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Background: Even amid the coronavirus disease-19 (COVID-19) pandemic, the spread of multidrug-resistant bacteria and infection control are still important tasks. After recognizing the carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak that occurred in the isolation room for COVID-19, we would like to introduce what infection control measures were implemented to eradicate it. Materials and Methods: All COVID-19 patients with CRAB in any specimen admitted to the COVID-19 isolation ward of the tertiary hospital in Korea from October to November 2021 were analyzed. Results: During the outbreak, 23 patients with COVID-19 and CRAB infections were identified. The index case was an 85-year-old female referred from a long-term care facility. CRAB was identified in sputum culture in most patients (91.3%). The CRAB outbreak occurred mainly in the rooms around the index case. Environmental cultures on the floor, air inlet, air outlet, and window frame of the rooms were performed. The antimicrobial resistance patterns of CRAB from patients and the environment were identical; whole-genome sequencing analyses revealed isolated clonality. Infection control measures with enhanced environmental cleaning using 1,000 ppm sodium hypochlorite and phenolic compounds, enhanced hand hygiene, additional education, and mandatory additional gowning and gloving of COVID-19 personal protective equipment (PPE) were applied on 29 October. No CRAB infection cases occurred from 2 November for two weeks. Conclusion: In addition to applying PPE and COVID-19 precautions in COVID-19 isolation wards, adhering to strict contact precautions along with environmental control can help prevent the spread of multidrug-resistant bacteria. [ABSTRACT FROM AUTHOR]

Familial searching is a useful technique in a forensic investigation. Using genetic information, it is possible to identify individuals, determine familial relationships, and obtain racial/ethnic information. The total number of shared alleles (TNSA) and likelihood ratio (LR) methods have traditionally been used, and novel data-mining classification methods have recently been applied here as well. However, it is difficult to apply these methods to identify familial relationships above the third degree (e.g., uncle-nephew and first cousins). Therefore, we propose to apply a stacking ensemble machine learning algorithm to improve the accuracy of familial relationship identification. Using real data analysis, we obtain superior relationship identification results when applying metaclassifiers with a stacking algorithm rather than applying traditional TNSA or LR methods and data mining techniques. [ABSTRACT FROM AUTHOR]

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 cellmediated 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 include [ABSTRACT FROM AUTHOR]

Background/Aims: This study aimed to review the indications, methods, cooperation, complications, and outcomes of percutaneous endoscopic gastrostomy (PEG). Methods: Questionnaires were sent to 200 hospitals, of which 62 returned their questionnaires, with a response rate of approximately 30%. Descriptive statistics were calculated to analyze the responses to the questionnaires. Results: In 2019, a total of 1,052 PEGs were performed in 1,017 patients at 62 hospitals. The main group who underwent PEG was older adult patients with brain disease, particularly stroke. Nutritional supply was an important purpose of the PEG procedure. “The pull method” was the most commonly used for initial PEG insertion. The complications related to PEG were mostly mild, with leakage being the most common. Patients who underwent PEG procedures were primarily educated regarding the post-procedure management and complications related to PEG. Preoperative meetings were skipped at >50% of the institutions. Regarding the cooperation between the nutrition support team (NST) and the physician performing PEG, few endoscopists answered that they cooperated with NST before and after PEG. Moreover, the rate of NST certification obtained by physicians performing PEG and the frequency of attendance at NST-related conferences were relatively low. Conclusions: This study shows a similar trend to that found in the previous PEG guidelines. However, it covers new aspects, including team-based work for PEG procedure, nutrition support, and education for patients and guardians. Therefore, each medical institution needs to select an appropriate method considering the medical environment and doctor’s abilities. [ABSTRACT FROM AUTHOR]

Purpose We aimed to assess the humoral response to and reactogenicity of coronavirus disease 2019 (COVID-19) vaccination according to the vaccine type and to analyze factors associated with immunogenicity in actively treated solid cancer patients (CPs). Materials and Methods Prospective cohorts of CPs, undergoing anticancer treatment, and healthcare workers (HCWs) were established. The participants had no history of previous COVID-19 and received either mRNA-based or adenovirus vector-based (AdV) vaccines as the primary series. Blood samples were collected before the first vaccination and after 2 weeks for each dose vaccination. Spike-specific binding antibodies (bAbs) in all participants and neutralizing antibodies (nAbs) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wild-type, Delta, and Omicron variants in CPs were analyzed and presented as the geometric mean titer. Results Age-matched 20 HCWs and 118 CPs were included in the analysis. The bAb seroconversion rate and antibody concentrations after the first vaccination were significantly lower in CPs than in HCWs. After the third vaccination, antibody levels in CPs with a primary series of AdV were comparable to those in HCWs, but nAb titers against the Omicron variant did not quantitatively increase in CPs with AdV vaccine as the primary series. The incidence and severity of adverse reactions post-vaccination were similar between CPs and HCWs. Conclusion CPs displayed delayed humoral immune response after SARS-CoV-2 vaccination. The booster dose elicited comparable bAb concentrations between CPs and HCWs, regardless of the primary vaccine type. Neutralization against the Omicron variant was not robustly elicited following the booster dose in some CPs, implying the need for additional interventions to protect them from COVID-19. [ABSTRACT FROM AUTHOR]

