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Park S, Choi J, Lee Y, Noh J, Kim N, Lee J, Cho G, Kim S, Yoo DK, Kang CK, Choe PG, Kim NJ, Park WB, Kim S, Oh MD, Kwon S, Chung J. An ancestral SARS-CoV-2 vaccine induces anti-Omicron variants antibodies by hypermutation. Nat Commun 2024; 15:3368. [PMID: 38643233 PMCID: PMC11032360 DOI: 10.1038/s41467-024-47743-1] [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: 10/06/2023] [Accepted: 04/10/2024] [Indexed: 04/22/2024] Open
Abstract
The immune escape of Omicron variants significantly subsides by the third dose of an mRNA vaccine. However, it is unclear how Omicron variant-neutralizing antibodies develop under repeated vaccination. We analyze blood samples from 41 BNT162b2 vaccinees following the course of three injections and analyze their B-cell receptor (BCR) repertoires at six time points in total. The concomitant reactivity to both ancestral and Omicron receptor-binding domain (RBD) is achieved by a limited number of BCR clonotypes depending on the accumulation of somatic hypermutation (SHM) after the third dose. Our findings suggest that SHM accumulation in the BCR space to broaden its specificity for unseen antigens is a counterprotective mechanism against virus variant immune escape.
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Affiliation(s)
- Seoryeong Park
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaewon Choi
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
- Integrated Major in Innovative Medical Science, Seoul National University, Seoul, Republic of Korea
| | - Yonghee Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jinsung Noh
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
- Bio-MAX Institute, Seoul National University, Seoul, Republic of Korea
| | - Namphil Kim
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - JinAh Lee
- Zoonotic Virus Laboratory, Institut Pasteur Korea, Seongnam, Republic of Korea
| | - Geummi Cho
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sujeong Kim
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Duck Kyun Yoo
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seungtaek Kim
- Zoonotic Virus Laboratory, Institut Pasteur Korea, Seongnam, Republic of Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Sunghoon Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea.
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea.
- Bio-MAX Institute, Seoul National University, Seoul, Republic of Korea.
| | - Junho Chung
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Lee M, Lee CM, Byun JM, Shin DY, Koh Y, Hong J, Choe PG, Park WB, Kim NJ, Yoon SS, Oh MD, Kang CK, Kim I. Risk factors for resistant gram-positive bacteremia in febrile neutropenic patients with cancer. J Infect Chemother 2024:S1341-321X(24)00097-7. [PMID: 38518846 DOI: 10.1016/j.jiac.2024.03.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Gram-positive bacteria are frequently resistant to empirical beta-lactams in febrile neutropenic patients with cancer. As microbiology and antibiotic susceptibility changes, we reevaluated the risk factors for resistant Gram-positive bacteremia in febrile neutropenic patients with cancer. METHODS Episodes of bacteremic febrile neutropenia in Seoul National University Hospital from July 2019 to June 2022 were reviewed. Resistant Gram-positive bacteria were defined as a pathogen susceptible only to glycopeptide or linezolid in vitro (e.g., methicillin-resistant staphylococci, penicillin-resistant viridans streptococci, and ampicillin-resistant enterococci). Episodes were compared to identify independent risk factors for resistant Gram-positive bacteremia. RESULTS Of 225 episodes, 78 (34.7%) involved resistant Gram-positive bacteremia. Multivariate analysis revealed that breakthrough bacteremia while being administered antibiotics (adjusted odds ratio [aOR], 6.794; 95% confidence interval [95% CI], 3.130-14.749; P < 0.001) and catheter-related infection (aOR 4.039, 95% CI 1.366-11.946; P = 0.012) were associated with resistant Gram-positive bacteremia. Chronic liver disease (aOR 0.231, 95% CI 0.059-0.905; P = 0.035) and hypotension at bacteremia (aOR 0.454, 95% CI 0.218-0.945; P = 0.035) were inversely associated with resistant Gram-positive bacteremia. CONCLUSIONS Resistant Gram-positive bacteria should be considered in breakthrough bacteremia and catheter-related infection in febrile neutropenic patients with cancer.
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Affiliation(s)
- Minkyeong Lee
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Huh K, Lee SO, Kim J, Lee SJ, Choe PG, Kang JM, Yang J, Sung H, Kim SH, Moon C, Seok H, Shi HJ, Wi YM, Jeong SJ, Park WB, Kim YJ, Kim J, Ahn HJ, Kim NJ, Peck KR, Kim MS, Kim SI. Prevention of Cytomegalovirus Infection in Solid Organ Transplant Recipients: Guidelines by the Korean Society of Infectious Diseases and the Korean Society for Transplantation. Infect Chemother 2024; 56:101-121. [PMID: 38527780 PMCID: PMC10990892 DOI: 10.3947/ic.2024.0016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
Cytomegalovirus (CMV) is the most important opportunistic viral pathogen in solid organ transplant (SOT) recipients. The Korean guideline for the prevention of CMV infection in SOT recipients was developed jointly by the Korean Society for Infectious Diseases and the Korean Society of Transplantation. CMV serostatus of both donors and recipients should be screened before transplantation to best assess the risk of CMV infection after SOT. Seronegative recipients receiving organs from seropositive donors face the highest risk, followed by seropositive recipients. Either antiviral prophylaxis or preemptive therapy can be used to prevent CMV infection. While both strategies have been demonstrated to prevent CMV infection post-transplant, each has its own advantages and disadvantages. CMV serostatus, transplant organ, other risk factors, and practical issues should be considered for the selection of preventive measures. There is no universal viral load threshold to guide treatment in preemptive therapy. Each institution should define and validate its own threshold. Valganciclovir is the favored agent for both prophylaxis and preemptive therapy. The evaluation of CMV-specific cell-mediated immunity and the monitoring of viral load kinetics are gaining interest, but there was insufficient evidence to issue recommendations. Specific considerations on pediatric transplant recipients are included.
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Affiliation(s)
- Kyungmin Huh
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jungok Kim
- Division of Infectious Diseases, Department of Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Su Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeseok Yang
- Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, College of Medicine, Busan, Korea
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University Medicine, Ansan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Su Jin Jeong
- Division of Infectious Diseases, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Joon Ahn
- Department of Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Department of Surgery, The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee CM, Kim M, Park SW, Kang CK, Choe PG, Kim NJ, Jo HJ, Shin HM, Lee CH, Kim HR, Park WB, Oh MD. Clinical outcomes and immunological features of COVID-19 patients receiving B-cell depletion therapy during the Omicron era. Infect Dis (Lond) 2024; 56:116-127. [PMID: 37916860 DOI: 10.1080/23744235.2023.2276784] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023] Open
Abstract
Background: The clinical outcomes and immunological features of coronavirus disease 2019 (COVID-19) patients receiving B-cell depletion therapy (BCDT), especially in Omicron variant era, have not been fully elucidated. We aimed to investigate the outcomes and immune responses of COVID-19 patients receiving BCDT during the Omicron period.Methods: We retrospectively compared clinical outcomes between COVID-19 patients treated with BCDT (the BCDT group) and those with the same underlying diseases not treated with BCDT (the non-BCDT group). For immunological analyses, we prospectively enrolled COVID-19 patients receiving BCDT and immunocompetent COVID-19 patients as controls. We measured humoral and cellular immune responses using the enzyme-linked immunosorbent assay and flow cytometry.Results: Severe to critical COVID-19 was more frequent in the BCDT group than in the non-BCDT group (41.9% vs. 28.3%, p = .030). BCDT was an independent risk factor for severe to critical COVID-19 (adjusted odds ratio [aOR] 2.21, 95% confidence interval [CI] 1.21-4.04, p = .010) as well as for COVID-19-related mortality (aOR 4.03, 95% CI 1.17-13.86, p = .027). Immunological analyses revealed that patients receiving BCDT had lower anti-S1 IgG titres and a tendency to higher proportions of activated CD4+ T-cells than the controls.Conclusions: BCDT was associated with worse COVID-19 outcomes in the Omicron period. Humoral immune response impairment and T-cell hyperactivation were the main immunological features of COVID-19 patients treated with BCDT, which may have contributed to the worse outcomes of COVID-19 in this population.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Jae Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Park JH, Kim TS, Jo HJ, Lee CM, Lee M, Kang CK, Choe PG, Park WB, Kim NJ. Reduction of blood culture contamination rates through simplified personal protective equipment in COVID-19 patient care setting. J Hosp Infect 2024:S0195-6701(24)00033-1. [PMID: 38309667 DOI: 10.1016/j.jhin.2024.01.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Affiliation(s)
- J H Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - T S Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - H J Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - C M Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - M Lee
- Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - P G Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea.
| | - W B Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - N J Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Infection Control Office, Seoul National University Hospital, Seoul, Republic of Korea
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Lee SH, Hur HJ, Kim SN, Ahn JH, Ro DH, Hong A, Park HY, Choe PG, Kim B, Park HY. Predicting delirium and the effects of medications in hospitalized COVID-19 patients using machine learning: A retrospective study within the Korean Multidisciplinary Cohort for Delirium Prevention (KoMCoDe). Digit Health 2024; 10:20552076231223811. [PMID: 38188862 PMCID: PMC10771056 DOI: 10.1177/20552076231223811] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Delirium is commonly reported from the inpatients with Coronavirus disease 2019 (COVID-19) infection. As delirium is closely associated with adverse clinical outcomes, prediction and prevention of delirium is critical. We developed a machine learning (ML) model to predict delirium in hospitalized patients with COVID-19 and to identify modifiable factors to prevent delirium. Methods The data set (n = 878) from four medical centers was constructed. Total of 78 predictors were included such as demographic characteristics, vital signs, laboratory results and medication, and the primary outcome was delirium occurrence during hospitalization. For analysis, the extreme gradient boosting (XGBoost) algorithm was applied, and the most influential factors were selected by recursive feature elimination. Among the indicators of performance for ML model, the area under the curve of the receiver operating characteristic (AUROC) curve was selected as the evaluation metric. Results Regarding the performance of developed delirium prediction model, the accuracy, precision, recall, F1 score, and the AUROC were calculated (0.944, 0.581, 0.421, 0.485, 0.873, respectively). The influential factors of delirium in this model included were mechanical ventilation, medication (antipsychotics, sedatives, ambroxol, piperacillin/tazobactam, acetaminophen, ceftriaxone, and propacetamol), and sodium ion concentration (all p < 0.05). Conclusions We developed and internally validated an ML model to predict delirium in COVID-19 inpatients. The model identified modifiable factors associated with the development of delirium and could be clinically useful for the prediction and prevention of delirium in COVID-19 inpatients.
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Affiliation(s)
- So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul,
South Korea
| | - Hyun Jung Hur
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung Nyun Kim
- Department of Psychiatry, Seoul Medical Center, Seoul, South Korea
| | - Jang Ho Ahn
- Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Arum Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam,
South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Back Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Youn Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
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Sulmonte CJ, Flinn JB, Yusuf H, Martin E, Luciano NJ, Kim H, Choe PG, Das A, Garibaldi BT, Hynes NA. Preparing the Frontlines: Delivering Special Pathogen Training to Maryland Hospital Staff. Health Secur 2024; 22:65-73. [PMID: 38241511 DOI: 10.1089/hs.2023.0035] [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] [Indexed: 01/21/2024] Open
Abstract
Healthcare workers (HCWs) at community hospitals, also known as frontline hospitals (FLHs), may encounter patients with possible infectious diseases, including those caused by high-consequence pathogens such as Zaire ebolavirus. We created and piloted a 1-day, in-person, didactic and skills training program to determine the feasibility and acceptability of implementing an educational program to enhance the knowledge and skills needed to respond when a patient with a potential high-consequence pathogen presents to an FLH. The Maryland Department of Health queried all 104 state FLHs to identify their interest in participating in the pilot training program. HCWs from 12 (75%) of the 16 interested FLHs participated in the program before it was interrupted by the COVID-19 pandemic. In addition to pathogen-specific training based on the Identify, Isolate, and Inform framework, we provided skills training in the proper use of personal protective equipment, spill cleanup, and removal of an incapacitated HCW from an isolation area. We conducted a paired pretraining and posttraining knowledge assessment and measured a significant learning gain among 135 participants (2-tailed t test, P<.05). Over 95% of the participants reported that the training was relevant to their daily work and the clinical simulations and reference material were useful and appropriate for their learning level. Findings from this pilot program demonstrated the feasibility and acceptability of a 1-day combined didactic and skills training program focused on high-consequence pathogens. We plan to reengage the original FLHs and add regional FLHs in an updated training effort based on our findings.
