• Pediatric Infection and Vaccine
• /
• v.28 no.2
• /
• pp.82-91
• /
• 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
• /
• v.11 no.1
• /
• pp.81-89
• /
• 2004

Purpose : Retropharyngeal and parapharyngeal abscesses are often distinguishable from other head and neck abscesses on clinical grounds, but these infections can combine and the presentations are similar to one another. Because of the advances of antibiotic therapy, the frequency of the diseases decreased considerably, but recently the incidence of neck abscesses has increased. We sought to describe the clinical presentation of patients with deep neck abscess, and implications on management. Methods : For 10 year periods, 94 cases of charts were reviewed retrospectively, who were diagnosed as neck abscesses aged below 16 years old(between January 1993 to August 2003) in 4 hospitals. Deep neck abscesses were diagnosed by surgical pus drainage, neck CT (homogenous, hypodense area with ring enhancement) and neck sono findings. Results : The annual incidence of deep neck abscess has been increased since 2000. The median age of the patients was 4 years(range, 26 days~15 years); 63% of the patients were younger than 5 years. Abscesses in the submandibular space(34%) were most common, followed by peritonsillar space(29.7%), retropharyngeal space(11.7%), combined(10.8%), parotid space(7.4%) and parapharyngeal space(6.4%). Fever(73.4%), sore throat(37.2%), decreased oral intake(34%) and neck pain(27.7%) were the most common symptoms. In 6 children(6.4%), there was refusal to move neck, in 6(6.4%) headache, and in 4(4.3%) torticollis. Respiratory distress was observed in only 1 patient(2.1%) and stridor in 1 other(2.1%). The most common physical examinations were neck swelling/mass(67%), pharyngitis(46.8%), tonsillitis(36.2 %), and cervical lymphadenopathy(28.7%). Neck stiffness was observed in 4 patients(4.3%). Total 35 organisms were isolated in 33 patients. The most common organisms cultured by patients' blood or pus were S. aureus(34%) and S. pyogenes(28.6%). Most organisms were gram positive, and had sensitivities in vancomycin(96.4%), cefotaxime(88.9%), cephalothin (86.4%), trimethoprime-sulfamethoxazole(83.3%), and clindamycin(77.8%). 77 patients(81.9%) underwent surgery plus antibiotics; 17 patients(18.1%) were treated with antibiotics only. There is no significant differences between two groups. In duration of admission, fever after admission, and antibiotic treatment. Conclusion : The incidence of deep neck abscess has increased recently and the major symptoms have been changed. The incidence of respiratory distress or stridor is decreasing, while the incidence of abnormal head and neck symptoms and signs like headache, neck stiffness, refusal to move neck, or torticollis are increasing. Gram positive organisms are predominant, S. aureus is the most common followed by S. pyogenes. 1st generation cephalosporin has high sensitivity on gram positive organisms. Treatment with surgery plus antibiotics dose not significantly decrease total duration of antibiotic treatment or admission compared to treatment with antibiotics alone.

• Pediatric Infection and Vaccine
• /
• v.12 no.2
• /
• pp.157-165
• /
• 2005

Purpose : Children occupy a large proportion of burn victims. So we want to aid to pediatric burn care through the understanding of the bacterial distribution in burn wounds and antibiotic susceptibility against isolated microorganisms from burn wounds. Methods : We analysed the medical records of 213 pediatric burn patients(0~15 years), 406 samples that grew bacteria in burn wound sites. Results : Of the total 213 patients, male were 59.6% and female were 40.4%. Scalding burn was the most common(78.4%), flame burn was the second(16.4%). Pathogens were isolated in 406 samples. The most common was Pseudomonas aeruginosa(58.1%). Next were Enterococcus species, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, Acinetobacter species. P. aeruginosa was resistant to trimethoprim-sulfamethoxazole in 100%, cephalothin in 98.1%, ampicillin-sulbactam in 96.2%, ampicillin in 95.3%, ceftriaxone in 95.2%, tobramycin in 93.7%, cefoperazone in 68.9%, ceftazidime in 67.7%. Enterococcus species were resistant to tetracycline in 63.9%, streptomycin in 45.5%, gentamicin in 36.1%, penicillin G in 13.7%. S. aureus was resistant to gentamicin in 89.7%, tetracycline in 86.2%, ciprofloxacin in 86.2%, penicillin G in 84.3%, oxacillin in 78.4%, erythromycin in 76.5%. Acinetobacter species were resistant to ampicillin-sulbactam in 100%, gentamicin in 85.7%, ampicillin in 83.3%, piperacillin in 61.5%. Conclusion : P. aeruginosa was highly resistant to drugs like cefoperazone in 68.9%, ceftazidime 67.7%. S. aureus was highly resistant to penicillin G in 84.3%, oxacillin in 25.9 %, but none to vancomycin in 0%, teicoplanin in 2.2%. According to the study, Acinetobacter species turned out to be multi-resistant strains, so careful attention must be paid to the choice of antibiotics.

