• Clinical and Experimental Pediatrics
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• v.56 no.2
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• pp.68-74
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• 2013

Purpose: To evaluate the effectiveness of new management policies on the incidence of invasive Candida infections Methods: This observational study involved a retrospective analysis of the patients' medical records. In total, 99 very low birth weight infants, who were admitted to the neonatal intensive care unit at Ajou University Hospital from January 2010 to December 2011, were enrolled for the study. Period I, defined as the period before the revision of management policies, comprised 57 infants; whereas, period II, defined as the period after the implementation of new management policies, comprised 42 infants. The new management policies entailed a reduction in antibiotic and histamine type 2 receptor blocker (H2 blocker) use, duration of central venous catheterization, and duration of endotracheal intubation. Results: There was a significant overall decrease in the use of antibiotics including 3rd generation cephalosporin and H2 blockers (P<0.05), and a significantly lower incidence of invasive Candida infections in period II as compared to period I (0/42 vs. 6/57, respectively; P=0.037). Comparison between infants with invasive Candida infections (n=6) and those without (n=93) showed that gestational age (odds ratio [OR], 0.909; 95% confidence interval [CI], 0.829 to 0.996; P=0.042) and the duration of 3rd generation cephalosporin use (OR, 1.093; 95% CI, 1.009 to 1.183; P=0.029) were statistically significant risk factors. Conclusion: The new management policies effectively decreased overall use of antibiotics, especially 3rd generation cephalosporin, and H2 blockers, which led to a significantly lower incidence of invasive Candida infections.

• YAKHAK HOEJI
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• v.52 no.2
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• pp.101-110
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• 2008

Total Knee Replacement (TKR) surgery is one of the invasive procedures for patients with late-stage knee joint disorders. In the present study, economic efficiency was compared between uses of the 2nd and 3rd generation cephalosporins for the prophylaxis before and after the surgery using frequency analysis in terms of various factors such as medication costs, the number of days of antibiotic use and hospitalization due to TKR surgery. The results showed that the 3rd generation cephalosporins did not reduce the infection rate and total medication costs, but rather raised antibiotic cost in comparison with the 2nd ones. A frequent use of the 3rd ones is closely related to emergence of resistant bacterial strains. Therefore, we suggest that unnecessary prescriptions for the broad spectrum antibiotics should be avoided.

• Childhood Kidney Diseases
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• v.23 no.1
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• pp.29-35
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• 2019

Purpose: We aimed to determine characteristics of host, causative organisms, and antibiotic susceptibility of bacteria in pediatric patients with UTI living in metropolitan area of Korea. Methods: Retrospective investigation was done for the causative organisms of UTI in 683 pediatric cases treated at Ajou University Hospital from 2012 to 2017. Patients were classified into Escherichia coli and non-E. coli group, where E. coli group was subdivided into ESBL(+) and ESBL(-) groups based on whether the bacteria could produce extended spectrum beta-lactamase (ESBL). Antibiotic susceptibility of the causative organism was also determined. Results: A total of 683 UTIs occurred in 550 patients, of which 463 (67.8%) were first-time infection and 87 (32.2%) were recurrent ones (2-7 recurrences, 2.52 average), and 64.9% were male and 35.1% were female. The most common causative organism was E. coli (77.2%) and ESBL(+) E. coli was found in 126 cases. The susceptibility of E. coli to 3rd or 4th generation cephalosporin was relatively higher than that to ampicillin or amoxicillin/clavulanic acid. ESBL(+) E. coli showed higher resistance rate to 3rd or 4th generation cephalosporin than ESBL(-) E. coli. Conclusion: New treatment guideline should be considered due to the incidence of ESBL(+) E. coli increased up to one quarter of UTI cases.

