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Jeong-Hwan Hwang,
Pyoeng Gyun Choe,
Nak Hyun Kim,
Ji Hwan Bang,
Kyoung-Ho Song, Wan Beom Park,
Eu Suk Kim,
Sang Won Park,
Hong-Bin Kim,
Nam Joong Kim,
Myoung-Don Oh,
Kang Won Choe
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ABSTRACT: Korea is a low prevalence country for human immunodeficiency virus (HIV) infection and has an intermediate tuberculosis (TB) burden. We previously reported that the incidence of TB in HIV-infected patients was 9.6 cases per 100 person-years (P-Y) between 1988 and 1997. The aims of the present study were to measure any change in incidence from the previous study, and to identify risk factors for TB in HIV-infected patients. We reviewed all medical records of HIV-infected patients who were followed-up in one tertiary hospital between 1998 and 2010. Over the total observation period of 5858.33 P-Y, TB developed in 70 patients (1.19 cases per 100 P-Y; 95% confidence interval [CI], 0.91-1.47 cases per 100 P-Y). Based on Poisson regression, one risk factor associated with TB was an initial CD4+ cell count below 200 cells/µL (relative risk, 2.34; 95% CI, 1.47-3.73). Mean CD4+ cell counts of pulmonary, extrapulmonary, and both pulmonary and extrapulmonary TB were 179.8 cells/µL, 138.3 cells/µL, and 114.2 cells/µL, respectively (P = 0.55). In conclusion, the incidence of TB in HIV-infected patients has decreased since the previous study. An initial CD4+ cell count below 200 cells/µL is an independent risk factor for development of TB in HIV-infected patients.
Journal of Korean medical science 03/2013; 28(3):374-7. · 0.84 Impact Factor
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ABSTRACT: Background: Diagnostic error can be caused by several types of cognitive bias, which may be reversed by enhancing analytic reasoning. Aims: To evaluate whether enhancing analytic reasoning can increase diagnostic accuracy in objective structured clinical examination (OSCE) in medical students. Methods: All fourth-year medical students, randomly assigned to the analytic reasoning or control groups, undertook the OSCE with four cases using standardized patients. The analytic reasoning group was requested to list differential diagnoses and findings compatible or not compatible with each diagnosis prior to providing a diagnosis, while the control group provided a diagnosis without these processes. Mean diagnostic accuracy scores (perfect score, 4.0) from four cases of OSCE were compared between the two groups. Results: One hundred forty-five students were randomly assigned to the analytic reasoning group (n = 65) or the control group (n = 80). The baseline characteristics, including grade point average and the scores from each patient encounter, were comparable between groups. Mean diagnostic accuracy scores were significantly higher in the analytic reasoning group than in the control group (3.40 ± 0.66 versus 3.05 ± 0.98; p = 0.011). Conclusion: Enhancement of analytic reasoning may improve diagnostic accuracy in novice doctors.
Medical Teacher 01/2013; · 1.22 Impact Factor
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Jinyong Park,
Tae Min Kim,
Jeong-Hwan Hwang,
Nak-Hyun Kim,
Pyoeng Gyun Choe,
Kyoung-Ho Song,
Eu Suk Kim,
Sang-Won Park,
Hong Bin Kim,
Nam Joong Kim, Wan Beom Park,
Myoung-Don Oh
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ABSTRACT: We evaluated risk factors for neutropenic fever and febrile prolonged neutropenia during vincristine-including chemotherapy to treat HIV-related lymphoma to investigate whether protease inhibitor (PI) treatment is associated with infectious complications due to drug interactions with chemotherapeutic agents. We included all HIV patients who received chemotherapy including vincristine for lymphoma at a single referral center in 1999-2010. Neutropenic fever was defined as absolute neutrophil count < 500 cells/µL with body temperature over 38℃; and prolonged neutropenia was defined if it persisted over 7 days. CODOX-M/IVAC and Stanford regimens were considered high-risk regimens for prolonged neutropenia. We analyzed 48 cycles of chemotherapy in 17 HIV patients with lymphoma. There were 22 neutropenic fever and 12 febrile prolonged neutropenia events. In multivariate analysis, neutropenic fever was associated with old age and low CD4 cell count, but not with PI use or ritonavir-boosted PI use. Low CD4 cell count and high-risk regimens were associated with febrile prolonged neutropenia. Neutropenic fever and febrile prolonged neutropenia is associated with old age, low CD4 cell count, and high-risk regimens, but not PI use, in HIV patients undergoing chemotherapy including vincristine for lymphoma.
