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Kim J, Myung R, Kim B, Kim J, Kim T, Lee MS, Kim UJ, Park DW, Kim YS, Lee CS, Kim ES, Lee SH, Chang HH, Lee SS, Park SY, Choi HJ, Kim HI, Ha YE, Wi YM, Choi S, Shin SY, Pai H. Incidence of Clostridioides difficile Infections in Republic of Korea: A Prospective Study With Active Surveillance vs. National Data From Health Insurance Review & Assessment Service. J Korean Med Sci 2024; 39:e118. [PMID: 38565175 PMCID: PMC10985502 DOI: 10.3346/jkms.2024.39.e118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. METHODS To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. RESULTS In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patient-days was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25-12.05) and 4.18 per 1,000 admissions (range: 1.92-8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68-13.90) and 6.73 per 1,000 admissions (range: 3.18-15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. CONCLUSION The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.
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Affiliation(s)
- Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Rangmi Myung
- Department of Non-benefits Management, National Health Insurance Service, Wonju, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | | | - Tark Kim
- Divison of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Mi Suk Lee
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Uh Jin Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Yeon-Sook Kim
- Division of Infectious Diseases, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chang-Seop Lee
- Department of Internal Medicine and Research Institute of Clinical Medicine, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seung Soon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Se Yoon Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hye In Kim
- Department of Infectious Diseases, Daegu Fatima Hospital, Daegu, Korea
| | - Young Eun Ha
- Department of Infectious Diseases, Bucheon Sejong Hospital, Bucheon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University, Changwon, Korea
| | - Sungim Choi
- Division of Infectious Diseases, Dongguk University Ilsan Hospital, Goyang, Korea
| | - So Youn Shin
- Department of Infectious Diseases, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Cruz-Lim EM, Mou B, Baker S, Arbour G, Stefanyk K, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R. Prospective Longitudinal Assessment of Quality of Life After Stereotactic Ablative Radiotherapy for Oligometastases: Analysis of the Population-based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:148-156. [PMID: 38087705 DOI: 10.1016/j.clon.2023.11.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/11/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
AIMS To evaluate longitudinal patient-reported quality of life (QoL) in patients treated with stereotactic ablative radiotherapy (SABR) for oligometastases. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases, conducted in six regional cancer centres in British Columbia, Canada from 2016 to 2020. Prospective QoL was measured using treatment site-specific QoL questionnaires at pre-treatment baseline and at 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. Patients with bone metastases were assessed with the Brief Pain Inventory (BPI). Patients with liver, adrenal and abdominopelvic lymph node metastases were assessed with the Functional Assessment of Chronic Illness Therapy-Abdominal Discomfort (FACIT-AD). Patients with lung and intrathoracic lymph node metastases were assessed with the Prospective Outcomes and Support Initiative (POSI) lung questionnaire. The two one-sided test procedure was used to assess equivalence between the worst QoL score and the baseline score of individual patients. The mean QoL at all time points was used to determine the trajectory of QoL response after SABR. The proportion of patients with 'stable', 'improved' or 'worsened' QoL was determined for all time points based on standard minimal clinically important differences (MCID; BPI worst pain = 2, BPI functional interference score [FIS] = 0.5, FACIT-AD Trial Outcome Index [TOI] = 8, POSI = 3). RESULTS All enrolled patients with baseline QoL assessment and at least one follow-up assessment were analysed (n = 133). On equivalence testing, the patients' worst QoL scores were clinically different from baseline scores and met MCID (BPI worst pain mean difference: 1.8, 90% confidence interval 1.19 to 2.42]; BPI FIS mean difference: 1.68, 90% confidence interval 1.15 to 2.21; FACIT-AD TOI mean difference: -8.76, 90% confidence interval -11.29 to -6.24; POSI mean difference: -4.61, 90% confidence interval -6.09 to -3.14). However, the mean FIS transiently worsened at 9, 18 and 21 months but eventually returned to stable levels. The mean FACIT and POSI scores also worsened at 36 months, albeit with a limited number of responses (n = 4 and 8, respectively). Most patients reported stable QoL at all time points (range: BPI worst pain 71-82%, BPI FIS 45-78%, FACIT-AD TOI 50-100%, POSI 25-73%). Clinically significant stability, worsening and improvement were seen in 70%/13%/18% of patients at 3 months, 53%/28%/19% at 18 months and 63%/25%/13% at 36 months. CONCLUSIONS Transient decreases in QoL that met MCID were seen between patients' worst QoL scores and baseline scores. However, most patients experienced stable QoL relative to pre-treatment levels on long-term follow-up. Further studies are needed to characterise patients at greatest risk for decreased QoL.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - S Baker
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - G Arbour
- University of British Columbia, British Columbia, Canada
| | - K Stefanyk
- University of British Columbia, British Columbia, Canada
| | - W Jiang
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, British Columbia, Canada; BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Ho
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, British Columbia, Canada; BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, British Columbia, Canada; BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, British Columbia, Canada; BC Cancer - Victoria, Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, British Columbia, Canada; BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, British Columbia, Canada; BC Cancer - Prince George, Prince George, British Columbia, Canada.
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Cruz-Lim EM, Mou B, Jiang W, Liu M, Bergman A, Schellenberg D, Alexander A, Berrang T, Bang A, Chng N, Matthews Q, Carolan H, Hsu F, Miller S, Atrchian S, Chan E, Ho C, Mohamed I, Lin A, Huang V, Mestrovic A, Hyde D, Lund C, Pai H, Valev B, Lefresne S, Tyldesley S, Olson R, Baker S. Predictors of Quality of Life Decline in Patients with Oligometastases treated with Stereotactic Ablative Radiotherapy: Analysis of the Population-Based SABR-5 Phase II Trial. Clin Oncol (R Coll Radiol) 2024; 36:141-147. [PMID: 38296662 DOI: 10.1016/j.clon.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/15/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
AIMS Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. MATERIALS AND METHODS The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. RESULTS One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25-43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0-29.6) and 40% (95% confidence interval 28.0-51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59-17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41-66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92-16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85-5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. CONCLUSIONS Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies.
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Affiliation(s)
- E M Cruz-Lim
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - B Mou
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - W Jiang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - M Liu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - A Bergman
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - D Schellenberg
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - A Alexander
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - T Berrang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - A Bang
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - N Chng
- BC Cancer - Prince George, British Columbia, Canada
| | - Q Matthews
- BC Cancer - Prince George, British Columbia, Canada
| | - H Carolan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - F Hsu
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Abbotsford, British Columbia, Canada
| | - S Miller
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Atrchian
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - E Chan
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - C Ho
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - I Mohamed
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - A Lin
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - V Huang
- BC Cancer - Surrey, British Columbia, Canada
| | - A Mestrovic
- BC Cancer - Vancouver, British Columbia, Canada
| | - D Hyde
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Kelowna, British Columbia, Canada
| | - C Lund
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada
| | - H Pai
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - B Valev
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Victoria, British Columbia, Canada
| | - S Lefresne
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - S Tyldesley
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Vancouver, British Columbia, Canada
| | - R Olson
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Prince George, British Columbia, Canada
| | - S Baker
- University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer - Surrey, British Columbia, Canada.
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Pai H. Presidential address 2024: the expansion of computer-based testing to numerous health professions licensing examinations in Korea, preparation of computer-based practical tests, and adoption of the medical metaverse. J Educ Eval Health Prof 2024; 21:2. [PMID: 38373801 PMCID: PMC10948918 DOI: 10.3352/jeehp.2024.21.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Hyunjoo Pai
- President, Korea Health Personnel Licensing Examination Institute, Seoul, Korea
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Yoon C, Kim J, Jang W, Ko JW, Kim J, Pai H, Lee Y, Kim B. Clinical and microbiological characteristics of female patients with acute pyelonephritis who experienced urinary tract infections within the previous year. J Infect Public Health 2024; 17:349-358. [PMID: 38198967 DOI: 10.1016/j.jiph.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/26/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND This study aimed to examine the clinical and microbiological characteristics of female patients with recurrent acute pyelonephritis (APN). METHODS A retrospective cohort study was conducted at a tertiary care hospital in South Korea from July 2019 to December 2021. All female patients aged ≥ 19 years who were diagnosed with community-acquired APN on admission were enrolled. The recurrent group included patients with APN who experienced urinary tract infections within the previous year. The clinical characteristics, types of causative organisms, major antibiotic resistance, and molecular characteristics of Escherichia coli strains were compared between the recurrent and non-recurrent groups. RESULTS A total of 285 patients with APN were analyzed, including 41 (14.4%) in the recurrent group. Compared to the non-recurrent group, the recurrent group had a higher Charlson Comorbidity Index (1.8 ± 2.1 vs. 1.1 ± 1.5; P = 0.01) and a higher proportion of bladder abnormalities, such as neurogenic bladder (12.2% vs. 2.0%; P = 0.001) and urinary catheterization (12.2% vs. 1.6%; P < 0.001). Escherichia coli was the most common causative organism in both groups. The proportion of Klebsiella pneumoniae (17.1% vs. 4.7%; P = 0.007) and Pseudomonas aeruginosa (5.7% vs. 0.5%; P = 0.014) as a causative organism was higher in the recurrent group. Regarding the microbiological characteristics of Escherichia coli, there were no significant differences in the proportion of antibiotic resistance, phylogenetic groups, resistance genes, and virulence factors between the two groups. Multivariable analysis showed that neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were significantly associated with recurrent APN. CONCLUSIONS The proportion of causative organisms except Escherichia coli was higher in the recurrent group than in the non-recurrent group. Neurogenic bladder and a history of admission or antibiotic use during 1 year prior to inclusion were risk factors for recurrent APN.
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Affiliation(s)
- Choseok Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Jeoungyeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Wooyoung Jang
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Ji Won Ko
- School of Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jinnam Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea; Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Bongyoung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, South Korea; Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
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Kim J, Cho Y, Lim SK, Seo MR, Sohn JW, Kim B, Rho M, Pai H. Comparative analyses of the faecal resistome against β-lactam and quinolone antibiotics in humans and livestock using metagenomic sequencing. Sci Rep 2023; 13:20993. [PMID: 38017092 PMCID: PMC10684531 DOI: 10.1038/s41598-023-48221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Abstract
To assess the prevalence and abundance of antibiotic resistance genes in human and livestock gut microbiomes, 87 humans (healthy individuals and patients with Clostridioides difficile infection (CDI)) and 108 livestock (swine, cattle, and chickens) were enrolled. Gut microbiomes and fluoroquinolone-resistant Escherichia coli isolates were sequenced, and mobile genetic elements adjacent to the β-lactamase (bla) and transferable quinolone resistance (qnr) genes were compared using metagenomic contigs. Each group of humans and livestock exhibited distinctive microbiota and resistome compositions in the gut. Concerning the resistome of bla and qnr, the prevalence rates between chickens and patients with CDI were the most similar (R2 = 0.46); blaTEM, blaOXA, blaCTX-M, and qnrS were highly prevalent in both groups. According to genomic and phylogenetic analyses, blaCTX-M and blaOXA expressed lineage specificity to either humans or livestock, while qnrS and blaTEM displayed a shared lineage between humans and livestock. A qnrS1 mobilome comprising five genes, including two recombinases, a transposase, and a plasmid gene, is commonly found in human and chicken gut microbiomes. Humans and chickens showed the most similar gut resistomes to β-lactams and quinolones. QnrS and blaTEM displayed especially strong co-occurrence between the guts of humans and livestock.
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Affiliation(s)
- Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Youna Cho
- Department of Computer Science and Engineering, Hanyang University, Seoul, 04763, Republic of Korea
| | - Suk-Kyung Lim
- Bacterial Disease Division, Animal and Plant Quarantine Agency, 177 Hyeokin 8-ro, Gimcheon-si, Gyeongsangbuk-do, 39660, Republic of Korea
| | - Mi-Ran Seo
- ConnectaGen Inc., F 203, MisaCentumbiz 2F, Jojeong-Dearo, Hanam-si, Gyeonggi-do, 12918, Republic of Korea
| | - Jang Won Sohn
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea
| | - Mina Rho
- Department of Computer Science and Engineering, Hanyang University, Seoul, 04763, Republic of Korea.
