin was introduced to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. It is an aminoglycoside with proven in vitro activity against MRSA strains. Pharmacokinetic advantages such as concentration-dependant bactericidal activity, prolonged post-antibiotic effect are its feature of aminoglycoside like others. But there are only few clinical data of this new kind of antibiotics outside of Japan, the first country approved its use against MRSA infections. We studied the clinical and bacteriological efficacy and safety of arbekacin in the treatment of infections caused by MRSA. METHODS: During the period between December 2001 and October 2002, we prospectively enrolled 21 patients with culture proven MRSA infection and evaluated the clinical and bacteriological efficacy and adverse events of arbekacin. Patients were treated with arbekacin sulphate 100 mg intravenously twice daily for 14 days. RESULTS: Patients were included if they had signs and symptoms of active MRSA infection including bacteremia, soft tissue infection, urinary tract infection, pneumonia etc. A total of 21 patients with MRSA infection were enrolled. Four patients experienced adverse events; 3 nephrotoxicities, 1 hepatotoxicity. One of them with elevated creatinine was unable to continue the study. Efficacy were evaluated on 19 patients with duration of arbekacin longer than 9 days. A favorable bacteriological response (eradicated or presumed eradicated) occurred in 13 (68.5%) patients. CONCLUSION: Although this clinical study was limited in number and in proper randomization, arbekacin alone was less effective than combination therapy with glycopeptides for the treatment of MRSA infection. However, our limited data suggested the efficacy of arbekacin alone for the treatment which needs shorter duration. The combination treatment of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycosides. The combination therapy of arbekacin and glycopeptide appeared to be less nephrotoxic than other aminoglycoside.

A Case of Klebsiella pneumoniae Parotitis with Bacteremia / 감염과화학요법

Acute bacterial parotitis is primarily a disease of the aged and clinically ill patients. Dehydration, dry mouth resulting from surgery or medication use, sialolithiasis, malnutrition and systemic illness are prominent predisposing factors. Staphylococcus aureus is the most common pathogen associated with acute bacterial parotitis. However, streptococci, gram-negative bacteria, and anaerobes have also been reported to be associated with the disease. Nevertheless, acute parotitis caused by Klebsiella pneumoniae has never been earlier reported in Korea. We describe a case of acute parotitis which developed in a 73 year-old women with K. pneumoniae bacteremia. In this case, the patient initially received supportive care. Oral amoxicillin/clavulanic acid were initiated because the painful swelling of the left parotid gland, and overlying erythema was aggravated and pus from Stensen's duct was drained. She complained of fever in spite of oral amoxicillin/claulanic acid administration for 4days. Then, the antibiotics were switched to intravenous ampicillin/sulbactam, and the patient recovered fully after 2 weeks of intravenous antibiotics therapy.

A Case of Gallbladder Actinomycosis / 감염과화학요법

Actinomycosis is a chronic suppurative and granulomatous disease, characterized by abscess formation, tissue fibrosis, and draining sinuses. Actinomycosis of the gallbladder is very rare and has not yet been reported in Korea. We report a case of actinomycosis of the gallbladder in an 80- year-old women with history of cholelithiasis for 3 years, preoperatively misidentified as gallbladder cancer. Histologic section of the gallbladder showed Gram-positive branching bacilli compatible with actinomyces. After cholecystectomy, the patient received intravenous ampicillin for 4 days, followed by amoxicillin for 4 months thereafter.