The Nationwide Surveillance Results of Nosocomial Infections along with Antimicrobial Resistance in Intensive Care Units of Sixteen University Hospitals in Korea, 2004 / 병원감염관리

BACKGROUND: This study was to evaluate a nationwide nosocomial infection rate and antimicrobial resistance in intensive care units(ICUs) in Korea. METHODS: The study was carried out at 16 university-affiliated teaching hospitals from July through October 2004. We performed a prospective multicenter study to investigate nosocomial infection rates, device-associated infection rated, and causative pathogens and their antimicrobial resistance. RESULTS: The urinary tract was the most commonly involved site. Nosocomial infection rate was 12.48 in medical. ICU (MICU), 9.59 in medical surgical ICU (MSICU), 14.76 in surgical ICU (MSICU), and 11.60 in other lCU. Device-associated infection rates were as follow: 1) rates of urinary catheter-associated urinary tract infection were 4.26 in MICU, 3.17 in SICU, 4.88 in MSICU, and 5.87 in other ICU; 2) rates of central line-associated bloodstream infection were 3.24 in MICU, 1.56 in SlCU, 2.36 in MSICU, and 1.78 in other ICU; 3) rates of ventilator-associated pneumonia were 3.61 in MlCU, 13.05 in SICU, 1.68 in MSICU, and 4.84 in other lCU. Staphylococcus aureus was the most frequently identified microorganism in this study; 93% of S. aurues were resistant to methicillin; 17% of Pseudomonas aeruginosa isolated were resistant to imipenem; 11% of Enterococcus faecium and 18% of Enterococcus faecalis showed resistance to vancomycin. Over a half of Acinetobacter spp, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli showed resistant to fluoroquinolone. Conclusion: This study shows the seriousness of antimicrobial resistance and the importance of infection control in the lCU in Korea. This study should provide a theoretical strategy to enforce the infection control.

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.

Survival Analysis of Hemodialysis Patients: A Single Center Study / 대한신장학회잡지

PURPOSE: In order to investigate the survival rate, causes of death, and the predictors of death in hemodialysis patients with chronic renal failure. METHODS: Among the 3,462 patients who started hemodialysis in Asan Medical Center between May 1989 and December 1999, we selected 674 patients who were closely observed at least for 3 months since they began hemodialysis as an initial replacement therapy for chronic renal failure. Demographic and clinical characteristics, including diabetes mellitus, hepatitis viral marker, and laboratory findings at the beginning of hemodialysis were retrospectively analyzed RESULTS: The mean age of the patients was 51.0+/-14.8 years, and their sex ratio was 1.4:1(M:F). The proportion of patients with diabetic nephropathy was 34.4%. The mean follow-up period was 34.2+/-28.1 months and 117 patients died(17%). The greatest number of patients were found to have died of cardiac problems(23%), followed by cerebrovascular disease(16.2%), infection(13.7%) and malignant disease(11.1%). The survival rate of the 674 patients was found to range from 1 to 10 years:96% at 1 year, 88% at 2, 73% at 5, and 54% at 10 years. In order to determine the independent predictors of death, we used Cox proportional hazards model. The predictors of death in hemodialysis patients were found to be (i) male(Relative risk(RR)=1.46, p=0.06), (ii) people over 60 years of age(RR=1.54, p=0.03), diabetes mellitus(RR=1.45, p=0.06), and (iii) low level of serum creatinine(RR=0.65, p < 0.001). CONCLUSION: Cardiovascular disease and infectious diseases were important causes of death in hemodialysis patients. Old age and low serum creatinine at the beginning of hemodialysis were significant predictors of death.