Publications by authors named "Kyung Hwa Park"

142 Publications

Impact of adverse events of adjuvant and neoadjuvant chemotherapies on outcomes of patients with pancreatic ductal adenocarcinoma.

Cancer Chemother Pharmacol 2021 Apr 7. Epub 2021 Apr 7.

Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.

Purpose: Recently, the number of patients with pancreatic ductal adenocarcinoma (PDAC) who have received both neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) has been increasing. However, whether adverse events (AEs) during AC influence the prognosis of patients with resected PDAC who do or do not receive NAC remains uncertain.

Methods: Patients with PDAC who underwent a pancreatectomy between 2011 and 2019 were divided into two groups: an upfront surgery (UFS) group (n = 72), and an NAC group (n = 77). Patients who received AC were then divided into two groups: an AE grade 0/1/2 group (AE-G-0/1/2) and an AE grade 3/4 group (AE-G-3/4). The relationship between AEs and patient outcome and predictors of AE-G-3/4 were investigated.

Results: AC was used in 54 and 65 patients in the UFS and NAC groups, respectively. In the NAC group, the relative dose intensity (RDI) and AC completion rate as well as the overall survival rate of patients with AE-G-3/4 (n = 15) during AC were significantly worse than those of patients with AE-G-0/1/2 (n = 50). However, similar differences were not observed in the UFS group. A multivariate analysis revealed that AE-G-3/4 during NAC, AC agent (gemcitabine), an albumin level < 3.5 g/dL, and an estimated glomerular filtration rate < 90 mL/min/1.73 m before the initiation of AC were independent predictors of AE-G-3/4 during AC.

Conclusions: AE-G-3/4 during AC was associated with a lower RDI and AC completion rate and a worse outcome among patients with PDAC who had received NAC.
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http://dx.doi.org/10.1007/s00280-021-04267-5DOI Listing
April 2021

Efficacy of Adjuvant Chemotherapy According to the Pathological Response to Neoadjuvant Chemotherapy Among Patients With Pancreatic Ductal Adenocarcinoma.

Anticancer Res 2021 Mar;41(3):1629-1639

Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.

Background/aim: An association between the pathological response to neoadjuvant chemotherapy (NAC) and the efficacy of adjuvant chemotherapy (AC) in patients with pancreatic ductal adenocarcinoma (PDAC) remains unknown.

Patients And Methods: A total of 121 patients with PDAC who underwent a pancreatectomy between January 2013 and March 2020 were divided into two groups: an upfront surgery (UFS) group (n=42), and an NAC (gemcitabine plus S-1) group (n=79). In the NAC group, the pathological response was evaluated using the Evans classification.

Results: The overall survival was significantly higher in patients with an AC relative dose intensity (RDI) ≥80% than in patients with an AC RDI <80% in the UFS, NAC-Evans IIa, and NAC-Evans IIb+III groups. However, this difference was not observed in the NAC-Evans I group.

Conclusion: AC is preferable for patients with NAC-Evans IIa or IIb+III, but more effective AC regimens may be needed for NAC-Evans I patients.
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http://dx.doi.org/10.21873/anticanres.14925DOI Listing
March 2021

Factors associated with mask wearing among psychiatric inpatients during the COVID-19 pandemic.

Schizophr Res 2021 02 15;228:235-236. Epub 2021 Jan 15.

Department of Psychiatry, Chonnam National University Medical School, Gwangju, South Korea; Gwangju Mental Health and Welfare Commission, Gwangju, South Korea. Electronic address:

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http://dx.doi.org/10.1016/j.schres.2020.12.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831677PMC
February 2021

Is left-sided involvement of hepatocellular carcinoma an important preoperative predictive factor of poor outcome?

World J Surg Oncol 2020 Dec 3;18(1):317. Epub 2020 Dec 3.

Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.

Background: The tumor location is the most simple clinical factor and important in liver surgery to make surgical procedure. However, no previous study has investigated the prognostic differences and clinical features of hepatocellular carcinoma showing specific laterality. This study is the first report to focus on the laterality and aimed to lead to more simple and useful predictive factor rather than recent complicated predictive models.

Methods: Patients who underwent liver resection for the first time for single tumors located within each lobe between 2000 and 2018 were enrolled. We divided them into two groups based on tumor location: a right-sided group and a left-sided group. Univariable and multivariable analyses were performed to assess survival differences in relation to several other factors.

Results: There were 595 eligible patients; the 5-year survival rates and disease-free survival rates were 49.5% and 19.1% in the left-sided group and 55.6% and 24.5% in the right-sided group, respectively (p = 0.026). Statistical analyses revealed that the following preoperative prognostic factors were independently significant (p < 0.05) in the left-sided group: indocyanine green retention rate at 15 min, alpha fetoprotein, protein induced by vitamin K absence or antagonists-II level, and larger tumor size.

Conclusion: The left-sided group had a poorer prognosis than the right-sided group. A left-sided tumor location is a significant preoperative factor predictive of poor outcome in patients with hepatocellular carcinoma.
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http://dx.doi.org/10.1186/s12957-020-02100-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716469PMC
December 2020

Prosthetic valve endocarditis by Trichosporon mucoides: A case report and review of literature.

Medicine (Baltimore) 2020 Oct;99(41):e22584

Department of Infectious Diseases, Chonnam National University Hospital.

Nationale: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations.

Diagnosis: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed.

Interventions: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy.

Outcomes: There has been no sign of recurrence for 18-months after treatment completion.

Lessons: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.
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http://dx.doi.org/10.1097/MD.0000000000022584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7544388PMC
October 2020

Antimicrobial susceptibility of Staphylococcus species isolated from prosthetic joints with a focus on fluoroquinolone-resistance mechanisms.

