Clinical Features of Stenotrophomonas Maltaphilia Infection / 대한내과학회지

OBJECTIVE: Stenotrophomonas maltophilia has been emerging as an important nosocomial pathogen in recent years in patients with impaired host- defense mechanism or who has been exposed to large amount of inocula. This organism is usually resistant to multiple (commonly used) antimicrobial agents, particularly to those of the beta-lactam class. To evaluate the clinical feature of Stenotrophomonas maltophilia infection and in vitro anti- microbial susceptibility, we performed a retrospective study. METHODS: We analyzed the result of in vitro antimicrobial susceptibility test for 200 isolates of S. maltophilia and the annual isolation rate during the period between January 1990 and December 1994 in our institution, and performed a retrospective study for the available records of 165 cases among them. The data were obtained with only the first isolation of the organism for each patients. RESULTS: Total of 165 initial isolates, the isolates were from wounds in 50(30.3%), urine in 47(28.5%), the respiratory tract in 37(22.4%), blood in 9(5.5%), bile in 6(3.6%), and miscellaneous sources in 16(9.7%). The 84.2% of isolates were hospital-acquired isolate and 58.3% of these patients had received antecedent antibiotic therapy: polymicrobial growth was demonstrated in 61.9% of the cases. In vitro antimicrobial susceptibiiity test, ofloxacin was active against the isolates in 89.2%, moxalactam in 85.9%, ciprofloxacin in 83.9%, TMP-SMX(trimethoprim-sulfamethoxazole) in 64.2%, As expected, S. maltophilia isolates were, in general, not susceptible to cephalosporins, penicillins. The annual isolation rate at Kyung Hee University hospital was not increased significantly from 1990 to 1994, 19.53 per 10,000 patients dismissals in 1990, 13.56 in 1994. The major underlying diseases of patients were malignancy(17.6%), cerebrovascular disorder(17%), diabetic mellitus(13.3%). Mortality rate is 10.3%. CONCLUSION: S. maltophilia has been emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy. And this organism is resistant to multiple antimicrobial agents, particularly to those of the beta-lactam class. When antimicrobial treatment is necessary, the clinician should be guided by results of in vitro susceptibility testing because of the notable in vitro resistance of S. maltophilia to commonly used antibiotics. And when S. maltophilia has been recovered from a patient, wound and contact isolation is warranted.

Clinical Significance of Aeromonas Bacteremia / 대한내과학회지

OBJECTIVES: Aeromonas species is a gram-negative, facultative anaerobe of the family Vibrionaceae. The organism has been recognized as a pathogen associated with illness in human, such as acute gastroenteritis, cellulitis, septicemia, and other rare diseases. METHODS: To evaluate the clinical significance of Aeromonas bacteremia in Korea and it's susceptibility of antibiotics, we evaluated the 17patients with Aeromonas bacteremia. Identification was done by use of API 20E system and antibiotic susceptibility was tested with disk diffusion method. RESULTS: Male to female ratio was 11:6, and mean age was 54.1years(8-85years) old. Liver cirrhosis was the most common underlying disease(10cases of 17patients, 58.8%a). Other underlying diseases were as follows: gallstone in 2cases, cholangiocarcinoma in 2cases, and aplastic anemia in 1case, cerebral infarction in 1case. But one had no underlying disease. So Aeromonas bacteremia were occurred in 14immunocompromised patients(82.3%), and in 10patients with hepatobiliary diseases, A. hydrophila was most commonly isolated(13cases, 764%), and the A sobria(4cases, 23.5%) was infrequently isolated. The overall fatality was 47%, and there had no significant difference in fatality between A. hydrophila and A sobria All Aeromonas species had resistance to ampicillin and carbenicillin. CONCLUSION: Because Aeromonas bacteremia may occur through water-borne route, especially in immunocompromised host. We should pay attention to immunocompromised patients, espacially having hepatobiliary disease.

Diagnostic Efficacy and Complications by Transthoracic Fine NeedleAspiration Biopsy of Localized Lung Lesions / 결핵

BACKGROUND: Transthoracic fine needle aspiration and biopsy(TNAB) has become a frequently used technique in the investigation of the intrathoracic lesions because of its safety, reliability, and accuracy. METHOD: Data on 125 patients who underwent TNAB from 1990 through 1994 were studied to determine the diagnostic sensitivity, accuracy and complications of this procedure as related to lesion type and location. RESULTS: 1. The over-all diagnostic sensitivity of TNAB was 61.6%(77 of 125 patients). 2. The diagnostic yields were as high as 89.9% for malignant lesions, but a specific diagnosis of benign lesions were obtained only in 30% of benign lung lesions. 3. The correlation between results of TNAB cytology and of final histology was as high as 88.2%. 4. Lung lesions that were greater than 3cm in size had a higher proportion of correct diagnosis(73.3%) as compared with lesions 3cm or less in size(38.1%). But there was no significant difference between the central and peripheral lung lesions. 5. There were no serious complications to TNAB. In 12.8% of the procedures a pneumothorax developed, indicating a chest tube in 1.6% of the procedures. In 2 cases, minimal hemoptysis developed which did not require treatment. CONCLUSION: In our experience, TNAB represents a minor and safe procedure, which permits a direct approach to localized malignant lung lesions with a high degree of accuracy.