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

10,383 View
213 Download
3 Web of Science
3 Crossref

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

Development and Experimental Evaluation of Respiratory Assist Device by Use of Right Thoracic Negative Pressure Ventilation: Joong Hwan Oh, Sang Hun Lee, Hyun Kyo Lim, Young Hee Lee, Sung Hoon Kim; Korean J Crit Care Med. 2005;20(2):165-169.

1,400 View
14 Download

Abstract PDF: BACKGROUND
A diaphragm pacing with electrical stimulation is a new respiratory assist device which has advantages over mechanical ventilation. Unilateral phrenic nerve stimulation makes uneven distribution of intrathoracic negative pressure and most likely relates to paradoxical motion of the diaphragm. Our purpose is to investigate a respiratory effect of right phrenic nerve pacing after thoracotomy compared with bilateral pacing. METHODS: Five dogs were examined under the general anesthesia. Right 5th intercostal space was opened. Two pacing leads were placed around the phrenic nerve and connected to the stimulator. Chest wall was closed after chest tube insertion. Ventilator was off without self respiration. Swan-Ganz catheter was introduced to the pulmonary artery, cardiac output, central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP). Arterial blood gases (PO2 & PCO2), end-tidal PCO2 (PETCO2) and tidal volume were measured with nerve stimulation. Left phrenic nerve was managed as the same manner. RESULTS: Right phrenic nerve pacing resulted in a tidal volume of 186+/-5 ml, PETCO2 of 55.0+/-2.3 mmHg, Arterial PO2 of 115+/-12 mmHg, PCO2 of 59+/-4 mmHg, Cardiac output of 2.3+/-0.5 L/min, CVP of 12.0+/-2.3 mmHg, PCWP of 14.2+/-2.5 mmHg. Bilateral phrenic nerve pacing resulted in a tidal volume of 418+/-3 ml, PETCO2 of 47.0+/-2.7 mmHg, PO2 of 289+/-10 mmHg, PCO2 of 42+/-3 mmHg, Cardiac output of 3.1+/-0.4 L/min, CVP of 10.2+/-2.5 mmHg, PCWP of 14.5+/-2.7 mmHg. Right phrenic nerve pacing showed significantly lower tidal volume, PO2 and higher PETCO2 and arterial blood PCO2 (p<0.05).
CONCLUSIONS
Right phrenic nerve pacing plays a role to develop respiratory assist. However the effect is less than the bilateral pacing.

First
Prev
Page of 1
Next
Last

Search