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1.
J Korean Med Sci ; 39(12): e118, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38565175

RESUMEN

BACKGROUND: Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. METHODS: To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. RESULTS: In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patient-days was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25-12.05) and 4.18 per 1,000 admissions (range: 1.92-8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68-13.90) and 6.73 per 1,000 admissions (range: 3.18-15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. CONCLUSION: The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.


Asunto(s)
Clostridioides difficile , Infecciones por Clostridium , Infección Hospitalaria , Humanos , Estudios Prospectivos , Incidencia , Espera Vigilante , Infección Hospitalaria/epidemiología , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/epidemiología , República de Corea/epidemiología , Centros de Atención Terciaria , Seguro de Salud
2.
J Korean Med Sci ; 38(42): e347, 2023 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-37904658

RESUMEN

BACKGROUND: In this study, we aimed to compare the effectiveness and adverse reactions of nirmatrelvir/ritonavir and molnupiravir in high-risk outpatients with coronavirus disease 2019 (COVID-19). METHODS: This multicenter prospective observational study evaluated the rate of hospitalization, death, and adverse events within 28 days of oral antiviral agent prescription (molnupiravir, n = 240; nirmatrelvir/ritonavir, n = 240) to 480 nonhospitalized adult patients with COVID-19 from August 2, 2022 to March 31, 2023. RESULTS: Patients receiving molnupiravir had a higher prevalence of comorbidities (85.8% vs. 70.4%; P < 0.001) and a higher Charlson comorbidity index (2.8 ± 1.4 vs. 2.5 ± 1.5; P = 0.009) than those receiving nirmatrelvir/ritonavir. Three patients required hospitalization (nirmatrelvir/ritonavir group, n = 1 [0.4%]; molnupiravir group, n = 2 [0.8%]; P = 1.000). Nirmatrelvir/ritonavir was associated with a higher risk of adverse events than molnupiravir (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.27-3.03), especially for patients aged 65 years and older (OR, 3.04; 95% CI, 1.71-5.39). The severity of adverse events in both groups was mild to moderate and improved after discontinuation of medication. In the molnupiravir group, age ≥ 65 years (OR, 0.43 95% CI, 0.22-0.86) and appropriate vaccination (OR, 0.37; 95% CI, 0.15-0.91) reduced the occurrence of adverse events. CONCLUSION: The rates of hospitalization and death were low and not significantly different between high-risk patients who received either nirmatrelvir/ritonavir or molnupiravir. Although adverse events were more frequent with nirmatrelvir/ritonavir than with molnupiravir, none were severe. Nirmatrelvir/ritonavir can be safely used to treat COVID-19, while molnupiravir could be considered as an alternative treatment option for high-risk groups.


Asunto(s)
COVID-19 , Pacientes Ambulatorios , Adulto , Humanos , Ritonavir/efectos adversos , Tratamiento Farmacológico de COVID-19 , Antivirales/efectos adversos
3.
Infection ; 45(1): 67-74, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-27541039

RESUMEN

PURPOSE: Various immunocompromised conditions increase the risk of meningitis caused by Listeria monocytogenes. However, the relative importance of these risk factors has not been well established. We determined the risk factors that predict meningitis due to L. monocytogenes compared to that caused by Streptococcus pneumoniae. METHODS: A nationwide multicenter case-control study was conducted in Korea. Cases of meningitis caused by L. monocytogenes between 1998 and 2013 were included. Patients with pneumococcal meningitis were included as controls. Multivariate logistic regression analysis was used to predict the risk factors of Listeria meningitis. RESULTS: A total of 36 cases and 113 controls were enrolled. The most significant predictive risk factor of Listeria meningitis was a prior history of receiving immunosuppressive therapy (odds ratio 8.12, 95 % CI 2.47-26.69). Chronic liver disease was the second most important predictive risk factor (OR 5.03, 95 % CI 1.56-16.22). Delaying appropriate antibiotic therapy by more than 6 h (hazard ratio 2.78) and fatal underlying disease (hazard ratio 2.88) were associated with increased mortality. CONCLUSIONS: Patients with a prior history of receiving immunosuppressive therapy within 1 month and chronic liver disease have 8.1-fold and 5-fold increased risk of meningitis by L. monocytogenes compared to S. pneumoniae, respectively.


