Publications by authors named "Bongyoung Kim"

47 Publications

Status of antimicrobial stewardship programmes in Korean hospitals including small to medium-sized hospitals and the awareness and demands of physicians: a nationwide survey in 2020.

J Glob Antimicrob Resist 2021 Jun 18;26:180-187. Epub 2021 Jun 18.

Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam 13620, Gyeonggi-do, South Korea.

Objectives: This study aimed to identify the status of antimicrobial stewardship programmes (ASPs) in small to medium-sized Korean hospitals as well as the awareness and demands about ASPs of physicians.

Methods: A questionnaire was designed based on a questionnaire from a previous nationwide survey in 2018 targeting large hospitals in Korea and modified to reflect the results of in-depth interviews with non-infectious diseases (IDs) physicians at secondary care hospitals. The survey targeted all hospitals with ≥150 beds in South Korea and was performed in May-June 2020. Only one ASP-associated physician per hospital participated in the survey.

Results: The survey response rate was 31.9% (217/680). ID specialists comprised the majority of medical personnel participating in ASPs in tertiary care hospitals. Conversely, in secondary and primary care hospitals there was no predominant medical personnel for ASPs and the median full-time equivalent was 0 for all types of medical personnel. Tertiary care hospitals, more than secondary and primary care hospitals, tended to perform ASP activities more actively. 'Workforce for ASPs', 'Establishment of healthcare fees for ASPs' and 'Development of tools for ASPs' were the most important required support for ASP improvement.

Conclusion: The level of ASP establishment was more limited in primary care hospitals than in secondary and tertiary care hospitals in Korea. To improve ASPs in Korean hospitals, a supporting workforce and the establishment of a healthcare fee for ASPs appear to be necessary.
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http://dx.doi.org/10.1016/j.jgar.2021.06.001DOI Listing
June 2021

Clinical Characteristics of Patients with Adrenal Insufficiency and Fever.

J Korean Med Sci 2021 Jun 14;36(23):e152. Epub 2021 Jun 14.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Background: Because persistent fever often occurs in adrenal insufficiency, it might be confused with infectious diseases. This study aimed to identify clinical characteristics and risk factors of patients with adrenal insufficiency and fever.

Methods: All adult patients (n = 150) admitted to a tertiary care hospital in South Korea and diagnosed with adrenal insufficiency between 1 March 2018, and 30 June 2019, were recruited. Patients were excluded if they had: 1) proven structural problems in the adrenal or pituitary gland; 2) a history of chemotherapy within 6 months prior to the diagnosis of adrenal insufficiency; and 3) other medical conditions that may cause fever.

Results: Among the included patients, 45 (30.0%) had fever at the time of the diagnosis of adrenal insufficiency. The mean C-reactive protein level was higher (11.25 ± 8.54 vs. 4.36 ± 7.13 mg/dL) in patients with fever than in those without fever. A higher proportion of patients with fever changed antibiotics (33.3% vs. 1.0%). On multivariate logistic regression analysis, female sex (odds ratio [OR], 0.32) lowered the risk of adrenal insufficiency with fever, while a history of surgery within 6 months (OR, 4.35), general weakness (OR, 7.21), and cough (OR, 17.29) were significantly associated with that.

Conclusion: The possibility of adrenal insufficiency should be considered in patients with fever of unknown origin, especially those with risk factors.
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http://dx.doi.org/10.3346/jkms.2021.36.e152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8203850PMC
June 2021

High fecal carriage of bla, bla, and plasmid-mediated quinolone resistance genes among healthy Korean people in a metagenomic analysis.

Sci Rep 2021 Mar 12;11(1):5874. Epub 2021 Mar 12.

Department of Biomedical Informatics, Hanyang University, Seoul, 04763, Republic of Korea.

To characterize the carriage of antibiotic resistance genes (ARGs) in the gut microbiome of healthy individuals. Fecal carriage of ARGs was investigated in 61 healthy individuals aged 30 to 59 years through whole metagenome sequencing of the gut microbiome and a targeted metagenomic approach. The number of ARGs in the gut microbiome was counted and normalized per million predicted genes (GPM). In the Korean population, the resistome ranged from 49.7 to 292.5 GPM (median 89.7). Based on the abundance of ARGs, the subjects were categorised into high (> 120 GPM), middle (60‒120 GPM), and low (< 60 GPM) ARG groups. Individuals in the high ARG group tended to visit hospitals more often (P = 0.065), particularly for upper respiratory tract infections (P = 0.066), and carried more bla (P = 0.008). The targeted metagenome approach for bla and plasmid-mediated quinolone resistance (PMQR) genes revealed a high fecal carriage rate; 23% or 13.1% of the subjects carried bla or bla, respectively. Regarding PMQR genes, 59% of the subjects carried PMQR, and 83% of them harboured 2‒4 PMQR genes (qnrB 44.3%, qnrS 47.5% etc.). The presence of bla correlated with ARG abundance in the gut resistome, whereas PMQR genes were irrelevant to other ARGs (P = 0.176). Fecal carriage of bla and PMQR genes was broad and multiplexed among healthy individuals.
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http://dx.doi.org/10.1038/s41598-021-84974-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955109PMC
March 2021

Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey.

Antimicrob Resist Infect Control 2021 03 6;10(1):48. Epub 2021 Mar 6.

Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.

Background: An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea.

Methods: A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting.

Results: The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1-6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected.

Conclusions: We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.
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http://dx.doi.org/10.1186/s13756-021-00913-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937201PMC
March 2021

Comparison of the clinical characteristics of community-acquired acute pyelonephritis between male and female patients.

J Infect Chemother 2021 Jul 25;27(7):1013-1019. Epub 2021 Feb 25.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea. Electronic address:

Background: Community-acquired acute pyelonephritis (CA-APN) is relatively rare in men. This study aimed to compare the clinical characteristics of CA-APN between male and female patients.

