Publications by authors named "Se Yoon Park"

60 Publications

Impacts of Side Effects to BNT162b2 and the First Dose of ChAdOx1 Anti-SARS-CoV-2 Vaccination on Work Productivity, the Need for Medical Attention, and Vaccine Acceptance: A Multicenter Survey on Healthcare Workers in Referral Teaching Hospitals in the Republic of Korea.

Vaccines (Basel) 2021 Jun 14;9(6). Epub 2021 Jun 14.

Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea.

To establish a successful anti-SARS-CoV-2 vaccination strategy, it is necessary to take possible tradeoffs into account. We conducted a survey on vaccinated healthcare workers (HCWs) inthree referral teaching hospitals in the Republic of Korea. We investigated the frequency of vaccination side effects (SEs), the impact on their work productivity, the need for medical attention, and vaccine acceptance. Three groups of HCWs were surveyed: 1406 who had received the first dose of BNT162b2 (BNT162b2#1), 1168 who had received the second dose of BNT162b2 (BNT162b2#2), and 1679 who had received the first dose of ChAdOx1 (ChAdOx1#1). More SEs and impact on work productivity were reported in ChAdOx1#1 than in the other two groups. However, among individuals aged ≥40 years, no significant difference of absence from work was found between ChAdOx1#1 and BN162b2#2 (4.4%, 31/699 vs. 3.0%, 12/405; = 0.26), and none were hospitalized. Older HCWs in ChAdOx1#1 showed intention to receive the second dose of the vaccine. Although the incidence of SEs and their impacts were greater after the first dose of ChAdOx1 than BNT162b2 in young people, significant impact of SEs seemed to be rare in individuals aged ≥40 years, regardless of the vaccine they received.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/vaccines9060648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232011PMC
June 2021

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jgar.2021.06.001DOI Listing
June 2021

Risk factors for isolation of multi-drug resistant organisms in coronavirus disease 2019 pneumonia: a multicenter study.

Am J Infect Control 2021 Jun 16. Epub 2021 Jun 16.

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

Objectives: Superimposed multi-drug resistant organisms (MDROs) co-infection can be associated with worse outcomes in patients with severe coronavirus disease 2019 (COVID-19), even if these patients were managed with strict airborne and contact precautions. Identifying risk factors for isolation of MDROs is critical to COVID-19 treatment.

Methods: All eligible adult patients with confirmed COVID-19 pneumonia from 10 hospitals in the Republic of Korea between February 2020 and May 2020 were retrospectively enrolled. Using this cohort, epidemiology and risk factors for isolation of MDROs were evaluated.

Results: Of 152 patients, 47 with microbial culture results were included. Twenty isolates of MDROs from 13 (28%) patients were cultured. Stenotrophomonas maltophilia (five isolates) was the most common MDRO, followed by methicillin-resistant staphylococcus aureus (four isolates). MDROs were mostly isolated from sputum samples (80%, 16/20). The median time from hospitalization to MDRO isolation was 28 days (interquartile range, 18-38 days). In-hospital mortality was higher in patients with MDRO isolation (62% versus 15%; p = 0.001). Use of systemic corticosteroids after diagnosis of COVID-19 (adjusted odds ratio [aOR]: 15.07; 95% confidence interval [CI]: 2.34-97.01; p = 0.004) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR: 6.09; 95% CI: 1.02-36.49; p = 0.048) were associated with MDRO isolation.

Conclusions: MDROs were isolated from 28% of COVID-19 pneumonia patients with culture data and 8.6% of the entire cohort. Previous LTCF stay and adjunctive corticosteroid use were risk factors for the isolation of MDROs. Strict infection prevention strategies may be needed in these COVID-19 patients with risk factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2021.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251653PMC
June 2021

SARS-CoV-2-Specific Antibody and T Cell Response Kinetics According to Symptom Severity.

Am J Trop Med Hyg 2021 Jun 17. Epub 2021 Jun 17.