Insoles are used to treat various foot diseases, including plantar foot, diabetic foot ulcers, and refractory plantar fasciitis. In this study, we investigated the effects of 3-dimensional image-based (3-D) insole in healthy volunteers with no foot diseases. Additionally, the comfort of the 3-D insole was compared with that of a custom-molded insole. A singlecenter, randomized, open clinical trial was conducted to address the effectiveness of insole use in a healthy population with no foot or knee disease. Two types of arch support insoles were evaluated for their effectiveness: a 3-D insole and a custom-molded insole. Fifty Korean volunteers participated in the study and were randomly allocated into the "3-D insole" (n = 40) or "custom-molding insole" (n = 10) groups. All subjects wore 3-D insoles or custommolded insoles for 2 weeks. The sense of wearing shoes (Visual Analog Scale [VAS] and score) and fatigue of the foot were used to assess the insole effects at the end of the 2-week study period. The 3-D insole groups showed significantly improved sense of wearing shoes (VAS, p = 0.0001; score, p = 0.0002) and foot fatigue (p = 0.0005) throughout the study period. Although the number of subjects was different, the custom-molding insole group showed no significant changes in the sense of wearing shoes (VAS, 0.1188; score, p = 0.1483). Foot fatigue in the 3-D insole group improved significantly (p = 0.0005), which shows that a 3-D insole might have favorable effects on foot health in a healthy population. [ABSTRACT FROM AUTHOR]

Background Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use by minimizing the spread of antimicrobial resistance. The core elements for implementing ASPs in healthcare facilities have been developed by the World Health Organization, international research group and government agencies of various countries. However, to date, there is no documented core elements for implementation of ASP in Korea. This survey aimed to establish a national consensus on a set of core elements and their related checklist items for the implementation of ASPs in Korean general hospitals. Materials and Methods The survey was conducted from July 2022 to August 2022 by the Korean Society for Antimicrobial Therapy with support from the Korea Disease Control and Prevention Agency. A literature review was conducted by searching Medline and relevant websites to retrieve a list of core elements and checklist items. These core elements and checklist items were evaluated by a multidisciplinary panel of experts using a structured modified Delphi consensus procedure, using two-step survey included online in-depth questionnaires and in-person meeting. Results The literature review identified 6 core elements (Leadership commitment, Operating system, Action, Tracking, Reporting, and Education) and 37 related checklist items. Fifteen experts participated in the consensus procedures. Ultimately, all 6 core elements were retained, and 28 checklist items were proposed, all with ≥80% agreement; in addition 9 items were merged into 2 items, 2 items were deleted, and 15 items were rephrased. Conclusion This Delphi survey provides useful indicators for the implementation of ASP in Korea and suggests national policy improvement about the barriers (e.g., shortage of staffing and financial support) existing in Korea for optimal implementation of ASPs. [ABSTRACT FROM AUTHOR]

Background: Recent studies reported that prepregnancy body mass index (BMI) and weight gain during pregnancy affect birth weight and contribute to childhood obesity. However, no such data are available in Korea. Purpose: This study gathered data on weight gain during pregnancy and its impact on birth weight and childhood obesity in Korea. Methods: We reviewed 1,753 singleton full-term babies born at CHA Bundang Medical Center in 2014-2016. We first review each maternal and baby factor based on prepregnancy BMI (underweight, normal, overweight/obese) and then divided them into low, normal, and excess gestational weight gain (GWG) groups based on the American Institute of Medicine (IOM) guidelines. We reviewed the characteristics of each group and analyzed the association between maternal GWG based on IOM guidelines and child BMI after 6 years. Results: The maternal prepregnancy BMI group showed a significant difference in birth weight and child BMI at 6 years. As the prepregnancy BMI increased, the birth weight and BMI at 6 years also increased (P<0.001). Mean birth weight and child BMI at 6 years differed significantly among the GWG groups. Furthermore, excess postpartum weight gain increased the risk of childhood overweight and obesity (odds ratio, 2.21; 95% confidence interval, 1.40-3.49). Conclusion: Excess weight gain during pregnancy should be avoided due to its short- and long-term association with childhood obesity. Owing to the high prevalence of excess GWG and childhood obesity, excess weight gain during pregnancy can have significant public health implications. [ABSTRACT FROM AUTHOR]

Currently, antimicrobial resistance (AMR) is a major threat to global public health. The antimicrobial stewardship program (ASP) has been proposed as an important approach to overcome this crisis. ASP supports the optimal use of antimicrobials, including appropriate dosing decisions, administration duration, and administration routes. In Korea, efforts are being made to overcome AMR using ASPs as a national policy. The current study aimed to develop core elements of ASP that could be introduced in domestic medical facilities. A Delphi survey was conducted twice to select the core elements through expert consensus. The core elements for implementing the ASP included (1) leadership commitment, (2) operating system, (3) action, (4) tracking, (5) reporting, and (6) education. To ensure these core elements are present at medical facilities, multiple departments must collaborate as teams for ASP operations. Establishing a reimbursement system and a workforce for ASPs are prerequisites for implementing ASPs. To ensure that ASP core elements are actively implemented in medical facilities, it is necessary to provide financial support for ASPs in medical facilities, nurture the healthcare workforce in performing ASPs, apply the core elements to healthcare accreditation, and provide incentives to medical facilities by quality evaluation criteria. [ABSTRACT FROM AUTHOR]

배경: Computed tomography (CT) is a very useful tool for evaluating the etiology of patients with sepsis or septic shock. However, it is difficult to obtain contrast-enhanced CT images due to concerns about nephrotoxicity caused by contrast media, especially in patients with septic acute kidney injury (AKI). In this study, we aim to investigate the relationship between contrast media administration and long-term mortality and chronic kidney disease in patients with septic AKI. 방법: A total of 1,521 patients with septic shock admitted to a tertiary hospital in South Korea from July 2008 to November 2019 were retrospectively reviewed. A total of 609 adult septic shock patients with AKI who underwent contrast or non-contrast CT scans were enrolled. The primary outcome was 90-day mortality rate. The secondary outcomes were worsening AKI, 28-day mortality rate, chronic kidney disease, and maintain dialysis at 90 days between contrast CT group and non-contrast CT group. 결과: Of 609 septic AKI patients, 220 patients (36.1%) underwent contrast CT and 389 patients (63.9%) underwent non-contrast CT. The median age was 70.9 years, and 305 (50.1%) were male. There were no statistically significant differences in the outcomes between the contrast and non-contrast CT groups: 90-day mortality, 55.3% vs. 57.4%, p=0.682; worsening AKI, 1.8% vs. 2.1%, p=0.999; 28-day mortality, 41.4% vs. 42.3%, p=0.898; chronic kidney disease, 13.2% vs. 15.3%, p=0.73; and maintain dialysis at 90day, 0.0% vs. 0.8%, p=0.482. 결론: In conclusion, intravenous contrast media administration was not associated with long-term mortality, chronic renal impairment, and dialysis in patients with septic AKI. [ABSTRACT FROM AUTHOR]