Methods: We prospectively collected the clinical and microbiological data of hospitalized CA-APN patients aged ≥19 years in South Korea from March 2010 to February 2011 in 11 hospitals and from September 2017 to August 2018 in 8 hospitals. Only the first episodes of APN of each patient during the study period were included.

Results: From 2010 to 2011, 573 patients from 11 hospitals were recruited, and from 2017 to 2018, 340 patients were recruited from 8 hospitals. Among them, 5.9% (54/913) were male. Male patients were older (66.0 ± 15.2 vs. 55.3 ± 19.0 years, P < 0.001), had a higher Charlson comorbidity index (1.3 ± 1.5 vs. 0.7 ± 1.2, P = 0.027), and had a higher proportion of structural problems in the urinary tract (40.7% vs. 6.1%, P < 0.001) than female patients. Moreover, the total duration of antibiotic treatment was longer (21.8 ± 17.8 d vs. 17.3 ± 9.4 d, P = 0.001) and the proportion of carbapenem usage was higher (24.1% vs. 9.5%, P = 0.001) in men than in women. Male patients were hospitalized for longer durations than female patients (median, 10 d vs. 7 d, P < 0.001).

Conclusions: Male CA-APN patients were older and had more comorbidities than female CA-APN patients. In addition, male patients received antibiotic treatment for a longer duration than female patients.
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http://dx.doi.org/10.1016/j.jiac.2021.02.014DOI Listing
July 2021

What is the optimal antibiotic treatment strategy for carbapenem-resistant Acinetobacter baumannii (CRAB)? A multicentre study in Korea.

J Glob Antimicrob Resist 2021 03 8;24:429-439. Epub 2021 Feb 8.

Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. Electronic address:

Objectives: The optimal treatment option for carbapenem-resistant Acinetobacter baumannii (CRAB) is still limited. This study investigated the efficacy of three or more antibiotic types and regimens for treatment of CRAB infection in high CRAB endemic areas.

Methods: A multicentre retrospective study was conducted to evaluate the efficacy of treatment types and regimens of CRAB infections in 10 tertiary hospitals in the Republic of Korea. The outcomes comprised 7-day and 28-day mortality, and clinical and microbiological responses at 7 days, 28 days, and the end of treatment. Nephrotoxicity and hepatotoxicity were evaluated as drug adverse reactions.

Results: A total of 282 patients were included in the study. Among the CRAB strains, the two most susceptible antibiotics were colistin (99.6%) and minocycline (80.4%). A combination of colistin and carbapenem significantly reduced 7-day mortality, and a sulbactam-containing regimen significantly reduced 28-day mortality. Colistin monotherapy was significantly associated with increased 7-day and 28-day mortality. A minocycline-containing regimen showed the best microbiological responses at 7 days, 28 days, and the end of treatment. Colistin and tigecycline were associated with increased nephrotoxicity and hepatotoxicity, respectively. Subgroup analysis of patients with pneumonia showed similar results to the overall CRAB infection.

Conclusions: A combination of colistin and carbapenem and sulbactam-containing regimen may contribute improved mortality in CRAB infections. Colistin monotherapy should be considered cautiously in severe CRAB infections or CRAB pneumonia. A minocycline-containing regimen showed the best microbiological responses, and further studies may be needed to evaluate improved mortality.
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http://dx.doi.org/10.1016/j.jgar.2021.01.018DOI Listing
March 2021

Lipid indices as simple and clinically useful surrogate markers for insulin resistance in the U.S. population.

Sci Rep 2021 Jan 27;11(1):2366. Epub 2021 Jan 27.

Department of Internal Medicine, Hallym University, Chuncheon, Republic of Korea.

This study aimed to compare the accuracy of novel lipid indices, including the visceral adiposity index (VAI), lipid accumulation product (LAP), triglycerides and glucose (TyG) index, TyG-body mass index (TyG-BMI), and TyG-waist circumference (TyG-WC), in identifying insulin resistance and establish valid cutoff values. This cross-sectional study used the data of 11,378 adults, derived from the United States National Health and Nutrition Examination Survey (1999-2016). Insulin resistance was defined as a homeostasis model assessment-insulin resistance value above the 75th percentile for each sex and race/ethnicities. The area under the curves (AUCs) were as follows: VAI, 0.735; LAP, 0.796; TyG index, 0.723; TyG-BMI, 0.823, and; TyG-WC, 0.822. The AUCs for TyG-BMI and TyG-WC were significantly higher than those for VAI, LAP, and TyG index (vs. TyG-BMI, p < 0.001; vs. TyG-WC, p < 0.001). The cutoff values were as follows: VAI: men 1.65, women 1.65; LAP: men 42.5, women 42.5; TyG index: men 4.665, women 4.575; TyG-BMI: men 135.5, women 135.5; and TyG-WC: men 461.5, women 440.5. Given that lipid indices can be easily calculated with routine laboratory tests, these values may be useful markers for insulin resistance risk assessments in clinical settings.
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http://dx.doi.org/10.1038/s41598-021-82053-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7840900PMC
January 2021

Fluoroquinolone Can Be an Effective Treatment Option for Acute Pyelonephritis When the Minimum Inhibitory Concentration of Levofloxacin for the Causative Is ≤16 mg/L.

Antibiotics (Basel) 2021 Jan 2;10(1). Epub 2021 Jan 2.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea.

The purpose of this study was to determine whether the fluoroquinolone (FQ) minimum inhibitory concentration (MIC) for the causative agent influences the clinical response of FQ treatment at 72 h in patients with community-acquired acute pyelonephritis (CA-APN). We prospectively collected the clinical data of women with CA-APN from 11 university hospitals from March 2010 to February 2012 as well as isolates from the urine or blood. In total, 78 patients included in this study received FQ during the initial 72 h, and the causative was detected. The clinical response at 72 h was significantly higher in patients with a levofloxacin MIC ≤ 16 mg/L than in those with an MIC > 16 mg/L (70.4% vs. 28.6%, = 0.038). No difference was observed in clinical response at 72 h based on ciprofloxacin MIC. To summarize, FQ can be an effective treatment option for CA-APN when levofloxacin MIC against is ≤16 mg/L.
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http://dx.doi.org/10.3390/antibiotics10010037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823373PMC
January 2021

Infectious Diseases Physician Workforce in Korea.