Diagn Microbiol Infect Dis 2021 Jan 12;99(1):115173. Epub 2020 Aug 12.

Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea. Electronic address:

We investigated susceptibility to antimicrobials of 89 staphylococcal species from PJIs and analyzed fluoroquinolone (FQ)-resistance mechanisms. Staphylococcal isolates showed high resistance to oral antimicrobials, with the exception of TMP-STX and linezolid. The main mechanism of resistance to FQ was mutations in quinolone-resistance-determining-regions. Fifteen percent of Staphylococcus aureus overexpressed efflux-pump genes.
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http://dx.doi.org/10.1016/j.diagmicrobio.2020.115173DOI Listing
January 2021

Effects of branched-chain amino acids on postoperative tumor recurrence in patients undergoing curative resection for hepatocellular carcinoma: A randomized clinical trial.

J Hepatobiliary Pancreat Sci 2020 Nov 8;27(11):819-829. Epub 2020 Oct 8.

Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan.

Background/purpose: No effective postoperative adjuvant therapies have been established for patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate the effect of oral administration of branched-chain amino acids (BCAA) on the recurrence-free survival (RFS) after hepatic resection in HCC patients.

Methods: In this randomized clinical trial, HCC patients undergoing curative resections were randomly assigned in a 1:1 ratio to the BCAA group or surgery-alone group. The BCAA group received BCAA (Livact ) for up to 4 years. The primary endpoint was RFS. The secondary endpoint was overall survival (OS). Multivariate analysis was performed to detect the clinical characteristics significantly associated with RFS.

Results: Between January 2010 and October 2014, 156 patients (75 in BCAA group and 81 in surgery-alone group) were enrolled in the study. Of these, two patients were excluded from the efficacy analysis. Comparison of the survival curves by the log rank test demonstrated no significant difference in the RFS (P = .579) or OS (P = .268) between the BCAA and the control group. Multivariate analysis revealed that the RFS was significantly associated with age and number of tumors. A beneficial effect of BCAA on the RFS was found in patients younger than 72 years old with a HbA1c level of < 6.4%.

Conclusions: Oral BCAA supplementation could not reduce the risk of recurrence after hepatic resection in HCC patients; however, the results suggested that BCAA supplementation may be beneficial for selected patients who were younger and had mildly impaired glucose tolerance.
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http://dx.doi.org/10.1002/jhbp.830DOI Listing
November 2020

A comparison of epidemiology and clinical outcomes between influenza A H1N1pdm09 and H3N2 based on multicenter surveillance from 2014 to 2018 in South Korea.

Influenza Other Respir Viruses 2021 Jan 25;15(1):99-109. Epub 2020 Aug 25.

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

Background: After pandemic, A(H1N1)pdm09 is generally known to be associated with younger adults' infection and greater severity than seasonal A(H3N2) but some inconsistences between recent studies exist.

Objectives: We aimed to compare the epidemiology and clinical outcomes of A(H1N1)pdm09 and A(H3N2) to verify and consolidate about the knowledge of known differences of subtypes.

Methods: Data were retrospectively collected from the hospital-based influenza morbidity and mortality surveillance in South Korea in nine tertiary care hospitals, from August 31, 2014, to August 25, 2018. Patients with H1N1pdm09 or H3N2 infection admitted in the emergency room or ward were recruited.

Results: A total of 1747 patients had influenza A and were divided into two groups those with A(H1N1)pdm09 (n = 240) and those with A(H3N2) (n = 1507). A(H1N1)pdm09 group had younger age (mean age ± standard deviation 50.0 ± 18.8 in H1N1 vs 53.4 ± 21.1 in H3N2, P = .030), lower influenza vaccination (27.9% vs 43.9%, P < .001) and pneumococcal vaccination rates (41.0% vs 51.9%, P < .001), and fewer underlying diseases (67.5% vs 74.0%, P = .035) than the A(H3N2) group. Influenza A subtypes were not associated with pneumonia risk (adjusted odds ratios [AOR] of A(H1N1)pdm09: 0.7 [95% confidence interval [CI]: 0.4-1.2, P = .172]) and in-hospital mortality (hazard ratio (HR) of A(H1N1)pdm09: 1.0 (95% CI: 0.3-3.1, P = .983)). Influenza vaccination reduced in-hospital mortality in hospitalized patients (HR: 0.3 (95% CI: 0.1-0.7), P = .005).

Conclusions: A(H1N1)pdm09 infection was more common in younger patients without significant difference in pneumonia risk and in-hospital mortality between subtypes. Influenza vaccination was associated with reduced in-hospital mortality.
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http://dx.doi.org/10.1111/irv.12795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767957PMC
January 2021

Viral Load Kinetics of SARS-CoV-2 Infection in Saliva in Korean Patients: a Prospective Multi-center Comparative Study.

J Korean Med Sci 2020 Aug 10;35(31):e287. Epub 2020 Aug 10.

Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Korea.

Background: This study was performed to compare the viral load and kinetics of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in saliva with those in standard nasopharyngeal/oropharyngeal (NP/OP) swabs.

Methods: Fifteen patients with SARS-CoV-2 infection from four hospitals were prospectively enrolled and matched samples of nasopharyngeal/oropharyngeal swabs and saliva were collected at Day 1 of admission and every other day till consequently negative for two times. Real-time reverse transcription polymerase chain reaction (rRT-PCR) was performed to detect the envelope (E) and RNA-dependent RNA polymerase (RdRP) genes.

