Case Report : Acute Purulent Staphylococcal Pericarditis with Cardiac Tamponade in a Hemodialysis Patient

( Ji Youn Kim ),( Seon Wook Park ),( Seung Hwa Lee ),( Yong Wook Kim ),( Min Kyu Kim ),( Tae Jin Park ),( Jang Won Seo ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.1

Purulent pericarditis is a rare disease in both end-stage renal disease (ESRD) patients and the general population. We report herein a case of acute purulent staphylococcal pericarditis with cardiac tamponade managed by intravenous antibiotics and pericardiocentesis with drainage. A 54-year-old man with ESRD, who had been on hemodialysis (HD) for the previous six months, was admitted to the hospital because of fever. He had a history of a recent episode of staphylococcal bacteremia associated with venography for arteriovenous fistula (AVF) malfunction. On the sixth day after admission, severe intradialytic hypotension arose during HD. Echocardiography showed a large pericardial effusion with hemodynamic significance. Emergency pericardiocentesis with drainage was performed. Acute purulent staphylococcal pericarditis with cardiac tamponade was diagnosed and intravenous vancomycin was administered for four weeks. On the 23rd day, the patient was discharged from the hospital after the drainage catheter`s removal. Ten days after discharge, however, he was re-admitted because of dyspnea on exertion. Eventually, the patient expired because of heart failure caused by progressive constrictive pericarditis. We suggest that acute purulent pericarditis should be considered in dialysis patients who develop fever and severe hypotension during HD, especially after known staphylococcal infections.

소아 피부 및 연조직 감염 환자에서의 황색포도알균의 항생제 감수성의 변화: 2010년부터 2018년까지 단일기관에서의 경험

조용선,이신혜,이택진 대한소아감염학회 2019 Pediatric Infection and Vaccine Vol.26 No.3

Purpose: Staphylococcus aureus is a major cause of skin and soft tissue infections (SSTIs). This study aimed to determine the temporal trends in antibiotic susceptibility of S. aureus in SSTI patients aged <19 years. Methods: This retrospective observational study was conducted in pediatric patients with SSTI caused by community-associated S. aureus. Microbiologic and demographic data were collected, and the trends of antibiotic susceptibility results were evaluated. Results: From January 2010 to December 2018, a total of 807 S. aureus isolates were included. An overall increase in susceptibility of isolates to oxacillin was noted (P<0.001), with 75.0% of isolates being oxacillin-susceptible in 2018. S. aureus remained highly susceptible to trimethoprim/sulfamethoxazole and tetracycline, with 97.6% and 95.2% isolate susceptibility in 2018, respectively. Isolates from younger children aged 1 to 5 years had a significantly lower rate of susceptibility to oxacillin than older children aged 6 to 18 years (53.4% vs. 75.0%, P<0.001). Conclusions: The proportion of methicillin-resistant S. aureus isolates appears to decrease in pediatric patients with community-associated SSTI caused by S. aureus. Clinicians should be aware of regional susceptibility patterns when choosing empirical regimens. 목적: 피부 및 연조직 감염(skin and soft tissue infections [SSTIs])의 가장 흔한 원인은 황색포도알균(Staphylococcus aureus)이다. 본 연구는 19세 미만의 SSTI 환자에서 분리된 황색포도알균의 항생제 감수성의 변화추이를 알아보고자 하였다. 방법: 황색포도알균이 분리된 소아청소년 지역사회관련 SSTI 환자에서 후향적 관찰연구를 시행하였다. 미생물학 및 인구학적 자료를 수집하고, 항생제 감수성의 변화추이를 관찰하였다. 결과: 2010년 1월부터 2018년 12월까지 총 807개의 지역사회관련 황색포도알균이 연구에 포함되었다. Oxacillin에 대한 감수성은 전반적으로 증가하여(P<0.001) 2018년에는 75.0%였다. Trimethoprim/sulfamethoxazole과 tetracycline에 대한 감수성은 매우 높게 유지되어 2018년 각각 97.6%와 95.2%였다. 만 1–5세 연령군에서 만 6–18세 연령군에 비해 oxacillin 감수성이 유의하게 낮았다(53.4% vs. 75.0%, P<0.001). 결론: 소아청소년의 지역사회관련 SSTI의 원인이 된 황색포도알균 중 메티실린내성 황색포도알균의 비율이 감소하고 있는 것으로 보인다. 임상의는 경험적 항생제를 선택할 때 지역적 항생제 감수성 양상을 확인해야 한다.

