Journal List > Infect Chemother > v.42(6) > 1035037

The Korean Society of Infectious Diseases, Korean Society for Chemotherapy, and The Korean Society of Clinical Microbiology: Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections


There are many various diseases in the gastrointestinal infections, and we tried to make a diagnosis and treatment guideline for common diseases based on available diagnostic tools and antimicrobial susceptibility of major pathogens causing gastrointestinal infections in our country. This guideline was developed by the committee of Korean Society for Chemotherapy, and covers infectious diarrhea, antibiotic associated diarrhea, enteric fever, hepatobiliary infection, and complicated intraabdominal infection.


1. World Health Organization. World health report 2003: shaping the future. Geneva: WHO; 2003.
2. Korea Centers for Disease Control and Prevention. Water & foodborne diseases outbreaks in Korea, 2008. Public Health Wkly Rep. 2009; 2:584–590.
3. Cho SH, Shin HH, Choi YH, Park MS, Lee BK. Enteric bacteria isolated from acute diarrheal patients in the Republic of Korea between the year 2004 and 2006. J Microbiol. 2008; 46:325–330.
4. Lee JI, Park SH, Kim MS, Oh YH, Yu IS, Choi BH, Lee GC, Kim MS, Jang SY, Lee CH. Surveillance of acute gastroenteritis in Seoul, Korea, during May 2004 and June 2007. J Bacteriol Virol. 2009; 39:363–371.
5. Korea Centers for Disease Control and Prevention. The analysis on the prevalence status and characteristics of bacterial pathogens causing acute diarrhea in Korea, 2007. Public Health Wkly Rep. 2008; 1:116–122.
6. Lim HS. Contributing factors of infectious waterborne and foodborne outbreaks in Korea. J Korean Med Assoc. 2007; 50:582–591.
7. Joo HJ, Chung KH, Kim YM, Kim SG, Park MS, Chang JK, Shin SW. An outbreak of Yersinia pseudotuberculosis infection. J Korean Pediatr Soc. 1990; 33:342–350.
8. Shin HR, Suh BS, Song JB, Lee DH, Lee MB, Park JH, Kim MS, Shin YH, Lee SW, Ohrr HC. An epidemiologic investigation of typhoid fever outbreak in Pusan, 1996. Korean J Epidemiol. 1997; 19:122–130.
9. Lim HS, Jung C, Bae GR, Hur YJ, Lee SW, Jeong EK. Epidemiologic investigation of an outbreak of shigellosis in Kyongju, Korea. Korean J Prev Med. 2000; 33:1–9.
10. Park S, Kim SH, Kee HY, Seo JJ, Ha DR, Cho SH, Lee BK. Enterotoxigenic Escherichia coli outbreak in a high school. Infect Chemother. 2006; 38:30–38.
11. Min YS, Lim HS, Lee K, Lim SH, Lee BS. Epidemiologic investigation on an outbreak of shigellosis in Seongju-gun, Korea, 2003. J Prev Med Public Health. 2005; 38:189–196.
12. Lim HS, Min YS, Lee HS. Epidemiologic investigation on an outbreak of salmonellosis in Yeongcheon-si, 2004. J Prev Med Public Health. 2005; 38:457–464.
13. Kim KY, Lee HK, Cho SR. Pulsed-Field Gel Electrophoresis analysis of a Salmonella london outbreak in neontes. J Korean Soc Neonatol. 2001; 8:222–228.
14. Kim J, Kim S, Jeon S, Kang Y, Jeon D, Kim J, Lee B. The first outbreak of shigellosis caused by Shigella dysenteriae type 8 in Korea. Korean J Clin Microbiol. 2005; 8:153–159.
15. Jin SM, Lee TY. An epidemiological survey on the outbreak of cholera of overseas travelers in Daejeon. Korean J Epidemiol. 2006; 28:119–128.
16. Giannella RA, Broitman SA, Zamcheck N. Gastric acid barrier to ingested microorganisms in man: studies in vivo and in vitro. Gut. 1972; 13:251–256.
17. Rabbani GH, Albert MJ, Hamidur Rahman AS, Moyenul Isalm M, Nasirul Islam KM, Alam K. Short-chain fatty acids improve clinical, pathologic, and microbiologic features of experimental shigellosis. J Infect Dis. 1999; 179:390–397.
18. Donnelly MA, Steiner TS. Two nonadjacent regions in enteroaggregative Escherichia coli flagellin are required for activation of toll-like receptor 5. J Biol Chem. 2002; 277:40456–40461.
19. Lehrer RI, Lichtenstein AK, Ganz T. Defensins: antimicrobial and cytotoxic peptides of mammalian cells. Annu Rev Immunol. 1993; 11:105–128.
20. Jiang ZD, Okhuysen PC, Guo DC, He R, King TM, DuPont HL, Milewicz DM. Genetic susceptibility to enteroaggregative Escherichia coli diarrhea: polymorphism in the interleukin-8 promotor region. J Infect Dis. 2003; 188:506–511.
21. Jiang ZD, DuPont HL, Garey K, Price M, Graham G, Okhuysen P, Dao-Tran T, LaRocco M. A common polymorphism in the interleukin 8 gene promoter is associated with Clostridium difficile diarrhea. Am J Gastroenterol. 2006; 101:1112–1116.
22. Mohamed JA, DuPont HL, Jiang ZD, Belkind-Gerson J, Figueroa JF, Armitige LY, Tsai A, Nair P, Martinez-Sandoval FJ, Guo DC, Hayes P, Okhuysen PC. A novel single-nucleotide polymorphism in the lactoferrin gene is associated with susceptibility to diarrhea in North American travelers to Mexico. Clin Infect Dis. 2007; 44:945–952.
23. Lindesmith L, Moe C, Marionneau S, Ruvoen N, Jiang X, Lindblad L, Stewart P, LePendu J, Baric R. Human susceptibility and resistance to Norwalk virus infection. Nat Med. 2003; 9:548–555.
24. Farthing M, Lindberg G, Dite P, Khalif I, Salazar-Lindo E, Ramakrishna BS, Goh K, Thomson A, Khan AG. In: World Gastroenterology Organisation practice guideline: Acute diarrhea. 2008 March 2008.
25. Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, Hennessy T, Griffin PM, DuPont H, Sack RB, Tarr P, Neill M, Nachamkin I, Reller LB, Osterholm MT, Bennish ML, Pickering LK; Infectious Diseases Society of America. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001; 32:331–351.
26. Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. N Engl J Med. 2004; 350:38–47.
27. DuPont HL. Guidelines on acute infectious diarrhea in adults. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1997; 92:1962–1975.
28. Navaneethan U, Giannella RA. Mechanisms of infectious diarrhea. Nat Clin Pract Gastroenterol Hepatol. 2008; 5:637–647.
29. Wolf MK. Occurrence, distribution, and associations of O and H serogroups, colonization factor antigens, and toxins of enterotoxigenic Escherichia coli. Clin Microbiol Rev. 1997; 10:569–584.
30. Centers for Disease Control and Prevention. Foodborne outbreaks of enterotoxigenic Escherichia coli-Rhode Island and New Hampshire, 1993. MMWR Morb Mortal Wkly Rep. 1994; 43:81, 87–89.
31. Sánchez J, Holmgren J. Virulence factors, pathogenesis and vaccine protection in cholera and ETEC diarrhea. Curr Opin Immunol. 2005; 17:388–398.
32. Shogomori H, Futerman AH. Cholera toxin is found in detergent-insoluble rafts/domains at the cell surface of hippocampal neurons but is internalized via a raft-independent mechanism. J Biol Chem. 2001; 276:9182–9188.
33. Mourad FH, O\'Donnell LJ, Dias JA, Ogutu E, Andre EA, Turvill JL, Farthing MJ. Role of 5-hydroxytryptamine type 3 receptors in rat intestinal fluid and electrolyte secretion induced by cholera and Escherichia coli enterotoxins. Gut. 1995; 37:340–345.
34. Canani RB, De Marco G, Passariello A, Buccigrossi V, Ruotolo S, Bracale I, Porcaro F, Bifulco G, Guarino A. Inhibitory effect of HIV-1 Tat protein on the sodium-D-glucose symporter of human intestinal epithelial cells. AIDS. 2006; 20:5–10.
35. Griffin PM. Escherichia coli O157:H7 and other enterohemorrhagic E. coli. In: Blaser M, Smith PD, Ravdin JI, et al., editors. Infections of the Gastrointestinal tract. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2002. pp. 627-642.
36. Su C, Brandt LJ. Escherichia coli O157:H7 infection in humans. Ann Intern Med. 1995; 123:698–714.
37. Phalipon A, Sansonetti PJ. Shigellosis: innate mechanisms of inflammatory destruction of the intestinal epithelium, adaptive immune response, and vaccine development. Crit Rev Immunol. 2003; 23:371–401.
38. Giannella RA. Infectious enteritis and proctocolitis and food poisoning. In: Feldman M, Friedman LS, Sleisenger MH, editors. Sleisenger & Fordtran\'s gastrointestinal and liver disease. 8th ed. Philadelphia: Elsevier Saunders; 2006. pp. 2333-2391.
39. Grassl GA, Finlay BB. Pathogenesis of enteric Salmonella infections. Curr Opin Gastroenterol. 2008; 24:22–26.
40. Hickey TE, McVeigh AL, Scott DA, Michielutti RE, Bixby A, Carroll SA, Bourgeois AL, Guerry P. Campylobacter jejuni cytolethal distending toxin mediates release of interleukin-8 from intestinal epithelial cells. Infect Immun. 2000; 68:6535–6541.
41. DuPont HL. Clinical practice: bacterial diarrhea. N Engl J Med. 2009; 361:1560–1569.
42. Talan D, Moran GJ, Newdow M, Ong S, Mower WR, Nakase JY, Pinner RW, Slutsker L; EMERGEncy ID NET Study Group. Etiology of bloody diarrhea among patients presenting to United States emergency departments: prevalence of Escherichia coli O157:H7 and other enteropathogens. Clin Infect Dis. 2001; 32:573–580.
43. Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers\' diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg. 2009; 80:609–614.
