• Journal of Korean Biological Nursing Science
• /
• v.8 no.1
• /
• pp.5-14
• /
• 2006

Staphyloccus aureus is one of the most important pathogens in clinical settings. It is also one of the leading causes of nosocomial infections and the dissemination of multiple drug-resistant strains, mainly methicillin resistant Staphyloccus aureus, and the recent emergence of a vancomycin resistant MRSA is the concern to hospital worldwide. MRSA strains have acquired multiple resistance to a wide range of antibiotics, including aminoglycosides and macrolides. $\beta$-Lactam resistance of methicillin-resistnat Staphyococcus aureus is determined by the function of penicillin binding protein 2'(PBP2') encoded by the methicillin resistance gene mec A. MRSA strains carry methicillin resistance gene mecA, encoded by a mobile genetic element designated staphylococoal cassette chromosome mec(SCCmec). MRSA clones are defined by the type of SCCmec element and the genotype of the methicilline-susceptible Staphyococcus aureus chromosome in which the SCCmec element is integrated.

• Biomolecules & Therapeutics
• /
• v.25 no.6
• /
• pp.569-577
• /
• 2017

Sepsis is a syndrome characterized by systemic inflammatory responses to a severe infection. Acute hyper-inflammatory reactions in the acute phase of sepsis have been considered as a primary reason for organ dysfunction and mortality, and advances in emergency intervention and improved intensive care management have reduced mortalities in the early phase. However it has been recognized that increased deaths in the late phase still maintain sepsis mortality high worldwide. Patients recovered from early severe illness are unable to control immune system with sepsis-induced immunosuppression such as immunological tolerance, exhaustion and apoptosis, which make them vulnerable to nosocomial and opportunistic infections ultimately leading to threat to life. Based on strategies to reverse immunosuppression, recent developments in sepsis therapy are focused on molecules having immune enhancing activities. These efforts are focused on defining and revising the immunocompromised status associated with long-term mortality.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.740-745
• /
• 1985

A retrospective double blind study comparing 7 day with 2 day regimen of antibiotic prophylaxis was conducted among 200 patients undergoing open heart surgery. No case of endocarditis and wound infection occurred. Pneumonia developed in 5 cases of the 7 day and 1 case of the 2 day group. Urinary tract infection without clinical significance developed in 1 case of the 7 day and 3 cases of the 2 day group. Bacteremia developed in 2 cases of the 7 day and 1 case of the 2 day group. We concluded as follows: l. Administration of antibiotics for 2 days appears to be without substantial risk of infection comparing long term 7 day regimen. 2. 7 days of antibiotics may actually increase the risk of serious infection such as nosocomial pneumonia, and predispose to the development of infections with fungi or antibiotic resistant bacteria. 3. 2 days of prophylaxis is more beneficial than long term 7 day regimen for example economically.

• Microbiology and Biotechnology Letters
• /
• v.46 no.4
• /
• pp.434-437
• /
• 2018

Pseudomonas aeruginosa accounts for a significant proportion of nosocomial infections. This study examined the antimicrobial susceptibility pattern and clonal relatedness of P. aeruginosa isolates of clinical and environmental origin. These isolates displayed susceptibility to levofloxacin, ciprofloxacin, gentamicin, imipenem, and ceftazidime of 65.0%, 62.5%, 90.0%, 100%, and 85%, respectively. PCR-RAPD analysis of the P. aeruginosa isolates revealed marked variation. No correlation was observed between the antibiotic resistance profiles and the DNA typing patterns.

• Journal of Yeungnam Medical Science
• /
• v.28 no.2
• /
• pp.133-144
• /
• 2011

Background: Tigecycline (TIG), a new broad-spectrum glycylcycline with anti-multidrug-resistant-(MDR)-pathogen activity, was launched in March 2009 in South Korea, but there are insufficient clinical studies on its use in the country. As such, this study was performed to analyze cases of severe MDR-pathogen-caused infections treated with TIG. Methods: Patients treated with TIG within the period from May 2009 to June 2010 were enrolled in this study. Their clinical and microbiologic data were reviewed retrospectively. Results: Twenty-one patients were treated with TIG for complicated skin and soft-tissue infections (cSSTIs) (42.9%), complicated intra-abdominal infections (cIAIs) (38.1%), or pneumonia (19.1%) caused by MDR pathogens like carbapenem-resistant $Acinetobacter$ $baumannii$ (76.2%), methicillin-resistant $Staphylococcus$ $aureus$ (61.9%), extended-spectrum beta-lactamase-producing $Escherichia$ $coli$ and $Klebsiella$ $pneumoniae$ (38.1%), and penicillin-resistant $Enterococcus$ species (33.3%). Thirteen patients (61.9%) had successful clinical outcomes while five (23.8%) died within 30 days. The rate of clinical success was highest in cSSTI (77.8%), followed by cIAI (50%) and pneumonia (50%), and the mortality rate was highest in pneumonia (50%), followed by cIAI (25%) and cSSTI (11.1%), Conclusion: Tigecycline therapy can be an option for the treatment of severe MDR-pathogen-caused infections in South Korea, Due to its high risk of failure and mortality, however, prudence is required in its clinical use for the treatment of severe infections like nosocomial pneumonia.

