• The Korean Journal of Medicine
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• v.99 no.3
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• pp.149-157
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• 2024

Background/Aims: Carbapenems are recommended for treating bacteremia caused by extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E). However, this has resulted in a significant rise in the utilization of carbapenems in cases of ESBL-E infection. We evaluated the clinical outcomes of patients with ESBL-E bacteremia treated with non-carbapenem antimicrobials. Methods: We conducted a retrospective case-control study of a cohort of patients with documented ESBL-E bacteremia from January 2021 to December 2021. The patients were divided into two groups according to whether they received non-carbapenem or carbapenem therapy. The rates of treatment failure, 30-day mortality and microbiologic failure, and the durations of hospitalization and of antimicrobial therapy were compared between the two groups. Antimicrobial susceptibility testing and phenotypic identification of ESBL-E were performed using the Vitek 2 system. Results: Of 118 patients with ESBL-E bacteremia, 54 received non-carbapenem drugs (non-carbapenem group [NCG]) and 64 received carbapenems (carbapenem group [CG]). Treatment failure at 30 days occurred in 16.7% of the patients in the NCG and in 18.8% in the CG (p = 0.65). The 30-day mortality rate was 14.8% in the NCG and 17.2% in the CG (p = 0.63). Extra-urinary tract infection and prior antimicrobial therapy within 30 days were risk factors for treatment failure in patients with ESBL-E bacteremia. The clinical outcomes did not differ significantly between the two groups, challenging the prevailing preference for carbapenems in the treatment of ESBL-E bacteremia. Conclusions: Non-carbapenem antimicrobials such as piperacillin/tazobactam are recommended for patients with mild ESBL-E bacteremia in South Korea.

• The Journal of the Korean dental association
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• v.28 no.3 s.250
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• pp.291-301
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• 1990

• Childhood Kidney Diseases
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• v.16 no.2
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• pp.89-94
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• 2012

Purpose: The option of selecting isotonic rather than hypotonic fluids for maintenance fluid in children has been advocated by some authors. Pneumonia and CNS infections are frequent clinical settings for acute hyponatremia because of nonosmotic anti-diuretic hormone stimuli in children. We conducted the present study to identify the incidence of hyponatremia in pneumonia and CNS infection of children and to determine the importance of maintenance intravenous fluid therapy regimen and other related factors. Methods: The study included 1,992 patients admitted to the Department of Pediatrics at Pusan National University Children's Hospital between November 2008 and August 2011, who were diagnosed with pneumonia or CNS infections and checked for serum sodium concentration. Their clinical data including laboratory findings were reviewed retrospectively. Results: During the study period, 218 patients were identified to have acute hyponatremia among 1,992 patients. The overall incidence of hyponatremia was 10.9%. The incidence of hyponatremia in encephalitis (37.3%) was highest and the incidence in bacterial meningitis (27.4%), viral meningitis (20.0%), bacterial pneumonia (11.1%), mycoplasma pneumonia (9.2%), and viral pneumonia (6.8%) were in descending order. The mean age was higher in hyponatremic patients than in isonatremic patients. The incidence of hyponatremia was higher in who had 0.18% NaCl in 5% dextrose (D5 0.18% NS) than 0.45% NaCl in 5% dextrose infusion (D5 1/2NS) (9.0% vs. 2.2%). SIADH was identified in 20.5% among hospital acquired hyponatremic patients after adequate evaluation for SIADH. Conclusion: We recommend D5 1/2NS rather than D5 0.18% NS as the maintenance fluid given to children with pneumonia or infectious CNS diseases.

• Pediatric Infection and Vaccine
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• v.27 no.1
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• pp.62-68
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• 2020

Acute bacterial sinusitis is one of the most common diseases in children, and 5-13% of patients with viral upper respiratory infection experience secondary bacterial sinusitis as a complication. Isolated sphenoid sinusitis is rarer than frontal, maxillary, and ethmoid sinusitis. However, it presents potentially devastating complications, such as cranial nerve involvement, brain abscess, and meningitis, owing to its anatomical location. Nontypeable Haemophilus influenzae (NTHi) commonly causes acute bacterial sinusitis but rarely causes bacteremia, particularly in immunocompetent patients. We present a rare case of a 14-year-old boy with bacteremia due to isolated sphenoid sinusitis caused by NTHi.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.535-547
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• 1995