• The Korean Journal of Pharmacology
• /
• v.28 no.1
• /
• pp.81-89
• /
• 1992

Enuresis is a common voiding disorder among children. There are several therapeutic regimens for the disorder available today; behavioral therapies, psychotherapy, bladder training, sleep interruption, hypnosis and drug therapy. Recently, the efficacy of drug therapy has been acknowledged, particularly of antidepressants. Among the tricyclic antidepressants, imipramine is most frequently employed for the treatment of enuresis. Present study was undertaken to investigate the mechanism of imipramine on the contractility of urinary bladder in relation to the calcium modulation using isolated strips of rat detrusor urinae. 1. The electric fileld stimulation-induced contraction was abolished by imipramine, but partially inhibited by atropine. 2. Imipramine reduced the basal tone and diminished the phasic activity of detrusor muscle concentration-dependently, which was similar to that of diltiazem, a calcium channel blocker. 3. Imipramine suppressed the maximal responses and shifted the concentration-response curves of bethanechol and ATP to right. 4. Imipramine inhibited the calcium-induced recovery of tension in calcium-free physiologic salt solution (PSS) with a mode of action similar to that of diltizaem. 5. A23187, a calcium ionophore recovered the basal tone which had been reduced by imipramine in normal PSS. 6. In calcium-free PSS, A23187 could recover the abolished basal tone with the pretreatment of imipramine, but it exerted a partial recovery with the pretreatment of TMB-8, an inhibitor of intracellular calcium release. Based on these results, it is suggested that the inhibitory action of imipramine on the detrusor muscle exerted in part by blockade of the muscarinic and purinergic receptors, and interference with the influx of extracellular calcium, but not with the release of intracellular stored calcium, is involved in its mechanism of action.

• Pediatric Infection and Vaccine
• /
• v.15 no.2
• /
• pp.121-128
• /
• 2008

Purpose : The seasonality of influenza virus and rotavirus are well recognized in winter and so viral surveillance and laboratory-based diagnostics are important to guide the timing of prophylaxis and other interventions. Yet the seasonality of these two viruses are changing in Korea. We evaluated the prevalence and clinical features of influenza virus and rotavirus. Methods : From September 2001 to August 2005, nasopharyngeal aspirates were cultured from the hospitalized patients with lower respiratory infections and the stools from hospitalized patients with gastroenteritis were tested for rotavirus. We retrospectively analysed the medical records. Results : During the study period, respiratory virus was isolated in 578 (18.5%) out of 3,121 patients. Influenza virus was isolated in 143 cases. The seasonal distribution of influenza infection was from December to June of the next year. The ratio of males to females was 1.3:1 and the median age was 17 months. The most common diagnosis of influenza infection was bronchiolitis. Fever and cough were present in 94.4% and 83.9% of the patients, respectively. During the same period, 3,850 patients were admitted for gastroenteritis and 1,047 (27%) patients were positive for rotavirus. Rotavirus was prevailed from December to June of the next year and it presented in year-round. The ratio of males to females was 1.1:1 and the median age was 16 months. Diarrhea and vomiting were the most common symptoms. Conclusion : The recent peak prevalence of influenza virus and rotavirus in Korea was in winter and the late spring, respectively. So we need to expand surveillance and carefully consider the correct period to vaccinate people.

