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Study of nosocomial pneumoniae in ICU of a hospital.
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Yeoun Aeng Kim, Soon Duck Kim, Je Suk Lee
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Korean J Epidemiol. 2005;27(2):61-69.
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PURPOSE
As a retrospective study by using of medical records, this was to investigate the incidence rate of nosocomial pneumonia and risk factors and to determine the causing agent.METHODS Subjects were 336 patients during the period from January 2003 through December 2003. Nosocomial pneumonia was defined according to the definition(CDC, 1992).The statistical SPSS was used to analyze data that included chi-square, t-test and multiple logistic regression.RESULTS The actual number of patients with nosocomial pneumonia turned out to be 42 out of total 336 patients during the survey period. The incidence rate was 125 per 1,000 patients and 16.7 patients per 1,000 patient-days, which is comparable with 217 patients with ventilator-associated pneumonia per 1,000 patients and 34.8 per 1,000 patient-days. The significant risk factors for nosocomial pneumonia were identified as cardiomegaly based on chest radiography (OR=4.93; 95% CI=1.11-21.94), cerebral hemorrhage(OR=6.27; 95% CI=1.63-24.16), cerebral infarction(OR=4.39; 95% CI=1.05-18.40) and the duration of admission (OR=5.57; 95% CI=3.14-9.88).
Causing agents of nosocomial pneumonia were Staphylococcus aureus 21.8%, Pseudomonas aeruginosa 17.4% and Acinetobacter baumani 17.4%. Ventilator-associated pneumonia were Acinetobacter baumani 27.5%, Staphylococcus aureus 24.2%, Pseudomonas aeruginosa 13.8%.CONCLUSIONS The cardiomegaly at admission, diagnosis and duration of admission were considered to enhance the incidence rate of nosocomial pneunoniae. Further studies and intervention actions would be necessary to deal with the nosocomial pneunoniae.
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An Epidemiologic Study on the Nosocomial Bloodstream Infection in Two Hospitals.
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Mi Jeung Ahn, Chang Kyu Lee, Chae Seung Lim, You Cheol Shin, Soon Duck Kim
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Korean J Epidemiol. 2001;23(2):33-43.
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In this study, nosocomial bloodstream infection rate and fatality rate for 774 and 386 patients, who whose blood cultivation were obtained after 48 hours of hospitalization between March 1999 and February 2000 in two university hospitals, were sought. A distribution of etiologic agent and risk factors of the nosocoial bloodstream infection were also investigated.METHODS This study was carried out through medical record review and a structural questionnaire. Besides registers of microbe cultivation in the department of clinical pathology and medical records of patients were checked. The nosocomial bloodstream infection was also checked through medical records of patients using the standard of CDC. Statistical analysis were performed using SAS 6.12.RESULTS The nosocomial bloodstream infection rate in hospital K and hospital A were 3.9 and 3.5 per 1,000 discharged patients, respectively. Although the rates were increased accoding to patients' age, they were different by medical departments, showing the highest level in the ICU.
The fatality rate from nosocomial bloodstream infection in hospital K and hospital A were 12.5% and 21.8%, respectively. A distribution of etiologic agent of the nosocomial bloodstream infection in hospital K was 17 cases(21.8%) of Coagulase negative staphylococcus(CNS), 12 cases(15.0%) of Staphylococcus aureus and 8 cases(10.0%) of Enterococcus spp. For hospital A, it was 14 cases925.4%) of Coagulase negative taphylococcus(CNS), 9 cases(16.4%) of Staphylococcus aureus and 7 cases(12.7%) of Klebsiella pneumoniae. While risk factors of the nosocomial bloodstream infection edentified in hospital K were ICU, intracranial injury and hospitalization period, those for hospital A were a use of the central nenous tube, intracranial injury and hospitalization period.CONCLUSION It is expected that nosocomial bloodstream infection increases as aged group increases by the change of the population structure, as the usage of invasive instrument increases by development of new medical instrument as well as large scale hospitals. For these reasons, further studies developing countermeasures against nosocomial bloodstream infection are recommended.
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A Population-Based Case-Control Study on the Risk Factors of Congenital Heart Malformations.