Asunto(s)
Listeria monocytogenes , Meningitis por Listeria/epidemiología , Meningitis Neumocócica/epidemiología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Factores de Riesgo , Resultado del Tratamiento
4.
BMC Infect Dis ; 17(1): 404, 2017 06 07.
Artículo en Inglés | MEDLINE | ID: mdl-28592240

RESUMEN

BACKGROUND: Due to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern. We conducted a prospective, randomized, open-label comparison of the therapeutic efficacy of piperacillin-tazobactam (PTZ), cefepime, and ertapenem in febrile nosocomial urinary tract infection with ESBL-producing Escherichia coli (ESBL-EC). METHODS: This study was conducted at three university hospitals between January 2013 and August 2015. Hospitalized adult patients presenting with fever were screened for healthcare-associated urinary tract infection (HA-UTI). When ESBL-EC was solely detected and susceptible to a randomized antibiotic in vitro, the case was included in the final analysis. Participants were treated for 10-14 days with PTZ, cefepime, or ertapenem. RESULTS: A total of 66 participants were evenly assigned to the PTZ and ertapenem treatment groups. After the recruitment of six participants, assignment to the cefepime treatment group was stopped because of an unexpectedly high treatment failure rate. The baseline characteristics of these participants did not differ from participants in other treatment groups. The clinical and microbiological response to PTZ treatment was estimated to be 94% and was similar to the response to ertapenem treatment. The efficacy of cefepime was 33.3%. In the cefepime group, age, Charlson comorbidity index, genotype, and minimal inhibitory concentration (MIC) did not significantly affect the success of treatment. Similarly, genotype seemed to be irrelevant with respect to clinical outcome in the PTZ group. Expired cases tended to involve septic shock with a high Charlson comorbidity index and high MIC. CONCLUSION: Results from this study suggest that PTZ is effective in the treatment of urinary tract infection caused by ESBL-EC when the in vitro test indicates susceptibility. In addition, cefepime should not be used as an alternative treatment for urinary tract infection caused by ESBL-EC. TRIAL REGISTRATION: The trial was registered with the Clinical Research Information Service of Korea Centers for Disease Control and Prevention. (KCT0001895).


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Escherichia coli/tratamiento farmacológico , Escherichia coli/efectos de los fármacos , Ácido Penicilánico/análogos & derivados , Infecciones Urinarias/tratamiento farmacológico , Inhibidores de beta-Lactamasas/uso terapéutico , Anciano , Anciano de 80 o más Años , Cefepima , Cefalosporinas/uso terapéutico , Infección Hospitalaria , Ertapenem , Escherichia coli/enzimología , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Ácido Penicilánico/uso terapéutico , Piperacilina/uso terapéutico , Combinación Piperacilina y Tazobactam , Estudios Prospectivos , República de Corea , Tazobactam , Infecciones Urinarias/microbiología , beta-Lactamasas/genética , beta-Lactamas/uso terapéutico
5.
BMC Infect Dis ; 16: 331, 2016 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-27418274