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Affiliation(s)
- Christopher J Sulmonte
- Christopher J. Sulmonte Jr, MHA, is Administrative Director of Biocontainment, Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Jade B Flinn
- Jade B. Flinn, MSN, RN, is Unit Director, Biocontainment Unit; Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD
| | - Hasiya Yusuf
- Hasiya Yusuf, MD, MPH, is a Resident, Department of Internal Medicine, Jacobi Medical Center, Bronx, NY, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Elena Martin
- Elena Martin, MPH, is a Medical Student, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Nicholas J Luciano
- Nicholas J. Luciano, MPH, is a Medical Student, Tulane University School of Medicine, New Orleans, LA, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Hyungwoo Kim
- Hyungwoo Kim, MD, MPH, is Global Medical Director, Early Pipeline Vaccines, Rockville Center for Vaccines Research, Rockville, MD, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Pyoeng Gyun Choe
- Pyoeng Gyun Choe, MD, PhD, MPH, is a Professor, Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Asar Das
- Asar Das, MD, MPH, is a Resident Physician, MercyOne Northeast Iowa Family Medicine and Residency, Waterloo, IA, MPH Students at the Johns Hopkins Bloomberg School of Public Health when the research described was carried out
| | - Brian T Garibaldi
- Brian T. Garibaldi, MD, is an Associate Professor, Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Noreen A Hynes
- Noreen A. Hynes, MD, MPH, is an Associate Professor, Division of Infectious Diseases; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Lee CM, Choe PG, Kang CK, Jo HJ, Kim NJ, Yoon SS, Kim TM, Park WB, Oh MD. Impact of T-Cell Engagers on COVID-19-Related Mortality in B-Cell Lymphoma Patients Receiving B-Cell Depleting Therapy. Cancer Res Treat 2024; 56:324-333. [PMID: 37448122 PMCID: PMC10789957 DOI: 10.4143/crt.2023.738] [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: 06/08/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE B-cell depleting therapies, including T-cell engager (TCE), are increasingly used for patients with hematologic malignancies, including during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to evaluate the relationship between TCE therapy and COVID-19-related outcomes among patients with COVID-19 and B-cell lymphomas receiving B-cell depleting therapy. MATERIALS AND METHODS This retrospective cohort study included patients with B-cell lymphoma, who were admitted to Seoul Natio-nal University Hospital with COVID-19 between September 2021 and February 2023, and received B-cell depleting therapy before COVID-19 diagnosis. Multivariable logistic regression was used to identify factors associated with severe to critical COVID-19 and COVID-19-related mortality. RESULTS Of 54 patients with B-cell lymphomas and COVID-19 who received B-cell depleting therapy, 14 were treated with TCE (TCE group) and 40 with rituximab (RTX group). COVID-19-related mortality was higher in the TCE group than in the RTX group (57.1% vs. 12.5%, p=0.002). In multivariable analyses, TCE therapy (adjusted odds ratio [aOR], 7.08; 95% confidence interval [CI], 1.29 to 38.76; p=0.024) and older age (aOR, 1.06; 95% CI, 1.00 to 1.13; p=0.035) were associated with severe to critical COVID-19. TCE therapy (aOR, 8.98; 95% CI, 1.48 to 54.40; p=0.017), older age (aOR, 1.13; 95% CI, 1.02 to 1.26; p=0.022), and prior bendamustine therapy (aOR, 7.78; 95% CI, 1.17 to 51.65; p=0.034) were independent risk factors for COVID-19-related mortality. CONCLUSION B-cell lymphoma patients treated with TCE had significantly worse outcomes from COVID-19 than those treated with RTX. TCE therapy should be used with caution in B-cell lymphoma patients during the COVID-19 epidemic.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyeon Jae Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Seoul National University Cancer Research Institute, Seoul,
Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
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9
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Lee M, Park WB, Kim ES, Kim Y, Park SW, Lee E, Oh MD, Kim NJ, Kim HB, Song KH, Choe PG, Kang CK, Lee CM, Choi Y, Moon SM, Choi SJ, Jeon J, Bang J. Possibility of Decreasing Incidence of Human Immunodeficiency Virus Infection in Korea. Infect Chemother 2023; 55:451-459. [PMID: 37674340 PMCID: PMC10771950 DOI: 10.3947/ic.2023.0056] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/16/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The number of newly diagnosed cases of human immunodeficiency virus (HIV) infection in Korea, which had increased until 2019, has markedly decreased since the coronavirus disease 2019 pandemic started. This study evaluated whether the decrease is due to a reduction in the incidence of HIV infection and/or delayed diagnosis during the pandemic. MATERIALS AND METHODS We reviewed the medical records of 587 newly diagnosed patients with HIV infection between February 2018 and January 2022 from four general hospitals, and their characteristics were compared between the pre-pandemic and pandemic periods. The lapse time from infection to diagnosis was estimated using an HIV modeling tool. RESULTS The estimated mean times to diagnosis were 5.68 years (95% confidence interval [CI]: 4.45 - 6.51 years) and 5.41 years (95% CI: 4.09 - 7.03 years) before and during the pandemic, respectively (P = 0.016). The proportion of patients with acquired immunodeficiency syndrome-defining illnesses, expected to visit hospitals regardless of the pandemic, decreased from 17.2% before the pandemic to 11.9% during the pandemic (P = 0.086). CONCLUSION The decrease in the number of newly diagnosed cases of HIV infection in Korea might have resulted from an actual decrease in the incidence of HIV infection rather than a worsening of underdiagnosis or delayed diagnosis.
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Affiliation(s)
- Minkyeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yeonjae Kim
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yunsang Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jaehyun Jeon
- Department of Internal Medicine, National Medical Center, Seoul, Korea.
| | - Jihwan Bang
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
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10
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Kim IS, Kang CK, Lee SJ, Lee CH, Kim M, Seo C, Kim G, Lee S, Park KS, Chang E, Jung J, Song KH, Choe PG, Park WB, Kim ES, Bin Kim H, Kim NJ, Oh MD, Lee JE, Shin HM, Kim HR. Tracking antigen-specific TCR clonotypes in SARS-CoV-2 infection reveals distinct severity trajectories. J Med Virol 2023; 95:e29199. [PMID: 37916645 DOI: 10.1002/jmv.29199] [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: 05/22/2023] [Revised: 09/13/2023] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
Despite the importance of antigen-specific T cells in infectious disease, characterizing and tracking clonally amplified T cells during the progression of a patient's symptoms remain unclear. Here, we performed a longitudinal, in-depth single-cell multiomics analysis of samples from asymptomatic, mild, usual severe, and delayed severe patients of SARS-CoV-2 infection. Our in-depth analysis revealed that hyperactive or improper T-cell responses were more aggressive in delayed severe patients. Interestingly, tracking of antigen-specific T-cell receptor (TCR) clonotypes along the developmental trajectory indicated an attenuation in functional T cells upon severity. In addition, increased glycolysis and interleukin-6 signaling in the cytotoxic T cells were markedly distinct in delayed severe patients compared to usual severe patients, particularly in the middle and late stages of infection. Tracking B-cell receptor clonotypes also revealed distinct transitions and somatic hypermutations within B cells across different levels of disease severity. Our results suggest that single-cell TCR clonotype tracking can distinguish the severity of patients through immunological hallmarks, leading to a better understanding of the severity differences in and improving the management of infectious diseases by analyzing the dynamics of immune responses over time.
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Affiliation(s)
- Ik Soo Kim
- Department of Microbiology, Gachon University College of Medicine, Incheon, South Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Gwanghun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Soojin Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyoung Sun Park
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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11
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Oh JK, Jung J, Lee SA, Lee S, Lee EJ, Chang E, Kang CK, Choe PG, Kim YJ, Kim NJ, Song JM, Kang DH, Song JK, Oh MD, Park WB, Kim DH. Impact of routine brain imaging on the prognosis of patients with left-sided valve infective endocarditis without neurological manifestations. Int J Cardiol 2023; 389:131175. [PMID: 37442351 DOI: 10.1016/j.ijcard.2023.131175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE). METHODS Among patients diagnosed with possible or definite IE in two tertiary referral centers between January 2005 and March 2019, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All-cause mortality at 3 months, attributable mortality (defined as death directly related to IE), and fatal neurological events compared after adjustment using inverse probability of treatment weighting (IPTW). RESULTS During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24-1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25-1.42). The risks of attributable mortality and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (> 10 mm) or acute-onset microorganisms. CONCLUSIONS Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings could improve clinical outcomes.
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Affiliation(s)
- Jin Kyung Oh
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Jongtak Jung
- Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyoung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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12
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Oh SM, Byun JM, Lee CM, Kang CK, Shin DY, Koh Y, Hong J, Choe PG, Park WB, Kim NJ, Yoon SS, Kim I, Oh MD. Empirical vs pre-emptive broad-spectrum antifungal therapy for acute myelogenous leukaemia in the era of antimould prophylaxis. Int J Antimicrob Agents 2023; 62:106954. [PMID: 37595849 DOI: 10.1016/j.ijantimicag.2023.106954] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION This study compared clinical outcomes in patients with acute myelogenous leukaemia (AML) who developed prolonged (≥4 days) febrile neutropenia (FN) and received either empirical or pre-emptive antimould prophylaxis in order to evaluate the need for routine empirical antifungal therapy. METHODS This retrospective study reviewed adult patients (aged ≥18 years) with AML who developed prolonged FN and received antimould prophylaxis during induction or re-induction chemotherapy at a single centre between September 2016 and December 2020. Patients were categorized into pre-emptive or empirical groups based on whether or not there was clinical evidence of invasive fungal infection (IFI) at the start of antifungal treatment, respectively. Clinical outcomes were compared between the two groups after propensity score matching (PSM). RESULTS In total, 229 chemotherapy episodes (36 and 193 in the empirical and pre-emptive groups, respectively) were analysed. In the pre-emptive group, broad-spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 PSM, there were no significant differences between the empirical and pre-emptive groups in terms of the incidence of proven or probable IFI [0/36 (0%) vs 5/97 (5.2%); P=0.323], all-cause mortality [3/36 (8.3%) vs 4/97 (4.1%); P=0.388] and IFI-related mortality [0/36 (0.0%) vs 1/45 (2.2%); P=0.556]. CONCLUSION The differences in clinical outcomes between empirical and pre-emptive antifungal therapy in patients with AML who received antimould prophylaxis were not significant. Therefore, broad-spectrum antifungal therapy in patients receiving antimould prophylaxis may be delayed until there is clear evidence of IFI.
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Affiliation(s)
- Sang-Min Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim SH, Wi YM, Moon C, Kang JM, Kim M, Kim J, Kim JM, Seok H, Shi HJ, Lee SJ, Lee JY, Jeong SJ, Choe PG, Huh K, Lee SO, Kim SI. Recommendations for SARS-CoV-2 testing and organ procurement from deceased donors in the Republic of Korea. Korean J Transplant 2023; 37:145-154. [PMID: 37614183 PMCID: PMC10583974 DOI: 10.4285/kjt.23.0034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
We present a summary of the evidence on testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and organ procurement from deceased donors and provide recommendations based on current clinical data and the guidelines from major transplant organizations. Because of the limited historical experience with coronavirus disease 2019 (COVID-19), certain recommendations in this document are based on theoretical rationales rather than clinical data. The recommendations in this manuscript may be subject to revision as subsequent clinical studies provide definitive evidence regarding COVID-19 in organ procurement.
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Affiliation(s)
- Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yu Mi Wi
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Chisook Moon
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minhwa Kim
- Korea Organ Donation Agency, Seoul, Korea
| | - Jungok Kim
- Division of Infectious Diseases, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Jin Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ji Yeon Lee
- Division of Infectious Diseases, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Lee E, Kim S, Lee SY, Jeong J, Bang J, Oh J, Shin SD, Kim NJ, Choe PG, Oh MD. Risk Factors for the Prescription of Ineffective Antiviral Candidates for COVID-19 During the Early Pandemic Period in Korea. J Korean Med Sci 2023; 38:e280. [PMID: 37698205 PMCID: PMC10497349 DOI: 10.3346/jkms.2023.38.e280] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/14/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Although the evidence of treatment for coronavirus disease 2019 (COVID-19) changed rapidly, little is known about the patterns of potential pharmacological treatment during the early period of the COVID-19 pandemic in Korea and the risk factors for ineffective prescription. METHODS Using claims data from the Korean National Health Insurance System, this retrospective cohort study included admission episodes for COVID-19 from February to December 2020. Ineffective antiviral prescriptions for COVID-19 were defined as lopinavir/ritonavir (LPN/r) and hydroxychloroquine (HCQ) prescribed after July 2020, according to the revised National Institute of Health COVID-19 treatment guidelines. Factors associated with ineffective prescriptions, including patient and hospital factors, were identified by multivariate logistic regression analysis. RESULTS Of the 15,723 COVID-19 admission episodes from February to June 2020, 4,183 (26.6%) included prescriptions of LPN/r, and 3,312 (21.1%) included prescriptions of HCQ. Of the 48,843 admission episodes from July to December 2020, after the guidelines were revised, 2,258 (4.6%) and 182 (0.4%) included prescriptions of ineffective LPN/r and HCQ, respectively. Patient factors independently associated with ineffective antiviral prescription were older age (adjusted odds ratio [aOR] per 10-year increase, 1.17; 95% confidence interval [CI], 1.14-1.20) and severe condition with an oxygen requirement (aOR, 2.49; 95% CI, 2.24-2.77). The prescription of ineffective antiviral drugs was highly prevalent in primary and nursing hospitals (aOR, 40.58; 95% CI, 31.97-51.50), public sector hospitals (aOR, 15.61; 95% CI, 12.76-19.09), and regions in which these drugs were highly prescribed before July 2020 (aOR, 10.65; 95% CI, 8.26-13.74). CONCLUSION Ineffective antiviral agents were prescribed to a substantial number of patients during the first year of the COVID-19 pandemic in Korea. Treatment with these ineffective drugs tended to be prolonged in severely ill patients and in primary and public hospitals.