배경: This study aimed to investigate the prognosis and prognostic factors for mortality in progressive multifocal leukoencephalopathy (PML) patients through a long observation period. 방법: This retrospective study was conducted in two tertiary hospitals in South Korea from 1999 to 2021. Patients diagnosed with PML were reviewed according to the American Academy of Neurology diagnostic criteria. The primary endpoint was long-term overall mortality. Each patient was followed up till death or the end of the study period. 결과: Total of 47 PML patients were included. Of 27 patients (57.4%) were diagnosed with HIV. Median last follow-up modified Rankin Scale (mRS) score was higher in the non-HIV PML group than that in the HIV group (5 vs. 4, p=0.020). Median survival duration was lower in the non-HIV group (184 vs. 1,564 days). The 1-year and overall mortality rates of PML patients were significantly higher in the non-HIV group than that in HIV group (60.0% vs. 25.9%, p=0.019; 80.0% vs. 40.7%, p=0.007). Initial mRS score (HR 1.685, p=0.038) and highly active antiretroviral therapy (HAART) in HIV patients (HR 0.374, p=0.013) had a significant effect on overall mortality. 결론: Survival duration of HIV-positive PML patients receiving HAART improved; however, the mortality rate is still high. Introduction of HAART in HIV patients and initial mRS score are significant prognostic factors for overall mortality in PML patients. [ABSTRACT FROM AUTHOR]

배경: Currently, therapeutic agents have focused on the hyperinflammatory response to severe COVID-19. If the similarities and differences between the immune responses of COVID-19 and bacterial sepsis could be identified in detail, it would provide an additional candidate for immunomodulators to treat severe COVID-19. We aimed to demonstrate the characteristics of the immunologic status of coronavirus disease 2019 (COVID-19) and sepsis patients through plasma cytokine/chemokine analysis. 방법: Patients diagnosed with severe COVID-19 or septic shock with lymphopenia, who were matched for age, sex, steroid administration, lymphocyte count, and severity, formed the study population. A total of 20 analytes were measured by Luminex assay. The study’s primary outcome was to compare the plasma cytokine/chemokines levels between the two study groups. 결과: A total of 36 patients were enrolled in this study. COVID-19 patients who were administered steroids showed significantly higher levels of plasma granulocyte macrophage colony-stimulating factor (GM-CSF) [16.3 pg/ml; interquartile range (IQR), 9.8-20.0 and 0.0 pg/ml; IQR, 0.0-3.9; P = 0.019]. Plasma interleukin-15 (IL-15) (0.0 pg/ml; IQR, 0.0-0.0 and 4.444 pg/ml; IQR, 0.0-5.120; P = 0.031), and IL-17A (0.0 pg/ml; IQR, 0.0-0.0 and 9.922 pg/ml; IQR, 0.0-12.937; P = 0.031) levels in COVID-19 group were lower than the sepsis group. The IL-10 (0.0 pg/ml; IQR, 0.0-2.4 and 29.1 pg/ml; IQR, 9.6-51.3; P = 0.017) and B-cell-activating factor of the TNF family (0.0 pg/ml; IQR, 0.0-0.0 and 1.8 pg/ml; IQR, 0.0-2.5; P = 0.032) levels were significantly lower in the non-steroid administered COVID-19 group. 결론: Differences in plasma cytokine/chemokines levels were observed between COVID-19 and sepsis patients with matching variables. GM-CSF showed higher concentration in COVID-19 group with steroid administration, implicating the efficacy of anti-GM-CSF antibodies as an adjunctive therapy to steroids in severe COVID-19 patients. [ABSTRACT FROM AUTHOR]

배경: COVID-19 increases the risk of invasive pulmonary aspergillosis. However, the risk factors for and the outcomes of COVID-19 associated pulmonary aspergillosis (CAPA) is reported differently from hospital to hospital and is not fully defined yet. We aim to identify the risk factors for and outcomes of CAPA in critically-ill COVID-19 patients. 방법: A single center retrospective cohort study was conducted in critically-ill COVID-19 patients with National Institute of Allergy and Infectious Disease Ordinal Scale of 6 or higher who admitted to a tertiary care hospital in South Korea from March 2020 to January 2022. CAPA was retrospectively defined using modified Aspergillosis in Intensive Care Unit (modified AspICU) criteria. 결과: A total of 269 critically-ill COVID-19 patients were hospitalized during the study period and 50 (18.6%) patients were diagnosed with CAPA (Table 1). The overall incidence of CAPA was 8.69 case per 1000 patient-day. (Figure 1) Median time from admission to CAPA diagnosis was 12 days. Multivariable analysis showed that receiving solid organ transplantation (odds ratio [OR] 4.716, 95% confidence intervals [CI] 1.137-19.556, p=0.033), mechanical ventilator use (OR 2.485, 95% CI 1.213-5.095, p=0.013), high dose steroid use (mean dose>1.5mg/kg/day) (OR 6.946, 95% CI 2.312-20.865, p=0.001), and having lymphopenia (OR 3.04, 95% CI 1.443-6.407, p=0.03) were independent risk factors for developing CAPA (Table 2,3). Patients with CAPA showed significantly higher 28-day mortality (46.0% vs. 15.5%, p<0.0001), in-hospital mortality (72.0% vs. 19.2%, p<0.0001) and longer hospital length of stay (31 vs. 16 days, p<0.001) compared to patients without CAPA. (Table 2) 결론: In this study, the severity of COVID-19, use of high dose steroid and immunocompromised conditions could be important risk factors for developing CAPA and CAPA diagnosis was associated with worse outcome. [ABSTRACT FROM AUTHOR]