- Department of Biomedical Informatics, Hanyang University, Seoul, 04763, Republic of Korea.
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, 04763, Republic of Korea.
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Kim D, Lee J, Shyaka C, Kwak JH, Pai H, Rho M, Ciufolini MA, Han M, Park JH, Kim YR, Jung S, Jang AR, Kim E, Lee JY, Lee H, Son YJ, Hwang HJ. Identification of Micrococcin P2-Derivatives as Antibiotic Candidates against Two Gram-Positive Pathogens. J Med Chem 2023; 66:14263-14277. [PMID: 37796116 DOI: 10.1021/acs.jmedchem.3c01309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Thiopeptides exhibit potent antimicrobial activity against Gram-positive pathogens by inhibiting bacterial protein synthesis. Micrococcins are among the structurally simpler thiopeptides, but they have not been exploited in detail. This research involved a computational simulation of micrococcin P2 (MP2) docking in parallel with the structure-activity relationship (SAR) studied. The incorporation of particular nitrogen heterocycles in the side chain of MP2 enhances the antimicrobial activity. Micrococcin analogues 6c and 6d thus proved to be more effective against impetigo and C. difficile infection (CDI), respectively, as compared to current first-line treatments. Compound 6c also showed a shorter treatment period than that of a first-line treatment for impetigo. This may be attributed to its ability to downregulate pro-inflammatory cytokines. Compound 6d had no observed recurrence for C. difficile and exerted a minimal impact on the beneficial gut microbiome. Their pharmacokinetic properties and low toxicity profile make these compounds ideal candidates for the treatment of impetigo and CDI and validate their involvement in preclinical development.
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Affiliation(s)
- Dahyun Kim
- A&J Science Co., Ltd., 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Jusuk Lee
- A&J Science Co., Ltd., 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Clovis Shyaka
- A&J Science Co., Ltd., 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Jin-Hwan Kwak
- School of Life Science, Handong Global University, 558 Handong Ro, Heunghae-Eup, Buk-Gu, Pohang 37554, Republic of Korea
- Office of the President, Sunlin University, 30, 36 Chogok-gil, Heunghae-Eup, Buk-Gu, Pohang 37560, Republic of Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, 232 Wangsimri Ro, Seongdong-Gu, Seoul 04763, Republic of Korea
| | - Mina Rho
- Department of Computer Science, Hanyang University, 222 Wangsimri Ro, Seongdong-Gu, Seoul 04763, Republic of Korea
| | - Marco A Ciufolini
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6K 1Z1, Canada
| | - Minwoo Han
- New Drug Development Center, Daegu Gyeongbuk Medical Innovation Foundation, 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Jong-Hwan Park
- Laboratory Animal Medicine, College of Veterinary Medicine and Animal Medical Institute, Chonnam National University, 77 Yongbong-ro, Buk-Gu, Gwangju 61186, Republic of Korea
- Nodcure Inc., 77 Yongbong-ro, Buk-Gu, Gwangju 61186, Republic of Korea
| | - Young-Rok Kim
- School of Life Science, Handong Global University, 558 Handong Ro, Heunghae-Eup, Buk-Gu, Pohang 37554, Republic of Korea
| | - Sungji Jung
- School of Life Science, Handong Global University, 558 Handong Ro, Heunghae-Eup, Buk-Gu, Pohang 37554, Republic of Korea
| | - Ah-Ra Jang
- Nodcure Inc., 77 Yongbong-ro, Buk-Gu, Gwangju 61186, Republic of Korea
| | - Eunjung Kim
- School of Life Science, Handong Global University, 558 Handong Ro, Heunghae-Eup, Buk-Gu, Pohang 37554, Republic of Korea
| | - Jee-Young Lee
- New Drug Development Center, Daegu Gyeongbuk Medical Innovation Foundation, 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Hakyeong Lee
- A&J Science Co., Ltd., 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Young-Jin Son
- A&J Science Co., Ltd., 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
| | - Hee-Jong Hwang
- A&J Science Co., Ltd., 80 Chumbok Ro, Dong Gu, Daegu 41061, Republic of Korea
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8
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Pai H. Presidential address: improving item validity and adopting computer-based testing, clinical skills assessments, artificial intelligence, and virtual reality in health professions licensing examinations in Korea. J Educ Eval Health Prof 2023; 20:8. [PMID: 36967486 PMCID: PMC10129871 DOI: 10.3352/jeehp.2023.20.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Hyunjoo Pai
- President, Korea Health Personnel Licensing Examination Institute, Seoul, Korea
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9
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Kim J, Kim B, Pai H. Diversity of binary toxin positive Clostridioides difficile in Korea. Sci Rep 2023; 13:576. [PMID: 36631661 PMCID: PMC9834304 DOI: 10.1038/s41598-023-27768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
The objective of this study is to determine the trend and diversity of binary toxin-positive Clostridioides difficile over 10 years in Korea. Binary toxin-positive strains were selected from a tertiary hospital in Korea in 2009-2018. The multi-locus sequence typing and antibiotic susceptibility test were performed. Among the 3278 isolates in 2009-2018, 58 possessed binary toxin genes (1.7%). The proportion of CDT- positive isolates was 0.51-4.82% in 2009-2018, which increased over the 10-year period (P = 0.023). Thirteen sequence types (STs) were identified; ST5 (14 [24%]), ST11 (11 [19%]), ST221 (10 [17%]), ST201 (7 [12%]) and ST1 (5 [9%]) were popular. All 58 isolates were susceptible to vancomycin and piperacillin/tazobactam, and clindamycin and moxifloxacin were active in 69.0% and 62% of isolates, respectively. ST1 strains were resistant to several antibiotics, including moxifloxacin (80%), clindamycin (60%) and rifaximin (60%). Moreover, four of five ST1 presented a metronidazole minimum inhibitory concentration of 4 µg/mL. Moxifloxacin resistance was highest (72.3%) for ST11. In conclusion, binary toxin-positive strains are non-prevalent in Korea and involve diverse STs. ST1 strains were resistant to several antibiotics.
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Affiliation(s)
- Jieun Kim
- grid.49606.3d0000 0001 1364 9317Division of Infectious Diseases, Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763 Korea
| | - Bongyoung Kim
- grid.49606.3d0000 0001 1364 9317Division of Infectious Diseases, Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763 Korea
| | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-Ro, Seongdong-Gu, Seoul, 04763, Korea.
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10
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Go JW, Lee SE, Park JH, Pai H, Kim DS, Kim B. 547. Risk factors that can predict adrenal insufficiency in fever of unknown origin. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Adrenal insufficiency is one of the causes of fever of unknown origin (FUO), however, it is often mistaken for an infectious disease, leading to unnecessary antibiotic use. The purpose of this study is to find out risk factors that can predict adrenal insufficiency in FUO patients so that set a target to recommend the adrenocorticotropic hormone (ACTH) stimulation test.
Methods
This study was conducted retrospectively in a tertiary hospital with 846 beds in South Korea. All adult inpatients (age ≥ 19 years) who have requested a consult with the department of infectious disease (ID) for FUO between 1 July, 2019 and 30 June, 2020 were included in the study. Among them, those who underwent an ACTH stimulation test and had a fever of 37.8°C or higher within 48 hours of the ACTH stimulation test were finally included in the study subjects.
Results
A total of 202 FUO patients were enrolled and 61 (30.1%) were finally diagnosed with adrenal insufficiency. Patient with adrenal insufficiency had higher charlson comorbidity index score than others (2.36±1.88 vs. 1.85±2.06, P=0.016). In addition, higher proportion of patients who used immunosuppressant (31.1% vs. 6.4%, P< 0.001) and/or corticosteroid (19.7% vs. 3.5%, P< 0.001) within 3 months were observed in adrenal insufficiency group. Patients with adrenal insufficiency tended to show hypotension (21.3% vs. 10.6%, P=0.044), lower white blood cell count [10^3/uL] (9.27±6.30 vs. 10.54±5.82, P=0.025), lower hemoglobin (4.38±9.96 vs. 1.70±2.10, P=0.023), lower albumin (8.25±0.94 vs. 8.49±0.60, P=0.009), and higher creatinine (1.39±1.61 vs. 1.05±1.57, P=0.044) than those without adrenal insufficiency. In a multivariate analysis, use of immunosuppressant within 3 months (OR 6.06, 95% CI 1.82–20.13, P = 0.003), use of corticosteroid within 3 months (OR 8.23, 95% CI 1.35–50.17, P = 0.022), sodium ≥ 136.7 (OR 3.43, 95% CI 1.49–7.88, P = 0.004), and calcium ≥ 8.4 (OR 0.31, 95% CI 0.14-0.71, P = 0.005) were proven to be factors that can predict adrenal insufficiency in FUO patients.
Conclusion
When FUO patients have a history of immunosuppressant/corticosteroid use within 3 months, and/or shows sodium ≥ 136.7, or calcium < 8.4 at initial laboratory test, performing ACTH stimulation test is recommended.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Ji Won Go
- Hanyang University College of Medicine , Seongdong-gu, Seoul-t'ukpyolsi , Republic of Korea
| | - Seung Eun Lee
- Hanyang University College of Medicine , Seongdong-gu, Seoul-t'ukpyolsi , Republic of Korea
| | - Jung Hwan Park
- Hanyang University College of Medicine , Seongdong-gu, Seoul-t'ukpyolsi , Republic of Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine , Seongdong-gu, Seoul-t'ukpyolsi , Republic of Korea
| | - Dong Sun Kim
- Hanyang University College of Medicine , Seongdong-gu, Seoul-t'ukpyolsi , Republic of Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine , Seongdong-gu, Seoul-t'ukpyolsi , Republic of Korea
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11
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Kim J, Kim E, Kim B, Kim J, Lee HJ, Park JS, Hwang S, Rho M, Pai H. Different maturation of gut microbiome in Korean children. Front Microbiol 2022; 13:1036533. [PMID: 36504822 PMCID: PMC9726757 DOI: 10.3389/fmicb.2022.1036533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Gut microbiome plays a crucial role in maintaining human health and is influenced by food intake, age, and other factors. Methods In this study based in Korea, we examined the bacterial taxonomic composition of the gut microbiota in infants (≤ 1 year), toddlers (1-<4 years), and school-aged children (4-13 years) and compared them with those of healthy adults to investigate the microbiota changes in early life and their association with the resistome. We used whole metagenome sequences obtained by Illumina HiSeq sequencing and clinical information of 53 healthy children, and sequence data of 61 adults from our previous study. Results Our results indicate that the bacterial proportion of the gut in the population ranging from infants to adults forms three clusters: the Ruminococcus-Eubacterium (G1), Bifidobacterium-Escherichia (G2), and Bacteroides-Faecalibacterium (G3) groups. The gut microbiota of infants and toddlers (100% of infants and 85% of toddlers) constituted mostly of G2 and G3 groups, whereas 90% of adults showed G1-type gut microbiota. School-aged children showed a transitional gut microbiota composition of both infants and adults (31%, 38%, and 31% in G1, G2, and G3, respectively). Notably, the three clusters of microbiota showed significantly different patterns of bacterial diversity (p < 0.001): G2 showed the lowest Shannon index, followed by G3 and G1 (1.41, 2.08, and 2.48, respectively; median Shannon index). When combined with the adult group, alpha diversity showed a positive correlation with age (R2 = 0.3). Furthermore, clustering the composition of antibiotic resistance genes (ARG) identified two clusters (A1 and A2), and most of G1 (95%) and G3 (80%) belonged to A1. However, G2 showed the least diversity and the highest abundance of ARGs. Nine ARG families showed a significant difference among age groups; three tetracycline resistance genes, tet32, tetO, and tetW, showed a positive correlation, and six other genes, ampC, TEM, ileS, bacA, pmr transferase, and cepA, showed a negative correlation with age. Discussion In conclusion, our results highlighted that a delayed persistence of the Bifidobacterium-dominant enterotype with a lower bacterial diversity was observed in Korean children up to 13 years of age, which suggests a different maturation process with a delayed maturation time.