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Affiliation(s)
- Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seungyeon Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea
- College of Pharmacy, Dankook University, Cheonan, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Jeong
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jihwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Park JH, Kim TS, Lee CM, Kang CK, Park WB, Kim NJ, Choe PG, Oh MD. Effect of Wearing Personal Protective Equipment (PPE) for COVID-19 Treatment on Blood Culture Contamination: Implication for Optimal PPE Strategies. J Korean Med Sci 2023; 38:e180. [PMID: 37309699 DOI: 10.3346/jkms.2023.38.e180] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/06/2023] [Indexed: 06/14/2023] Open
Abstract
The personal protective equipment (PPE) used to minimize exposure to hazards can hinder healthcare workers from performing sophisticated procedures. We retrospectively reviewed 77,535 blood cultures (202,012 pairs) performed in 28,502 patients from January 2020 to April 2022. The contamination rate of all blood cultures was significantly elevated in the coronavirus disease 2019 ward at 4.68%, compared to intensive care units at 2.56%, emergency rooms at 1.13%, hematology wards at 1.08%, and general wards at 1.07% (All of P < 0.001). This finding implies that wearing PPE might interfere with adherence to the aseptic technique. Therefore, a new PPE policy is needed that considers the balance between protecting healthcare workers and medical practices.
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Affiliation(s)
- Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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16
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Kang J, Kim HS, Yi HJ, Lee Y, Lee SH, Song KH, Park HY, Oh HS, Yoon D, Choe PG, Lee EJ, Choi CH, Sim M, Yu ES, Paik JW, Park HY. Causing trouble and being transmissible: COVID-19 survivors’ experiences of stigma and discrimination in South Korea. Front Psychiatry 2023; 14:1103572. [PMID: 36998621 PMCID: PMC10043256 DOI: 10.3389/fpsyt.2023.1103572] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundThe stigma associated with coronavirus disease (COVID-19) is relatively neglected in policies for handling the disease. Stigmatization occurs only within specific social contexts in local societies.ObjectiveThis study aims to examine COVID-19 survivors’ experiences of social stigma and discrimination in South Korea in the first 2 years of the pandemic.MethodsSemi-structured interviews were conducted.ResultsOf 52 participants, 45 reported that they had to cope with stigma and discrimination in their intimate social relationships, workplaces, and children’s schools, ranging from subtle actions to job loss. Sexual minorities who were involved in mass disease transmission in the early part of the pandemic experienced a higher level of stigmatization. The stigmatization dealt with in this study was related to two themes: survivors’ sense of causing trouble and possibility of transmission.ConclusionBy intertwining this stigma with the experiences of public health measures through the voices of survivors, this study reveals the local context of East Asia in terms of culture-specific aspects of COVID-19-related stigma.
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Affiliation(s)
- Jiyeon Kang
- Department of Anthropology, Seoul National University, Seoul, Republic of Korea
| | - Hyang Soo Kim
- Department of Nursing Science, Sungshin Women’s University, Seoul, Republic of Korea
| | - Hyun Ji Yi
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yesung Lee
- Department of Anthropology, Seoul National University, Seoul, Republic of Korea
| | - So Hee Lee
- Department of Psychiatry, National Medical Center, Seoul, Republic of Korea
- So Hee Lee,
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hye Yeon Park
- Department of Psychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hong Sang Oh
- Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Doran Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Pyoeng Gyun Choe
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Joo Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chi-Hyun Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Minyoung Sim
- National Center for Disaster and Trauma, National Center for Mental Health, Seoul, Republic of Korea
| | - Eun-Seung Yu
- Department of Counseling Psychology, The Cyber University of Korea, Seoul, Republic of Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Hye Yoon Park,
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17
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Chang E, Im D, Lee HY, Lee M, Lee CM, Kang CK, Park WB, Kim NJ, Choe PG, Oh M. Impact of discontinuing isolation in a private room for patients infected or colonized with vancomycin-resistant enterococci (VRE) on the incidence of healthcare-associated VRE bacteraemia in a hospital with a predominantly shared-room setting. J Hosp Infect 2023; 132:1-7. [PMID: 36473555 DOI: 10.1016/j.jhin.2022.11.017] [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: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Isolating patients infected or colonized with vancomycin-resistant enterococci (VRE) in a private room or cohort room to prevent hospital transmission is controversial. AIM To evaluate the effect of a relaxed isolation policy for VRE-infected or colonized patients on healthcare-associated (HA) VRE bacteraemia in an acute care hospital with a predominantly shared-room setting. METHODS The incidence of HA VRE bacteraemia was compared during a private isolation era (October 2014-September 2017), a cohort isolation era (October 2017-June 2020), and a no isolation era (July 2020-June 2022). Using Poisson regression modelling, an interrupted time-series analysis was conducted to analyse level changes and trends in incidences of HA VRE bacteraemia for each era. FINDINGS The proportion of VRE-infected or -colonized patients staying in shared rooms increased from 18.3% in the private isolation era to 82.6% in the no isolation era (P < 0.001). There was no significant difference in the incidences of HA VRE bacteraemia between the private isolation era and the cohort isolation era (relative risk: 1.01; 95% confidence interval: 0.52-1.98; P = 0.977) or between the cohort isolation era and the no isolation era (0.99; 0.77-1.26; P = 0.903). In addition, there was no significant slope increase in the incidence of HA VRE bacteraemia between any of the eras. CONCLUSION In a hospital with predominantly shared rooms, the relaxation of isolation policy did not result in increased HA VRE bacteraemia, when other infection control measures were maintained.
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Affiliation(s)
- E Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Im
- Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - H Y Lee
- Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - M Lee
- Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - C M Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - W B Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - N J Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
| | - P G Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea.
| | - M Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control, Seoul National University Hospital, Seoul, Republic of Korea
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18
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Kang CK, Kim MG, Park SW, Kim YW, Lee CM, Choe PG, Park WB, Kim NJ, Kim M, Lee S, Kim IS, Lee CH, Shin HM, Kim HR, Oh MD. Comparable humoral and cellular immunity against Omicron variant BA.4/5 of once-boosted BA.1/2 convalescents and twice-boosted COVID-19-naïve individuals. J Med Virol 2023; 95:e28558. [PMID: 36755360 DOI: 10.1002/jmv.28558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/07/2022] [Revised: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
The fourth vaccination dose confers additional protective immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in individuals with no prior coronavirus disease-19 (COVID-19). However, its immunological benefit against currently circulating BA.4/5 is unclear in individuals who have received a booster shot and been infected with Omicron variant BA.1/2. We analyzed immune responses in whom had been boosted once and did not have COVID-19 (n = 16), boosted once and had COVID-19 when BA.1/2 was dominant in Korea (Hybrid-6M group, n = 27), and boosted twice and did not have COVID-19 (Vx4 group, n = 15). Antibody binding activities against RBDo BA.1 and RBDo BA.4/5 , antigen-specific memory CD4+ and CD8+ T-cell responses against BA.4/5, and B-cell responses against SARS-CoV-2 wild-type did not differ statistically between the Hybrid-6M and Vx4 groups. The humoral and cellular immune responses of the Hybrid-6M group against BA.4/5 were comparable to those of the Vx4 group. Individuals who had been boosted and had an Omicron infection in early 2022 may not have high priority for an additional vaccination.
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Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min-Gang Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Wook Park
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Woo Kim
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soojin Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ik Soo Kim
- Department of Microbiology, School of Medicine, Gachon University, Incheon, Republic of Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Convergence Research Center for Dementia, Seoul National University Medical Research Center, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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19
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Lee CM, Choe PG, Kang CK, Lee E, Song KH, Bang JH, Kim E, Kim HB, Kim NJ, Kim HR, Kim Y, Lee CH, Shin H, Park SW, Park WB, Oh MD. Low humoral and cellular immune responses early after breakthrough infection may contribute to severe COVID-19. Front Immunol 2023; 14:1106664. [PMID: 37033936 PMCID: PMC10073433 DOI: 10.3389/fimmu.2023.1106664] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Little is known about the immune determinants for severe coronavirus disease 2019 (COVID-19) in individuals vaccinated against severe acute respiratory syndrome coronavirus 2. We therefore attempted to identify differences in humoral and cellular immune responses between patients with non-severe and severe breakthrough COVID-19. Methods We prospectively enrolled hospitalized patients with breakthrough COVID-19 (severe and non-severe groups) and uninfected individuals who were vaccinated at a similar time (control group). Severe cases were defined as those who required oxygen therapy while hospitalized. Enzyme-linked immunosorbent assays and flow cytometry were used to evaluate humoral and cellular immune responses, respectively. Results Anti-S1 IgG titers were significantly lower in the severe group than in the non-severe group within 1 week of symptom onset and higher in the non-severe group than in the control group. Compared with the control group, the cellular immune response tended to be diminished in breakthrough cases, particularly in the severe group. In multivariate analysis, advanced age and low anti-S1 IgG titer were associated with severe breakthrough COVID-19. Conclusions Severe breakthrough COVID-19 might be attributed by low humoral and cellular immune responses early after infection. In the vaccinated population, delayed humoral and cellular immune responses may contribute to severe breakthrough COVID-19.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hang-Rae Kim
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngju Kim
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Han Lee
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Mu Shin
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Sang-Won Park, ; Wan Beom Park,
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Sang-Won Park, ; Wan Beom Park,
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Sang-Won Park, ; Wan Beom Park,
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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20
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Lee CM, Kim M, Kang CK, Choe PG, Kim NJ, Bang H, Cho T, Shin HM, Kim HR, Park WB, Oh MD. Different degree of cytokinemia and T-cell activation according to serum IL-6 levels in critical COVID-19. Front Immunol 2023; 14:1110874. [PMID: 37081872 PMCID: PMC10110916 DOI: 10.3389/fimmu.2023.1110874] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/27/2023] [Indexed: 04/22/2023] Open
Abstract
Introduction Tocilizumab, a humanized anti-interleukin-6 receptor (IL-6R) antibody, is recommended for the treatment of severe to critical coronavirus diseases 2019 (COVID-19). However, there were conflicting results on the efficacy of tocilizumab. Therefore, we hypothesized that the differences in tocilizumab efficacy may stem from the different immune responses of critical COVID-19 patients. In this study, we described two groups of immunologically distinct COVID-19 patients, based on their IL-6 response. Methods We prospectively enrolled critical COVID-19 patients, requiring oxygen support with a high flow nasal cannula or a mechanical ventilator, and analyzed their serial samples. An enzyme-linked immunosorbent assay and flow cytometry were used to evaluate the cytokine kinetics and cellular immune responses, respectively. Results A total of nine patients with critical COVID-19 were included. The high (n = 5) and low IL-6 (n = 4) groups were distinguished by their peak serum IL-6 levels, using 400 pg/mL as the cut-off value. Although the difference of flow cytometric data did not reach the level of statistical significance, the levels of pro-inflammatory cytokines and the frequencies of intermediate monocytes (CD14+CD16+), IFN-γ+ CD4+ or CD8+ T cells, and HLA-DR+PD-1+ CD4+ T cells were higher in the high IL-6 group than in the low IL-6 group. Conclusion There were distinctive two groups of critical COVID-19 according to serum IL-6 levels having different degrees of cytokinemia and T-cell responses. Our results indicate that the use of immune modulators should be more tailored in patients with critical COVID-19.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeeun Bang
- Research and development team 2, Molecular Diagnostics Division, Quantamatrix Inc., Seoul, Republic of Korea
| | - Taeeun Cho
- Research and development team 2, Molecular Diagnostics Division, Quantamatrix Inc., Seoul, Republic of Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Hang-Rae Kim, ; Wan Beom Park,
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Anatomy & Cell Biology and Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Hang-Rae Kim, ; Wan Beom Park,
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- *Correspondence: Hyun Mu Shin, ; Hang-Rae Kim, ; Wan Beom Park,
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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21
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Park DH, Kang CK, Choe PG, Kim NJ, Park WB, Oh MD. How We Have Treated Severe to Critically Ill Patients With Coronavirus Disease 2019 in Korea. J Korean Med Sci 2022; 37:e353. [PMID: 36536547 PMCID: PMC9763707 DOI: 10.3346/jkms.2022.37.e353] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
Since 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, and the coronavirus disease 2019 (COVID-19) pandemic currently continues. In response to this unprecedented pandemic, several researchers and medical staff have struggled to find appropriate treatments for COVID-19. Patients with mild symptoms can recuperate with symptomatic care, however establishing treatment for severe to critically ill patients who can have a high mortality has been essential. Accordingly, the guidelines for COVID-19 treatment have evolved through numerous trials and errors and have been relatively well established to date. In the Republic of Korea, several evidence-based guidelines for COVID-19 treatment were released and revised, reflecting various research and regional medical conditions. To date, approximately 3 years after the beginning of the COVID-19 pandemic, we are reflecting on the changes in the guidelines thus far and have summarized the treatment experience of severe to critically ill patients with COVID-19. The Korean guidelines for COVID-19 treatment have been updated continuously as the National Institutes of Health (NIH) guidelines have changed. Dexamethasone is currently used as the backbone for the treatment of severe to critically ill patients with COVID-19, and remdesivir, baricitinib, and tocilizumab can be added depending on a patient's situation. In addition, venous thromboembolism prophylaxis is one of the important adjunctive therapies for patients with severe COVID-19. In the clinical field, treatment of severely ill patients with COVID-19 based on guidelines is widely practiced by medical staff and established currently.