• Pediatric Infection and Vaccine
• /
• v.5 no.1
• /
• pp.104-114
• /
• 1998

Purpose : Enteroviruses are the most common cause of aseptic meningitis. The epidemics of aseptic meningitis in 1993 and 1996 were mostly caused by echovirus type 9. Identification of the causative virus of aseptic meningitis in epidemics, is very important not only for diagnosis but also for epidemiologic purpose. The purpose of this study was to identify the causative virus and investigate the relationship between aseptic meningitis, prevailed in Masan and surrounding areas in Kyoungsangnamdo in 1997, and its clinical manifestations. Methods : One hundred twenty eight cerebrospinal fluid(CSF) and 239 stool specimens were obtained from 239 patients(213 children and 26 adult patients) with aseptic meningitis were admitted to Masan Fatima Hospitals from March to October 1997. Viral isolation and serotype identification was performed by cell culture and immunofluorescent test. Enteroviruses not typed by immunofluorescent test was confirmed by reverse transcription-polymerase chain reaction(RT-PCR). Results : 1) The peak incidence was noted in June. 2) The age of 239 patients(pediatrics-213 cases, internal medicine-26 cases) that were diagnosed ranged from neonate to 35 years, the age of the patients of pediatrics ranged from neonate to 15years(mean 4.9 years), the age of the patients of internal medicine (above 16 years) ranged from 16 years to 35 years(mean 24.2 years). 3) Fifty-three(41.4%) of 128 CSF specimens were positive for enteroviruses, and 163(68.2%) of 239 stool specimens were positive for enteroviruses respectively. 4) Serotypes of 53 enteroviruses isolated from CSF were 16(30.2%) of echovirus type 30, 6(11.3%) of echovirus type 6, 1 of echovirus type 4, 4 of untyped echovirus, 1 of coxsackievirus type B5, and 24 isolates of untyped enteroviruses. Of 163 enterovirus isolated from stool were 72(44.2%) of echovirus type 30, 21(12.9%) of echovirus type 6, 1 of echovirus type 4, 17(10.4%) of undetermined subtyped echovirus, 1 of coxsackievirus type B5, 2 of A24, 3 of undetermined subtyped coxsackievirus type B, and 46 isolates of untyped enterovirus. Conclusion : There were epidemics of aseptic meningitis in the central areas of Kyoungsangnamdo from March to October 1997. The main causative organism was thought to be the echovirus type 30, and echovirus type 4, 6, coxsackievirus B5 and A24 were also thought to contribute to the epidemics.

• Childhood Kidney Diseases
• /
• v.8 no.2
• /
• pp.214-222
• /
• 2004

Purpose: Appropriate antibiotic therapy is important in childhood urinary tract infection and the selection of anibiotics is based on antimicrobial sensitivity of Escherichia coli. Extended-Spectrum ${\beta}-Lactamase(ESBL)$ is an enzyme produced by gram-negative bacilli that has the ability to hydrolyse penicillins, broad-spectrum cephalosporin and monobactam. There have been many reports of outbreaks of hospital infection by ESBL-producing organism. However, community-acquired infection with ESBL-producing organism are rare. This study was performed to retrospectively identify the incidence, characteristics and risk factors of ESBL (+) E. coli in community-acquired childhood UTI. Methods: In 288 children admitted in Ewha Womans University Hospital with E. coli UTI from Mar 2001 to February 2003, ESBL was isolated. ESBL was confirmed by the utilization of an automatized machine(Vitek GNS 433 card) using liquid medium dilution method according to National Committee for Clinical Laboratory Standard. The clinical characteristics, risk factors, antimicrobial resistance and treatment effectiveness were compared with ESBL(-) E. coli UTI. Results: Of 288 E. coli isolates, 31(10.8%) produced ESBL and 93.5%(29/31) occurred in infants younger than 6 month of age(P<0.01). No significant differences were noted in prior antibiotic use, prior admission history and underlying urogenital anomaly. Antimicrobial resistance was significantly higher in ESBL(+) E. coli compared with control patients (P<0.05). Although ceftriaxone showed 100% resistance in ESBL(+) E. coli, bacteriologic sterilization rate after ceftriaxone therapy was higher(96.8%). However, the recurrence rate of febrile UTI within 6 months was higher(25.8%) than control patients(6.6%). Conclusion: Epidemiologic study is required to find out any new risk factors of community-acquired ESBL(+) E. coli UTI and changes in selection of empirical antibiotics should be considered.