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Affiliation(s)
- Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Erin Kim
- Department of Computer Science and Engineering, Hanyang University, Seoul, South Korea
| | - Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jinsup Kim
- Department of Clinical Development, Novel Pharma Inc., Seoul, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jun-Sun Park
- Translational Research Center, Research Institute of Public Health, National Medical Center, Seoul, Republic of Korea
| | - Sehee Hwang
- Cancer Information Center, Yonsei University Health System, Yonsei Cancer Center, Seoul, South Korea,Sehee Hwang,
| | - Mina Rho
- Department of Computer Science and Engineering, Hanyang University, Seoul, South Korea,Department of Biomedical Informatics, Hanyang University, Seoul, South Korea,Mina Rho,
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea,*Correspondence: Hyunjoo Pai,
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Abstract
Clostridioides difficile infection is a global public health threat. Extensive in vitro assays using clinical isolates have identified micrococcin P2 (MP2, 1) as a particularly effective anti-C. difficile agent. MP2 possesses a mode of action that differs from other antibiotics and pharmacokinetic properties that render it especially promising. Its time-kill studies have been investigated using hypervirulent C. difficile ribotype 027. DSS (dextran sulfate sodium)-induced in vivo mouse studies with that strain indicate that 1 is better than vancomycin and fidaxomicin. Thus, micrococcin P2 is a valuable platform to be exploited for the development of new anti-C. difficile antibiotics.
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Affiliation(s)
- Young-Jin Son
- A&J Science Co., Ltd., 80 Chumbok Road, Dong Gu, Daegu, 41061, Republic of Korea
- Department of Agricultural Biotechnology, Seoul National University, 1 Gwanak Road, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Young-Rok Kim
- School of Life Science, Handong Global University, 558 Handong Road, Heunghae-eup, Buk-gu, Pohang, 37554, Republic of Korea
| | - Sang-Hun Oh
- School of Life Science, Handong Global University, 558 Handong Road, Heunghae-eup, Buk-gu, Pohang, 37554, Republic of Korea
| | - Sungji Jung
- School of Life Science, Handong Global University, 558 Handong Road, Heunghae-eup, Buk-gu, Pohang, 37554, Republic of Korea
| | - Marco A Ciufolini
- Department of Chemistry, University of British Columbia, 2036 Main Mall, Vancouver, BC V6K 1Z1, Canada
| | - Hee-Jong Hwang
- A&J Science Co., Ltd., 80 Chumbok Road, Dong Gu, Daegu, 41061, Republic of Korea
| | - Jin-Hwan Kwak
- School of Life Science, Handong Global University, 558 Handong Road, Heunghae-eup, Buk-gu, Pohang, 37554, Republic of Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni Road, Seongdong-gu, Seoul, 04763, Republic of Korea
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13
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Cho Y, Kim J, Pai H, Rho M. Deciphering Resistome in Patients With Chronic Obstructive Pulmonary Diseases and Clostridioides difficile Infections. Front Microbiol 2022; 13:919907. [PMID: 35983323 PMCID: PMC9378971 DOI: 10.3389/fmicb.2022.919907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Antibiotics alter the gut microbiome and cause dysbiosis leading to antibiotic-resistant organisms. Different patterns of antibiotic administration cause a difference in bacterial composition and resistome in the human gut. We comprehensively investigated the association between the distribution of antibiotic resistance genes (ARGs), bacterial composition, and antibiotic treatments in patients with chronic obstructive pulmonary diseases (COPD) and Clostridioides difficile infections (CDI) who had chronic or acute intermittent use of antibiotics and compared them with healthy individuals. We analyzed the gut microbiomes of 61 healthy individuals, 16 patients with COPD, and 26 patients with CDI. The COPD patients were antibiotic-free before stool collection for a median of 40 days (Q1: 9.5; Q3: 60 days), while the CDI patients were antibiotic-free for 0 days (Q1: 0; Q3: 0.3). The intra-group beta diversity measured by the median Bray-Curtis index was the lowest for the healthy individuals (0.55), followed by the COPD (0.69) and CDI groups (0.72). The inter-group beta diversity was the highest among the healthy and CDI groups (median index = 0.89). The abundance of ARGs measured by the number of reads per kilobase per million reads (RPKM) was 684.2; 1,215.2; and 2,025.1 for the healthy, COPD, and CDI groups. It was negatively correlated with the alpha diversity of bacterial composition. For the prevalent ARG classes, healthy individuals had the lowest diversity and abundance of aminoglycoside, β-lactam, and macrolide-lincosamide-streptogramin (MLS) resistance genes, followed by the COPD and CDI groups. The abundances of Enterococcus and Escherichia species were positively correlated with ARG abundance and the days of antibiotic treatment, while Bifidobacterium and Ruminococcus showed negative correlations for the same. In addition, we analyzed the mobilome patterns of aminoglycoside and β-lactam resistance gene carriers using metagenomic sequencing data. In conclusion, the ARGs were significantly enhanced in the CDI and COPD groups than in healthy individuals. In particular, aminoglycoside and β-lactam resistance genes were more abundant in the CDI and COPD groups, but the dominant mobile genetic elements that enable the transfer of such genes showed similar prevalence patterns among the groups.
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Affiliation(s)
- Youna Cho
- Department of Computer Science, Hanyang University, Seoul, South Korea
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
- Hyunjoo Pai,
| | - Mina Rho
- Department of Computer Science, Hanyang University, Seoul, South Korea
- Department of Biomedical Informatics, Hanyang University, Seoul, South Korea
- *Correspondence: Mina Rho,
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14
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Kim B, Kim J, Jo HU, Kwon KT, Ryu SY, Wie SH, Kim J, Park SY, Hong KW, Kim HI, Kim HA, Kim MH, Bae MH, Sohn YH, Kim J, Lee Y, Pai H. Changes in the characteristics of community-onset fluoroquinolone-resistant Escherichia coli isolates causing community-acquired acute pyelonephritis in South Korea. J Microbiol Immunol Infect 2022; 55:678-685. [PMID: 35140038 DOI: 10.1016/j.jmii.2022.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/16/2021] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE This study aimed to examine the changes in the characteristics of community-onset fluoroquinolone-resistant (FQ-R) Escherichia coli isolates causing community-acquired acute pyelonephritis (APN) in South Korea. METHODS Blood or urine samples were prospectively collected from patients aged ≥15 years with community-acquired APN who were admitted to one of the eight Korean hospitals included in this study between September 2017 and August 2018. Phylogenetic typing, multilocus sequence typing, and molecular characterization of β-lactamase resistance and plasmid-mediated quinolone resistance (PMQR) determinants were performed. The data were compared with those from a previous study with the same design conducted in 2010-2011. RESULTS A total of 300 and 346 isolates were identified in 2010-2011 and 2017-2018, respectively. Among them, 76 (22.0%) and 77 (25.7%) FQ-R isolates were identified in 2010-2011 and 2017-2018, respectively. A significantly higher antimicrobial resistance against third-to fourth-generation cephalosporins, including cefotaxime (23.9% vs. 77.9%, P < 0.001), were observed among FQ-R isolates in 2017-2018 than among those in 2010-2011. A higher proportion of ST131 isolates (27.6% vs. 66.2%, P < 0.001), as well as isolates that had extended-spectrum β-lactamase (ESBL)/plasmid-mediated AmpC β-lactamase (PABL) (23.7% vs. 79.2%, P < 0.001), was observed in 2017-2018 than in 2010-2011. Further, more PMQR determinants (11.8% vs. 40.8%, P < 0.001) were observed in 2017-2018 than in 2010-2011. CONCLUSIONS Among uropathogenic FQ-R E. coli isolates in South Korea, the prevalence of ST131 and the proportion of isolates containing ESBL and/or PMQR determinants have increased.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
| | - Jeoungyeon Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyun-Uk Jo
- Department of Urology, Good Moonhwa Hospital, Busan, South Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seong-Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Kyung-Wook Hong
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Hye In Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Mi-Hee Kim
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mi Hyun Bae
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | | | - Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
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15
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Yoon C, Park SY, Kim B, Kwon KT, Ryu SY, Wie SH, Jo HU, Kim J, Hong KW, Kim HI, Kim HA, Kim MH, Bae MH, Sohn YH, Kim J, Lee Y, Pai H. Relationship between the appropriateness of antibiotic treatment and clinical outcomes/medical costs of patients with community-acquired acute pyelonephritis: a multicenter prospective cohort study. BMC Infect Dis 2022; 22:112. [PMID: 35105335 PMCID: PMC8805410 DOI: 10.1186/s12879-022-07097-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate use of antibiotics not only increases antibiotic resistance as collateral damage but also increases clinical failure rates and medical costs. The purpose of this study was to determine the relationship between the appropriateness of antibiotic prescription and outcomes of community-acquired acute pyelonephritis (CA-APN). METHODS A multicenter prospective cohort study was conducted at eight hospitals in Korea between September 2017 and August 2018. All hospitalized patients aged ≥ 19 years who were diagnosed with CA-APN on admission were recruited. The appropriateness of empirical and definitive antibiotics, as well as the appropriateness of antibiotic treatment duration and route of administration, was evaluated in accordance with the guideline and expert opinions. Clinical outcomes and medical costs were compared between patients who were administered antibiotics 'appropriately' and 'inappropriately.' RESULTS A total of 397 and 318 patients were eligible for the analysis of the appropriateness of empirical and definitive antibiotics, respectively. Of them, 10 (2.5%) and 18 (5.7%) were administered 'inappropriately' empirical and definitive antibiotics, respectively. Of the 119 patients whose use of both empirical and definitive antibiotics was classified as 'optimal,' 57 (47.9%) received antibiotics over a longer duration than that recommended; 67 (56.3%) did not change to oral antibiotics on day 7 of hospitalization, even after stabilization of the clinical symptoms. Patients who were administered empirical antibiotics 'appropriately' had shorter hospitalization days (8 vs. 10 days, P = 0.001) and lower medical costs (2381.9 vs. 3235.9 USD, P = 0.002) than those who were administered them 'inappropriately.' Similar findings were observed for patients administered both empirical and definitive antibiotics 'appropriately' and those administered either empirical or definitive antibiotics 'inappropriately'. CONCLUSIONS Appropriate use of antibiotics leads to better outcomes, including reduced hospitalization duration and medical costs.
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Affiliation(s)
- Choseok Yoon
- The Medical Commend of Internal Medicine, 27th Infantry Division Medical Team, Republic of Korea Army, Hwacheon, Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seong-Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Uk Jo
- Department of Urology, Good Moonhwa Hospital, Busan, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea
| | - Kyung-Wook Hong
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hye In Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Mi-Hee Kim
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi-Hyun Bae
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | | | - Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea
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16
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Kim J, Kim J, Kim B, Pai H. Which is the Preferred Regimen for Non-Severe Clostridioides difficile Infection in Korea, Vancomycin or Metronidazole? Infect Chemother 2022; 54:213-219. [PMID: 35706079 PMCID: PMC9259900 DOI: 10.3947/ic.2022.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
The emergence of hypervirulent Clostridioides difficile strains has decreased the efficacy of metronidazole in the treatment of C. difficile infection (CDI). Therefore, revised guidelines no longer recommend the use of metronidazole as a first-line regimen for CDI and restrict its use for non-severe CDI, only when vancomycin and fidaxomicin are unavailable. In Korea, an epidemic caused by a hypervirulent C. difficile strain or the emergence of metronidazole resistant C. difficile strains have not been reported. This review article aims to compare the treatment outcomes and adverse effects of vancomycin and metronidazole and discuss the validity of the guidelines of various agencies, which restrict the use of metronidazole, for Korean patients. There are no substantial adverse effects of metronidazole, and its clinical outcomes against non-severe CDI are similar to those of vancomycin. Based on these findings, we recommend that the use of metronidazole for the treatment of non-severe CDI is still an appropriate option in Korea.