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Affiliation(s)
- Do Hyeon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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22
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Oh SM, Lee CM, Choi SJ, Lee E, Kang CK, Moon SM, Choe PG, Song KH, Park WB, Bang JH, Kim ES, Park SW, Kim HB, Kim IH, Kim NJ, Oh MD. 208. Clinical outcomes of empirical versus pre-emptive broad spectrum antifungal therapy in patients with acute myelogenous leukemia receiving antimold prophylaxis. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.285] [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: 12/23/2022] Open
Abstract
Abstract
Background
Since antimold prophylaxis has been widely used in induction chemotherapy for acute myelogenous leukemia (AML), it should be re-evaluated whether broad spectrum antifungal therapy should be empirically used in prolonged febrile neutropenia. Therefore, we compared clinical outcomes of empirical versus pre-emptive antifungal therapy in patients with AML receiving antimold prophylaxis.
Methods
From September 2016 to December 2020, all adult AML patients (≥ 18 years) receiving antimold prophylaxis who had febrile neutropenia for ≥ 4 days during induction or re-induction chemotherapy at Seoul National University Hospital were retrospectively reviewed. They were classified into the empirical group (therapeutic broad spectrum antifungal agents had been used without evidence of invasive fungal infection [IFI]) or the pre-emptive group (antimold prophylaxis had been maintained until the emergence of IFI’s evidence). We compared clinical outcomes between the two groups after propensity score matching.
Results
A total of 229 chemotherapy episodes, 36 in the empirical group and 193 in the pre-emptive group, were analyzed. In the pre-emptive group, broad spectrum antifungal therapy was administered in 45 (23.3%) episodes. After 1:3 matching with age, gender, induction or re-induction chemotherapy, and worst qSOFA score at febrile neutropenia, incidence of proven or probable IFI (0/36 [0%] in the empirical group vs. 5/97 [5.2%] in the pre-emptive group, P=0.323) and all-cause mortality (3/36 [8.3%] in the empirical group vs. 4/97 [4.1%] in the pre-emptive group, P=0.388) were not different between the two groups.
Conclusion
Clinical outcomes of empirical versus pre-emptive broad spectrum antifungal therapy were comparable in patients with AML receiving antimold prophylaxis. Broad spectrum antifungal therapy could be delayed until the emergence of evidence of IFI, in the current era of antimold prophylaxis.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Sang-Min Oh
- Jeonbuk National University Medical School , Jeonju, Cholla-bukto , Republic of Korea
| | - Chan Mi Lee
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Seong Jin Choi
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Eunyoung Lee
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Chang Kyung Kang
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Song Mi Moon
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Pyoeng Gyun Choe
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Kyoung-Ho Song
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Wan Beom Park
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Ji Hwan Bang
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Eu Suk Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Sang Won Park
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Hong Bin Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - In Ho Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Nam Joong Kim
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
| | - Myoung-don Oh
- Seoul National University College of Medicine , Seoul, Seoul-t'ukpyolsi , Republic of Korea
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23
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Lee CM, Kim CJ, Kim SE, Park KH, Bae JY, Choi HJ, Jung Y, Lee SS, Choe PG, Park WB, Suk Kim E, Song JE, Kwak YG, Hee Lee S, Lee S, Cheon S, Kim YS, Kang YM, Bang JH, Jung SI, Song KH, Bin Kim H. 1855. Risk factors for early mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. Open Forum Infect Dis 2022. [PMCID: PMC9752596 DOI: 10.1093/ofid/ofac492.1484] [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: 12/23/2022] Open
Abstract
Background Although many deaths due to carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia occur within a few days after the onset of bacteremia, risk factors for early mortality (EM) have not been deeply investigated. We aimed to determine the risk factors for EM and the difference between risk factors associated with EM and late mortality (LM) in CRAB bacteremia. Methods All patients with CRAB bacteremia in 10 hospitals during a 1-year study period were identified. We prospectively collected patients’ clinical data, including microbiological and demographic data, underlying comorbidities, origin of bacteremia, severity of illness, antibiotic therapy, and mortality. Among the cases with mortality within 30 days, EM and LM were defined as death within 3 and more than 5 calendar days from the first positive blood culture, respectively. Results A total of 212 CRAB bacteremia cases were included in the analysis. Of 122 (57.5%) patients with 30-day mortality, EM was observed in 75 (61.5%) patients and LM in 39 (32.0%) patients. The proportion of severe sepsis or septic shock, Pitt score, and Sequential Organ Failure Assessment (SOFA) score were significantly higher in 30-day deaths than 30-day survivors. These factors of clinical severity were also significantly higher in patients with EM than those with LM. While urinary tract infection as the factor of site of infection and the severity of illness were independent predictors of LM, only factors representing the severity of illness were independent risk factors for EM. Appropriate empirical antibiotic therapy was associated with reduced risk of EM.
![]() ![]() Conclusion The difference between risk factors for EM and LM was identified in this study. Our data suggest that a large proportion of CRAB bacteremia with high severity progress to a rapidly fatal course, regardless of the underlying diseases or source of infection. Further studies might be needed to investigate the microbiological factors associated with CRAB and pathogen-host interaction in patients with EM. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Chan Mi Lee
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Chung-Jong Kim
- Ewha Womans University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Seong Eun Kim
- Chonnam National University Medical School, Gwangju, Kwangju-jikhalsi, Republic of Korea
| | - Kyung-Hwa Park
- Chonnam National University Medical School, Gwangju, Kwangju-jikhalsi, Republic of Korea
| | - Ji Yun Bae
- Ewha Womans University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Hee Jung Choi
- Ewha Womans University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - YoungHee Jung
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Seung Soon Lee
- Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Kangwon-do, Republic of Korea
| | - Pyoeng Gyun Choe
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Wan Beom Park
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Eu Suk Kim
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Je Eun Song
- Inje University Ilsan Paik Hospital, Goyang, Kyonggi-do, Republic of Korea
| | - Yee Gyung Kwak
- Ilsan Paik Hospital, Ilsan, Kyonggi-do, Republic of Korea
| | - Sun Hee Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University Hospital, Seo-gu, Pusan-jikhalsi, Republic of Korea
| | - Shinwon Lee
- Division of Infectious Disease, Department of Internal Medicine, Pusan National University Hospital, Seo-gu, Pusan-jikhalsi, Republic of Korea
| | - Shinhye Cheon
- Chungnam National University Hospital, Daejeon, Ch'ungch'ong-namdo, Republic of Korea
| | - Yeon Sook Kim
- Chungnam National University School of Medicine, Daejeon, Ch'ungch'ong-namdo, Republic of Korea
| | - Yu Min Kang
- Myongji Hospital, Goyang, Kyonggi-do, Republic of Korea
| | - Ji Hwan Bang
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
| | - Sook-In Jung
- Chonnam National University Medical School, Gwangju, Kwangju-jikhalsi, Republic of Korea
| | - Kyoung-Ho Song
- Seoul National University College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea
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24
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Kang J, Jang H, Kim TH, Cho U, Bang H, Jang J, Lee W, Joo H, Noh J, Lee GY, Shin DH, Kang CK, Choe PG, Kim NJ, Oh MD, Song M, Kwon S, Veas F, Park WB. Accurate Diagnosis of COVID-19 from Self-Collectable Biospecimens Using Synthetic Apolipoprotein H Peptide-Coated Nanoparticle Assay. Anal Chem 2022; 94:17186-17194. [PMID: 36399654 PMCID: PMC9718094 DOI: 10.1021/acs.analchem.2c03813] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A high-throughput, accurate screening is crucial for the prevention and control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Current methods, which involve sampling from the nasopharyngeal (NP) area by medical staffs, constitute a fundamental bottleneck in expanding the testing capacity. To meet the scales required for population-level surveillance, self-collectable specimens can be used; however, its low viral load has hindered its clinical adoption. Here, we describe a magnetic nanoparticle functionalized with synthetic apolipoprotein H (ApoH) peptides to capture, concentrate, and purify viruses. The ApoH assay demonstrates a viral enrichment efficiency of >90% for both SARS-CoV-2 and its variants, leading to an order of magnitude improvement in analytical sensitivity. For validation, we apply the assay to a total of 84 clinical specimens including nasal, oral, and mouth gargles obtained from COVID-19 patients. As a result, a 100% positivity rate is achieved from the patient-collected nasal and gargle samples, which exceeds that of the traditional NP swab method. The simple 12 min pre-enrichment assay enabling the use of self-collectable samples will be a practical solution to overcome the overwhelming diagnostic capacity. Furthermore, the methodology can easily be built on various clinical protocols, allowing its broad applicability to various disease diagnoses.
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Affiliation(s)
- Junwon Kang
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul08826, Korea
- Integrated Major in Innovative Medical Science, Seoul National University, Seoul03080, Korea
| | - Haewook Jang
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul08826, Korea
| | - Tae Hyun Kim
- Bio-MAX Institute, Seoul National University, Seoul08826, Korea
- Department of Electrical and Computer Engineering, Seoul National University, Seoul08826, Korea
| | - Untack Cho
- QuantaMatrix Inc., Seoul08506, Korea
- Interdisciplinary Program in Cancer Biology, Seoul National University College of Medicine, Seoul03080, Korea
| | | | | | - Wooseok Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul08826, Korea
| | - Hyelyn Joo
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul08826, Korea
| | - Jinsung Noh
- Bio-MAX Institute, Seoul National University, Seoul08826, Korea
- Department of Electrical and Computer Engineering, Seoul National University, Seoul08826, Korea
| | - Gi Yoon Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul08826, Korea
| | - Dong Hoon Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul03080, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul03080, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul03080, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul03080, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul03080, Korea
| | - Manki Song
- International Vaccine Institute, Seoul08826, Korea
| | - Sunghoon Kwon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul08826, Korea
- Bio-MAX Institute, Seoul National University, Seoul08826, Korea
- Department of Electrical and Computer Engineering, Seoul National University, Seoul08826, Korea
- QuantaMatrix Inc., Seoul08506, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul03080, Korea
| | - Francisco Veas
- Copernicus Integrated Solutions for Biosafety Risks (CISBR), Mauguio34130, France
- ApoH-Technologies, 94 Allée des Fauvettes, La Grande Motte34280, France
- UMR5151/French Research Institute for Development (IRD), University of Montpellier (UM), Montpellier 34093, France
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul03080, Korea
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25
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Oh SM, Lee JS, Jo HJ, Kim D, Park D, Hwang YH, Choi Y, Lee CM, Lee S, Chang E, Lee E, Kim TS, Seong MW, Choe PG, Kim NJ. Clinical application of the Panbio™ COVID-19 Ag rapid test device and SSf-COVID19 kit for the detection of SARS-CoV-2 infection. BMC Res Notes 2022; 15:357. [PMID: 36471453 PMCID: PMC9720920 DOI: 10.1186/s13104-022-06226-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We evaluated the sensitivity and specificity of the Panbio™ COVID-19 Ag rapid test device using nasal swabs and those of the SSf-COVID19 kit, one of RT-PCR tests, using saliva specimens. These tests were compared with RT-PCR tests using nasopharyngeal swabs for the diagnosis of SARS-CoV-2 infection. The three diagnostic tests were simultaneously conducted for patients aged ≥ 18 years, who were about to be hospitalized or had been admitted for COVID-19 confirmed by RT-PCR in two research hospitals from August 20 to October 29, 2021. Nasal swabs were tested using the Panbio™ COVID-19 Ag rapid test device. More than 1 mL of saliva was self-collected and tested using the SSf-COVID19 kit. RESULTS In total, 157 patients were investigated; 124 patients who were about to be hospitalized and 33 patients already admitted for COVID-19. The overall sensitivity and specificity of the Panbio™ COVID-19 Ag rapid test device with nasal swabs were 64.7% (95% confidence interval [CI] 47.9-78.5%) and 100.0% (95% CI 97.0-100.0%), respectively. The median time to confirm a positive result was 180 s (interquartile range 60-255 s). The overall sensitivity and specificity of the SSf-COVID19 kit with saliva specimens were 94.1% (95% CI 80.9-98.4%) and 100.0% (95% CI 97.0-100.0%), respectively.