Background: Intensive care units(ICUs) probably represent the single largest identifiable source of infection within the hospital. Although there are several studies on ICU infections in respect to their bacteriology or mortality rate for individual types of ICU, few studies have compared ICU infections between different types of ICU. The aim of this study was to identify clinical differences in bacteremia between medical ICU(MICU) and surgical ICU(SICU) patients. Methods: 256 patients with bacteremia were retrospectively evaluated. Medical records were reviewed to obtain the clinical and bacteriologic informations. Results: 1) The mean age of the patients with bacteremia of MICU($58.6{\pm}17.2\;yr$) was greater than that of all MICU patients($54.3{\pm}17.1\;yr$)(p<0.01), but there was no significant difference in SICU patients(patients with bacteremia of SICU: $56.3{\pm}18.6\;yr$, all SICU patients: $62.0{\pm}16.8$)(p>0.05). ICU stay was longer(MICU patients: $23.4{\pm}40.8$ day, SICU patients: $30.3{\pm}26.8$ day) than the mean stay of all patients($6.8{\pm}15.5$ day)(p<0.05, respectively). Bacteremia of both ICU patients developed past the average day of ICU stay(all MICU patients: 7.9 day, all SICU patients: 6.0 day, MICU bacteremia: 19th day, SICU bacteremia: 17th day of ICU stay)(p<0.05, respectively). 2) There were no significant differences in mean age, sex, and length of stay of both ICU patients with bacteremia. 3) Use of antibiotics or steroid, use of percutaneous devices and invasive procedures before development of bacteremia were more frequent in SICU patients than in MICU patients(prior antibiotics use: MICU 45%, SICU 63%, p<0.05; steroid use: MICU 14%, SICU 36%, p<0.01; use of percutaneous devices: MICU 19%, SICU 39%, p<0.01; invasive procedures: MICU 19%, SICU 61 %, p<0.01). 4) The prevalence of community acquired infections was significantly higher in MICU patients than in SICU patients(MICU 42%, SICU 9%)(p<0.01), whereas SICU patients showed higher prevalence of ICU-acquired infection than MICU patients(MICU 48%, SICU 78%)(p<0.01). 5) There were no differences in causative organisms, primary sites of infection and time interval to bacteremia between both ICUs. 6) There were no significant differences in outcome according to pathogenic organisms or primary sites of infection. 7) The mortality rate was higher in patients with bacteremia than without bacteremia(MICU mortality rate: patients with bacteremia 72.5%, patients without bacteremia 36.0%, p<0.01; SICU mortality rate: patients with bacteremia 40.3%, patients without bacteremia 8.5%, p<0.05), and the mortality rate of MICU bacteremia was significantly higher compared with that of SICU bacteremia(MICU 72.5%, SICU 40.3%)(p<0.01). Conclusion: ICU patients with bacteremia stayed longer before the development of bacteremia, and showed higher mortality than the overall ICU population. The incidence of bacteremia was higher in MICU patients than SICU patients. MICU patients with bacteremia showed higher prevalence of liver diseases and acute respiratory failure, community-acquired bacteremia and greater mortality rate than SICU patients with bacteremia. SICU patients with bacteremia, on the other hand, showed higher prevalence of trauma, prior use of immunosuppressive agents, invasive procedures, and ICU-acquired bacteremia, and lower mortality rate than MICU patients with bacteremia.

• Clinical and Experimental Pediatrics
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• v.48 no.11
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• pp.1193-1200
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• 2005

Purpose : Invasive bacterial infection is a major cause of morbidity and mortality in children. Previously, we reported etiology of invasive infections in healthy children in 1985-1995. This study was performed to update etiology of invasive bacterial infections in the previously healthy children. Methods : We reviewed medical records of 98 episodes of invasive bacterial infections in immunocompetent children at the Seoul National University Children's Hospital in 1996-2004. Results : The frequent pathogens identified over all age groups were Streptococcus pneumoniae (33%) and Staphylococcus aureus(33%). The proportion of Salmonella species and Haemophilus influenzae has been declined to 4% each from 23% and 14%, respectively, compared to previous study. S. agalactiae was the most common isolate in the infants ${\leq}3$ months. Among the infants and children aged 3 months to 2 years and children of 2-5 years, S. pneumoniae(57%, 52%, respectively, in each group) was the most common isolates followed by S. aureus(17% and 24%, respectively). S. aureus was the most common isolates(73%) in children >5 years. Primary bacteremia was the most common clinical diagnosis(27%). S. pneumoniae was responsible for 42% of primary bacteremia, 50% of meningitis, and 69% of bacteremic pneumonia and empyema. S. aureus accounted for 80% of bone and joint infections. The case fatality rate was 8.1% for all invasive infections. Conclusion : We reviewed frequency of bacterial agents of invasive infections in children. The data may be useful for pediatricians to select adequate empirical antibiotics in the management of invasive bacterial infections.

