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1.
Infect Chemother ; 52(1): 59-69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32239811

RESUMO

BACKGROUND: Cancer patients can be at a higher risk of infection due to drug-resistant bacteria than the general population for various reasons. We performed a retrospective study to evaluate possible risk factors and outcomes of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteremia in cancer patients. MATERIALS AND METHODS: Cases were divided into two groups based on whether or not the isolated strain produced ESBL and multivariable regressions were done to identify possible risk factors of ESBL-KP bacteremia and mortality. For ESBL-producing strain, additional molecular analysis was done. RESULTS: 278 cases with KP bacteremia were identified between 2010 and 2012, of which ESBL-producers were 50 (18%). The presence of percutaneous drainage catheter [odds ratio (OR) 4.99, P <0.001] and prior exposure to certain classes of antibiotics including third-generation cephalosporin (OR 2.14, P = 0.03) had significant associations with ESBL-KP bacteremia. Individuals who died within 14 days after the onset of KP bacteremia were more likely to have higher mean Pitt bacteremia score (1.56 in survival group vs. 3.43 in mortality group, P <0.001), hemodialysis (OR 17.03, P = 0.01) and chronic liver disease (OR 5.57, P = 0.01). Although 14-day mortality was higher with ESBL production (OR 2.76, P = 0.04), no significant differences in 30-day mortality (OR 1.67, P = 0.20) and other morbidity indices were observed. 49 ESBL-KP isolates, 65.4% of them produced CTX-M-14 and CTX-M-15 enzymes, and ST711 was the most common. CONCLUSION: There were several differences in clinical characteristics between ESBL-KP and non-ESBL-KP bacteremia in cancer patients, similar to previous reports including non-cancer patients.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32128641

RESUMO

Although multilocus sequence typing (MLST) has been used to study molecular epidemiology and to explore the population structure of Enterococcus faecium, vancomycin-resistant E. faecium (VREF) strains lacking the pstS gene that were non-typable using conventional MLST methods were reported recently. We found nationwide emergence of VREF isolates lacking pstS in Korea and hereby report the molecular characteristics of these isolates. Forty-six VREF isolates lacking the pstS gene were identified among 300 VREF rectal isolates collected from hospitalized patients between 2014 and 2015. MLST was performed and clonal relatedness was determined by pulsed-field gel electrophoresis (PFGE). Four VREF ST1421 isolates were whole-genome sequenced. Among the VREF rectal isolates lacking pstS, 98% were classified as ST1421, which has identical allelic profiles to ST17 for all housekeeping genes except pstS. PFGE pattern analyses revealed 32 pulsotypes. All isolates harbored Tn1546 components with various transposase and insertion sequences. The whole-genome sequencing of four VREF ST1421 isolates showed that the pstS gene region was deleted at various locations with considerable inversion. The pstS gene was also depleted in 12.1% of 33 VREF clinical isolates in 2006-2007 and in 11.8% of 59 clinical isolates in 2012-2013. VREF ST1421 strains lacking the pstS gene have emerged in Korea. The emergence and spread of pstS-deleted VREF strains pose a serious challenge for epidemiological investigation. Alternative molecular typing methods to MLST will be increasingly necessary.

3.
Int J Infect Dis ; 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32179139

RESUMO

OBJECTIVES: The performance of the investigational-use-only version of the BioFire® FilmArray® Pneumonia Panel (FA-Pneumo), a high-order nested multiplex PCR, was evaluated for detection of typical respiratory bacterial pathogens and antibiotic resistance genes in sputa and endotracheal aspirate (ETA) specimens. METHODS: Thirty-one sputa and 69 ETA specimens were analyzed. The diagnostic performance of FA-Pneumo was assessed using routine microbiological methods as the reference standard. RESULTS: Overall sensitivity and specificity for organism detection using FA-Pneumo were 98.5% and 76.5%, respectively. The sensitivities for each pathogen were 100%, except for Klebsiella aerogenes, and the range of specificity was 83.3 - 99.0%. FA-Pneumo detected antimicrobial resistance genes in 17 out of 18 specimens (94.4%) that were resistant by antimicrobial susceptibility testing. FA-Pneumo additionally detected 25 resistance genes in 22 specimens, and sequencing for the presence of resistance genes confirmed the majority of these results (20/25, 80%). Semi-quantitative analysis of bacterial nucleic acid amounts by FA-Pneumo revealed that 88.2% of the identified bacteria (67/76) with ≥ 106 copies/mL also gave culture-positive results with significant amounts of bacteria. CONCLUSION: FA-Pneumo is a rapid test with high sensitivity for detection of bacteria and antimicrobial resistance genes from sputum and ETA specimens and could aid in determining antibiotic therapy.