Results: The cycle threshold values of saliva were comparable to those of NP/OP swabs overall ( = 0.720, Mann-Whitney U test). However, the overall sensitivity of rRT-PCR using saliva was 64% (34/53), which is lower than the 77% (41/53) using NP/OP swabs. The sensitivity of rRT-PCR using saliva was especially lower in early stage of symptom onset (1-5 days; 8/15; 53%) and in patients who did not have sputum (12/22; 55%).

Conclusion: Saliva sample itself is not appropriate for initial diagnosis of coronavirus disease 2019 (COVID-19) to replace NP/OP swabs, especially for the person who does not produce sputum. COVID-19 cannot be excluded when the test using saliva is negative, and it is necessary to retest using NP/OP swabs.
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http://dx.doi.org/10.3346/jkms.2020.35.e287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415999PMC
August 2020

Clinical Course and Outcomes of 3,060 Patients with Coronavirus Disease 2019 in Korea, January-May 2020.

J Korean Med Sci 2020 Aug 3;35(30):e280. Epub 2020 Aug 3.

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

Background: The fatality rate of patients with coronavirus disease 2019 (COVID-19) varies among countries owing to demographics, patient comorbidities, surge capacity of healthcare systems, and the quality of medical care. We assessed the clinical outcomes of patients with COVID-19 during the first wave of the epidemic in Korea.

Methods: Using a modified World Health Organization clinical record form, we obtained clinical data for 3,060 patients with COVID-19 treated at 55 hospitals in Korea. Disease severity scores were defined as: 1) no limitation of daily activities; 2) limitation of daily activities but no need for supplemental oxygen; 3) supplemental oxygen via nasal cannula; 4) supplemental oxygen via facial mask; 5) non-invasive mechanical ventilation; 6) invasive mechanical ventilation; 7) multi-organ failure or extracorporeal membrane oxygenation therapy; and 8) death. Recovery was defined as a severity score of 1 or 2, or discharge and release from isolation.

Results: The median age of the patients was 43 years of age; 43.6% were male. The median time from illness onset to admission was 5 days. Of the patients with a disease severity score of 3-4 on admission, 65 (71.5%) of the 91 patients recovered, and 7 (7.7%) died due to illness by day 28. Of the patients with disease severity scores of 5-7, 7 (19.5%) of the 36 patients recovered, and 8 (22.2%) died due to illness by day 28. None of the 1,324 patients who were < 50 years of age died; in contrast, the fatality rate due to illness by day 28 was 0.5% (2/375), 0.9% (2/215), 5.8% (6/104), and 14.0% (7/50) for the patients aged 50-59, 60-69, 70-79, and ≥ 80 years of age, respectively.

Conclusion: In Korea, almost all patients of < 50 years of age with COVID-19 recovered without supplemental oxygen. In patients of ≥ 50 years of age, the fatality rate increased with age, reaching 14% in patients of ≥ 80 years of age.
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http://dx.doi.org/10.3346/jkms.2020.35.e280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402927PMC
August 2020

Features of Hepatocellular Carcinoma With Micro Hepatic Vein Invasion and their Correlation With Hepatitis B and C Virus.

Anticancer Res 2020 Jul;40(7):3983-3990

Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan.

Background/aim: Few studies have studied micro hepatic vein invasion in hepatocellular carcinoma (HCC). We explored the correlation between hepatic vein invasion and hepatitis B/C virus infection.

Patients And Methods: Between April 2000 and February 2018, 869 patients underwent liver resection for HCC at a single center. The patients were divided into two groups: those with micro hepatic vein invasion (VV+) and those without (VV-). The clinical data, overall survival (OS) and correlations with the presence of hepatitis B and C viruses were investigated.

Results: There were 817 VV- patients and 43 VV+ patients. OS was 66.2 months for VV- patients and 9.9 months for VV+ patients (p=0.0010). VV+ patients had significantly higher levels of serum HBV DNA (p=0.016).

Conclusion: HCC patients with micro hepatic vein invasion showed significantly shorter OS. A higher level of HBV DNA appears to be a risk factor for micro hepatic vein invasion.
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http://dx.doi.org/10.21873/anticanres.14391DOI Listing
July 2020

The ABO Blood Group Impacts the Survival of Patients Undergoing Pancreatoduodenectomy for Biliary Tract Cancer.

In Vivo 2020 Jul-Aug;34(4):1893-1900

Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.

Background/aim: Although ABO blood group has been reported to be associated with the outcome of patients with pancreatic cancer, little is known about its impact on patients with biliary tract cancer (BTC). We evaluated the prognostic relevance of ABO blood group in patients who had undergone resection of BTC.

Patients And Methods: A total of 154 patients with BTC undergoing pancreatoduodenectomy were retrospectively reviewed. Associations between ABO blood group and patient survival were evaluated by univariate and multivariate analysis.

Results: The 5-year overall survival rate was higher in group O patients (n=46) than in other blood group patients (n=108) (65.8% vs. 47%, p=0.005). Multivariate analysis revealed that a non-O blood group was an independent risk factor for poor survival (p=0.021).

Conclusion: ABO blood group is associated with the prognosis of patients with resected BTC; group O patients have a better outcome.
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http://dx.doi.org/10.21873/invivo.11985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439892PMC
February 2020

Microbial Etiology of Pyogenic Vertebral Osteomyelitis According to Patient Characteristics.

Open Forum Infect Dis 2020 Jun 20;7(6):ofaa176. Epub 2020 May 20.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Background: It is difficult to select an appropriate empirical antibiotic treatment regimen for patients with culture-negative pyogenic vertebral osteomyelitis (PVO). Having knowledge of the distribution of microorganisms according to patient characteristics can help clinicians make informed choices regarding empirical antibiotics. The aim of this study was to determine the microbial distribution among individuals with PVO according to their demographic and clinical characteristics.