44. DuPont HL, Ericsson CD, Farthing MJ, Gorbach S, Pickering LK, Rombo L, Steffen R, Weinke T. Expert review of the evidence base for self-therapy of travelers\' diarrhea. J Travel Med. 2009; 16:161–171.
45. DuPont HL, Jiang ZD, Okhuysen PC. A randomized, double-blind, placebo controlled trial of rifaximin to prevent travelers\' diarrhea. Ann Intern Med. 2005; 142:805–812. [Erratum in: Ann Intern Med 2005;143:239].
46. DuPont HL, Ericsson CD, Farthing MJ, Gorbach S, Pickering LK, Rombo L, Steffen R, Weinke T. Expert review of the evidence base for prevention of travelers\' diarrhea. J Travel Med. 2009; 16:149–160.
47. Kelly CP, LaMont JT. Clostridium difficile-more difficult than ever. N Engl J Med. 2008; 359:1932–1940.
48. Munoz C, Baqar S, van de Verg L, Thupari J, Goldblum S, Olson JG, Taylor DN, Heresi GP, Murphy JR. Characteristics of Shigella sonnei infection of volunteers: signs, symptoms, immune responses, changes in selected cytokines and acute-phase substances. Am J Trop Med Hyg. 1995; 53:47–54.
49. Marks MI, Pai CH, Lafleur L, Lackman L, Hammerberg O. Yersinia enterocolitica gastroenteritis: a prospective study of clinical bacteriologic and epidemiologic features. J Pediatr. 1980; 96:26–31.
50. Mikhail IA, Hyams KC, Podgore JK, Haberberger RL, Boghdadi AM, Mansour NS, Woody JN. Microbiologic and clinical study of acute diarrhea in children in Aswan, Egypt. Scand J Infect Dis. 1989; 21:59–65.
51. Speelman P, McGlaughlin R, Kabir I, Butler T. Differential clinical features and stool findings in shigellosis and amoebic dysentery. Trans Roy Soc Trop Med Hyg. 1987; 81:549–551.
52. Skirrow MB, Blaser MJ. Campylobacter jejuni. In: Blaser MJ, Smith PD, Ravdin JI, Greenberg HB, Guerrant RL, editors. Infections of the gastrointestinal tract. New York: Raven Press; 1995. pp. 825-848.
53. Rodrigue DC, Mast EE, Greene KD, Davis JP, Hutchinson MA, Wells JG, Barrett TJ, Griffin PM. A university outbreak of Escherichia coli O157:H7 infections associated with roast beef and an unusually benign clinical course. J Infect Dis. 1995; 172:1122–1125.
54. Stermer E, Lubezky A, Potasman I, Paster E, Lavy A. Is traveler\'s diarrhea a significant risk factor for the development of irritable bowel syndrome? A prospective study. Clin Infect Dis. 2006; 43:898–901.
55. Tam CC, Rodrigues LC, Petersen I, Islam A, Hayward A, O\'Brien SJ. Incidence of Guillain-Barré syndrome among patients with Campylobacter infection: a general practice research database study. J Infect Dis. 2006; 194:95–97.
56. Townes JM, Deodhar AA, Laine ES, Smith K, Krug HE, Barkhuizen A, Thompson ME, Cieslak PR, Sobel J. Reactive arthritis following culture-confirmed infections with bacterial enteric pathogens in Minnesota and Oregon: a population-based study. Ann Rheum Dis. 2008; 67:1689–1696.
57. Harris JC, Dupont HL, Hornick RB. Fecal leukocytes in diarrheal illness. Ann Intern Med. 1972; 76:697–703.
58. Guerrant RL, Wanke CA, Barrett LJ, Schwartzman JD. A cost effective and effective approach to the diagnosis and management of acute infectious diarrhea. Bull N Y Acad Med. 1987; 63:484–499.
59. Ethelberg S, Olsen KE, Gerner-Smidt P, Mølbak K. The significance of the number of submitted samples and patient-related factors for faecal bacterial diagnostics. Clin Microbiol Infect. 2007; 13:1095–1099.
60. Nalin DR, Cash RA, Islam R, Molla M, Phillips RA. Oral maintenance therapy for cholera in adults. Lancet. 1968; 2:370–373.
61. Duggan C, Santosham M, Glass RI. The management of acute diarrhea in children: oral rehydration, maintenance, and nutritional therapy. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1992; 41:1–20.
62. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ. 2001; 323:81–85.
63. New formula for oral rehydration salts will save millions of lives. World Health Organization. [Accessed 30 Sep 2010].
64. Lee JS. Management of acute infectious diarrhea. J Korean Med Assoc. 2007; 50:600–605.
65. Pai H. Acute infectious diarrhea. Korean J Med. 2007; 73:114–118.
66. Brown KH, Gastanaduy AS, Saavedra JM, Lembcke J, Rivas D, Robertson AD, Yolken R, Sack RB. Effect of continued oral feeding on clinical and nutritional outcomes of acute diarrhea in children. J Pediatr. 1988; 112:191–200.
67. Molla AM, Molla A, Nath SK, Khatun M. Food-based oral rehydration salt solution for acute childhood diarrhoea. Lancet. 1989; 2:429–431.
68. Duggan C, Nurko S. \"Feeding the gut\": the scientific basis for continued enteral nutrition during acute diarrhea. J Pediatr. 1997; 131:801–808.
69. Sandhu BK; European Society of Paediatric Gastroenterology, Hepatology, and Nutrition Working Group on Acute Diarrhoea. Rationale for early feeding in childhood gastroenteritis. J Pediatr Gastroenterol Nutr. 2001; 33 Suppl 2:S13–S16.
70. Adachi JA, Ostrosky-Zeichner L, DuPont HL, Ericsson CD. Empirical antimicrobial therapy for traveler\'s diarrhea. Clin Infect Dis. 2000; 31:1079–1083.
71. Zhang X, McDaniel AD, Wolf LE, Keusch GT, Waldor MK, Acheson DW. Quinolone antibiotics induce Shiga toxin-encoding bacteriophages, toxin production, and death in mice. J Infect Dis. 2000; 181:664–670.
72. Ohara T, Kojio S, Taneike I, Nakagawa S, Gondaira F, Tamura Y, Gejyo F, Zhang HM, Yamamoto T. Effects of azithromycin on shiga toxin production by Escherichia coli and subsequent host inflammatory response. Antimicrob Agents Chemother. 2002; 46:3478–3483.
73. Ochoa TJ, Chen J, Walker CM, Gonzales E, Cleary TG. Rifaximin does not induce toxin production or phage-mediated lysis of Shiga toxin-producing Escherichia coli. Antimicrob Agents Chemother. 2007; 51:2837–2841.
74. Tribble DR, Sanders JW, Pang LW, Mason C, Pitarangsi C, Baqar S, Armstrong A, Hshieh P, Fox A, Maley EA, Lebron C, Faix DJ, Lawler JV, Nayak G, Lewis M, Bodhidatta L, Scott DA. Traveler\'s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clin Infect Dis. 2007; 44:338–346.
75. Park EH, Kim JA, Choi SH, Bin JH, Cheigh HS, Suk DH, Lee SC, Kim YH. Isolation and antimicrobial susceptibility of Campylobacter jejuni from diarrhea patients. J Life Sci. 2007; 17:811–815.
76. Kim SM, Kim EC, Choi MR, So HA, Shim ES, Kim ES, Park SC, Seong CN, Chong Y. Cytolethal distending toxin production, genotypes and atimicrobial susceptibility of Campylobacter jejuni isolates from diarrhea patients and chickens. J Bacteriol Virol. 2008; 38:207–219.
77. Lee HJ. In: [ESBLsaengseong ijilgyun gamnyeomjeung jipdan balsaengui jeokjeonggwalli bangan maryeon]. KCDC; 2005.
78. KDCD. Epidemic of Extended-Spectrum β-Lactamase(ESBL)-producing Shigella sonnei. Commun Dis Mon Rep. 2005; 16:1–5.
79. KDCD. The present status of national antimicrobial resistance surveillance. Commun Dis Mon Rep. 2003; 14:273–282.
80. Das S, Saha R, Kaur IR. Trend of antibiotic resistance of Vibrio cholerae strains from East Delhi. Indian J Med Res. 2008; 127:478–482.
81. Oh BY, Kim JH, Gong YW, Kim HY, Lee MY, Koh YJ, Hwang KW, Jegal S, Lee JM. The trend of antimicrobial resistance of Escherichia coli isolated from healthy volunteers of community and hospital patients in Incheon. Korean J Microbiol. 2006; 42:252–256.
82. Spruill WJ, Wade WE. Diarrhea, constipation, and irritable bowel syndrome. In: Joseph TD, Robert LT, Gary CY, Gary RM, Barbara GW, Micheal L, editors. Pharmacotherapy a pathophysiologic approach. 7th ed. New York: McGraw Hill Medical; 2007. pp. 617-623.
83. Wang HH, Shieh MJ, Liao KF. A blind, randomized comparison of racecadotril and loperamide for stopping acute diarrhea in adults. World J Gastroenterol. 2005; 11:1540–1543.
84. Szajewska H, Skorka A, Dylag M. Meta-analysis: Saccharomyces boulardii for treating acute diarrhoea in children. Aliment Pharmacol Ther. 2007; 25:257–264.
85. Van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002; 109:678–684.
86. Floch MH, Walker WA, Guandalini S, Hibberd P, Gorbach S, Surawicz C, Sanders ME, Garcia-Tsao G, Quigley EM, Isolauri E, Fedorak RN, Dieleman LA. Recommendations for probiotic use--2008. J Clin Gastroenterol. 2008; 42 Suppl 2:S104–S108.
87. McFarland LV, Surawicz CM, Greenberg RN, Elmer GW, Moyer KA, Melcher SA, Bowen KE, Cox JL. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am J Gastroenterol. 1995; 90:439–448.
88. Bartlett JG. Antibiotic-associated diarrhea. Clin Infect Dis. 1992; 15:573–581.
89. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002; 346:334–339.
90. Song HJ, Shim KN, Jung SA, Choi HJ, Lee MA, Ryu KH, Kim SE, Yoo K. Antibiotic-associated diarrhea: candidate organisms other than Clostridium difficile. Korean J Intern Med. 2008; 23:9–15.
