• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.181-190
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• 2001

Purpose : Lymphadenitis is the most common complication of BCG vaccination and has various clinical course and prognosis, but there are no accurate guidelines for management of BCG lymphadenitis. We performed this study to reveal the clinical course of BCG lymphadenitis and provide guidelines for its management. Methods : From January, 1997, to May, 2000, 73 patients in the 3~24 months were enrolled. We investigated retrospectively the size, site, and number of lymphadenitis, tuberculin skin test induration, used BCG strains, vaccination age, injection site, treatment and clinical course. The effects of various variables on clinical course were evaluated. Results : 1) There were no statistically significant difference between lymphadenitis size and tuberculin test induration diameter, spontaneous resolution rate, and suppuration rate. 2) Later vaccination(${\geq}1$ mo) and supraclavicular lymphadenitis increased suppuration rate. Using domestic BCG product increased surgical treatment rate. 3) According to treatment(observation vs antituberculous medication), medication did not affect the prevention of suppuration and ironically increased the rate of suppuration and surgical treatment. 4) Suppurative lymphadenitis required more surgical treatment than non-supurative one. Conclusions : Clinical course of BCG lymphadenitis is affected by vaccination age, used BCG strains, site of lymphadenitis, antituberculous medication and suppuration, but not affected by size and number of lymphadenitis. For management of BCG lymphadenitis, systemic antituberculous medicaion is not recommended and regular follow up with observation should be the mainstay. But for suppuration, active surgical en bloc resection should be the treatment of choice.

• Pediatric Infection and Vaccine
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• v.26 no.3
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• pp.148-160
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• 2019

Purpose: This study aimed to investigate the molecular epidemiology of a methicillin-resistant Staphylococcus aureus (MRSA) outbreak at a newborn nursery and neonatal intensive care unit (NICU). Methods: During the outbreak, from August to September 2017, MRSA isolates collected from neonates and medical staff underwent genotyping and screened for virulence factors. Antibiotic susceptibilities were tested. Results: During the study period, 41 neonates were admitted at the nursery (n=27) and NICU (n=14). Of these, 7 had MRSA infections (skin infection [n=6] and sepsis [n=1]) and 4 were colonized with MRSA. Associated medical staff (n=32) were screened; three were nasal MRSA carriers. Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375 was found to be the skin infection outbreak causing strain, with multi-drug resistance including low-level mupirocin resistance. SCCmec type IVa, ST 72, and a novel spa type designated t17879, was the cause of MRSA sepsis. Many different types of MRSA were colonized on the neonates; however, SCCmec type IVa, ST 72, spa type t664 was colonized in both neonates and a NICU nurse. All MRSA isolates from colonized infants were positive for the Panton-Valentine leukocidin (PVL) toxin gene. Conclusions: The strain causing an outbreak of skin infections had multi-drug resistance. Also, MRSA colonized in the neonates were found to carry the PVL toxin gene. Because different strains are present during an outbreak, molecular epidemiologic studies are important to identify the outbreak strain and colonized strains which aid in effective control and prevention of future MRSA outbreaks.

• Pediatric Infection and Vaccine
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• v.8 no.2
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• pp.199-205
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• 2001

Purpose : Since the first report of vancomycin-resistant enterococci(VRE) in 1986, the resistance to vancomycin in enterococci has been increasingly rapidly. In this study, we investigated the clinical manifestations of pediatric patients with VRE and the pattern of the antibiotic use with increasing the rate of VRE in pediatrics Methods : We studied retrospectively 36 pediatric patients who were isolated VRE from January 1998 to December 2000. We classified patients into ICU and non ICU groups and reviewed species of VRE, specimens in which VRE were first detected and procedures performed before VRE detected. Results : We have found that the number of pediatric patients isolated VRE is increasingly annually in this study. In addition, the number of VRE-isolation in the ICU group and in patients who were operated or who underwent active procedures is much higher than that of in the non ICU group and in patients who were taken medication only. Enterococcus faecium is the main species of VRE. VRE showed high resistance to almost all antibiotics except tetracycline, and resistance was closely related to the duration of hospitalization and history of the antibiotic use. The proportion of the cephalosporin use was higher than any other antibiotic before VRE detection. In contrast, that of teicoplanin was higher than any other antibiotic after VRE detection(P<0.05). The cases of superinfection is higher in the ICU group than in non ICU group. Conclusion : In the hospital level, prevention of nosocomial infection through proper administrative policies, through surveillance of high risk VRE regions and prudent antibiotic use can prevent VRE outbreaks and corresponding side effects.