RESUMEN

BACKGROUND: The purported value of empirical therapy to cover methicillin-resistant Staphylococcus aureus (MRSA) has been debated for decades. The purpose of this study was to evaluate the effects of inappropriate empirical antibiotic therapy on clinical outcomes in patients with healthcare-associated MRSA bacteremia (HA-MRSAB). METHODS: A prospective, multicenter, observational study was conducted in 15 teaching hospitals in the Republic of Korea from February 2010 to July 2011. The study subjects included adult patients with HA-MRSAB. Covariate adjustment using the propensity score was performed to control for bias in treatment assignment. The predictors of in-hospital mortality were determined by multivariate logistic regression analyses. RESULTS: In total, 345 patients with HA-MRSAB were analyzed. The overall in-hospital mortality rate was 33.0 %. Appropriate empirical antibiotic therapy was given to 154 (44.6 %) patients. The vancomycin minimum inhibitory concentrations of the MRSA isolates ranged from 0.5 to 2 mg/L by E-test. There was no significant difference in mortality between propensity-matched patient pairs receiving inappropriate or appropriate empirical antibiotics (odds ratio [OR] = 1.20; 95 % confidence interval [CI] = 0.71-2.03). Among patients with severe sepsis or septic shock, there was no significant difference in mortality between the treatment groups. In multivariate analyses, severe sepsis or septic shock (OR = 5.45; 95 % CI = 2.14-13.87), Charlson's comorbidity index (per 1-point increment; OR = 1.52; 95 % CI = 1.27-1.83), and prior receipt of glycopeptides (OR = 3.24; 95 % CI = 1.08-9.67) were independent risk factors for mortality. CONCLUSION: Inappropriate empirical antibiotic therapy was not associated with clinical outcome in patients with HA-MRSAB. Prudent use of empirical glycopeptide therapy should be justified even in hospitals with high MRSA prevalence.


Asunto(s)
Antibacterianos/farmacología , Bacteriemia/mortalidad , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Vancomicina/farmacología , Adulto , Anciano , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Estudios de Casos y Controles , Infección Hospitalaria/microbiología , Femenino , Mortalidad Hospitalaria , Hospitales Universitarios , Humanos , Modelos Logísticos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Puntaje de Propensión , Estudios Prospectivos , República de Corea , Factores de Riesgo , Sepsis/tratamiento farmacológico , Sepsis/mortalidad , Vancomicina/uso terapéutico
6.
Antimicrob Agents Chemother ; 58(1): 317-24, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24165181

RESUMEN

The purpose of this study was to compare the clinical efficacy and safety of vancomycin to those of teicoplanin for the treatment of adult patients with health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) bacteremia. A multicenter observational study was prospectively conducted in 15 teaching hospitals in Korea between February 2010 and July 2011. Adult patients (≥18 years old) with HA-MRSA bacteremia who were initially treated with vancomycin (VAN) (n = 134) or teicoplanin (TEC) (n = 56) were enrolled. Clinical and microbiological responses and drug-related adverse events were compared between the two treatment groups using univariate and multivariate logistic regression analyses. The vancomycin and teicoplanin MICs were determined by Etest. The MRSA-related mortality, duration of fever, and duration of MRSA bacteremia in the treatment groups were not significantly different. There was no significant difference in the occurrence of drug-related adverse events. Among the 190 MRSA isolates, the VAN MICs ranged from 0.5 to 2 µg/ml (MIC50 and MIC90, 1.5 µg/ml), and the TEC MIC ranged from 0.5 to 8 µg/ml (MIC50, 3 µg/ml; MIC90, 6 µg/ml). In multivariate analyses, the antibiotic type (vancomycin or teicoplanin) was not associated with treatment outcomes. This study indicates that teicoplanin is an effective and safe alternative to vancomycin for the treatment of HA-MRSA bacteremia.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Teicoplanina/uso terapéutico , Vancomicina/uso terapéutico , Anciano , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Estudios Prospectivos , Resultado del Tratamiento
7.
Gut Microbes ; 16(1): 2341635, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38634770

RESUMEN

Carbapenem-resistant Enterobacteriaceae (CRE) pose a global health threat; however, there is still limited understanding of the risk factors and underlying mechanisms of CRE colonization in the gut microbiome. We conducted a matched case-control study involving 282 intensive care unit patients to analyze influencing covariates on CRE colonization. Subsequently, their effects on the gut microbiome were analyzed in a subset of 98 patients (47 CRE carriers and 51 non-CRE carriers) using whole metagenome sequences. The concomitant use of proton pump inhibitors (PPIs) and antibiotics was a significant risk factor for CRE colonization. The gut microbiome differed according to PPI administration, even within the CRE and non-CRE groups. Moreover, the transfer of mobile genetic elements (MGEs) harboring carbapenem resistance genes (CRGs) between bacteria was higher in the PPI-treated group than in the PPI-not-treated group among CRE carriers. The concomitant use of PPIs and antibiotics significantly alters the gut microbiome and increases the risk of CRE colonization by facilitating the transfer of CRGs among bacteria of the gut microbiome. Based on these findings, improved stewardship of PPIs as well as antibiotics can provide strategies to reduce the risk of CRE colonization, thereby potentially improving patient prognosis.


Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos , Microbioma Gastrointestinal , Humanos , Inhibidores de la Bomba de Protones , Estudios de Casos y Controles , Bacterias , Antibacterianos , Farmacorresistencia Microbiana
8.
Am J Trop Med Hyg ; 111(3): 661-670, 2024 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-38981464

RESUMEN

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infection with a high case fatality rate. The serious clinical features need to be further defined. We performed a retrospective analysis among SFTS patients in South Korea during 2016-2021 to update the current status. The basic epidemiology of all reported cases was analyzed, and the detailed clinical data of the subjects were further collected from study hospitals selected in terms of their geographic location and capability of SFTS care. Cases of SFTS were reported across the country and were greatly increased since the initial endemic phase, even under the passive surveillance system. The case fatality rate remained at approximately 16.8%. Coinfections at admission were present in 7.8% of the patients. Major complications included bleeding (15.2%), hemophagocytic lymphohistiocytosis (6.7%), bacteremia or candidemia (4.0%), and invasive pulmonary aspergillosis (1.7%). It took a median 4 days from the onset of illness to hospital admission. Rapid clinical deterioration was observed with a median 1 day for intensive care unit admission, 3 days for mechanical ventilation, 4 days for renal replacement therapy, and 5 days for death, all after the hospitalization. Multivariate analysis showed that the fatality was associated with older age, bacteremia, or candidemia during hospitalization, and the presence of several variables at admission such as fever, altered mentality, aspartate aminotransferase >200 IU/L, serum creatinine level >1.2 mg/dL, and prolonged prothrombin time and activated partial thromboplastin time. Treatment options to improve clinical outcomes are limited, despite best supportive care. Specific treatment is urgently needed to change the fatal course.


Asunto(s)
Síndrome de Trombocitopenia Febril Grave , Humanos , República de Corea/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Síndrome de Trombocitopenia Febril Grave/epidemiología , Adulto , Progresión de la Enfermedad , Anciano de 80 o más Años , Hemorragia/epidemiología , Hemorragia/etiología , Phlebovirus , Bacteriemia/epidemiología , Bacteriemia/microbiología , Bacteriemia/mortalidad
9.
Scand J Infect Dis ; 44(6): 419-26, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22385095

RESUMEN

BACKGROUND: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. We conducted a multicentre case-control study to determine the risk factors for SSI in patients undergoing gastric surgery and to establish strategies to reduce the risk of SSI. METHODS: Between January 2007 and December 2008, 121 patients who developed an SSI after gastric surgery were matched with controls who had undergone surgery on the dates closest to those of the cases, at 13 centres in Korea. RESULTS: The results of multivariate analyses showed that the independent risk factors for SSI after gastric surgery were older age (p = 0.016), higher body mass index (BMI) (p = 0.033), male gender (p = 0.047), and longer duration of prophylactic antibiotic use (p < 0.001). CONCLUSION: Older age, higher BMI, male gender, and longer duration of prophylactic antibiotic use were independently associated with significant increases in the risk of SSI. Additional prospective randomized studies are required to confirm these results.


Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Gastropatías/cirugía , Infección de la Herida Quirúrgica/epidemiología , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea/epidemiología , Factores de Riesgo
10.
J Glob Antimicrob Resist ; 31: 45-51, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35981691

RESUMEN

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.


Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Bacteriemia , Humanos , Infecciones por Acinetobacter/microbiología , Carbapenémicos/farmacología , Pruebas de Sensibilidad Microbiana , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacteriemia/microbiología , Factores de Riesgo
11.
J Glob Antimicrob Resist ; 31: 379-385, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-36400408

RESUMEN

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.


Asunto(s)
Acinetobacter baumannii , Bacteriemia , Enterobacteriaceae Resistentes a los Carbapenémicos , Staphylococcus aureus Resistente a Meticilina , Enterococos Resistentes a la Vancomicina , Humanos , Farmacorresistencia Bacteriana Múltiple , Estudios de Casos y Controles , Estrés Financiero , Bacterias Gramnegativas , Pseudomonas aeruginosa , República de Corea/epidemiología
12.
Sci Rep ; 12(1): 13934, 2022 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-35978016

RESUMEN

We aimed to estimate the socioeconomic burden of pneumonia due to multidrug-resistant Acinetobacter baumannii (MRAB) and Pseudomonas aeruginosa (MRPA). We prospectively searched for MRAB and MRPA pneumonia cases and matched them with susceptible-organism pneumonia and non-infected patients from 10 hospitals. The matching criteria were: same principal diagnosis, same surgery or intervention during hospitalisation, age, sex, and admission date within 60 days. We calculated the economic burden by using the difference in hospital costs, the difference in caregiver costs, and the sum of productivity loss from an unexpected death. We identified 108 MRAB pneumonia [MRAB-P] and 28 MRPA pneumonia [MRPA-P] cases. The estimated number of annual MRAB-P and MRPA-P cases in South Korea were 1309-2483 and 339-644, with 485-920 and 133-253 deaths, respectively. The annual socioeconomic burden of MRAB-P and MRPA-P in South Korea was $64,549,723-122,533,585 and $15,241,883-28,994,008, respectively. The results revealed that MRAB-P and MRPA-P occurred in 1648-3127 patients, resulted in 618-1173 deaths, and caused a nationwide socioeconomic burden of $79,791,606-151,527,593. Multidrug-resistant organisms (MDRO) impose a great clinical and economic burden at a national level. Therefore, controlling the spread of MDRO will be an effective measure to reduce this burden.


Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Neumonía , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/epidemiología , Antibacterianos/farmacología , Farmacorresistencia Bacteriana Múltiple , Humanos , Pruebas de Sensibilidad Microbiana , Neumonía/tratamiento farmacológico , Neumonía/epidemiología , Pseudomonas aeruginosa , Factores Socioeconómicos
13.
J Clin Med ; 10(2)2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33467637

RESUMEN

Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan-Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05-41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73-26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29-12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.

14.
Microorganisms ; 9(2)2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33578974

RESUMEN

Fecal microbiota transplantation (FMT) has been suggested as an alternative therapeutic option to decolonize carbapenem-resistant Enterobacteriaceae (CRE). However, the analysis of gut microbiota alteration in CRE carriers during FMT is still limited. Here, gut microbiota changes in CRE carriers were evaluated during FMT according to decolonization periods. The decolonization of 10 CRE carriers was evaluated after FMT, using serial consecutive rectal swab cultures. Alterations of gut microbiota before and after FMT (56 serial samples) were analyzed using high-throughput sequencing. The decolonization rates of CRE carriers were 40%, 50%, and 90% within 1, 3 and 5 months after initial FMT, respectively. Gut microbiota significantly changed after FMT (p = 0.003). Microbiota alteration was different between the early decolonization carriers (EDC) and late decolonization carriers (LDC). Microbiota convergence in carriers to donors was detected in EDC within 4 weeks, and keystone genera within the Bacteroidetes were found in the gut microbiota of EDC before FMT. The relative abundance of Klebsiella was lower in EDC than in LDC, before and after FMT. Our results indicate that FMT is a potential option for CRE decolonization. The gut microbiota of CRE carriers could be used to predict decolonization timing after FMT, and determine repeated FMT necessity.