Effect of Using Local Intrawound Vancomycin Powder in Addition to Intravenous Antibiotics in Posterior Lumbar Surgery: Midterm Result in a Single-Center Study

Gun-Ill Lee,백광흠,전형준,최규선 대한척추신경외과학회 2016 Neurospine Vol.13 No.2

Objective: We conducted this study to report the efficacy of local application of vancomycin powder in the setting of surgical site infection (SSI) of posterior lumbar surgical procedures and to figure out risk factors of SSIs. Methods: From February 2013 to December 2013, SSI rates following 275 posterior lumbar surgeries of which intrawound vancomycin powder was used in combination with intravenous antibiotics (Vanco group) were assessed. Compared with 296 posterior lumbar procedures with intravenous antibiotic only group from February 2012 to December 2012 (non-Vanco group), various infection rates were assessed. Univariate and multivariate analysis to figure out risk factors of infection among Vanco group were done. Results: Statistically significant reduction of SSI in Vanco group (5.5%) from non-Vanco group (10.5%) was confirmed (p=0.028). Mean follow-up period was 8 months. Rate of acute staphylococcal SSIs reduced statistically significantly to 4% compared to 7.4% of non-Vanco group (p=0.041). Deep staphylococcal infection decreased to 2 compared to 8 and deep methicillin-resistant Staphylococcus aureus infection also decreased to 1 compared to 5 in non-Vanco group. No systemic complication was observed. Statistically significant risk factors associated with SSI were diabetes mellitus, history of cardiovascular disease, length of hospital stay, number of instrumented level and history of previous surgery. Conclusion: In this series of 571 patients, intrawound vancomycin powder usage resulted in significant decrease in SSI rates in our posterior lumbar surgical procedures. Patients at high risk of infection are highly recommended as a candidate for this technique.

Clinical Efficacy and Safety of Arbekacin against Pneumonia in Febrile Neutropenia: A Retrospective Study in Patients with Hematologic Malignancies

Ohashi Takashi,Fujita Yukiyoshi,Irisawa Hiroyuki,Nakaminami Hidemasa,Arai Takahiro,Takahashi Masumi,Momiyama Emi,Murata Naoya,Murayama Kayoko,Saito Taeko 대한감염학회 2022 Infection and Chemotherapy Vol.54 No.1

Background Arbekacin (ABK) is an aminoglycoside that exhibits anti-methicillin-resistant Staphylococcus aureus (MRSA) and anti-Pseudomonas aeruginosa activities. Therefore, for patients with febrile neutropenia (FN) and concurrent pneumonia suspected to be caused by MRSA, ABK may be sufficiently effective even as a single agent. Materials and Methods Patients with hematologic malignancies treated with ABK who met the following criteria were included: 1) fever during neutropenia or functional neutropenia, 2) FN complicated by pneumonia, and 3) possible infection by antimicrobial-resistant Gram-positive cocci. Results This study encompassed 22 episodes involving 19 patients, of which, 15 (68.2%) were successfully treated with ABK. Of the nine episodes showing inadequate response to other anti-MRSA drugs, eight were successfully treated with ABK. Grade 2 or worse adverse events included acute kidney injury (13.6%) and increased transaminase levels (9.1%). Conclusion The present study demonstrated that ABK is effective and safe in patients with FN and concurrent pneumonia caused by antimicrobial-resistant Gram-positive cocci. ABK may also be effective in patients who are unresponsive to other anti-MRSA drugs. Therefore, ABK may be beneficial in the treatment of pneumonia caused by antimicrobial-resistant Gram-positive cocci in patients with FN. Background Arbekacin (ABK) is an aminoglycoside that exhibits anti-methicillin-resistant Staphylococcus aureus (MRSA) and anti-Pseudomonas aeruginosa activities. Therefore, for patients with febrile neutropenia (FN) and concurrent pneumonia suspected to be caused by MRSA, ABK may be sufficiently effective even as a single agent. Materials and Methods Patients with hematologic malignancies treated with ABK who met the following criteria were included: 1) fever during neutropenia or functional neutropenia, 2) FN complicated by pneumonia, and 3) possible infection by antimicrobial-resistant Gram-positive cocci. Results This study encompassed 22 episodes involving 19 patients, of which, 15 (68.2%) were successfully treated with ABK. Of the nine episodes showing inadequate response to other anti-MRSA drugs, eight were successfully treated with ABK. Grade 2 or worse adverse events included acute kidney injury (13.6%) and increased transaminase levels (9.1%). Conclusion The present study demonstrated that ABK is effective and safe in patients with FN and concurrent pneumonia caused by antimicrobial-resistant Gram-positive cocci. ABK may also be effective in patients who are unresponsive to other anti-MRSA drugs. Therefore, ABK may be beneficial in the treatment of pneumonia caused by antimicrobial-resistant Gram-positive cocci in patients with FN.

