Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis

BACKGROUND: The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients. MATERIALS AND METHODS: We prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March 2010 to February 2011. RESULTS: Positive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827 CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0% vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis, hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with Pitt score ≥ 1, flank pain or azotemia were significantly more likely to have such structural abnormalities. CONCLUSION: Blood cultures are clinically useful for diagnosis of CA-APN, and bacteremia is predictive factor for hospital mortality. Early radiologic imaging studies should be considered for CA-APN patients with Pitt scores ≥1, flank pain or azotemia.

Susceptibility of Escherichia coli from Community-Acquired Urinary Tract Infection to Fosfomycin, Nitrofurantoin, and Temocillin in Korea

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.

Susceptibility of Escherichia coli from Community-Acquired Urinary Tract Infection to Fosfomycin, Nitrofurantoin, and Temocillin in Korea

With increase of multi-drug resistant Escherichia coli in community-acquired urinary tract infections (CA-UTI), other treatment option with a therapeutic efficacy and a low antibiotic selective pressure is necessary. In this study, we evaluated in vitro susceptibility of E. coli isolates from CA-UTI to fosfomycin (FM), nitrofurantoin (NI), temocillin (TMO) as well as trimethoprim-sulfamethoxazole (SMX), ciprofloxacin (CIP) and cefepime (FEP). The minimal inhibitory concentrations were determined by E-test or agar dilution method according to the Clinical and Laboratory Standards Institute guidelines, using 346 E. coli collected in 12 Korean hospitals from March 2010 to February 2011. FM, NI and TMO showed an excellent susceptibility profile; FM 100% (346/346), TMO 96.8% (335/346), and NI 99.4% (344/346). Conversely, resistance rates of CIP and SMX were 22% (76/346) and 29.2% (101/349), respectively. FEP still retained an activity of 98.5%. In Korea, NI and TMO in addition to FM are a good therapeutic option for uncomplicated CA-UTI, especially for lower UTI.

A Case of Ticagrelor Rescue Therapy in a Patient with Subacute Stent Thrombosis / 대한내과학회지

Stent thrombosis (ST) is a rare but catastrophic complication of a drug-eluting stent. Although dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the occurrence of ST, it continues to occur and is occasionally associated with clopidogrel resistance. Here, we describe a 71-yr-old man with subacute stent thrombosis and clopidogrel resistance following drug-eluting stent implantation who underwent successful ticagrelor rescue therapy.

A Case of Ticagrelor Rescue Therapy in a Patient with Subacute Stent Thrombosis / 대한내과학회지

Stent thrombosis (ST) is a rare but catastrophic complication of a drug-eluting stent. Although dual antiplatelet therapy with aspirin and clopidogrel significantly reduces the occurrence of ST, it continues to occur and is occasionally associated with clopidogrel resistance. Here, we describe a 71-yr-old man with subacute stent thrombosis and clopidogrel resistance following drug-eluting stent implantation who underwent successful ticagrelor rescue therapy.

A Case of Pericardiocentesis in Myxedema with Pericardial Effusion / 대한내분비학회지

Myxedema is the nonpitting edema caused by the accumulation of glycosaminoglycans in subcutaneous and other interstitial tissue that occurs in hypothyroid patients. It is most often present in long-standing or severe primary hypothyroidism. While pericardial effusion appears to be a frequent occurrence in patients with myxedema, the development of cardiac tamponade in hypothyroid patients is distinctly unusual because of the slow formation of the pericardial effusion and the ability of the pericardium to distend. Recently we experienced a case of myxedema with pericardial effusion. The patient was 39-year-old female who was admitted due to aggrevated dyspnea for 1 month. She was obese and myxedematous. Chest X-ray revealed marked cardiomegaly. Two-dimensional echocardiography imaged massive pericardial effusion, especially left ventricular posterior wall and right ventricular side. The thyroid function test showed an obvious hypothyroid state. The patient was intubated and given controlled ventilation because of labored breathing, hypoxemia, and hypercapnea. After one half liter of straw-colored fluid was removed by pericardiocentesis, and she was given thyroid hormone replacement therapy, progressive clinical improvement was noted over course of next few weeks. We report this case with reviews of the literatures.

The Study about the Accuracy of Diacan - S When Had Used to Glucose Oxidase Method and Diascan - S for Blood Glucose / 대한마취과학회지

On department of anesthesiology, Hanyang university hospital, we used to the Diascan-S for portable blood glucose monitoring during surgery with anesthesia. So, we try to know about the accuracy, the precision and the specificity of that instrument. Period to check for blood glucose was devided to 3 groups that are on just after induction, the operation of main lesion, the end of surgery and we compared to the blood glucose level by the Diascan-S and the standard reference test. Central laboratory used glucose oxidase method to check blood glueose as the standard reference test. Thereafter we got the conclusions as follow. 1) We had got to good correlation between the blood glucose level by Diascan-S and the stan-dard reference test. (Y=65+0.64X, correlation coefficiency 0.58, p value; 0.0000) 2) When the blood glucose levels had devided as below from l00 mg/dl, 100 mg/dl to 150 mg/ dl and above 150 mg/dl, we only got to good correlation blood glocose level by Diascan-S and the standard reference test from 100 mg/dl to l50 mg/dl. (Y=11+2.5X, correlation coefficieny ; 0.51, p value ; 0.0000) 3) When we had tested for blood glucose on ]ust after anesthesia induction and the operation on main lesion, the end of surgery, the results of each period have a good correation each other by Diascan-S and the standard reference test. (a) Just after anesthesia induction Y = 51+0.50X, correlation coefficiency 0.52, p value 0.0000 (b) Operation for main lesion Y = 80+0.38X, correlation coefficiency 0.45, p value 0.0000 (c) End of surgery Y = 61+0.54X, correlation coefficiency ; 0.62, p value 0.0000 4) The condition of instrument had devided to two conditions of Diascan-S as was calibrated by technician reqularly or not, got to more confident correlation coefficiency when the Diascan-S had calibrated by technician reqularly. (a) had calibrated reqularly Y = 40+0.62X, correlation coefficiency 0.65, p value: 0.0000 (b) had not calibration Y = 77+0.42X, correlation coefficiency ; 0.36, p value: 0.0026 By above results, we got conclusions that portable glucose monitoring instrument(Diascan-s) can use to know to change of blood sugar during anesthesia. And then, if we got the result of blood glucose level as belows 100 mg/dl or above 150 mg/dl when used Diascan-S, should try to test again and must compared to standard reference test of central laboratory. Diascan-S must be ca)ibrated by technician reqularly if we try to get more accurate results of blood glucose by Diascan-S.