• Pediatric Infection and Vaccine
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• v.24 no.3
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• pp.160-167
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• 2017

Purpose: Because children with asplenia have an increased risk of fulminant infection associated with a high fatality, chemoprophylaxis, and vaccinations against encapsulated bacteria are recommended. However, there have been few reports of the burden of severe bacterial infection and the current status of chemoprophylaxis and immunization among children with asplenia in Korea. Methods: We conducted a retrospective study including children with asplenia who were treated at our institute between January 1997 and December 2016. Results: From a total of 213 children with asplenia, 114 (53.5%) had congenital asplenia and 58 (27.2%) had functional asplenia. The remaining 41 (19.3%) had acquired asplenia with the median age at splenectomy being 12.2 years (range, 5.0 to 16.9 years); the most common cause of splenectomy was hereditary spherocytosis (39.0%). The chemoprophylaxis rate was 16.4%. The immunization rates were 44.1% for pneumococcus, 53.0% for Haemophilus influenzae type B, and 10.7% for meningococcus. The incidence of invasive bacterial infection among children with asplenia was 0.28/100 person-year; a total of six episodes (2.8%) were observed in five patients with congenital asplenia and one patient with functional asplenia. The median age for these infections was 15 months (range, 4 to 68 months). Five of the six episodes were bacteremia, and the other was meningitis. The most common pathogen was Streptococcus pneumoniae (n=3), followed by H. influenzae (n=1). Three of the six patients (50.0%) died, all of whom had pneumococcal bacteremia. None of the six had chemoprophylaxis or proper vaccinations. Conclusions: Although there is an increased risk of a severe infection proper vaccinations and chemoprophylaxis are still lacking. Physicians should be encouraged to implement appropriate chemoprophylaxis and immunizations for patients with asplenia.

• Childhood Kidney Diseases
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• v.13 no.2
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• pp.261-266
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• 2009

Rhabdomyolysis, the clinical syndrome caused by the injury to skeletal muscle resulting in the release of muscle cell contents into the systemic circulation, has been described in association with various factors. The causes include crush injury, skeletal muscle overuse, heat, drug, abuse of alcohols and metabolic disorders as well as several types of viral and bacterial infections. We report two cases of rhabdomyolysis, which were complicated by uncommon causes, parainfluenza virus type I infection and hypernatremia.

• Journal of Veterinary Clinics
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• v.27 no.5
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• pp.573-578
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• 2010

A 4-year-old intact male Shih Tzu dog (weighing 5 kg), was presented with signs of severe dyspnea, exercise intolerance and cyanosis. Diagnostic studies suggested a reverse patent ductus arteriosus (rPDA) with pneumonia. Despite emergency treatments with oxygen, diuretics, antibiotics and medical therapy for hyperkalemia, the dog died of ventricular fibrillation from hyperkalemia and dehydration. Necropsy revealed the rPDA with a marked descending aortic dilation and abnormally arisen left common carotid artery.

• Journal of Veterinary Clinics
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• v.32 no.4
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• pp.338-342
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• 2015

A 12-year-old castrated male miniature Schnauzer had anorexia, vomiting, lethargy, and fever for four days. The dog had leukocytosis, thrombocytopenia, hypoglycemia, hypoalbuminemia, hyperbilirubinemia, increased hepatic enzymes on hematologic and biochemical examinations. On abdominal ultrasonographs, there was an enlarged gallbladder with hyperechoic irregular wall thickening. Echocardiography showed vegetative change and regurgitation of aortic and mitral valves. E.coli was identified through ultrasound guided percutaneous cholecystocentesis and bile culture. Bacterial cholecystitis and concurrent endocarditis were diagnosed. The dog was recovered from sepsis with antibacterial and aggressive supportive therapy.

• Pediatric Infection and Vaccine
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• v.25 no.2
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• pp.82-90
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• 2018