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Affiliation(s)
- Sang-Min Oh
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea ,grid.411545.00000 0004 0470 4320Present Address: Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, 20 Geonjiro, Deokjin-gu, 54907 Jeonju, Jeollabuk-do Republic of Korea
| | - Jee-Soo Lee
- grid.31501.360000 0004 0470 5905Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Hyeon Jae Jo
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Donghwan Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Dohyeon Park
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Young Hoon Hwang
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Yunsang Choi
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Chan Mi Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Seungjae Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Euijin Chang
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Eunyoung Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea ,grid.412479.dDivision of Infectious Diseases, Seoul Metropolitan Government – Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, 07061 Seoul, Republic of Korea
| | - Taek Soo Kim
- grid.31501.360000 0004 0470 5905Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Moon-Woo Seong
- grid.31501.360000 0004 0470 5905Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
| | - Nam Joong Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, 03080 Seoul, Republic of Korea
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26
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Song KH, Kim CJ, Choi NK, Ahn J, Choe PG, Park WB, Kim NJ, Choi HJ, Bae JY, Kim ES, Lee H, Park JS, Jung Y, Lee SS, Park KH, Jung SI, Kim YS, Bang JH, Lee S, Kang YM, Kwak YG, Kim HB. Clinical and economic burden of bacteremia due to multidrug-resistant organisms in Korea: a prospective case control study. J Glob Antimicrob Resist 2022; 31:379-385. [PMID: 36400408 DOI: 10.1016/j.jgar.2022.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/15/2022] [Revised: 08/10/2022] [Accepted: 11/05/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The socioeconomic and clinical burden of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), multidrug-resistant Acinetobacter baumannii (MRAB), multidrug-resistant Pseudomonas aeruginosa (MRPA), and carbapenem-resistant Enterobacteriaceae (CRE) have not yet been adequately addressed. METHODS We prospectively searched for MDRO bacteremia cases with matched controls from 10 hospitals across Korea during a 6-month period in 2017. Patients were classified into the MDRO, susceptible organism, and no-infection groups. The corresponding susceptible or no-infection controls had been selected according to predefined criteria. We collected clinical information and estimated the total additional medical cost due to MDRO infections using the multistate model. RESULTS During the 6-month period, a total of 486 MDRO bacteremia cases (260, 87, 18, 20, and 101 cases of MRSA, MRAB, MRPA, CRE, and VRE, respectively) were identified. The 90-d mortality rates were 30.4%, 63.2%, 16.7%, 55.0%, and 47.5%, respectively. The additional costs caused by bacteremia were $15 768, $35 682, $39 908, $72 051, and $33 662 per MDRO type, respectively. Based on these 6-month data, the estimated annual number of bacteremia cases due to these five MDRO in Korea were 7979 (4070, 1396, 218, 461, and 1834 cases, respectively). Overall, this caused an estimated 3280 (1237, 882, 36, 254, and 871, respectively) deaths and cost $294 505 002 ($84 707 359, $74 387 364, $10 344 370, $45 850 215, and $79 215 694, respectively) (range $170,627,020-$416,094,679) in socioeconomic loss. CONCLUSIONS A tremendous clinical and economic burden is caused by MDRO bacteremia compared with antibiotic-susceptible and no-infection groups. Substantial investment and efforts by related government agencies and medical staffs are needed.
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Affiliation(s)
- Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Ji Yun Bae
- Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyunju Lee
- Department of Paediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Younghee Jung
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Seung Soon Lee
- Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, South Korea
| | - Yeon-Sook Kim
- Division of Infectious Diseases, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Ji-Hwan Bang
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Centre, Seoul, Korea
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, South Korea
| | - Yu Min Kang
- Kangwon National University Hospital, Chuncheon, South Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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27
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Lee JS, Yun KW, Jeong H, Kim B, Kim MJ, Park JH, Shin HS, Oh HS, Sung H, Song MG, Cho SI, Kim SY, Kang CK, Choe PG, Park WB, Kim NJ, Oh MD, Choi EH, Park S, Kim TS, Lee JH, Sung H, Park SS, Seong MW. SARS-CoV-2 shedding dynamics and transmission in immunosuppressed patients. Virulence 2022; 13:1242-1251. [PMID: 35891618 PMCID: PMC9336477 DOI: 10.1080/21505594.2022.2101198] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern have been emerging. However, knowledge of temporal and spatial dynamics of SARS-CoV-2 is limited. This study characterized SARS-CoV-2 evolution in immunosuppressed patients with long-term SARS-CoV-2 shedding for 73–250 days, without specific treatment. We conducted whole-genome sequencing of 27 serial samples, including 26 serial samples collected from various anatomic sites of two patients and the first positive sample from patient 2‘s mother. We analysed the intrahost temporal dynamics and genomic diversity of the viral population within different sample types. Intrahost variants emerging during infection showed diversity between individual hosts. Remarkably, N501Y, P681R, and E484K, key substitutions within spike protein, emerged in vivo during infection and became the dominant population. P681R, which had not yet been detected in the publicly available genome in Korea, appeared within patient 1 during infection. Mutually exclusive substitutions at residues R346 (R346S and R346I) and E484 (E484K and E484A) of spike protein and continuous turnover of these substitutions occurred. Unique genetic changes were observed in urine samples. A household transmission from patient 2 to his mother, at least 38 days after the diagnosis, was characterized. Viruses may differently mutate and adjust to the host selective pressure, which could enable the virus to replicate efficiently for fitness in each host. Intrahost variants could be candidate variants likely to spread to the population eventually. Our findings may provide new insights into the dynamics of SARS-CoV-2 in response to interactions between the virus and host.
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Affiliation(s)
- Jee-Soo Lee
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Wook Yun
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeonju Jeong
- Department of Internal Medicine, Gyeonggi Provincial Medical Center, Ansung Hospital, Anseong Gyeonggi-do, Republic of Korea
| | - Boram Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Man Jin Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Seob Shin
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Sae Oh
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hobin Sung
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung Gi Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Im Cho
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Laboratory Medicine, National Medical Center, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seungman Park
- Department of Laboratory Medicine, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Hee Lee
- Department of Haematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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28
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Lee CM, Kim CJ, Kim SE, Park KH, Bae JY, Choi HJ, Jung Y, Lee SS, Choe PG, Park WB, Kim ES, Song JE, Kwak YG, Lee SH, Lee S, Cheon S, Kim YS, Kang YM, Bang JH, Jung SI, Song KH, Kim HB. Risk factors for early mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteraemia. J Glob Antimicrob Resist 2022; 31:45-51. [PMID: 35981691 DOI: 10.1016/j.jgar.2022.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/10/2022] [Revised: 06/18/2022] [Accepted: 08/12/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Although many deaths due to carbapenem-resistant Acinetobacter baumannii (CRAB) bacteraemia occur within a few days after the onset of bacteraemia, risk factors for early mortality (EM) have not been deeply investigated. We aimed to determine the risk factors for EM and the difference between risk factors associated with EM and late mortality (LM) in CRAB bacteraemia. METHODS Clinical information on all patients with CRAB bacteraemia in 10 hospitals during a 1-year period was collected. Among the cases with mortality within 30 days, EM and LM were defined as death within 3 and more than 5 calendar days from the first positive blood culture, respectively. RESULTS In total, 212 CRAB bacteraemia cases were included in the analysis. Of 122 (57.5%) patients with 30-day mortality, EM was observed in 75 (61.5%) patients and LM in 39 (32.0%) patients. The proportion of severe sepsis or septic shock, Pitt score, and Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with EM than those with LM. Although urinary tract infection as the site of infection and the severity of illness were independent predictors of LM, only factors representing the severity of illness were independent risk factors for EM. CONCLUSION Our results suggest that a large proportion of CRAB bacteraemia with high severity progresses to a rapidly fatal course, regardless of the underlying diseases or source of infection. Further studies might be needed to investigate the microbiological factors associated with CRAB and pathogen-host interaction in patients with EM.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Seong Eun Kim
- Department of Infectious diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kyung-Hwa Park
- Department of Infectious diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji Yun Bae
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Younghee Jung
- Graduate School of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Soon Lee
- Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Je Eun Song
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Shinhye Cheon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yeon Sook Kim
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Yu Min Kang
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea; Present address: Department of Internal Medicine, Myongji Hospital, Goyang, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul Metropolitan Boramae Hospital, Seoul, Republic of Korea
| | - Sook-In Jung
- Department of Infectious diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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Kim J, Chang E, Park SY, Lee DW, Kang CK, Choe PG, Kim NJ, Oh MD, Park WB, Lee KH, Im SA. Evaluation of Seropositivity After Standard Doses of Vaccination Against SARS-CoV-2 in Patients With Early Breast Cancer Receiving Adjuvant Treatment. Oncologist 2022; 27:e931-e937. [PMID: 36218350 PMCID: PMC9732225 DOI: 10.1093/oncolo/oyac196] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) pandemic affected millions of individuals, and patients with cancer are known to be more susceptible. Vaccines against SARS-CoV-2 have been developed and used for patients with cancer, but scarce data are available on their efficacy in patients under active anti-cancer therapies. MATERIALS AND METHODS In this study, we semi-quantitatively measured the titers of the immunoglobulin G against the anti-spike protein subunit 1 of SARS-CoV-2 after vaccination of patients with early breast cancer undergoing concurrent chemotherapy, endocrinal or targeted non-cytotoxic treatments, and no treatments. RESULTS Standard doses of COVID-19 vaccines provided sufficient immune responses in patients with early breast cancer, regardless of the type of anticancer therapies. However, the post-vaccination serum anti-spike antibody titers were significantly lower in the patients under cytotoxic chemotherapy. CONCLUSION Our study emphasizes the importance of the personalized risk stratification and consideration for booster doses in more vulnerable populations.