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Data on the longevity of humoral and cell-mediated immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with coronavirus disease 2019 (COVID-19) are limited. We evaluated the detailed kinetics of antibody and T-cell responses at the acute, convalescent, and post-convalescent phases in COVID-19 patients with a wide range of severity. We enrolled patients with COVID-19 prospectively from four hospitals and one community treatment center between February 2020 and January 2021. symptom severity was classified as mild, moderate, or severe/critical. Patient blood samples were collected at 1 week (acute), 1 month (convalescent), and 2 months after symptom onset (post-convalescent). Human SARS-CoV-2 IgG and IgM antibodies were measured using in-house-developed ELISA. The SARS-CoV-2-specific T-cell responses against overlapping peptides of spike proteins and nucleoprotein were measured by interferon-γ enzyme-linked immunospot assays. Twenty-five COVID-19 patients were analyzed (mild, n = 5; moderate, n = 9; severe/critical, n = 11). IgM and IgG antibody responses peaked at 1 month after symptom onset and decreased at 2 months. IgG response levels were significantly greater in the severe/critical group compared with other groups. Interferon-γ-producing T-cell responses increased between 1 week and 1 month after symptom onset, and had a trend toward decreasing at 2 months, but did not show significant differences according to severity. Our data indicate that SARS-CoV-2-specific antibody responses were greater in those with severe symptoms and waned after reaching a peak around 1 month after symptom onset. However, SARS-CoV-2-specific T-cell responses were not significantly different according to symptom severity, and decreased slowly during the post-convalescent phase.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4269/ajtmh.20-1594DOI Listing
June 2021

Promotion of healthcare personnel vaccinations among newly employed doctors and nurses: Evidence-guided strategy.

Vaccine 2021 06 20;39(26):3480-3485. Epub 2021 May 20.

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

Objective: Healthcare personnel vaccinations are important to prevent vaccine-preventable diseases in hospitals. We evaluated the seroprevalence, vaccination rates, and barriers to vaccination among newly employed nurses and doctors.

Methods: A cross-sectional study was conducted at a university hospital in the Republic of Korea from 2017 to 2020. The immune status for hepatitis B virus (HBV), varicella zoster virus (VZV), and hepatitis A virus (HAV) was tested. HBV, VZV, measles, mumps, and rubella (MMR) vaccinations were mandatory. HAV and tetanus-diphtheria-pertussis (Tdap) vaccinations were also recommended by specialists. A web-based survey on factors affecting vaccination completion was conducted.

Results: For the 668 participants, the mean age was 26 ± 2 (±SD) years. Seroprevalence was 86% for HBV, 93% for VZV, and 59% for HAV. Vaccine completion rates were 40% for HBV, 70% for VZV, 65% for MMR, 42% for HAV, and 70% for Tdap. Overall compliance for mandatory vaccines was 54%. A total of 402 subjects who had worked for over one year were surveyed, with a 22% response rate. More than 50% of respondents gave the following reasons for not receiving recommend vaccines: 1) they were busy (77%), 2) vaccination process was complicated (68%), and 3) they simply forgot about vaccination (55%). Healthcare personnel agreed to be frequently informed of immunization requirements and for monitoring of vaccination rates.

Conclusion: Vaccination compliance among newly employed doctors and nurses was 54%. Active interventions such as simplifying the vaccination process and frequent notifications are needed to achieve optimal immunization rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vaccine.2021.05.025DOI Listing
June 2021

Clinical characteristics and outcomes of infective endocarditis: impact of haemodialysis status, especially vascular access infection on short-term mortality.

Infect Dis (Lond) 2021 Sep 26;53(9):669-677. Epub 2021 Apr 26.

Department of Internal Medicine, Division of Cardiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.

Background: Patients on haemodialysis (HD) are at high risk of infective endocarditis (IE). Research comparing the microbiological features as well as clinical characteristics and outcomes of HD and non-HD patients with IE is limited. Specifically, no data focussed on vascular access infections (VAIs) have been reported.

Methods: The medical records of patients with IE were retrospectively reviewed from January 2010 to February 2020 in a referral hospital in Korea. Those with definite or possible IE by modified Duke criteria were included in the study. The clinical characteristics, microbiological features, echocardiographic findings and outcomes of the patients were analysed.

Results: Of the 80 patients with IE, 34 had undergone HD and 46 had not. HD patients with IE had a higher in-hospital mortality rate (50% vs. 17.4%,  = .004) than non-HD patients. In multivariable stepwise Cox proportional hazards regression analysis, HD (hazard ratio = 2.633; 95% confidential interval: 1.053-6.582;  = .038) was predictors of 60-day mortality in IE patients. In HD patients, the presence of VAI was associated with a high in-hospital mortality rate (70.59% vs. 29.41%,  = .039) and all of the patients with VAIs (100%) had methicillin-resistant (MRSA) as a causative pathogen.

Conclusions: HD patients with IE showed high in-hospital mortality. HD, high C-reactive protein levels and lower left ventricular ejection fraction were predictors of 60-day mortality in IE patients. In particular, HD patients with VAIs had higher mortality rates and MRSA should be considered as the causative microorganism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/23744235.2021.1916587DOI Listing
September 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13756-021-00913-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937201PMC
March 2021

Predictors of Acute Kidney Injury and 28-Day Mortality in Carbapenem-Resistant Complex Bacteremia.