Methods: We reviewed the medical records of patients admitted to our hospital with culture-confirmed PVO between January 2005 and December 2017 and collected data on demographics, underlying diseases, and radiographic and microbiological results. Statistical analysis was performed to identify associations between specific bacteria and specific patient characteristics.

Results: A total of 586 patients were included in the study. The prevalence of infections was higher in young patients than in old patients, while gram-negative bacterial infections and were more prevalent in older patients. Gram-negative bacterial infections were more common in women than in men (32.1% vs 16.4%;  < .05), in patients with cirrhosis than in those without (32.7% vs 21.1%;  < .05), and in patients with a solid tumor than in those without (31.0% vs 20.7%;  < .05). Methicillin-resistant infections were more prevalent in patients with chronic renal disease than in those without (34.4% vs 14.7%;  < .05).

Conclusions: The microbial etiology of PVO varies according to patient characteristics. Patient characteristics should thus be considered when choosing empirical antibiotics in patients with culture-negative PVO.
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http://dx.doi.org/10.1093/ofid/ofaa176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270706PMC
June 2020

Case report: nosocomial fungemia caused by Candida diddensiae.

BMC Infect Dis 2020 May 27;20(1):377. Epub 2020 May 27.

Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.

Background: Candida diddensiae, a yeast found in olive oil, is considered non-pathogenic to humans. Here, we describe the first case of fungemia caused by C. diddensiae in a hospitalized patient with underlying diseases.

Case Presentation: A 62-year-old woman was admitted because of multiple contusions due to repeated falls and generalized weakness. She presented with chronic leukopenia due to systemic lupus erythematosus, and multiple cranial nerve neuropathies due to a recurring chordoma. She was given a lipid emulsion containing total parenteral nutrition (TPN) starting on the day of admission. Broad-spectrum antibiotics had been administered during her last hospital stay and from day 8 of this hospitalization. However, no central venous catheter was used during this hospital stay. Blood cultures obtained on hospital days 17, 23, and 24 yielded the same yeast, which was identified as C. diddensiae via sequence analyses of the internal transcribed spacer region and D1/D2 regions of the 26S ribosomal DNA of the rRNA gene. In vitro susceptibility testing showed that the minimum inhibitory concentration of fluconazole for all isolates was 8 μg/mL. On day 23, TPN was discontinued and fluconazole therapy was started. Blood cultures obtained on day 26 were negative. The fluconazole therapy was replaced with micafungin on day 26 and the patient exhibited improvements.

Conclusion: The use of lipid TPN may potentially contribute to the occurrence of nosocomial fungemia by C. diddensiae, an unusual Candida species.
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http://dx.doi.org/10.1186/s12879-020-05095-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251903PMC
May 2020

Viral kinetics of SARS-CoV-2 in asymptomatic carriers and presymptomatic patients.

Int J Infect Dis 2020 Jun 4;95:441-443. Epub 2020 May 4.

Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, South Korea; Chonnam National University Medical School, Gwangju, South Korea. Electronic address:

From a total of 71 laboratory-confirmed cases, three presymptomatic patients and 10 patients with entirely asymptomatic infections were identified. In two of the three incubation period patients, the viral titer in the presymptomatic period was very high (Ct value<20). The median number of days to first negative RT-PCR in the asymptomatic carriers was 4.5 (range 2.5-9), and all asymptomatic carriers reached a first RT-PCR Ct>35 within 14 days after diagnosis. Patients who have COVID-19 may already be infectious before there are symptoms, and 14 days of isolation after diagnosis may be sufficient in entirely asymptomatic cases.
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http://dx.doi.org/10.1016/j.ijid.2020.04.083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196533PMC
June 2020

Comparison of In Vivo Pharmacokinetics and Pharmacodynamics of Vancomycin Products Available in Korea.

Yonsei Med J 2020 Apr;61(4):301-309

Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea.

Purpose: Few studies have been investigated the in vivo efficacy of generic vancomycin products available outside of the United States. In this study, we aimed to compare the in vivo pharmacokinetics (PK) and pharmacodynamics (PD) of five generic vancomycin products available in Korea with those of the innovator.

Materials And Methods: The in vitro vancomycin purity of each product was examined using high-pressure liquid chromatography. Single-dose PK analyses were performed using neutropenic mice. The in vivo efficacy of vancomycin products was compared with that of the innovator in dose-effect experiments (25 to 400 mg/kg per day) using a thigh-infection model with neutropenic mice.

Results: Generic products had a lower proportion of vancomycin B (range: 90.3-93.8%) and a higher proportion of impurities (range: 6.2-9.7%) than the innovator (94.5% and 5.5%, respectively). In an in vivo single-dose PK study, the maximum concentration (C) values of each generic were lower than that of the innovator, and the geographic mean area under the curve ratios of four generics were significantly lower than that of the innovator (all <0.1). In the thigh-infection model, the maximum efficacies of generic products reflected in maximal effect (E) values were not significantly different from the innovator. However, the PD profile curves of some generic products differed significantly from that of the innovator in mice injected with a high level of Mu3 (all ≤0.05).

Conclusion: Some generic vancomycin products available in Korea showed inferior PK and PD profiles, especially in mice infected with hetero-vancomycin-resistant Staphylococcus aureus.
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http://dx.doi.org/10.3349/ymj.2020.61.4.301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105400PMC
April 2020

Report on a new species of Plutomurus (Collembola, Tomoceridae) from a South Korean limestone cave, with notes on its DNA barcode.

Zootaxa 2020 Jan 3;4718(1):zootaxa.4718.1.9. Epub 2020 Jan 3.

Department of Biology Education and Institute of Science Education, Jeonbuk National University, Jeonju, 54896, Korea.