Journal of Korean medical science 12/2012; 27(12):1468-71. · 0.84 Impact Factor
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ABSTRACT: Although tigecycline is considered one of the few therapeutic options for carbapenem-resistant Acinetobacter baumannii (CRAB) bacteraemia, its role in the treatment of CRAB bacteraemia remains unclear. We describe the clinical outcomes of 9 patients who received tigecycline for CRAB bacteraemia. Although all CRAB blood isolates were susceptible to tigecycline, 5 (56%) deaths were related to CRAB bacteraemia and 1 case of breakthrough CRAB bacteraemia was observed during tigecycline therapy. Clinical outcomes of tigecycline therapy may be poor in patients with tigecycline-susceptible CRAB bacteraemia, although multiple factors including delayed treatment could contribute to the poor outcomes.
Scandinavian Journal of Infectious Diseases 10/2012; · 1.72 Impact Factor
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Chung-Jong Kim,
Nak-Hyun Kim,
Kyoung-Ho Song,
Pyoeng Gyun Choe,
Eu Suk Kim,
Sang Won Park,
Hong-Bin Kim,
Nam-Joong Kim,
Eui-Chong Kim, Wan Beom Park,
Myoung-Don Oh
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ABSTRACT: Nontuberculous mycobacteria (NTM) are classified into 2 categories: slow-growing mycobacteria (SGM) and rapid-growing mycobacteria (RGM), based on interval to colony formation by subculture on solid media. However, little is known about the growth rate of NTM in liquid broth media. We evaluated the differences in time to growth detection (TGD) of RGM and SGM in liquid broth media according to acid-fast stain. Among the 696 NTM isolates, 201 were RGM and 495 were SGM. In acid-fast bacilli (AFB)-negative specimens, the mean TGD was 133 h for RGM and 269 h for SGM (P < 0.001). In AFB-positive specimens, the mean TGD was 112 ± 37 h for RGM and 155 ± 125 h for SGM (P = 0.063). In the AFB-negative group, a cut-off value of 6 days was most effective for distinguishing SGM from RGM; however, in the AFB-positive group, an appropriate cut-off value was hard to define with TGD only.
Diagnostic microbiology and infectious disease 10/2012; · 2.45 Impact Factor
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Younghee Jung,
Myung Jin Lee,
Hye-Yun Shin,
Nak-Hyun Kim,
Jeong-Hwan Hwang,
Jinyong Park,
Pyoeng Gyun Choe, Wan Beom Park,
Eu Suk Kim,
Sang-Won Park,
Kyoung Un Park,
Hong Bin Kim,
Nam-Joong Kim,
Eui-Chong Kim,
Kyoung-Ho Song,
Myoung-Don Oh
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ABSTRACT: BACKGROUND: Healthcare-associated (HCA) infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in communityonset Klebsiella pneumoniae bloodstream infection (KpBSI). METHODS: We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA) infection, and analyzed risk factors for mortality in patients with community-onset KpBSI. RESULTS: Of 553 patients with community-onset KpBSI, 313 (57%) were classified as HCA- KpBSI and 240 (43%) as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006). Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001). In multivariate analysis, high Charlson's weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality. CONCLUSIONS: HCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.
BMC Infectious Diseases 10/2012; 12(1):239. · 3.12 Impact Factor
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Wan Beom Park,
Nak-Hyun Kim,
Kye-Hyung Kim,
Seung Hwan Lee,
Won-Seok Nam,
Seo Hyun Yoon,
Kyoung-Ho Song,
Pyoeng Gyun Choe,
Nam Joong Kim,
In-Jin Jang,
Myoung-Don Oh,
Kyung-Sang Yu
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ABSTRACT: Background. Blood levels of voriconazole, a first line therapy for invasive aspergillosis, may correlate with adverse events and treatment response. However, no randomized controlled studies have been conducted to evaluate the clinical utility of routine therapeutic drug monitoring (TDM) of voriconazole. This study aimed to determine whether routine TDM of voriconazole reduces drug adverse events or improves treatment response in invasive fungal infections. Methods. This was a randomized, assessor-blinded, controlled, single center trial. One hundred ten adult patients were randomly assigned to TDM or non-TDM groups. In the TDM group, voriconazole dosage was adjusted (target range, 1.0-5.5 mg/L) according to the serum trough level measured on the fourth day after initiation of voriconazole. The non-TDM group received a fixed, standard dosage. Voriconazole-related adverse events were monitored, and treatment response was assessed three months after the initiation of therapy. Results. Baseline characteristics including the CYP2C19 genotype were comparable between the two groups. While the incidence of adverse events was not different between the TDM group and the non-TDM group (both 42%; P = .97), the proportion of voriconazole discontinuation due to adverse events was significantly lower in the TDM group than in the non-TDM group (4% vs 17%; P = .02). A complete or partial response was observed in 81% (30 of 37) of patients in the TDM group compared to 57% (20 of 34) in the non-TDM group (P = .04). Conclusions. Routine TDM of voriconazole may reduce drug discontinuation due to adverse events and improve the treatment response in invasive fungal infections. Clinical Trial Registration. NCT00890708.