J Korean Med Sci 2020 Dec 21;35(49):e428. Epub 2020 Dec 21.

Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.

This study aimed to evaluate the infectious disease (ID) physician workforce in Korea. We investigated the acquisition of ID physicians from 1992 to 2019 with their current working place in the Health Care System. We defined ID physicians working at general or tertiary-care hospitals as active ID physicians. A total 275 physicians acquired ID as a sub-specialty. Among the 275, 242 were active ID physicians. The density of active ID physicians was 0.47 per 100,000 population. Of all the 17 administrative districts, 11 (64.7%) fell short of 0.47, and 131 medical institutions employed the service of ID physicians. The median number of beds per adult ID physician was 372 (interquartile range, 280-507). It is essential to secure human resources to respond to emerging infectious diseases and perform the inherent work of ID physicians.
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http://dx.doi.org/10.3346/jkms.2020.35.e428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752260PMC
December 2020

Association between Antibiotic Consumption and Incidence of Infection in a Hospital.

J Korean Med Sci 2020 Dec 7;35(47):e407. Epub 2020 Dec 7.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Previous exposure to antimicrobials is a major risk factor for infection (CDI). Antibiotic prescription and toxin assay records of patients admitted to a tertiary hospital in Korea from 2009 to 2013 were collected to investigate the association between antibiotic consumption and CDI incidence. A Spearman's correlation analysis between CDI incidence (positive result of toxin assay/10,000 admissions) and antibiotic consumption (defined daily dose/1,000 patient-days) was performed on a monthly basis. Using the matched month approach, we found a significant correlation between CDI rate and moxifloxacin consumption (Spearman's = 0.351, < 0.001). Furthermore, using the one-month delay approach, we found that the consumption of clindamycin (Spearman's = 0.272, = 0.037) and moxifloxacin (Spearman's = 0.297, = 0.022) was significantly correlated with CDI incidence. Extended-spectrum cephalosporins did not have any effect on CDI incidence.
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http://dx.doi.org/10.3346/jkms.2020.35.e407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721558PMC
December 2020

Trend of Antibiotic Usage for Hospitalized Community-acquired Pneumonia Cases in Korea Based on the 2010-2015 National Health Insurance Data.

J Korean Med Sci 2020 Dec 7;35(47):e390. Epub 2020 Dec 7.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.

Background: This study is to describe the changes in prescribing practices of antibiotics to treat community-acquired pneumonia (CAP) in Korea during 2010-2015.

Methods: The claim database of the Health Insurance Review and Assessment Service in Korea was used to select adult patients (≥ 18 years of age) admitted between 2010 and 2015, with the International Classification of Diseases, Tenth Revision codes relevant to all-cause pneumonia for the first or second priority discharge diagnosis. The episodes with hospital-acquired or healthcare-associated pneumonia were excluded. Consumption of each antibiotic was converted to defined daily dose (DDD) per episode. The amount of antibiotic consumption was compared between patients with CAP aged < 65 years and those aged ≥ 65 years.

Results: The average amount of antibiotic consumption per episode was 15.5 DDD, which remained stable throughout the study period ( = 0.635). Patients aged ≥ 65 years received more antibiotics than those aged < 65 years (15.7 vs. 15.3 DDD). Third-generation cephalosporin (4.9 DDD/episode, 31.4%) was the most commonly prescribed, followed by macrolide (2.7 DDD/episode, 17.1%) and beta-lactam/beta-lactamase inhibitor (BL/BLI) (2.1 DDD/episode, 13.6%). The consumption amount of fourth-generation cephalosporin (4th CEP) ( = 0.001), BL/BLI ( = 0.003) and carbapenem ( = 0.002) increased each year during the study period. The consumption of 4th CEP and carbapenem was doubled during 2010-2015.

Conclusion: The prescription of broad-spectrum antibiotics such as 4th CEP and carbapenem to treat CAP increased in Korea during 2010-2015.
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http://dx.doi.org/10.3346/jkms.2020.35.e390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721565PMC
December 2020

Factors Associated with the Delayed Termination of Viral Shedding in COVID-19 Patients with Mild Severity in South Korea.

Medicina (Kaunas) 2020 Nov 29;56(12). Epub 2020 Nov 29.

Department of Physical Medicine and Rehabilitation, National Health Insurance Ilsan Hospital, Goyang 10326, Korea.

: We aimed to analyze factors associated with the period of viral shedding in patients with confirmed COVID-19 who experienced only mild symptoms. : We conducted a multicenter retrospective study from three community treatment centers (CTCs) of South Korea. All patients included were admitted to the three centers before 31 March 2020. We collected data about clinical characteristics and the result of real-time reverse transcription polymerase chain reaction (RT-PCR). : Viral shedding was terminated within 32 days and 36 days in 75% and 90% of patients, respectively (range: 8-49 days). The mean period of viral shedding was 23.8 ± 8.7 days. In the multivariate Cox proportional hazards regression analysis, the existence of underlying comorbidities lowered the probability of the termination of viral shedding (HR = 0.561, 95% CI 0.388-0.812). Female sex and presence of COVID-19-associated symptoms also lowered the probability, but the significance was marginal. : The existence of underlying comorbidities was associated with delayed termination of viral shedding in COVID-19 patients with mild severity.
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http://dx.doi.org/10.3390/medicina56120659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761510PMC
November 2020

Psychological distress among infectious disease physicians during the response to the COVID-19 outbreak in the Republic of Korea.

BMC Public Health 2020 Nov 27;20(1):1811. Epub 2020 Nov 27.

Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Daegu, Jung-gu, 41944, South Korea.

Background: This study aimed to investigate psychological distress among infectious disease (ID) physicians during the coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea.