P152 : Staphylococcal skin infection in juvenile dermatomyositis with unusual unilateral Linear distribution

( Bo Kyung Kim ),( Seung Joon Oh ),( Mi Ryung Roh ) 대한피부과학회 2014 대한피부과학회 학술발표대회집 Vol.66 No.1

포도상구균 폐렴을 동반한 고면역글로불린 E 증후군 1례

오흥원,서원석,신상만 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.1

The hyperimmunoglobulin E syndrome is a rare primary immunodeficiency disorder characterized by extremely high serum IgE levels and eosinophilia, and serious recurrent bacterial infections of the skin and sinopulmonary tract in early life. Associated clinical features are coarse facial appearance and chronic eczematoid dermatitis. The most common organism that infect these patients are S. aureus and C. albicans. The patients' serum IgE levels are elevated but the basic immunologic mechanism is not fully understood. It is believed that the elevated IgE levels reflect a T-cell imbalance characterized by T-cell activation and a deficiency of suppressor T cells to inhibit IgE production. We have experienced a case of hyperimmunoglobulin E syndrome in a ??-year-old boy who had suffered from recurrent staphylococcal pneumonia and onychomycosis and chronically pruritic dermatitis from 3 months of age with elevated serum IgE level. A brief review of the related literature is presented.

요근 농양의 임상적 특징 및 결과 고찰

최정현 ( Choe Jeong Hyeon ),김민철 ( Kim Min Cheol ),임승관 ( Im Seung Gwan ),조숙경 ( Jo Sug Gyeong ),신승수 ( Sin Seung Su ),오윤정 ( O Yun Jeong ),최영화 ( Choe Yeong Hwa ),박광주 ( Park Gwang Ju ),황성철 ( Hwang Seong Cheol 대한내과학회 2003 대한내과학회지 Vol.65 No.3

Background : Psoas abscess is a rare condition with vague clinical presentations, therefore misdiagnosis or delayed diagnosis is often made. We have reviewed the characteristics of the clinical presentation, microbiology, and treatment of 24 patients with

성인에서 발병한 과면역글로불린 E 증후군 1예

이재천,박주상,윤지열,정두련,문희범,우준희,류지소 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.1

과민역글로불린 E 증후군은 영유아기부터 반복적인 부비동, 호흡기감염 및 농양의 형성, 습진성 피부 질환 및 혈청 면역글로불린 E의 상승을 보이는 드문 질환이다. 특징적으로 농양은 발열이나 균혈증을 동반하지 않으며, 포도상구균이 흔한 원인균이며, 배농 및 항균제 정주로 효과적으로 치료된다. 향후 병태생리 및 치료에 대한 연구가 필 요하다. 저자들은 성인기에 발병한 반복적인 피하 농양 형성, 습진성 피부질환, 혈청 면역글로불린 E의 상승 등으로 과면역글포블린 E 증후군으로 진단된 증례를 국내 최초로 보고하는 바이다. Hyperimmunoglobulin E syndrome, rarely reported, is a syndrome of hyperimniunoglo-bulinemia E. eczematous skin lesion, and recurrent staphylococcal infections on respiratory system and skin with abscess formation, mostly from early in life. The abscess is not accompamed with fever and bacteremia, that is a characteristic 'cold abscess' We report a case of 56 year-old woman who manifested this syndrome from adulthood. with the review of literatures.