4.
Artigo em Inglês | MEDLINE | ID: mdl-32184173

RESUMO

OBJECTIVES: Previous studies reported inconsistent results between pneumonia and meteorological factors. We aimed to identify principal meteorological factors associated with pneumonia and to estimate the effect size and lag time. METHODS: This is a nationwide population-based study using a healthcare claims database merged with a weather database in eight metropolitan cities in Korea. We applied a stepwise approach using the Granger causality test and generalized additive model to elucidate the association between weekly pneumonia incidence (WPI) and meteorological factors/air pollutants (MFAP). Impulse response function was used to examine the time lag. RESULTS: In total, 2,011,424 cases of pneumonia were identified from 2007 to 2017. Among MFAP, diurnal temperature range (DTR), humidity, and particulate matter ≤2.5 µm in diameter (PM2.5) had the lowest Akaike information criterion (0.40) and showed statistically significant associations with WPI (p<0.001 for all 3 MFAPs). The association of DTR and WPI showed an inverted U pattern for bacterial and unspecified pneumonia, whereas for viral pneumonia, WPI increased gradually in a more linear manner with DTR and no substantial decline. Humidity showed a consistent pattern in all three pneumonia categories. WPI steeply increased up to 10-20 µg/m3 of PM2.5 but did not show a further increase in higher concentrations. Based on the result, we examined the effect of MFAP in different lag times up to 3 weeks. CONCLUSIONS: DTR, humidity, and PM2.5 were identified as MFAP most closely associated with WPI. With the model, we were able to visualize the effect-time association of MFAP and WPI.

5.
Infect Chemother ; 52(1): 105-109, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32100487
6.
Clin Infect Dis ; 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31994704

RESUMO

BACKGROUND: Clinically relevant categorization of antimicrobial resistance is critical to mitigating the threat it poses. Difficult-to-treat resistance (DTR) is a recently proposed category defined as non-susceptibility to all first-line antibiotic agents. METHODS: A retrospective study was conducted with non-duplicate cases of gram-negative bloodstream infection (GNBSI) caused by four major taxa (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter species) identified from a nationwide surveillance database. DTR was defined as non-susceptibility to all the ß-lactams and fluoroquinolones tested. Patient characteristics and mortality were compared between DTR GNBSI and GNBSI caused by carbapenem-resistant (CR+/DTR-) and extended-spectrum cephalosporin-resistant (ESCR+/DTR-) isolates using CDC definitions. Adjusted odds ratios (aORs) for 30-day in-hospital mortality were examined for DTR in overall and in propensity score-matched cohorts. RESULTS: A total of 1,167 episodes of monomicrobial GNBSI were identified, and 147 (12.6%) of the isolates were DTR. The majority of DTR isolates were Acinetobacter spp. (79.6%) and P. aeruginosa (17.7%). DTR infections were associated with previous antibiotic use, healthcare contact, ventilator use, and lower respiratory tract infection. Crude mortality for GNBSI caused by DTR was 50.3%. A multivariable model showed that only DTR, but not other categories, was significantly associated with mortality (aOR, 3.58; 95% CI, 1.27-10.19). DTR was also a significant predictor for mortality in the analysis of propensity score-matched cohorts (aOR, 3.48; 1.82-6.79). CONCLUSIONS: In patients with GNBSI, DTR were associated with higher mortality than those in other resistance categories. Our findings suggest that DTR could be useful for surveillance and prognostication.

