Publications by authors named "Tae Hyong Kim"

73 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.
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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.
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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.
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http://dx.doi.org/10.1016/j.ajic.2021.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251653PMC
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.
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http://dx.doi.org/10.1016/j.vaccine.2021.05.025DOI Listing
June 2021

Safety and immunogenicity of a seasonal quadrivalent influenza vaccine (GC3110A) in healthy participants aged ≥ 65 years.

Vaccine 2021 06 13;39(27):3621-3625. Epub 2021 May 13.

Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea.

Background: Seasonal Influenza is still considered associated with seasonal morbidity and hospitalization in the elderly population. The World Health Organization (WHO) recommended seasonal quadrivalent influenza vaccine (QIV) to reduce burden of two currently circulating influenza B lineages. Until 2019 Korean National Immunization Program (NIP) recommended trivalent influenza vaccine (TIV) after ongoing debates on cost effectiveness of QIV for elderly population. Although influenza vaccine only showed modest effect on reducing influenza in elderly, this study aimed to evaluate the immunogenicity and safety of inactivated QIV in healthy participants ≥ 65 years of age.

Methods: A total of 274 healthy participants aged ≥ 65 years received a QIV. Seroconversion-based vaccine efficacy of 4 strains of seasonal influenza was assessed 21 days after vaccination and adverse events were monitored until 180 days after vaccination.

Results: The percentages of participants seroconverted after vaccination on HI antibody against each strain were 36.5% (99/271) to A/H1N1, 47.6% (129/271) to A/H3N2, 40.6% (110/271) to B Yamagata, and 49.1% (133/271) to B Victoria. The percentages of participants seroprotected after vaccination on HI antibody against each strain were 81.2% (220/271) to A/H1N1, 98.5% (267/271) to A/H3N2, 95.2% (258/271) to B Yamagata, and 93.7% (254/271) to B Victoria. There was no serious adverse event (SAE) related with the study vaccine.

Conclusion: The quadrivalent split influenza vaccine is expected to offer seroprotection against influenza A and both influenza B lineages even in the elderly population.
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http://dx.doi.org/10.1016/j.vaccine.2021.05.001DOI Listing
June 2021

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

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

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

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

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

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

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

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.
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http://dx.doi.org/10.1089/mdr.2020.0312DOI Listing
March 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.
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http://dx.doi.org/10.3947/ic.2020.0104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032912PMC
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.
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http://dx.doi.org/10.3346/jkms.2020.35.e428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752260PMC
December 2020

Acceleration Magnitude at Impact Following Loss of Balance Can Be Estimated Using Deep Learning Model.

Sensors (Basel) 2020 Oct 28;20(21). Epub 2020 Oct 28.

Department of Biomechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Suwon 440-746, Korea.

Pre-impact fall detection can detect a fall before a body segment hits the ground. When it is integrated with a protective system, it can directly prevent an injury due to hitting the ground. An impact acceleration peak magnitude is one of key measurement factors that can affect the severity of an injury. It can be used as a design parameter for wearable protective devices to prevent injuries. In our study, a novel method is proposed to predict an impact acceleration magnitude after loss of balance using a single inertial measurement unit (IMU) sensor and a sequential-based deep learning model. Twenty-four healthy participants participated in this study for fall experiments. Each participant worn a single IMU sensor on the waist to collect tri-axial accelerometer and angular velocity data. A deep learning method, bi-directional long short-term memory (LSTM) regression, is applied to predict a fall's impact acceleration magnitude prior to fall impact (a fall in five directions). To improve prediction performance, a data augmentation technique with increment of dataset is applied. Our proposed model showed a mean absolute percentage error (MAPE) of 6.69 ± 0.33% with r value of 0.93 when all three different types of data augmentation techniques are applied. Additionally, there was a significant reduction of MAPE by 45.2% when the number of training datasets was increased by 4-fold. These results show that impact acceleration magnitude can be used as an activation parameter for fall prevention such as in a wearable airbag system by optimizing deployment process to minimize fall injury in real time.
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http://dx.doi.org/10.3390/s20216126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663134PMC
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.
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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.
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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.
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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.
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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.

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http://dx.doi.org/10.1017/ice.2020.151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198461PMC
September 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.
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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.
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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).
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http://dx.doi.org/10.1093/ofid/ofz236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6590979PMC
June 2019

Machine learning-based pre-impact fall detection model to discriminate various types of fall.

J Biomech Eng 2019 Apr 10. Epub 2019 Apr 10.