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Affiliation(s)
| | | | - Song Yi Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wan Beom Park
- Wan Beom Park, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea. Tel: +82 2 2072 3596; Email
| | - Kyung-Hun Lee
- Corresponding author: Kyung-Hun Lee, MD, PhD, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongro-gu, Seoul 03080, Republic of Korea. Tel: 82 2 2072 7207; Email
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea,Cancer Research Institute, Seoul National University, Seoul, Korea
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30
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Kang CK, Choi B, Kim S, Sun CH, Yoon SH, Kim K, Chang E, Jung J, Choe PG, Park WB, Kim ES, Kim HB, Kim NJ, Oh MD, Im H, Kim J, Lee YH, Lee J, Chun H, Koh Y, Lee JY, Moon JH, Song KH, Jung I. Clinical impact of clonal hematopoiesis on severe COVID- 19 patients without canonical risk factors. Haematologica 2022; 108:257-260. [PMID: 36106393 PMCID: PMC9827170 DOI: 10.3324/haematol.2022.280621] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,*CKK and BC contributed equally as co-first authors
| | - Baekgyu Choi
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon,*CKK and BC contributed equally as co-first authors
| | | | | | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul
| | - Kyukwang Kim
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul
| | | | - Joohae Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul
| | - Yong Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu
| | - Jaehee Lee
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu
| | - Hyonho Chun
- Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Genome Opinion Inc., Seoul
| | - Ji Yeon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
| | - Joon Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
| | - Inkyung Jung
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology (KAIST), Daejeon,JYL, JHM, K-HS and IJ contributed equally as co-senior authors
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Lee CM, Lee E, Park WB, Choe PG, Song KH, Kim ES, Park SW. Breakthrough COVID-19 Infection During the Delta Variant Dominant Period: Individualized Care Based on Vaccination Status Is Needed. J Korean Med Sci 2022; 37:e252. [PMID: 35971766 PMCID: PMC9424692 DOI: 10.3346/jkms.2022.37.e252] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 05/27/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The clinical features of coronavirus disease 2019 (COVID-19) patients in the COVID-19 vaccination era need to be clarified because breakthrough infection after vaccination is not uncommon. METHODS We retrospectively analyzed hospitalized COVID-19 patients during a delta variant-dominant period 6 months after the national COVID-19 vaccination rollout. The clinical characteristics and risk factors for severe progression were assessed and subclassified according to vaccination status. RESULTS A total of 438 COVID-19 patients were included; the numbers of patients in the unvaccinated, partially vaccinated and fully vaccinated groups were 188 (42.9%), 117 (26.7%) and 133 (30.4%), respectively. The vaccinated group was older, less symptomatic and had a higher Charlson comorbidity index at presentation. The proportions of patients who experienced severe progression in the unvaccinated and fully vaccinated groups were 20.3% (31/153) and 10.8% (13/120), respectively. Older age, diabetes mellitus, solid cancer, elevated levels of lactate dehydrogenase and chest X-ray abnormalities were associated with severe progression, and the vaccination at least once was the only protective factor for severe progression. Chest X-ray abnormalities at presentation were the only predictor for severe progression among fully vaccinated patients. CONCLUSION In the hospitalized setting, vaccinated and unvaccinated COVID-19 patients showed different clinical features and risk of oxygen demand despite a relatively high proportion of patients in the two groups. Vaccination needs to be assessed as an initial checkpoint, and chest X-ray may be helpful for predicting severe progression in vaccinated patients.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
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32
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Banday AR, Stanifer ML, Florez-Vargas O, Onabajo OO, Papenberg BW, Zahoor MA, Mirabello L, Ring TJ, Lee CH, Albert PS, Andreakos E, Arons E, Barsh G, Biesecker LG, Boyle DL, Brahier MS, Burnett-Hartman A, Carrington M, Chang E, Choe PG, Chisholm RL, Colli LM, Dalgard CL, Dude CM, Edberg J, Erdmann N, Feigelson HS, Fonseca BA, Firestein GS, Gehring AJ, Guo C, Ho M, Holland S, Hutchinson AA, Im H, Irby L, Ison MG, Joseph NT, Kim HB, Kreitman RJ, Korf BR, Lipkin SM, Mahgoub SM, Mohammed I, Paschoalini GL, Pacheco JA, Peluso MJ, Rader DJ, Redden DT, Ritchie MD, Rosenblum B, Ross ME, Anna HPS, Savage SA, Sharma S, Siouti E, Smith AK, Triantafyllia V, Vargas JM, Vargas JD, Verma A, Vij V, Wesemann DR, Yeager M, Yu X, Zhang Y, Boulant S, Chanock SJ, Feld JJ, Prokunina-Olsson L. Genetic regulation of OAS1 nonsense-mediated decay underlies association with COVID-19 hospitalization in patients of European and African ancestries. Nat Genet 2022; 54:1103-1116. [PMID: 35835913 PMCID: PMC9355882 DOI: 10.1038/s41588-022-01113-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [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] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 05/26/2022] [Indexed: 12/22/2022]
Abstract
The chr12q24.13 locus encoding OAS1-OAS3 antiviral proteins has been associated with coronavirus disease 2019 (COVID-19) susceptibility. Here, we report genetic, functional and clinical insights into this locus in relation to COVID-19 severity. In our analysis of patients of European (n = 2,249) and African (n = 835) ancestries with hospitalized versus nonhospitalized COVID-19, the risk of hospitalized disease was associated with a common OAS1 haplotype, which was also associated with reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) clearance in a clinical trial with pegIFN-λ1. Bioinformatic analyses and in vitro studies reveal the functional contribution of two associated OAS1 exonic variants comprising the risk haplotype. Derived human-specific alleles rs10774671-A and rs1131454 -A decrease OAS1 protein abundance through allele-specific regulation of splicing and nonsense-mediated decay (NMD). We conclude that decreased OAS1 expression due to a common haplotype contributes to COVID-19 severity. Our results provide insight into molecular mechanisms through which early treatment with interferons could accelerate SARS-CoV-2 clearance and mitigate against severe COVID-19.
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Affiliation(s)
- A Rouf Banday
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Megan L Stanifer
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Oscar Florez-Vargas
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Olusegun O Onabajo
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Brenen W Papenberg
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Muhammad A Zahoor
- Toronto Centre for Liver Disease, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lisa Mirabello
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Timothy J Ring
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Chia-Han Lee
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Paul S Albert
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Evangelos Andreakos
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Evgeny Arons
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Greg Barsh
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Leslie G Biesecker
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - David L Boyle
- Altman Clinical & Translational Research Institute, UC San Diego Health Sciences, San Diego, CA, USA
| | - Mark S Brahier
- Georgetown University School of Medicine, Washington, DC, USA
| | | | - Mary Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD, USA
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Rex L Chisholm
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leandro M Colli
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Clifton L Dalgard
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carolynn M Dude
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeff Edberg
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nathan Erdmann
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Benedito A Fonseca
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Gary S Firestein
- Altman Clinical & Translational Research Institute, UC San Diego Health Sciences, San Diego, CA, USA
| | - Adam J Gehring
- Toronto Centre for Liver Disease, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Cuncai Guo
- Division of Cellular Polarity and Viral Infection, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michelle Ho
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Steven Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Amy A Hutchinson
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Hogune Im
- Genome Opinion, Inc., Seoul, Republic of Korea
| | - Les'Shon Irby
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Naima T Joseph
- Department of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Robert J Kreitman
- Laboratory of Molecular Biology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Bruce R Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven M Lipkin
- Department of Medicine and Program in Mendelian Genetics, Weill Cornell Medicine, New York, NY, USA
| | - Siham M Mahgoub
- Department of Medicine, Infectious Diseases Division, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA
| | - Iman Mohammed
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Guilherme L Paschoalini
- Department of Medical Imaging, Hematology, and Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Daniel J Rader
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marylyn D Ritchie
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Brooke Rosenblum
- Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - M Elizabeth Ross
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Hanaisa P Sant Anna
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Sharon A Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Sudha Sharma
- Department of Biochemistry and Molecular Biology, National Human Genome Center, Howard University College of Medicine, Washington, DC, USA
| | - Eleni Siouti
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Triantafyllia
- Laboratory of Immunobiology, Center for Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Joselin M Vargas
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jose D Vargas
- Veterans Affairs Medical Center, Washington, DC, USA
| | - Anurag Verma
- Department of Genetics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vibha Vij
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Duane R Wesemann
- Department of Medicine, Division of Allergy and Immunology, Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Meredith Yeager
- Cancer Genomics Research Laboratory, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Xu Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Yu Zhang
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Steeve Boulant
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, FL, USA
- Division of Cellular Polarity and Viral Infection, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephen J Chanock
- Laboratory of Genetic Susceptibility, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Ludmila Prokunina-Olsson
- Laboratory of Translational Genomics, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
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Park DH, Lee CM, Chang E, Kang CK, Park WB, Kim NJ, Choe PG, Oh MD. Clinical Impact of Empirical Antibiotic Therapy in Patients With Coronavirus Disease 2019 Requiring Oxygen Therapy. J Korean Med Sci 2022; 37:e238. [PMID: 35880508 PMCID: PMC9313981 DOI: 10.3346/jkms.2022.37.e238] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 12/27/2022] Open
Abstract
Despite the low prevalence of secondary bacterial infection in coronavirus disease 2019 (COVID-19) patients, most of them were administered antibiotic therapy empirically. However, the prognostic impact of empirical antibiotic therapy has not been evaluated. We conducted retrospective propensity score-matched case-control study of 233 COVID-19 patients with moderate to severe illnesses who required oxygen therapy and evaluated whether empirical antibiotic therapy could improve clinical outcomes. Empirical antibiotic therapy did not improve clinical outcomes including length of stay, days with oxygen requirement, the proportion of patients with increased oxygen demand, the proportion of patients who required mechanical ventilation, and overall mortality. This finding implies that routine administration of antibiotics for the treatment of COVID-19 is not essential and should be restricted.
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Affiliation(s)
- Do Hyeon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Kang CK, Kim M, Hong J, Kim G, Lee S, Chang E, Choe PG, Kim NJ, Kim IS, Seo JY, Song D, Lee DS, Shin HM, Kim YW, Lee CH, Park WB, Kim HR, Oh MD. Corrigendum: Distinct Immune Response at 1 Year Post-COVID-19 According to Disease Severity. Front Immunol 2022; 13:929770. [PMID: 35686133 PMCID: PMC9171241 DOI: 10.3389/fimmu.2022.929770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Jisu Hong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gwanghun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Soojin Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ik Soo Kim
- Department of Microbiology, School of Medicine, Gachon University, Incheon, South Korea
| | - Jun-Young Seo
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Daesub Song
- College of Pharmacy, Korea University, Sejong, South Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Yong-Woo Kim
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea.,Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea.,BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Lee CM, Kim YJ, Jung SI, Kim SE, Park WB, Choe PG, Kim ES, Kim CJ, Choi HJ, Lee S, Lee SH, Jung Y, Bang JH, Cheon S, Kwak YG, Kang YM, Park KH, Song KH, Kim HB. Different clinical characteristics and impact of carbapenem-resistance on outcomes between Acinetobacter baumannii and Pseudomonas aeruginosa bacteraemia: a prospective observational study. Sci Rep 2022; 12:8527. [PMID: 35595789 PMCID: PMC9123196 DOI: 10.1038/s41598-022-12482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to evaluate the differences in clinical characteristics and impact of carbapenem resistance (CR) on outcomes between Acinetobacter baumannii (Ab) and Pseudomonas aeruginosa (Pa) bacteraemia. We prospectively identified all patients with Ab and Pa bacteraemia in 10 hospitals over 1 year. Treatment failure was defined as all-cause 30-day mortality, persistent bacteraemia, or recurrent bacteraemia within 30 days. We included 304 Ab and 241 Pa bacteraemia cases. CR was detected in 216 patients (71%) with Ab bacteraemia and 55 patients (23%) with Pa bacteraemia. Treatment failure was significantly higher in CR-Ab than in CR-Pa (60.6% vs. 34.5%, P = 0.001). In Ab, severe sepsis or septic shock and high Pitt bacteraemia score were independent risk factors for treatment failure in the inappropriate empirical antibiotics group. In Pa, hospital-acquired infection and high Pitt bacteraemia score were independent risk factors for treatment failure in both groups. CR was an independent risk factor in Ab for treatment failure in both groups, but not in Pa bacteraemia. We demonstrated significant differences in clinical characteristics and impact of CR on clinical outcomes between Ab and Pa bacteraemia, suggesting that different treatment approaches may be needed.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Young-Jun Kim
- Department of Internal Medicine, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Sook-In Jung
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seong Eun Kim
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Hospital, Seoul, Republic of Korea
| | - Hee Jung Choi
- Department of Internal Medicine, Ewha Womans University Hospital, Seoul, Republic of Korea
| | - Shinwon Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Sun Hee Lee
- Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Younghee Jung
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul Metropolitan Boramae Hospital, Seoul, Republic of Korea
| | - Shinhye Cheon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yu Min Kang
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.,Department of Internal Medicine, Myongji Hospital, Goyang, Republic of Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
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36
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Kim JH, Kim TS, Chang E, Kang CK, Choe PG, Kim NJ, Oh MD, Park WB, Kim I. Effectiveness of antimicrobial stewardship programmes based on rapid antibiotic susceptibility testing of haematologic patients having high-risk factors for bacteraemia related mortality: A post-hoc analysis of an RCT. Int J Antimicrob Agents 2022; 60:106604. [PMID: 35588970 DOI: 10.1016/j.ijantimicag.2022.106604] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES A randomised controlled trial showed that rapid phenotypic antibiotic susceptibility testing (AST) with antimicrobial stewardship programmes (ASP) increases the proportion of haematologic patients with bacteraemia receiving optimal targeted therapy within 72 hrs of blood culture collection. The present post-hoc analysis aimed to evaluate the effects of rapid phenotypic AST intervention in haematologic patients at high risk of a poor outcome from bacteraemia. METHODS Haematologic patients with bacteraemia (n = 116) were assigned randomly to a conventional AST group or a rapid AST group. The two outcome measures were the proportion of patients receiving optimal targeted therapy at 72 hrs post-blood culture collection and the time to optimal targeted therapy; subgroup analysis was conducted based on baseline demographics (age, sex) and prognostic (Charlson comorbidity index, haematologic treatment intensity, Pitt bacteraemia score, appropriateness of empirical antibiotic therapy and multidrug-resistant organism) indicators. The interaction effect between the intervention and subgroup factors was examined using regression model analysis. RESULTS Age, sex, Charlson comorbidity index, haematologic treatment intensity, Pitt bacteraemia score and appropriateness of empirical antibiotic therapy had no significant interaction effects on the proportion of patients receiving optimal targeted therapy (P = 0.129-0.826). However, infection by a multidrug-resistant organism did have a significant interaction effect (P = 0.042). Regarding time to optimal targeted therapy, there were no significant interaction effects between the intervention and subgroup factors (P = 0.156-0.848). CONCLUSIONS Rapid phenotypic AST intervention may accelerate early optimal targeted antimicrobial treatment of haematologic patients, even those in high-risk subgroups with bacteraemia.