Methods: Using an online-based survey link sent via text message and email, we conducted a survey from April 21 to 25, 2020, targeting all ID physicians currently working in ID (n = 265). The questionnaire was based on the Maslach Burnout Inventory-Human Services Survey and the Depression, Anxiety, and Stress Scales, and information was collected on factors protecting against psychological distress and difficulties in relation to COVID-19.

Results: Of 265 ID physicians, 115 (43.3%) responded, showing burnout (97, 90.4%), depression (20, 17.4%), anxiety (23, 20.0%), and stress (5, 4.3%). There were no differences in terms of distress between ID physicians who were directly involved in the care of patients with COVID-19 or not. Greater than 50% of physicians valued their work and felt recognized by others, whereas < 10% indicated that sufficient human and financial support and private time had been provided during the outbreak. The most challenging issues concerned a lack of attending physicians caring for COVID-19 patients or infection control practitioners, a shortage of personal protective equipment or airborne infection isolation rooms, pressure for research, and lack of guidelines for COVID-19 management.

Conclusions: During the COVID-19 outbreak in the Republic of Korea, most respondents reported psychological distress. Preparing strategies to secure human resources are crucial to prepare effectively for future epidemics and pandemics.
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http://dx.doi.org/10.1186/s12889-020-09886-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691971PMC
November 2020

Human resources required for antimicrobial stewardship activities for hospitalized patients in Korea.

Infect Control Hosp Epidemiol 2020 12 26;41(12):1429-1435. Epub 2020 Oct 26.

Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.

Objectives: We calculated the human resources required for an antimicrobial stewardship program (ASP) in Korean hospitals.

Design: Multicenter retrospective study.

Setting: Eight Korean hospitals ranging in size from 295 to 1,337 beds.

Methods: The time required for performing ASP activities for all hospitalized patients under antibiotic therapy was estimated and converted into hours per week. The actual time spent on patient reviews of each ASP activity was measured with a small number of cases, then the total time was estimated by applying the determined times to a larger number of cases. Full-time equivalents (FTEs) were measured according to labor laws in Korea (52 hours per week).

Results: In total, 225 cases were reviewed to measure time spent on patient reviews. The median time spent per patient review for ASP activities ranged from 10 to 16 minutes. The total time spent on the review for all hospitalized patients was estimated using the observed number of ASP activities for 1,534 patients who underwent antibiotic therapy on surveillance days. The most commonly observed ASP activity was 'review of surgical prophylactic antibiotics' (32.7%), followed by 'appropriate antibiotics recommendations for patients with suspected infection without a proven site of infection but without causative pathogens' (28.6%). The personnel requirement was calculated as 1.20 FTEs (interquartile range [IQR], 1.02-1.38) per 100 beds and 2.28 FTEs (IQR, 1.93-2.62) per 100 patients who underwent antibiotic therapy, respectively.

Conclusion: The estimated time required for human resources performing extensive ASP activities on all hospitalized patients undergoing antibiotic therapy in Korean hospitals was ~1.20 FTEs (IQR, 1.02-1.38) per 100 beds.
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http://dx.doi.org/10.1017/ice.2020.1234DOI Listing
December 2020

Quantitative characterization of Clostridioides difficile population in the gut microbiome of patients with C. difficile infection and their association with clinical factors.

Sci Rep 2020 10 19;10(1):17608. Epub 2020 Oct 19.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea.

Objective was to analyse bacterial composition and abundance of Clostridioides difficile in gut microbiome of patients with C. difficile infection (CDI) in association with clinical characteristics. Whole metagenome sequencing of gut microbiome of 26 CDI patients was performed, and the relative abundance of C. difficile and its toxin genes was measured. Clinical characteristics of the patients were obtained through medical records. A strong correlation between the abundance of C. difficile and tcdB genes in CDI patients was found. The relative abundance of C. difficile in the gut microbiome ranged from undetectable to 2.8% (median 0.089). Patients with fever exhibited low abundance of C. difficile in their gut, and patients with fewer C. difficile organisms required long-term anti-CDI treatment. Abundance of Bifidobacterium and Bacteroides negatively correlated with that of C. difficile at the genus level. CDI patients were clustered using the bacterial composition of the gut: one with high population of Enterococcus (cluster 1, n = 12) and another of Bacteroides or Lactobacillus (cluster 2, n = 14). Cluster1 showed significantly lower bacterial diversity and clinical cure at the end of treatment. Additionally, patients with CDI exhibited increased ARGs; notably, bla, bla and bla were enriched. C. difficile existed in variable proportion of the gut microbiome in CDI patients. CDI patients with Enterococcus-rich microbiome in the gut had lower bacterial diversity and poorer clinical cure.
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http://dx.doi.org/10.1038/s41598-020-74090-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573688PMC
October 2020

Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic in South Korea in the Past Decade.

Antibiotics (Basel) 2020 Sep 18;9(9). Epub 2020 Sep 18.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Korea.

This study examined changes in the clinical characteristics of community-acquired acute pyelonephritis (CA-APN) in South Korea between the period 2010-2011 and 2017-2018. We recruited all CA-APN patients aged ≥19 years who visited eight hospitals in South Korea from September 2017 to August 2018, prospectively. Data collected were compared with those from the previous study in 2010-2012, with the same design and participation from 11 hospitals. A total of 617 patients were enrolled and compared to 818 patients' data collected in 2010-2011. was the most common causative pathogen of CA-APN in both periods (87.3% vs. 86.5%, = 0.680). isolates showed significantly higher antimicrobial resistance against fluoroquinolone (32.0% vs. 21.6%, < 0.001), cefotaxime (33.6% vs. 8.3%, < 0.001), and trimethoprim/sulfamethoxazole (37.5% vs. 29.2%, = 0.013) in 2017-2018 than in 2010-2011. Total duration of antibiotic treatment increased from 16.55 ± 9.68 days in 2010-2011 to 19.12 ± 9.90 days in 2017-2018 ( < 0.001); the duration of carbapenem usage increased from 0.59 ± 2.87 days in 2010-2011 to 1.79 ± 4.89 days in 2010-2011 ( < 0.001). The median hospitalization was higher for patients in 2017-2018 than in 2010-2011 (9 vs. 7 days, < 0.001). In conclusion, antimicrobial resistance of to almost all antibiotic classes, especially third generation cephalosporin, increased significantly in CA-APN in South Korea. Consequently, total duration of antibiotic treatment, including carbapenem usage, increased.
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http://dx.doi.org/10.3390/antibiotics9090617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559700PMC
September 2020

What should we prepare for the next coronavirus disease 2019 outbreak? A survey on the opinions of infectious diseases specialists in South Korea.