Microb Drug Resist 2021 Mar 3. Epub 2021 Mar 3.

Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.

Colistin is an, antibiotic used to treat carbapenem-resistant complex (CRABC) infection. However, colistin is well known for its nephrotoxicity. To accurately assess the effects of colistin on acute kidney injury (AKI) and 28-day mortality, we investigated the risk factors associated with AKI and mortality in patients with CRABC bacteremia who received or never received colistin. Patients with CRABC bacteremia aged ≥18 years were retrospectively identified for 3 years at five tertiary teaching hospitals. AKI was defined by using the Kidney Disease Improving Global Outcomes criteria. AKI developed in 103 (34.9%) of the 295 patients enrolled patients. AKI developed more frequently in patients who received colistin than in patients who did not (46.7% vs. 29.5%,  = 0.004). Multivariate analysis showed that intravenous colistin usage was an independent risk factor for AKI in these patients. Nonfatal disease, catheter-related bloodstream infection, and administration of colistin were protective factors for 28-day mortality. However, the sequential organ failure assessment score and AKI were associated with poor outcomes. In conclusion, colistin may be a double-edged sword; although it causes AKI, it also reduces 28-day mortality in patients with CRABC bacteremia. Therefore, colistin administration as an appropriate antibiotic may improve CRABC bacteremia prognosis, despite its nephrotoxicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/mdr.2020.0312DOI Listing
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jiac.2021.02.014DOI Listing
July 2021

Machine-Learning-Based Approach to Differential Diagnosis in Tuberculous and Viral Meningitis.

Infect Chemother 2020 Dec 11. Epub 2020 Dec 11.

Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.

Background: Tuberculous meningitis (TBM) is the most severe form of tuberculosis, but differentiating between the diagnosis of TBM and viral meningitis (VM) is difficult. Thus, we have developed machine-learning modules for differentiating TBM from VM.

Material And Methods: For the training data, confirmed or probable TBM and confirmed VM cases were retrospectively collected from five teaching hospitals in Korea between January 2000 - July 2018. Various machine-learning algorithms were used for training. The machine-learning algorithms were tested by the leave-one-out cross-validation. Four residents and two infectious disease specialists were tested using the summarized medical information.

Results: The training study comprised data from 60 patients with confirmed or probable TBM and 143 patients with confirmed VM. Older age, longer symptom duration before the visit, lower serum sodium, lower cerebrospinal fluid (CSF) glucose, higher CSF protein, and CSF adenosine deaminase were found in the TBM patients. Among the various machine-learning algorithms, the area under the curve (AUC) of the receiver operating characteristics of artificial neural network (ANN) with ImperativeImputer for matrix completion (0.85; 95% confidence interval 0.79 - 0.89) was found to be the highest. The AUC of the ANN model was statistically higher than those of all the residents (range 0.67 - 0.72, <0.001) and an infectious disease specialist (AUC 0.76; = 0.03).

Conclusion: The machine-learning techniques may play a role in differentiating between TBM and VM. Specifically, the ANN model seems to have better diagnostic performance than the non-expert clinician.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3947/ic.2020.0104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032912PMC
December 2020

Etiology, Characteristics, and Outcomes of Community-Onset Pyomyositis in Korea: A Multicenter Study.

Infect Chemother 2021 Jan 7. Epub 2021 Jan 7.

The Korean Skin and Soft Tissue Study Group, Korea.

Background: Pyomyositis (PM) is a serious soft tissue infection and despite its clinical importance, previous studies have not been able to fully determine the clinical characteristics and microbial epidemiology of PM in Korea, which we therefore aimed to investigate.

Materials And Methods: We retrospectively identified 140 adult patients diagnosed with PM from 13 general hospitals between January 2012 and December 2015. We analyzed the clinical and microbial characteristics of community-onset PM and compared them with community-acquired (CA) and healthcare-associated (HCA) PM.

Results: One hundred eleven organisms were isolated from 96 (68.6%) patients with PM. (38 patients) was the most common pathogen, followed by streptococci (24 patients), and enteric Gram-negative organisms (27 patients). Methicillin-resistant (MRSA) was identified in four (2.9%) patients and in-hospital mortality reached 8.6% (12/140). Enterococci isolates were identified in the HCA PM subgroup only The proportion of MRSA isolates was not comparable between CA and HCA PM subgroups. In the 83 patients with PM infected by monomicrobial pathogens, isolates of Gram-negative organisms were more commonly found in HCA PM subgroup than in CA PM subgroup (47.6% [10/21] of patients with HCA PM 20.7% [12/58] of patients with CA PM; = 0.01).