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Affiliation(s)
- Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jinyeong Kim
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Cheong T, Ahn J, Kim YS, Pai H, Kim B. Quantitative Evaluation of the Economic Impact of Antimicrobial Resistance on the Treatment of Community-Acquired Acute Pyelonephritis in Korea. Infect Chemother 2022; 54:456-469. [PMID: 36047300 PMCID: PMC9533169 DOI: 10.3947/ic.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background Materials and Methods Results Conclusion
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Affiliation(s)
- Taul Cheong
- Department of Economics, Indiana University Purdue University Indianapolis, Indianapolis, USA
| | - Jungmo Ahn
- School of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yun Seop Kim
- The Office of Research Strategy, Korea University Medical Center, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Kim J, Kim GY, Lee JH, Kim B, Pai H. Binary toxin-producing Clostridioides difficile shows diverse multilocus sequence typing (MLST) clade and types in Korea. Int J Antimicrob Agents 2021. [DOI: 10.1016/j.ijantimicag.2021.106421.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Because persistent fever often occurs in adrenal insufficiency, it might be confused with infectious diseases. This study aimed to identify clinical characteristics and risk factors of patients with adrenal insufficiency and fever. METHODS All adult patients (n = 150) admitted to a tertiary care hospital in South Korea and diagnosed with adrenal insufficiency between 1 March 2018, and 30 June 2019, were recruited. Patients were excluded if they had: 1) proven structural problems in the adrenal or pituitary gland; 2) a history of chemotherapy within 6 months prior to the diagnosis of adrenal insufficiency; and 3) other medical conditions that may cause fever. RESULTS Among the included patients, 45 (30.0%) had fever at the time of the diagnosis of adrenal insufficiency. The mean C-reactive protein level was higher (11.25 ± 8.54 vs. 4.36 ± 7.13 mg/dL) in patients with fever than in those without fever. A higher proportion of patients with fever changed antibiotics (33.3% vs. 1.0%). On multivariate logistic regression analysis, female sex (odds ratio [OR], 0.32) lowered the risk of adrenal insufficiency with fever, while a history of surgery within 6 months (OR, 4.35), general weakness (OR, 7.21), and cough (OR, 17.29) were significantly associated with that. CONCLUSION The possibility of adrenal insufficiency should be considered in patients with fever of unknown origin, especially those with risk factors.
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Affiliation(s)
- Wooyoung Jang
- School of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Youngseok Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Sun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Jang W, Jo HU, Kim B, Kwon KT, Ryu SY, Wie SH, Kim J, Park SY, Hong KW, Kim HI, Kim HA, Kim MH, Bae MH, Sohn YH, Kim J, Lee Y, Pai H. Comparison of the clinical characteristics of community-acquired acute pyelonephritis between male and female patients. J Infect Chemother 2021; 27:1013-1019. [PMID: 33642250 DOI: 10.1016/j.jiac.2021.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/07/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Community-acquired acute pyelonephritis (CA-APN) is relatively rare in men. This study aimed to compare the clinical characteristics of CA-APN between male and female patients. METHODS We prospectively collected the clinical and microbiological data of hospitalized CA-APN patients aged ≥19 years in South Korea from March 2010 to February 2011 in 11 hospitals and from September 2017 to August 2018 in 8 hospitals. Only the first episodes of APN of each patient during the study period were included. RESULTS From 2010 to 2011, 573 patients from 11 hospitals were recruited, and from 2017 to 2018, 340 patients were recruited from 8 hospitals. Among them, 5.9% (54/913) were male. Male patients were older (66.0 ± 15.2 vs. 55.3 ± 19.0 years, P < 0.001), had a higher Charlson comorbidity index (1.3 ± 1.5 vs. 0.7 ± 1.2, P = 0.027), and had a higher proportion of structural problems in the urinary tract (40.7% vs. 6.1%, P < 0.001) than female patients. Moreover, the total duration of antibiotic treatment was longer (21.8 ± 17.8 d vs. 17.3 ± 9.4 d, P = 0.001) and the proportion of carbapenem usage was higher (24.1% vs. 9.5%, P = 0.001) in men than in women. Male patients were hospitalized for longer durations than female patients (median, 10 d vs. 7 d, P < 0.001). CONCLUSIONS Male CA-APN patients were older and had more comorbidities than female CA-APN patients. In addition, male patients received antibiotic treatment for a longer duration than female patients.
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Affiliation(s)
- Wooyoung Jang
- School of Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hyun-Uk Jo
- Department of Urology, Good Moonhwa Hospital, Busan, South Korea
| | - Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seong-Yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Kyung-Wook Hong
- Division of Infectious Diseases, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Hye In Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Mi-Hee Kim
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mi Hyun Bae
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | | | - Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea.
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Seok H, Choi WS, Lee S, Moon C, Park DW, Song JY, Cheong HJ, Kim J, Kim JY, Park MN, Kim YR, Lee HJ, Kim B, Pai H, Jo YM, Kim JH, Sohn JW. What is the optimal antibiotic treatment strategy for carbapenem-resistant Acinetobacter baumannii (CRAB)? A multicentre study in Korea. J Glob Antimicrob Resist 2021; 24:429-439. [PMID: 33571708 DOI: 10.1016/j.jgar.2021.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/13/2021] [Accepted: 01/29/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The optimal treatment option for carbapenem-resistant Acinetobacter baumannii (CRAB) is still limited. This study investigated the efficacy of three or more antibiotic types and regimens for treatment of CRAB infection in high CRAB endemic areas. METHODS A multicentre retrospective study was conducted to evaluate the efficacy of treatment types and regimens of CRAB infections in 10 tertiary hospitals in the Republic of Korea. The outcomes comprised 7-day and 28-day mortality, and clinical and microbiological responses at 7 days, 28 days, and the end of treatment. Nephrotoxicity and hepatotoxicity were evaluated as drug adverse reactions. RESULTS A total of 282 patients were included in the study. Among the CRAB strains, the two most susceptible antibiotics were colistin (99.6%) and minocycline (80.4%). A combination of colistin and carbapenem significantly reduced 7-day mortality, and a sulbactam-containing regimen significantly reduced 28-day mortality. Colistin monotherapy was significantly associated with increased 7-day and 28-day mortality. A minocycline-containing regimen showed the best microbiological responses at 7 days, 28 days, and the end of treatment. Colistin and tigecycline were associated with increased nephrotoxicity and hepatotoxicity, respectively. Subgroup analysis of patients with pneumonia showed similar results to the overall CRAB infection. CONCLUSIONS A combination of colistin and carbapenem and sulbactam-containing regimen may contribute improved mortality in CRAB infections. Colistin monotherapy should be considered cautiously in severe CRAB infections or CRAB pneumonia. A minocycline-containing regimen showed the best microbiological responses, and further studies may be needed to evaluate improved mortality.
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Affiliation(s)
- Hyeri Seok
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Chisook Moon
- Division of Infectious Diseases, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jieun Kim
- Division of Infectious Diseases, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jin Yong Kim
- Department of Internal Medicine, Incheon Medical Center, Incheon, Republic of Korea
| | - Mi Na Park
- Infection Control Office, Incheon Medical Center, Incheon, Republic of Korea
| | - Yang Ree Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo-Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bongyoung Kim
- Division of Infectious Diseases, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunjoo Pai
- Division of Infectious Diseases, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Yu Mi Jo
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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Kim B, Kwon KT, Ryu SY, Wie SH, Jo HU, Kim J, Park SY, Hong KW, Kim HI, Kim HA, Kim MH, Bae MH, Sohn YH, Kim J, Lee Y, Pai H. 1667. Change in characteristics of community-onset ciprofloxacin-resistant E. coli isolates causing community-acquired acute pyelonephritis in South Korea. Open Forum Infect Dis 2020. [PMCID: PMC7778248 DOI: 10.1093/ofid/ofaa439.1845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to examine the change in characteristics of community-onset ciprofloxacin-resistant (CIP-R) E. coli isolates causing community-acquired acute pyelonephritis (CA-APN) in South Korea between 2010-2011 and 2017-2018. Methods E. coli samples isolated from the blood or urine were collected from patients with CA-APN aged 19 years and more who were admitted to 8 Korean hospitals from September 2017 to August 2018, prospectively. One isolate was collected from each patient. Phylogenetic typing, multilocus sequence typing (MLST), and molecular characterization of β-lactamase resistance and plasmid-mediated quinolone resistance (PMQR) determinants were performed. The data were compared with those from the previous study with same design in 2010-2011. Results A total of 346 and 300 isolates were collected during 2017-2018 and 2010-2011, respectively. Among them, 76 (22.0%) and 77 (25.7%) were CIP-R isolates. Significantly higher antimicrobial resistance against ampicillin (75.7% vs. 100%, P < 0.001) and cefotaxime (23.9% vs. 77.9%, P < 0.001) were observed for isolates in 2017-2018 compared to those in 2010-2011. The proportion of phylogenic group B2 had increased significantly (44.7% vs. 79.2%, P < 0.001). As for MLST, the proportion of ST131 (27.6% vs. 66.2%, P < 0.001) had increased while that of ST393 (18.4% vs. 3.9%, P =0.004) had decreased significantly. Higher proportion of CIP-R E. coli isolates in 2017-2018 had extended-spectrum β-lactamase (ESBL)/plasmid-mediated AmpC β-lactamase (PABL) (23.7% vs. 79.2%, P < 0.001) and PMQR determinant (11.8% vs. 40.8%, P < 0.001) compared to those in 2010-2011. Phlogenetic tree ![]()
Analyzed by SplitsTree ![]()
Conclusion Among uropathogenic CIP-R E. coli isolates in South Korea, ST131 predominance had become more prominent and the proportion of containing ESBL/PABL and/or PMQR determinants had increased. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Bongyoung Kim
- Hanyang University College of Medicine, Seongdong-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea, Daegu, Taegu-jikhalsi, Republic of Korea
| | - Seong-yeol Ryu
- Keimyung University Dongsan Medical Center, Daegu, Taegu-jikhalsi, Republic of Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Kyonggi-do, Kyonggi-do, Republic of Korea
| | - Hyun-uk Jo
- Department of Urology, School of Medicine, Eulji University, Daejeon, Korea, Daejeon, Taejon-jikhalsi, Republic of Korea
| | - Jieun Kim
- Department of Internal medicine, Hanyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kyung-Wook Hong
- Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea, Jinju, Kyongsang-namdo, Republic of Korea
| | - Hye In Kim
- Daegu Fatima Hospital, Daegu, Taegu-jikhalsi, Republic of Korea
| | - Hyun ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea, Daegu, Taegu-jikhalsi, Republic of Korea
| | - Mi-Hee Kim
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Kyonggi-do, Kyonggi-do, Republic of Korea
| | - Mi-Hyun Bae
- Department of laboratory medicine, Hanyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Yong-Hak Sohn
- Seegene Medical Foundation, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Yangsoon Lee
- Department of laboratory medicine, Hanyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Hyunjoo Pai
- Department of Internal medicine, Hanyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
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Abstract
Previous exposure to antimicrobials is a major risk factor for Clostridioides difficile infection (CDI). Antibiotic prescription and C. difficile toxin assay records of patients admitted to a tertiary hospital in Korea from 2009 to 2013 were collected to investigate the association between antibiotic consumption and CDI incidence. A Spearman's correlation analysis between CDI incidence (positive result of toxin assay/10,000 admissions) and antibiotic consumption (defined daily dose/1,000 patient-days) was performed on a monthly basis. Using the matched month approach, we found a significant correlation between CDI rate and moxifloxacin consumption (Spearman's r = 0.351, P < 0.001). Furthermore, using the one-month delay approach, we found that the consumption of clindamycin (Spearman's r = 0.272, P = 0.037) and moxifloxacin (Spearman's r = 0.297, P = 0.022) was significantly correlated with CDI incidence. Extended-spectrum cephalosporins did not have any effect on CDI incidence.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Kim B, Myung R, Lee MJ, Kim J, Pai H. Trend of Antibiotic Usage for Hospitalized Community-acquired Pneumonia Cases in Korea Based on the 2010-2015 National Health Insurance Data. J Korean Med Sci 2020; 35:e390. [PMID: 33289366 PMCID: PMC7721565 DOI: 10.3346/jkms.2020.35.e390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/14/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study is to describe the changes in prescribing practices of antibiotics to treat community-acquired pneumonia (CAP) in Korea during 2010-2015. METHODS The claim database of the Health Insurance Review and Assessment Service in Korea was used to select adult patients (≥ 18 years of age) admitted between 2010 and 2015, with the International Classification of Diseases, Tenth Revision codes relevant to all-cause pneumonia for the first or second priority discharge diagnosis. The episodes with hospital-acquired or healthcare-associated pneumonia were excluded. Consumption of each antibiotic was converted to defined daily dose (DDD) per episode. The amount of antibiotic consumption was compared between patients with CAP aged < 65 years and those aged ≥ 65 years. RESULTS The average amount of antibiotic consumption per episode was 15.5 DDD, which remained stable throughout the study period (P = 0.635). Patients aged ≥ 65 years received more antibiotics than those aged < 65 years (15.7 vs. 15.3 DDD). Third-generation cephalosporin (4.9 DDD/episode, 31.4%) was the most commonly prescribed, followed by macrolide (2.7 DDD/episode, 17.1%) and beta-lactam/beta-lactamase inhibitor (BL/BLI) (2.1 DDD/episode, 13.6%). The consumption amount of fourth-generation cephalosporin (4th CEP) (P = 0.001), BL/BLI (P = 0.003) and carbapenem (P = 0.002) increased each year during the study period. The consumption of 4th CEP and carbapenem was doubled during 2010-2015. CONCLUSION The prescription of broad-spectrum antibiotics such as 4th CEP and carbapenem to treat CAP increased in Korea during 2010-2015.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science & Economics, Korea University, Seoul, Korea
| | - Myoung Jae Lee
- Department of Economics, College of Political Science & Economics, Korea University, Seoul, Korea.