Purpose: Survival after liver transplantation (LT) has improved over the years, but infection is still a major complication. We aimed to identify the characteristics of bacterial infections in pediatric LT recipients. Methods: This study is a retrospective review of 189 consecutive children undergoing LT between 2000 and 2015 at a single center. In this study, the incidence of infection was determined for the following periods: within 1 month, between 1-5 months, and between 6-12 months. Patients who underwent liver transplants more than once or multiple organ transplants were excluded. Results: All patients had received postoperative antibiotic for 3 days. Only the maintenance immunosuppression with oral tacrolimus and steroids were performed. As a result, 132 bacterial infections developed in 87 (46.0%) patients (0.70 events per person-year). Bacterial infections occurred most frequently within the first month (n=84, 63.6%) after LT. In the pathogens, Staphylococcus aureus (15.2%), Enterococcus species (15.2%), and Klebsiella species (13.6%) were most common. Regarding the organ infected, bloodstream was most common (n=39, 29.5%), followed by peritoneum (n=28, 21.2%), urinary tract (n=25, 18.9%), and lungs (n=20, 15.2%). We changed prophylactic antibiotics from ampicillin-sulbactam to piperacillin-tazobactam at 2011, October, there were no significant effects in the prevalence of antibiotics resistant bacterial infections. The 1-year mortality was 9.0% (n=17), in which 41.2% (n=7) was attributable to bacterial infection; septicemia (n=4), pneumonia (n=2), and peritonitis (n=1). Conclusions: The incidence and type of bacterial infectious complications after LT in pediatric patients were similar to those of previous studies. Bacterial complications affecting mortality occur within 6 months after transplantation, so proper prophylaxis and treatment in this period may improve the prognosis of LT.

• Clinical and Experimental Pediatrics
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• v.46 no.3
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• pp.265-270
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• 2003

Purpose : To characterize the infants under 3 months of age with urinary tract infections(UTIs), and especially patients with bacteremia or meningitis Methods : Hospital records of all the infants under 3 months of age discharged from our hospital for 69 consecutive months with the diagnosis of initial episode of UTI were reviewed. UTI was defined when patients had fever with pyuria, and had urine culture results of ${\geq}10^5$ colony forming units/mL from a bag specimen. Patients with previously known urologic abnormality or immunodeficiency were excluded. Nosocomial infections were also excluded from the study. Results : The male:female ratio was 35 : 6. Of the urine cultures, 40(97.6%) yielded single pathogen, one yielded two pathogens. Escherichia coli was the predominant isolate from the urine. Five patients(12%) also had bacteremia. Pathogens isolated from the blood cultures were E. coli(4) and Enterococcus faecalis(1). No patient had culture-positive meningitis or cerebrospinal fluid pleocytosis. Clinical or laboratory findings between patients with and without bacteremia were not different significantly. The rate of vesicoureteral reflux(VUR) was 44%. The sensitivity of ultrasound for detection of VUR was 38%; specificity was 50%. Conclusion : Clinical and laboratory data were not helpful for identifying patients with bacteremia at the time of presentation. Consequently, blood cultures need to be obtained from all febrile infants under 3 months of age with UTIs. A large-scale study including the indication of lumbar puncture for infants with a febrile UTI and study of evaluation and treatment of infants under 3 months of age with UTIs are required.

• Clinical and Experimental Pediatrics
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• v.46 no.8
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• pp.758-762
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• 2003

Purpose : Our examination was designed to determine the diagnostic properties of the cutoff point for the prediction of bacteremia in febrile children less than 3 years of age. Cutoff point is the value that simultaneously maximizes both sensitivity and specificity. Methods : We conducted a retrospective study of febrile children, less than 3 years of age, who clinically have no identifiable source of fever. Peripheral blood leukocyte count(WBC), absolute neutrophil count(ANC), erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were measured at the same time. All patients received blood culture, urine culture and/or CSF culture. Bacterial infection was defined as single pathogen isolated from the CSF or blood or a urinary tract infection (UTI). Patients were dichotomized into two groups : those with bacterial infection and no bacterial infection. We analyzed the characteristics of the children in the two groups. Results : Seventy-one patients(44 males; 27 females) were enrolled in the study. Twenty patients (28%) had a serious bacterial infection(twelve urinary tract infection, five bacteremia, three meningitis) and fifty-one(72%) had no serious bacterial infection. WBC, ESR and CRP were significantly different between the two groups(P<0.05). The cutoff point of WBC, ESR and CRP were $20,000/mm^3$, 30 mm/hr and 3.0 mg/dL, respectively. The sensitivity and specificity of each cutoff point were WBC(75%, 75%), ESR(79%, 68%) and CRP(83%, 77%), respectively. Conclusion : These data show the ability of predictors to identify febrile children less than 3 years of age with bacterial infection. Febrile children who reach the cutoff point must be treated intensively and those who do not reach the cutoff point can be carefully managed without administering antimicrobial agents.