Conclusion: Gram-positive cocci such as and streptococci were dominant etiologies in community-onset PM, whereas MRSA appears to an uncommon causative organism of PM in Korea. Enteric Gram-negative organisms should also be considered as major etiologies, especially in HCA PM patient population in Korea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3947/ic.2020.0102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032918PMC
January 2021

Kinetics of Serological Response in Patients with Severe Fever with Thrombocytopenia Syndrome.

Viruses 2020 12 25;13(1). Epub 2020 Dec 25.

Department of Microbiology, Korea University College of Medicine, Seongbuk-gu, Seoul 02841, Korea.

Severe fever with thrombocytopenia syndrome (SFTS) is caused by SFTS virus (SFTSV). We investigated the detailed kinetics of serologic response in patients with SFTS. Twenty-eight patients aged ≥18 years were enrolled between July 2015 and October 2018. SFTS was confirmed by detecting SFTSV RNA in their plasma using reverse transcription polymerase chain reaction. SFTSV-specific IgG and IgM were measured using immunofluorescence assay (IFA) and enzyme-linked immunosorbent assay (ELISA). We found that SFTSV-specific IgG was detected at days 5-9 after symptom onset, and its titer was rising during the course of disease. SFTSV-specific IgM titer peaked at around week 2-3 from symptom onset. The SFTSV-specific seropositive rates for days 5-9, 10-14, 15-19, and 20-24 from symptom onset using IFA and ELISA were 63%, 76%, 90%, and 100%, and 58%, 86%, 100%, and 100%, respectively, for IgG, whereas they were 32%, 62%, 80%, and 100%, and 53%, 62%, 70%, and 100%, respectively, for IgM. The delayed IgM response could be attributed to the low sensitivity of SFTSV-specific IgM IFA or ELISA and/or impaired immune responses. The IgM test using IFA or ELISA that we used in this study is, therefore, insufficient for the early diagnosis of SFTS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/v13010006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7823500PMC
December 2020

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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3346/jkms.2020.35.e428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752260PMC
December 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-020-09886-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7691971PMC
November 2020

Factors of Severity in Patients with COVID-19: Cytokine/Chemokine Concentrations, Viral Load, and Antibody Responses.

Am J Trop Med Hyg 2020 12 27;103(6):2412-2418. Epub 2020 Oct 27.

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

The severity of COVID-19 ranges from mild to critical diseases. However, limited data have been published on the detailed kinetics of viral load and host immune response throughout the disease course depending on disease severity. In this study, we comprehensively analyzed viral load, antibody responses to SARS-CoV-2, and cytokines/chemokines during the disease course, and identified the factors related to severity. Nasopharyngeal (NP) and plasma specimens were obtained from 31 patients with COVID-19 during hospitalization. Viral RNA in NP specimens was quantified by reverse transcription-PCR. Anti-SARS-CoV-2 antibodies and cytokines/chemokines in plasma specimens were analyzed by ELISA and cytometric bead array. The viral load in patients with COVID-19 peaked at the early stage of the disease and continuously decreased. Severe and critical cases showed higher viral load and prolonged viral shedding than asymptomatic and mild cases. Whereas plasma IgG was gradually increased and maintained during hospitalization, plasma IgM peaked at 3 weeks after symptom onset and dissipated. The antibody response in severe and critical cases was slightly delayed but stronger than those in others. High levels of interferon (IFN)-α, IFN-γ-induced protein-10, monokine induced by IFN-γ, and interleukin-6 at 5-10 days from symptom onset were associated with the severity of COVID-19. Our data indicate that high viral load in the respiratory tract and excessive production of cytokines and chemokines between 1 and 2 weeks from the symptom onset were significantly associated with the severity of COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4269/ajtmh.20-1110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695090PMC
December 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/ice.2020.1234DOI Listing
December 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.
View Article and Find Full Text PDF

Download full-text PDF

Source
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.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3904/kjim.2020.222DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652668PMC
November 2020

Effectiveness of surgical, KF94, and N95 respirator masks in blocking SARS-CoV-2: a controlled comparison in 7 patients.

Infect Dis (Lond) 2020 Nov - Dec;52(12):908-912. Epub 2020 Aug 26.

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Background: Data on the filtration efficacies of various masks against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are limited. We thus evaluate the effectiveness of the surgical mask, the N95 respirator mask, and its equivalent (KF94 mask) in filtering SARS-CoV-2.