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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Nandi S, Mukherjee G, Chen QB, Frauendorf S, Banik R, Bhattacharya S, Dar S, Bhattacharyya S, Bhattacharya C, Chatterjee S, Das S, Samanta S, Raut R, Ghugre SS, Rajbanshi S, Ali S, Pai H, Asgar MA, Das Gupta S, Chowdhury P, Goswami A. First Observation of Multiple Transverse Wobbling Bands of Different Kinds in ^{183}Au. Phys Rev Lett 2020; 125:132501. [PMID: 33034500 DOI: 10.1103/physrevlett.125.132501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/17/2020] [Accepted: 08/27/2020] [Indexed: 06/11/2023]
Abstract
We report the first observation of two wobbling bands in ^{183}Au, both of which were interpreted as the transverse wobbling (TW) band but with different behavior of their wobbling energies as a function of spin. It increases (decreases) with spin for the positive (negative) parity configuration. The crucial evidence for the wobbling nature of the bands, dominance of the E2 component in the ΔI=1 transitions between the partner bands, is provided by the simultaneous measurements of directional correlation from the oriented states ratio and the linear polarization of the γ rays. Particle rotor model calculations with triaxial deformation reproduce the experimental data well. A value of spin, I_{m}, has been determined for the observed TW bands below which the wobbling energy increases and above which it decreases with spin. The nucleus ^{183}Au is, so far, the only nucleus in which both the increasing and the decreasing parts are observed and thus gives the experimental evidence of the complete transverse wobbling phenomenon.
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Affiliation(s)
- S Nandi
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - G Mukherjee
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Q B Chen
- Physik-Department, Technische Universität München, D-85747 Garching, Germany
| | - S Frauendorf
- Department of Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - R Banik
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Soumik Bhattacharya
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - Shabir Dar
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - S Bhattacharyya
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - C Bhattacharya
- Variable Energy Cyclotron Centre, 1/AF, Bidhan Nagar, Kolkata 700064, India
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai 400094, India
| | - S Chatterjee
- UGC-DAE CSR, Kolkata Centre, Kolkata 700098, India
| | - S Das
- UGC-DAE CSR, Kolkata Centre, Kolkata 700098, India
| | - S Samanta
- UGC-DAE CSR, Kolkata Centre, Kolkata 700098, India
| | - R Raut
- UGC-DAE CSR, Kolkata Centre, Kolkata 700098, India
| | - S S Ghugre
- UGC-DAE CSR, Kolkata Centre, Kolkata 700098, India
| | - S Rajbanshi
- Department of Physics, Presidency University, Kolkata 700043, India
| | - Sajad Ali
- Government General Degree College at Pedong, Kalimpong 734311, India
| | - H Pai
- Saha Institute of Nuclear Physics, Kolkata 700064, India
| | - Md A Asgar
- Department of Physics, Prabhat Kumar College, Contai 721404, India
| | - S Das Gupta
- Victoria Institution (College), Kolkata 700009, India
| | - P Chowdhury
- University of Massachusetts Lowell, Lowell, Massachusetts 01854, USA
| | - A Goswami
- Saha Institute of Nuclear Physics, Kolkata 700064, India
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Park S, Moon S, Pai H, Kim B. Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection. PLoS One 2020; 15:e0234966. [PMID: 32569313 PMCID: PMC7307762 DOI: 10.1371/journal.pone.0234966] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/AIM Prolonged maintenance of central venous catheters, including peripherally inserted central catheters (PICCs), is a major risk factor for central line-associated bloodstream infection (CLABSI). This study was conducted to evaluate the appropriate duration of PICC maintenance to prevent CLABSI. METHODS A single-center retrospective study was conducted at an 824-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. CLABSI was diagnosed according to the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). To identifying statistical correlations between catheter days and PABSI, the odds ratio for PABSI on the basis of the continuous value of catheter days was analyzed using restricted cubic spline splits with five knots. The optimal cut-off value for catheter days was identified by maximizing the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS A total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Among them, 36 were confirmed as having a PABSI (3.5%, 36/1014; 1.14 per 1000 catheter days). In the restricted cubic spline regression, catheter days showed a dose-dependent relationship with the risk of PABSI. The AUC of the ROC curve for developing a PABSI according to the duration of catheter maintenance was 0.715 (95% CI, 0.639-0.790); the calculated optimal cut-off value was 25 days. CONCLUSION The incidence of PABSI was 1.14 per 1000 catheter days and the optimal cut-off value of catheter days to avoid a PABSI was 25 days.
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Affiliation(s)
- Seonghun Park
- School of Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Shinje Moon
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail:
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Kim B, Seo MR, Kim J, Kim Y, Wie SH, Ki M, Cho YK, Lim S, Lee JS, Kwon KT, Lee H, Cheong HJ, Park DW, Ryu SY, Chung MH, Pai H. Molecular Epidemiology of Ciprofloxacin-Resistant Escherichia coli Isolated from Community-Acquired Urinary Tract Infections in Korea. Infect Chemother 2020; 52:194-203. [PMID: 32406212 PMCID: PMC7335657 DOI: 10.3947/ic.2020.52.2.194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/28/2020] [Indexed: 12/29/2022] Open
Abstract
Background Escherichia coli is the predominant causative pathogen for community-acquired urinary tract infections (UTIs), and the increase in fluoroquinolone-resistant E. coli is of great concern in Korea. The objectives of this study were to investigate the genotypic characteristics and molecular epidemiology of ciprofloxacin-resistant (CIP-R) E. coli isolated from community-acquired UTIs in Korea. Materials and Methods E. coli samples isolated from the blood or urine were collected from patients with community-acquired acute pyelonephritis aged 15 years and more who were admitted to 12 Korean hospitals from 1st April 2010 to 29th February 2012. Phylogenetic typing, multilocus sequence typing, and molecular characterization of β-lactamase and plasmid-mediated quinolone resistance determinants were performed for CIP-R E. coli isolates. Results A total of 569 E. coli isolates were collected, and 122 (21.4%) isolates were CIP-R isolates. The most prevalent sequence type (ST) was ST131 (28.7%, 35/122), followed by ST393 (14.7%, 18/122), ST1193 (13.1%, 16/122), ST38 (9.0%, 11/122), and ST405 (8.2%, 10/122). The antimicrobial resistance rates of ST131 to cefepime (22.9%, 8/35), ST38 to gentamicin (100%, 11/11), and ST405 to cefotaxime (66.7%, 6/9) were significantly higher than the resistance rates of all other STs combined. Notably, 40% (4/10) of ST405 clones produced extended-spectrum β-lactamases and were co-resistant to trimethoprim/sulfamethoxazole. aac(6′)-1b-cr (20%, 7/35) and CTX-M-14 (40%, 4/10) were more frequently observed in ST131 and ST405 compared with other clones, respectively. Conclusions Among the CIP-R uropathogenic E. coli isolates in this study, ST131, ST38, and ST405 were specifically associated with antimicrobial resistance.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Ran Seo
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, National Medical Center, Seoul, Korea
| | - Seong Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Medical College, Gacheon University, Incheon, Korea
| | - Seungkwan Lim
- Department of Internal Medicine, Ansung Hospital, Gyeonggi Provincial Medical Center, Ansung, Korea
| | - Jin Seo Lee
- Division of Infectious Diseases, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyuck Lee
- Division of Infectious Diseases, Dong-A University Hospital, Dong-A University, Busan, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Korea University Guro Hospital, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Korea University Ansan Hospital, Ansan, Korea
| | - Seong Yeol Ryu
- Division of Infectious Diseases, Dongsan Hosptial, Keimyeong University, Daegu, Korea
| | - Moon Hyun Chung
- Division of Infectious Diseases, Seogwipo Medical Center, Jeju, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Kim B, Hwang H, Kim J, Lee MJ, Pai H. Ten-year trends in antibiotic usage at a tertiary care hospital in Korea, 2004 to 2013. Korean J Intern Med 2020; 35:703-713. [PMID: 30257553 PMCID: PMC7214379 DOI: 10.3904/kjim.2017.332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/03/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/AIMS This study was performed to evaluate trends in antibiotic usage at a tertiary care hospital in Korea. METHODS This study collated antibiotic prescription data and total patient days for inpatients at a tertiary care hospital in Korea between 2004 and 2013. The consumption of each class of antibiotic was converted to defined daily dose (DDD)/1,000 patient-days. We defined 3rd generation cephalosporins, 4th generation cephalosporins, β-lactam/β-lactamase inhibitors, and fluoroquinolones as broad-spectrum antibiotics; carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin were defined as antibiotics against multidrug-resistant (MDR) pathogens. Other antibiotic classes were defined as nonbroad-spectrum antibiotics. RESULTS Mean antibiotic consumption was 920.69 DDD/1,000 patient-days. The proportions of broad-spectrum antibiotics, antibiotics against MDR pathogens, and nonbroad-spectrum antibiotics were 41.8% (384.48/920.69), 3.5% (32.24/920.69), and 54.7% (503.97/920.69), respectively. Consumption of broad-spectrum antibiotics (coefficient for time 0.141; p = 0.049) and antibiotics against MDR pathogens (coefficient for time 0.185; p < 0.001) showed a significant increasing trend over the study period. Nonbroad-spectrum antibiotic consumption showed a significant decreasing trend over the study period (coefficient for time -2.601; p < 0.001). CONCLUSION Over the 10-year period, a stepwise increase in the consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens was observed at a tertiary care hospital in Korea. Conversely, during the same period, nonbroad-spectrum antibiotic consumption showed a significant decreasing trend.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Hyeonjun Hwang
- School of Economic Sciences, Washington State University, Pullman, WA, USA
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Myoung-jae Lee
- Department of Economics, Korea University College of Political Science and Economics, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- Correspondence to Hyunjoo Pai, M.D. Department of Internal Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea Tel: +82-2-2290-8356 Fax: +82-2-2298-9183 E-mail:
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Banik R, Bhattacharyya S, Biswas S, Bhattacharya S, Mukherjee G, Rajbanshi S, Dar S, Nandi S, Ali R, Chatterjee S, Das S, Das Gupta S, Ghugre SS, Goswami A, Mondal D, Mukhopadhyay S, Pai H, Pal S, Pandit D, Raut R, Ray P, Samanta S. Exploring the structure of Xe isotopes in A ~ 130 region: Single particle and collective excitations. EPJ Web Conf 2020. [DOI: 10.1051/epjconf/202023204001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
High and medium spin structures of 130,131Xe have been studied using α-induced fusion-evaporation reaction and the Indian National Gamma Array (INGA) coupled with a digital data acquisition system. Various new band structures and near yrast levels of 131Xe have been established. The multipolarities of the observed transitions have been assigned on the basis of the DCO ratios and the polarization asymmetry measurements. Band structures based on 1-quasi-particle (qp), 3-qp configurations have been observed. A new Magnetic Rotational (MR) band based on 5-qp configuration has also been established in 131Xe. The MR band has been interpreted in terms of shears mechanism with principal axis cranking (SPAC) calculations. Shell Model calculations are carried out to describe the non yrast states of 131Xe above the 11/2− isomer. New excited states have also been identified in 130Xe, produced in the same reaction.