7.
Clin Infect Dis ; 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31996920

RESUMO

BACKGROUND: Reports of serious neuropsychiatric events (NPEs), specifically suicide/suicide attempts following the use of oseltamivir, have led to public concerns. This study aimed to determine whether an association exists between oseltamivir use and neuropsychiatric events. METHOD: This study was a population-based retrospective cohort study on a random sample of 50% of individuals in the Korean National Health Insurance Service (KNIS) database aged ≥8 years who were diagnosed with influenza from 2009 to 2017. The primary exposure was oseltamivir prescription at the time of influenza diagnosis, whereas the primary outcome was a diagnosis of an NPE within 30 days after the influenza diagnosis. Information on oseltamivir prescription, diagnoses of NPEs, demographic characteristics, comorbidities, drugs prescribed within the year before influenza diagnosis, and healthcare utilization were extracted from the KNIS database. RESULTS: Of 3,352,015 individuals included in the analysis, 1,266,780 (37.8%) were prescribed oseltamivir. The incidence of NPEs was 0.86% and 1.16% in patients who were and were not prescribed oseltamivir, respectively (hazard ratio [HR]: 0.74, 95% confidence interval [CI]: 0.73-0.75, P<0.001). Oseltamivir use was not associated with a difference in the overall risk of NPEs in the adjusted model (HR: 0.98, 95% CI: 0.96-1.01, P=0.16), but the incidence of moderate-to-severe NPEs was significantly lower in those prescribed oseltamivir (HR: 0.92, 95% CI: 0.88-0.96, P<0.001). CONCLUSION: Treating influenza with oseltamivir does not increase the risk of NPEs; thus, public concern regarding its use is unwarranted.

8.
Mycoses ; 63(1): 89-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610064

RESUMO

BACKGROUND: Posaconazole is used to prevent invasive fungal infections (IFIs) in patients with haematologic malignancy. In this study, we compared plasma posaconazole concentrations (PPCs) and the incidence of breakthrough IFIs between patients with haematologic malignancy receiving posaconazole oral suspension vs tablet. METHODS: We retrospectively collected data on adult patients with haematologic malignancies who received posaconazole prophylaxis during chemotherapy from April 2014 through May 2018. A total of 242 cases with PPCs, 88 in the oral suspension group and 154 in the tablet group, were included in this study. RESULTS: Patients receiving tablets achieved a significantly higher mean PPC than did those on oral suspension (1.631 ± 0.878 µg/mL in the tablet group vs. 0.879 ± 0.585 µg/mL in the oral suspension group). One hundred and thirty-seven of 154 patients (89.0%) receiving tablets had PPCs of 0.7 µg/mL or more, while only 41 of 88 patients (46.6%) receiving oral suspension attained an optimal level (P < .001). The incidence of breakthrough IFIs was significantly higher in the oral suspension group compared with in the tablet group (14.8% of oral suspension vs. 4.5% of tablet; P = .005). In the analysis including patients receiving posaconazole tablets, hypoalbuminemia (< 3.5 g/dL) was found to be a risk factor associated with suboptimal levels (odds ratio: 8.872; 95% confidence interval: 3.011 - 26.141; P < .001). CONCLUSIONS: Suboptimal PPCs in the tablet group were less common than those in the oral suspension group. Therapeutic drug monitoring may be still necessary even in patients receiving posaconazole tablets, especially in those with hypoalbuminemia.