91. Bartlett JG. Clostridium difficile: clinical considerations. Rev Infect Dis. 1990; 12 Suppl 2:S243–S251.
92. Kelly CP, Pothoulakis C, LaMont JT. Clostridium difficile colitis. N Engl J Med. 1994; 330:257–262.
93. Hookman P, Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol. 2009; 15:1554–1580.
94. Tae CH, Jung SA, Song HJ, Kim SE, Choi HJ, Lee M, Hwang Y, Kim H, Lee K. The first case of antibiotic-associated colitis by Clostridium difficile PCR ribotype 027 in Korea. J Korean Med Sci. 2009; 24:520–524.
95. Byun TJ, Han DS, Ahn SB, Cho HS, Kim TY, Eun CS, Jeon YC, Sohn JH, Kang JO. Clinical characteristics and changing epidemiology of Clostridium difficile associated disease (CDAD). Korean J Gastroenterol. 2009; 54:13–19.
96. Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. 1997; 92:739–750.
97. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31:431–455.
98. Olson MM, Shanholtzer CJ, Lee JT Jr, Gerding DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol. 1994; 15:371–381.
99. Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN. Nosocomial Clostridium difficile colonisation and diseases. Lancet. 1990; 336:97–100.
100. Samore MH, DeGirolami PC, Tlucko A, Lichtenberg DA, Melvin ZA, Karchmer AW. Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clin Infect Dis. 1994; 18:181–187.
101. Pépin J, Routhier S, Gagnon S, Brazeau I. Management and outcomes of a first recurrence of Clostridium difficile-associated disease in Quebec, Canada. Clin Infect Dis. 2006; 42:758–764.
102. Lee KS, Shin WG, Jang MK, Kim HS, Kim HS, Park CJ, Lee JY, Kim KH, Park JY, Lee JH, Kim HY, Cho SJ, Yoo JY. Who are susceptible to pseudomembranous colitis among patients with presumed antibiotic-associated diarrhea? Dis Colon Rectum. 2006; 49:1552–1558.
103. Gerding DN. Diagnosis of Clostridium difficile-associated disease: patient selection and test perfection. Am J Med. 1996; 100:485–486.
104. Aichinger E, Schleck CD, Harmsen WS, Nyre LM, Patel R. Nonutility of repeat laboratory testing for detection of Clostridium difficile by use of PCR or enzyme immunoassay. J Clin Microbiol. 2008; 46:3795–3797.
105. Lyras D, O\'Connor JR, Howarth PM, Sambol SP, Carter GP, Phumoonna T, Poon R, Adams V, Vedantam G, Johnson S, Gerding DN, Rood JI. Toxin B is essential for virulence of Clostridium difficile. Nature. 2009; 458:1176–1179.
106. Shin BM, Kuak EY, Yoo SJ, Shin WC, Yoo HM. Emerging toxin A-B+ variant strain of Clostridium difficile responsible for pseudomembranous colitis at a tertiary care hospital in Korea. Diagn Microbiol Infect Dis. 2008; 60:333–337.
107. Shin BM, Kuak EY, Yoo HM, Kim EC, Lee K, Kang JO, Whang DH, Shin JH. Multicentre study of the prevalence of toxigenic Clostridium difficile in Korea: results of a retrospective study 2000-2005. J Med Microbiol. 2008; 57:697–701.
108. Bouza E, Muñoz P, Alonso R. Clinical manifestations, treatment and control of infections caused by Clostridium difficile. Clin Microbiol Infect. 2005; 11 Suppl 4:57–64.
109. Reller ME, Lema CA, Perl TM, Cai M, Ross TL, Speck KA, Carroll KC. Yield of stool culture with isolate toxin testing versus a two-step algorithm including stool toxin testing for detection of toxigenic Clostridium difficile. J Clin Microbiol. 2007; 45:3601–3605.
110. Shin BM, Kuak EY, Lee EJ, Songer JG. Algorithm combining toxin immunoassay and stool culture for diagnosis of Clostridium difficile infection. J Clin Microbiol. 2009; 47:2952–2956.
111. Kim SH, Jung SH, Lee YJ, Hyeon WJ, Yoo YW, Lee HI, Yang HW, Kim A, Cha SW. The role of flexible sigmoidoscopy in the diagnosis of Clostridium difficile-associated diarrhea. Korean J Med. 2010; 78:318–324.
112. Modena S, Gollamudi S, Friedenberg F. Continuation of antibiotics is associated with failure of metronidazole for Clostridium difficile-associated diarrhea. J Clin Gastroenterol. 2006; 40:49–54.
113. Nelson R. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev. 2007; CD004610.
114. Park HS, Han DS. Management of antibiotics-associated diarrhea. Korean J Gastroenterol. 2009; 54:5–12.
115. Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, Bourgault AM, Nguyen T, Frenette C, Kelly M, Vibien A, Brassard P, Fenn S, Dewar K, Hudson TJ, Horn R, René P, Monczak Y, Dascal A. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005; 353:2442–2449.
116. Pépin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, Pépin K, Chouinard D. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004; 171:466–472.
117. Miller M, Gravel D, Mulvey M, Taylor G, Boyd D, Simor A, Gardam M, McGeer A, Hutchinson J, Moore D, Kelly S. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010; 50:194–201.
118. Teasley DG, Gerding DN, Olson MM, Peterson LR, Gebhard RL, Schwartz MJ, Lee JT Jr. Prospective randomised trial of metronidazole versus vancomycin for Clostridium-difficile-associated diarrhoea and colitis. Lancet. 1983; 2:1043–1046.
119. Wenisch C, Parschalk B, Hasenhündl M, Hirschl AM, Graninger W. Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis. 1996; 22:813–818.
120. Anonymous. Recommendations for preventing the spread of vancomycin resistance: recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 1995; 44:1–13.
121. Musher DM, Aslam S, Logan N, Nallacheru S, Bhaila I, Borchert F, Hamill RJ. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis. 2005; 40:1586–1590.
122. Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, Godin D, Bourassa C. Increasing risk of relapse after treatment Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis. 2005; 40:1591–1597.
123. Aslam S, Hamill RJ, Musher DM. Treatment of Clostridium difficile-associated disease: old therapies and new strategies. Lancet Infect Dis. 2005; 5:549–557.
124. Wilcox MH, Howe R. Diarrhea caused by Clostridium difficile: response time for treatment with metronidazole and vancomycin. J Antimicrob Chemother. 1995; 36:673–679.
125. Zar FA, Bakkanagari SR, Moorthi KM, Davis MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007; 45:302–307.
126. Apisarnthanarak A, Razavi B, Mundy LM. Adjunctive intracolonic vancomycin for severe Clostridium difficile colitis: case series and review of the literature. Clin Infect Dis. 2002; 35:690–696.
127. Lamontagne F, Labbé AC, Haeck O, Lesur O, Lalancette M, Patino C, Leblanc M, Laverdière M, Pépin J. Impact of emergency colectomy on survival of patients with fulminant Clostridium difficile colitis during an epidemic caused by a hypervirulent strain. Ann Surg. 2007; 245:267–272.
128. Longo WE, Mazuski JE, Virgo KS, Lee P, Bahadursingh AN, Johnson FE. Outcome after colectomy for Clostridium difficile colitis. Dis Colon Rectum. 2004; 47:1620–1626.
129. Nair S, Yadav D, Corpuz M, Pitchumoni CS. Clostridium difficile colitis: factors influencing treatment failure and relapse-a prospective evaluation. Am J Gastroenterol. 1998; 93:1873–1876.
130. Kyne L, Warny M, Qamar A, Kelly CP. Association between antibody response to toxin A and protection against recurrent Clostridium difficile diarrhoea. Lancet. 2001; 357:189–193.
131. Kapoor K, Chandra M, Nag D, Paliwal JK, Gupta RC, Saxena RC. Evaluation of metronidazole toxicity: a prospective study. Int J Clin Pharmacol Res. 1999; 19:83–88.
132. McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol. 2002; 97:1769–1775.
133. McPherson S, Rees CJ, Ellis R, Soo S, Panter SJ. Intravenous immunoglobulin for the treatment of severe, refractory, and recurrent Clostridium difficile diarrhea. Dis Colon Rectum. 2006; 49:640–645.
134. Tielman NM, Crump JA, Guerrant RL. Enteric fever and other causes of abdominal symptoms with fever. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett\'s Principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone Elsevier; 2010. pp. 1399-1405.
135. Pai H. The Korean Society of Infectious Diseases. In: Infectious Diseases. 1st ed. Seoul: Koonja; 2007. Salmonella and Shigella infections; pp. 423-433.
136. Yoo S, Pai H, Byeon JH, Kang YH, Kim S, Lee BK. Epidemiology of Salmonella enterica serotype Typhi infections in Korea for recent 9 years: trends of antimicrobial resistance. J Korean Med Sci. 2004; 19:15–20.
137. Lee K, Yong D, Yum JH, Lim YS, Kim HS, Lee BK, Chong Y. Emergence of multidrug-resistant Salmonella enterica serovar Typhi in Korea. Antimicrob Agents Chemother. 2004; 48:4130–4135.
138. Lim HS. Changing patterns of communicable diseases in Korea. J Prev Med Public Health. 2005; 38:117–124.
140. Seo S, Lee MA. The serogroup and antimicrobial resistance of Salmonella spp. isolated from the clinical specimens during 6 years in a tertiary university hospital. Korean J Clin Microbiol. 2004; 7:72–76.
141. Park JE, Chung MH, Lee JS, Kim JJ. An imported case of typhoid fever refractory to ciprofloxacin treatment. Infect Chemother. 2007; 39:46–49.
142. Kim DB, Kim SH, Oh SJ, Kim DK, Choi SM, Kim M, Shin WS. Three cases of ciprofloxacin treatment failure in imported typhoid fever. Korean J Med. 2009; 77:377–381.
143. Lee KS, Lee HY, Jeon EJ, Chung JW. A case of typhoid fever to failed ciprofloxacin, infected in Korea. Infect Chemother. 2008; 40:175–178.
144. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twentieth informational supplement. M100-S20. Wayne, PA: CLSI; 2010.
145. Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet. 2005; 366:749–762.