A new species of Plutomurus Yosii, 1956, P. jangamensis sp. nov., was found in a limestone cave of South Korea. The new species is very similar to P. gul (Yosii, 1966) in the general pattern of cephalic and body chaetotaxy, absence of eye, presence of pointed tenent hair, number of lateral macrochaetae in basal segment of dens, and number of mucronal intermediate tooth; however, the two species can be distinguished by the small spines arranged in-a-row along with dental spines and lighter body color. This species, however, shows variability and was not easily classified morphologically as P. jangamensis sp. nov. and P. gul., in terms of body color, formula of dental spine, or even the number of prelabral chaetae. Partial DNA sequences of the mitochondrial cytochrome c oxidase subunit I (COI) gene were used as DNA barcodes to distinguish the species. This result suggests that the COI gene is useful for discrimination of P. jangamensis sp. nov. with high support (bootstrap=100). An identification key to the world species of Plutomurus is also provided.
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http://dx.doi.org/10.11646/zootaxa.4718.1.9DOI Listing
January 2020

Clinical characteristics and risk factors for complications of candidaemia in adults: Focus on endophthalmitis, endocarditis, and osteoarticular infections.

Int J Infect Dis 2020 Apr 30;93:126-132. Epub 2020 Jan 30.

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea. Electronic address:

Objectives: This study evaluated the incidence, risk factors, and clinical characteristics of complications of candidaemia in adults, with a focus on endophthalmitis, endocarditis, and osteoarticular infections.

Methods: All patients ≥18 years old with candidaemia in two Korean tertiary hospitals from 2007 to 2016 were investigated. Complications of candidaemia were defined as the presence of endophthalmitis, endocarditis, or osteoarticular infections documented in patients with candidaemia. The clinical characteristics and risk factors for candidaemia with complications were analysed in the patients who underwent ophthalmological examinations.

Results: Of 765 adult patients with candidaemia, 34 (4.4%) met the definition of complications, including endophthalmitis in 29 (3.8%), endocarditis in 4 (0.5%), and osteoarticular infections in 3 (0.4%). Of the 225 patients who underwent ophthalmological examinations, 29 (12.9%) had endophthalmitis. Candida albicans was an independent risk factor for complicated candidaemia (OR, 5.12; 95% CI, 2.17-12.09; P < 0.001). Although the mortality rate was no higher in complicated candidaemia, the duration of antifungal therapy was longer (23.1 ± 17.6 vs. 16.4 ± 10.8 days, P = 0.042), and 13 patients (39.3%) underwent additional procedures or surgery.

Conclusions: Complications of candidaemia occurred in 4.4% of adult patients. C. albicans was an independent risk factor for complicated candidaemia in adults. Complications of candidaemia might need prolonged treatment and additional procedures or surgery. Therefore, careful evaluation and active treatment of candidaemia with complications should be encouraged.
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http://dx.doi.org/10.1016/j.ijid.2020.01.049DOI Listing
April 2020

The microbiological characteristics of isolated from patients with native valve infective endocarditis.

Virulence 2019 12;10(1):948-956

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

The microbiological characteristics of causing infective endocarditis (IE) have not been investigated thoroughly. We compared the characteristics of isolates from patients with and without IE. Cases of bacteremia (SAB) were collected from 10 hospitals over 7 years. Cases of native valve IE were matched with non-IE controls according to the following criteria: central-line-associated infection, community-acquired infection, methicillin susceptibility, and if possible, the primary site of infection. Genes coding virulence factors were analyzed using multiplex polymerase chain reactions. Fibrinogen and fibronectin-binding properties were assessed using binding assays. The fibronectin-binding protein A gene () was sequenced. Of 2,365 cases of SAB, 92 had IE. After matching, 37 pairs of isolates from the IE cases and non-IE controls were compared; was detected in 91.9% of the IE isolates and 100% of the non-IE isolates ( = 0.24). While the fibrinogen binding ratio was similar (1.07 ± 0.33 . 1.08 ± 0.26, = 0.89), the fibronectin-binding ratio was significantly higher in the IE-group (1.31 ± 0.42 . 1.06 ± 0.31, = 0.01). The proportions of major single-nucleotide polymorphisms in were as follows: E652D (2.9% . 2.7%), H782Q (65.6% . 60.6%), and K786N (65.6% . 72.7%). The fibronectin-binding ratio was positively correlated with the number of SNPs present in IE cases ( < 0.001) but not in the non-IE controls ( = 0.124). Fibronectin-binding might play a key role in SAB IE. However, the degree of binding may be mediated by genetic variability between isolates.
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http://dx.doi.org/10.1080/21505594.2019.1685631DOI Listing
December 2019

Effectiveness of repeated influenza vaccination among the elderly population with high annual vaccine uptake rates during the three consecutive A/H3N2 epidemics.

Vaccine 2020 01 2;38(2):318-322. Epub 2019 Nov 2.

Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea; Asian Pacific Influenza Institute (APII), Seoul, South Korea. Electronic address:

Background: Annually, about 80% of the Korean elderly aged ≥65 years receive influenza vaccination. Repeated annual vaccination has been suggested as an important factor of poor influenza vaccine effectiveness (VE), though reported conflicting results.

Methods: During the consecutive A/H3N2-dominant influenza seasons between 2012 and 2015, we comparatively evaluated the VE (repeated vs. current season only) against laboratory-confirmed influenza, pneumonia and hospitalization in the elderly aged ≥65 years with influenza-like illness (ILI). Clinical and demographic data were collected prospectively, and vaccination status of prior and current seasons was verified using the immunization registry data of Korean Centers for Disease Control and Prevention.