배경: Infective endocarditis (IE) remains a major medical problem with high morbidity and mortality. Appropriate antibiotic treatment lowers the risk of embolism, recurrence, and long-term mortality. However, there are concerns about adverse drug reactions and resistant strains due to long-term use of antibiotics. Therefore, we compared the difference in overall mortality according to the duration of postoperative antibiotics therapy in patients with IE. 방법: From 2005 to 2017, we retrospectively reviewed 416 patients with IE at a 2400-bed tertiary hospital in South Korea. A total of 234 IE patients who underwent valve surgery and appropriate duration of antibiotics were enrolled. They were divided into two groups based on the 2 weeks of postoperative antibiotic therapy. The primary outcome was long-term overall all-cause mortality. The secondary outcomes were reoperation rate, recurrence rate, and postoperative complications. 결과: The median follow-up duration was 71 (interquartile range [IQR], 46–109) months. The duration of postoperative antibiotic therapy was less than 2 weeks in 62 patients (26.5%) and more than 2 weeks in 172 patients (73.5%). The median age was 53 ([IQR], 39–63) years. The overall mortality was 12.8% (30/234). There were no statistical differences in overall mortality (12.9% vs. 12.8%, p=0.982), reoperation (6.5% vs. 4.1%, p=0.488), and recurrence (8.1% vs. 2.9%, p=0.135) between patients with postoperative antibiotic therapy less than 2 weeks and for ≥2 weeks, respectively. The duration of postoperative antibiotic therapy based on 2 weeks in the Kaplan-Meier curve was not associated with overall mortality (log-rank test, p=0.877). 결론: In conclusion, there was no statistically significant difference in the overall mortality, recurrence, and reoperation rate according to the duration of postoperative antibiotic therapy. If surgery and recommended total antibiotic duration are properly performed, a shorter duration of postoperative antibiotics might be considered. [ABSTRACT FROM AUTHOR]

배경: Dagnosis of invasive aspergillosis (IA) is often difficult due to need for invasive procedures. Next-generation sequencing of plasma microbial cell free DNA (cfDNA) can be a novel non-invasive diagnostic method. We evaluated the clinical accuracy and utility of microbial cfDNA whole genome sequencing (WGS) for diagnosis of IA in patients with hematologic malignancy (HM) or coronavirus disease (COVID-19). 방법: A single-center prospective cohort study was conducted in a tertiary hospital in Korea. We enrolled adult patients with HM or severe COVID-19, who suspected of IA and collected plasma samples. cfDNA was extracted from plasma and WGS was performed. IA diagnosis was retrospectively confirmed according to EORTC/MSG definitions in patients with HM, and modified AspICU criteria in patients with severe COVID-19. The final diagnosis of IA was compared to the results of microbial cfDNA WGS. 결과: Between Mar 2021 and Feb 2022, a total of 64 microbial cfDNA WGS was performed on the plasma samples from 37 participants (19 with HM and 19 with COVID-19) and 7 controls who didn’t have any evidence of fungal infection. In participants with HM, aspergillus cfDNA was detected in 100% (1/1) of proven and 84.6% (11/13) of probable IA cases. In participants with COVID-19, 46.7% (7/15) of probable IA showed positive aspergillus cfDNA. Positive agreement of detection of aspergillus cfDNA versus conventional diagnosis of proven/probable IA was significantly higher in participants with HM compared to COVID-19 (85.7% vs. 46.7%, p=0.011). Fifteen of 19 (78.9%) participants with positive aspergillus cfDNA had exposure to antifungal agents. In 7 participants, non-aspergillus pathogens detected by microbial cfDNA WGS were in accordance with those identified through conventional culture. 결론: Detection of aspergillus cfDNA showed high concordance with conventional diagnostic methods of proven/probable IA in patients with HM and could be a helpful non-invasive approach to IA diagnosis in those populations. [ABSTRACT FROM AUTHOR]

Background/Aims Little is known about the association between infantile colic and the later onset of irritable bowel syndrome (IBS). Methods This study examined all 917 707 children who were born in Korea between 2007 and 2008. Infantile colic was defined with 1 or more diagnoses of ICD-10 code R10.4 or R68.1 at the age of 5 weeks to 4 months, and infants with a diagnosis of infantile colic and without were allocated into the infantile colic group and the control group. IBS was defined as 2 or more diagnoses of ICD-10 code K58.X after 4 years of age. Each child was traced until 2017. The risk of IBS with infantile colic was evaluated using a Cox proportional hazards model with propensity score inverse probability of treatment weighting (IPTW). Results After IPTW, 363 528 and 359 842 children were allocated to the control group and the infantile colic group, respectively. The infantile colic group had a higher risk of developing IBS in childhood (hazard ratio [95% CI], 1.12 [1.10 to 1.13]) than the control group. Moreover, the subgroup analyses according to the feeding status, birth weight, sex, or economic status, showed that the risk of IBS with former infantile colic remained statistically significant. Conclusions Children with a diagnosis of infantile colic during the infant period had a significant risk of developing IBS after 4 years of age. Understanding the pathogenesis of infantile colic in the neonatal period may reduce the prevalence and severity of functional gastrointestinal disorders from childhood to adolescence to adulthood. [ABSTRACT FROM AUTHOR]