• Tuberculosis and Respiratory Diseases
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• v.47 no.2
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• pp.184-194
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• 1999

Backgrounds : The advent of penicillin has led to the marked reduction in the mortality from pneumococcal bacteremia, however, the mortality is still relatively high in this post-antibiotic era. Actually the prevalence of infection due to penicillin-resistant penumococci is increasing worldwide, and it is especially high in Korea due to irrelevant use of antibiotics. So, the high mortality of pneumococcal sepsis might be related to the emergence of penicillin-resistant strains, however, many other antibiotics, which eradicate pneumococci effectively, are available in these days. This has led us to suspect the role of penicillin-resistance in the high mortality rate. In this study, we evaluated the effect of penicillin resistance on the mortality of patients with penumococcal bacte remia. Methods: The study population consisted of 50 adult patients with penumococcal bacteremia who were admitted between Jan, 1990 and July, 1997. Medical records were analyzed retrospectively. Results: Most of the patients (96%) had underlying diseases. The most common local disease associated with pneumococcal bacteremia was pneumonia (42%), which was followed by spontaneous bacterial peritonitis (14%), cholangitis (10%), meningitis (8%), liver abscess (4%), pharyngotonsillitis (4%), sinusitis (2%) and cellulitis (2%). While the overall case-fatality rate in this study was 24%, it was higher when peumococcal bacteremia was associated with pneumonia (42%) or meningitis (50%). The rate of penicillin resistance was 40%, which was increased rapidly from 1991. The rate of penicillin resistance was significantly higher in patients with the history of recent antibiotics use and hospitalization within 3 months respectively. The clinical manifestations, that is, age, severity of underlying diseases, nosocomial infection, associated local diseases, and the presence of shock or acute renal failure were not statistically different between the patients with penicillin-resistant and -sensitive pneumococcal bacteremia. The mortality of patients infected with penicillin-resistant pneumococci was not statistically different from those with penicillin-sensitive pneumococcal bacteremia. Conclusion: Penicillin resistance is not associated with high mortality in adult patients with pneumococcal bacteremia. As the overall mortality is high, active penumococcal vaccination is recommended in patients with high risk of infection.

• Journal of Life Science
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• v.8 no.6
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• pp.711-722
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• 1998

This study was undertaken to determine the antimicrobial susceptibilities of 716 bacterial strains among 1,104 microbes which were isolated in blood culture from 13,595 in-patients and out-patients in K hospital during the pe-riod of 1993 to 1996. The results obtained were as follows : The isolation rate of microbes from the blood culture for 3 years was 8.1% (1,104/13,595). Among 716 bacte-rial strains, Escherichia coli and Staphylococcus epidermidis were 29.8% (213) and 19.5% (140) respectively. The bacterial isolation frequency according to ages was high at fifties, sixties and two or less years old groups, especially the isolation rate of S. epidermidis was 47% at two or less years old group and that of Salmonella typhi was 36% at thirties years old group. The seasonal isolation rate of the bacterial species except E. coli was high during May to September. Gram positive cocci were resistant to penicillin-G except Enterococcus faecalis, but susceptible to vanco-mycin and teicoplanin. Gram negative bacilli were susceptible to amikacin, ciprofloxacin, and imipenem, but resistant to ampicillin except S. typhi. These results indicate that bacterial strains isolated from bacteremia patients were resis-tant to penicillins, but susceptible to vancomycin, teicoplanin, amikacin, ciprofloxacin and imipenem.

• Journal of Veterinary Clinics
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• v.26 no.1
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• pp.23-28
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• 2009

Peritoneal dialysis (PD) is a clinical technique that therapeutically removes toxic solutes from body fluids and normalizes endogenous solutes whose aberrant concentrations disrupt normal physiology. This study retrospectively evaluated clinical outcomes and complications of PD in 20 dogs with renal failure. Blood works (total count of red blood cells (RBC), packed cell volume (PCV), the serum biochemical, and electrolyte values related to renal insufficiency) and complications associated with peritoneal dialysis, and clinical outcomes were recorded before and after PD. Additionally, creatinine reduction ratio (CRR) and urea nitrogen reduction ratio (URR) were calculated for evaluating the efficacy of PD. PD resulted in a significant (p < 0.05) reduction in blood urea nitrogen (BUN) concentration in 19 dogs, while a significant (p < 0.05) reduction in creatinine concentration in 17 dogs. The complications of PD were hypoalbuminemia (12/20, 60%), anemia (10/20, 50%), subcutaneous dialysate leakage (9/20, 45%), bacterial peritonitis (6/20, 30%), dialysate retention (5/20, 25%) and limb edema (4/20, 20%). This study demonstrated that PD was effective in reducing the magnitude of azotemia in dogs with renal failure especially in acute phase, although the complication rate was high but manageable.