15.
J Clin Microbiol ; 48(1): 311-3, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19889903

RESUMEN

Panton-Valentine leukocidin (PVL)-negative, SCCmec type IVa strains are the most common strains of methicillin-resistant Staphylococcus aureus (MRSA) circulating in the community in South Korea. This report describes five elderly patients presenting in 2006 to 2007 with invasive community-associated MRSA infection caused by a PVL-negative, SCCmec type IVa strain with sequence type 72 and spa type t324.


Asunto(s)
Toxinas Bacterianas/biosíntesis , Infecciones Comunitarias Adquiridas/microbiología , Exotoxinas/biosíntesis , Leucocidinas/biosíntesis , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Infecciones Estafilocócicas/microbiología , Anciano , Anciano de 80 o más Años , Toxinas Bacterianas/genética , Técnicas de Tipificación Bacteriana , Dermatoglifia del ADN , ADN Bacteriano/genética , Exotoxinas/genética , Femenino , Genotipo , Humanos , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Pruebas de Sensibilidad Microbiana , República de Corea
16.
Diagn Microbiol Infect Dis ; 94(1): 88-92, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30658867

RESUMEN

To find an alternative regimen for the treatment of extended-spectrum ß-lactamase (EBSL)-producing Enterobacteriaceae infections, we examined the in vitro activity of flomoxef against Escherichia coli and Klebsiella pneumoniae having CTX-M-1 group and/or CTX-M-9 group ESBLs. Boronic acid disk methods and polymerase chain reaction amplification were used to detect for ESBL, and AmpC ß-lactamase and AmpC ß-lactamase co-producers were excluded. Minimum inhibitory concentrations (MICs) were determined for flomoxef by broth microdilution. One hundred seventy-six isolates (E. coli, n = 93 and K. pneumoniae, n = 83) were analyzed for susceptibility test. A total of 94.3% (166/176) of isolates were susceptible to flomoxef (MIC50/MIC90 were 0.5/8 µg/mL); 98.9% of the ESBL-producing E. coli (MIC50/MIC90 were 1/4 µg/mL) and 89.2% of the ESBL-producing K. pneumoniae (MIC50/MIC90 were 0.5/16 µg/mL) were susceptible to flomoxef. Flomoxef has good in vitro activity against ESBL-producing E. coli and K. pneumoniae and could be considered as an alternative for infections caused by these organisms.


Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Proteínas de Escherichia coli/metabolismo , Escherichia coli/efectos de los fármacos , Klebsiella pneumoniae/efectos de los fármacos , beta-Lactamasas/metabolismo , Escherichia coli/enzimología , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Hospitales Universitarios , Humanos , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/aislamiento & purificación , Corea (Geográfico) , Pruebas de Sensibilidad Microbiana
17.
Infect Chemother ; 51(2): 217-243, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31271003

RESUMEN

Acute gastroenteritis is common infectious disease in community in adults. This work represents an update of 'Clinical guideline for the diagnosis and treatment of gastrointestinal infections' that was developed domestically in 2010. The recommendation of this guideline was developed regarding the following; epidemiological factors, test for diagnosis, the indications of empirical antibiotics, and modification of antibiotics after confirming pathogen. Ultimately, it is expected to decrease antibiotic misuse and prevent antibiotic resistance.