Korean J Intern Med 2020 11 23;35(6):1270-1278. Epub 2020 Sep 23.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Background/aims: This study aimed to collect information on the opinions of Korean infectious disease (ID) experts on coronavirus disease 2019 (COVID-19) and related issues in preparation for a future outbreak.

Methods: A survey was conducted over the course of 5 days (from April 21 to 25, 2020), targeting all adult ID specialists currently in the medical field in South Korea (n = 265). An online-based survey was forwarded via text message and e-mail. Only one response was accepted from each participant.

Results: Of these 265 ID specialists gotten to, 132 (49.8%) responded. The highest proportion of the respondents envisaged the current COVID-19 outbreak to end after December 2020 (47.7% for the domestic Korean outbreak and 70.5% for the global pandemic); moreover, 60.7% of them stated that a second nationwide wave is likely to occur between September and December 2020 in South Korea. N95 respirators were considered to be the most important item in hospitals in preparation for a second wave. The most important policy to be implemented at the national level was securing national hospitals designated for the treatment of ID (67.4%).

Conclusion: ID experts in South Korea believe that the COVID-19 pandemic may not be easily controlled and that a second nationwide wave is likely to occur in South Korea. Our results indicate that Korean ID specialists believe that a high level of preparation is needed in various aspects, including the procurement of personal protective equipment, to respond efficiently to a second outbreak.
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http://dx.doi.org/10.3904/kjim.2020.222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652668PMC
November 2020

Differences in antibiotic usage patterns for acute pyelonephritis according to hospital type and region in the Republic of Korea: A population-based study.

Medicine (Baltimore) 2020 Sep;99(37):e21896

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.

This study aimed to determine the differences in antibiotic usage patterns in the treatment of acute pyelonephritis according to hospital type and region in Korea.The claims database of the Health Insurance Review and Assessment Service in Korea was used to select patients with the International Classification of Diseases, Tenth Revision code N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis in 2010-2014. Usage of each class of antibiotics was expressed as the defined daily dose (DDD)/event.The average antibiotic usage per inpatient event was 11.3 DDD. The average antibiotic usage was the highest among patients admitted to tertiary hospitals (13.8 DDD), followed by those admitted to secondary hospitals (11.5 DDD), clinics (10.0 DDD), and primary hospitals (9.8 DDD). According to the geographic analyses, third-generation cephalosporins were highly prescribed in some southern regions; fluoroquinolones and aminoglycosides were highly prescribed in some centrally located regions of the Korean peninsula. The hotspots for carbapenem usage included Seoul and Gyeonggi province cluster and Busan cluster: these regions include the capital city and the second biggest city in Korea, respectively.In conclusion, the antibiotic usage patterns for acute pyelonephritis in Korea differ according to the hospital type and region.
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http://dx.doi.org/10.1097/MD.0000000000021896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489635PMC
September 2020

Development of Antibiotic Classification for Measuring Antibiotic Usage in Korean Hospitals Using a Modified Delphi Method.

J Korean Med Sci 2020 Aug 3;35(30):e241. Epub 2020 Aug 3.

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

In 2019, a project designed to develop a system for measuring and comparing antibiotic usage in hospitals was launched in Korea. As part of this project, we developed a means to classify antibiotic usage in Korean hospitals using a modified Delphi method. In results, the following categories of antibiotic classification were accepted for use in Korean hospitals: 1) broad-spectrum antibacterial agents predominantly used for hospital-onset infections in adults, 2) broad-spectrum antibacterial agents predominantly used for community-acquired infections in adults, 3) antibacterial agents predominantly used for resistant gram-positive infections in adults, 4) narrow-spectrum beta-lactam agents in adults, 5) antibacterial agents predominantly used for extensive antibiotic resistant gram-negative bacteria in adults, and 6) total antibacterial agents.
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http://dx.doi.org/10.3346/jkms.2020.35.e241DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402924PMC
August 2020

Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection.

PLoS One 2020 22;15(6):e0234966. Epub 2020 Jun 22.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Background/aim: Prolonged maintenance of central venous catheters, including peripherally inserted central catheters (PICCs), is a major risk factor for central line-associated bloodstream infection (CLABSI). This study was conducted to evaluate the appropriate duration of PICC maintenance to prevent CLABSI.

Methods: A single-center retrospective study was conducted at an 824-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. CLABSI was diagnosed according to the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). To identifying statistical correlations between catheter days and PABSI, the odds ratio for PABSI on the basis of the continuous value of catheter days was analyzed using restricted cubic spline splits with five knots. The optimal cut-off value for catheter days was identified by maximizing the area under the receiver operating characteristic (ROC) curve (AUC).

Results: A total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Among them, 36 were confirmed as having a PABSI (3.5%, 36/1014; 1.14 per 1000 catheter days). In the restricted cubic spline regression, catheter days showed a dose-dependent relationship with the risk of PABSI. The AUC of the ROC curve for developing a PABSI according to the duration of catheter maintenance was 0.715 (95% CI, 0.639-0.790); the calculated optimal cut-off value was 25 days.

Conclusion: The incidence of PABSI was 1.14 per 1000 catheter days and the optimal cut-off value of catheter days to avoid a PABSI was 25 days.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234966PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307762PMC
September 2020

Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea.