• Journal of Korean Public Health Nursing
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• v.15 no.2
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• pp.239-248
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• 2001

The purpose of this study was to analyze risk factors for nosocomial pneumonia in patients admitted to NS ICU, and to provide a basic data to decrease respiratory nosocomial infection rate engendered from medical environments in NS ICU. The study site was the NS ICU at a university hospital located in Seoul, Korea. The subjects were 31 patients diagnosed with nosocomial pneumonia, who were selected from the initial list of 300 potential subjects who had been a) admitted between September 1999 and January 2000, and September 2000 and January 2001, b) resided at the NS ICU over 72 hours. The diagnostic standard of nosocomial pneumonia was based on the nosocomial infection guides of C university hospital. The data were analyzed using frequencies and logistic regression analysis. The sputums obtained from the subjects were cultivated and causal viruses were separated. The results were as follows: 1. The nosocomial pneumonia rate was $10.3\%$. There were 7 types of causal viruses separated from the sputum. and the most prevalent type of virus was MRSA as $62.2\%$. 2. The factors significantly influencing the incidence of nosocomial pneumonia included age, the residential duration at the NS ICU, GCS scores, diabetes mellitus, insertion of tracheal tube and its duration, tracheostomy and its length of insertion, the use of artificial ventilator and the length of its use, and the insertion of naso-gastic tube. The most significant risk factor among these was the insertion of tracheal tube (odds ratio=18.684. $95\%$ CI=6.849-50.974), followed by the use of tracheostomy (odds ratio=15.419, $95\%$ CI=6.615-35.942), the insertion of naso-gastric tube (odds ratio=14.875, $95\%$ CI=6.396-34.595), and the use of artificial ventilator (odds ratio=13.000. $95\%$ CI=5.633­30.001). 3. Regarding the use of the mechanical aids, the insertion of tracheal tube resulted in 12.968 times increase of the nosocomial pneumonia rate, and the use of artificial ventilator lead 6.714 times increase of the nosocomial pneumonia rate. One point increase of the GCS score resulted in the 1.210 times increase of the nosocomial pneumonia rate. For patients who had tracheal tube, tracheostomy, and artificial ventilator, one day increase of their residential duration at NS ICU lead 1.073 times increase of the nosocomial pneumonia rate. 4. In terms of duration of the mechanical aid usage, one day increase in the use of artificial ventilator engendered 1.080 times increase in the nosocomial pneumonia rate. One day increase of the residential duration at the NS ICU lead 1.604 times increase in the nosocomial pneumonia rate. As one point of the GCS score increased, 0.876 times decrease of the nosocomial pneumonia rate was reported. These study findings show that the risk factors significantly influencing the incidence of nosocomial pneumonia include the use of tracheal tube, tracheostomy, naso-gastic tube, and artificial ventilator. It is recommended that nurses working at NS ICU should pay more attention to the patients with these factors as the risky group for the nosocomial pneumonia, and thus make more active efforts to provide nosocomial pneumonia prevention strategies for them. In further studies patients admitted to the different types of ICUs such as internal medicine or surgery unit ICU will be also included, and more wide investigation of nosocomial pneumonia risk factors will be conducted through one-year longitudinal follow up.

• Pediatric Infection and Vaccine
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• v.5 no.1
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• pp.69-78
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• 1998

Purpose : The risk of severe tuberculous disease such as meningitis or miliary tuberculosis increases as younger is the child at the time of infection. Therefore, the early diagnosis and prompt treatment is mandatory for infants with tuberculosis. This study was undertaken to describe the epidemiology, clinical and radiographic manifestations, and response to therapy in infants with tuberculous disease. Methods : Medical records of 29 infants with tuberculosis diagnosed at the Seoul National University Children's Hospital from July, 1985, to April, 1997, were reviewed, retrospectively. A case of tuberculosis was confirmed if M. tuberculosis was isolated from any body site or if there was histologic proof of tuberculosis. Otherwise, the diagnoses were individualized considering history of contact with contagious adult case, clinical manifestations, chest X-ray findings, result of a Mantoux test reaction with 5 tuberculin unit of PPD, and the response to therapy. Results : The mean age at diagnosis was $7.00{\pm}2.65$ months (range, 3 to 12 months). Twelve cases had isolated pulmonary diseases, and the rest had pulmonary disease and meningitis, 5 cases; pulmonary disease and cervical lymphadenitis, 3; isolated meningitis, 3; and miliary tuberculosis, 6. Source case was identified in 19 cases, 7 of which were detected with retrograde manner. Twenty seven of 29 were symptomatic at their initial visit. The presenting symptoms were mainly respiratory or neurologic, and respiratory difficulty was accompanied in 7 cases. Physical examination revealed wheezing in 7 cases and decreased breath sounds in 9. Hepatomegaly or hepatosplenomegaly were frequent. Chest radiographs showed lung parenchymal disease with hilar lymphadenopathy in 18 cases, and focal or generalized emphysematous change in 7 cases. Conclusion : Most of the infants with tuberculosis are symptomatic at diagnosis, and many of infants with intrathoracic tuberculosis presented with symptoms of bronchial obstruction. When tuberculosis is suspected in an infant, the adult source case should be vigorously investigated to aid in diagnosis and for the prevention of further transmission of tuberculous disease. Almost half of infant tuberculosis are preventable if prophylaxis were given when adult cases were diagnosed.