146. Rahman M, Siddique AK, Shoma S, Rashid H, Salam MA, Ahmed QS, Nair GB, Breiman RF. Emergence of multidrug-resistant Salmonella enterica serotype Typhi with decreased ciprofloxacin susceptibility in Bangladesh. Epidemiol Infect. 2006; 134:433–438.
147. Ray P, Sharma J, Marak RS, Garg RK. Predictive efficacy of nalidixic acid resistance as a marker of fluoroquinolone resistance in Salmonella enterica var Typhi. Indian J Med Res. 2006; 124:105–108.
148. Crump JA, Barrett TJ, Nelson JT, Angulo FJ. Reevaluating fluoroquinolone breakpoints for Salmonella enterica serotype Typhi and for non-Typhi salmonellae. Clin Infect Dis. 2003; 37:75–81.
149. Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002; 347:1770–1782.
150. Shukla S, Patel B, Chitnis DS. 100 years of Widal test and its reappraisal in an endemic area. Indian J Med Res. 1997; 105:53–57.
151. Lee CK, Lee S, Choi JK, Lee ST. Usefulness of Widal test in the diagnosis of typhoid fever. Korean J Infect Dis. 2001; 33:206–209.
152. Gotuzzo E, Carrillo C. Quinolones in typhoid fever. Infect Dis Clin Pract. 1994; 3:345–351.
153. White NJ, Parry CM. The treatment of typhoid fever. Curr Opin Infect Dis. 1996; 9:298–302.
154. Rupali P, Abraham OC, Jesudason MV, John TJ, Zachariah A, Sivaram S, Mathai D. Treatment failure in typhoid fever with ciprofloxacin susceptibile Salmonella enterica serotype Typhi. Diagn Microbiol Infect Dis. 2004; 49:1–3.
155. Crump JA, Kretsinger K, Gay K, Hoekstra RM, Vugia DJ, Hurd S, Segler SD, Megginson M, Luedeman LJ, Shiferaw B, Hanna SS, Joyce KW, Mintz ED, Angulo FJ; Emerging Infections Program FoodNet and NARMS Working Groups. Clinical response and outcome of infection with Salmonella enterica serotype Typhi with decreased susceptibility to fluoroquinolones: a United States foodnet multicenter retrospective cohort study. Antimicrob Agents Chemother. 2008; 52:1278–1284.
156. Threlfall EJ, Ward LR, Skinner JA, Smith HR, Lacey S. Ciprofloxacin-resistant Salmonella typhi and treatment failure. Lancet. 1999; 353:1590–1591.
157. Chinh NT, Parry CM, Ly NT, Ha HD, Thong MX, Diep TS, Wain J, White NJ, Farrar JJ. A randomized controlled comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid-resistant enteric fever. Antimicrob Agents Chemother. 2000; 44:1855–1859.
158. Effa EE, Bukirwa H. Azithromycin for treating uncomplicated typhoid and paratyphoid fever (enteric fever). Cochrane Database Syst Rev. 2008; CD006083.
159. Parry CM, Ho VA, Phuong le T, Bay PV, Lanh MN, Tung le T, Tham NT, Wain J, Hien TT, Farrar JJ. Randomized controlled comparison of ofloxacin, azithromycin, and an ofloxacin-azithromycin combination for treatment of multidrug-resistant and nalidixic acid-resistant typhoid fever. Antimicrob Agents Chemother. 2007; 51:819–825.
160. Thaver D, Zaidi AK, Critchley J, Azmatullah A, Madni SA, Bhutta ZA. A comparison of fluoroquinolones versus other antibiotics for treating enteric fever: meta-analysis. BMJ. 2009; 338:b1865.
161. Thaver D, Zaidi AK, Critchley JA, Azmatullah A, Madni SA, Bhutta ZA. Fluoroquinolone for treating typhoid and paratyphoid fever (enteric fever). Cochrane Database Syst Rev. 2008; CD004530.
162. Bhutta ZA. Quinolone-resistant Salmonella paratyphi B meningitis in a newborn: a case report. J Infect. 1997; 35:308–310.
163. Girgis NI, Sultan Y, Hammad O, Farid Z. Comparison of the efficacy, safety and cost of cefixime, ceftriaxone and aztreonam in the treatment of multidrug-resistant Salmonella typhi septicemia in children. Pediatr Infect Dis J. 1995; 14:603–605.
164. Mandal S, Mandal M, Pal NK. In vitro efficacy of ciprofloxacin alone and in combination with amoxicillin against Salmonella typhi isolates. Indian J Exp Biol. 2003; 41:360–362.
165. Mandal S, Mandal MD, Pal NK. Combination effect of ciprofloxacin and gentamicin against clinical isolates of Salmonella enterica serovar Typhi with reduced susceptibility to ciprofloxacin. Jpn J Infect Dis. 2003; 56:156–157.
166. Kim DM, Yun NR, Chung JH, Ryu HH. Time kill studies of antibiotics against a nalidixic acid resistant Salmonella enterica serotype Typhi. Infect Chemother. 2008; 40:207–211.
167. Dutta P, Mitra U, Dutta S, De A, Chatterjee MK, Bhattacharya SK. Ceftriaxone therapy in ciprofloxacin treatment failure typhoid fever in children. Indian J Med Res. 2001; 113:210–213.
168. Punjabi NH, Hoffman SL, Edman DC, Sukri N, Laughlin LW, Pulungsih SP, Rivai AR, Moechtar A, Woodward TE. Treatment of severe typhoid fever in children with high dose dexamethasone. Pediatr Infect Dis J. 1988; 7:598–600.
169. Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR, Rockhill RC, Woodward TE, Loedin AA. Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. N Engl J Med. 1984; 310:82–88.
170. Rogerson SJ, Spooner VJ, Smith TA, Richens J. Hydrocortisone in chloramphenicol-treated severe typhoid fever in Papua New Guinea. Trans R Soc Trop Med Hyg. 1991; 85:113–116.
171. Wain J, Hien TT, Connerton P, Ali T, Parry CM, Chinh NT, Vinh H, Phuong CX, Ho VA, Diep TS, Farrar JJ, White NJ, Dougan G. Molecular typing of multiple-antibiotic-resistant Salmonella enterica serovar Typhi from Vietnam: application to acute and relapse cases of typhoid fever. J Clin Microbiol. 1999; 37:2466–2472.
172. Ferreccio C, Morris JG Jr, Valdivieso C, Prenzel I, Sotomayor V, Drusano GL, Levine MM. Efficacy of ciprofloxacin in the treatment of chronic typhoid carriers. J Infect Dis. 1988; 157:1235–1239.
173. Gotuzzo E, Guerra JG, Benavente L, Palomino JC, Carrillo C, Lopera J, Delgado F, Nalin DR, Sabbaj J. Use of norfloxacin to treat chronic typhoid carriers. J Infect Dis. 1988; 157:1221–1225.
174. Hosoglu S, Aldemir M, Akalin S, Geyik MF, Tacyildiz IH, Loeb M. Risk factors for enteric perforation in patients with typhoid Fever. Am J Epidemiol. 2004; 160:46–50.
175. Hwang JW, Lee HM, Han DH, Oh JE, Ha JS, Cho DH, Shim SG. A case of typhoid fever with manifestations of acute hepatitis. Korean J Med. 2008; 75:77–81.
176. Han BH, Cho DW, Jun TH, Ju GJ, Lee JG, Lee JS, Song GY. A case of typhoid fever complicated with pleurisy and hepatitis. Korean J Med. 2003; 65 Suppl 3:S717–S720.
177. Lee JD, Myung SJ, Kim HR, Cho YB, Choi MJ, Kim TH, Kwon KH, Kim JW, Park YS, Moon YS. A case of icteric typhoid hepatitis complicated with splenic infarction. Korean J Gastroenterol. 2000; 35:801–805.
178. Cho DG, Jo MS, Cho KD, Song SH, Kim CH, Lee SH. Empyema and pericarditis by Salmonella group D complicating malignant thymoma with pleural metastasis: a case report. Korean J Thorac Cardiovasc Surg. 2004; 37:382–385.
179. Jean K, Kwon NH, Chang HH, Jung SI, Oh WS, Kim S, Park KR, Song JH. A case of typhoid fever complicated with meningitis, cervical spondylitis and epidural abscess. Infect Chemother. 2003; 35:53–56.
180. Rim MS, Park CM, Ko KH, Lim SC, Park KO. Pleural empyema due to Salmonella: a case report. Korean J Intern Med. 2000; 15:138–141.
181. Han SW, Yoo JH, Kwon SS, Kim SH, Park JC, Hong EJ, Choi GS, Park YW, Chang CH, An JW, Park YK, Kang JY, Park SM, Shin WS. A case of typhoid fever complicated with massive fatal hemoptysis. Infect Chemother. 2004; 36:326–329.
182. Choi JW, Choi SJ, Kwon HC, Cheong JY, Lee KM, Yoo BM, Hahm KB, Kim JH, Cho SW. A case of Salmonella liver abscess. Korean J Gastroenterol. 2006; 47:316–319.
183. Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med. 2008; 358:2804–2811.
184. Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, Hirota M, Nagino M, Tsuyuguchi T, Mayumi T, Yoshida M, Strasberg SM, Pitt HA, Belghiti J, de Santibanes E, Gadacz TR, Gouma DJ, Fan ST, Chen MF, Padbury RT, Bornman PC, Kim SW, Liau KH, Belli G, Dervenis C. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:27–34.
185. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, Büchler MW, Belghiti J, de Santibanes E, Gouma DJ, Neuhaus H, Dervenis C, Fan ST, Chen MF, Ker CG, Bornman PC, Hilvano SC, Kim SW, Liau KH, Kim MH. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:52–58.
186. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, O\'Neill PJ, Chow AW, Dellinger EP, Eachempati SR, Gorbach S, Hilfiker M, May AK, Nathens AB, Sawyer RG, Bartlett JG. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50:133–164.
187. Tanaka A, Takada T, Kawarada Y, Nimura Y, Yoshida M, Miura F, Hirota M, Wada K, Mayumi T, Gomi H, Solomkin JS, Strasberg SM, Pitt HA, Belghiti J, de Santibanes E, Padbury R, Chen MF, Belli G, Ker CG, Hilvano SC, Fan ST, Liau KH. Antimicrobial therapy for acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:59–67.