Results: During the first A/H3N2-dominant season in 2012-2013, influenza vaccine showed statistically significant effectiveness against influenza A infection only and when vaccinated in the current season only (VE 53%, 95% CI 15-77). In the latter two seasons (2013-2015 years), the adjusted VE for influenza A was indistinguishable between repeated vaccination and vaccination in the current season only.

Conclusion: During consecutive influenza A/H3N2 epidemics, poor influenza vaccine effectiveness may be more pronounced among the elderly population with a high annual vaccine uptake rate.
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http://dx.doi.org/10.1016/j.vaccine.2019.10.012DOI Listing
January 2020

Clinical Significance of Neoadjuvant Chemotherapy With Gemcitabine Plus S-1 for Resectable Pancreatic Ductal Adenocarcinoma.

In Vivo 2019 Nov-Dec;33(6):2027-2035

Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan

Background/aim: Little is known about the efficacy of neoadjuvant chemotherapy (NAC) with gemcitabine plus S-1 (GS) for patients with resectable pancreatic ductal adenocarcinoma (R-PDAC). The aim of this study was to investigate differences in the long-term outcome of patients with R-PDAC undergoing pancreatectomy with and without NAC-GS to clarify the clinical significance of NAC-GS.

Patients And Methods: A total of 77 patients with R-PDAC who were scheduled for pancreatectomy between January 2012 and December 2017 were enrolled. Of these patients, 39 received NAC-GS (GS group) and 38 had upfront surgery (UFS group).

Results: Among the 77 patients, one patient in each group did not undergo pancreatectomy due to intraoperative non-curative factors. Median tumor size and the number of lymph nodes with metastasis were significantly lower in the GS group than in the UFS group (p=0.002 and p=0.017). However, the 5-year overall survival rate was similar in the two groups (26.1% versus 21.5%, p=0.930).

Conclusion: NAC-GS may not be recommended for patients with R-PDAC since it does not seem to offer any survival benefits.
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http://dx.doi.org/10.21873/invivo.11700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899096PMC
March 2020

A Prospective Cohort Study of Durations of Bacteremia According to Different Phenotypes and a New Concept of Persistent Bacteremia.

Antimicrob Agents Chemother 2019 12 20;64(1). Epub 2019 Dec 20.

Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

The purpose of this study was to describe and compare the duration of bacteremia (SAB) according to methicillin resistance and the primary foci of infection. We also aimed to newly define persistent SAB considering these results. Nonduplicated episodes of SAB in patients aged ≥15 years from 14 hospitals in the Republic of Korea were analyzed between January 2009 and February 2018. The duration of SAB was defined as the number of days from the time of administration of an antibiotic to which the isolate was susceptible after the onset of SAB to the last day of a positive blood culture for SAB durations were described and compared based on methicillin resistance and the primary foci of infection. Cases in the top quartile for the duration of bacteremia in the respective clinical context were classified as newly defined persistent SAB, and its association with in-hospital mortality was evaluated. A total of 1,917 cases were analyzed. The duration of SAB was longer in patients with methicillin-resistant SAB (MRSAB;  = 995) than in patients with methicillin-susceptible SAB (MSSAB;  = 922) (median duration, 1 day [interquartile range, 1 to 3 days] for MSSAB and 1 day [interquartile range, 0 to 5 days] for MRSAB; 0.001). The duration of bacteremia was longer in patients with endocarditis and bone and joint, endovascular, and surgical site infections and was shorter in patients with skin and soft tissue infections. Newly defined persistent SAB was independently associated with in-hospital mortality (adjusted odds ratio, 1.97; 95% confidence interval, 1.54 to 2.53; 0.001). The durations of SAB were dependent on methicillin resistance and the primary foci of infection, and considering these contexts, persistent SAB was significantly associated with in-hospital mortality.
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http://dx.doi.org/10.1128/AAC.01656-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187606PMC
December 2019

Microsatellite Analysis of Recurrent Lesions Confirms Merit of Anatomical Liver Resection for Hepatocellular Carcinoma.

Anticancer Res 2019 Aug;39(8):4315-4324

Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan.

Background/aim: This study aimed to obtain accurate differential diagnosis (DDx) of multicentric carcinogenesis (MC) and intrahepatic metastasis (IM) in recurrent lesions of hepatocellular carcinoma.

Materials And Methods: A total of 79 patients who underwent re-hepatectomy (2000-2013) were examined. PCR was used to analyze 13 chromosomal microsatellite loci by PCR. On the basis of this genetic analysis, the recurrent lesions were diagnosed as IM, MC or not determined (ND). Subsequently, DDx was compared with types of resection and outcome.

Results: The recurrent lesions were diagnosed as IM in 33 patients, MC in 44, and ND in 2. The anatomical resection group included 14 IM lesions (28%) and 36 MC lesions (72%), while the non-anatomical resection group included 19 IM lesions (70%) and 8 MC lesions (30%) (p<0.001).

Conclusion: Anatomical resection at initial hepatectomy may reduce the likelihood of IM recurrence, leading to a better outcome for patients with HCC.
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http://dx.doi.org/10.21873/anticanres.13597DOI Listing
August 2019

Synergy and Activity of Tigecycline-Ciprofloxacin Combination Therapy against Vibrio vulnificus Sepsis.

Antimicrob Agents Chemother 2019 10 23;63(10). Epub 2019 Sep 23.

Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea

The mortality rate associated with sepsis remains high. An time-kill assay revealed synergism between tigecycline and ciprofloxacin. The survival rate was significantly higher in mice treated with tigecycline plus ciprofloxacin than in mice treated with cefotaxime plus minocycline. Thus, combination treatment with tigecycline-ciprofloxacin may be an effective novel antibiotic regimen for sepsis.
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http://dx.doi.org/10.1128/AAC.00310-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761547PMC
October 2019

Impact of preoperative percutaneous transhepatic biliary drainage on post-operative survival in patients with distal cholangiocarcinoma.