9.
Eur J Clin Microbiol Infect Dis ; 39(1): 159-167, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520270

RESUMO

Infections caused by extended-spectrum ß-lactamase-producing Enterobacteriales (ESBL-PE) are commonly treated with intravenous antibiotics. This study investigated whether oral antimicrobial therapy (OAT) is as effective as intravenous antimicrobial therapy (IVT) for acute pyelonephritis (APN) caused by ESBL-PE. A retrospective cohort of patients with APN caused by ESBL-PE was studied at a tertiary-care hospital from January 2014 through December 2016. The OAT group comprised patients treated with an appropriate oral antimicrobial agent following 7 days or less of IVT. The primary endpoint was treatment failure defined as clinical and/or microbiological failure. The secondary endpoint was length of hospital stay and recurrences of APN within 2 months and within 1 year. Propensity score matching and multivariable Cox proportional hazard modeling were used to minimize bias. Among 238 eligible cases, Escherichia coli (83.6%) was the most common pathogen. Sixty patients received OAT after a median of four days of appropriate IVT, and 178 patients completed treatment with IVT. Fluoroquinolones (58.3%) were the most commonly prescribed OAT, followed by trimethoprim-sulfamethoxazole and amoxicillin-clavulanate. OAT was not associated with treatment failure (adjusted OR 0.66; 95% CI 0.18-2.44) and hospitalization length was shorter in the OAT group (6.2 days versus 10.7 days; P < 0.01). APN recurrence caused by ESBL-PE infection within 2 months was not associated with OAT (adjusted HR 0.56; 95% CI 0.16-2.00). OAT reduced hospital stay without adverse effects on treatment outcome. OAT could be safely applied as a carbapenem-saving option in treatment of APN.

10.
Ann Lab Med ; 40(1): 63-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432641

RESUMO

As 16S ribosomal RNA (rRNA)-targeted sequencing can detect DNA from non-viable bacteria, it can be used to identify pathogens from clinical samples even in patients pretreated with antibiotics. We compared the results of 16S rRNA-targeted sequencing and culture for identifying bacterial species in normally sterile body fluid (NSBF): cerebrospinal, pericardial, peritoneal and pleural fluids. Over a 10-year period, a total of 312 NSBF samples were evaluated simultaneously using 16S rRNA-targeted sequencing and culture. Results were concordant in 287/312 (92.0%) samples, including 277 (88.8%) negative and 10 (3.2%) positive samples. Of the 16 sequencing-positive, culture-negative samples, eight showed clinically relevant isolates that included Fusobacterium nucleatum subsp. nucleatum, Streptococcus pneumoniae, and Staphylococcus spp. All these samples were obtained from the patients pretreated with antibiotics. The diagnostic yield of 16S rRNA-targeted sequencing combined with culture was 11.2%, while that of culture alone was 6.1%. 16S rRNA-targeted sequencing in conjunction with culture could be useful for identifying bacteria in NSBF samples, especially when patients have been pretreated with antibiotics and when anaerobic infection is suspected.


Assuntos
Bactérias/isolamento & purificação , RNA Ribossômico 16S/metabolismo , Antibacterianos/farmacologia , Líquido Ascítico/microbiologia , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/crescimento & desenvolvimento , Líquido Cefalorraquidiano/microbiologia , Técnicas de Laboratório Clínico , Humanos , RNA Ribossômico 16S/química , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
11.
Ther Adv Respir Dis ; 13: 1753466619885529, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31680646

RESUMO

BACKGROUND: Despite the increasing use of colistin in clinical practice, the optimal dosing, and administration route have not been established. This study aimed to evaluate the clinical outcome and safety of intravenous (IV) colistin with a loading dose (LD) and adjunctive aerosolized (AS) colistin administration in critically ill patients with hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) caused by carbapenem-resistant gram-negative bacteria (CRGNB). METHODS: We retrospectively reviewed 191 critically ill patients who received colistin for the treatment of HAP or VAP caused by CRGNB. Patients were divided into three groups: non-LD IV (patients received only IV colistin without LD), LD IV (patients received only IV colistin with LD), and AS-LD (patients received IV colistin with LD and adjunctive AS colistin). RESULTS: There was no difference in clinical response between the three groups. However, the rate of microbiological eradication was significantly higher in the AS-LD group (60%) than in the non-LD IV (31%), and LD IV (33%) groups (p = 0.010). Patients treated with adjunctive AS colistin in combination with LD IV had significantly lower 30-day mortality rates than patients treated with IV colistin alone (p = 0.027). After adjusting for potential confounding factors, adjunctive AS colistin was still significantly associated with lower mortality (adjusted OR 0.338, CI 95% 0.132-0.864, p = 0.024). However, nephrotoxicity did not change according to the use of LD regimen and AS colistin administration (p = 0.100). CONCLUSIONS: Adjunctive AS colistin in combination with IV colistin with LD was related to an improved 30-day mortality and microbiological outcome without an increase in nephrotoxicity in critically ill patients with HAP and VAP caused by CRGNB. The reviews of this paper are available via the supplemental material section.