Department of Biomechatronic Engineering, College of Biotechnology and Bioengineering, Sungkyunkwan University, Republic of Korea, 2066 Seoburo, Jangangu, Suwon, Gyeonggi, 16419, Republic of Korea, Tel: +82-31-290-7827, Fax: +82-31-290-7830.

Preimpact fall detection can send alarm service faster to reduce long-lie conditions and decrease the risk of hospitalization. Detecting various types of fall to determine the impact site or direction prior to impact is important because it increases the chance of decreasing the incidence or severity of fall-related injuries. In this study, a robust preimpact fall detection model was developed to classify various activities and falls as multi-class and its performance was compared with the performance of previous developed models. Twelve healthy subjects participated in this study. All subjects were asked to place an inertial measuring unit module by fixing on a belt near the left iliac crest to collect accelerometer data for each activity. Our novel proposed model consists of feature calculation and infinite latent feature selection algorithm, auto labeling of activities, application of machine learning classifiers for discrete and continuous time series data. Nine machine-learning classifiers were applied to detect falls prior to impact and derive final detection results by sorting the classifier. Our model showed the highest classification accuracy. Results for the proposed model that could classify as multi-class showed significantly higher average classification accuracy of 99.57 ± 0.01% for discrete data-based classifiers and 99.84 ± 0.02% for continuous time series-based classifiers than previous models (p < 0.01). In the future, multi-class preimpact fall detection models can be applied to fall protector devices by detecting various activities for sending alerts or immediate feedback reactions to prevent falls.
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http://dx.doi.org/10.1115/1.4043449DOI Listing
April 2019

Risk Factors for Delayed Isolation of Patients with Active Pulmonary Tuberculosis in an Acute-care Hospital.

Sci Rep 2019 03 19;9(1):4849. Epub 2019 Mar 19.

Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, 04401, Republic of Korea.

The objective of the current study was to determine the factors associated with delayed isolation of pulmonary tuberculosis (TB). In this retrospective study, data of patients newly diagnosed with pulmonary TB from January 2015 through December 2017 at a referral hospital were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days of admission. We analyzed the clinical, microbiological, and radiological factors associated with delayed isolation of pulmonary TB. A total of 134 patients with positive sputum acid-fast bacilli (AFB) cultures were analyzed, of which 44 (33%) were isolated within 3 days after admission. In multivariate logistic regression analysis, older age (p = 0.01), admission to departments other than Infectious Disease or Pulmonology (p = 0.005), and presence of malignancy (p = 0.02) were associated with delayed isolation. Patients with a radiologic diagnosis of active pulmonary TB were likely to be isolated early (p = 0.01). Better awareness of pulmonary TB among attending practitioners in hospital settings is required. Delay in isolation is associated with older age, malignancy, hospitalization to departments other than Infectious Disease or Pulmonology, and non-confident radiologic diagnosis of active pulmonary TB.
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http://dx.doi.org/10.1038/s41598-019-41086-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424955PMC
March 2019

Epidemiological, clinical, and microbiological characteristics of carbapenemase-producing Enterobacteriaceae bloodstream infection in the Republic of Korea.

Antimicrob Resist Infect Control 2019 5;8:48. Epub 2019 Mar 5.

Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 04401 Republic of Korea.

Background: Carbapenemase-producing Enterobacteriaceae (CPE) is an important pathogen in nosocomial infections; nevertheless, only a few studies regarding CPE infection and its epidemiological factors have been conducted in the Republic of Korea (ROK). We aimed to analyze the clinical, microbiological, and epidemiological characteristics of CPE bloodstream infections (BSIs) in the ROK.

Methods: This retrospective cohort study included data collected from the National Surveillance System from January 2015 to December 2016 based on the epidemiologic survey performed by an epidemiologist from the Korea Centers for Disease Control and Prevention. We selected patients with CPE BSI from the Korea National Institute of Health based on carbapenemase genotyping.

Results: In this study, 131 CPE BSIs were identified, and the proportion of CPE BSI among total CPE isolates was 7%. accounted for 69% of all CPE BSIs, and 66% of these produced carbapenemase. Among nine provinces in ROK, one province had NDM as the most common carbapenemase. CPE was susceptible to amikacin, tigecycline, and gentamicin (76, 41, and 39%, respectively). Of 29 patients tested for colistin sensitivity, one patient showed colistin resistance. The most common CPE BSI sources were pneumonia, primary bacteremia, and biliary tract infection. Multivariable analysis showed that adequate antibiotic use at CPE detection was significantly associated with decreased 30-day mortality.

Conclusions: CPE BSIs are prevalent in the ROK. Moreover, most CPE BSIs originated from hospital-acquired infection, demonstrating the need to improve hospital infection control strategies.
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http://dx.doi.org/10.1186/s13756-019-0497-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402157PMC
April 2020

Aggressive Contact Investigation of In-Hospital Exposure to Active Pulmonary Tuberculosis.