• Proceedings of the Korean Journal of Food and Nutrition Conference
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• 2003.07a
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• pp.79-79
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• 2003

최근 소득수준의 향상과 여성의 사회진출로 인해 우리의 식생활도 많은 부분이 사회화되고 있다. 즉 완전조리식품과 반조리식품이 급격히 증가하고 있다. 기존의 인스탄트식품이 저가격, 반건강 특성으로 생각되어진 반면 최근 고가의 건강 지향적인 반조리식품으로 변화하고 있다. 이러한 경향은 식품가공기술 및 식품포장기술의 향상과 사회적요구에 부합된 결과로 사료된다. 이에 대표적인 경우가 다양한 소스류의 상품화 경향이다. 본 연구개발 사업에서 이루어지는 냉면소스도 가정에서 하기에는 번거롭고, 건강지향적 식생활로 메밀의 수효가 증가하여 냉면의 소비가 증가하리라 생각된다. 현재 시판되고 있는 기존의 몇몇의 제품들이 있기는 하나 제조공정, 보존상태 등에서 많은 문제점이 있다. 따라서 문헌 통하여 기존제품의 배합비를 조사하고, 냉면소스 배합비의 최적화를 위해 10여차례에 걸쳐 20종류의 소스에 대하여 배합비의 변화와 관능검사에 의해 배주스, 양파, 겨자, 마늘, 설탕, 물엿, 소금, 미원, 참기름, 고춧가루, 진간장, 생강즙, 식초, 파인애플로 구성된 소스를 개발하였다. 개발된 소스의 pH, 당도, 염도, 색차를 측정하여 관능검사의 결과와 비교 검토하였고, 식품재료의 차이에 의한 맛의 변화를 보정하기 위한 근거로 사용하였다. 저장성 검사를 위해 일반세균과 대장균을 검사하였다. 그 결과는 다음과 같다. 소비자들의 기호에 맞는 냉면소스를 개발하기 위해 다양한 식품의 배합을 시도하여 상품성이 있을 것으로 판단되는 recipe를 완성하였고, 일반인(주부)들을 상대로 한 호감도 조사에서도 좋은 성적을 나타내었다. 시료를 1주간격으로 한달간 실험한 결과 쇠고기가 들어 있는 제품을 제외하구 대장균은 검출되지 않았으며 일반세균은 위생법의 허용치내에 있었다. 쇠고기가 있는 제품은 가격상승과 저장성에 문제가 있어 이를 제하고 최종적인 레시피를 결정하였다.있었다. 그러나 식이 섭취상태와의 관련성은 나타나지 않았다. 이상에서 생활습관이 신체계측치 및 혈중 지질 농도와 일부 상관을 보이는 것을 알 수 있었으며, 건강위험 요인도 관찰할 수 있었다. 고지혈증은 심혈관계질환의 주요한 위험 인자로 알려져 있으며, 그 유발 요인에는 여러 환경적인 요인과 식이 요인이 있다. 또한 생활습관은 영양소의 섭취량에도 영향을준다. 이처럼 식이 요인과 생활습관은 단독 혹은 상호 영향을 주게 되므로 고지혈증 및 심혈관계질환을 개선하려면 식사요법과 생활습관 교정을 병행하여야 한다. 고지혈증의 원인 중의 하나로 지적되고 있는 음주와 흡연은 상호 유도작용이 있으므로 금연이나 절주를 하고자 할 경우 두가지를 동시에 자제해야 효과적일 것으로 생각된다. 폐경후 여성들에게 발생 빈도가 높은 심혈관질환의 위험요인인 고지혈증을 예방하고자 하는 노력은 폐경후 여성들의 삶의 질적 향상을 위해서도 매우 중요하다. 또한 균형식 섭취와 운동을 통해 혈중 지질 수준을 건강하게 유지하고, 비만으로의 이행을 방지함으로써 심혈관계질환을 예방하도록 하여야겠다.료보다 절반이하 수준이었다. Ferric citrate는 차이가 거의 없었으며 ferrous lactate는 70%수준이었다. 이상의 결과에서 철분강화우유에 사용하기 적합한 철분염은 ferrous lactate, ferric citrate였는데 특히 ferrous lactate는 제품의 이화학적 품질, 생이용성 측면 모두에서 가장 좋은 것으로 나타났다.다 높았으며, 1회당 평균 8.1$\pm$5.1개의 난포란을 회수하였다. investigation can be separated into sampling and analytical uncertainties, it can be used as a criterion where the resources for the inves