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Soon Ho Soh, Byung Chul Chun, Soon Duck Kim, Bae Jung Yoon, Yong Tae Yum
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Korean J Epidemiol. 1999;21(2):234-247.
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The multifactorial hypothesis is proposed as a working hypothesis which encompass both the genetic and environmental factors known to participate in the etiology of congenital heart malformations. So, it is believed that avoidance of suspected environmental factors in early pregnancy is the most certain preventive measure of congenital heart malformations. This study has been undertaken in order to find the possible environmental risk factors for congenital heart malformations in Korea.
A total of 114 mothers of first graders of the elementary schools with congenital heart malformations confirmed through the screening program in Kyonggi Province from 1992 to 1995 were included as cases. And 206 mothers of healthy students matched by sex and elementary schools comprised the control group. Environmental risk factors including drug use during the first trimester of pregnancy, and other confounders were collected by telephone interview using standardized questionnaires by well trained interviewers.
The result of multivariate logistic regression analysis showed that congenital heart malformation were associated with family history of congenital heart malformations(OR=2.94, 95% CI: 1.08, 7.96), the order of birth(OR=0.49, 95% CI: 0.31, 0.79). And the coffee consumption over 14 cups/week during early pregnancy showed marginal significance(OR=3.52, 95%CI: 0.98, 12.62). The mother's age at the subject birth and father's smoking at home were significant in linear trend test(p<0.05). It is recommended that the genetic counselling and the avoidance of known environmental risk factors in early pregnancy were needed to prevent congenital heart malformations.
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Indigenous Malaria Surveillance in Korea.
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Dae Seong Kim, Soon Duck Kim, Yong Tae Yum, Chae Seung Lim, Kab Ro Lee, Mi Sook Park, Bae Jung Yoon
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Korean J Epidemiol. 1997;19(2):180-189.
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Malaria, one of the compulsory notifiable diseases, has been diappeared from Korea based on that fact no notification on malaria case was received from local health agencies during the last decade or so. Recently, Indigenous malaria has been re-emerged since 1993 and 549 cases was notificated till 1996. We conducted a surveillance system on the resurgent malaria outbreaks in the northern area of Kyonggi Province around the Imjin River. Malaria Surveillance Networks(MSNs) were established in Paju and Yoncheon between August 1996 and December 1996. When a febrile patient visits a clinic or a hospital, clinician takes a blood sample and refer to district malaria laboratory for the sample. The blood sample is examined in the malaria laboratory(public health center), and if malaria parasites are found, a radical or curative treatment is offered to patients. MSNs took 94 febrile cases and identified 23 malaria cases(24.5%). All malaria cases were infected by the indigenous vivax malaria. In Paju, 14 of 62 febrile cases(22.6%) were malaria outbreaks and 9 of 32 febrile cases(28.1%) in Yoncheon. In Korea resurgent malaria, malaria surveillance system should be operated for a program based on the district public health center with the coupled laboratory and dispensary.
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Cohort Study.
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Yong Tae Yum, Soon Duck Kim
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Korean J Epidemiol. 1994;16(1):116-135.
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The cohort study is an observational epidemiological study which selects the specific study population attempting to study the relatiqnship between an exposure to the purported cause and the subsequent risk of developing disease in accordance of time direction. Since Doll and Hill had studied the association between lung cancer and smoking behavior among the British medical doctors in the years of the last fifties, the defined group cohort studies analysing the relationship between an exposure and the occurence of a disease have become very popular. Cohort studies can be classified as either prospective or retrospective, depending on the temporal relationship between the initiation of the study and the occurence of the disease. Cohort studies are admitted as the very valuable studies for demonstrating the association between an exposure and a disease because it is possible to drive relative and attributable risks and often incidence measures. They can even examine multiple effects of a single exposure. However, they are usually expensive to carry out and large cohorts are required for rare diseases in addition to the time consum ing works. There are also very significant problems associated with selection of appropriate groups to be studied as far as complete ascertainment of disease occurence in them. Usually it is necessary that we must compromise to provide the opportunity for various types of bias such as selection bias, follow-up bias, information bias or misclassification, confounding bias and post hoc bias to occur which can result in incorrect conclusions. Only the success of a cohort study would be expected when the investigator pay the deep care in recognizing and correcting for these biases.
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