We investigated an outbreak of Acinetobacter baumannii in an intensive care unit and in the surgery, medicine, neurology, and urology wards of the Kosin University Gospel Hospital in Busan, Korea. The outbreak involved 36 cases of infection by A. baumannii producing the OXA-23 ␤-lactamase over an 8-month period and was caused by a single pulsed-field gel electrophoresis clone. The epidemic isolates were characterized by a modified cloverleaf synergy test. Isoelectric focusing of crude bacterial extracts detected one nitrocefin-positive band with a pI value of 6.65. PCR amplification and characterization of the amplicons by direct sequencing indicated that the epidemic isolates carried a bla OXA-23 determinant. The epidemic isolates were characterized by a multidrug resistance phenotype that remained unchanged over the outbreak, including penicillins, cephamycins, extended-spectrum cephalosporins, carbapenems, monobactams, and aminoglycosides. This study shows that the bla OXA-23 resistance determinant may become an emerging therapeutic problem.Acinetobacter baumannii has emerged as an important nosocomial pathogen in outbreaks of hospital infections and is ranked second after Pseudomonas aeruginosa among nosocomial pathogens of aerobic nonfermentative gram-negative bacilli (17,19). A. baumannii causes respiratory and urinary tract infections, meningitis, endocarditis, burn infections, and wound sepsis, especially in intensive care units (ICUs) (4). A. baumannii infections are often difficult to eradicate due to high-level resistance to many antibiotics as a result of both intrinsic and acquired mechanisms. ␤-Lactamase production is the most important mechanism of acquired ␤-lactam resistance in gram-negative pathogens (21). Carbapenems (e.g., imipenem and meropenem) have become the drugs of choice against Acinetobacter infections in many centers but are being compromised by the emergence of carbapenem-hydrolyzing ␤-lactamase (carbapenemase) of molecular classes B and D (14). Class B carbapenemases found thus far in Acinetobacter spp. include various IMP-and VIM-type metallo-␤-lactamases (http: //www.lahey.org/studies/webt.asp), but most Acinetobacter spp. produce zinc-independent members of ␤-lactamase molecular class D (1). Sequenced carbapenemases of this latter class from that species include the following two distinct clusters: (i) the OXA-23-like cluster (OXA-23 and -27) and (ii) the OXA-24-like cluster . OXA-23 and OXA-27 have 99% amino acid identity, whereas they have only 60% identity with those of OXA-24-like cluster (1,3,6,7).Over an 8-month period from January to August 2003, 193 A. baumannii isolates were isolated from 193 patients hospitalized at the Kosin University Gospel Hospital. The purpose of the present study was to investigate an outbreak of A. baumannii in Korea and to characterize the imipenem resistance mechanism of the outbreak isolates. MATERIALS AND METHODS Bacterial strains and susceptibility tests. A total of 193 nonrepetitive clinical isolates of A. baumannii were isolated from Ja...

Subarachnoid hemorrhage (SAH) induces an inflammatory reaction and may lead to ischemic brain damage. The pathogenesis of brain dysfunction and delayed ischemic symptoms remain difficult to understand despite extensive surveys of such reactions. Cytokine production in the central nervous system following SAH and its relation with clinical outcome have hardly been studied. This study was aimed to determine whether the levels of IL-1 , IL-6 and TNF-in the initial cerebrospinal fluid would increase following aneurysmal SAH, and be related with development of delayed ischemic deficit and clinical outcome. Nineteen patients suffering from aneurysmal SAH and 12 control volunteers were the subjects in this study. Cerebrospinal fluid samples were obtained on admission and the levels of each cytokine were determined with enzyme-linked immunosorbent assay. Patients with aneurysmal subarachnoid hemorrhage showed elevated levels of IL-1 ‚ and TNF-on admission. The patients with poor neurological status showed high levels of IL-1 ‚ and IL-6. The patients who developed delayed ischemic deficit had high level of IL-6. We suggest that elevated level of IL-6 in cerebrospinal fluid of patients with aneurysmal SAH on admission can predict the high risk of delayed ischemic deficit.

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A 41-yr-old man was admitted with acute headache, neck stiffness, and febrile sensation. Cerebrospinal fluid examination showed pleocytosis, an increased protein level and, a decreased glucose concentration. No organisms were observed on a culture study. An imaging study revealed pituitary macroadenoma with hemorrhage. On the 7th day of the attack, confusion, dysarthria, and right-sided facial paralysis and hemiparesis were noted. Cerebral infarction on the left basal ganglia was confirmed. Neurologic deficits gradually improved after removal of the tumor by endoscopic transnasal transsphenoidal approach. It is likely that the pituitary apoplexy, aseptic chemical meningitis, and cerebral infarction are associated with each other. This rare case can serve as a prime example to clarify the chemical characteristics of pituitary apoplexy.

There are debatable claims in the optimal approach for clipping of the anterior communicating artery (AcomA) aneurysm. The authors invented the superior orbital rim approach (SORA) as an alternative and minimally invasive approach for the treatment of AcomA aneurysm. The authors reviewed retrospectively all the medical records of 27 patients of subarachnoid hemorrhage due to ruptured AcomA aneurysm. who were admitted to Kosin University Gospel Hospital for last 2 yr. Fourteen women (51.9%) and 13 men (48.1%) were from 29 to 79 yr in age. The mean aneurysm size was 6.2 mm ranging from 4 to 12 mm. A favorable Glasgow outcome scale (GOS) of 4 or 5 was achieved in 92.6%, a GOS score of 3 in 3.7%, and 1 death (GOS 1) occurred in 3.7% of the patients. During the follow-up between 4 and 28 months (mean, 17.5 months) after the surgery, the prognosis of the patients and the cosmetic results were favorable compared with conventional approach. We became to believe that it was an alternative, effective and minimally invasive approach to the surgical treatment of AcomA aneurysm.