18.
Infect Chemother ; 51(3): 295-304, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31583863

RESUMEN

BACKGROUND: Acute infectious diarrhea (AID) is a commonly observed condition globally. Several studies recommend against the use of empiric antibiotic therapy for AID, except in some cases of travelers' diarrhea. However, many physicians prescribe antimicrobial agents for AID. We aimed to determine the rate of antibiotic use and the associated prescription patterns among adults with AID. MATERIALS AND METHODS: This population-based, retrospective epidemiological study was performed using Korean National Health Insurance claims data from 2016 to 2017. The study population comprised adults (age ≥18 years) who had visited clinics with AID-related complaints. Exclusion criteria were the presence of Crohn's disease, ulcerative colitis, irritable bowel syndrome, and other non-infectious forms of colitis. Patients who underwent surgery during admission were also excluded. RESULTS: The study population comprised 1,613,057 adult patients with AID (767,606 [47.6%] men). Young patients (age 18 - 39 years) accounted for 870,239 (54.0%) of the study population. Overall, 752,536 (46.7%) cases received antibiotic prescriptions. The rate of antibiotic administration tended to be higher among elderly patients (age ≥65 years) than among younger patients (49.5% vs. 46.4%, P <0.001). The antibiotics most frequently prescribed in both monotherapy and combination regimens were fluoroquinolones (29.8%), rifaximin (26.8%), second-generation cephalosporins (9.2%), third-generation cephalosporins (7.3%), trimethoprim/sulfamethoxazole (5.5%), and ß-lactam/ß-lactamase inhibitors (5.3%). Patients who visited tertiary care hospitals had lower rates of antibiotic therapy (n = 14,131, 41.8%) than did those visiting private clinics (n = 532,951, 47.1%). In total, 56,275 (62.3%) admitted patients received antibiotic therapy, whereas outpatients had lower rates of antibiotic prescription (n = 694,204, 46.0%). CONCLUSION: This study revealed differences between the antibiotics used to treat AID in Korea and those recommended by the guidelines for AID treatment. Multifaceted efforts are necessary to strengthen physicians' adherence to published guidelines.

19.
J Clin Microbiol ; 46(12): 4061-3, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-18971367

RESUMEN

Seventy-three liver abscess isolates of serotype K1 Klebsiella pneumoniae from a nationwide collection in Korea were genotypically characterized using pulsed-field gel electrophoresis and multilocus sequence typing. We found that serotype K1 K. pneumoniae strains that caused liver abscesses in Korea were genotypically related and that most were sequence type 23.


Asunto(s)
Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/aislamiento & purificación , Absceso Hepático/epidemiología , Absceso Hepático/microbiología , Análisis por Conglomerados , Dermatoglifia del ADN , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/inmunología , Corea (Geográfico)/epidemiología , Análisis de Secuencia de ADN , Serotipificación
20.
Am J Infect Control ; 44(12): 1520-1525, 2016 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-27520786

RESUMEN

BACKGROUND: Universal decolonization is recommended in intensive care units (ICUs) that have unacceptably high rates of methicillin-resistant Staphylococcus aureus (MRSA) despite implementation of basic prevention strategies. METHODS: An interrupted time series study was performed to evaluate the effect of daily chlorhexidine bathing on the acquisition of MRSA in a medical ICU with MRSA endemicity. There was a 14-month control period and a 16-month chlorhexidine bathing period. Segmented Poisson regression analysis was performed to assess the impact of daily chlorhexidine bathing on the incidence density of MRSA. Also, chlorhexidine susceptibility testing with polymerase chain reaction for the qacA/B gene was performed on MRSA isolates collected during the chlorhexidine bathing period. RESULTS: There was a significant reduction in trend (-0.056; 95% confidence interval, -0.095 to -0.017; P = .005) of incidence density of MRSA despite a significant increase in both level and trend of MRSA prevalence rates during the chlorhexidine bathing period. However, there was no significant reduction in level of incidence density of MRSA during the interventional period. Minimum inhibitory concentration of chlorhexidine and the detection rates of the qacA/B gene for a total of 174 MRSA isolates did not increase during the chlorhexidine bathing period. CONCLUSIONS: Daily chlorhexidine bathing resulted in a significantly decreasing trend of MRSA acquisition rates irrespective of increased MRSA prevalence rates in the medical ICU. There was no shift of chlorhexidine-resistant MRSA strains.


Asunto(s)
Antiinfecciosos Locales/administración & dosificación , Baños , Clorhexidina/administración & dosificación , Infección Hospitalaria/prevención & control , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiinfecciosos Locales/farmacología , Niño , Clorhexidina/farmacología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Femenino , Humanos , Incidencia , Unidades de Cuidados Intensivos , Análisis de Series de Tiempo Interrumpido , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/microbiología , Adulto Joven
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