J Korean Med Sci 2019 Feb 12;34(7):e58. Epub 2019 Feb 12.

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

Background: In-hospital detection of newly diagnosed active pulmonary tuberculosis (TB) is important for prevention of potential outbreaks. Here, we report our experience of the aggressive contact investigation strategy in a university hospital in the Republic of Korea after healthcare workers (HCWs), patients, and visitors experience an in-hospital exposure to active pulmonary TB.

Methods: A contact investigation after the unexpected detection of newly diagnosed active pulmonary TB (index patients) was performed in a university hospital from August 2016 to April 2017. Initial and 3-month-post-exposure chest radiographs were advised for all patients, visitors, and HCWs in close contact with the index patients. An additional tuberculous skin test or interferon gamma releasing assay was performed at the time of exposure and 3 months post-exposure in HCWs in close contact with the index patients.

Results: Twenty-four index patients were unexpectedly diagnosed with active pulmonary TB after admission to the hospital with unassociated diseases. The median time from admission to TB diagnosis was 5 days (range, 1-22 days). In total, 1,057 people were investigated because of contact with the index patients, 528 of which had close contact (206 events in 157 HCWs, 322 patients or visitors). Three months post exposure, 9 (9.2%) among 98 TB-naïve close contact HCWs developed latent tuberculosis infections (LTBIs). Among the 65 close contact patients or visitors, there was no radiological or clinical evidence of active pulmonary TB.

Conclusion: An aggressive contact investigation after an unexpected in-hospital diagnosis of active pulmonary TB revealed a high incidence of LTBI among TB-naïve HCWs who had contact with the index patients.
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http://dx.doi.org/10.3346/jkms.2019.34.e58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6384434PMC
February 2019

Monomicrobial gram-negative necrotizing fasciitis: An uncommon but fatal syndrome.

Diagn Microbiol Infect Dis 2019 Jun 4;94(2):183-187. Epub 2019 Jan 4.

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

This study aimed to characterize patients with monomicrobial gram-negative necrotizing fasciitis in three university hospitals in Korea. In this study, of the 115 patients with community-acquired necrotizing fasciitis, 67 (58%) had monomicrobial infections: 31 (27%) in the gram-negative group and 36 (31%) in the gram-positive group. The majority of patients in the gram-negative group were infected with Escherichia coli followed by Klebsiella pneumoniae and Vibrio vulnificus. More patients in the gram-negative group showed liver cirrhosis than those in the gram-positive group (39% vs. 14%, P = 0.02). In a multivariable logistic regression analysis, liver cirrhosis (adjusted odds ratio [aOR], 13.7; 95% confidence interval [CI], 2.9-67.0), treatment with antibiotics without surgery (aOR, 10.2; 95% CI, 2.1-48.3), and lower level of albumin (aOR 4.9; 95% CI, 1.6-14.9) were associated with 30-day mortality. Our findings suggest that gram-negative necrotizing fasciitis is more often associated with liver cirrhosis and has poorer outcomes than gram-positive necrotizing fasciitis.
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http://dx.doi.org/10.1016/j.diagmicrobio.2018.12.013DOI Listing
June 2019

A Phase III Study to Evaluate the Immunogenicity and Safety of GC1107 (Adult Tetanus Diphtheria Vaccine) in Healthy Adults.

J Korean Med Sci 2019 Jan 16;34(4):e31. Epub 2019 Jan 16.

Department of Pediatrics, Seoul St. Mary's Hosptial, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background: This study was conducted to assess the immunogenicity and safety of GC1107 (adult tetanus diphtheria [Td] vaccine). The primary goal was to evaluate the non-inferiority of the immunogenicity of GC1107 compared to the control vaccine. Additionally, the safety profiles of GC1107 and the control vaccine were compared.

Methods: The subjects were adults ≥ 18 years old who were not injected with Td or adult tetanus-diphtheria-pertussis (TdaP) vaccine within the recent 5 years. A total of 253 subjects were enrolled and randomized to either the GC1107 group or the control group. For immunogenicity assessment, blood samples were collected at baseline and 28 days after vaccination and antibody titer of diphtheria and tetanus were assessed.