Emerg Infect Dis 2020 Oct 22;26(10):2338-2345. Epub 2020 Jun 22.

As a part of measures to decrease spikes in coronavirus disease (COVID-19) cases and deaths outside of hospitals, the government of South Korea introduced a plan for community treatment centers (CTCs) to isolate and monitor patients with mild COVID-19 symptoms. We assessed outcomes of 568 patients admitted to 3 CTCs near Daegu. More (64.6%) women than men (35.4%) were admitted, and the mean age of patients was 36.0 years (SD +15.0 years). Among all patients, 75.7% remained asymptomatic while at the CTCs. The mean time patients remained at CTCs was 19.6 days (SD +5.8 days) from the day of diagnosis until our study ended on March 23, 2020. Because they offer appropriate clinical triaging and daily monitoring for patients, CTCs are a safe alternative to medical institutions for asymptomatic or mildly symptomatic patients with COVID-19.
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http://dx.doi.org/10.3201/eid2610.201539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510708PMC
October 2020

Molecular Epidemiology of Ciprofloxacin-Resistant Isolated from Community-Acquired Urinary Tract Infections in Korea.

Infect Chemother 2020 Jun 13;52(2):194-203. Epub 2020 May 13.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Background: is the predominant causative pathogen for community-acquired urinary tract infections (UTIs), and the increase in fluoroquinolone-resistant is of great concern in Korea. The objectives of this study were to investigate the genotypic characteristics and molecular epidemiology of ciprofloxacin-resistant (CIP-R) isolated from community-acquired UTIs in Korea.

Materials And Methods: samples isolated from the blood or urine were collected from patients with community-acquired acute pyelonephritis aged 15 years and more who were admitted to 12 Korean hospitals from 1st April 2010 to 29th February 2012. Phylogenetic typing, multilocus sequence typing, and molecular characterization of β-lactamase and plasmid-mediated quinolone resistance determinants were performed for CIP-R isolates.

Results: A total of 569 isolates were collected, and 122 (21.4%) isolates were CIP-R isolates. The most prevalent sequence type (ST) was ST131 (28.7%, 35/122), followed by ST393 (14.7%, 18/122), ST1193 (13.1%, 16/122), ST38 (9.0%, 11/122), and ST405 (8.2%, 10/122). The antimicrobial resistance rates of ST131 to cefepime (22.9%, 8/35), ST38 to gentamicin (100%, 11/11), and ST405 to cefotaxime (66.7%, 6/9) were significantly higher than the resistance rates of all other STs combined. Notably, 40% (4/10) of ST405 clones produced extended-spectrum β-lactamases and were co-resistant to trimethoprim/sulfamethoxazole. (20%, 7/35) and CTX-M-14 (40%, 4/10) were more frequently observed in ST131 and ST405 compared with other clones, respectively.

Conclusions: Among the CIP-R uropathogenic isolates in this study, ST131, ST38, and ST405 were specifically associated with antimicrobial resistance.
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http://dx.doi.org/10.3947/ic.2020.52.2.194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335657PMC
June 2020

Diabetes mellitus increases mortality in acute pyelonephritis patients: a population study based on the National Health Insurance Claim Data of South Korea for 2010-2014.

Infection 2020 Jun 16;48(3):435-443. Epub 2020 Apr 16.

Department of Internal Medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.

Objective: Diabetes mellitus has been suspected to increase mortality in acute pyelonephritis (APN) patients and the goal of this study is to verify this suspicion with a large data set based on almost the entire population of South Korea.

Methods: A nationwide cohort study was conducted using a South Korean Health Insurance Review and Assessment Service claim database. We collected demographic and clinical information including comorbidities of patients with APN as the primary discharge diagnosis during 2010-2014. Then we compared the in-hospital mortality and recurrence of APN across the diabetes and non-diabetes groups.

Results: Among 845,656 APN patients, 12.4% had diabetes mellitus. The median age was 65 in the diabetes group, which was much higher than 47 in the non-diabetes group; the female proportion was 91-92% in both groups. The in-hospital mortality rate was higher in the diabetes group (2.6/1000 events in the diabetes group vs. 0.3/1000 in the non-diabetes group, P < 0.001). When covariates (age, sex, and the modified Charlson comorbidity index) were controlled with panel logistic regression, diabetes was still associated with a higher in-hospital mortality in APN patients (OR 2.66, 95% CI 2.19-3.23). The increasing effect of diabetes on in-hospital mortality of APN patients varied greatly with age: the effect was large for age 15-49 (OR 15.06, 95% CI 5.27-43.05), slightly smaller for age 50-64 (OR 12.17, 95% CI 5.71-25.92), and much smaller for age ≥ 65 (OR 2.10, 95% CI 1.72-1.92).

Conclusions: Our data indicate that the mortality of APN is higher in the patients with diabetes and this effect becomes stronger for young patients.
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http://dx.doi.org/10.1007/s15010-020-01419-2DOI Listing
June 2020

Prognostic factors for neurological outcomes in Korean targeted temperature management recipients with return of spontaneous circulation after out-of-hospital cardiac arrests: A nationwide observational study.

Medicine (Baltimore) 2020 Apr;99(15):e19581

Department of Emergency Medicine, Armed Force Capital Hospital, Seongnam, Republic of Korea.