Background: It is necessary to develop a roadmap for antimicrobial usage monitoring in order to perform monitoring of antimicrobial use at the national level properly. Therefore, this study aimed to develop a roadmap for establishing surveillance and monitoring of antimicrobial use in medical institutions at the national level. Materials and Methods: A modified Delphi study was conducted, including 3 rounds of an online survey and a virtual meeting with 16 expert panels. The survey items were developed based on a literature review of the surveillance systems for antimicrobial use in 12 countries and interviews with experts. The questionnaire was designed to include both the surveillance and benchmarking systems. Results: Regarding the scope of target institutions to be included in the surveillance system, medical institutions for sentinel surveillance had the highest proportion of agreement among the panels (75.0%, 9/12). For the benchmarking system, “tertiary- and secondarycare hospitals” were accepted as the scope of target institutions at the current moment. Furthermore, the National Health Insurance claims and prescription data of individual hospitals were considered appropriate data sources for the surveillance system. As for the measures to promote the participation of hospitals in the benchmarking system, “compensation through the establishment of antimicrobial management fees” and “set the participation in the program as a quality evaluation or accreditation index for hospital evaluation” were accepted. Conclusion: This study provides a roadmap for establishing an antimicrobial use monitoring and benchmarking system for medical institutions at a national level in Korea. [ABSTRACT FROM AUTHOR]

Despite the coronavirus disease 2019 (COVID-19) vaccination roll-out, variant-related outbreaks have occurred repeatedly in Korea. Although public hospitals played a major role in COVID-19 patients’ care, difficulty incorporating evolving COVID-19 treatment guidelines called for a clinical pathway (CP). Eighteen public hospitals volunteered, and a professional review board was created. CPs were formulated containing inclusion/exclusion criteria, application flow charts, and standardized order sets. After CP roll-out, key parameters improved, such as increased patient/staff five-point satisfaction scores (0.41/0.57) and decreased hospital stays (1.78 days)/medical expenses (17.5%). The CPs were updated consistently after roll-out as new therapeutics drugs were introduced and quarantine policies changed. Despite the coronavirus disease 2019 (COVID-19) vaccination roll-out, variant-related outbreaks have occurred repeatedly in Korea. Although public hospitals played a major role in COVID-19 patients’ care, difficulty incorporating evolving COVID-19 treatment guidelines called for a clinical pathway (CP). Eighteen public hospitals volunteered, and a professional review board was created. CPs were formulated containing inclusion/exclusion criteria, application flow charts, and standardized order sets. After CP roll-out, key parameters improved, such as increased patient/staff five-point satisfaction scores (0.41/0.57) and decreased hospital stays (1.78 days)/medical expenses (17.5%). The CPs were updated consistently after roll-out as new therapeutics drugs were introduced and quarantine policies changed. [ABSTRACT FROM AUTHOR]

배경 Patients with cancer are at greater risk of severe COVID-19 and have been prioritized for COVID-19 vaccination including booster doses. We aimed to assess the immunogenicity and safety of COVID-19 vaccination and analyze factors associated with the immunogenicity of the vaccine among actively treat- ed solid cancer patients (CPs) in Korea. 방법 A prospective cohort was established among CPs undergoing anticancer treatment in a tertiary hospital in Korea. Patients in this cohort had no history of previous SARS-CoV-2 infection confirmed by baseline serological testing and received at least one dose of COVID-19 vaccine in accordance with the vaccine strategy. Blood samples were collected before prime vaccination, and beyond 2 weeks for each dose of vaccine administration. Spike (S)- specific IgG antibodies were analyzed on each sample. Adverse events (AEs) within 7 days following each vaccine dose were collected. Data from age-matched healthcare workers (HCWs) recruited into a separate study are included as a comparison cohort. 결과 Between April 2021 to November 2021, we enrolled 134 CPs; 118 were eligible for analysis. The demographics of CPs and HCWs are described in Table 1. CPs were treated with cytotoxic agents (78.8%), immunotherapy (16.9%), target therapy (18.6%), and others (5.9%), that were given either alone or in combinations. The rate of seroconversion after 1st vaccination in CPs was significantly lower than in HCWs (p value=0.001), however, all CPs and HCWs revealed seroconversion after 2nd vaccination (Figure 1). Antibody response was significantly increased following each dose of vaccination in both CPs and HCWs (Figure 2A). The geometric mean titer (GMT) of S-specific IgG antibodies after 2nd vaccination in CPs who received a primary set of adenovirus vector vaccine were significantly lower than that in HCWs, whereas CPs who received a primary set of mRNA vaccines showed comparable GMT with HCWs after 2nd vaccination (Figure 2B). After the 3rd vaccination, there was no statistical difference in GMT of S-specific antibodies between CPs and HCWs regardless of the type of primary vaccine. In age-matched analysis between good responders (defined as those with higher antibody titers after 2nd vaccination than the mean of age-stratified HCW cohort) and poor responders (defined as those with lower titers) among CPs, there was no significant difference in other factors including the type of vaccine, cancer or anticancer treatment except lower leukocyte counts in poor responders treated with cytotoxic agents. The incidence and severity of AEs were similar between CPs and HCWs without any severe vaccine-related AEs. 결론 Patients with solid cancer had delayed antibody response compared to HCWs after the 1st vaccination but all CPs showed seroconversion after 2nd vaccination. Antibody responses similar to that of HCWs were achieved after the 3rd dose of vaccination in actively treated CPs in this study. [ABSTRACT FROM AUTHOR]

African tick-bite fever (ATBF), caused by Rickettsia africae, is the second most frequent cause of fever after malaria in travelers returning from Southern Africa. As the Korean outbound travelers are increasing every year, tick-borne rickettsial diseases as a cause of febrile illness are likely to increase. We describe a febrile Korean returning traveler who showed two eschars after visiting the rural field in Manzini, Swaziland. We performed nested polymerase chain reaction using the eschar and diagnosed the patient with ATBF. He was treated with oral doxycycline for 7 days, and recovered without any complications. We believe that the present case is the first ATBF case diagnosed in a Korean traveler. [ABSTRACT FROM AUTHOR]