Pharmacokinetics and Tolerance of the Phage Endolysin-Based Candidate Drug SAL200 after a Single Intravenous Administration among Healthy Volunteers

Jun, Soo Youn,Jang, In Jin,Yoon, Seonghae,Jang, Kyungho,Yu, Kyung-Sang,Cho, Joo Youn,Seong, Moon-Woo,Jung, Gi Mo,Yoon, Seong Jun,Kang, Sang Hyeon American Society for Microbiology 2017 Antimicrobial Agents and Chemotherapy Vol.61 No.6

<P><B>ABSTRACT</B></P><P>This study was a phase 1, single-center, randomized, double-blind, placebo-controlled, single-dosing, and dose-escalating study of intravenous SAL200. It is a new candidate drug for the treatment of antibiotic-resistant staphylococcal infections based on a recombinant form of the phage endolysin SAL-1. The study evaluated the pharmacokinetics, pharmacodynamics, and tolerance among healthy male volunteers after the intravenous infusion of single ascending doses of SAL200 (0.1, 0.3, 1, 3, and 10 mg/kg of body weight). SAL200 was well tolerated, and no serious adverse events (AEs) were observed in this clinical study. Most AEs were mild, self-limiting, and transient. The AEs reported in more than three participants were fatigue, rigors, headache, and myalgia. No clinically significant values with respect to the findings of clinical chemistry, hematology, and coagulation analyses, urinalysis, vital signs, and physical examinations were observed, and no notable trends in our electrocardiogram (ECG) results for any tested dose were noticed. A greater-than-dose-proportional increase with regard to systemic exposure and the maximum serum concentration was observed when the SAL200 dose was increased from 0.1 mg/kg to 10 mg/kg. This investigation constitutes the first-in-human phase 1 study of an intravenously administered, phage endolysin-based drug. (This study has been registered at ClinicalTrials.gov under identifier NCT01855048 and at the Clinical Research Information Service [https://cris.nih.go.kr/cris/] under identifier KCT0000968.).</P>

Evaluation of Challenges in Diagnosis of Spontaneous Subacute Pyogenic Spondylodiscitis in Immunocompetent Patients: Experiences from a Tertiary Care Center

Naveen Pandita,Souvik Paul,Gagandeep Yadav,Roop Bhushan Kalia,Pankaj Kandwal 대한척추외과학회 2019 Asian Spine Journal Vol.13 No.4

Study Design: Prospective clinical study. Purpose: We evaluated the challenges faced during diagnosis and management of patients with subacute pyogenic discitis and discussed various clues in clinical history, radiologic and hematologic parameters of these patients that helped in establishing their diagnosis. Overview of Literature: Present literature available shows that in patients with subacute spondylodiscitis and infection with less virulent organisms, the clinical picture often is confusing and the initial radiologic and hematologic studies do not contribute much toward establishing the diagnosis. Methods: Demographic pattern, predisposing factors, clinical presentation, comorbidities, microbiology, treatment, neurologic recovery, and complications of 11 patients were prospectively reviewed regarding their contribution toward the conformation of diagnosis of subacute pyogenic discitis. Results: Mean age at presentation was 46.0 years with average preoperative Oswestry Disability Index and Visual Analog Scale scores of 83.4 and 7.18, respectively. Mean follow-up duration was 12.0 months. The most common site of infection was the lumbar spine, followed by the thoracic spine (n=1). Infective organisms were isolated in only 45% of cases. Staphylococcus aureus was the most common causative organism isolated. Conclusions: Diagnosing subacute spondylodiscitis in a patient presenting with subacute low backache poses a diagnostic challenge. Clinical and radiologic picture are deceiving, and bacteriologic results often are negative, further complicating the picture. A detailed medical history along with clinical, radiologic, and biochemical parameters prevents missing the diagnosis. Serial serum C-reactive protein and alkaline phosphatases were more reliable blood parameters in cases of subacute presentation.