188. Kim J, Ihm C. Usefulness of bile cultures and predictive factors for bacteriobilia in percutaneous cholecystostomy in patients with acute cholecystitis. Korean J Lab Med. 2007; 27:281–285.
189. Ko SH, Moon JH, Lee BD. Clinical analysis of cholecystitis: acalculous cholecystitis compared to calculous cholecystitis. J Korean Surg Soc. 2002; 62:249–258.
190. Gastrointestinal imaging; right upper quadrant pain. American College of Radiology Committee on Appropriateness Criteria. [Accessed 30 Sep 2010]. Available at:
191. Ahn BY, Yun YK, Whang YJ, Jun SH, Yu WS, Lee JB. A clinical analysis of acaluclous cholecystitis. J Korean Surg Soc. 1997; 53:579–587.
192. Sung IK, Lee KT, Lee JK, Kim YH, Lee SH, Son HJ, Lee JH, Lyul P, Kim JJ, Koh KC, Paik SW, Rhee JC, Choi KW, Choi SH, Kim YI. Bacteriological study of bile in patients with cholangitis due to biliary tract obstruction. Korean J Med. 1998; 55:28–32.
193. Marne C, Pallarés R, Martín R, Sitges-Serra A. Gangrenous cholecystitis and acute cholangitis associated with anaerobic bacteria in bile. Eur J Clin Microbiol. 1986; 5:35–39.
194. Laterre PF, Colardyn F, Delmée M, De Waele J, Legrand JC, Van Eldere J, Vergison A, Vogelaers D; IDAB. Antimicrobial therapy for intra-abdominal infections: guidelines from the Infectious Disease Advisory Board (IDAB). Acta Chir Belg. 2006; 106:2–21.
195. Antimicrobial resistance newsletter. 2009. WHO network on antimicrobial resistance monitoring: Korean focal and core laboratory.
196. Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK; Active Bacterial Core surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007; 298:1763–1771.
197. Sifri CD, Madoff LA. Infections of the liver and biliary system. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett\'s principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier Churchill Livingston; 2005. pp. 1035-1044.
198. UK Working Party on Acute Pancreatitis. UK guidelines for the management of acute pancreatitis. Gut. 2005; 54:iii1–iii9.
199. Dervenis C, Johnson CD, Bassi C, Bradley E, Imrie CW, McMahon MJ, Modlin I. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference. Int J Pancreatol. 1999; 25:195–210.
200. American Gastroenterological Association (AGA) Institute on \"Management of Acute Pancreatits\" Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA Institute medical position statement on acute pancreatitis. Gastroenterology. 2007; 132:2019–2021.
201. Kim TH. Medical management of acute pancreatitis. Korean J Med. 2008; 75:280–284.
202. Lee SK. Medical treatments of necrotizing pancreatitis. Korean J Med. 2007; 73:237–242.
203. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993; 128:586–590.
204. Villatoro E, Bassi C, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev. 2006; CD002941.
205. Sharma VK, Howden CW. Prophylactic antibiotic administration reduces sepsis and mortality in acute necrotizing pancreatitis: a meta-analysis. Pancreas. 2001; 22:28–31.
206. Lumsden A, Bradley EL 3rd. Secondary pancreatic infections. Surg Gynecol Obstet. 1990; 170:459–467.
207. Räty S, Sand J, Nordback I. Difference in microbes contaminating pancreatic necrosis in biliary and alcoholic pancreatitis. Int J Pancreatol. 1998; 24:187–191.
208. Baron MJ, Madoff LC. Pancreatic infection. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett\'s principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier Churchill Livingston; 2005. pp. 1045-1053.
209. Büchler M, Malfertheiner P, Friess H, Isenmann R, Vanek E, Grimm H, Schlegel P, Friess T, Beger HG. Human pancreatic tissue concentration of bactericidal antibiotics. Gastroenterology. 1992; 103:1902–1908.
210. Ratschko M, Fenner T, Lankisch PG. The role of antibiotic prophylaxis in the treatment of acute pancreatitis. Gastroenterol Clin North Am. 1999; 28:641–659.
211. Ha J, Choi SP, Lee WH, Yoo SS, Kim HJ, Kim TH, Lee OJ. A clinical study on pyogenic liver abscesses: the changes in the clinical features during the recent 12 years. Korean J Med. 2008; 74:37–50.
212. Lok KH, Li KF, Li KK, Szeto ML. Pyogenic liver abscess: clinical profile, microbiological characteristics, and management in a Hong Kong hospital. J Microbiol Immunol Infect. 2008; 41:483–490.
213. Nah BK, Kim YS, Moon HS, Park KO, Kim SM, Lee YS, Yang HW, Seo SW, Kim SH, Lee BS, Kim NJ, Lee HY. Recent changes of organism and treatment in pyogenic liver abscess. Korean J Hepatol. 2003; 9:275–283.
214. Acute abdominal pain and fever or suspected abdominal abscess. American College of Radiology Committee on Appropriateness Criteria®. [Accessed 30 Sep 2010]. Available at:
215. Lee OJ, Kim YC. A clinical study on liver abscess. Korean J Gastroenterol. 1994; 26:506–520.
216. Pitt HA, Zuidema GD. Factors influencing mortality in the treatment of pyogenic hepatic abscess. Surg Gynecol Obstet. 1975; 140:228–234.
217. Aucott JN, Ravdin JI. Amebiasis and \"nonpathogenic\" intestinal protozoa. Infect Dis Clin North Am. 1993; 7:467–485.
218. Oh YJ, Min PC. Clinical study of liver abscess. J Korean Surg Soc. 1976; 18:13–22.
219. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004; 39:1654–1659.
220. Wie SH, Chang UI, Kim JD, Lee JR, Paik CN, Chung WC, Lee KM, Yang JM. Clinical features of 141 cases of pyogenic liver abscess over a 10-year period and antibiotic sensitivity to the causative organisms. Infect Chemother. 2008; 40:199–206.
221. Kim DW, Han SP, Kim SJ, Cha BK, Ann GY, Jung SM, Kim SM, Do JH, Kim JG, Chang SK, Park SM. A clinical study on liver abscess over a recent 10-year period. Korean J Med. 2004; 66:478–486.
222. Seo TJ, Park CH, Lee SH, Lee SJ, Park JH, Park JH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Kim SJ. A clinical study on liver abscess fro recent 15 years in Gwangju-Chonnam province. Korean J Med. 2005; 68:26–38.
223. Jin HY, Lee S, Park JH, Choi EG, Lee HB, Lee ST, Ahn DS. Comparison of pyogenic liver abscesses caused by Klebsiella pneumoniae and non-K. pneumoniae pathogens. Korean J Infect Dis. 2001; 33:202–205.
224. Cheng HP, Siu LK, Chang FY. Extended-spectrum cephalosporin compared to cefazolin for treatment of Klebsiella pneumoniae-caused liver abscess. Antimicrob Agents Chemother. 2003; 47:2088–2092.
225. Lee SS, Chen YS, Tsai HC, Wann SR, Lin HH, Huang CK, Liu YC. Predictors of septic metastatic infection and mortality among patients with Klebsiella pneumoniae liver abscess. Clin Infect Dis. 2008; 47:642–650.
226. Yoo HM, Kim WH, Shin SK, Chun WH, Kang JK, Park IS. The changing patterns of liver abscess during the past 20 years: a study of 482 cases. Yonsei Med J. 1993; 34:340–351.
227. Kim SB, Moon SE. A clinical study on liver abscess. J Korean Surg Soc. 1992; 43:691–698.
228. Neuschwander-Tetri BA. Bacterial, parasitic, fungal, and granulomatous liver diseases. In: Goldman L, Ausiello D, editors. Cecil Medicine. 23rd ed. Philadelphia: Saunders; 2007. pp. 1128-1135.
229. Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr. Amebiasis. N Engl J Med. 2003; 348:1565–1573.
230. Stanley SL Jr. Amoebiasis. Lancet. 2003; 361:1025–1034.
231. Aucott JN, Ravdin JI. Amebiasis and \"nonpathogenic\" intestinal protozoa. Infect Dis Clin North Am. 1993; 7:467–485.
232. Miller RA, Jong EC. Amebiasis, giardiasis, and other intestinal protozoal infections. In: Jong EC, McMullen R, editors. The travel & tropical medicine manual. 2nd ed. Philadelphia: WB Saunders; 1995. pp. 325-341.
233. Tan YM, Chung AY, Chow PK, Cheow PC, Wong WK, Ooi LL, Soo KC. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm. Ann Surg. 2005; 241:485–490.
234. Hope WW, Vrochides DV, Newcomb WL, Mayo-Smith WW, Iannitti DA. Optimal treatment of hepatic abscess. Am Surg. 2008; 74:178–182.
235. Zerem E, Hadzic A. Sonographically guided percutaneous cahtheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol. 2007; 189:W138–W142.
236. Giorgio A, de Stefano G, Di Sarno A, Liorre G, Ferraioli G. Percutaneous needle aspiration of multiple pyogenic abscesses of the liver: 13-year single-center experience. AJR Am J Roentgenol. 2006; 187:1585–1590.
237. Barakate MS, Stephen MS, Waugh RC, Gallagher PJ, Solomon MJ, Storey DW, Sheldon DM. Pyogenic liver abscess: a review of 10 years\' experience in management. Aust N Z J Surg. 1999; 69:205–209.
238. Ch Yu S, Hg Lo R, Kan PS, Metreweli C. Pyogenic liver abscess: treatment with needle aspiration. Clin Radiol. 1997; 52:912–916.
239. Giorgio A, Tarantino L, Mariniello N, Francica G, Scala E, Amoroso P, Nuzzo A, Rizzatto G. Pyogenic liver abscesses: 13 years of experience in percutaneous needle aspiration with US guidance. Radiology. 1995; 195:122–124.
240. Chavez-Tapia NC, Hernandez-Calleros J, Tellez-Avila FI, Torre A, Uribe M. Image-guided percutaneous procedure plus metronidazole versus metronidazole alone for uncomplicated amoebic liver abscess. Cochrane Database Syst Rev. 2009; CD004886.
