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.

Acute Lymphadenitis with Cellulitis Caused by Staphylococcus lugdunensis / 대한진단검사의학회지

Although coagulase-negative staphylococci (CNS) have been considered part of the resident flora on the human skin, Staphylococcus lugdunensis is an unusually virulent CNS and can cause many types of infection. We report a rare case of acute lymphadenitis with cellulitis in the right infraauricular region caused by S. lugdunensis. A 62-yr-old woman visited the Department of Otolaryngology of Busan Paik university hospital. She had a palpable mass and swelling in the right infraauricular region and complained of aggressive pain and a febrile sensation in the region for 5 days. On the suspicion of abscess with infection, percutaneous aspiration was performed and smooth, flat, white, opaque colonies grew on a blood agar plate as a pure culture. The biochemical test results showed the organism to be catalase positive, tube coagulase negative, ornithine decarboxylase positive, slide coagulase positive, and latex agglutination tests for coagulase positive. The API Staph Kit was used to identify the isolate to the species level as S. lugdunensis with a 64.6% probability (profile 6716152). We confirmed the species identification of this strain by 16S rDNA sequence analysis. The patient's clinical condition improved with appropriate antimicrobial therapy and pus drainage.

Risk Factors for Nosocomial Urinary Tract Infection in the Intensive Care Unit with a Positive Urine Culture and Foley Catheterization / 간호학회지

PURPOSE: The purpose of this study was to identify the risk factors for a nosocomial urinary tract infection in intensive care units with a foley catheterization which showed a positive urine culture. METHOD: Three-hundred eighty-seven patients were included in the study. A retrospective review of the electrical medical record system's databases and medical record sheets in hospitalized patients from January 2003 to December 2003 was used. The collected data was analyzed by descriptive statistics, t-test, chi-square test and logistic regression analysis. RESULT: The frequency of the participants' nosocomial urinary tract infection was 72.9%. Significant risk factors for a nosocomial urinary tract infection were 'age', 'place of catheter insertion', 'frequency of catheter change', and 'duration of catheterization'. These variables explained 18.4% of variance in the experience of nosocomial urinary tract infection in intensive care units with foley catheterization. CONCLUSION: Medical personnel can decrease the incidence of a nosocomial urinary tract infection by recognizing and paying attention to the duration of catheterization, frequency of catheter change, and place of catheter insertion. As a result, specific and scrupulous strategies should be developed to reflect these factors for decreasing nosocomial urinary tract infections.

Status of Nosocomial Urinary Tract Infections in the ICU: Molecular Epidemiology of Imipenem Resistant P. aeruginosa / 간호학회지

PURPOSE: This retrospective study was done to evaluate the status of nosocomial urinary tract infections and to determine the risk factors andtransmission route of causal IRPA through molecular epidemiology. METHOD: Two hundred ninety-nine of 423 patients admitted to the internal medicine and surgery ICU at a university hospital incity B had a positiveurine culture. Twelve of the 299 patients who had a urinary tract infection had IRPA strains. The data was collected from November 1, 2004 to January 31, 2005. The following results were obtained after the data was analyzed using percentile and UPGMA. RESULT: The rate of nosocomial urinary tract infections in the ICU was 10.8%. Therewere 16.8 cases of infection based on the period of hospitalization. There were 16.9 cases of infection based on the use of a foley catheter. The rate of nosocomial urinary tract infection in the ICU and urinary tract infections related to IRPA were higher in patients with the following characteristics: men, old age, admission through the emergency room, longer than seven days admission, severity of admitting causes, disturbance of consciousness, hydration less than 300cc in 24hours, a long course of antibiotics, a long period of foley catheterization and perineal care. Most of the microorganisms that caused the urinary tract infection were gram negative bacilli, among which P. aeruginosa was found in 70 patients (18.5%) and IRPA in 12 (4.0%). Among the 12 IRPA strains that were tested with PFGE, eight showed a dice coefficient higher than 80%, suggesting a genetic relationship. They were related with the period of hospitalization in the same ICU. These patients all received direct care for a urinary tract infection. CONCLUSION: Through these results, IRPA can be consideredas a contributing factors to urinary tract infections thus, active preventative measures are needed by the medical staff.

A Study on Nausea & Vomiting, Anorexia and Food intake in Cancer Patients undergoing Chemotherapy Overtime: Comparison between Cervix Cancer and Stomach Cancer / 성인간호학회지

PURPOSE: This study was conducted to investigate the level of nausea & vomiting, anorexia and food intake during the periods of chemotherapy and 14 days after discharge. METHOD: The subjects were 40 cancer patients(cervix cancer : 20 patients, stomach cancer: 20 patients) who had chemotherapy with Cisplatin & 5-Fu. Data were analyzed by mean & standard deviation, ANCOVA. RESULT: 1. The severity of nausea & vomiting with anorexia in cancer patients receiving chemotherapy was the highest at the 3rd day and then it gradually decreased. At the 14th day after discharge, nausea & vomiting with anorexia still remained with very low levels. 2. The amount of food intake was the lowest on the 3rd day and then gradually increased. However, it was 53.3-72.5% of the ordinary food intake on the 14th day after discharge. Calorie intake was 625.31 Kcal on the 3rd day and 1130.92 Kcal on the 7th day after discharge. 3. There were no significant differences in nausea & vomiting, anorexia, food intake, calory intake between those with cervix cancer and stomach cancer. CONCLUSION: In cancer patients nausea & vomiting and anorexia were severe and food intake was very poor during chemotherapy but afterwards they were gradually improved, but were not completely recovered on the 14th day after discharge. Therefore the nursing intervention regarding the increase of food intake was necessary during chemotherapy and after discharge.