Clinical Infectious Diseases 07/2012; 55(8):1080-7. · 9.15 Impact Factor
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Jae Hyun Jeon,
Kyuseok Kim,
Woong Dae Han,
Sang Hoon Song,
Kyoung Un Park,
Joong Eui Rhee,
Kyoung-Ho Song, Wan Beom Park,
Eu Suk Kim,
Sang Won Park,
Nam Joong Kim,
Myoung-Don Oh,
Hong Bin Kim
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ABSTRACT: There is little information about the effectiveness of ciprofloxacin in regions where ciprofloxacin-resistant Escherichia coli is prevalent. This study was conducted to evaluate whether ciprofloxacin is effective as the initial empirical antibiotic for treatment of uncomplicated acute pyelonephritis (APN) due to ciprofloxacin-resistant E. coli. A total of 255 women with clinical diagnoses of uncomplicated APN due to E. coli were enrolled in the emergency department between March 2005 and December 2008. All enrolled patients were initially treated with ciprofloxacin. Patients were followed up 4 to 7 days after the start of therapy and 14 to 21 days after its completion. At the first follow-up visit, ciprofloxacin was changed to the appropriate antibiotic when necessary, depending on the antibiotic susceptibility results. Not only improvement of symptoms and signs but also microbiologic eradication was assessed at each visit. Fifteen percent (39/255) of the E. coli isolates were resistant to ciprofloxacin. There was no statistically significant difference between the clinical cure rates of the ciprofloxacin-susceptible group and the ciprofloxacin-resistant group at the first follow-up (87.0% versus 76.9%, P = 0.135) or the second follow-up (98.6% versus 94.9%, P = 0.177). However, there was a lower microbiologic cure rate in the ciprofloxacin-resistant group than in the ciprofloxacin-susceptible group (92.4% versus 41.7%, P = 0.000) at the first follow-up visit. No complications occurred in the ciprofloxacin-resistant group during the follow-up period. Our findings indicate that ciprofloxacin is an appropriate choice for empirical therapy of uncomplicated APN and has no serious adverse outcomes, if it is tailored appropriately, even for women infected with ciprofloxacin-resistant E. coli.
Antimicrobial Agents and Chemotherapy 03/2012; 56(6):3043-6. · 4.84 Impact Factor
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ABSTRACT: We retrospectively reviewed medical records to identify the factors that affect the results of culture in patients with pyogenic vertebral osteomyelitis. In multivariate analysis, the presence of paravertebral abscess was associated with positive results of microbiologic culture. Prior antibiotic exposure, especially of longer duration, was strongly associated with negative results.
Antimicrobial Agents and Chemotherapy 01/2012; 56(4):2122-4. · 4.84 Impact Factor
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Se Youn Choi,
Inho Kim,
Nam Joong Kim,
Seung-Ah Lee,
Youn-Ak Choi,
Ji-Yeon Bae,
Ji Hyun Kwon,
Pyoeng Gyun Choe, Wan Beom Park,
Sung-Soo Yoon,
Seonyang Park,
Byoung Kook Kim,
Myoung-Don Oh
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ABSTRACT: The aim of this study is to investigate the hematological manifestations of human immunodeficiency virus (HIV) infection, the risk factors for cytopenia, and the effect of highly active anti-retroviral therapy (HAART) on cytopenia.
Medical records of patients treated for HIV at the Seoul National University Hospital from January 2005 to March 2010 were retrospectively reviewed. To determine the impact of HIV itself, we excluded HIV patients who had other conditions that could have resulted in hematological manifestations. Multiple logistic regression analyses were performed to identify risk factors for cytopenia.