• Korean Journal of Microbiology
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• v.48 no.2
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• pp.93-101
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• 2012

We analyzed mupirocin resistance rates among staphylococcal isolates collected from a Korean hospital in 2003 (100 isolates), 2005 (195 isolates), 2006 (151 isolates), and 2009 (112 isolates). In Staphylococcus aureus, rates of high-level mupirocin resistance (MIC, minimal inhibitory concentration ${\geq}512{\mu}g/ml$) decreased and did not appear since 2005. In contrast, low-level mupirocin resistance (MIC $8-256{\mu}g/ml$) was not detected in 2003 and 2005 but its rates later increased to 6.9% in 2009. Total resistance rates of coagulase-negative staphylococci (CNS) were significantly higher than those of S. aureus. The rates of high-level resistance of CNS increased from 16.0% in 2003 to 31.5% in 2009. The rate of low-level resistance of CNS was 8.0% in 2003 and around 11% later. In all high-level resistant isolates, the ileS-2 gene was detected. All low-level resistant isolates contained the known V588F mutation in ileS gene. Previously unknown mutations such as V458G in S. aureus and D172A, Y490H and I750V in CNS were identified additionally. One S. aureus isolate with high-level resistance was resistant to oxacillin and several topical antibiotics commonly used for the treatment of skin infection. Ten S. aureus isolates with low-level resistance were also resistant to all of these antibiotics except fusidic acid. CNS isolates with high-level (61 isolates) and low-level resistance (27 isolates) exhibited significantly higher resistance rates to these antibiotics than mupirocin-susceptible CNS isolates (167 isolates). In conclusion, prevention of the emergence of mupirocin resistance is necessary for the effective treatment of skin infection by staphylococci.

• Journal of the Korean Society of Radiology
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• v.17 no.2
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• pp.257-265
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• 2023

The purpose of this study was to vaccinate every year according to the general characteristics of COVID-19, whether to vaccinate every year according to the vaccination experience, whether to vaccinate every year according to knowledge/attitude about vaccination, and negative responses to the vaccinate every year In order to understand the factors affecting the vaccination physician every year by identifying the factors of Statistical analysis is based on general characteristics, variables based on vaccination experience, and knowledge/attitudes related to vaccination. The doctor calculates the frequency and percentage, A square test (-test) was performed, and if the chi-square test was significant but the expected frequency was less than 5 for 25% or more, a ratio difference test was performed with Fisher's exact test. Through multiple logistic regression analysis using variables that were significant in simple analysis, a predictive model for future vaccination and the effect size of each independent variable were estimated. As statistical analysis software, SAS 9.4 (SAS Institute Inc., Cary, NC, USA) was used, and because the sample size was not large, the significance level was set at 10%, and when the p-value was less than 0.10, it was interpreted as statistically significant. In the simple logistic regression analysis, the reason why they answered that they would not be vaccinated every year was that they answered 'to prevent infection of family and hospital guests' rather than 'to prevent my infection' as the reason for the vaccination. It was 11.0 times higher and 3.67 times higher in the case of 'for the formation of collective immunity of the local community and the country'. The adverse reactions experienced after the 1st and 2nd vaccination were 8.42 times higher in those who did not experience pain at the injection site than those who did not, 4.00 times higher in those who experienced swelling or redness, and 5.69 times higher in those who experienced joint pain. There was a 5.57 times higher rate of absenteeism annually than those who did not. In addition, the more anxious they felt about vaccination, the more likely they were to not get the vaccine every year by 2.94 times.