• Pediatric Infection and Vaccine
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• v.13 no.1
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• pp.71-77
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• 2006

Purpose : Shigellosis is still an important cause of acute food-borne diarrheal diseases throughout the world. We investigated the transmission routes and clinical course through the outbreak of shigellosis in Mapo-Gu, Seoul. Methods : From October 7th to November 19th in 2005, Mapo-Gu public health center had referred 32 patients with confirmed or suspected shigellosis to the National Medical Center. We had investigated source of infection, epidemiology, laboratory findings, and clinical course of the cases occurred during this outbreak. Results : Among 32 patients, 24 patients had been confirmed with shigellosis, 8 patients had been diagnosed with suspected shigellosis. They ranged in age from 5 months to 12 years old and their mean age was 6.5 years. The clinical manifestations were as follows; diarrhea, fever, abdominal pain and asymptomatic condition. Symptoms had sustained for 3.7 days on the average. S. sonnei were cultured by rectal swab and founded to be resistant to ampicillin and TMP/SMX except to 3rd generation cephalosporin. After treatment with antibiotics such as cefixime and ceftriaxone or imipenem and conservative treatment with electrolyte and fluid replacement for 5~7 days, Stool cultures of the rectal swab grew no Shigella in these cases except 3 cases. Conclusion : An outbreak of shigellosis had occurred in a preschool and elementary school children. From the same results of antimicrobial susceptibility and pulsed-field gel electrophoresis patterns in this study, we suggest that the outbreak of shigellosis in this report had been originated from a single strain. According to all negative results about suspected food and water cultures, we couldn't find out source of infection. Through materials offerred by Mapo-Gu Public Health Center, we presumed the trasmission routes probably were person-to-person.

• Pediatric Infection and Vaccine
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• v.28 no.2
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• pp.82-91
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• 2021

Background: The purpose of this study was to investigate the association between antibiotic use and the antimicrobial resistance of gram-negative bacteria isolated from blood cultures in a pediatric population. Methods: From January 2014 to June 2018, the antibiotic resistance pattern of Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa obtained from bacteremic patients aged ≤18 years hospitalized at Asan Medical Center Children's Hospital was analyzed and the parenteral antibiotic consumption data were retrieved. Results: During the study period, the blood culture was positive for K. pneumoniae (6.4%; 105/1,628), E. coli (5.6%; 91/1,628), P. aeruginosa (3.3%; 54/1,628), and A. baumannii (2.5%; 41/1,628), and the extended-spectrum antibiotic resistance rate of gram-negative bacteria was consistently high. The overall resistance rate of E. coli and K. pneumoniae to extendedspectrum cephalosporin was 49.3% and 54.4%, respectively. Carbapenem-resistant E. coli was first detected in 2014; its overall resistance rate to carbapenem was 5.3%. There was a linear correlation between the usage of 3rd generation cephalosporin and the resistance of A. baumannii (r²=0.96, P=0.004) and carbapenem usage and the resistance of K. pneumoniae (r²=0.79, P=0.045). Conclusions: A positive linear correlation was observed between antibiotic resistance and the corresponding antibiotic usage in 3rd generation cephalosporin resistant A. baumannii and carbapenem resistant K. pneumoniae. The judicious use of antibiotics in healthcare settings is important to minimize selection for extended-spectrum β-lactamase (ESBL) and carbapenem resistance in gram-negative bacteria.

• Pediatric Infection and Vaccine
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• v.14 no.2
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• pp.162-170
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• 2007