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Affiliation(s)
- Jeong-Han Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Euijin Chang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
| | - Inho Kim
- Division of Haematology-Oncology, Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
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Lee CM, Lee Y, Kang SJ, Kang CK, Choe PG, Song KH, Park WB, Kim ES, Jung SI, Kim HB, Oh MD, Park KH, Kim NJ. Positivity rates of mycobacterial culture in patients with tuberculous spondylitis according to methods and sites of biopsies: An analysis of 206 cases. Int J Infect Dis 2022; 121:161-165. [PMID: 35568362 DOI: 10.1016/j.ijid.2022.05.021] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the mycobacterial culture positivity rates according to biopsy methods and sites in patients with tuberculous spondylitis (TS) and identify which tissues are the best sites for the diagnosis of TS. METHODS We retrospectively identified and reviewed medical records of all patients with TS in three university-affiliated hospitals in the Republic of Korea from January 2003 to December 2020. TS was diagnosed by culture or histopathologic examination of vertebral bodies or paraspinal tissues and characteristic clinical and radiologic features. Patients with TS who received a needle biopsy or underwent surgical biopsy were investigated. The sites of needle biopsy were classified as vertebral bodies or paraspinal tissues. RESULTS During the study period, 206 tissues from 200 patients with TS were included in the analysis. The culture positivity rates of vertebral bodies obtained by needle biopsy, paraspinal tissues obtained by needle biopsy, and tissues obtained by surgery were 69.0%, 85.3%, and 83.2%, respectively. Multivariate logistic regression identified that paraspinal tissues as biopsy sites were independently associated with mycobacterial culture positivity in TS undergoing needle biopsy (adjusted odds ratio, 3.68; 95% confidence interval: 1.13-11.99, P = 0.030). CONCLUSIONS We demonstrated that the positivity rates of mycobacterial culture in TS were 69.0-85.3%. Paraspinal tissues as biopsy sites were significantly associated with culture positivity in needle biopsy, suggesting that targeting paraspinal tissues during needle biopsy may be the best method for diagnosing TS.
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Affiliation(s)
- Chan Mi Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjung Lee
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seung-Ji Kang
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sook In Jung
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hwa Park
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kang CK, Shin HM, Choe PG, Park J, Hong J, Seo JS, Lee YH, Chang E, Kim NJ, Kim M, Kim YW, Kim HR, Lee CH, Seo JY, Park WB, Oh MD. Broad humoral and cellular immunity elicited by one-dose mRNA vaccination 18 months after SARS-CoV-2 infection. BMC Med 2022; 20:181. [PMID: 35508998 PMCID: PMC9067342 DOI: 10.1186/s12916-022-02383-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Practical guidance is needed regarding the vaccination of coronavirus disease 2019 (COVID-19) convalescent individuals in resource-limited countries. It includes the number of vaccine doses that should be given to unvaccinated patients who experienced COVID-19 early in the pandemic. METHODS We recruited COVID-19 convalescent individuals who received one or two doses of an mRNA vaccine within 6 or around 18 months after a diagnosis of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Their samples were assessed for IgG-binding or neutralizing activity and cell-mediated immune responses against SARS-CoV-2 wild-type and variants of concern. RESULTS A total of 43 COVID-19 convalescent individuals were analyzed in the present study. The results showed that humoral and cellular immune responses against SARS-CoV-2 wild-type and variants of concern, including the Omicron variant, were comparable among patients vaccinated within 6 versus around 18 months. A second dose of vaccine did not significantly increase immune responses. CONCLUSION One dose of mRNA vaccine should be considered sufficient to elicit a broad immune response even around 18 months after a COVID-19 diagnosis.
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Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, 25159, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Jiyoung Park
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Jisu Hong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Jung Seon Seo
- Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Yung Hie Lee
- Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, South Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Department of Internal Medicine, Seoul Asan Medical Center, Seoul, 05505, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Yong-Woo Kim
- Wide River Institute of Immunology, Seoul National University, Hongcheon, 25159, South Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, South Korea
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, 25159, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, 08030, South Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, 03080, South Korea.
- BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, 03080, South Korea.
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, 03080, South Korea.
| | - Jun-Young Seo
- Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, 03722, South Korea.
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, South Korea
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Park DH, Lee E, Jung J, Kang CK, Song KH, Choe PG, Park WB, Bang JH, Kim ES, Kim HB, Park SW, Kim NJ, Oh MD. Changes in Anxiety Level and Personal Protective Equipment Use Among Healthcare Workers Exposed to COVID-19. J Korean Med Sci 2022; 37:e126. [PMID: 35470600 PMCID: PMC9039197 DOI: 10.3346/jkms.2022.37.e126] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The relationship between changes in anxiety levels and personal protective equipment (PPE) use is yet to be evaluated. The present study assessed this relationship among healthcare workers (HCWs) involved in the care of patients with coronavirus disease 2019 (COVID-19). METHODS An online survey was conducted in a municipal hospital with 195 nationally designated negative pressure isolation units in Korea. Anxiety level was measured using the self-rating anxiety scale (SAS), and changes in anxiety levels were assessed based on the time when COVID-19 vaccine was introduced in March 2021 in Korea. Monthly PPE usage between June 2020 and May 2021 was investigated. RESULTS The mean SAS score (33.25 ± 5.97) was within normal range and was lower than those reported in previous studies conducted before COVID-19 vaccination became available. Among the 93 HCWs who participated, 64 (68.8%) answered that their fear of contracting COVID-19 decreased after vaccination. The number of coveralls used per patient decreased from 33.6 to 0. However, a demand for more PPE than necessary was observed in situations where HCWs were exposed to body fluids and secretions (n = 38, 40.9%). Excessive demand for PPE was not related to age, working experience, or SAS score. CONCLUSION Anxiety in HCWs exposed to COVID-19 was lower than it was during the early period of the pandemic, and the period before vaccination was introduced. The number of coveralls used per patient also decreased although an excessive demand for PPE was observed.
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Affiliation(s)
- Do Hyeon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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40
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Kang CK, Kim M, Hong J, Kim G, Lee S, Chang E, Choe PG, Kim NJ, Kim IS, Seo JY, Song D, Lee DS, Shin HM, Kim YW, Lee CH, Park WB, Kim HR, Oh MD. Distinct Immune Response at 1 Year Post-COVID-19 According to Disease Severity. Front Immunol 2022; 13:830433. [PMID: 35392102 PMCID: PMC8980227 DOI: 10.3389/fimmu.2022.830433] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/07/2021] [Accepted: 02/23/2022] [Indexed: 01/10/2023] Open
Abstract
Background Despite the fact of ongoing worldwide vaccination programs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), understanding longevity, breadth, and type of immune response to coronavirus disease-19 (COVID-19) is still important to optimize the vaccination strategy and estimate the risk of reinfection. Therefore, we performed thorough immunological assessments 1 year post-COVID-19 with different severity. Methods We analyzed peripheral blood mononuclear cells and plasma samples at 1 year post-COVID-19 in patients who experienced asymptomatic, mild, and severe illness to assess titers of various isotypes of antibodies (Abs) against SARS-CoV-2 antigens, phagocytic capability, and memory B- and T-cell responses. Findings A total of 24 patients (7, 9, and 8 asymptomatic, mild, and severe patients, respectively) and eight healthy volunteers were included in this study. We firstly showed that disease severity is correlated with parameters of immune responses at 1 year post-COVID-19 that play an important role in protecting against reinfection with SARS-CoV-2, namely, the phagocytic capacity of Abs and memory B-cell responses. Interpretation Various immune responses at 1 year post-COVID-19, particularly the phagocytic capacity and memory B-cell responses, were dependent on the severity of the prior COVID-19. Our data could provide a clue for a tailored vaccination strategy after natural infection according to the severity of COVID-19.
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Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Jisu Hong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
| | - Gwanghun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Soojin Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ik Soo Kim
- Department of Microbiology, School of Medicine, Gachon University, Incheon, South Korea
| | - Jun-Young Seo
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Daesub Song
- College of Pharmacy, Korea University, Sejong, South Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Yong-Woo Kim
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
- *Correspondence: Hang-Rae Kim, ; Wan Beom Park, ; Chang-Han Lee,
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- *Correspondence: Hang-Rae Kim, ; Wan Beom Park, ; Chang-Han Lee,
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anatomy & Cell Biology, Seoul National University College of Medicine, Seoul, South Korea
- BrainKorea21 (BK21) FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, South Korea
- Medical Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, South Korea
- *Correspondence: Hang-Rae Kim, ; Wan Beom Park, ; Chang-Han Lee,
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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Choe PG, Hong J, Park J, Chang E, Kang CK, Kim NJ, Lee CH, Park WB, Oh MD. Persistent Antibody Responses up to 18 Months after Mild SARS-CoV-2 Infection. J Infect Dis 2022; 226:1224-1230. [PMID: 35299253 PMCID: PMC8992248 DOI: 10.1093/infdis/jiac099] [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: 12/06/2021] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background Humoral immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may wane rapidly in persons recovered from mild coronavirus disease 2019 (COVID-19), but little is known about the longevity. Methods Serum samples were obtained 8, 12, and 18 months after infection from 20 patients with mild COVID-19. The binding activities of serum antibodies (IgA, IgG, and IgM) against SARS-CoV-2 antigens of the Wuhan-1 reference strain (wild-type) and the B.1.1.7, P.1, B.1.167.2, and B.1.1.529 variants were measured by enzyme-linked immunosorbent assays. Neutralizing antibody titers were measured using a cytopathic effect-based live virus neutralization assay. Results Serum IgA and IgG antibodies against spike or receptor-binding domain (RBD) protein of wild-type SARS-CoV-2 were detected for up to 18 months, and neutralizing antibodies persisted for 8 to 18 months after infection. However, any significant antibody responses against RBD proteins of SARS-CoV-2 variants were not observed, and median neutralizing antibody titers against the Delta variant at 8, 12, and 18 months were 8–11 fold lower than against wild-type viruses (P < .001). Conclusions Humoral immunity persisted for up to 18 months after SARS-CoV-2 infection in patients with mild COVID-19. Humoral immune activity against more recently circulating variants, however, was reduced in this population.
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Affiliation(s)
- Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jisu Hong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiyoung Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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42
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Kang CK, Kim M, Lee S, Kim G, Choe PG, Park WB, Kim NJ, Lee CH, Kim IS, Jung K, Lee DS, Shin HM, Kim HR, Oh MD. Corrigendum to: Longitudinal Analysis of Human Memory T-Cell Response According to the Severity of Illness up to 8 Months After Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Infect Dis 2022; 227:1113-1114. [PMID: 35258550 PMCID: PMC9383586 DOI: 10.1093/infdis/jiab557] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minji Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soojin Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gwanghun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang-Han Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Pharmacology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Ik Soo Kim
- Department of Microbiology, School of Medicine, Gachon University, Incheon, Republic of Koreaand
| | - Keehoon Jung
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21 FOUR Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Choe PG, Kim Y, Chang E, Kang CK, Kim NJ, Cho NH, Park WB, Oh MD. Kinetics of Neutralizing Antibody Responses Against SARS-CoV-2 Delta Variant in Patients Infected at the Beginning of the Pandemic. J Korean Med Sci 2022; 37:e67. [PMID: 35226425 PMCID: PMC8885454 DOI: 10.3346/jkms.2022.37.e67] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022] Open
Abstract
We investigated the kinetics of the neutralizing antibody responses to the severe acute respiratory syndrome-coronavirus-2 delta variant over the course of 1 year in 16 patients infected at the beginning of the pandemic. In patients with severe disease, neutralizing responses to the delta variant were detectable, albeit at lower levels than responses to the wild type. Neutralizing responses to the delta variant were undetectable, however, in asymptomatic persons. This finding implies that the vaccination strategy for persons with past natural infection should depend on the severity of the previous infection.
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Affiliation(s)
- Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yuri Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam-Hyuk Cho
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea.
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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44
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Bae NY, Byun JM, Kang CK, Choe PG, Kim NJ, Kim MS, Park KJ, Yoon SS. Successful treatment of angioinvasive aspergillosis causing diaphragmatic rupture with bowel perforation and cerebral aspergillosis in a patient with FLT3-mutated acute myeloid leukemia: A case report. Medicine (Baltimore) 2022; 101:e28700. [PMID: 35089228 PMCID: PMC8797513 DOI: 10.1097/md.0000000000028700] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Throughout the clinical course of acute myeloid leukemia (AML), aspergillosis infection remains a significant determinant of treatment outcomes and survival. To emphasize the importance of early diagnosis and appropriate application of integrated therapeutic approaches, we present a case of AML patient who survived through angioinvasive aspergillosis infection causing diaphragmatic rupture with bowel perforation and cerebral aspergillosis during active AML treatment. PATIENT CONCERNS A 39-year old male with FLT3-mutated AML was transferred to our hospital due to persistent fever after induction therapy. DIAGNOSIS AND INTERVENTIONS During voriconazole treatment for his invasive pulmonary aspergillosis, the patient was diagnosed with colon perforation at splenic flexure and suspected perforation of left diaphragm with communication with left pleural space. Although pancytopenic, emergency laparotomy was performed with granulocyte transfusion. Also, dual antifungal therapy with voriconazole and micafungin was applied. With supportive care, he was able to successfully complete 3 cycles of consolidation using tyrosine kinase inhibitor. However, 80 days after the last chemotherapy, the patient experienced seizure caused by a single 1.5 cm sized enhancing mass in the right occipital lobe. Diagnostic and therapeutic mass removal was carried out, and pathology-confirmed cerebral aspergillosis was diagnosed. OUTCOMES The patient's neurologic symptoms are resolved and he is leukemia free, but remains on voriconazole for his cerebral aspergillosis till this day. CONCLUSIONS Our case highlights the importance of timely integrated intervention and adequate underlying disease control in treatment of invasive aspergillosis in immunocompromised patients. Such rigorous efforts can save even the most seemingly dismal case.