12.
Infect Chemother ; 51(4): 414-426, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31782276

RESUMO

Tuberculosis has been a major public health threat in modern Korea. A few reports from the mid-1940s have demonstrated a high prevalence of latent and active tuberculosis infections. The high disease burden urged the newly established government to place a high priority on tuberculosis control. The government led a nationwide effort to control tuberculosis by building dedicated hospitals, conducting mass screening, providing technical and material support for microbiological diagnosis, administering Bacillus Calmette-Guérin vaccination, and improving appropriate antibiotic treatment through public health centers. Such concerted efforts resulted in a gradual decrease in the disease burden of tuberculosis, as demonstrated by National Tuberculosis Prevalence Surveys and notifiable disease statistics. While great progress has been made, new challenges - including an aging population, outbreaks in schools and healthcare facilities, and migration from high-prevalence countries - lie ahead. Here, we review the modern history of tuberculosis in Korea, focusing on epidemiology and public health policies.

13.
Respir Res ; 20(1): 213, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31554510

RESUMO

BACKGROUND: The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure. METHODS: A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality. RESULTS: All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0-97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01-1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34-72.65) were independently associated with increased mortality. CONCLUSIONS: There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure.


Assuntos
Soronegatividade para HIV , Pneumonia por Pneumocystis/terapia , Insuficiência Respiratória/fisiopatologia , Adulto , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/mortalidade , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
14.
Eur J Clin Microbiol Infect Dis ; 38(11): 2113-2120, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31372903

RESUMO

Therapeutic drug monitoring (TDM) of teicoplanin is aimed at minimizing the clinical impact of pharmacokinetic variability; however, its benefits are still being defined. We performed a retrospective study of teicoplanin TDM focusing on the dose-serum concentration relationship and clinical outcomes in a clinical setting. From January 2017 to December 2018, patients receiving teicoplanin ≥ 72 h with TDM were enrolled. Patients were divided into three groups: non-loading (NL) group, low-dose loading (LD) group (loading dose < 9 mg/kg), and high-dose loading (HD) group (≥ 9 mg/kg). Serum teicoplanin trough concentration (Cmin) and adverse events (AEs) were evaluated in each regimen. A subgroup of patients with bacteremia was analyzed to evaluate clinical efficacy. Among 65 patients, 12, 18, and 35 were grouped in NL, LD, and HD, respectively. Achievement rates of Cmin > 20 mg/L within 10 days were significantly different among the groups (25.0%, 38.9%, and 68.6% in the NL, LD, and HD groups, respectively; P = 0.014). Fourteen patients (21.5%) had AEs, and higher Cmin over 10 days (adjusted odds ratio 2.08 per every 20 mg/L increases, 95% CI 1.13-3.84, P = 0.019) and age ≥ 65 years (P = 0.009) were identified as independent risk factors. In the subgroup analysis, HD regimen (P = 0.050) and high mean Cmin over 10 days (P = 0.025) were significantly associated with treatment success. Although HL regimen could achieve Cmin targets and improve clinical outcome during teicoplanin treatment, high Cmin was associated with AEs during treatment. Routine TDM can be helpful to optimize teicoplanin administration.


Assuntos
Antibacterianos/administração & dosagem , Esquema de Medicação , Monitoramento de Medicamentos , Teicoplanina/administração & dosagem , Adulto , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/sangue , Bacteriemia/tratamento farmacológico , Relação Dose-Resposta a Droga , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Teicoplanina/efeitos adversos , Teicoplanina/sangue , Resultado do Tratamento
15.
Sci Rep ; 9(1): 8750, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217476