A total of 621 cases were investigated, and after exclusion, data of 472 patients were analyzed. The frequency of cytopenia was anemia, 3.0% (14/472); neutropenia, 10.0% (47/472); thrombocytopenia, 2.4% (12/472); lymphopenia, 25.7% (121/470); isolated cytopenia, 11.2% (53/472); and bicytopenia, 2.1% (10/472). The leading risk factor for cytopenia identified by multivariate logistic regression methods was AIDS status at initial presentation. After HAART, cytopenia was reversed in the majority of patients (thrombocytopenia, 100%; neutropenia, 91.1%; and anemia, 84.6%).
This study isolated the impact of HIV infection alone on hematologic manifestations and confirmed that these changes were reversible by HAART. Control of the HIV infection will have the main role in the management of hematological manifestations of the virus.
The Korean journal of hematology 12/2011; 46(4):253-7.
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ABSTRACT: The current study aimed to evaluate immunogenicity and safety of a newly developed diphtheria-tetanus toxoid (Td) vaccine, GC1107 (Green Cross Corporation, Yongin, Korea), in comparison with placebo and active comparator (licensed Td vaccine) in healthy Korean adults. A randomized, double-blind, placebo and active comparator-controlled study was conducted. Forty subjects were randomly administered a single intramuscular dose of GC1107, active comparator or placebo in a ratio of 2:1:1. At 2 and 4 weeks after vaccination, anti-diphtheria antibody levels in the GC1107 group increased 9.2 and 9.3 times, respectively, compared to predose titers. The corresponding values were 9.3 and 8.3 times for the active comparator group. Anti-tetanus antibody levels increased 39.0 and 37.9 fold at 2 and 4 weeks, respectively, after GC1107 administration, and 12.2 and 14.7 fold after active comparator administration. No increases in tetanus or diphtheria antibody were observed for the placebo group. Adverse events in the GC1107 and active comparator groups were more frequent than for the placebo group, but there were no significant differences between the two active treatments. In conclusion, GC1107 was well tolerated and provided significant boosts of anti-tetanus and anti-diphtheria antibodies.
Vaccine 08/2011; 29(44):7638-43. · 3.77 Impact Factor
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ABSTRACT: About 20% of methicillin-susceptible Staphylococcus aureus (MSSA) isolates have a substantial inoculum effect with cefazolin, suggesting that cefazolin treatment may be associated with clinical failure for serious MSSA infections. There are no well-matched controlled studies comparing cefazolin with nafcillin for the treatment of MSSA bacteremia. A retrospective propensity-score-matched case-control study was performed from 2004 to 2009 in a tertiary care hospital where nafcillin was unavailable from August 2004 to August 2006. The cefazolin group (n = 49) included MSSA-bacteremic patients treated with cefazolin during the period of nafcillin unavailability, while the nafcillin group (n = 84) comprised those treated with nafcillin. Treatment failure was defined as a composite outcome of a change of antibiotics due to clinical failure, relapse, and mortality. Of 133 patients, 41 patients from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment failure rates were not significantly different at 4 or 12 weeks (10% [4/41] versus 10% [4/41] at 4 weeks [P > 0.99] and 15% [6/41] versus 15% [6/41] at 12 weeks [P > 0.99]). Cefazolin treatment was interrupted less frequently than nafcillin treatment due to drug adverse events (0% versus 17%; P = 0.02). Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia.
Antimicrobial Agents and Chemotherapy 08/2011; 55(11):5122-6. · 4.84 Impact Factor
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ABSTRACT: Non-faecalis and non-faecium enterococci are an occasional cause of bacteremia, and some cases of infective endocarditis caused by these pathogens have been reported. However, the rate of infective endocarditis in non-faecalis and non-faecium enterococcal bacteremia is still undetermined. We compared the clinical features and the rate of infective endocarditis of 70 cases of non-faecalis and non-faecium enterococcal bacteremia with those of 65 cases of Enterococcus faecalis bacteremia. Non-faecalis and non-faecium enterococcal bacteremia was more frequently associated with biliary tract infection and polymicrobial bacteremia, and was less frequently associated with infective endocarditis, than was E. faecalis bacteremia (57% vs. 28%, p<0.01; 47% vs. 31%, p=0.05; 1% vs. 14%, p<0.01, respectively).
Chonnam medical journal. 08/2011; 47(2):111-5.
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ABSTRACT: Voriconazole is the drug of choice for invasive aspergillosis. We describe three patients who presented with severe hyponatremia after the initiation of voriconazole treatment. One patient expired while the other two patients recovered after a dose adjustment or discontinuation of the antifungal. The voriconazole trough levels were checked in all and two were elevated. These findings mandate monitoring electrolyte levels during voriconazole therapy.