241. Sharma MP, Rai RR, Acharya SK, Ray JC, Tandon BN. Needle aspiration of amoebic liver abscess. BMJ. 1989; 299:1308–1309.
242. Van Allan RJ, Katz MD, Johnson MB, Laine LA, Liu Y, Ralls PW. Uncomplicated amebic liver abscess: prospective evaluation of percutaneous therapeutic aspiration. Radiology. 1992; 183:827–830.
243. Weinke T, Grobusch MP, Güthoff W. Amebic liver abscess-rare need for percutaneous treatment modalities. Eur J Med Res. 2002; 7:25–29.
244. Blessmann J, Binh HD, Hung DM, Tannich E, Burchard G. Treatment of amoebic liver abscess with metronidazole alone or in combination with ultrasound-guided needle aspiration: a comparative, prospective and randomized study. Trop Med Int Health. 2003; 8:1030–1034.
245. Mazuski JE. Antimicrobial treatment for intra-abdominal infections. Expert Opin Pharmacother. 2007; 8:2933–2945.
246. Mazuski JE, Solomkin JS. Intraabdominal infections. Surg Clin North Am. 2009; 89:421–437.
247. Lee SB, Lee WC, Jung HC, Song SH, Lee DW, Kim YB, Chung JS, Kwak IS, Cho GJ, Rha HY, Chang CH. Clinical characteristics and prognostic factors of bacteremia and sepsis. Korean J Med. 1999; 56:347–358.
248. Hong SK, Hong SB, Lim CM, Koh Y. The characteristics and prognostic factors of severe sepsis in patients who were admitted to a medical intensive care unit of a tertiary hospital. Korean J Crit Care Med. 2009; 24:28–32.
249. Infectious Diseases Society of Taiwan; Taiwan Surgical Society of Gastroenterology; Medical Foundation in Memory of Dr. Deh-Lin Cheng; Foundation of Professor Wei-Chuan Hsieh for Infectious Diseases Research and Education; CY Lee's Research Foundation for Pediatric Infectious Diseases and Vaccines. Guidelines for antimicrobial therapy of intra-abdominal infections in adults. J Microbiol Immunol Infect. 2008; 41:279–281.
250. Park SW, Park JW, Lee SI. Analysis on the etiology and prognostic factors of community-acquired bacteremia in a community-based tertiary hospital. Infect Chemother. 2005; 37:255–264.
251. Yun SJ, Koh YT, Sim MS, Suh DY, Park DS. Culture-sensitivity test and infectious complication in perforated appendicitis. J Korean Soc Coloproctol. 2000; 16:73–77.
252. Roehrborn A, Thomas L, Potreck O, Ebener C, Ohmann C, Goretzki PE, Röher HD. The microbiology of postoperative peritonitis. Clin Infect Dis. 2001; 33:1513–1519.
253. Swenson BR, Metzger R, Hedrick TL, McElearney ST, Evans HL, Smith RL, Chong TW, Popovsky KA, Pruett TL, Sawyer RG. Choosing antibiotics for intra-abdominal infections: what do we mean by \"high risk\"? Surg Infect (Larchmt). 2009; 10:29–39.
254. Kang CI, Cheong HS, Chung DR, Peck KR, Song JH, Oh MD, Choe KW. Clinical features and outcome of community-onset bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Eur J Clin Microbiol Infect Dis. 2008; 27:85–88.
255. Goldstein EJ, Citron DM, Warren YA, Tyrrell KL, Merriam CV, Fernandez H. In vitro activity of moxifloxacin against 923 anaerobes isolated from human intra-abdominal infections. Antimicrob Agents Chemother. 2006; 50:148–155.
256. Solomkin JS, Reinhart HH, Dellinger EP, Bohnen JM, Rotstein OD, Vogel SB, Simms HH, Hill CS, Bjornson HS, Haverstock DC, Coulter HO, Echols RM. Results of a randomized trial comparing sequential intravenous/oral treatment with ciprofloxacin plus metronidazole to imipenem/cilastatin for intra-abdominal infections. The Intra-Abdominal Infection Study Group. Ann Surg. 1996; 223:303–315.
257. Solomkin JS, Wilson SE, Christou NV, Rotstein OD, Dellinger EP, Bennion RS, Pak R, Tack K. Results of a clinical trial of clinafloxacin versus imipenem/cilastin for intraabdominal infections. Ann Surg. 2001; 233:79–87.
258. Wagner JM, McKinney WP, Carpenter JL. Does this patient have appendicitis? JAMA. 1996; 276:1589–1594.
259. Silen W. In: Cope\'s early diagnosis of the acute abdomen. 12th ed. New York: Oxford University Press; 2005. pp. 298.
260. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005; 185:406–417.
261. Urban BA, Fishman EK. Targeted helical CT of the acute abdomen: appendicitis, diverticulitis, and small bowel obstruction. Semin Ultrasound CT MR. 2000; 21:20–39.
262. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006; 241:83–94.
263. Oh BY, Lim KS, Lee YJ, Kim W, Choi OK. Early diagnosis of acute appendicitis by use of ultrasonography in emergency department. J Korean Soc Emerg Med. 1998; 9:586–594.
264. Cueto J, D\'Allemagne B, Vázquez-Frias JA, Gomez S, Delgado F, Trullenque L, Fajardo R, Valencia S, Poggi L, Ballí J, Diaz J, González R, Mansur JH, Franklin ME. Morbidity of laparoscopic surgery for complicated appendicitis: an international study. Surg Endosc. 2006; 20:717–720.
265. Akinci D, Akhan O, Ozmen MN, Karabulut N, Ozkan O, Cil BE, Karcaaltincaba M. Percutaneous drainage of 300 intraperitoneal abscesses with long-term follow-up. Cardiovasc Intervent Radiol. 2005; 28:744–750.
266. De Waele JJ, Hoste EA, Blot SI. Blood stream infections of abdominal origin in the intensive care unit: characteristics and determinants of death. Surg Infect (Larchmt). 2008; 9:171–177.
267. Dougherty SH. Antimicrobial culture and susceptibility testing has little value for routine management of secondary bacterial peritonitis. Clin Infect Dis. 1997; 25 Suppl 2:S258–S261.
268. Kokoska ER, Silen ML, Tracy TF Jr, Dillon PA, Kennedy DJ, Cradock TV, Weber TR. The impact of intraoperative culture on treatment and outcome in children with perforated appendicitis. J Pediatr Surg. 1999; 34:749–753.
269. Montravers P, Gauzit R, Muller C, Marmuse JP, Fichelle A, Desmonts JM. Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy. Clin Infect Dis. 1996; 23:486–494.
270. Marshall JC, Maier RV, Jimenez M, Dellinger EP. Source control in the management of severe sepsis and septic shock: an evidence-based review. Crit Care Med. 2004; 32 11 Suppl:S513–S526.
271. Koperna T, Schulz F. Prognosis and treatment of peritonitis. Do we need new scoring systems? Arch Surg. 1996; 131:180–186.
272. Koperna T, Schulz F. Relaparotomy in peritonitis: prognosis and treatment of patients with persisting intraabdominal infection. World J Surg. 2000; 24:32–37.
273. Mulier S, Penninckx F, Verwaest C, Filez L, Aerts R, Fieuws S, Lauwers P. Factors affecting mortality in generalized post-operative peritonitis: multivariate analysis in 96 patients. World J Surg. 2003; 27:379–384.
274. Grunau G, Heemken R, Hau T. Predictors of outcome in patients with postoperative intra-abdominal infection. Eur J Surg. 1996; 162:619–625.
275. Betsch A, Wiskirchen J, Trübenbach J, Manncke KH, Belka C, Claussen CD, Duda SH. CT-guided percutaneous drainage of intra-abdominal abscesses: APACHE III score stratification of 1-year results. Acute physiology, age, chronic health evaluation. Eur Radiol. 2002; 12:2883–2889.
276. Theisen J, Bartels H, Weiss W, Berger H, Stein HJ, Siewert JR. Current concepts of percutaneous abscess drainage in post-operative retention. J Gastrointest Surg. 2005; 9:280–283.
277. Maher MM, Gervais DA, Kalra MK, Lucey B, Sahani DV, Arellano R, Hahn PF, Mueller PR. The inaccessible or undrainable abscess: how to drain it. Radiographics. 2004; 24:717–735.
278. Allo MD, Bennion RS, Kathir K, Thompson JE Jr, Lentz M, Meute M, Finegold SM. Ticarcillin/clavulanate versus imipenem/cilistatin for the treatment of infections associated with gangrenous and perforated appendicitis. Am Surg. 1999; 65:99–104.
279. Oliva ME, Rekha A, Yellin A, Pasternak J, Campos M, Rose GM, Babinchak T, Ellis-Grosse EJ, Loh E; 301 Study Group. A multicenter trial of the efficacy and safety of tigecycline versus imipenem/cilastatin in patients with complicated intra-abdominal infections [Study ID Numbers: 3074A1-301-WW; Identifier: NCT00081744]. BMC Infect Dis. 2005; 5:88.
280. Namias N, Solomkin JS, Jensen EH, Tomassini JE, Abramson MA. Randomized, multicenter, double-blind study of efficacy, safety, and tolerability of intravenous ertapenem versus piperacillin/tazobactam in treatment of complicated intra-abdominal infections in hospitalized adults. Surg Infect (Larchmt). 2007; 8:15–28.
281. Malangoni MA, Song J, Herrington J, Choudhri S, Pertel P. Randomized controlled trial of moxifloxacin compared with piperacillin-tazobactam and amoxicillin-clavulanate for the treatment of complicated intra-abdominal infections. Ann Surg. 2006; 244:204–211.
282. Paterson DL, Rossi F, Baquero F, Hsueh PR, Woods GL, Satishchandran V, Snyder TA, Harvey CM, Teppler H, Dinubile MJ, Chow JW. In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART). J Antimicrob Chemother. 2005; 55:965–973.
283. Lee K, Kim YA, Park YJ, Lee HS, Kim MY, Kim EC, Yong D, Chong Y; Korean Nationwide Surveillance of Antimicrobial Resistance Group. Increasing prevalence of vancomycin-resistant enterococci, and cefoxitin-, imipenem- and fluoroquinolone-resistant gram-negative bacilli: a KONSAR study in 2002. Yonsei Med J. 2004; 45:598–608.