Results: The seroprotection rates of diphtheria and tetanus were 89.76% and 91.34%, respectively, in the GC1107 group, and 87.80% and 86.99% in the control group. The geometric mean titer (GMT) of the anti-diphtheria antibody increased after vaccination in both groups, showing no significant difference between the groups ( = 0.139). The anti-tetanus GMTs after vaccination also showed comparable increases in both groups, and showed no significant difference ( = 0.860). In the safety evaluation, solicited local adverse reactions occurred in 81.2% of the subjects in the GC1107 group and in 86.4% of the subjects in the control group. Solicited systemic adverse events occurred in 33.2% of the subjects in the GC1107 group and in 47.2% of the subjects in the control group, which did not reach statistical significance.

Conclusion: This phase III study demonstrated non-inferiority in immunogenicity and comparable safety of GC1107 compared with the control Td vaccine.

Trial Registration: ClinicalTrials.gov Identifier: NCT02361866.
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http://dx.doi.org/10.3346/jkms.2019.34.e31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345633PMC
January 2019

Identifying the time to cure for patients with classic scabies after infection control intervention in acute care hospital settings.

Am J Infect Control 2019 05 5;47(5):588-590. Epub 2018 Dec 5.

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

Scabies is a re-emerging parasitic disease, particularly in hospitalized patients. This is a retrospective study analyzing adult patients with scabies admitted to a referral university hospital between 2008 and 2018. All patients were treated an average of 3times using scabicides; the median isolation period and time to cure were 14 and 15days, respectively.
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http://dx.doi.org/10.1016/j.ajic.2018.10.007DOI Listing
May 2019

Endoscopic resection using argon plasma coagulation for treating esophageal mucosal bridge in a patient with acquired immunodeficiency syndrome.

Turk J Gastroenterol 2019 Aug;30(8):758-760

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

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http://dx.doi.org/10.5152/tjg.2018.18463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699573PMC
August 2019

Natural prognosis of carbapenem-resistant Acinetobacter baumannii bacteremia in patients who did not receive appropriate antibiotic treatment: A retrospective multicenter study in Korea.

Medicine (Baltimore) 2018 Oct;97(43):e12984

Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.

Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is a major issues in current era. The aim of study was to investigate the natural prognosis and prognostic factors associated with 28-day mortality in patients with CRAB bacteremia who were not receiving appropriate antibiotic treatment.Adult patients with CRAB bacteremia were retrospectively identified between April 2012 and March 2015 at 5 tertiary hospitals in Republic of Korea. Patients who were transferred to another hospital within 28 days of onset of bacteremia and who receive appropriate antibiotics more than 48 hours were excluded. We investigated prognostic factors associated with 28-day mortality in patients with CRAB bacteremia without appropriate antibiotic treatment.Of enrolled 205 patients, 143 (69.8%) patients died within 28 days after blood culture. Of patients with 28-day mortality, 88.9% (127/143) of patients died within 5 days. Of 78 patients who survived more than 5 days, the 28-day mortality was 20.5% (16/78). Diabetes mellitus (adjusted odds ratio [aOR] 3.81, 95% confidence interval [95% CI] 1.19-12.20), immunocompromised (aOR 8.72, 95% CI 2.62-29.70), sequential organ failure assessment (SOFA) ≥ 10 (aOR 13.87, 95% CI 3.70-51.96), vasopressor use (aOR 7.03, 95% CI 1.79-27.60), and pneumonia (aOR 4.44, 95% CI 1.67-11.78) were found to be the factors independently associated with the 28-day mortality.The 28-day mortality in patients with CRAB bacteremia without appropriate treatment was high, although some patients could survive. Severity and underlying conditions were important prognostic factors in patients with CRAB bacteremia.
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http://dx.doi.org/10.1097/MD.0000000000012984DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221697PMC
October 2018

Immunogenicity and safety of an egg-based inactivated quadrivalent influenza vaccine (GC3110A) versus two inactivated trivalent influenza vaccines with alternate B strains: A phase Ⅲ randomized clinical trial in adults.

Hum Vaccin Immunother 2019 15;15(3):710-716. Epub 2018 Nov 15.

a Division of Infectious Diseases, Department of Internal Medicine , Korea University College of Medicine1 , Seoul , Korea.