Medical mycology: official publication of the International Society for Human and Animal Mycology 06/2011; 50(1):103-5. · 2.13 Impact Factor
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ABSTRACT: Neutrophils play an important role in immunological function. Neutropenic patients are vulnerable to infection, and except fever is present, inflammatory reactions are scarce in many cases. Additionally, because infections can worsen rapidly, early evaluation and treatments are especially important in febrile neutropenic patients. In cases in which febrile neutropenia is anticipated due to anticancer chemotherapy, antibiotic prophylaxis can be used, based on the risk of infection. Antifungal prophylaxis may also be considered if long-term neutropenia or mucosal damage is expected. When fever is observed in patients suspected to have neutropenia, an adequate physical examination and blood and sputum cultures should be performed. Initial antibiotics should be chosen by considering the risk of complications following the infection; if the risk is low, oral antibiotics can be used. For initial intravenous antibiotics, monotherapy with a broad-spectrum antibiotic or combination therapy with two antibiotics is recommended. At 3-5 days after beginning the initial antibiotic therapy, the condition of the patient is assessed again to determine whether the fever has subsided or symptoms have worsened. If the patient's condition has improved, intravenous antibiotics can be replaced with oral antibiotics; if the condition has deteriorated, a change of antibiotics or addition of antifungal agents should be considered. If the causative microorganism is identified, initial antimicrobial or antifungal agents should be changed accordingly. When the cause is not detected, the initial agents should continue to be used until the neutrophil count recovers.
The Korean Journal of Internal Medicine 06/2011; 26(2):220-52.
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ABSTRACT: To investigate the risk factors for late presentation in the Republic of Korea, where massive mandatory screening for HIV infection was conducted by the government until the late 1990s.
Data over the period 1987-2008 were analyzed from HIV patients for whom records of CD4 cell counts within 3 months of HIV diagnosis were available. Using multivariate logistic regression analysis including demographic and clinical variables, we examined factors associated with late presentation, defined as having a CD4 cell count of less than 200 cells/mm(3) at the time of diagnosis.
Of a total of 994 patients with a new diagnosis of HIV infection, 405 (41%) were late presenters. As the proportion of patients diagnosed by mandatory screening decreased over time (31% in 1987-1998 versus 8% in 1999-2008, P < 0.001), the proportion of late presenters increased (31% in 1987-1998 versus 43% in 1999-2008, P = 0.007). The independent risk factors for late presentation were older age (adjusted odds ratio [aOR], per increase of 10 years, 1.31; 95% confidence interval [CI], 1.15-1.49; P < 0.001), male sex (aOR, 1.74; 95% CI, 1.03-2.95; P = 0.040), negativity for VDRL (aOR, 1.58; 95% CI, 1.16-2.14; P = 0.003), and diagnosis after 1999 (aOR, 1.64; 95% CI, 1.05-2.56; P = 0.031).
Older age, male sex, negativity for VDRL, and diagnosis after 1999, were associated with late presentation, and the proportion of late presenters increased after the mandatory testing policy was abolished.
The Journal of infection 05/2011; 63(1):60-5. · 4.13 Impact Factor
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Eu Suk Kim,
Hye Jin Lee,
Gyung-Tae Chung,
Yeong-Seon Lee,
Dong-Hyeon Shin,
Sook-In Jung,
Kyoung-Ho Song, Wan-Beom Park,
Nam Joong Kim,
Kyoung Un Park,
Eui-Chong Kim,
Myoung-Don Oh,
Hong Bin Kim
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ABSTRACT: We used several molecular typing methods to analyze 196 methicillin-resistant Staphylococcus aureus (MRSA) and 139 methicillin-susceptible S. aureus (MSSA) isolates collected between 1996 and 2005. The sequence type 72 MRSA has increased in frequency in the community in the Republic of Korea and in hospitals in recent years.