284. Snydman DR, Cuchural GJ Jr, McDermott L, Gill M. Correlation of various in vitro testing methods with clinical outcomes in patients with Bacteroides fragilis group infections treated with cefoxitin: a retrospective analysis. Antimicrob Agents Chemother. 1992; 36:540–544.
285. Aldridge KE, O\'Brien M. In vitro susceptibilities of the Bacteroides fragilis group species: change in isolation rates significantly affects overall susceptibility data. J Clin Microbiol. 2002; 40:4349–4352.
286. Snydman DR, Jacobus NV, McDermott LA, Supran S, Cuchural GJ Jr, Finegold S, Harrell L, Hecht DW, Iannini P, Jenkins S, Pierson C, Rihs J, Gorbach SL. Multicenter study of in vitro susceptibility of the Bacteroides fragilis group, 1995 to 1996, with comparison of resistance trends from 1990 to 1996. Antimicrob Agents Chemother. 1999; 43:2417–2422.
287. Snydman DR, Jacobus NV, McDermott LA, Ruthazer R, Goldstein EJ, Finegold SM, Harrell LJ, Hecht DW, Jenkins SG, Pierson C, Venezia R, Rihs J, Gorbach SL. National survey on the susceptibility of Bacteroides fragilis group: report and analysis of trends for 1997-2000. Clin Infect Dis. 2002; 35 Suppl 1:S126–S134.
288. Roh KH, Kim S, Kim CK, Yum JH, Kim MS, Yong D, Lee K, Kim JM, Chong Y. Resistance trends of Bacteroides fragilis group over an 8-year period, 1997-2004, in Korea. Korean J Lab Med. 2009; 29:293–298.
289. Oh H, Nord CE, Barkholt L, Hedberg M, Edlund C. Ecological disturbances in intestinal microflora caused by clinafloxacin, an extended-spectrum quinolone. Infection. 2000; 28:272–277.
290. Sullivan A, Edlund C, Nord CE. Effect of antimicrobial agents on the ecological balance of human microflora. Lancet Infect Dis. 2001; 1:101–114.
291. Cho YK, Lee J, Suh SO, Kim SW, Jang JY, Kim SG, Yoon YK, Lee WJ, Kim MJ. A randomized, controlled, open, multi-center clinical trial comparing ertapenem versus ceftriaxone plus metronidazole for the treatment of complicated intra-abdominal infections in adults. Infect Chemother. 2005; 37:330–336.
292. Yellin AE, Heseltine PN, Berne TV, Appleman MD, Gill MA, Riggio CE, Chenella FC. The role of Pseudomonas species in patients treated with ampicillin and Sulbactam for gangrenous and perforated appendicitis. Surg Gynecol Obstet. 1985; 161:303–307.
293. Cohn SM, Lipsett PA, Buchman TG, Cheadle WG, Milsom JW, O\'Marro S, Yellin AE, Jungerwirth S, Rochefort EV, Haverstock DC, Kowalsky SF. Comparison of intravenous/oral ciprofloxacin plus metronidazole versus piperacillin/tazobactam in the treatment of complicated intraabdominal infections. Ann Surg. 2000; 232:254–262.
294. Ohlin B, Cederberg A, Forssell H, Solhaug JH, Tveit E. Piperacillin/tazobactam compared with cefuroxime/metronidazole in the treatment of intra-abdominal infections. Eur J Surg. 1999; 165:875–884.
295. Mosdell DM, Morris DM, Voltura A, Pitcher DE, Twiest MW, Milne RL, Miscall BG, Fry DE. Antibiotic treatment for surgical peritonitis. Ann Surg. 1991; 214:543–549.
296. Wacha H, Hau T, Dittmer R, Ohmann C. Risk factors associated with intraabdominal infections: a prospective multicenter study. Peritonitis Study Group. Langenbecks Arch Surg. 1999; 384:24–32.
297. Montravers P, Dupont H, Gauzit R, Veber B, Auboyer C, Blin P, Hennequin C, Martin C. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006; 34:646–652.
298. Montravers P, Lepape A, Dubreuil L, Gauzit R, Pean Y, Benchimol D, Dupont H. Clinical and microbiological profiles of community-acquired and nosocomial intra-abdominal infections: results of the French prospective, observational EBIIA study. J Antimicrob Chemother. 2009; 63:785–794.
299. Montravers P, Chalfine A, Gauzit R, Lepape A, Pierre Marmuse J, Vouillot C, Martin C. Clinical and therapeutic features of nonpostoperative nosocomial intra-abdominal infections. Ann Surg. 2004; 239:409–416.
300. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000; 118:146–155.
301. Lodise TP Jr, Patel N, Kwa Graves J, Furuno JP, Graffunder E, Lomaestro B, McGregor JC. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection. Antimicrob Agents Chemother. 2007; 51:3510–3515.
302. Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE; Infectious Diseases Society of America. Guidelines for treatment of candidiasis. Clin Infect Dis. 2004; 38:161–189.
303. Calandra T, Bille J, Schneider R, Mosimann F, Francioli P. Clinical significance of Candida isolated from peritoneum in surgical patients. Lancet. 1989; 2:1437–1440.
304. Solomkin JS, Flohr AB, Quie PG, Simmons RL. The role of Candida in intraperitoneal infections. Surgery. 1980; 88:524–530.
305. Fierobe L, Decré D, Mùller C, Lucet JC, Marmuse JP, Mantz J, Desmonts JM. Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation to nasal colonization. Clin Infect Dis. 1999; 29:1231–1238.
306. Patel M, Kumar RA, Stamm AM, Hoesley CJ, Moser SA, Waites KB. USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. J Clin Microbiol. 2007; 45:3431–3433.
307. Trividic M, Gauthier ML, Sparsa A, Ploy MC, Mounier M, Boulinguez S, Bedane C, Bonnetblanc JM. Methi-resistant Staphylococcus aureus in dermatological practice: origin, risk factors and outcome. Ann Dermatol Venereol. 2002; 129:27–29.
308. Rojo D, Pinedo A, Clavijo E, García-Rodriguez A, García V. Analysis of risk factors associated with nosocomial bacteraemias. J Hosp Infect. 1999; 42:135–141.
309. Jensen AG, Wachmann CH, Poulsen KB, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Risk factors for hospital-acquired Staphylococcus aureus bacteremia. Arch Intern Med. 1999; 159:1437–1444.
310. Kim OS, Yoon SW, Kang YJ, Kim YK, Lee NY, Lee JH, Oui M, Cho YA, Sung YH, Suh GY, Peck KR, Chung DR, Song JH. Rate of nasal colonization of methicillin-resistant Staphylococcus aureus at admission to a medical intensive care unit. Korean J Nosocomial Infect Control. 2007; 12:42–49.
311. Blot S, De Waele JJ. Critical issues in the clinical management of complicated intra-abdominal infections. Drugs. 2005; 65:1611–1620.
312. Burnett RJ, Haverstock DC, Dellinger EP, Reinhart HH, Bohnen JM, Rotstein OD, Vogel SB, Solomkin JS. Definition of the role of enterococcus in intraabdominal infection: analysis of a prospective randomized trial. Surgery. 1995; 118:716–721.
313. Sitges-Serra A, López MJ, Girvent M, Almirall S, Sancho JJ. Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg. 2002; 89:361–367.
314. Falagas ME, Barefoot L, Griffith J, Ruthazar R, Snydman DR. Risk factors leading to clinical failure in the treatment of intra-abdominal or skin/soft tissue infections. Eur J Clin Microbiol Infect Dis. 1996; 15:913–921.
315. Krobot K, Yin D, Zhang Q, Sen S, Altendorf-Hofmann A, Scheele J, Sendt W. Effect of inappropriate initial empiric antibiotic therapy on outcome of patients with community-acquired intra-abdominal infections requiring surgery. Eur J Clin Microbiol Infect Dis. 2004; 23:682–687.
316. Sturkenboom MC, Goettsch WG, Picelli G, in\'t Veld B, Yin DD, de Jong RB, Go PM, Herings RM. Inappropriate initial treatment of secondary intra-abdominal infections leads to increased risk of clinical failure and costs. Br J Clin Pharmacol. 2005; 60:438–443.
317. Bartlett JG, Gerding DN. Clinical recognition and diagnosis of Clostridium difficile infection. Clin Infect Dis. 2008; 46 Suppl 1:S12–S18.
318. Wilton P, Smith R, Coast J, Millar M. Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness. J Health Serv Res Policy. 2002; 7:111–117.
319. Mazuski JE, Sawyer RG, Nathens AB, DiPiro JT, Schein M, Kudsk KA, Yowler C; Therapeutic Agents Committee of the Surgical Infections Society. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: evidence for the recommendations. Surg Infect (Larchmt). 2002; 3:175–233.
320. Mazuski JE, Sawyer RG, Nathens AB, DiPiro JT, Schein M, Kudsk KA, Yowler C; Therapeutic Agents Committee of the Surgical Infections Society. The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: an executive summary. Surg Infect (Larchmt). 2002; 3:161–173.
321. Gleisner AL, Argenta R, Pimentel M, Simon TK, Jungblut CF, Petteffi L, de Souza RM, Sauerssig M, Kruel CD, Machado AR. Infective complications according to duration of antibiotic treatment in acute abdomen. Int J Infect Dis. 2004; 8:155–162.
322. Blot S, De Waele JJ. Critical issues in the clinical management of complicated intra-abdominal infections. Drugs. 2005; 65:1611–1620.
323. Hedrick TL, Evans HL, Smith RL, McElearney ST, Schulman AS, Chong TW, Pruett TL, Sawyer RG. Can we define the ideal duration of antibiotic therapy? Surg Infect (Larchmt). 2006; 7:419–432.
324. Lennard ES, Dellinger EP, Wertz MJ, Minshew BH. Implications of leukocytosis and fever at conclusion of antibiotic therapy for intra-abdominal sepsis. Ann Surg. 1982; 195:19–24.

Table 1.