Two antigenically distinct influenza B lineage viruses (Yamagata/Victoria) have been co-circulating globally since the mid-1980s. The quadrivalent influenza vaccine (QIV) may provide better protection against unpredictable B strains. We conducted a randomized, double-blind, phase III trial to evaluate the immunogenicity and safety of an egg-based inactivated, split-virion QIV (GC3110A). Subjects aged ≥ 19 years were randomized 2:1:1 to be vaccinated with QIV- GC3110A, trivalent influenza vaccine (TIV) containing the Yamagata lineage strain (TIV-Yamagata), or TIV containing the Victoria lineage strain (TIV-Victoria). Hemagglutination inhibition assays were performed 21 days post-vaccination. Solicited/unsolicited adverse events (AEs) were assessed within 21 days after vaccination, while serious AEs were reported up to six months after vaccination. A total of 1,299 were randomized to receive QIV-GC3110A (648 subjects), TIV-Yamagata (325 subjects), or TIV-Victoria (326 subjects). Compared to the TIVs, the QIV-GC3110A met the non-inferiority criteria for all four subtype/lineage strains with respect to the geometric mean titer (GMT) ratio and the difference of seroconversion rate. The safety profiles of QIV-GC3110A were consistent with those of TIV. In conclusion, QIV-GC3110A is safe, immunogenic, and comparable to strain-matched TIV.
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http://dx.doi.org/10.1080/21645515.2018.1536589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605850PMC
February 2020

Therapeutic outcome of spinal implant infections caused by Staphylococcus aureus: A retrospective observational study.

Medicine (Baltimore) 2018 Oct;97(40):e12629

Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul.

Spinal implant infection is a rare but significant complication of spinal fusion surgery, and the most common pathogen is Staphylococcus aureus. It is difficult to treat due to this pathogen's biofilm-forming ability and antibiotic resistance. We evaluated the therapeutic outcome of treatments for S aureus spinal implant infections. We retrospectively reviewed all patients with S aureus spinal implant infections at 11 tertiary-care hospitals over a 9-year period. Parameters predictive of treatment failure and recurrence were analyzed by Cox regression. Of the 102 patients with infections, 76 (75%) were caused by methicillin-resistant S aureus (MRSA) and 51 (50%) were late-onset infections. In all, 83 (81%) patients were managed by debridement, antibiotics, and implant retention (DAIR) and 19 (19%) had their implants removed. The median duration of all antibiotic therapies was 52 days. During a median follow-up period of 32 months, treatment failure occurred in 37 (36%) cases. The median time to treatment failure was 113 days, being <1 year in 30 (81%) patients. DAIR (adjusted hazard ratio [aHR], 6.27; P = .01) and MRSA infection (aHR, 4.07; P = .009) were independently associated with treatment failure. Rifampin-based combination treatments exhibited independent protective effects on recurrence (aHR, 0.23; P = .02). In conclusion, among patients with S aureus spinal implant infections, MRSA and DAIR were independent risk factors for treatment failure, and these risk factors were present in the majority of patients. In this difficult-to-treat population, the overall treatment failure rate was 36%; rifampin may improve the outcomes of patients with S aureus spinal implant infections.
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http://dx.doi.org/10.1097/MD.0000000000012629DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200525PMC
October 2018

Low Lymphocyte Proportion in Bronchoalveolar Lavage Fluid as a Risk Factor Associated with the Change from Trimethoprim/sulfamethoxazole used as First-Line Treatment for Pneumocystis jirovecii Pneumonia.

Infect Chemother 2018 Jun;50(2):110-119

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

Background: Trimethoprim/sufamethoxazole (TMP/SMX) is the recommended treatment for Pneumocystis jirovecii pneumonia (PCP). However, the efficacy and the safety of alternative salvage treatments are less guarauteed especially when patient experiences treatment failure and/or an adverse drug reactions (ADR). The purpose of this study is to recognize potential risk factors imitating successful treatment with TMP/SMX among PCP patients.

Materials And Methods: Ninety one adult patients diagnosed with PCP were included after searching electronical medical records from January 2013 through July 2015 at Asan Medical Center Seoul, Korea. We compared clinical characteristics and laboratory findings including bronchoalveolar lavage (BAL) fluid analysis in patients who experienced TMP/SMX treatment failure or ADR (the case group) versus those who did not (the control group).

Results: Among the enrolled PCP patients, 39 (42.9%) required salvage treatment owing to either treatment failure (28, 28.6%) and/or ADR (17, 18.7%). The BAL lymphocyte percentage (25% [IQR, 8-40%] vs. 47% [IQR, 15-62%]; P = 0.005) was lower in the case group. Diabetes mellitus (adjusted odds ratio [aOR] 4.98, 95% confidence interval [95% CI] 1.20-18.58), glomerular filtration rate ≤50 mL/min (aOR 4.48, 95% CI 1.08-18.66), and BAL lymphocyte percentage ≤45% (aOR 9.25, 95% CI 2.47-34.58) were independently associated with the case group in multivariate analysis.

Conclusion: This study suggests that BAL lymphocyte count may play some role during PCP treatment. Further studies should be followed to reveal what the role of BAL lymphocyte is in the PCP treatment.
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http://dx.doi.org/10.3947/ic.2018.50.2.110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031595PMC
June 2018
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