• Journal of Ecology and Environment
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• v.48 no.1
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• pp.17-23
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• 2024

Background: Honey bees play a crucial role in pollination and ecological balance. Apis mellifera L. colonies, especially those located in specific geographic regions, such as the palm garden in Eastern Thailand, are susceptible to potential threats from microbial contaminants. Understanding and detecting microbial organisms in these beehives is essential for the preservation of bee health, honey production, and the broader ecosystem. However, the problem of microbial infection and antibiotic-resistant bacteria is more severe and continuously increasing, resulting in a health, economic, and social crisis. The purpose of this study is to determine the prevalence of microorganisms in A. mellifera beehives in palm gardens in Rayong province, Eastern Thailand. Results: Ten swabs in transport media were swabbed and obtained from different parts of each beehive (1 swab per beehive), for a total of 10 hives. Traditional microbial culture-based methods, biochemical tests, and antimicrobial susceptibility (disc-diffusion) tests were used to detect microbial organisms and antibiotic resistance in bacteria. The swab tests from nine beehives resulted in the detection of Gram-positive bacteria (63.64%), Gram-negative bacteria (27.27%), and fungi/yeast (9.09%). These microorganisms are classified as a group of coagulase-negative Staphylococcus spp. and made up 40.91% of the bacteria discovered. Other bacteria found were Coryneform bacteria (13.64%), Pantoea spp. (13.64%), Bacillus spp. (9.09%), yeast (9.09%), glucose non-fermentative Gram-negative bacilli (9.09%), and Pseudomonas spp. (4.55%). However, due to the traditional culture-based and 0biochemical tests usually used to identify the microbial organisms in clinical specimens and the limitation of identifying some environmental microbial species, the results of the antimicrobial susceptibility test cannot reveal if the organism is resistant or susceptible to the drug. Nevertheless, drug-sensitive inhibition zones were formed with each antibiotic agent. Conclusions: Overall, the study supports prevention, healthcare, and public health systems. The contamination of microorganisms in the beehives may affect the quality of honey and other bee products or even the health of the beekeeper. To avoid this kind of contamination, it is therefore necessary to wear personal protective equipment while harvesting honey and other bee products.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.6
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• pp.306-316
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• 2015

Objectives: The facial bones are the most noticeable area in the human body, and facial injuries can cause significant functional, aesthetic, and psychological complications. Continuous study of the patterns of facial bone fractures and changes in trends is helpful in the prevention and treatment of maxillofacial fractures. The purpose of the current clinico-statistical study is to investigate the pattern of facial fractures over a 4-year period. Materials and Methods: A retrospective analysis of 1,824 fracture sites was carried out in 1,284 patients admitted to SMG-SNU Boramae Medical Center for facial bone fracture from January 2010 to December 2013. We evaluated the distributions of age/gender/season, fracture site, cause of injury, duration from injury to treatment, hospitalization period, and postoperative complications. Results: The ratio of men to women was 3.2:1. Most fractures occurred in individuals aged between teens to 40s and were most prevalent at the middle and end of the month. Fractures occurred in the nasal bone (65.0%), orbital wall (29.2%), maxillary wall (15.3%), zygomatic arch (13.2%), zygomaticomaxillary complex (9.8%), mandibular symphysis (6.5%), mandibular angle (5.9%), mandibular condyle (4.9%), and mandibular body (1.9%). The most common etiologies were fall (32.5%) and assault (26.0%). The average duration of injury to treatment was 6 days, and the average hospitalization period was 5 days. Eighteen postoperative complications were observed in 17 patients, mainly infection and malocclusion in the mandible. Conclusion: This study reflects the tendency for trauma in the Seoul metropolitan region because it analyzes all facial fracture patients who visited our hospital regardless of the specific department. Distinctively, in this study, midfacial fractures had a much higher incidence than mandible fractures.

• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.167-177
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• 2023

Background: Pressure injuries are localized areas of damage to the skin and/or underlying tissue, usually over a bony prominence due to pressure. Cerebrovascular disease increases the risk of pressure injuries due to the immobility caused by physical paralysis. The general approach to managing a patient with pressure injuries should include pain relief, the treatment of the infection, optimizing nutritional intake, proper positioning, and contamination prevention. Nonetheless, the duration of treatment for pressure injuries varies from person to person. Case report: An 80-year-old female intracerebral hemorrhage patient developed a pressure injury. To improve the injury faster, a Radix Astragali pharmacoacupuncture solution was applied to the pressure sore. The pressure injury's width, length, and depth was assessed using a ruler, and the exudate amount and tissue types were assessed. The treatment was performed for 35 days. The rate at which the size of the pressure sore lessened increased since the Radix Astragali pharmacoacupuncture solution was applied to the pressure sore. In addition, the tissue type of the pressure injury improved, and the exudates decreased. There was no significant difference in the Pressure Ulcer Scale for Healing Tool 3.0, since the Radix Astragali pharmacoacupuncture solution was applied to the pressure injury. Conclusion: This clinical case study suggests that the Radix Astragali pharmacoacupuncture solution might be effective in speeding up the healing of pressure injuries.