배경: Coronavirus disease 2019 (COVID-19) in immunocompromised patients has become an important issue as severe acute respiratory syndrome coronavirus 2 has continuously spread. Sarcopenia is associated with a worse prognosis in COVID-19 and prevalent in lung transplant patients. This study aimed to investigate the difference in clinical outcomes according to sarcopenia in lung transplant patients with COVID-19. 방법: This study included patients who diagnosed as COVID-19 from December 2021 to May 2022 after lung transplantation in Severance Hospital. Thoracic muscle volume was measured using the cross-sectional area of the pectoralis, paraspinal, serratus, and latissimus muscles at the fourth vertebral region and the erector spinae muscle at the 12th vertebral region using the computed tomography (CT) scan after COVID-19. Multivariate logistic analysis was conducted to identify the associated factors with sarcopenia in lung transplant patients with COVID-19. 결과: Sixty-one patients with COVID-19 after lung transplantation were enrolled in this study and forty-two patients (68.9%) had sarcopenia. In the sarcopenic group, the length of stays was longer (12 days; inter-quartile range [IQR], 6-34 and 5.5 days; IQR, 5-12; P = 0.017), and there was no case of in-hospital death and invasive mechanical ventilator application in non-sarcopenic group. Multivariate logistic regression analysis showed that forced expiratory volume before COVID-19 and serum albumin were associated with sarcopenia. Thirteen of the patients in the sarcopenic group underwent subsequent CT scans after a median of 12 days, and the thoracic muscle index showed a further decreasing trend. 결론: In lung transplant patients with COVID-19, sarcopenia is frequently accompanied and might be associated with a worse prognosis. Assessment and interventions for sarcopenia is needed to improve the prognosis of lung transplant patients with COVID-19. [ABSTRACT FROM AUTHOR]

배경: Interest in complications and sequelae following COVID-19 is increasing. Several articles have reported COVID-19-associated autoimmune diseases and the association of autoantibodies with the severity of COVID-19. Thromboembolic complications frequently occur in COVID-19 patients, and the anti-phospholipid antibody (aPL) is frequently detected. We conducted this study to investigate the prevalence, clinical significance, and persistence of anti-nuclear antibody (ANA) and aPL in COVID-19. 방법: This study enrolled the patients diagnosed with COVID-19 with oxygen demand, admitted to Severance Hospital, running a critical care unit for COVID-19 in South Korea from July 2020 to March 2022. ANA and aPLs were assessed using the immuno-assay kit. 결과: A total of 250 patients were enrolled during the study period. Among them, five patients showed ANA-positive, and 41 showed aPL-positive (IgM anti-Cardiolipin (aCL) antibody for seven patients, IgG aCL for seven patients, IgM anti-β2Glycoprotein1 antibody (aβ2-GPI) for 32 patients, and IgG aβ2-GPI for one patient). Two of the five ANA-positive patients, 13 of the 32 IgM aβ2-GPI-positive patients, 5 of the 7 IgM aCL-positive patients, and 2 of the 7 IgG aCL-positive patients were eligible for follow-up analysis, and 100%, 69.2%, 40%, and 50% of the patients remained autoantibody-positive, respectively. Except for the IgG aCL group, there were no differences in clinical outcomes, including thromboembolic complications, between the autoantibody-positive and negative groups. 결론: Our study demonstrated that a significant proportion of COVID-19 patients with oxygen demand showed autoantibody-positive and persisted several months after symptom onset. Whether these autoantibodies are related to long-term sequelae in COVID-19 patients requires further research. [ABSTRACT FROM AUTHOR]

배경: This study aimed to investigate the immunogenicity and reactogenicity of ChAdOx1 nCoV-19 vaccine according to pre-existing adenovirus(Ad) immunity. 방법: We prospectively enrolled individuals scheduled for COVID-19 vaccination in a tertiary hospital with 2,400 beds from March 2020. Pre-existing Ad immunity data was obtained by enzyme-linked immunosorbent assay at time point T0, before 1st ChAdOx1 nCov-19 vaccination. Immunogenicity data were obtained at 5 time points along the primary series of ChAdOx1 nCov-19 vaccination. Reactogenicity data were collected over 7 days after each vaccination. 결과: Total of 68 adult patients with two dose ChAdOx1 nCov-19 vaccination were finally enrolled. Pre-existing Ad immunity was positive in 49 patients (72.1%), and negative in 19 patients (27.9%). The geometric mean titer (GMT) of S-specific IgG antibodies were statistically higher in individuals without pre-existing Ad immunity at several time points: before 2nd ChAdOx1 nCov-19 vaccination (56.4 [36.6-125.0] vs. 51.0 [17.9-122.3], p=0.024); 2-3weeks after 2nd ChAdOx1 nCov-19 vaccination (629.5 [451.5-926.5] vs. 555.0 [287.3-926.0], p=0.049); 3 months after 2nd ChAdOx1 nCov-19 vaccination (274.5 [160.5-655.3] vs. 176.0 [94.3-255.3], p=0.033). The plaque reduction neutralization test (PRNT50) after 1st ChAdOx1 nCov-19 vaccination were statistically higher in individuals without pre-existing Ad immunity (245.2 [142.6-377.1] vs. 94.1 [44.4-157.5], p=0.021). In the absence of pre-existing Ad immunity, systemic events were observed with a higher frequency and chills were observed to be statistically significantly higher (73.7% vs. 31.9%, p=0.002). 결론: In individuals without pre-existing Ad immunity, the immune response to ChAdOx1 nCoV-19 vaccination was higher intensity and the reactogenicity to ChAdOx1 nCoV-19 vaccination was observed with a higher frequency. In order for Ad-derived vaccination to have sufficient immune response and longevity, it is necessary to evaluate pre-existing Ad immunity. [ABSTRACT FROM AUTHOR]

These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea. [ABSTRACT FROM AUTHOR]

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx. [ABSTRACT FROM AUTHOR]