RESUMO

Surveillance remains an important tool for timely outbreak detection and response. Many countries, including Korea, have established national infectious disease surveillance systems with clinical notification. We aimed to evaluate the National Health Insurance Claims-based Surveillance (NHICS) compared to conventional passive report-based National Infectious Diseases Surveillance (NIDS). Reported to claimed cases ratios (R/C ratio) were evaluated from monthly notifiable disease cases captured by NIDS and NHICS. The relationships between 26 infectious diseases and each surveillance system were analysed using Pearson's correlation analysis and linear regression. There was an overall increase in R/C ratio from 2010-2017 (0.37 to 0.78). In 22 infectious diseases, there was a correlation between NIDS and NHICS. Moreover, claim-based surveillance showed less fluctuating disease incidence rates than report-based surveillance for specific infectious diseases, such as varicella, mumps, and scarlet fever. However, for infectious diseases with episodic outbreaks or low incidence, it was difficult to assess NHICS usefulness. Claim-based surveillance is less affected by limitations of conventional report-based surveillance systems, such as reporting rate. Given delays in claim systems, a claim-based surveillance is expected to be complementary to conventional systems for the detection of various infectious diseases with the advancement of bio-information technology.

16.
Int J Infect Dis ; 85: 7-9, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096050

RESUMO

Staphylococcal scarlet fever (SSF) is characterized by an exanthem without enanthem, bullae, or exfoliation, and is known to be related to Staphylococcus aureus toxins, especially superantigens. It has been reported in children and young adults. Herein, we report the first case of an elderly patient with SSF caused by staphylococcal enterotoxin M (SEM), associated with otitis externa. The patient presented with maculopapular rashes on both arms, thighs, and abdomen and with erythroderma on the face, ears, neck, chest, and back, all of which was followed by desquamation on the face, ears, and trunk. A culture of ear discharge grew methicillin susceptible S. aureus that was only positive for SEM among the superantigens tested.


Assuntos
Enterotoxinas/toxicidade , Escarlatina/microbiologia , Staphylococcus aureus/isolamento & purificação , Idoso , Enterotoxinas/metabolismo , Humanos , Masculino , Escarlatina/diagnóstico , Staphylococcus aureus/genética , Staphylococcus aureus/metabolismo , Superantígenos/genética , Superantígenos/metabolismo
17.
Eur J Clin Microbiol Infect Dis ; 38(5): 937-944, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30868326

RESUMO

Extended-spectrum ß-lactamase-producing Enterobacteriales (ESBL-PE) are often associated with inappropriate empirical therapy (IAT). The aim of this study was to investigate whether IAT of acute pyelonephritis (APN) caused by ESBL-PE is related to adverse outcomes. A retrospective cohort study was performed at a tertiary-care hospital from 2014 through 2016. Patients who had APN caused by ESBL-PE and were definitely treated with appropriate antibiotics for at least 7 days were enrolled. IAT was defined as when inappropriate empirical antibiotics were given 48 h or longer after initial diagnosis of APN. Primary endpoint was treatment failure defined as clinical and/or microbiologic failure. Secondary endpoints were length of hospital stay and recurrence of APN. Propensity score matching was used to adjust heterogeneity of each group. Among 175 eligible cases, 59 patients received IAT and 116 patients received appropriate empirical antimicrobial therapy (AT). Treatment failure was observed in five (8.4%) patients and nine (7.8%) patients in each group, respectively. After matching, the treatment failure rate was similar between both groups (adjusted odd ratio [aOR] 1.05; 95% confidence index [CI] 0.26-4.15). The length of hospital stay (median 11 days in the IAT group versus 11 days in the AT group; P = 0.717) and absence of recurrence within 2 months (90.3% in IAT and 86.7% in AT; P = 0.642) were also similar. IAT did not adversely affect the clinical outcome. In this regard, clinicians should be more cautious about indiscriminate prescription of broad-spectrum antibiotics such as carbapenem empirically for treatment of APN possibly caused by ESBL-PE.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/enzimologia , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , beta-Lactamases/biossíntese , Doença Aguda , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Feminino , Humanos , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , República da Coreia , Estudos Retrospectivos , Centros de Atenção Terciária , Falha de Tratamento , Resultado do Tratamento
18.
J Korean Med Sci ; 34(7): e53, 2019 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-30804728

RESUMO

The number of reported varicella cases is continuously increasing in Korea; however, associated medical utilization is declining. The ratio between varicella insurance claims and reports of passive infectious disease surveillance has gradually increased to > 80% since the second half of 2017. The recent increase in reported varicella cases is influenced by improved reporting. We calculated the varicella incidence and cumulative incidence in each birth cohort according to age. The cumulative incidence rate among children aged < 6 years in the birth cohort born after the National Immunization Program introduced the varicella vaccine was about 60% lower than among children born before.