• Journal of Chest Surgery
• /
• v.42 no.2
• /
• pp.175-183
• /
• 2009

Background: Mitral valve abnormalities in the pediatric population are rare. Mitral valve replacement or pediatric mitral lesions can cause problems such as a lack of growth potential. There re only limited experiences with mitral valve repair at any institution, so the purpose of his study is to evaluate the outcomes of mitral valve repair n pediatric patients. Material and Method: Sixty-four consecutive children (28 males and 36 females) with a mean age of $5.5{\pm}4.7$ years underwent mitral valve repair for treating their congenital mitral valve disease between January 1996 and December 2005. The patients were divided into two groups: group 1 (34 patients (53.1%)) had isolated disease (mitral anomaly with or without trial septal defect or patent ductus arteriosus) and group 2 (30 patients (46.9%)) had complex disease (mitral anomaly with concurrent intracardiac disease, except atrioventricular septal defect). Result: The overall in-hospital mortality was 6.3%; group 1 had 5.9% mortality and group 2 had 10.0% mortality. The postoperative morbidity was 18.8%; group 1 and 2 had 14.7% and 23.3% postoperative morbidity, respectively, and there as no significant difference among the groups. The median follow-up was 4.6 years range: $0.5{\sim}12.2$ years). The 10-year survival rate was 95.3%. The 10-year freedom from re-operation rate was 76.1% with 10 re-operations. The majority of the functional classifications were annular dilatation and leaflet prolapse. A mean of $2.1{\pm}1.1$ procedures per patient were performed. The echocardiography that was done at the immediate postoperative period showed a significant improvement in the mitral valve function. The follow-up echocardiographic results were significantly improved. However, mitral stenosis newly developed over time, and there ere significant differences according to the repair strategies. Conclusion: The patients who underwent mitral valve repair for congenital mitral anomalies showed good results. The follow-up echocardiography revealed satisfactory short-term and long-term results. Close follow-up is necessary to detect the development of postoperative mitral stenosis or regurgitation.

• Clinical and Experimental Pediatrics
• /
• v.50 no.5
• /
• pp.476-483
• /
• 2007

Purpose : The objective of this study was to assess ventricular function by tissue Doppler imaging (TDI) in children with congenital heart disease (CHD) who have been undergoing open heart surgery (OHS) using cardiopulmonary bypass. We tried to compare the parameters of tissue Doppler imaging before and after OHS in patients with congenital heart disease. Methods : This study was conducted on 32 patients with CHD after OHS from January 2005 to December 2005 at Kyungpook National University hospital. Patients who underwent 2-D echocardiography before and after their OHS. All patients were divided into three groups, left ventricular volume overloading group (group 1), and right ventricular volume overloading group (group 2), and right ventricular pressure overloading group (group 3). The TDIs were examined before and 1 to 3 months after OHS. Peak early diastolic (E), and peak late diastolic (A) velocity of transmitral flow were measured by pulsed wave Doppler examination. Peak systolic (Sm), peak early diastolic (Em), and peak late diastolic (Am) velocity in apical 4-chamber and 2-chamber views were measured by TDI. The author calculated E/Em ratio. Results : The patients were 14 boys and 18 girls and the average age of patients was 2 years and 3 months. The congenital heart diseases which have to get OHS were ventricular septal defect (13 cases), atrial septal defect (7), atrioventricular septal defect (3), isolated pulmonary stenosis (2) and tetralogy of Fallot (7). There were significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view (P<0.05). Conclusion : This study showed significant decrease of Sm, Em, Am measured on tricuspid annulus and E/Em measured on mitral annulus in apical 4 chamber view after OHS. These changes might be due to the effects of cardiopulmonary bypass in OHS and/or hemodynamic changes after correction of congenital heart disease. To clarify these changes, further study on more patients is needed.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.17 no.3
• /
• pp.605-610
• /
• 2003