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Affiliation(s)
- Nan Young Bae
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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45
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Choi SJ, Jung J, Kim ES, Kim HB, Park JS, Park KU, Lee H, Lee E, Choe PG, Kim JY, Lee EJ, Song KH. Diagnostic Performance, Stability, and Usability of Self-Collected Combo Swabs and Saliva for Coronavirus Disease 2019 Diagnosis: A Case-Control Study. Infect Chemother 2022; 54:517-528. [PMID: 36196610 PMCID: PMC9533156 DOI: 10.3947/ic.2022.0081] [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: 06/04/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background Self-sampling procedures to detect severe acute respiratory syndrome coronavirus 2 is important for patients who have difficulty visiting the hospital and may decrease the burden for health care workers (HCWs). The objective of this study was to evaluate the diagnostic performance, stability and usability of self-collected nasal and oral combo swabs and saliva specimens. Materials and Methods We conducted a case-control study with 50 patients with coronavirus disease 2019 (COVID-19) and 50 healthy volunteers from March, 2021 to June, 2021. We performed real-time reverse-transcription polymerase chain reaction to compare the diagnostic performance of self-collected specimens using positive percent agreements (PPAs). Results The PPAs between self-collected and HCW-collected specimens were 77.3 - 81.0% and 80.5 -86.7% for the combo swabs and saliva specimens, respectively. The PPAs increased to 88.9 - 89.2% and 81.2 - 82.1% with a cycle threshold value ≤30. Conclusion The diagnostic performance of self sampling was comparable to that of HCW sampling in patients with high viral loads and may thus assist in the early diagnosis of COVID-19.
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Affiliation(s)
- Seong Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Yeon Kim
- Department of Internal Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Eun Joo Lee
- Department of Pediatrics, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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46
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Kim SH, Choi Y, Lee D, Lee H, Kim JH, Choi ES, Jung YM, Lee J, Choe PG, Lee JY, Do Y, Park CW, Park JS, Jun JK, Lee SM, Lee JY. Impact of COVID-19 on pregnant women in South Korea: focusing on prevalence, severity, and clinical outcomes. J Infect Public Health 2022; 15:270-276. [PMID: 35066387 PMCID: PMC8761582 DOI: 10.1016/j.jiph.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 02/09/2023] Open
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47
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Jung J, Choe PG, Choi S, Kim E, Lee HY, Kang CK, Lee J, Park WB, Lee S, Kim NJ, Choi EH, Oh M. Reduction in the acquisition rate of carbapenem-resistant Acinetobacter baumannii (CRAB) after room privatization in an intensive care unit. J Hosp Infect 2021; 121:14-21. [PMID: 34929231 DOI: 10.1016/j.jhin.2021.12.012] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acinetobacter baumannii is one of the major pathogens responsible for healthcare-associated infections, especially in intensive care units (ICUs). AIM To evaluate the effect of room privatization in an ICU on the acquisition of carbapenem-resistant A. baumannii (CRAB). METHODS Between March and August 2017, a medical ICU was renovated from a multibed bay room to single rooms. Acquisition of CRAB was compared between patients admitted to the ICU over 18 months pre-renovation (September 2015 to February 2017) and post-renovation (September 2017 to February 2019). A Cox proportional hazard model was used with adjustment for demographics and comorbidities. FINDINGS Of the 901 patients, who contributed 8,276 patient-days, 95 (10.5%) acquired CRAB during their ICU stay. The CRAB acquisition rate was significantly higher during the pre-renovation period (1.87 per 100 patient-days) than during the post-renovation period (0.39 per 100 patient-days) (P < 0.001). In the multivariable Cox regression model, CRAB acquisition was significantly associated with the presence of a feeding tube (adjusted hazard ratio [aHR], 6.08; 95% confidence interval [CI], 2.46-15.06; P < 0.001), continuous renal replacement therapy (aHR, 1.66; 95% CI, 1.09-2.53; P = 0.019) and admission after renovation of the ICU to single rooms (aHR, 0.23; 95% CI, 0.12-0.41; P < 0.001). CONCLUSIONS Renovation of ICUs to single rooms is an efficient strategy to prevent transmission of multidrug-resistant organisms and hospital-acquired infections.
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Affiliation(s)
- J Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - P G Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea.
| | - S Choi
- Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
| | - E Kim
- Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
| | - H Y Lee
- Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
| | - C K Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
| | - J Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - W B Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
| | - S Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - N J Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
| | - E H Choi
- Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - M Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Infection Control and Prevention, Seoul National University Hospital, Seoul, Republic of Korea
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48
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Choe PG, Jeong SI, Kang CK, Yang L, Lee S, Cho JY, Han SS, Kim DK, Lee SM, Park WB, Oh MD, Kim NJ. Exploration for the effect of renal function and renal replacement therapy on pharmacokinetics of remdesivir and GS-441524 in patients with COVID-19: A limited case series. Clin Transl Sci 2021; 15:732-740. [PMID: 34761554 PMCID: PMC8652615 DOI: 10.1111/cts.13194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/07/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022] Open
Abstract
Remdesivir, an antiviral agent for the treatment of coronavirus disease 2019 (COVID‐19), is metabolized intracellularly, with these metabolites eliminated predominantly in urine. Because of a lack of safety and pharmacokinetic (PK) data, remdesivir is not currently recommended for patients with estimated glomerular filtration rate less than 30 ml/min/1.73 m2 and those on hemodialysis. This study evaluated the PKs of remdesivir and its metabolite, GS‐441524, in patients with COVID‐19 who were and were not receiving renal replacement therapy (RRT). This study enrolled two patients with normal renal function, two with impaired renal function not receiving RRT, two receiving continuous RRT (CRRT), and three undergoing intermittent hemodialysis (IHD). Patients were administered 200 mg remdesivir on the first day, followed by 100 mg/day for 5–10 days. Serial blood samples were collected for PK analysis, and PK parameters were assessed by a noncompartmental method. Systemic exposure to remdesivir was higher in patients with impaired renal function and those receiving CRRT than in patients with normal renal function, but was similar in patients undergoing IHD and those with normal renal function. By contrast, systemic exposure to GS‐441524 was highest in patients undergoing IHD, followed by patients with impaired renal function and those receiving CRRT, and lowest in patients with normal renal function. The PK profiles of remdesivir and GS‐441524 varied according to renal function and RRT. The impact of PK changes of remdesivir and its metabolite on safety and efficacy should be considered when administering remdesivir to patients with COVID‐19 with renal impairment.
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Affiliation(s)
- Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sae Im Jeong
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Liju Yang
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Sang Min Lee
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Hospital, Seoul, Korea
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Hwang YH, Song KH, Choi Y, Go S, Choi SJ, Jung J, Kang CK, Choe PG, Kim NJ, Park WB, Oh MD. Can reactogenicity predict immunogenicity after COVID-19 vaccination? Korean J Intern Med 2021; 36:1486-1491. [PMID: 34038996 PMCID: PMC8588964 DOI: 10.3904/kjim.2021.210] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 04/29/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to assess the association between local and systemic reactogenicity and humoral immunogenicity after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. METHODS Adverse events were prospectively evaluated using an electronic diary in 135 healthy adults who received a SARS-CoV-2 vaccine (AZD1222, AstraZeneca/Oxford, n = 42; or BNT162b2, Pfizer/BioNTech, n = 93). We semi-quantitatively measured anti-S1 immunoglobulin G (IgG) using an enzyme-linked immunosorbent assay at baseline, 3 weeks after the first dose of AZD1222 or BNT162b2, and 2 weeks after the second dose of BNT162b2. We evaluated the association between the maximum grade of local or systemic adverse events and the anti-S1 IgG optical density using multivariate linear regression with adjustment for age, sex, and use of antipyretics. RESULTS The median age of the 135 vaccinees was 30 years (36 years in the AZD1222 group and 29 years in the BNT162b2 group) and 25.9% were male (9.5% in the AZD1222 group and 33.3% in the BNT162b2 group). Local and systemic adverse events were generally comparable after the first dose of AZD1222 and the second dose of BNT162b2. The grades of local and systemic adverse events were not significantly associated with anti-S1 IgG levels in the AZD1222 or BNT162b2 group. CONCLUSION Local and systemic reactogenicity may not be associated with humoral immunogenicity after SARS-CoV-2 vaccination.
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Affiliation(s)
- Young Hoon Hwang
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Yunsang Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Suryeong Go
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Su-Jin Choi
- Laboratory of Infection & Immunity, Seoul National University Hospital Biomedical Research Institute, Seoul,
Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Nam-Joong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Myoung-don Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
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Bolton KL, Koh Y, Foote MB, Im H, Jee J, Sun CH, Safonov A, Ptashkin R, Moon JH, Lee JY, Jung J, Kang CK, Song KH, Choe PG, Park WB, Kim HB, Oh MD, Song H, Kim S, Patel M, Derkach A, Gedvilaite E, Tkachuk KA, Wiley BJ, Chan IC, Braunstein LZ, Gao T, Papaemmanuil E, Esther Babady N, Pessin MS, Kamboj M, Diaz LA, Ladanyi M, Rauh MJ, Natarajan P, Machiela MJ, Awadalla P, Joseph V, Offit K, Norton L, Berger MF, Levine RL, Kim ES, Kim NJ, Zehir A. Clonal hematopoiesis is associated with risk of severe Covid-19. Nat Commun 2021; 12:5975. [PMID: 34645798 PMCID: PMC8514469 DOI: 10.1038/s41467-021-26138-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [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] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/10/2021] [Indexed: 01/08/2023] Open
Abstract
Acquired somatic mutations in hematopoietic stem and progenitor cells (clonal hematopoiesis or CH) are associated with advanced age, increased risk of cardiovascular and malignant diseases, and decreased overall survival. These adverse sequelae may be mediated by altered inflammatory profiles observed in patients with CH. A pro-inflammatory immunologic profile is also associated with worse outcomes of certain infections, including SARS-CoV-2 and its associated disease Covid-19. Whether CH predisposes to severe Covid-19 or other infections is unknown. Among 525 individuals with Covid-19 from Memorial Sloan Kettering (MSK) and the Korean Clonal Hematopoiesis (KoCH) consortia, we show that CH is associated with severe Covid-19 outcomes (OR = 1.85, 95%=1.15-2.99, p = 0.01), in particular CH characterized by non-cancer driver mutations (OR = 2.01, 95% CI = 1.15-3.50, p = 0.01). We further explore the relationship between CH and risk of other infections in 14,211 solid tumor patients at MSK. CH is significantly associated with risk of Clostridium Difficile (HR = 2.01, 95% CI: 1.22-3.30, p = 6×10-3) and Streptococcus/Enterococcus infections (HR = 1.56, 95% CI = 1.15-2.13, p = 5×10-3). These findings suggest a relationship between CH and risk of severe infections that warrants further investigation.
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Affiliation(s)
- Kelly L Bolton
- Department of Medicine, Washington University, St Louis, MO, USA.
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Genome Opinion Inc., Seoul, Korea
- Center for Precision Medicine, Seoul National University Hospital, Seoul, Korea
| | - Michael B Foote
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Justin Jee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Anton Safonov
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ryan Ptashkin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joon Ho Moon
- Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Yeon Lee
- Department of Internal Medicine, National Medical Center, Seoul, Korea
| | - Jongtak Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Han Song
- Genome Opinion Inc., Seoul, Korea
| | | | - Minal Patel
- Center for Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andriy Derkach
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erika Gedvilaite
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaitlyn A Tkachuk
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian J Wiley
- Department of Medicine, Washington University, St Louis, MO, USA
| | - Ireaneus C Chan
- Department of Medicine, Washington University, St Louis, MO, USA
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Teng Gao
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elli Papaemmanuil
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Esther Babady
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa S Pessin
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mini Kamboj
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Luis A Diaz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Rauh
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mitchell J Machiela
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Vijai Joseph
- Clinical Genetics Research Lab, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kenneth Offit
- Clinical Genetics Research Lab, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larry Norton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Computational Oncology Service, Department of Epidemiology & Biostatistics, Center for Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ross L Levine
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Ahmet Zehir
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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