Targeted temperature management (TTM) is recommended for comatose patients after out-of-hospital cardiac arrests (OHCAs). Even after successful TTM, several factors could influence the neuroprotective effect of TTM. The aim of this study is to identify prognostic factors associated with good neurological outcomes in TTM recipients.This study used nationwide data during 2012 to 2016 to investigate prognostic factors associated with good neurological outcomes in patients who received TTM after the return of spontaneous circulation (ROSC). Multivariate logistic regression analysis was conducted to analyse the factors that may affect the neurological outcomes in the TTM recipients.The study included 1578 eligible patients, comprising 767 with good and 811 with poor neurological outcomes. Multivariable analyses showed that OHCA in public places (OR, 1.599; 95% CI, 1.100-2.323, P = .014), initial shockable rhythms (OR, 1.721; 95% CI, 1.191-2.486, P = .004), pre-hospital ROSCs (OR, 6.748; 95% CI, 4.703-9.682, P < .001), bystander cardiopulmonary resuscitation (CPR) (OR, 1.715; 95% CI, 1.200-2.450, P = .003), and primary coronary interventions (PCIs) (OR, 2.488; 95% CI, 1.639-3.778, P < .001) were statistically significantly associated with good neurological outcomes. Whereas, increase of age (OR, 0.962; 95% CI, 0.950-0.974, P < .001) and conventional cooling (OR, 0.478; 95% CI, 0.255-0.895, P = .021) were statistically significantly associated with poor neurological outcome.This study suggests that being younger, experiencing OHCA in public places, having initial shockable rhythm, pre-hospital ROSC, and bystander CPR, implementing PCIs and applying intravascular or surface cooling devices compared to conventional cooling method could predict good neurological outcomes in post-cardiac arrest patients who received TTM.
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http://dx.doi.org/10.1097/MD.0000000000019581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440340PMC
April 2020

A Case of Human Immunodeficiency Virus -triggered Hemophagocytic Lymphohistocytosis Presenting with Severe Bleeding Tendency.

Infect Chemother 2018 11 1. Epub 2018 Nov 1.

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Human immunodeficiency virus (HIV) is one of the less common triggers of secondary hemophagocytic lymphohistiocytosis (HLH) in which coagulation disorder is a frequent manifestation. Here, we present a case of HIV-triggered secondary HLH presenting with severe bleeding tendency and fever. Despite high-dose dexamethasone infusion (10 mg/body surface area/day), progressive disseminated intravascular coagulation and thrombocytopenia resulted in massive hemathochezia: the bleeding episode ceased after endoscopic hemoclipping. After then, he took a highly-active antiretroviral therapy (HAART). Eventually, body temperature and overall laboratory findings normalized in response to HAART. Clinicians should not overlook HIV infection as a possible trigger of secondary HLH. In such cases, HAART is the core treatment.
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http://dx.doi.org/10.3947/ic.2018.0203DOI Listing
November 2018

New-onset atrial fibrillation predicting for complicating cardiac adverse outcome in scrub typhus infection.

Clin Cardiol 2019 Dec 3;42(12):1210-1221. Epub 2019 Oct 3.

Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Republic of Korea.

Background: Scrub typhus is a well-known infectious disorder of the Asia-Pacific region. However, adverse cardiac outcomes are an under-recognized complication of scrub typhus infection, and new-onset AF has been reported to be a prognostic factor in other, more common infectious diseases. The present study investigated whether new-onset atrial fibrillation (AF) is significantly associated with 3-month mortality and adverse cardiac complications in scrub typhus infection.

Methods: We examined data from the National Health Information Database (NHID) which covers nearly the entire population of South Korea, from 2006 to 2016. In total, 233 473 patients diagnosed with scrub typhus infection were selected as study participants. New-onset AF, acute heart failure (AHF), ischemic heart disease (IHD), and 3-month mortality were analyzed using a generalized estimating equation model with a Poisson distribution.

Results: Of these, 2402 patients (1%) were diagnosed with new-onset AF (87.2% were over 60 years of age, 43.3% were male). Those with new-onset AF were more likely to have underlying cardiovascular disease compared to those without new-onset AF. After being adjusted for demographic factors and comorbidities, those with new-onset AF had a higher incidence risk of concurrent AHF (4.1-fold) and IHD (1.9-fold) compared with those without new-onset AF. In particular, the 3-month mortality was also significantly associated with new-onset AF (1.3-fold), concurrent AHF (2.4-fold), and IHD (13.7-fold).

Conclusions: New-onset AF was significantly associated with 3-month mortality and concurrent AHF and IHD. Therefore, new-onset AF could be a poor prognostic factor for 3-month mortality and cardiac complications in scrub typhus infection.
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http://dx.doi.org/10.1002/clc.23276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906989PMC
December 2019

Association of ambient temperature with the outcomes in witnessed out-of-hospital cardiac arrest patients: a population-based observational study.

Sci Rep 2019 09 16;9(1):13417. Epub 2019 Sep 16.

Department of Emergency Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea.

This study aimed to identify the association between ambient temperature (AT) and patient outcome of witnessed out-of-hospital cardiac arrest (OHCA) occurring outdoors. This retrospective nationwide, population-based cohort study recruited witnessed adult OHCA patients in South Korea from January 2012 to December 2016. Meteorological data of 17 metropolitan cities and provinces were retrieved from the Korea Meteorological Administration database. Primary outcome was sustained return of spontaneous circulation (ROSC) in hospital. Secondary outcome was survival to hospital discharge. By the standard of quartile categories of AT (Q1 = 7.1 °C; Q2 = 17.7 °C; Q3 = 23.5 °C), three comparative analyses for ROSC and survival were performed between low and high AT groups. Propensity score matching (1:1) was performed for both AT groups. Among the 142,906 OHCA patients, 1,295 were included. In the multivariate analysis for matched groups by the standard of 7.1 °C (Q1), proportion of ROSC was significantly higher in the high AT-Q1 group than in the low AT-Q1 group (adjusted odds ratio [aOR] 2.02, 95% confidence interval [CI] 1.19-3.44). No significant difference in survival was shown between both AT-Q1 groups (aOR 1.24, 95% CI 0.61-2.52). In the standard of 17.7 °C (Q2) and 23.5 °C (Q3), no significant differences in ROSC and survival were found between the low and high AT groups. In conclusion, no obvious correlation existed between AT and patient outcomes such as sustained ROSC or survival to discharge in this study.
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http://dx.doi.org/10.1038/s41598-019-50074-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746864PMC
September 2019

Ribotype variability of Clostridioides difficile strains in patients with hospital-acquired C. difficile infections, community-acquired C. difficile infections, and colonization with toxigenic and non-toxigenic strains of C. difficile.