According to the Leukemia and Lymphoma Society, leukemia is a malignant disease (cancer) that originates in a cell in the marrow. It is characterized by the uncontrolled growth of developing marrow cells. There are two major classifications of leukemia: myelogenous or lymphocytic, which can each be acute or chronic. The terms myelogenous or lymphocytic denote the cell type involved. Thus, four major types of leukemia are: acute or chronic myelogenous leukemia and acute or chronic lymphocytic leukemia. Leukemia, lymphoma and myeloma are considered to be related cancers because they involve the uncontrolled growth of cells with similar functions and origins. The diseases result from an acquired (not inherited) genetic injury to the DNA of a single cell, which becomes abnormal (malignant) and multiplies continuously. In the United States, about 2,000 children and 27,000 adults are diagnosed each year with leukemia. Treatment for cancer may include one or more of the following: chemotherapy, radiation therapy, biological therapy, surgery and bone marrow transplantation. The most effective treatment for leukemia is chemotherapy, which may involve one or a combination of anticancer drugs that destroy cancer cells. Specific types of leukemia are sometimes treated with radiation therapy or biological therapy. Common side effects of most chemotherapy drugs include hair loss, nausea and vomiting, decreased blood counts and infections. Each type of leukemia is sensitive to different combinations of chemotherapy. Medications and length of treatment vary from person to person. Treatment time is usually from one to two years. During this time, your care is managed on an outpatient basis at M. D. Anderson Cancer Center or through your local doctor. Once your protocol is determined, you will receive more specific information about the drug(s) that Will be used to treat your leukemia. There are many factors that will determine the course of treatment, including age, general health, the specific type of leukemia, and also whether there has been previous treatment. there is considerable interest among basic and clinical researchers in novel drugs with activity against leukemia. the vast history of experience of traditional oriental medicine with medicinal plants may facilitate the identification of novel anti leukemic compounds. In the present investigation, we studied 31 kinds of anti leukemic medicinal plants, which its pharmacological action was already reported through many experimental articles and oriental medical book: 『pharmacological action and application of anticancer traditional chinese medicine』 In summary: Used leukemia cellline are HL60, HL-60, Jurkat, Molt-4 of human, and P388, L-1210, L615, L-210, EL-4 of mouse. 31 kinds of anti leukemic medicinal plants are Panax ginseng C.A Mey; Polygonum cuspidatum Sieb. et Zucc; Daphne genkwa Sieb. et Zucc; Aloe ferox Mill; Phorboc diester; Tripterygium wilfordii Hook .f.; Lycoris radiata (L Her)Herb; Atractylodes macrocephala Koidz; Lilium brownii F.E. Brown Var; Paeonia suffruticosa Andr.; Angelica sinensis (Oliv.) Diels; Asparagus cochinensis (Lour. )Merr; Isatis tinctoria L.; Leonurus heterophyllus Sweet; Phytolacca acinosa Roxb.; Trichosanthes kirilowii Maxim; Dioscorea opposita Thumb; Schisandra chinensis (Rurcz. )Baill.; Auium Sativum L; Isatis tinctoria, L; Ligustisum Chvanxiong Hort; Glycyrrhiza uralensis Fisch; Euphorbia Kansui Liou; Polygala tenuifolia Willd; Evodia rutaecarpa (Juss.) Benth; Chelidonium majus L; Rumax madaeo Mak; Sophora Subprostmousea Chunet T.ehen; Strychnos mux-vomical; Acanthopanax senticosus (Rupr.et Maxim.)Harms; Rubia cordifolia L. Anti leukemic compounds, which were isolated from medicinal plants are ginsenoside Ro, ginsenoside Rh2, Emodin, Yuanhuacine, Aleemodin, phorbocdiester, Triptolide, Homolycorine, Atractylol, Colchicnamile, Paeonol, Aspargus polysaccharide A.B.C.D, Indirubin, Leonunrine, Acinosohic acid, Trichosanthin, Ge 132, Schizandrin, allicin, Indirubin, cmdiumlactone chuanxiongol, 18A glycyrrhetic acid, Kansuiphorin A 13 oxyingenol Kansuiphorin B. These investigation suggest that it may be very useful for developing more effective anti leukemic new dregs from medicinal plants.