ANZ J Surg 2019 09 7;89(9):E363-E367. Epub 2019 Jul 7.

Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.

Background: The aim of this study was to investigate the long-term impact of the type of preoperative biliary drainage used for patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma (DCC).

Methods: A total of 84 patients with DCC who underwent preoperative biliary drainage between June 2000 and December 2016 were divided into groups for whom percutaneous transhepatic biliary drainage (PTBD) (n = 24) or endoscopic biliary drainage (EBD) (n = 60) was used.

Results: The 5-year overall survival in the PTBD group was significantly worse than that in the EBD group (16.7% versus 52.3%, P = 0.007). After propensity score matching (22 patients in each group), the 5-year overall survival in the PTBD group was still worse than that in the EBD group (13.6% versus 61.2%, P = 0.003). Multivariate analysis revealed that PTBD was independent risk factor for both poor survival (P = 0.028) and peritoneal recurrence (P = 0.018). The incidence of multiple sites at initial recurrence tended to be higher in the PTBD group than in the EBD group (P = 0.080).

Conclusions: PTBD should not be performed for patients undergoing pancreatoduodenectomy for DCC, except when EBD is contraindicated, as PTBD is significantly associated with shorter survival and peritoneal recurrence.
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http://dx.doi.org/10.1111/ans.15329DOI Listing
September 2019

Outcomes of Third-Generation Cephalosporin Plus Ciprofloxacin or Doxycycline Therapy in Patients with Vibrio vulnificus Septicemia: A Propensity Score-Matched Analysis.

PLoS Negl Trop Dis 2019 06 12;13(6):e0007478. Epub 2019 Jun 12.

Department of Infectious Diseases, Chonnam National University Hospital, Gwang-ju, Republic of Korea.

Background: Combination therapy with a third-generation cephalosporin (TGC) and a tetracycline analogue is recommended for Vibrio vulnificus infection. The combination of a TGC and ciprofloxacin has synergistic in vitro bactericidal activity against V. vulnificus. No clinical study has compared the standard regimen with TGC plus ciprofloxacin therapy for V. vulnificus infection.

Methods: Patients with a confirmed V. vulnificus infection at two medical centers in Korea from 1991 to 2016 were enrolled in this study. The patients were grouped according to the type of antibiotic administered. A retrospective propensity-score-matched case-control study of patients treated with TGC plus doxycycline or TGC plus ciprofloxacin was performed. The clinical characteristics and outcomes of the patients were analyzed.

Results: A total of 218 patients were confirmed to have V. vulnificus septicemia during the study, and the 30-day survival rate was 39% (85/218). The patients were classified into the following six treatment groups: TGC monotherapy (n = 82), TGC plus doxycycline therapy (n = 42), TGC plus ciprofloxacin therapy (n = 39), ciprofloxacin monotherapy (n = 14), other β-lactam monotherapy (n = 10), and other (n = 31). The survival rates of these groups were as follows: TGC monotherapy (35%), TGC plus doxycycline (38%), TGC plus ciprofloxacin (54%), ciprofloxacin monotherapy (29%), other β-lactam (20%), and other (39%). The 30-day survival rate showed no significant difference between the TGC plus doxycycline and TGC plus ciprofloxacin groups (log-rank test, P = 0.18). Among the 81 patients treated with TGC plus doxycycline or TGC plus ciprofloxacin, 12 per treatment group were selected by propensity-score matching. There was no significant difference in the baseline characteristics or the frequency of fasciotomy between the two groups. The 30-day survival rate showed no significant difference between the TGC plus doxycycline (50%) and TGC plus ciprofloxacin (67%) groups (log-rank test, P = 0.46).

Conclusion: Our data suggest that the outcome of TGC plus ciprofloxacin therapy was comparable to that of TGC plus doxycycline therapy in patients with V. vulnificus septicemia.
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http://dx.doi.org/10.1371/journal.pntd.0007478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590838PMC
June 2019

Preoperative lymphocyte-to-monocyte ratio is useful for stratifying the prognosis of hepatocellular carcinoma patients with a low Cancer of the Liver Italian Program score undergoing curative resection.

Ann Gastroenterol Surg 2019 May 23;3(3):325-335. Epub 2019 Apr 23.

Second Department of Surgery Dokkyo Medical University Tochigi Japan.

Background And Aim: Although the Cancer of the Liver Italian Program (CLIP) score is useful for prognostication of patients with hepatocellular carcinoma (HCC), a previous study has reported that the CLIP score was unable to stratify the postoperative outcomes of HCC patients in whom the score was low (0-1). Recent studies have reported that the preoperative lymphocyte-to-monocyte ratio (LMR) is useful for prognostication of patients with various cancer.

Methods: We reviewed 329 HCC patients with a low CLIP score (0-1) undergoing curative resection. This study had the approval of the Institutional Review Board (28068). Multivariate analyses were carried out to detect clinical factors correlating with overall survival (OS). Kaplan-Meier analysis and the log-rank test were used for comparison of OS.

Results: Multivariate analysis showed that LMR (<4.35/≥4.35) was significantly associated with OS (hazard ratio [HR], 2.022; 95% CI, 1.141-3.583; =0.016) as well as portal vein invasion (HR, 2.410; 95%CI, 1.258-4.618; =0.008). Kaplan-Meier analysis and the log-rank test showed a significant difference in OS and relapse-free survival between patients with high LMR and those with low LMR.