Background: Recently, a new scoring system was developed that uses the red blood cell distribution width (RDW), delta neutrophil index (DNI), and platelet count (PC) to predict mortality in patients with sepsis. We investigated whether a modified simple scoring system based on the RDW, DNI, and mean platelet volume-to-PC (MPV/PC) ratio could predict the mortality of patients with sepsis, and compared it to the previous scoring system. Methods: We conducted a retrospective cohort study of 264 adults who had been treated for sepsis in an emergency department between January 2016 and February 2019. Each patient was rated on a scale of 0 to 3 according to the modified scoring system. Point values were assigned based on RDW > 14.5%, DNI > 5.0%, and MPV/PC ratio >10.1. Results: The 28-day mortality rate was 14.4%. Those who died had higher scores than those who survived (mean: 1.55±0.92 vs 0.93±0.78, P < .001). The area under the curve for the new scoring system was higher than that of the previous scoring system (0.685 vs 0.645). Conclusion: The modified scoring system was a good predictor of the 28-day mortality and was more useful than the previous scoring system for predicting mortality in patients with sepsis. [ABSTRACT FROM AUTHOR]

Neutralizing antibodies targeted at the receptor-binding domain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein have been developed and now under evaluation in clinical trials. The US Food and Drug Administration currently issued emergency use authorizations for neutralizing monoclonal antibodies in non-hospitalized patients with mild to moderate coronavirus disease 2019 (COVID-19) who are at high risk for progressing to severe disease and/or hospitalization. In terms of this situation, there is an urgent need to investigate the clinical aspects and to develop strategies to deploy them effectively in clinical practice. Here we provide guidance for the use of anti-SARS-CoV-2 monoclonal antibodies for the treatment of COVID-19 based on the latest evidence. [ABSTRACT FROM AUTHOR]

배경 The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving. 방법 This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021. 결과 During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified. Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the en- hanced environmental cleaning using sodium hypochlorite (NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. 결론 Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning [ABSTRACT FROM AUTHOR]

Despite the global effort to mitigate the spread, coronavirus disease 2019 (COVID-19) has become a pandemic that took more than 2 million lives. There are numerous ongoing clinical studies aiming to find treatment options and many are being published daily. Some effective treatment options, albeit of variable efficacy, have been discovered. Therefore, it is necessary to develop an evidence-based methodology, to continuously check for new evidence, and to update recommendations accordingly. Here we provide guidelines on pharmaceutical treatment for COVID-19 based on the latest evidence. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the recent prevalence, management, and comorbidities of diabetes among Korean adults aged ≥30 years by analyzing nationally representative data. Methods: This study used data from the Korea National Health and Nutrition Examination Survey from 2016 to 2018, and the percentage and total number of people ≥30 years of age with diabetes and impaired fasting glucose (IFG) were estimated. Results: In 2018, 13.8% of Korean adults aged ≥30 years had diabetes, and adults aged ≥65 years showed a prevalence rate of 28%. The prevalence of IFG was 26.9% in adults aged ≥30 years. From 2016 to 2018, 35% of the subjects with diabetes were not aware of their condition. Regarding comorbidities, 53.2% and 61.3% were obese and hypertensive, respectively, and 72% had hypercholesterolemia as defined by low-density lipoprotein cholesterol (LDL-C) ≥100 mg/dL in people with diabetes. Of the subjects with diabetes, 43.7% had both hypertension and hypercholesterolemia. With regard to glycemic control, only 28.3% reached the target level of <6.5%. Moreover, only 11.5% of subjects with diabetes met all three targets of glycosylated hemoglobin, blood pressure, and LDL-C. The percentage of energy intake from carbohydrates was higher in diabetes patients than in those without diabetes, while that from protein and fat was lower in subjects with diabetes. Conclusion: The high prevalence and low control rate of diabetes and its comorbidities in Korean adults were confirmed. More stringent efforts are needed to improve the comprehensive management of diabetes to reduce diabetes-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and Methods: Patients admitted between 2009 - 2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion: Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered. [ABSTRACT FROM AUTHOR]

배경 Novel coronavirus (named SARS-CoV-2) can spread widely in confined settings including hospitals, cruise ships, prisons, and places of worship. In particular, a healthcare-associated outbreak could become the epicenter of COVID-19. This study aimed to evaluate the effects of different intervention strategies on the hospital outbreak within a tertiary hospital. 방법 A mathematical model was developed for the COVID-19 transmission within a 2500-bed tertiary hospital of South Korea. The study hospital consists of three main categories: ward, outpatient clinic(OPD), and emergency room(ER).The SEIR (susceptible-exposed-infectious-recovered) model with a compartment of doctor, nurse, patient, and caregiver was constructed. We assumed exposed and infectious people from the patient and caregiver group came into the ER and OPD. The effects of different intervention strategies such as front door screening, quarantine unit for newly admitted patients,early testing of suspected infected people, and personal protective equipment(PPE) for both medical staff and visitors were evaluated. We set worse and best cases based on different parameters and performed sensitivity analysis for the vulnerability of results for each intervention. 결과 The model suggested that the early testing (within eight hours) of infected cases and operating the quarantine ward for newly hospitalized patients are effective measures for decreasing incidence of COVID-19 within a hospital (81.3% and 70% decrease of number of incident cases, respectively, during 60 days). Front door screening for detecting suspected cases had only 42% effectiveness. Screening for prohibiting the admission of COVID-19 patients was more effective than the measures for patients before emergency room or outpatient clinic. Reinforcement of PPE for medical staff does not show an expected improvement of effectiveness. The effectiveness of front door screening and use of a quarantine unit are higher in the best case while the probability of control by testing and protection devices is higher in worst cases. 결론 This model suggests under the assumed conditions, some measures have a great influence on the incidence of COVID-19 within a hospital. Detecting the patients with COVID-19 from the ER and in wards before inflow to a hospital is effective in low transmission settings, and control by PPE is important in high transmission settings. Above all, the implementation of the preventive measures could reduce the size of a hospital outbreak. [ABSTRACT FROM AUTHOR]