Assuntos
Vacina contra Varicela/imunologia , Varicela/epidemiologia , Varicela/prevenção & controle , Criança , Pré-Escolar , Humanos , Programas de Imunização , Incidência , Lactente , Recém-Nascido , Formulário de Reclamação de Seguro , República da Coreia/epidemiologia
19.
Eur J Clin Microbiol Infect Dis ; 38(4): 793-800, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30693422

RESUMO

Human adenovirus (HAdV) is a common pathogen causing respiratory infections with outbreaks reported in the military and community. However, little information is available on the shedding kinetics. We performed a prospective study of immunocompetent adults confirmed with HAdV respiratory infection by multiplex real-time PCR during an outbreak of HAdV-55. Consecutive respiratory specimens of sputum or nasopharyngeal swab were collected from each patient every 2 days. Viral load was measured by real-time quantitative PCR. Of 32 enrolled patients, 27 (84.4%) had pneumonia. Five patients (15.6%) received cidofovir. Viral load was highest in the earliest samples at 8.69 log10 copies/mL. In a linear regression model, viral load declined consistently in a log-linear fashion at the rate of - 0.15 log10 copies/mL per day (95% confidence interval (CI): - 0.18, - 0.12; R2 = 0.32). However, the regression model estimated the viral shedding duration to be 55 days. The rate of decline in viral load did not differ between patients who received cidofovir and who did not. Patients with prominent respiratory symptoms or extensive involvement on chest radiograph had higher volume of viral excretion. Prolonged viral shedding was observed in otherwise healthy adults with HAdV-55 respiratory infection. This finding should be considered in the establishment of infection control and prevention strategies.


Assuntos
Infecções por Adenovirus Humanos/diagnóstico , Adenovírus Humanos/fisiologia , Infecções Respiratórias/virologia , Eliminação de Partículas Virais , Infecções por Adenovirus Humanos/tratamento farmacológico , Adenovírus Humanos/classificação , Adolescente , Surtos de Doenças , Humanos , Imunocompetência , Modelos Lineares , Masculino , Nasofaringe/virologia , Pneumonia Viral/diagnóstico , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real , República da Coreia/epidemiologia , Escarro/virologia , Carga Viral , Adulto Jovem
20.
Diagn Microbiol Infect Dis ; 94(1): 55-59, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30642718

RESUMO

To investigate factors for the recurrence of acute pyelonephritis (APN) caused by extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-PE), a retrospective cohort study was performed at a tertiary-care hospital from 2014 through 2016. Among 135 patients who had recovered from APN caused by ESBL-PE, the 1-year cumulative recurrence rates of APN caused by any pathogen or by ESBL-PE specifically were 35.6% and 22.1%, respectively. In a multivariate analysis, infectious disease (ID) consultation was associated with decreased recurrence (95% confidence interval [CI] = 0.24-0.96, P = 0.038 for recurrence caused by any pathogen; and 95% CI = 0.15-0.84, P = 0.019 for recurrence caused by ESBL-PE). History of APN within 1 year was a risk factor for recurrent APN caused by any pathogen (P = 0.011). Microbiological cure was a preventive factor for recurrent APN caused by ESBL-PE (P = 0.024). In conclusion, our data show that ID consultation protects against APN recurrence caused by ESBL-PE.


Assuntos
Assistência à Saúde/métodos , Infecções por Escherichia coli/epidemiologia , Escherichia coli/enzimologia , Pielonefrite/epidemiologia , Encaminhamento e Consulta , beta-Lactamases/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/microbiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem
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