Journal of clinical microbiology 03/2011; 49(5):1979-82. · 4.16 Impact Factor
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ABSTRACT: Information about the genotype of varicella-zoster virus (VZV) is useful to monitor outbreaks of vaccine strains. However, in South Korea, where varicella vaccine was introduced in 1988, there are limited data about the genotype of VZV. VZV was isolated from vesicular lesions of patients with herpes zoster or varicella in South Korea between January 2007 and June 2009. DNAs were purified from single-passage isolates. The genotype was determined by sequence analysis of open reading frame (ORF) 22. The PstI restriction enzyme site in ORF 38 and the BglI restriction enzyme site in ORF 54 were evaluated by restriction enzyme analysis. Forty-four patients with herpes zoster and nine patients with varicella were enrolled. The median age of patients with herpes zoster was 59.5 (range, 10 to 77) years, and the median age of patients with varicella was 8 (range, 6 to 9) years. In sequence analysis of ORF 22, all isolates were genotype J, irrespective of the age group. In restriction enzyme analysis, 51 of 54 (94.3%) isolates contained a PstI site in ORF 38, and all isolates contained a BglI site in ORF 54. Our data suggest that genotype J has been circulating since the 1940s in South Korea.
Journal of clinical microbiology 03/2011; 49(5):1913-6. · 4.16 Impact Factor
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Nak-Hyun Kim,
Moonsuk Kim,
Shinwon Lee,
Na Ra Yun,
Kye-Hyung Kim,
Sang Won Park,
Hong Bin Kim,
Nam-Joong Kim,
Eui-Chong Kim, Wan Beom Park,
Myoung-Don Oh
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ABSTRACT: Blood culture contamination leads to inappropriate or unnecessary antibiotic use. However, practical guidelines are inconsistent about the routine use of sterile gloving in collection of blood for culture.
To determine whether the routine use of sterile gloving before venipuncture reduces blood culture contamination rates.
Cluster randomized, assessor-blinded, crossover trial (ClinicalTrials.gov registration number: NCT00973063).
Single-center trial involving medical wards and the intensive care unit.
64 interns in charge of collection of blood for culture were randomly assigned to routine-to-optional or optional-to-routine sterile gloving groups for 1854 adult patients who needed blood cultures.
During routine sterile gloving, the interns wore sterile gloves every time before venipuncture, but during optional sterile gloving, sterile gloves were worn only if needed.
Isolates from single positive blood cultures were classified as likely contaminant, possible contaminant, or true pathogen. Contamination rates were compared by using generalized mixed models.
A total of 10 520 blood cultures were analyzed: 5265 from the routine sterile gloving period and 5255 from the optional sterile gloving period. When possible contaminants were included, the contamination rate was 0.6% in routine sterile gloving and 1.1% in optional sterile gloving (adjusted odds ratio, 0.57 [95% CI, 0.37 to 0.87]; P = 0.009). When only likely contaminants were included, the contamination rate was 0.5% in routine sterile gloving and 0.9% in optional sterile gloving (adjusted odds ratio, 0.51 [CI, 0.31 to 0.83]; P = 0.007).
Blood cultures from the emergency department, surgical wards, and pediatric wards were not assessed.
Routine sterile gloving before venipuncture may reduce blood culture contamination.
Annals of internal medicine 02/2011; 154(3):145-51. · 16.73 Impact Factor
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Wan Beom Park,
Won Kim,
Kook Lae Lee,
Jae-Joon Yim,
Moonsuk Kim,
Yong Jin Jung,
Nam Joong Kim,
Dong Hee Kim,
Yoon Jun Kim,
Jung-Hwan Yoon,
Myoung-don Oh,
Hyo Suk Lee
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ABSTRACT: To evaluate the incidence, risk factors and outcomes for anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic liver disease including cirrhosis.
A total of 107 patients with chronic liver disease were assessed for anti-TB DILI. Anti-TB DILI was defined as elevation of alkaline phosphatase (ALP), aspartate transaminase, or alanine transaminase, or an increase in Child-Turcotte-Pugh score within 2 months of initiating anti-TB medication. The risk factors for anti-TB DILI were evaluated by multivariate logistic regression analysis.
Fifty-eight (54%) patients had cirrhosis. Of 93 patients receiving one or more hepatotoxic anti-TB drugs, 18 (17%) experienced DILI: 11 (24%) among 46 patients with chronic hepatitis and 7 (15%) among 46 patients with compensated liver cirrhosis (P = 0.271). Independent risk factors for DILI were female sex, number of hepatotoxic anti-TB drugs administered and baseline ALP levels but not cirrhosis itself. Of the 18 patients with DILI, 13 (72%) successfully completed anti-TB treatment after switching to less hepatotoxic drug regimens.
Hepatotoxic anti-TB drugs may be safely used in the patients with chronic liver disease including compensated cirrhosis if number of hepatotoxic drugs used is adjusted appropriately.
The Journal of infection 10/2010; 61(4):323-9. · 4.13 Impact Factor