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.716-722
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• 2005

Purpose : A full view of the spectrum of all bacterial diseases in healthy children is essential to the establishment of public health priorities. Accurate information on the relative importance of the various pathogens in terms of the age of the affected patients, the site of infection and the case fatality rate are valuable to the clinician in choosing antimicrobial treatments. Methods : Fifty-nine episodes of bacteremia were analysed. Data were collected at Ilsan Paik Hospital from January 2000 to December 2003. Analysis of each collected episode included isolating pathogen from blood culture, diagnosis, hospital course, isolating pathogens from other tissue sites, and studying results of antimicrobial sensitivity tests. Results : Fifty-nine cases of community-acquired bacteremia were reviewed. The most common pathogen was Staphylococcus aureus(11 cases, 18.6 percent), followed by Salmonella(10 cases, 16.9 percent), E. coli(7 cases, 11.9 percent), Streptococcus pneumoniae(five cases, 8.5 percent), Streptococcus viridans(5 cases 8.5 percent). The most common diagnosis was bacteremia without an indentified focus(61 percent), followed by meningitis(12 percent), bacteremia with enteritis(10.2 percent) and bacteremia with urinary tract infection(8.5 percent). Salmonella was still an important causative agent of bacteremia. The relative importance of Haemophilus influenza and Streptococcus pneumoniae was lower than in other studies. The most common organism responsible for bacteremia without an identified focus was Staphylococcus aureus. The case-fatality was 3.4 percent for all cases of bacteremia. Conclusion : We reviewed the etiology of community-acquired bacteremia. These data may be useful in the establishment of public health priorities and serve as a reference for selection of antibiotics in the empirical therapy of suspected invasive bacterial infection.

• Journal of the korean veterinary medical association
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• v.43 no.8
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• pp.727-730
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• 2007

곰팡이성 위염은 곰팡이의 감염에 의해 산발적으로 발생하는 질병인데 곰팡이 낀 사료나 건초를 먹을 경우 발생하고 Candida albicans, Mucor, Rhizopus, Absidia, Morteierella 및 Aspergillus 같은 곰팡이가 원인이 된다. 이런 곰팡이성 위염은 세균성 내독소혈증, 패혈증, 스테로이드제제나 항생제의 장기간 사용 시에 곰팡이에 대한 저항 형성하여 점막층과 점막하직 및 장막층까지 약화시켜 폐사에 이르게 하기도 한다. 국내에서도 곰팡이에 의한 괴사성 위염으로 폐사한 예가 있어 사례를 보고한다.

• Pediatric Infection and Vaccine
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• v.17 no.2
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• pp.83-90
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• 2010

Purpose : Although the incidence of polymicrobial bloodstream infection (PBSI) has increased, only a few studies have so far focused on children. Therefore, in an effort to prevent more serious situations in pediatric patients, we analyzed the clinical features, organisms, and laboratory results of PBSI. Methods : We performed a retrospective review of the case records of 97 patients with polymicrobial bloodstream infection in the Severance hospital, from 2001 to 2008. Using t-test and chi-square test, we analyzed the underlying medical conditions, clinical characteristics, organisms, and laboratory results of those patients. Results : Annual incidence of polymicrobial bloodstream infection increased from 1.4 % in 2001 to 10.9% in 2008 in pediatric patients. Immunocompromised hemato-oncological malignancy was found in 31 (31.9%) patients, and was the most common underlying medical condition; cardiovascular disease was found in 15 patients (15.4%), neurologic disease in 10 patients (10.3%), and so on. Gram positive organisms were recovered in 143 cases and gram negative organisms were recovered in 101 cases of PBSI. Staphylococcus epidermidis was the most common organism. Factors affecting mortality included underlying medical disease, immune status, nosocomial infection, and central catheter-related infection, for which the rate of mortality showed a greater increase (P<0.05). Conclusion : Due to the close connection between PBSI and fatal conditions or high mortality, it requires more aggressive management. Compared with previous studies, we discovered that immunocompromised hemato-oncological malignancy was the most common underlying medical condition and that frequency of gram-positive bacteria and fungus isolated has increased.