Anaerobe 2019 Dec 9;60:102086. Epub 2019 Aug 9.

Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea. Electronic address:

There have been few available data that presented a direct comparison between polymerase chain reaction ribotype (RT) distribution of Clostridioides difficile strains from C. difficile infection (CDI) and colonization. To understand the epidemiology of CDI in a hospital setting, we compared RTs of C. difficile strains from hospital-acquired CDI (HA-CDI) and toxigenic colonization and from community-acquired CDI (CA-CDI) and non-toxigenic colonization using the stool samples submitted for C. difficile cultures at an institution during 2009, 2012, and 2014. Overall, 721 C. difficile strains were identified from 607 patients. Among them, 450 (62.4%) were HA-CDI, 20 (2.8%) were CA-CDI, 126 (17.5%) were toxigenic colonization, and 125 (17.3%) were non-toxigenic colonization. RT018, RT017, RT002, RT015, and RT001 isolates were the most prevalent RTs in HA-CDI, and they comprised 74.9% of the total HA-CDI isolates but accounted for 60.4% of isolates from toxigenic colonization. In total, 32 strain compromising 18 RTs from HA-CDI (7.1%) were not seen among the toxigenic colonization group, and 3 RTs with 5 strains from toxigenic colonization were not seen among the HA-CDI group. The distribution of RTs was the most diverse in CA-CDI and the least diverse in HA-CDI. Although 5 RT strains, which were prevalent in HA-CDI, comprised 40% of CA-CDI, 5 isolates (25%) revealed unknown RTs, which were uncommon in HA-CDI or toxigenic colonization. In 12 patients with both episodes of CDI and toxigenic colonization, 8 had 2 isolates with different RTs and 4 had isolates with identical RTs. In conclusion, although RT017 and RT018 were the most common in HA-CDI and toxigenic colonization, C. difficile strains from toxigenic colonization were more diverse than those from HA-CDI.
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http://dx.doi.org/10.1016/j.anaerobe.2019.102086DOI Listing
December 2019

Trend of antibiotics usage for acute pyelonephritis in Korea based on national health insurance data 2010-2014.

BMC Infect Dis 2019 Jun 25;19(1):554. Epub 2019 Jun 25.

Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.

Background: The objective of this study is to describe the changes in prescribing practices of antibiotics to treat acute pyelonephritis (APN) in Korea.

Methods: The claim data base of the Health Insurance Review and Assessment Service in Korea was used to select patients with ICD-10 codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, not specified as acute nor chronic) as the primary discharge diagnosis during 2010-2014. Consumption of each class of antibiotics was converted to Defined Daily Dose (DDD)/event.

Results: Throughout the five-year period, the average antibiotic consumption were 11.3 DDD per inpatient event and 6.0 DDD per outpatient event. The annual average antibiotic consumption increased for inpatients (P = 0.002), but remained stable for outpatients (P = 0.066). The use of parenteral antibiotics increased for inpatients (P < 0.001), but decreased for outpatients (P = 0.017). As for the the antibiotic classes, 3 generation cephalosporins (3 CEPs) was the most commonly prescribed (41.4%) for inpatients, followed by fluoroquinolones (FQs) (28.5%); for outpatient, FQs (54.8%) was the most commonly prescribed, followed by 3 CEPs (13.1%). The use of 3 CEPs (P < 0.001), beta-lactam/beta-lactamase inhibitors (P = 0.007), and carbapenems (P < 0.001) increased substantially for the treatment of hospitalized APN patients. In particular, carbapenems use increased 3.1-fold over the 5 years.

Conclusions: Prescription of broad-spectrum antibiotics increased much for the treatment of APN in Korea during 2010-2014.
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http://dx.doi.org/10.1186/s12879-019-4191-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593604PMC
June 2019

Change in antimicrobial susceptibility and PCR ribotypes of Clostridioides difficile in a hospital over 5 years: Correlation analysis with antimicrobial consumption.

Int J Antimicrob Agents 2019 Aug 5;54(2):154-158. Epub 2019 Jun 5.

Department of Internal Medicine, College of Medicine, Hanyang University, 232 Wangsimni-ro, Seongdong-gu, Seoul 133-792, South Korea. Electronic address:

Clostridioides difficile infection (CDI) is a major concern in hospital settings. Antimicrobial resistance is a key contributing factor in CDI outbreaks. This study analysed the antimicrobial susceptibility and PCR ribotypes (RTs) of 745 C. difficile isolates collected at a single institution over 5 years. Seventeen known RTs were identified in 643 isolates (86.3%), of which RTs 018, 017, 015, 001 and 002 were the most prevalent. Reduced susceptibility to metronidazole (MTZ) and vancomycin (VAN) was rare (2.0% and 0.7%, respectively). Resistance to rifaximin (RFX), moxifloxacin (MXF) and clindamycin (CLI) was high in multiple RTs (29.3%, 67.0% and 69.4% of total isolates, respectively). Antimicrobial susceptibility varied among RTs. Whilst non-susceptibility to VAN, RFX, MXF, CLI and piperacillin/tazobactam (TZP) mostly occurred in commonly identified RTs, MTZ resistance was observed in diverse RTs. Correlation analysis between the MICs of the six antimicrobials for annual isolates and antimicrobial consumption in the hospital by year showed variable degrees of correlation; significant positive correlation for TZP (P = 0.037), significant negative correlation for VAN (P < 0.001) and no significant correlation for the other antimicrobials. MIC creep of TZP occurred during the study period with the appearance of 19 isolates with TZP intermediate-resistance mostly in 2013 (89.5%; 17/19), and three RTs containing TZP-intermediate-resistant isolates, including RT015 (n = 4), RT002 (n = 12) and RT112 (n = 1), increased over time (P = 0.010). These findings suggest an association of antibiotic consumption and resistant C. difficile strains and question TZP use for limiting CDI in hospitals.
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http://dx.doi.org/10.1016/j.ijantimicag.2019.05.022DOI Listing
August 2019
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