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Abstract
Dysentery has been a major illness for a long time in our country. During Korean war, bacillary dysentery was common illness as well as other infectious diseases such as typhus fever, and Shigella flexneri occupied more than 90% of the cases reported by UN forces. After the war, the Korean National Institute of Health began to monitor the disease as a legal communicable disease. The incidence of dysentery decreased gradually from 1960 through 1980s and consistently low until 1997, and common serotype has changed from S. flexneri to S. sonnei. However, a nationwide epidemic of dysentery occurred at 1998, peaking at 2,462 cases in 2000, and continued until 2004. Most cases were S. sonnei, but the proportion of S. flexneri existed changing with time. There were several major epidemic cases during the period, and the dysentery outbreaks in 1998 and 1999 were associated with nationwide school meal provision which began in 1998. According to the region, Juju island particularly showed a high incidence rate in the period. Since 2005, the nationwide dysentery epidemic was over and incidence of dysentery remained stably low. Recently, multi-drug resistant Shigella infection imported from Southeast Asia appeared, and it requires continuous monitoring and control.
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Affiliation(s)
- Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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Tae Kwon K, Ryu SY, Wie SH, Jo HU, Yoon Park S, Hong KW, In Kim H, ah Kim H, Kim MH, Bae MH, Sohn YH, Kim J, Lee Y, Kim B, Pai H. 1451. Change in Clinical Characteristics of Community-Acquired Acute Pyelonephritis in South Korea: Comparison Between 2010–2011 and 2017–2018. Open Forum Infect Dis 2019. [PMCID: PMC6809382 DOI: 10.1093/ofid/ofz360.1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The aim of this study was to examine the change in clinical characteristics of community-acquired acute pyelonephritis (CA-APN) in South Korea between 2010–2011 and 2017–2018. Methods We recruited all CA-APN patients with age ≥19 years who visited 4 hospitals in South Korea from September 2017 to August 2018, prospectively. The inclusion criteria were: (i) presence of fever (body temperature ≥37.8°C), (ii) pyuria [≥5–9 white blood cells per high power field (WBC/HPF)], and (iii) clinical symptoms or signs relevant to APN. Patients diagnosed with APN more than 48 hours after admission, those transferred from other hospitals during treatment of APN, those with other reasons for fever and pyuria, and those with insufficient data were excluded. Each patient was included for the first episode during the study period. The collected data were compared with those from the previous study with the same design in 2010–2012, in which the same hospitals were participated. Results A total of 349 and 472 patients were recruited during 2017–2018 and 2010–2011, respectively. E. coli was the most common causative pathogen for CA-APN in both periods (87.5% vs. 86.6%, P = 0.727). Significantly higher antimicrobial resistance against fluoroquinolone (33.5% vs. 21.0%, P = 0.001), cefotaxime (34.8% vs. 7.6%, P P = 0.040) were observed for E. coli isolates in 2017–2018 compared with those in 2010–2011. The patients in 2017–2018 were older (60.71±17.29 vs. 55.77±18.60, P <0.001) and had higher Charlson’s comorbidity index (1.04±1.39 vs. 0.68±1.17, P<0.001) than those in 2010–2011. Total duration of antibiotic treatment increased from 15.40 ± 6.35 days in 2010–2011 to 21.74 ± 11.72 days in 2017–2018, P <0.001); the proportion of patients using carbapenem increased from 6.1% in 2010–2011 to 26.6% in 2010–2011 (P < 0.001). The median days of admission was higher for patients in 2017–2018 than those in 2010–2011 (10 vs. 8, P < 0.001). Conclusion Patients with CA-APN in South Korea were aging. Antimicrobial resistance of E. coli to almost all antibiotic classes, especially third-generation cephalosporin, increased significantly and total duration of antibiotic treatment and proportion of carbapenem usage increased, consequently. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Taegu-jikhalsi, Republic of Korea
| | - Seong-yeol Ryu
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daejongwanyeoksi, Taegu-jikhalsi, Republic of Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Kyonggi-do, Kyonggi-do, Republic of Korea
| | - Hyun-uk Jo
- Department of Urology, School of Medicine, Eulji University, Daejeon, Taejon-jikhalsi, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Kyung-Wook Hong
- Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Kyongsang-namdo, Republic of Korea
| | - Hye In Kim
- Department of Internal Meidcine, Daegu Fatima Hospital, Daegu, Taegu-jikhalsi, Republic of Korea
| | - Hyun ah Kim
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daejongwanyeoksi, Taegu-jikhalsi, Republic of Korea
| | - Mi-Hee Kim
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Kyonggi-do, Kyonggi-do, Republic of Korea
| | - Mi-Hyun Bae
- Department of laboratory medicine, Hanyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Yong-Hak Sohn
- Seegene Medical Foundation, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Jieun Kim
- Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Yangsoon Lee
- Department of laboratory medicine, Hanyang University College of Medicine, Seoul, Seoul-t’ukpyolsi, Republic of Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Songpa-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Songpa-gu, Seoul-t’ukpyolsi, Republic of Korea
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Park S, Moon S, Pai H, Kim B. 1172. The Proper Maintenance Duration for Peripherally Inserted Central Catheter (PICC) In order to Prevent Central Line-Associated Bloodstream Infection. Open Forum Infect Dis 2019. [PMCID: PMC6808665 DOI: 10.1093/ofid/ofz360.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Prolonged maintenance of central venous catheter including peripherally inserted central catheter (PICC) is a major risk factor for central line-associated bloodstream infection (CLABSI). Methods A single-center retrospective study was conducted in an 828-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. Patients were excluded if they: (1) were under 19 years old, (2) died, were discharged, or were transferred to other medical institutions within 3 days of PICC placement, and (3) had at least one result of absolute neutrophil count (ANC) under 500 cell/µL during catheterization. CLABSI was diagnosed using the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). For identifying the statistical correlation between catheter-days and PABSI, odd ratio for PABSI according to the continuous value of catheter-days was analyzed using restricted cubic spline splits with five knots. Receiver operating characteristic (ROC) curve was used to determine the diagnostic precision of applying catheter-days for PABSI. The optimal cut-off value of catheter-days was identified by maximizing the area under ROC curve (AUC). Results A total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Of them, 36 cases were confirmed as PABSI (3.5%, 36/1,014; 1.14 per 1,000 catheter days). In the restricted cubic spline regression, catheter maintenance days showed a dose-dependent relationship with the risk of PABSI. The ROC for developing PABSI according to catheter maintenance duration showed that the AUC was 0.715 (95% CI 0.639–0.790) and the optimal cut-off value was 25 days. Conclusion The incidence of PABSI was 1.14 per 1,000 catheter days and the optimal cut-off value of catheter-days for preventing PABSI was 25 days. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Seonghun Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seongdong-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Shinje Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seongdong-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seongdong-gu, Seoul-t’ukpyolsi, Republic of Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seongdong-gu, Seoul-t’ukpyolsi, Republic of Korea
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Seo MR, Kim B, Kim J, Pai H. Change in antimicrobial susceptibility and PCR ribotypes of Clostridioides difficile in a hospital over 5 years: Correlation analysis with antimicrobial consumption. Int J Antimicrob Agents 2019; 54:154-158. [DOI: 10.1016/j.ijantimicag.2019.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/11/2019] [Accepted: 05/25/2019] [Indexed: 01/05/2023]
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Kim B, Myung R, Lee MJ, Kim J, Pai H. Trend of antibiotics usage for acute pyelonephritis in Korea based on national health insurance data 2010-2014. BMC Infect Dis 2019; 19:554. [PMID: 31238896 PMCID: PMC6593604 DOI: 10.1186/s12879-019-4191-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this study is to describe the changes in prescribing practices of antibiotics to treat acute pyelonephritis (APN) in Korea. Methods The claim data base of the Health Insurance Review and Assessment Service in Korea was used to select patients with ICD-10 codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, not specified as acute nor chronic) as the primary discharge diagnosis during 2010–2014. Consumption of each class of antibiotics was converted to Defined Daily Dose (DDD)/event. Results Throughout the five-year period, the average antibiotic consumption were 11.3 DDD per inpatient event and 6.0 DDD per outpatient event. The annual average antibiotic consumption increased for inpatients (P = 0.002), but remained stable for outpatients (P = 0.066). The use of parenteral antibiotics increased for inpatients (P < 0.001), but decreased for outpatients (P = 0.017). As for the the antibiotic classes, 3rd generation cephalosporins (3rd CEPs) was the most commonly prescribed (41.4%) for inpatients, followed by fluoroquinolones (FQs) (28.5%); for outpatient, FQs (54.8%) was the most commonly prescribed, followed by 3rd CEPs (13.1%). The use of 3rd CEPs (P < 0.001), beta-lactam/beta-lactamase inhibitors (P = 0.007), and carbapenems (P < 0.001) increased substantially for the treatment of hospitalized APN patients. In particular, carbapenems use increased 3.1-fold over the 5 years. Conclusions Prescription of broad-spectrum antibiotics increased much for the treatment of APN in Korea during 2010–2014.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science & Economics, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Myoung-Jae Lee
- Department of Economics, College of Political Science & Economics, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Korea.
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.