Methods: Patients hospitalised with SARS-CoV-2 infection were instructed to cough five times each while wearing (1) no mask, (2) surgical mask, (3) KF94 mask, and (4) N95 mask. The coughs were separated by 20-second intervals, and the patients were rested for at least 5 min between each setting. SARS-CoV-2 viral loads in patient samples (i.e. nasopharyngeal swabs and saliva), petri dishes placed in front of the patients during coughing, and swabs from the outer and inner surfaces of the masks were analysed with PCR.

Results: A total of 7 patients with SARS-CoV-2 infection participated in the mask test. SARS-CoV-2 was detected on the petri dishes after coughing in 3 out of 7 cases with the surgical mask or no mask. Viral particles were not found in the petri dishes after coughing while wearing the N95 mask or the KF94 mask. While viral particles were detected in both the inner and outer surfaces of the surgical masks, those were detected only in the inner surfaces of the N95 and K94 masks.

Conclusion: Surgical masks were less effective in filtering viral particles from coughing patients with SARS-CoV-2 infection. N95 masks and its equivalents efficiently blocked SARS-CoV-2 particles from coughing patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/23744235.2020.1810858DOI Listing
October 2020

Scope of a weekly infection control team rounding in an acute-care teaching hospital: a pilot study.

Antimicrob Resist Infect Control 2020 08 15;9(1):123. Epub 2020 Aug 15.

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

Regular and well-organized inspection of infection control is an essential element of an infection control program. The aim of this study was to identify the functional scope of weekly infection control team rounding (ICTR) in an acute care hospital. We conducted weekly ICTR between January 18 and December 26, 2018 to improve the compliance to infection control and prevention measures at a 734-bed academic hospital in the Republic of Korea and analyzed the results retrospectively. We categorized the results into five groups: "well maintained," "improvement needed," "long-term support, such as space or manpower, needed," "not applicable," or "could not be observed". A total of nine categories and 85 sub-elements of infection control and prevention practices were evaluated. The median number of infection control team (ICT) visits per department was 7 (interquartile range [IQR]: 6-7). The ICT assessed a median of 16 elements (IQR: 12-22), and a total of 7452 results were obtained. Of those, 75% were monitored properly, 22% were "not applicable", and 4% were difficult to observe. The most common practices that were difficult to observe were strategies to prevent catheter-related surgical site infections, pneumonia, and occupationally acquired infections as well as injection safety practices. Although the ICTR was able to maintain regular visits to each department, further strategies beyond regular ICTR are needed to reduce category of "could not observed". This pilot study may provide an important reference for institutional infection prevention practices as it is the first study to investigate the functional coverage of ICTR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13756-020-00787-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428421PMC
August 2020

Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea.

JAMA Intern Med 2020 Nov;180(11):1447-1452

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

Importance: There is limited information about the clinical course and viral load in asymptomatic patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Objective: To quantitatively describe SARS-CoV-2 molecular viral shedding in asymptomatic and symptomatic patients.

Design, Setting, And Participants: A retrospective evaluation was conducted for a cohort of 303 symptomatic and asymptomatic patients with SARS-CoV-2 infection between March 6 and March 26, 2020. Participants were isolated in a community treatment center in Cheonan, Republic of Korea.

Main Outcomes And Measures: Epidemiologic, demographic, and laboratory data were collected and analyzed. Attending health care personnel carefully identified patients' symptoms during isolation. The decision to release an individual from isolation was based on the results of reverse transcription-polymerase chain reaction (RT-PCR) assay from upper respiratory tract specimens (nasopharynx and oropharynx swab) and lower respiratory tract specimens (sputum) for SARS-CoV-2. This testing was performed on days 8, 9, 15, and 16 of isolation. On days 10, 17, 18, and 19, RT-PCR assays from the upper or lower respiratory tract were performed at physician discretion. Cycle threshold (Ct) values in RT-PCR for SARS-CoV-2 detection were determined in both asymptomatic and symptomatic patients.

Results: Of the 303 patients with SARS-CoV-2 infection, the median (interquartile range) age was 25 (22-36) years, and 201 (66.3%) were women. Only 12 (3.9%) patients had comorbidities (10 had hypertension, 1 had cancer, and 1 had asthma). Among the 303 patients with SARS-CoV-2 infection, 193 (63.7%) were symptomatic at the time of isolation. Of the 110 (36.3%) asymptomatic patients, 21 (19.1%) developed symptoms during isolation. The median (interquartile range) interval of time from detection of SARS-CoV-2 to symptom onset in presymptomatic patients was 15 (13-20) days. The proportions of participants with a negative conversion at day 14 and day 21 from diagnosis were 33.7% and 75.2%, respectively, in asymptomatic patients and 29.6% and 69.9%, respectively, in symptomatic patients (including presymptomatic patients). The median (SE) time from diagnosis to the first negative conversion was 17 (1.07) days for asymptomatic patients and 19.5 (0.63) days for symptomatic (including presymptomatic) patients (P = .07). The Ct values for the envelope (env) gene from lower respiratory tract specimens showed that viral loads in asymptomatic patients from diagnosis to discharge tended to decrease more slowly in the time interaction trend than those in symptomatic (including presymptomatic) patients (β = -0.065 [SE, 0.023]; P = .005).