• Korean Journal of Occupational Health Nursing
• /
• v.11 no.1
• /
• pp.44-51
• /
• 2002

Purpose: Surgical Site Infection(SSI) is the third most common cause of nosocomial infection, so that it results in serious socioeconomic impact such as extra hospitalization, mortality and health care cost. The aim of this study was to analyses the SSI that based on the degree of wound contamination and patient risk index after general surgery and to generate a reference data for the effective management and reducing SSI. Method: From July, 1999 to June, 2000, 1080 cases which presented with surgical site infection after general surgery at S hospital in chunchon city were included in this study. The data were collected by review of the medical records retrospectively. The collected data, in accordance with the test purpose, is analyzed by SPSS/PC+ program, using real numbers, percentage, $X^2$ test, Pearson's correlation and stepwise logistic regression. Result: The overall wound infection rate was 4.7%(51 cases out of 1,080). The infection rate of clean wounds was 1.4%. Surgical site infection rate for patient risk index scores of 0, 1, 2 and 3 was 1.9%, 8.0%, 13.1% and 20.0%, respectively and increased significantly according to patient risk index(p=.000). Sixteen of the fifty one(31.4%) surgical site infections were found during an outpatient visit after discharge. Multivariate analysis, identified two independent variables : duration of postoperation stay(p=.000), age(p=.037). The most frequent isolated organisms were Pseudomonas aeruginosa(21%) and Staphylococcus aureus(21%). Also Staphylococcus aureus were all MRSA(Methicillin Resistant S. aureus). Conclusion: In this study, SSI was analysed according to the degree of wound contamination and patient risk index after general surgery. The data that obtained from this study is expected that it would be available for surveillance and control of SSI.

• Tuberculosis and Respiratory Diseases
• /
• v.47 no.3
• /
• pp.365-373
• /
• 1999

Background: Despite widespread use of tracheostomy in intensive care unit, it is still controversial to define the best timing from endotracheal intubation to tracheostomy under prolonged mechanical ventilation. Early tracheostomy has an advantage of easy airway maintenance and enhanced patient mobility whereas a disadvantage in view of nosocomial infection and tracheal stenosis. However, there is a controversy about the proper timing of tracheostomy. Methods: We conducted a retrospective study of the 35 medical and 15 surgical ICU patients who had admitted to Ewha Womans University Mokdong Hospital from January 1996 to August 1998 with the observation of APACHE III score, occurrence of nosocomial infections, and clinical outcomes during 28 days from tracheostomy in terms of early (n=25) vs. late (n=25) tracheostomy. We defined the reference day of early and late tracheostomy as 7th day from intubation. Results: The number of patients were 25 each in early and late tracheostomy group. The mean age were $48{\pm}18$ years in early tracheostomy group and $63{\pm}17$ years in late tracheostomy group, showing younger in early tracheostomy group. The median duration of intubation prior to tracheostomy was 3 days and 13 days in early and late tracheostomy groups. Organs that caused primary problem were nervous system in 27 cases(54%), pulmonary 14(28%), cardiovascular 4(8%), gastrointestinal 4(8%) and genitourinary 1(2%) in the decreasing order. Prolonged ventilation was the most common reason for the purpose of tracheostomy in both groups. APACHE m scores at each time of intubation and tracheostomy were slightly higher in late tracheostomy group but not significant statistically. Day to day APACHE III scores were not different between two groups with observation upto 7th day after tracheostomy, Occurrence of nosocomial infections, weaning from mechanical ventilation, and mortality showed no significant difference between two groups with observation of 28 days from tracheostomy. The mortality was increased as the APACHE m score upto 7 days after tracheostomy increased, but there were no increment for the mortality in terms of the time of tracheostomy and the days of ventilator use before tracheostomy, Conclusion: The early tracheostomy seems to have no benefit with respect to severity of illness, nosocomial infection, duration of ventilatory support, and mortality. It suggests that the time of tracheostomy is better to be decided on clinical judgement in each case. And in near future, prospective, randomized case-control study is required to confirm these results.