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Olson R, Liu M, Bergman A, Lam S, Hsu F, Mou B, Berrang T, Mestrovic A, Chng N, Hyde D, Matthews Q, Lund C, Glick D, Pai H, Basran P, Carolan H, Valev B, Tyldesley S, Schellenberg D. EP-1616 Population-based Phase II Trial of Stereotactic Radiotherapy for up to 5 Oligometastases: SABR-5. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Acute pyelonephritis (APN) is one of the most common community-acquired bacterial infections. Recent increases of antimicrobial resistance in urinary pathogens might have changed the other epidemiologic characteristics of APN. The objective of this study was to describe the current epidemiology of APN in Korea, using the entire population. METHODS From the claims database of the Health Insurance Review and Assessment Service in Korea, the patients with International Classification of Diseases, 10th Revision codes N10 (acute tubulo-interstitial nephritis) or N12 (tubulo-interstitial nephritis, neither acute nor chronic) as the primary discharge diagnosis during 2010-2014 were analyzed, with two or more claims during a 14-day period considered as a single episode. RESULTS The annual incidence rate of APN per 10,000 persons was 39.1 and was on the increase year to year (35.6 in 2010; 36.7 in 2011; 38.9 in 2012; 40.1 in 2013; 43.8 in 2014, P = 0.004). The increasing trend was observed in both inpatients (P = 0.014) and outpatients (P = 0.004); in both men (P = 0.042) and women (P = 0.003); and those aged under 55 years (P = 0.014) and 55 years or higher (P = 0.003). Eleven times more women were diagnosed and treated with APN than men (men vs. women, 6.5 vs. 71.3), and one of every 4.1 patients was hospitalized (inpatients vs. outpatients, 9.6 vs. 29.4). The recurrence rate was 15.8%, and the median duration from a sporadic episode (i.e., no episode in the preceding 12 months) to the first recurrence was 44 days. The recurrence probability increased with the number of previous recurrences. The average medical cost per inpatient episode was USD 1,144, which was 12.9 times higher than that per outpatient episode (USD 89). CONCLUSION The epidemiology of APN in Korea has been changing with an increasing incidence rate.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science and Economics, Korea University, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Myoung-jae Lee
- Department of Economics, College of Political Science and Economics, Korea University, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Kim B, Kim Y, Hwang H, Kim J, Kim SW, Bae IG, Choi WS, Jung SI, Jeong HW, Pai H. Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012: A nationwide multicenter study. Medicine (Baltimore) 2018; 97:e13719. [PMID: 30572507 PMCID: PMC6320075 DOI: 10.1097/md.0000000000013719] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption.Data on total antibiotic prescriptions, patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad-spectrum antibiotics and carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin as antibiotics against multidrug-resistant (MDR) pathogens.A 15.1% decrease in total antibiotic consumption was observed in 2012 compared to that observed in 2004. In contrast, a 10.2% and 70.7% increase in broad-spectrum antibiotics and antibiotics against MDR pathogens were observed, respectively, in the same period. The resistance rate of Escherichia coli to 3rd CEPs (17.6% in 2004, 21.7% in 2008, and 33.8% in 2012, P <.001) and ciprofloxacin (37.5% in 2004, 38.7% in 2008, and 46.6% in 2012, P = .001) demonstrated a significantly increasing trend. Similarly, the resistance rate of Klebsiella pneumoniae to 3rd CEPs (34.3% in 2004, 33.7% in 2008, and 44.5% in 2012, P <.001) gradually increased. Resistance of Acinetobacter baumanii and Pseudomonas aeruginosa to imipenem significantly increased throughout the study period (A baumanii: 8.9% in 2004, 40.8% in 2008, and 65.3% in 2012, P <.001; P aeruginosa: 25.1% in 2004, 31.5% in 2008, and 29.7% in 2008, P = .050).The consumption of carbapenems and FQs demonstrated significant positive correlation for resistance of E coli or K pneumoniae to 3rd CEPs as well as E coli or K pneumoniae to ciprofloxacin. Increasing resistance of A baumanii to ciprofloxacin was significantly correlated with increasing consumption of FQs; increasing resistance of A baumanii to imipenem was significantly correlated with increasing consumption of carbapenems.In conclusion, overall antimicrobial resistance increased and consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens subsequently increased in Korean hospitals.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine
| | - Yeonjae Kim
- Department of Infectious Diseases, National Medical Center, Seoul
| | - Hyeonjun Hwang
- School of Economic Science, Washington State University, Pullman, WA
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine
| | - Shin-Woo Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu
| | - In-Gyu Bae
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Sook In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine
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Kim B, Choi YW, Pai H, Kim J. A Case of Human Immunodeficiency Virus -triggered Hemophagocytic Lymphohistocytosis Presenting with Severe Bleeding Tendency. Infect Chemother 2018; 53:802-807. [PMID: 31668025 PMCID: PMC8731258 DOI: 10.3947/ic.2018.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/27/2017] [Indexed: 11/24/2022] Open
Abstract
Human immunodeficiency virus (HIV) is one of the less common triggers of secondary hemophagocytic lymphohistiocytosis (HLH) in which coagulation disorder is a frequent manifestation. Here, we present a case of HIV-triggered secondary HLH presenting with severe bleeding tendency and fever. Despite high-dose dexamethasone infusion (10 mg/body surface area/day), progressive disseminated intravascular coagulation and thrombocytopenia resulted in massive hemathochezia: the bleeding episode ceased after endoscopic hemoclipping. After then, he took a highly-active antiretroviral therapy (HAART). Eventually, body temperature and overall laboratory findings normalized in response to HAART. Clinicians should not overlook HIV infection as a possible trigger of secondary HLH. In such cases, HAART is the core treatment.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yeon Woo Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Kim B, Moon S, Bae GR, Lee H, Pai H, Oh SH. Factors associated with severe neurologic complications in patients with either hand-foot-mouth disease or herpangina: A nationwide observational study in South Korea, 2009-2014. PLoS One 2018; 13:e0201726. [PMID: 30096160 PMCID: PMC6086402 DOI: 10.1371/journal.pone.0201726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 07/20/2018] [Indexed: 11/19/2022] Open
Abstract
Background In 2009, a nationwide sentinel surveillance for hand-foot-mouth disease (HFMD) and herpangina (HA) with neurologic complications was initiated in South Korea. We used this surveillance system to investigate the clinical characteristics of patients with either HFMD or HA with neurologic complications, with the aim of determining risk factors for severe neurologic complications. Methods A retrospective review of medical records was conducted on all cases of HFMD and HA with neurologic complications that were reported in the national system between April 1, 2009 and December 31, 2014. A severe case was defined as having HFMD or HA with encephalitis, polio-like syndrome, or cardiopulmonary failure, and less-severe cases were defined as having HFMD or HA with aseptic meningitis. Results A total of 138 cases (less-severe: 90/138, 65.2%; severe: 48/138, 24.8%) were included from 28 hospitals; 28 ineligible cases were excluded. Of 48 severe cases, 27 (56.2%) had encephalitis; 14 (29.2%) had polio-like syndrome; and seven (14.6%) had cardiopulmonary syndrome. The median patient age was 36 months (IQR: 18–60) and 63 (45.7%) patients were female. Most patients completely recovered, except for seven cases that were fatal or resulted in long-term symptoms (5.1%, 3 patients with neurologic sequelae and 4 deaths). In a multivariable logistic regression analysis, lethargy (OR = 4.67, 95% CI: 1.37–15.96, P = 0.014), female sex (OR = 3.51, 95% CI: 1.17–10.50, P = 0.025), and enterovirus A71 (OR = 3.55, 95% CI: 1.09–11.57, P = 0.035) were significantly associated with severe neurologic complications in HFMD and HA patients. Conclusion In patients with HFMD and HA, lethargy, female, and enterovirus A71 may predict severe neurologic complications.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
- Department of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, Cheongju, South Korea
| | - Shinje Moon
- Department of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, Cheongju, South Korea
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, South Korea
| | - Geun-Ryang Bae
- Department of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, Cheongju, South Korea
- National Radiation Emergency Medical Center, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Hyungmin Lee
- Department of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, Cheongju, South Korea
- Department of Healthcare Associated Infection Control, Korea Centers for Disease Control and Prevention, Osong, Cheongju, South Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Sung Hee Oh
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
- * E-mail:
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Kim B, Hwang H, Kim J, Lee MJ, Pai H. A few antibiotics can represent the total hospital antibiotic consumption. BMC Infect Dis 2018; 18:247. [PMID: 29855273 PMCID: PMC5984315 DOI: 10.1186/s12879-018-3132-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/04/2018] [Indexed: 12/26/2022] Open
Abstract
Background Appropriate antibiotic use has become an important issue. However, collecting data on the use of all antibiotics in a hospital is difficult without an advanced computerized system and dedicated staff. This paper examines if 1–3 antibiotics can satisfactorily represent the total antibiotic consumption at the hospital level. Methods We collected antibiotic data from six large university hospitals in Korea for some years between 2004 and 2012. Since the total antibiotics consist of a few chosen representative antibiotics and the rest, we used those chosen antibiotics along with additional variables constructed only with t (time) such as t, t2, and t3 to capture the time trend and whether t belongs to each month or not to capture the monthly variations. The ordinary least squares method was used to explain the total antibiotic amount with these variables, and then the estimated model was employed to predict the use for 2013. To determine which antibiotics were the most representative in tracking general trends in antibiotic use over time, we tried various combinations of antibiotics to find the combination that best minimized the 2013 prediction error. Results We found that fluoroquinolones and aminoglycosides were the most representative, followed by beta-lactam/beta-lactamase inhibitors and 4th-generation and 3rd-generation cephalosporins. The mean prediction error over 12 months in 2013 with these few antibiotics was only 1–3% of the monthly antibiotic consumption amount. Conclusions The total antibiotic consumption amount at the hospital level can be represented sufficiently by a few antibiotics, such as fluoroquinolones and aminoglycosides, which means that hospitals can save resources by tracing only the usage of those few antibiotics instead of the entire inventory. Since the choice of fluoroquinolones and aminoglycosides is based solely on our Korean data, other hospitals may follow the same modelling methodology to find their own representative antibiotics. Electronic supplementary material The online version of this article (10.1186/s12879-018-3132-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Hyeonjun Hwang
- School of Economic Sciences, Washington State University, Pullman, USA
| | - Jieun Kim
- Department of Internal medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Myoung-Jae Lee
- Department of Economics, College of Political Science & Economics, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul, 02841, South Korea.
| | - Hyunjoo Pai
- Department of Internal medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.
