Two-Year Hospital-Wide Surveillance of Central Line-Associated Bloodstream Infections in a Korean Hospital

BACKGROUND: Surveillance and interventions of central line-associated bloodstream infections (CLABSIs) had mainly been targeted in intensive care units (ICUs). Central lines are increasingly used outside ICUs. Therefore, we performed a hospital-wide survey of CLABSIs to evaluate the current status and develop strategies to reduce CLBASI rates. METHODS: All hospitalized patients with central venous catheters (CVCs) were screened for CLABSIs from January 2014 through December 2015 at a 1,328 bed tertiary care teaching hospital in Korea using an electronic data-collecting system. Clinical information including type of CVC was collected. CLABSI rates were calculated using the definitions of the National Health and Safety Network after excluding mucosal barrier injury laboratory-confirmed bloodstream infection (BSI). RESULTS: A total of 154 CLABSIs were identified, of which 72 (46.8%) occurred in general wards and 82 (53.2%) in ICUs (0.81 and 2.71 per 1,000 catheter days), respectively. Non-tunneled CVCs were most common (68.6%) among 70 CLABSI events diagnosed within one week of their maintenance. On the other hand, tunneled CVCs and peripherally inserted central catheters (PICCs) were more common (60.5%) among 114 CLABSI events diagnosed more than a week after maintenance. Whereas the majority (72.2%) of CLABSIs in ICUs were associated with non-tunneled CVCs, tunneled CVCs (38.9%) and PICCs (36.8%) were more common in general wards. CONCLUSION: CLABSIs are less common in general wards than in ICUs, but they are more often associated with long-term indwelling catheters. Therefore, interventions to prevent CLABSIs should be tailored according to the type of ward and type of catheter.

The Clinical Significance of a History of Independent Walking in Children with Epilepsy / 대한소아신경학회지

PURPOSE: The developmental history is an important element in the evaluation of children with epilepsy. However, obtaining accurate information from history is often very difficult especially in older children because of their parents' incomplete recollection. This study was aimed to investigate if the timing of independent walking has a valuable clinical significance in children with epilepsy. METHODS: We classified 262 patients with epilepsy into normal and delayed groups from a history of the timing of independent walking at 18 months as a cutoff point. We compared their clinical and laboratory characteristics between two groups. RESULTS: Out of 262 patients, twenty one (8%) were delayed. There was no difference in seizure types between two groups. The Age of seizure onset and diagnosis of epilepsy was earlier in delayed group (5.6:2.2 years, P<0.001; 7.0:3.2 years, P<0.001). The proportion of Cesarean section and preterm delivery were also higher in delayed group (25%:52%, P= 0.010; 6%:29%, P<0.001). Abnormal MRI findings were more frequent in the delayed group (19%:86%, P<0.001). EEG at diagnosis showed no difference in epileptiform discharges, but background abnormality was more common in the delayed group (15%:81%, P<0.001). EEG at 1 year after the diagnosis showed both epileptiform discharges and background abnormality were more frequent in the delayed group (60%:90%, P=0.004; 14%:67%, P<0.001). CONCLUSION: Based on the result of this study, we strongly recommended that we should take a history of the timing of independent walking in children and adolescents with epilepsy.

Bronchiolitis Obliterans in Children: A Single Institution Experience / 소아알레르기및호흡기학회지

PURPOSE: Although bronchiolitis obliterans (BO) most often occurs after infection, the incidence of post-transplant BO has recently increased due to the increase of organ and bone marrow transplantation. However, there is limited data on the responses to treatment using measurements of pulmonary function in patients with BO. This study aimed to describe clinical characteristics and pulmonary function in children with BO from a single institute and to compare the responses according to treatment modalities in children with post-infectious BO. METHODS: This study was conducted on 22 children who were diagnosed with BO from January 2005 to December 2010. Based on the medical chart, treatment courses and prognosis of the patients were examined retrospectively. The severity of clinical symptoms was determined by the Denver symptom score, basal pulmonary function, and responses to bronchodilators; all parameters were measured and compared between the time of diagnoses and follow-up six months later. RESULTS: The mean age of the patients when diagnosed with BO was 8.3+/-6.6 years; of those patients, sixteen were boys and six were girls. Nineteen cases of BO were associated with acute infection, and the most common cause of those cases was adenovirus. Three cases of BO occurred following allogeneic bone marrow transplantation for acute myelogenous leukemia. The Denver symptom scores at the time of diagnosis were averaged to 3.95+/-0.63, and the average symptom score after follow-up of six months was 2.15+/-0.73. The averages of the % forced vital capacity (FVC), % forced expiratory volume in 1 second (FEV1), and % forced expiratory flow, midexpiratory phase (FEF25-75%) at the time of diagnosis were 69+/-13%, 40.5+/-12.7%, and 17.6+/-7.8%, respectively, and FEV1/FVC was 56.7+/-10.9%. The averages of %FVC, % FEV1, and %FEF25-75% six months after diagnosis were 78+/-17.3%, 62.5+/-16.5%, and 35.6+/-9.5%, respectively, and FEV1/FVC was improved to 70.7+/-18.9%. Symptom scores of the group treated with high dose systemic steroids decreased significantly compared to those of the group treated with inhaled corticosteroids (P<0.05). Likewise, improvement of FEV1/FVC after treatment was greater in the group treated with high dose systemic steroids than in the group treated with inhaled corticosteroids (P<0.05). CONCLUSION: Infections are the more frequent causes of BO in our institute, and adenovirus ismost common. Six-month follow-up study results suggest high dose systemic steroids could lead to better improvement of clinical symptoms and pulmonary function in children with post-infectious BO.