Conclusions And Relevance: In this cohort study of symptomatic and asymptomatic patients with SARS-CoV-2 infection who were isolated in a community treatment center in Cheonan, Republic of Korea, the Ct values in asymptomatic patients were similar to those in symptomatic patients. Isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamainternmed.2020.3862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7411944PMC
November 2020

Persistent severe acute respiratory syndrome coronavirus 2 detection after resolution of coronavirus disease 2019-associated symptoms/signs.

Korean J Intern Med 2020 07 19;35(4):793-796. Epub 2020 Jun 19.

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

There are limited data on the duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in respiratory specimens after resolution of coronavirus disease 2019 (COVID-19)-associated symptoms/signs. We determined duration of SARS-CoV-2 virus shedding in symptomatic patients after remission of symptoms. We investigated the duration of SARS-CoV-2 RNA detection using real-time reverse transcriptase polymerase chain reaction for SARS-CoV-2 in nasopharyngeal/oropharyngeal swabs or sputum or saliva. Six patients were included in the final analysis. The median (range) duration of SARS-CoV-2 viral detection after hospitalization was 34 days (22 to 67). After resolution of symptoms/signs, SARS-CoV-2 RNA was detected for median (range) of 26 days (9 to 48). Among the six patients, one had persistent detection of SARS-CoV-2 RNA until day 67 of hospitalization, which was 30 days after symptom resolution. This case represents the longest duration of SARS-CoV-2 detection, and highlights the need for long-term follow up of COVID-19 patients despite resolution of symptoms to confirm SARS-CoV-2 clearance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3904/kjim.2020.203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373965PMC
July 2020

Delayed Isolation of Active Pulmonary Tuberculosis in Hospitalized Patients: A Pivotal Role of Radiologic Evaluation.

AJR Am J Roentgenol 2020 08 20;215(2):359-366. Epub 2020 May 20.

Department of Radiology, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea.

The purpose of this study was to determine factors related to delayed isolation of patients hospitalized with active pulmonary tuberculosis (TB). A total of 130 immunocompetent hospitalized patients with active pulmonary TB who had positive sputum culture results from January 2015 to December 2017 were reviewed. Delayed isolation of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of hospitalization. Clinical and microbiologic characteristics of the patients and radiologic features on chest radiography ( = 130) and chest CT ( = 118) were retrospectively reviewed. Findings were compared between patients with early isolation and those with delayed isolation. Univariate and multivariate analyses were performed to determine independent predictors of delayed isolation. Forty-four patients (34%) had delayed isolation after initial hospitalization. On univariate and multivariate analyses, atypical presentation of active pulmonary TB on CT (odds ratio, 7.203; 95% CI, 2.203-23.551; = 0.001) and concurrent lung parenchymal diseases on CT (odds ratio, 14.605; 95% CI, 3.274-65.155; < 0.001) were significant predictors of delayed isolation of patients with active pulmonary TB. Awareness of the factors related to delayed diagnosis of active pulmonary TB is important to avoid an unexpected in-hospital outbreak of TB and control the disease. Atypical presentation of active pulmonary TB and concurrent lung parenchymal diseases on CT are significant factors related to delayed isolation of hospitalized patients with active pulmonary TB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.19.22540DOI Listing
August 2020

Olfactory and taste disorder: The first and only sign in a patient with SARS-CoV-2 pneumonia.

Infect Control Hosp Epidemiol 2020 09 20;41(9):1103. Epub 2020 Apr 20.

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

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/ice.2020.151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198461PMC
September 2020

Epidemiology and risk factors associated with Pneumocystis jirovecii pneumonia in kidney transplant recipients after 6-month trimethoprim-sulfamethoxazole prophylaxis: A case-control study.

Transpl Infect Dis 2020 Apr 24;22(2):e13245. Epub 2020 Jan 24.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity and mortality in kidney transplant recipients (KTRs), and prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX) is recommended. The aim of this study was to investigate incidence and risk factors for PCP in KTRs after 6-month TMP-SMX prophylaxis.