Purpose : While cases of vancomycin-resistant enterococci (VRE) have increasingly been reported worldwide since it was first reported in the late 1980s, there have been few systemic studies on the pediatric population. The purpose of this study is to contribute to the planning of VRE prevention by investigating the prevalence, risk factors and transmission of VRE infection. Methods : We studied 230 patients under age 15 years who were isolated VRE between January 2001 and December 2006 retrospectively. The patients were classified into the intensive care unit (ICU) and the non-ICU groups. We reviewed the procedures before VRE detection as well as antibiotic sensitivity of detected organisms. Results : The number of VRE-isolation cases was higher in the ICU group than the non-ICU group. Instances of VRE-isolation were also more prevalent in patients who underwent operations or active procedures while taking 3rd-generation cephalosporins or glycopeptides. Almost all antibiotics except tetracycline were resistant to VRE. The proportion of 3rd-generation cephalosporin use was higher than those of any other antibiotics before VRE detection. Additionally, the use of 3rd-generation cephalosporins has increased annually, but that of glycopeptides had decreased in 2006. Also, the rates of VRE isolation have been increasing since 1998. Conclusion : VRE infection is increasing in pediatric population. Strict adherence to appropriate infection control guidelines for the prevention of VRE transmission in hospitals, and tracking of VRE colonization through active surveillance in high risk units are recommended.

• Pediatric Infection and Vaccine
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• v.19 no.1
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• pp.12-18
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• 2012

Purpose : This study attempted to investigate the frequency, duration, and risk factors of antibiotic-associated diarrhea (AAD) in infants hospitalized due to febrile urinary tract infection (UTI). This is a basic research on the probiotics used in the prevention and treatment of AAD in infants. Methods : Medical records of the infants aged 3-6 months hospitalized in Gachon University Gil Hospital from January 2008 to September 2010 due to the febrile UTI were retrospectively reviewed. The episodes of loose or watery stool were investigated for frequency, onset, and duration. Those who had AAD and those who did not (non-AAD) were compared. The antibiotic regimens and the episodes of diarrhea were investigated in AAD group. Result : Total 147 infants were included. Fifty-four (36.7%) showed AAD. Intravenous third-generation cephalosporin ($3^{rd}$ CS) single therapy was used for 102 patients (69.4%), the $3^{rd}$ CS and non-$3^{rd}$ CS combination therapy for 24 (16.3%), and non-$3^{rd}$ CS combination therapy for 21 (14.3%). There was no significant difference in the dose of cefotaxime between AAD and non-AAD group (P=0.601). According to the antibiotic therapies above, in AAD group, there was no significant difference in the onset and duration of diarrhea respectively (P=0.717, P=0.830). Although the frequency of diarrhea was higher for the $3^{rd}$ CS and non-$3^{rd}$ CS combination therapy subgroup with $9.25{\pm}5.30$ times/day than the other two subgroups ($7.58{\pm}2.97$ times/day in $3^{rd}$ CS single therapy subgroup, $6.75{\pm}4.40$ times/day in non-$3^{rd}$ CS combination therapy subgroup), there was no statistical significance (P=0.078). Conclusion : AAD seems common to the infants aged 3-6 months with febrile UTI, regardless of regimen and amount of antibiotics in usual dosage. Further research on the effects of probiotics used in the prevention and treatment of AAD in infants is warranted.

• Korean Journal of Clinical Pharmacy
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• v.8 no.1
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• pp.19-22
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• 1998

Cefixime is an orally absorbed 3rd generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacteria and is highly resistant to $\beta-lactamase$ degradation. This study was carried out to evaluate the bioavailability of a new test drug of cefixime (100 mg/capsule) relative to the reference drug. The bioavailability was conducted on 20 healthy volunteers who received a single dose (400 mg) of the test and the reference drugs in the fasting state, in a randomized balanced 2-way crossover design. After dosing, serial blood samples were collected for a period of 12 hours. Plasma was analyzed for cefixime by a sensitive and validated HPLC assay. The major pharmacokinetic parameters $(AUC_{0-12hr},\;C_{max},\;T_{max})$ were calculated from the plasma concentration-time data of each volunteer. The $AUC_{0-12hr},\;C_{max}\;and\;T_{max}$ of the test drug were $36.91\pm11.85\;{\mu}g{\cdot}hr/ml,\;5.47\pm1.61\;{\mu}g/ml,\;and\;4.00\pm0.65\;hr,$ respectively, and those of the reference drug were $34.08\pm8.81\;{\mu}g{\cdot}hr/ml,\;5.25\pm1.40\;{\mu}g/ml,\;and\;4.20\pm0.62\;hr$, respectively. Mean differences of those parameters were 8.32, 4.29, and $4.76\%$, respectively, and the least significant differences at $\alpha$=0.05 for $AUC_{0-12hr},\;C_{max},\;T_{max}$ were 16.02, 13.78, and $11.76\%$, respectively. In conclusion, the test drug was bioequivalent with the reference drug.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.1
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• pp.33-38
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• 2002

