Acute and Critical Care

Original Articles

Infection
Outbreak of Imipenemase-1-Producing Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit: Jin Young Lee, Ji Young Park, Je Hun Kim, Young Hee Lee, Hee Young Yang, Jung Sik Yoo; Korean J Crit Care Med. 2017;32(1):29-38. Published online December 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00731

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Background
Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported.
Methods
Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame.
Results
During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions.
Conclusions
This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.

Citations

Citations to this article as recorded by

Alkyl deoxyglycoside-polymyxin combinations against critical priority carbapenem-resistant gram-negative bacteria
Ana M. de Matos, Patrícia Calado, Mónica Miranda, Rita Almeida, Amélia P. Rauter, M. Conceição Oliveira, Vera Manageiro, Manuela Caniça
Scientific Reports.2024;[Epub] CrossRef
Genotypic Distribution and Antimicrobial Susceptibilities of Carbapenemase-Producing Enterobacteriaceae Isolated From Rectal and Clinical Samples in Korean University Hospitals Between 2016 and 2019
Seri Jeong, Nuri Lee, Min-Jeong Park, Kibum Jeon, Han-Sung Kim, Hyun Soo Kim, Jae-Seok Kim, Wonkeun Song
Annals of Laboratory Medicine.2022; 42(1): 36. CrossRef
Characterization of Infections with Vancomycin-Intermediate Staphylococcus aureus (VISA) and Staphylococcus aureus with Reduced Vancomycin Susceptibility in South Korea
Jung Wan Park, Hyungmin Lee, Jung Wook Kim, Bongyoung Kim
Scientific Reports.2019;[Epub] CrossRef

Pulmonary
Percutaneous Dilatational Tracheostomy in Critically Ill Patients Taking Antiplatelet Agents: Sung Jin Nam, Ji Young Park, Hongyeul Lee, Taehoon Lee, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):183-188. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.183

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Abstract PDF

BACKGROUND
Percutaneous dilatational tracheostomy (PDT) has been considered as an alternative to surgical tracheostomy in intensive care units (ICU), and is widely used for critically ill patients who need prolonged mechanical ventilation. Few studies have reported on PDT performed in critically ill patients taking antiplatelet agents. Our goals are to assess not only the feasibility and safety of PDT, but also bleeding complications in the patients receiving such therapy.
METHODS
In a single institution, PDTs were performed by pulmonologists at the medical ICU bedside using the single tapered dilator technique and assisted by flexible bronchoscopy to confirm a secure puncture site. From March 2011 to February 2013, the patients' demographic and clinical data, procedural parameters, outcomes and complications were analyzed and compared complications between patients taking antiplatelet agents and those not.
RESULTS
PDTs were performed for 138 patients; the median age was 72 years, mean body mass index was 20.3 +/- 4.8 kg/m2, and mean acute physiology and chronic health evaluation II score was 24.4 +/- 9.4. Overall, the procedural success rate was 100% and the total procedural time was 25 +/- 8.5 min. There were no periprocedural life-threatening complications, and no statistical difference in the incidence of bleeding complications between patients who had taken antiplatelet agents and those had not (p = 0.657).
CONCLUSIONS
PDT performed in critically ill patients taking antiplatelet agents was a feasible procedure and was implemented without additional bleeding complications.

Citations

Citations to this article as recorded by

Open tracheostomy in patients with dual platelet aggregation inhibitors
Lorena Zapata-Contreras, Carlos Eduardo Hoyos-Cuervo, María Cristina Florián-Pérez
Colombian Journal of Anesthesiology.2019; 47(3): 189. CrossRef
Safety of Percutaneous Dilatational Tracheotomy in Patients on Dual Antiplatelet Therapy and Anticoagulation
Enzo Lüsebrink, Konstantin Stark, Mattis Bertlich, Danny Kupka, Christopher Stremmel, Clemens Scherer, Thomas J. Stocker, Mathias Orban, Tobias Petzold, Nikolaus Kneidinger, Hans-Joachim Stemmler, Steffen Massberg, Martin Orban
Critical Care Explorations.2019; 1(10): e0050. CrossRef
Safety and Feasibility of Percutaneous Dilatational Tracheostomy in the Neurocritical Care Unit
Dong Hyun Lee, Jin-Heon Jeong
Journal of Neurocritical Care.2018; 11(1): 32. CrossRef
Comparison of outcomes between vertical and transverse skin incisions in percutaneous tracheostomy for critically ill patients: a retrospective cohort study
Sung Yoon Lim, Won Gun Kwack, Youlim Kim, Yeon Joo Lee, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Critical Care.2018;[Epub] CrossRef

Case Reports

A Case of Laryngeal Mask Airway-Assisted Percutaneous Dilatational Tracheostomy: Ji Young Park, Taehoon Lee, Hongyeul Lee, Jae Ho Lee, Choon Taek Lee, Young Jae Cho; Korean J Crit Care Med. 2013;28(3):184-186.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.184

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Abstract PDF: Percutaneous dilatational tracheostomy (PDT) is a widely used method to perform tracheostomy in the critical care medicine for patients who need prolonged mechanical ventilation. Traditionally, PDT has been facilitated by bronchoscopy via the endotracheal tube. However, there are risks for blocking the view of correct puncture site on the trachea or being extubated unintentionally, which lead to loss of the airway. These complications are possibly due to insufficient bronchoscopic visualizations via endotracheal tube during the procedure. Using laryngeal mask airways (LMA) during PDT may overcome these problems and could provide a safer alternative method with superior visualizations of the trachea and larynx. We report a case of percutaneous tracheostomy being performed successfully under bronchoscopy with LMA in the intensive care unit.

Dantrolene and Post-operative Hyperthermia: A Case Report: Ja Kyung Koo, Cheol Hong Kim, Ah Leum Lim, Se Ah Kwon, Ji Young Park, Soon Jae Lee, In Gyu Hyun, Je Hyun Yoo; Korean J Crit Care Med. 2009;24(2):92-98.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.92

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Abstract PDF: Malignant hyperthermia is a rare, fatal pharmacogenetic disorder that occurs during general anesthesia following exposure to a depolarizing muscle relaxant, such as succinylcholine, or volatile anesthetics. Clinical findings in malignant hyperthermia include muscle rigidity, sinus tachycardia, increased CO2 production, skin cyanosis with mottling, and marked hyperthermia. For treatment, cooling techniques must be accompanied by discontinuation of the provocative medication. Furthermore, dantrolene administration is the mainstay of treatment for malignant hyperthermia, and should be initiated as soon as the diagnosis is suspected. We recently experienced a case with post-operative fever of 41.0degrees C refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration, in a patient with methicillin-sensitive Staphylococcus aureus monoarthritis of the knee and rapid progression of diffuse septic pneumonia requiring mechanical ventilation.

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