Methods: We conducted a case-control study of patients with PCP who received 6-month PCP prophylaxis with TMP-SMX after kidney transplantation (KT). In cases of rejection, PCP prophylaxis was provided for six additional months after anti-rejection therapy. Cytomegalovirus (CMV) infection was not considered an indication for PCP prophylaxis due to concerns of nephrotoxicity associated with TMP-SMX.

Results: Among 3941 kidney or pancreas-kidney transplant recipients, 67 (1.7%) developed PCP after discontinuing TMP-SMX. A total of 47 patients with KT PCP and 94 controls were included. Duration of PCP prophylaxis was similar between cases and controls (median 6 months, P = .53). In multivariate analysis, rejection (OR 3.9; 95% CI 1.4-11.1) and CMV infection (OR 2.4; 95% CI 1.0-5.8) were independently associated with PCP development after TMP-SMX. Rejection or CMV infection was observed in 70% of patients with PCP. Time to PCP development after rejection (median [IQR] 6 [5-19] months) was slightly shorter than after CMV infection (median [IQR] 9 [5-12] months; P = .18).

Conclusion: Post-prophylaxis PCP occurred in <2% of KTRs, and about two-thirds of these experienced rejection or CMV infection. These data suggest that at least 6 to 9-month additional chemoprophylaxis may be needed to prevent PCP in KTRs with transplant rejection or CMV infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/tid.13245DOI Listing
April 2020

Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers at a Referral Hospital in Korea.

Infect Chemother 2019 Dec;51(4):355-364

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

Background: Healthcare workers (HCWs) have a high risk of tuberculosis (TB) infection. Since August 2017, Korea has mandated the testing of latent TB infection (LTBI) and recommended treatment from HCWs at medical institutions. However, the acceptance/completion rate and adverse events of LTBI treatment have not been analyzed.

Materials And Methods: From February to August 2017, we conducted a retrospective study at a referral university hospital in Korea, to screen the interferon-gamma release assay (IGRA) tests conducted for all HCWs for detecting and treating LTBI. HCWs diagnosed with LTBI were offered a 9-month isoniazid (9H), 3-month isoniazid/rifampin (3HR), or 4-month rifampin regimen. We investigated the acceptance/completion rate, adverse events, and causes of discontinuation or change in LTBI medication. A major adverse event was one wherein a patient had any adverse event ≥grade 3 causing LTBI treatment interruption.

Results: Of the 1,538 HCWs, 1,379 underwent IGRA testing for LTBI. Among them, 13.6% (187/1,379) tested positive and 73.3% (137/187) received treatment. The overall completion rate was 97.8% (134/137). HCWs were significantly more likely to complete first-line therapy with 3HR than with 9H (91.4% vs. 76.7%, = 0.02). The most common major adverse event was hepatotoxicity (n = 7), followed by thrombocytopenia (n = 1) and anaphylactic shock (n = 1). Hepatotoxicity and hepatotoxicity (≥ grade 2) were more frequent in 9H than in 3HR (39.5% vs. 17.2%, = 0.006 and 18.6% vs. 3.7%, = 0.005, respectively). The median time to hepatotoxicity was 96 days (interquartile range, 20 - 103 days).

Conclusion: Completion of first-line therapy for LTBI is more likely with 3HR than with 9H. This might be related to the development of hepatotoxicity after around 3 months of treatment. Anaphylactic shock and platelet count should be carefully monitored in those receiving rifampin-containing regimens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3947/ic.2019.51.4.355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6940377PMC
December 2019

Early Intravenous Colistin Therapy as a Favorable Prognostic Factor for 28-day Mortality in Patients with CRAB Bacteremia: a Multicenter Propensity Score-Matching Analysis.

J Korean Med Sci 2019 Oct 14;34(39):e256. Epub 2019 Oct 14.

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

Background: Carbapenem-resistant (CRAB) infection is associated with high mortality. One of the strategies to reduce the mortality in patients with CRAB infections is to use intravenous colistin early but the effect of this strategy has not been proven. Therefore, we investigated the association of early colistin therapy with 28-day mortality in patients with CRAB bacteremia.

Methods: This retrospective multicenter propensity score-matching analysis was conducted in the Korea by reviewing the medical records of adult patients with CRAB bacteremia between January 2012 and March 2015. Early colistin therapy was defined as intravenous colistin administration for > 48 hours within five days after the blood culture collection. To identify the risk factors associated with the 28-day mortality in CRAB bacteremia, the clinical variables of the surviving patients were compared to those of the deceased patients.