Conclusion: Preoperative LMR is useful for stratifying the prognosis of HCC patients with a low CLIP score (0-1) undergoing curative resection.
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http://dx.doi.org/10.1002/ags3.12251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6524078PMC
May 2019

Lack of correlation of virulence gene profiles of Staphylococcus aureus bacteremia isolates with mortality.

Microb Pathog 2019 Aug 15;133:103543. Epub 2019 May 15.

Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address:

Purpose: Whole genome sequencing (WGS) analysis of Staphylococcus aureus is increasingly used in clinical practice. Although bioinformatics tools used in WGS analysis readily define the S. aureus virulome, the clinical value of this type of analysis is unclear. Here, virulence genes in S. aureus bacteremia (SAB) isolates were evaluated by WGS, with superantigens (SAgs) further evaluated by conventional PCR and functional assays, and results correlated with mortality.

Methods: 152 SAB isolates collected throughout 2015 at a large Minnesota medical center were studied and associated clinical data analyzed. Virulence genes were identified from previously-reported WGS data (https://doi.org/10.1371/journal.pone.0179003). SAg genes sea, seb, sec, sed, see, seg, seh, sei, sej, and tst were also assessed by individual PCR assays. Mitogenicity of SAgs was assessed using an in vitro proliferation assay with splenocytes from HLA-DR3 transgenic mice.

Results: Of the 152 SAB isolates studied, 106 (69%) were methicillin-susceptible S. aureus (MSSA). The number of deaths attributed and not attributed to SAB, and 30-day survivors were 24 (16%), 2 (1%), and 128 (83%), respectively. From WGS data, both MSSA and MRSA had high proportions of adhesion (>80%) and immune-evasion (>70%) genes. There was no difference in virulomes between survivor- and non-survivor-associated isolates. Although over 60% of SAB isolates produced functional SAgs, there were no differences in the distribution or prevalence of SAg genes between survivor- and non-survivor-associated isolates.

Conclusion: In this study of one year of SAB isolates from a large medical center, the S. aureus virulome, as assessed by WGS, and also for SAgs using individual PCRs and phenotypic characterization, did not impact mortality.
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http://dx.doi.org/10.1016/j.micpath.2019.103543DOI Listing
August 2019

A co-infection case report of Taenia saginata in a patient with subclinical clonorchiasis confirmed by the combination of diagnostic tools.

BMC Infect Dis 2019 Feb 6;19(1):115. Epub 2019 Feb 6.

Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.

Background: Clonorchiasis is the common parasitic infection in the general population of the Republic of Korea, however, taeniasis is scarcely reported recently. Here, we describe a case of co-infection with the cestode T. saginata in a patient with subclinical clonorchiasis diagnosed by a combination of diagnostic tools in Korea.

Case Presentation: A 56-year-old man visited the hospital having passed proglottids in his stool for the past two months and brought a stool sample with segments to our hospital. He had no abdominal symptoms, such as nausea, vomiting, abdominal pain, diarrhea, or constipation. He used to consume raw beef and fish frequently. We could not find evidence of gravid proglottids which contain fully developed uteri filled with ova or branched uterine structures, within the submitted sample. To identify the tapeworm species, we carried out molecular analyses on the proglottids. The cox1 and ef1a sequences had a 100% match with those of T. saginata and differed from the sequences of the other Taenia species. Upon examination of stool samples fixed by formalin-ether concentration method, no Taenia species ova were observed in 10 slides. Instead, C. sinensis ova were observed, despite the level of IgG specific to C. sinensis being within the normal range. The patient was treated with praziquantel (25 mg/kg, three times a day) for 3 days, and subsequently C. sinensis ova were not found in his stool.

Conclusion: Our case indicates that a combination of morphological, serological, and molecular diagnostic tools should be used for the accurate diagnosis of subclinical parasitic infections.
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http://dx.doi.org/10.1186/s12879-019-3758-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364428PMC
February 2019

Effectiveness of influenza and pneumococcal polysaccharide vaccines against influenza-related outcomes including pneumonia and acute exacerbation of cardiopulmonary diseases: Analysis by dominant viral subtype and vaccine matching.

PLoS One 2018 6;13(12):e0207918. Epub 2018 Dec 6.

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

Background: Influenza and pneumonia are leading causes of morbidity and mortality among the elderly. Although vaccination is a main strategy to prevent these infectious diseases, concerns remain with respect to vaccine effectiveness.

Methods: During three influenza seasons (2014-2015, 2015-2016 and 2016-2017), we evaluated the effectiveness of the influenza and pneumococcal vaccines against pneumonia and acute exacerbation of cardiopulmonary diseases among the elderly aged ≥65 years with influenza-like illness (ILI). Demographic and clinical data were collected prospectively.

Results: Among 2,119 enrolled cases, 1,302 (61.4%) and 871 (41.1%) received the influenza vaccine and 23-valent pneumococcal polysaccharide vaccine (PPV23), respectively. During an A/H3N2-dominant season with poor influenza vaccine effectiveness (2014-2015 season), neither the influenza vaccine nor PPV23 showed significant effectiveness against pneumonia or acute exacerbation of cardiopulmonary diseases. During seasons with good influenza vaccine effectiveness (2015-2016 and 2016-2017 seasons), the influenza vaccine was effective in preventing pneumonia, but PPV23 was not. In particular, the influenza vaccine was effective in preventing acute exacerbation of heart diseases (75.0%) during the A/H1N1-dominant 2015-2016 season.

Conclusion: The influenza vaccine was effective in preventing pneumonia only during vaccine-matched seasons with good effectiveness against circulating influenza viruses. In addition, the influenza vaccine was cardio-protective during a vaccine-matched A/H1N1-dominant season.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0207918PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283593PMC
May 2019