Recommendation of Strength and Quality of Evidence
Strength of Recommendation
A Good evidence to support a recommendation for (or against use)
B Moderate evidence to support a recommendation for (or against use)
C Poor evidence to support a recommendation
Quality of Evidence
I ≥1 properly randomized controlled trial
II ≥1 well-designed clinical trial without randomization or cohort or case-controlled analytic studies (preferably >1 center) or multiple time-series or dramatic results from uncontrolled experiments
III opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Table 2.
Microorganisms Identified in Infectious Diarrhea
Pathogen Number (%)
Lee JI (n=6788) [3] Cho SH (n=3785) [4] KCDC (n=8556) [2]
S. aureus 859 (12.7) 841 (24) 526 (6.1)
E. coli 275 (4.1) 2,037 (58.1) 1,926 (23.5)
Shigella spp. 32 (0.9) 86 (1.0)
Salmonella spp. 56 (0.8) 328 (9.4) 345 (4.0)
C. perfringens 161 (2.4) 111 (3.2) 467 (5.5)
V. parahaemolyticus 154 (4.4) 377 (4.4)
C. jejuni 309 (0.9) 89 (1.0)
B. cereus 246 (2.9)
Norovirus 2,465 (28.8)
Others 38 (0.6) 252 (7.2) 2,029 (23.7)
Table 3.
Antimicrobial Therapy in Bacterial Diarrhea
Microorganism Antibiotics
Shigella ciprofloxacin 750 mg once daily for 3 days or azithromycin 500 mg once daily for 3 days
Nontyphoidal Salmonella levofloxacin 500 mg (other fluoroquinolone) once daily for 7-10 days or azithromycin 500 mg once daily for 7 days
C. jejuni azithromycin 500 mg once daily for 3 days
V. cholerae doxycycline 300 mg single dose or erythromycin 250 mg 3 times daily for 3 days or azithromycin 500 mg once daily for 3 days
noncholeraic Vibrio ciprofloxacin 750 mg once daily for 3 days or azithromycin 500 mg once daily for 3 days
E. coli (except EHEC) ciprofloxacin 750 mg once daily for 3 days or azithromycin 500 mg once daily for 3 days
Table 4.
Suggested Approaches to Recurrent C. difficile Associated Diarrhea
Second recurrence*
Vancomycin in tapered and pulsed doses
125 mg 4 times daily for 14 days
125 mg 2 times daily for 7 days
125 mg once daily for 7 days
125 mg every 2 days for 8 days (4 doses)
125 mg once every 3 days for 15 days (5 doses)
Third recurrence
Vancomycin at a dose of 125 mg orally 4 times daily for 14 days, followed by rifaximin at a dose of 400 mg 2 times daily for 14 days
Other options for recurrent infection
Intravenous immunoglobulin at a dose of 150- 400 mg/kg once every 3 weeks for a total of 2 or 3 doses
Therapy with other microoganisms, including ‘fecal transplantation’
Therapy with probiotic such as Saccharomyces boulardii

* A probiotic such as Saccharomyces boulardii or lactobacilli species may be added during the final 2 weeks of the vancomycin taper and for at least 4 weeks thereafter (preferablly 8 weeks). However, the efficacy of probiotics in preventing recurrent C. difficile infection is unclear because of inconsistent study results. Bacteremia or fungemia may rarely complicate the use of probiotics in immunocompromised, critically ill patients.

Table 5.
Annual Reported Cases in Korea (No. of Patients)
’98 ’99 ’00 ’01 ’02 ’03 ’04 ’05 ’06 ’07 ’08 ’09
Typhoid fever 380 308 234 401 221 199 174 190 200 223 188 168
Paratyphoid fever 12 11 7 36 413 88 45 31 50 45 44 36
Table 6.
Antimicrobial Resistance Rates of Salmonella enterica serotype Typhi Isolates from 1999 to 2004 (%)
1999 (n=224) 2000 (n=153) 2001 (n=147) 2002 (n=66) 2003 (n=76) 2004 (n=34)
Amikacin 0.1 0.0 0.6 1.0 0.0 0.0
Ampicillin 9.0 22.1 28.6 14.8 7.9 3.0
Ampicillin/sulbactam 1.0 0.3 5.2 2.8 0.0 0.0
Cefixime 0.8 0.4 2.3 3.2 2.6 0.0
Chloramphenicol 4.7 6.8 11.7 3.3 6.6 3.0
Ciprofloxacin 0.0 0.0 0.7 0.3 6.6 3.0
Ceftriaxone 0.0 0.0 0.7 0.3 0.0 0.0
Cefotixin 0.2 0.2 1.5 0.9 0.0 0.0
Gentamicin 0.9 0.4 2.9 1.9 0.0 0.0
Kanamycin 1.2 0.6 4.3 1.6 0.0 0.0
Nalidixic acid 1.2 8.5 14.9 11.9 10.5 6.0
Streptomycin 13.5 60.7 41.1 26.9 14.5 6.0
Trimethoprim/sulfamethoxazole 2.4 1.2 4.3 7.7 5.3 3.0
Tetracycline 21.7 29.0 41.3 24.7 2.7 3.0
Table 7.
Suggested Antibiotic Treatment Regimens for Typhoid Fever
Primary drug
Alternative drug
Antibiotics Daily dose (mg/kg) Days Antibiotics Daily dose (mg/kg) Days
Uncomplicated typhoid fever (oral drug)
Fully susceptible Fluoroquinolone (ciprofloxacin, ofloxacin) 15 5-7 Trimethoprim/sulfamethoxazole 8/40 14
Multi-drug resistant (nalidixic acid susceptible) Fluoroquinolone 15 5-7 Azithromycin 8-10 7
Cefixime 20 7-14
Nalidixic acid resistant Cefixime 20 7-14 Fluoroquinolone 20 10-14
Azithromycin 8-10 7
Severe typhoid fever (parenteral drug)
Fully susceptible Fluoroquinolone 15 10-14 Trimethoprim/sulfamethoxazole 8/40 10-14
Multi-drug resistant (nalidixic acid susceptible) Fluoroquinolone 15 10-14 Ceftriaxone 60 10-14
Cefotaxime 80 10-14
Nalidixic acid resistant Ceftriaxone 60 10-14 Fluoroquinolone 20 10-14
Cefotaxime 80 10-14
Table 8.
Complications of Typhoid Fever
Abdominal Respiratory
Gastrointestinal perforation Bronchitis
Gastrointestinal hemorrhage Pneumonia (Salmonella enterica serotype Typhi, Streptococcus pneumoniae)
Hepatitis [175-177]
Cholecystitis (usually subclinical) Empyema [178, 180]
Pancreatitis Hemoptysis [181]
Cardiovascular Hematologic
Asymptomatic electrocardiographic changes Anemia
Myocarditis Disseminated intravasular coagulation
Endocarditis Hemophagocytic syndrome
Pericarditis [178] Others
Shock Chronic carriage
Aneurysm with or without rupture Focal abscess (liver[182], ovary, epidura [179], psoas muscle, spine, thyroid, scrotum)
Delirium Mediastinitis
Psychotic states Miscarriage
Meningitis [179] Pharyngitis
Impairment of coordination Relapse
Guillain-Barre syndrome
Table 9.
Empirical Antimicrobial Dosage for Intraabdominal Infections in Adults
Antimicrobials Dosage
β-lactam/β-lactamase inhibitor combination
 ampicillin/sulbactam 1.5-3 g every 6 hr
 piperacillin/tazobactam 3.375 g every 6 hr
 ticarcillin/clavulanic acid 3.1 g every 6 hr
 imipenem/cilastatin 500 mg every 6 hr or 1 g every 8 hr
 meropenem 1 g every 8 hr
 doripenem 500 mg every 8 hr
 ertapenem 1 g every 24 hr
 cefazolin 1-2 g every 8 hr
 cefuroxime 1.5 g every 8 hr
 cefoxitin 2 g every 6 hrs
 cefotaxime 1-2 g every 6-8 hr
 ceftriaxone 1-2 g every 12-24 hr
 ceftazidime 2 g every 8 hr
 cefepime 2 g every 8-12 hr
 cefoperazone/sulbactam 1-2 g every 12 hr
 ciprofloxacin 400 mg every 12 hr
 levofloxacin 750 mg every 24 hr
 moxifloxacin 400 mg every 24 hr
 gentamicin, tobramycin 5-7 mg/kg every 24 hr
 amikacin 15-20 mg/kg every 24 hr
 vancomycin 15-20 mg/kg every 8-12 hr
 teicoplanin 12 mg/kg every 24 hr
Linezololid 600 mg every 12 hr
Quinupristin/dalfopristin 7.5 mg/kg every 8 hr
Tigecycline initial 100 mg, then 50 mg every 12 hr
Metronidazole 500 mg every 8-12 hr or 1,500 mg every 24 hr
Aztreonam 1-2 g every 6-8 hr
Table 10.
Microorganisms Commonly Identified in Complicated Intraabdominal Infection
Microorganism Patients, % [255-257] Microorganisms, % [250] Microorganisms, % [251]
Facultative & Aerobic Gram-negative bacilli
Escherichia coli 71 45 69
Klebsiella species 14 17
 Pseudomonas aeruginosa 14 1 15
 Proteus mirabilis 5 2.3
Enterobacter species 5 5 7.5
Bacteroides fragilis 35
 Other Bacteroides species 71
Clostridium species 29
Prevotella species 12
Peptostreptococcus species 17
Fusobacterium species 9
Eubacterium species 17
Gram-positive aerobic cocci
Streptococcus species 38 7
Enterococcus faecalis 12 3
Enterococcus faecium 3
Enterococcus species 8
Staphylococcus aureus 4
Table 11.
Empirical Antibiotics Recommendation in Community Acquired Complicated intraabdominal Infection
Mild-to-moderate severity High severity
Cefoxitin (A-II) Ceftazidime or cefepime + metronidazole (A-I)
Cefuroxime+metronidazole (A-II) Piperacillin/tazobactam (A-I)
Ceftriaxone or cefotaxime+metronidazole (A-II) Imipenem/cilastatin (A-I)
Ciprofloxacin or levofloxacin +metronidazole (A-II) Meropenem (A-I)
Ertapenem (B-II)
Moxifloxacin (B-II)
Tigecycline (B-II)
Similar articles