Results: Of 303 enrolled patients, seventy-six (25.1%) patients received early colistin therapy. The 28-day mortality was 61.4% (186/303). Fatal or rapidly-fatal McCabe classifications, intensive care unit admission, Sequential Organ Failure Assessment scores ≥ 8, vasopressor use, and acute kidney injury were statistically independent poor prognostic factors. Catheter-related infection and early colistin therapy (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.21-0.94) were independent favorable prognostic factors associated with 28-day mortality in patients with CRAB bacteremia. Early colistin therapy was still significantly associated with lower 28-day mortality in the propensity score-matching analysis (aOR, 0.31; 95% CI, 0.11-0.88).

Conclusion: This study suggests that early colistin therapy might help reduce the mortality of patients with CRAB bacteremia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3346/jkms.2019.34.e256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6786961PMC
October 2019

Does Physician Leadership Influence Followers' Hand Hygiene Compliance?

Open Forum Infect Dis 2019 Jun 18;6(6):ofz236. Epub 2019 May 18.

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

The aim of this study was to determine factors influencing the hand hygiene compliance of a physician. We found a strong correlation between a leader's (staff member's or fellow's) and a follower's (resident's) hand hygiene compliance. Followers' appropriate hand hygiene compliance was significantly associated with the compliance of the leader ( = .01).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ofid/ofz236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590979PMC
June 2019

Etiology, characteristics, and outcomes of community-onset necrotizing fasciitis in Korea: A multicenter study.

PLoS One 2019 20;14(6):e0218668. Epub 2019 Jun 20.

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Background: Necrotizing fasciitis (NF) is a serious skin and soft tissue infection causing high mortality. Investigating region specific epidemiologic factors associated with NF is important for establishing appropriate treatment strategies. This multicenter study was done to provide an update of the microbial etiology, clinical characteristics, and outcomes of NF in Korea.

Materials And Methods: A retrospective cohort of adult patients with NF was established using patient data from 13 general hospitals between January 2012 and December 2015 in Korea. We evaluated microbial etiology and clinical characteristics to identify risk factors associated with in-hospital mortality; analyses were performed using binary logistic regression models.

Results: A total of 161 patients with NF were included. The most common underlying disease was diabetes mellitus (66 cases, 41.0%). A total of 148 organisms were isolated from 119 (73.9%) patients. Enteric Gram-negative organisms (36 patients) were the most common pathogen, followed by Staphylococcus aureus (30 patients) and streptococci (28 patients). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 6.2% (10/161) of patients. Of 37 enteric Gram-negative isolates tested, 26 (70.3%) isolates were susceptible to ceftriaxone. The in-hospital mortality rate was 22.4%. Intensive care unit admission, septic shock, and Gram-negative organism infections were significantly associated with in-hospital mortality, and surgery was not a favorable prognostic factor.

Conclusions: As initial empirical antibiotics, glycopeptides against MRSA and broad-spectrum antibiotics against third-generation cephalosporin-resistant organisms should be considered for patients with community-onset NF in Korea.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218668PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586320PMC
February 2020

Prevalence and Risk Factors for Positive Nasal Methicillin-Resistant Staphylococcus aureus Carriage Among Orthopedic Patients in Korea.

J Clin Med 2019 May 8;8(5). Epub 2019 May 8.

Department of Orthopedic Surgery, Soonchunhyang University Hospital, College of Medicine, Seoul 04401, Korea.

Methicillin-resistant (MRSA) causes purulent skin and soft tissue infections as well as other life-threatening diseases. Recent guidelines recommend screening for MRSA at the time of admission. However, few studies have been conducted to determine the prevalence and risk factors for MRSA colonization. A prospective data collection and retrospective analysis was performed. MRSA screening tests were performed using nasal swabs in patients enrolled between January 2017 and July 2018. Demographic data, socio-economic data, medical comorbidities, and other risk factors for MRSA carriage were evaluated among 1577 patients enrolled in the study. The prevalence of MRSA nasal carriage was 7.2%. Univariate regression analysis showed that colonization with MRSA at the time of hospital admission was significantly related to patient age, body mass index, smoking, alcohol, trauma, recent antibiotic use, and route of hospital admission. Multiple logistic regression analysis for the risk factors for positive MRSA nasal carriage showed that being under- or overweight, trauma diagnosis, antibiotic use one month prior to admission, and admission through an emergency department were related to MRSA colonization. This study highlights the importance of a preoperative screening test for patients scheduled to undergo surgery involving implant insertion, particularly those at risk for MRSA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8050631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572060PMC
May 2019