Purpose: The incidence of shigellosis had been decreased due to the use of antibiotics and the improvement of environmental sanitation but recently increases again. Shigellosis occurrs in mass outbreak through unsanitized meal preperation refered from welfare facility and school. We observed epidemic aspect and clinical coarse of childhood shigellosis. Methods: from December 2001 to January 2002, 22 inpatients with shigellosis in Dongbu Municipal Hospital were observed epidemiologically, clinically and microbiologically. Results: 1. The sexual ratio was 1:1 and mean age was $5.5{\pm}1.4$ years (14 months to 11 years). 2. The clinical manifestations were following: diarrhea (95.5%), high feve (10%) and asymptomatic (4.5%). The mean duration was $3.9{\pm}2.1$ days (1 to 12 days). All patients had no complication and normal serologic test. 3. S. sonnei was cultured in rectal swab, and was resistant to TMP/SMX and ampicillin, but susceptible to ampicillin/sulbactam and the 3rd generation cephalosporins. 4. The patients were treated by antibiotics with conservative treatment including electrolytes and fluid therapy for 5 days, resulting in improvement confirmed by negative reaction on stool culture. 5. These cases were all occurred in mass outbreak in day care center and were suspected to be secondary infection by members of family. Conclusion: This shigellosis occurred in day care center was secondary infection due to S. sonnei and had mild clinical coarse and improvement after antibiotic treatment.

• Childhood Kidney Diseases
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• v.10 no.1
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• pp.18-26
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• 2006

Purpose : Empirical antimicrobial treatment is indicated before bacteriological results are available for young children with febrile UTI to minimize renal scarring. To ensure appropriate therapy, knowledge of the prevalence of causative organisms and their susceptibility patterns to antimicrobials is mandatory. We performed a retrospective analysis investigating the local prevalence and resistance patterns of uropathogens, primarily E. coli, isolated from community-acquired UTIs. Methods : A total of 103 positive urine cultures from children with febrile UTI collected at Bundang CHA General Hospital from February 2004 to February 2005 were analyzed. Inclusion criteria were fever higher than $37.5^{\circ}C$, significant bacteriuria with single strain growth of at least 10s colony forming units/mL urine, and leukocyturia >5/HPF. Results : E. coli(89.3%) was the leading uropathogen followed by Enterococcus spp.(3.9%) Klebsiella spp.(2.9%), Citrobctcter spp.(1.9%) and Enterobacter spp.(1.9%). E. coli strains revealed a low proportion of antimicrobial susceptibility to ampicillin(AMP; 27.2%) ampicillinsulbactam(AMS; 34.8%) and trimethoprim-sulfamethoxazole(SXT; 65.2%). Susceptibility patterns to cephalosporins were as follows; cefazolin(1st generation; 91.3%), cefoxitin(2nd; 100%), ceftriaxone(3rd; 97.8%) and cefepime(4th; 97.8%). Three E. coli isolates produced ex tended - spectrum beta-lactamase(ESBL). Conclusion : Empirical treatment with AMP, AMS and SXT, which are commonly used in pediatric clinics, is not recommended for childhood UTI due to high incidence of resistance. The high level of susceptibility to cephalosporins makes these drugs reasonable alternatives. However the emergence of ESBL-producers, even though they are quite few, may have an impact on cephalosporin treatment in the future. (J Korean Soc Pediatr Nephrol 2006;10:18-26)