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Kim B, Kim J, Paik SS, Pai H. Atypical Presentation of Pneumocystis jirovecii Infection in HIV Infected Patients: Three Different Manifestations. J Korean Med Sci 2018; 33:e115. [PMID: 29629518 PMCID: PMC5890084 DOI: 10.3346/jkms.2018.33.e115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/08/2017] [Indexed: 12/04/2022] Open
Abstract
Advances in the treatment and prevention of Pneumocystis jirovecii infection (PJI) in human immunodeficiency virus (HIV) patients decreased incidence and mortality dramatically, however, it may be associated with an increased frequency of unusual manifestation such as cystic formation, pneumothorax, focal infiltration, nodular formation, or extrapulmonary lesions. We report three cases of PJI with atypical manifestations. Each case demonstrates different clinical features: multiple nodular pulmonary lesion (32-year-old man with abnormal chest X-ray finding), subpleural mass-like lesion (43-year-old man with left visual loss and right pleuritic chest pain), and extrapulmonary mass-like lesions in the liver, lymph nodes, and small bowel (39-year-old man with cough, sputum, and dyspnea). P. jirovecii was confirmed in all 3 cases and they were treated well. It is necessary to understand that PJI shows variable clinical features.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Sam Paik
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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Kim Y, Pai H. Reply: Is Taking Blood Cultures Indicated in Acute Pyelonephritis Patients Who Have Used Antibiotics before Presentation? Infect Chemother 2018; 50:50. [PMID: 29637754 PMCID: PMC5895832 DOI: 10.3947/ic.2018.50.1.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yeonjae Kim
- Center for Infectious Disease, National Medical Center, Seoul, Korea
| | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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Kim B, Pai H, Choi WS, Kim Y, Kweon KT, Kim HA, Ryu SY, Wie SH, Kim J. Current status of indwelling urinary catheter utilization and catheter-associated urinary tract infection throughout hospital wards in Korea: A multicenter prospective observational study. PLoS One 2017; 12:e0185369. [PMID: 28991927 PMCID: PMC5633151 DOI: 10.1371/journal.pone.0185369] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022] Open
Abstract
To evaluate the frequency and appropriateness of indwelling urinary catheters (IUC) use and the incidence of catheter-associated urinary tract infections (CA-UTI), and explore the risk factors for CA-UTI in hospitals as a whole, we conducted a study. This study was divided into two parts; a point-prevalence study on Dec 12th 2012 and a prospective cohort study from Dec 13th 2012 to Jan 9th 2013 were performed in six hospitals in Korea. All hospitalized patients with newly-placed IUCs were enrolled and monitored weekly for 28 days after IUC placement. In the point-prevalence study, the IUCs were present in median 14.9/100 hospitalized patients (1Q 14, 3Q 16) across the six hospitals. In the prospective cohort study, the median IUC-days per patient was 5 (1Q 3, 3Q 10) and the median CA-UTI prevalence per 1,000 catheter days was 1.9 (1Q 0.7, 3Q 3.8) with significant inter-hospital variation. The proportion of patients with inappropriate IUC maintenance increased with number of IUC-days (8.5% on day 7, 9.4% on day 14, 16.3% on day 21, and 23.1% on day 28). Urinary output monitoring (23/36, 63.9%) was the most common indication for inappropriate use after 1 week of ICU placement. In multivariate analysis, IUC-days was significantly associated with the development of CA-UTI (odds ratio 1.122, 95% confidence interval 1.074–1.173, P< 0.001). IUC-days and CA-UTI rates vary between hospitals. IUC-days is a risk factor for CA-UTI, and is correlated with inappropriate use.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Won Suk Choi
- Department of Internal Medicine, Korea University College of Medicine, Ansan, Korea
| | - Yeonjae Kim
- Department of Infectious Disease, National Medical Center, Seoul, Korea
| | - Ki Tae Kweon
- Department of Infectious Disease, Patima Hospital, Daegu, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Gyemyeong University College of Medicine, Daegu, Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Gyemyeong University College of Medicine, Daegu, Korea
| | - Seong-heon Wie
- Department of Internal Medicine, St. Vincent Hospital, Suwon, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- * E-mail:
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Kim B, Hwang H, Lee MJ, Kim J, Pai H. Changing Pattern of Antibiotics Usage Among Hospitalized Patients of a Tertiary Hospital in South Korea: 2004–2013. Open Forum Infect Dis 2017. [PMCID: PMC5631357 DOI: 10.1093/ofid/ofx163.772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This study was performed to evaluate the changing pattern of antibiotics usage among hospitalized patients of tertiary hospital in South Korea. Methods Total antibiotics prescription record of hospitalized patients from 2004 to 2013 were collected at a tertiary university hospitals. The antibiotics is defined as class J01 from anatomical therapeutic chemical classification system (ATC). The consumption of each class of antibiotic was converted to defined daily dose (DDD)/1,000 patient-days by using ATC of World Health Organization. Results Over the 10-year study period, the annual consumption of systemic antibiotics ranged from 815.10 to 1047.96. The proportion of broad-spectrum antibiotics and non-broad-spectrum antibiotics use are as follows: 45.4% (417.55/920.69) vs.. 54.6% (503.15/920.69), respectively. A 16.9% of decrease in total antibiotics consumption was observed in 2013 compared with 2004 (1000.69 in 2004 vs.. 831.46 in 2013). The decrease rate of non-broad spectrum antibiotics usage was 39.3% during the study period (607.21 in 2004 vs. 368.88 in 2013). In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed (14.9% of increase; 393.48 in 2004 vs. 462.58 in 2013). Among broad-spectrum antibiotics, a significant decrease trend was observed for third-generation cephaloporins (P < 0.001). In contrast, a significant increase trend was observed for β-lactam/lactamase (P < 0.001). The monthly overall consumption trend of fluoroquinolones and glycopeptides remained stable (P = 0.061; P = 0.107, respectively). In addition, there were significant decrease trends for consumption of non-broad-spectrum antibiotics, including first generation cephalosporins (P = 0.019) and aminoglycosides (P = 0.004). However, the consumption of second generation cephalosporins, imidazole and penicillins showed a stable trend (P = 0.175; P = 320; P = 0.234, respectively). Conclusion A total antibiotics consumption showed significantly decrease trend from 2004 to 2013. In contrast, a stepwise increase in consumption of broad-spectrum antibiotics was observed in the tertiary hospital in South Korea. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Bongyoung Kim
- Infecious Diseases, Eulji University College of Medicine, Daejeon, Korea, Republic of (South)
| | | | - Myoung-Jae Lee
- Department of Economics, Korea University College of Political Science and Economics, Seoul, Korea, Republic of (South)
| | - Jieun Kim
- Division of Infectious Diseases, Hanyang University Hospital, Seoul, Korea, Republic of (South)
| | - Hyunjoo Pai
- Infectious Diseases, Hanyang University college of medicine, Seoul, Korea, Republic of (South)
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Hong KH, Choi JP, Hong SH, Lee J, Kwon JS, Kim SM, Park SY, Rhee JY, Kim BN, Choi HJ, Shin EC, Pai H, Park SH, Kim SH. Predictors of mortality in Middle East respiratory syndrome (MERS). Thorax 2017; 73:286-289. [PMID: 28724637 DOI: 10.1136/thoraxjnl-2016-209313] [Citation(s) in RCA: 228] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 05/10/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022]
Abstract
We evaluated the clinical characteristics, cytokine/chemokine concentrations, viral shedding and antibody kinetics in 30 patients with Middle East respiratory syndrome (MERS), including 6 non-survivors admitted to 3 MERS-designated hospitals. Old age, low albumin, altered mentality and high pneumonia severity index score at admission were risk factors for mortality. In addition, severe signs of inflammation at initial presentation (at hospital days 1-4), such as high inducible protein-10 (p=0.0013), monocyte chemoattractant protein-1 (p=0.0007) and interleukin 6 (p=0.0007) concentrations, and poor viral control (high viral load at hospital days 5-10, p<0.001) without adequate antibody titres (low antibody titre at hospital days 11-16, p=0.07) during the course of disease, were associated with mortality.
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Affiliation(s)
- Ki-Ho Hong
- Department of Laboratory Medicine, Seoul Medical Center, Seoul, Republic of Korea
| | - Jae-Phil Choi
- Department of Internal Medicine, Seoul Medical Center, Seoul, Republic of Korea
| | - Seon-Hui Hong
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jeewon Lee
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Ji-Soo Kwon
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun-Mi Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Young Rhee
- Division of Infectious Diseases, Department of Internal Medicine, Dankook University Hospital, Cheonan, Republic of Korea
| | - Baek-Nam Kim
- Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Rebulic of Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University Hospital, Seoul, Republic of Korea
| | - Eui-Cheol Shin
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Han Yang University Hospital, Seoul, Republic of Korea
| | - Su-Hyung Park
- Biomedical Science and Engineering Interdisciplinary Program, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tyldesley S, Parimi S, Tsang E, Bachand F, Aparicio M, Duncan G, Sunderland K, Olson R, Pai H, Alexander A, Lapointe V, Chi K. EP-1359: Pain response in a Population-based study of Radium-223 for Metastatic Prostate Cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jieun Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hye-seon Kim
- Department of Thoracic and Cardiovascular Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Kim Y, Seo MR, Kim SJ, Kim J, Wie SH, Cho YK, Lim SK, Lee JS, Kwon KT, Lee H, Cheong HJ, Park DW, Ryu SY, Chung MH, Pai H. Usefulness of Blood Cultures and Radiologic Imaging Studies in the Management of Patients with Community-Acquired Acute Pyelonephritis. Infect Chemother 2017; 49:22-30. [PMID: 28271650 PMCID: PMC5382046 DOI: 10.3947/ic.2017.49.1.22] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/24/2017] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to examine the usefulness of blood cultures and radiologic imaging studies for developing therapeutic strategies in community-acquired acute pyelonephritis (CA-APN) patients. Materials and Methods We prospectively collected the clinical data of CA-APN patients who visited 11 hospitals from March 2010 to February 2011. Results Positive urine and blood cultures were obtained in 69.3% (568/820) and 42.7% (277/648), respectively, of a total of 827 CA-APN patients. Blood culture identified the urinary pathogen in 60 of 645 (9.3%) patients for whom both urine and blood cultures were performed; the organisms isolated from urine were inconsistent with those from blood in 11 and only blood cultures were positive in 49 patients. Final clinical failure was more common in the bacteremic patients than the non-bacteremic ones (8.0% vs. 2.7%, P = 0.003), as was hospital mortality (3.6% vs. 0.3%, P = 0.003). Likewise, durations of hospitalization and fever were significantly longer. Bacteremia was independent risk factor for mortality (OR 9.290, 1.145-75.392, P = 0.037). With regard to radiologic studies, the detection rate of APN was 84.4% (445/527) by abdominal computed tomography and 40% (72/180) by abdominal ultrasonography. Eighty-one of 683 patients (11.9%) were found to have renal abscess, perinephric abscess, urolithiasis, hydronephorosis/hydroureter or emphysematous cystitis, which could potentially impact on clinical management. Patients with Pitt score ≥ 1, flank pain or azotemia were significantly more likely to have such structural abnormalities. Conclusion Blood cultures are clinically useful for diagnosis of CA-APN, and bacteremia is predictive factor for hospital mortality. Early radiologic imaging studies should be considered for CA-APN patients with Pitt scores ≥1, flank pain or azotemia.
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Affiliation(s)
- Yeonjae Kim
- Center for Infectious Disease, National Medical Center, Seoul, Korea
| | - Mi Ran Seo
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Seong Jong Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Seong Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong Kyun Cho
- Department of Internal Medicine, Gil Hospital, Gacheon University, Incheon, Korea
| | - Seung Kwan Lim
- Department of Internal Medicine, Ajou University Hospital, Suwon, Korea
| | - Jin Seo Lee
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyuck Lee
- Department of Internal Medicine, Dong-A University Hospital, Busan, Korea
| | - Hee Jin Cheong
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dae Won Park
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong Yeol Ryu
- Department of Internal Medicine, Gyemyeong University Hospital, Daegu, Korea
| | - Moon Hyun Chung
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Hyunjoo Pai
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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Kim B, Pai H, Lee KH, Lee Y. Identification of Pasteurella canis in a Soft Tissue Infection Caused by a Dog Bite: The First Report in Korea. Ann Lab Med 2017; 36:617-9. [PMID: 27578520 PMCID: PMC5011120 DOI: 10.3343/alm.2016.36.6.617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/24/2016] [Accepted: 06/17/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, Hanyang University of College of Medicine, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, Hanyang University of College of Medicine, Seoul, Korea
| | - Kwang Hyun Lee
- Department of Orthopediatrics, Hanyang University of College of Medicine, Seoul, Korea
| | - Yangsoon Lee
- Department of Laboratory Medicine, Hanyang University of College of Medicine, Seoul, Korea.
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Kim J, Kim Y, Pai H. Clinical Characteristics and Treatment Outcomes of Clostridium difficile Infections by PCR Ribotype 017 and 018 Strains. PLoS One 2016; 11:e0168849. [PMID: 28002482 PMCID: PMC5176314 DOI: 10.1371/journal.pone.0168849] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/07/2016] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to identify the clinical characteristics of Clostridium difficile infections (CDIs) caused by toxin A-negative/toxin B-positive (A-B+) PCR ribotype 017 (R017) and A+B+ ribotype 018 (R018) strains, prevalent in Asian countries. From February 2010 through January 2013, all CDI patients in our hospital were enrolled; their medical records were retrospectively reviewed, and the isolates were characterized by toxigenic culture and PCR ribotyping. Based on the ribotypes, a total of 510 cases were categorized as R017 (139, 27.3%), R018 (157, 30.8%) and other ribotypes groups (214, 42.0%), and clinical variables were compared between R017 and other ribotypes, R018 and other ribotypes and R018 and R017 groups. The patients with R017 infections had a higher mean Charlson's comorbidity index (OR 1.1, 1-1.21, p = 0.05), lower serum albumin (OR 0.47, 0.31-0.73, p = 0.001) and lower CRP levels (OR 0.96, 0.92-0.99, p = 0.022) than those with other ribotypes. R018 infections caused more azotemia (OR 4.06, 1.28-12.91, p = 0.018) and more frequent severe CDI (OR 1.87, 1.12-3.13, p = 0.016) than the other ribotypes infections. R017 and R018 infections were more often associated with toxin positive stools (OR 2.94, 1.65-4.09, p<0.001; OR 4.55, 2.82-7.33, p<0.001). In terms of treatment outcomes, R017 infections caused a marginally higher 30-day mortality than other ribotypes infection. In a final multiple logistic regression model, 30-day mortality was associated with leukocytosis (OR 2.45, 1.0-6.01, p = 0.05) and hypoalbuminemia (OR 4.57, 1.83-11.39, p = 0.001), but only marginally with R017 infection (OR 2.14, 0.88-5.22, p = 0.094). In conclusion, infections by C. difficile R018 strains tend to cause more severe disease, while there was a trend for higher mortality with R017 infections.
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Affiliation(s)
- Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Yeonjae Kim
- Center for Infectious Diseases, National Medical Center, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
- * E-mail:
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