• Journal of Korean Academy of Nursing
• /
• v.17 no.3
• /
• pp.227-240
• /
• 1987

Infection has assumed increased importance as a cause of death among thermally injured individuals. Decreased treatment effectiveness and an increase in mortality are the hallmarks of nosocomial infection. Infection control is a monumental task that must be achieved to reduce mortalities. This was a retrospective study to survey the epidemiological features of nosocomial infections in a burn unit and to identify the possibilities for infection control. During the past 6 year 2 month period from July, 1981 to August, 1987, 306 burn patients were treated in the burn unit of university hospital. Among of these, 290 cases were the subjects of this study. The data were collected from the patients' records after discharge. All data collected were analyzed using percent, x$^2$-test, t-test with SPSS program. The results of this study are summariged as follows: 1) Infection rate was 40%. According to site, there were 67 cases of wound infection, 60 cases of post-operative skin graft infection, 20 cases of septicemia and 20 cases of donor site infection. As far as the burn size was concerned, the infection rate for patients whose burn size ranged 61 to 70%, was shown to be 100%, followed by the infection rate of 93.8%, for patients whose burn size ranged from 41~50%. As far as the period of time over which the infection developed, 5 to 7 days showed the highest frequency. Further infection was the main cause of deaths and complications. 2) Based upon the results obained by comparing the general characteristics, between a hospital infection-group and non-hospital infection group, there was a significant defference according to age, the time of the year when the accident happened, the place of accident or length of hospital-admission. And according to the result obtained by comparing the general characteristics of the burn, there was a significant difference according to burn size, burn depth, burn type, and burn site. And also based upon the result obtained by comparing the two groups according to method of treatment, there was a significant difference according to the use of antibiotics and to the type of wound-treatment, and for the 8 different binds of treatment related to infection, there was a significant difference for all. In conclusion, age, length of hospital-admission, burn size, burn type, burn site, burn depth, type of woundtreatment and the 8 different binds of treatment, which are related to burns, were shown to be the factors which affect the infection rate in burn patients.

• The Journal of the Korean Society for Microbiology
• /
• v.20 no.1
• /
• pp.1-11
• /
• 1985

A total of 211 strains of Staphylococcus aureus which included 118 strains isolated from various clinical specimens of admitted patients of University Hospital with systemic or severe cases of infection and 93 strains from infected skin diseases of out-patients of dermatology clinic located in rural area, were tested for the antimicrobial susceptibility to the 12 drugs of common use and the phage typing. An these were subjected to the study of plasmid profile analysis for the molecular epidemiology of nosocomial infections. University Hospital(UH) isolates showed higher frequency of resistance than local clinic(LC) isolates against 10 drugs excluding tetracycline(Tc), and trimethoprim(Tp). The MIC of UH isolates were above than $128{\mu}g/ml$ against 9 drugs except Tc, gentamicin(Gm), and Tp, but LC isolates did not show such a high level of MIC. There was difference of MIC needed to inhibit 90% of strains(MIC90) against each drugs tested between two groups of UH and LC isolates. UH isolates showed 2 to 4 times higher value of MIC90 by two-fold serial dilution of drug concentration than LC isolates. Tp was considered as an effective drug in treatment of staphylococcal infections whereas ampicillin and Gm were appeared to be ineffective. Seventy-three strains(61.9%) of UH isolates and 70(69.9%) of LC were typable with phages from Colindale Reference Laboratory. The prevailing phage type of UH isolates belonged to lytic group II were 27 strains(22.9%) and those of LC isolates belonged to lytic group II were 23 strains(24.7%). Thirteen strains(11.0%) of UH isolates were multiply resistant to more than 5 drugs to 10 drugs but none of LC isolates. Through the lysis method of Kado and Liu followed by agarose gel electrophoresis, none of 211 strains showed plasmid profile. These results were confirmed by re-examination through the method of Birnboim and Doly.

• Journal of Microbiology and Biotechnology
• /
• v.21 no.6
• /
• pp.659-664
• /
• 2011

Staphylococcus aureus (SA) bacteremia is associated with high mortality, and often results in metastatic infections. The methicillin-resistant SA (MRSA) is an urgent health care issue, as nosocomial infections with these bacteria represent limited treatment alternatives. Samples of whole blood containing challenge inoculums of SA and MRSA strains were passed through columns packed with surfaceheparinized polyethylene beads. The bound bacteria were eluted and quantitatively determined by culturing and by real-time PCR. Significant amounts of both SA and MRSA adhered to the heparinized beads (more than 65% of inoculated bacteria). After rinsing with buffer at high ionic strength, viable bacteria or bacterial DNA were eluted from the columns, indicating that the binding was specific. The conclusions that can be made from these experiments are that, as earlier reported in the literature, the high affinity of SA to heparin is retained in whole blood, and MRSA in whole blood binds to heparin with similar or higher affinity than SA. It should be possible to lower the amount of SA and/or MRSA from the blood of infected patients to levels that could be taken care of by the immune system. In previous studies, we have shown that passing blood from septic patients over beads coated with end-point-attached, biologically active heparin is a useful technique for regulating the levels of heparinbinding cytokine. These findings in combination with the present findings indicate the possibility of creating an apheresis technology for treatment of sepsis caused by SA and/or MRSA.