배경 Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome and corticosteroid has been considered as a possible therapeutic agent. However, there are limited data about when to start corticosteroid. 방법 A retrospective multicenter study was designed to explore the effects of early corticosteroid use on clinical outcomes in 7 hospitals in Korea. We reviewed 22 patients hospitalized with COVID-19 who needed to use corticosteroid. 결과 Of the 22 patient who received corticosteroid, 12 patients (55%) were treated within 10 days from diagnosis. There was no statistically significant difference in baseline characteristics. Initial PaO2/FiO2 ratio was 168.75. Overall case fatality rate was 25%. In early use group, mean time from diagnosis to steroid use was 4.08 days and duration was 14 days. In late use group, mean time from diagnosis to steroid use was 12.80 days and duration was 18.50 days. PaO2/Fio2 ratio, CRP, Ct value were improved overtime in both group. In early use group, time from symptom to discharge (32.4 days versus 60.0 days, p=0.030), time from diagnosis to discharge (27.8 days versus 57.4 days, p=0.024) and hospital stay (26.0 days versus 53.9 days, p=0.033) were shortened. 결론 Among patient with severe of life-threatening COVID-19, early use of corticosteroid was result in a statistically significant improvement in time to clinical outcome related with hospital stay. [ABSTRACT FROM AUTHOR]

Since the first case was reported in Wuhan, Hubei Province, China on December 12, 2019, Coronavirus disease 2019 (COVID-19) has spread widely to other countries since January 2020. As of April 16, 2020, 10635 confirmed cases have been reported, with 230 deaths in Korea. COVID-19 patients may be asymptomatic or show various clinical manifestations, including acute symptoms such as fever, fatigue, sore throat; pneumonia presenting as acute respiratory distress syndrome; and multiple organ failure. As COVID-19 has such varied clinical manifestations and case fatality rates, no standard antiviral therapy regimen has been established other than supportive therapy. In the present guideline, we aim to introduce potentially helpful antiviral and other drug therapies based on in vivo and in vitro research and clinical experiences from many countries. [ABSTRACT FROM AUTHOR]

To develop a clinical practice guideline for vaccination in patients with autoimmune inflammatory rheumatic disease (AIIRD), the Korean College of Rheumatology and the Korean Society of Infectious Diseases developed a clinical practice guideline according to the clinical practice guideline development manual. Since vaccination is unlikely to cause AIIRD or worsen disease activities, required vaccinations are recommended. Once patients are diagnosed with AIIRD, treatment strategies should be established and, at the same time, monitor their vaccination history. It is recommended to administer vaccines when the disease enters the stabilized stage. Administering live attenuated vaccines in patients with AIIRD who are taking immunosuppressants should be avoided. Vaccination should be considered in patients with AIIRD, prior to initiating immunosuppressants. It is recommended to administer influenza, Streptococcus pneumoniae, hepatitis A, hepatitis B, herpes zoster, measlesmumps- rubella virus, human papillomavirus, and tetanus-diphtheria-pertussis vaccines in patients with AIIRD; such patients who planned to travel are generally recommended to be vaccinated at the recommended vaccine level of healthy adults. Those who live in a household with patients with AIIRD and their caregivers should also be vaccinated at levels that are generally recommended for healthy adults. [ABSTRACT FROM AUTHOR]

Sepsis is one of the significant causes of morbidity and mortality. The burden caused by sepsis has continued to increase in recent years in the Korea, highlighting the urgent need for the implementation of strategies to improve sepsis treatment outcomes. We therefore designed a web-based sepsis registry system ("Korean Registry for Improving Sepsis Survival" [KISS]) protocol to be used in hospitals in the Korea for evaluation of the epidemiology and clinical characteristics of patients with sepsis, via an analysis of outcome predictors. The inclusion criteria of this registry are as follows: adult patients ≥18 years admitted to the participating hospitals who are diagnosed with sepsis or septic shock. Demographic and clinical information data of the patients will be collected from hospital medical records and will be recorded in a case report form, which will be entered into a web-based data management system. The analysis of the collected data will be performed as follows: (1) epidemiological and clinical characteristics of sepsis and septic shock, (2) application of sepsis bundles and antibiotic stewardship, and (3) audit and feedback. In conclusion, we aim to build the comprehensive web-based sepsis registry in the Korea through a nation-wide network of participating hospitals. Information collected and analyzed through the KISS can be used for further improvements in the clinical management of sepsis. Furthermore, the KISS will facilitate research leading to the formulation of public health policies regarding sepsis bundle and antibiotic stewardship strategies in the Korea. [ABSTRACT FROM AUTHOR]

There are a variety of causes of intestinal obstruction, with the most common cause being malignant diseases; however, volvulus, inflammatory bowel disease or diverticulitis, radiation injury, ischemia, and pseudo-obstruction can also cause colonic obstruction. These are benign conditions; however, delayed diagnosis of acute intestinal obstruction owing to these causes can cause critical complications, such as perforation. Therefore, high levels of clinical suspicion and appropriate treatment are crucial. There are variable treatment options for colonic obstruction, and endoscopic treatment is known to be a less invasive and an effective option for such. In this article, the authors review the causes of benign colonic obstruction and pseudo-obstruction and the role of endoscopy in treating them. [ABSTRACT FROM AUTHOR]

Background: The intestinal microbiota plays an important role in the pathogenesis of Clostridioides difficile-associated diarrhea, and regional and racial characteristics influence the microbiome composition and diversity. We investigated the intestinal microbiome characteristics of patients with C. difficile colitis (CD+) compared to those of patients with colitis not due to C. difficile (CD-), patients with vancomycin-resistant enterococci (VRE) colonization, and healthy controls, in Korea. Materials and Methods : We collected stool samples from 24,18,11 and 13 subjects within CD+, CD-, VRE and healthy control groups, respectively. The microbial communities were evaluated by 454-pyrosequencing of bacterial 16s rRNA. Results: The species richness and microbial diversity were significantly lower in the CD+ group compared to those in healthy controls, but not compared to those in CD- and VRE groups. Phylum-level analysis showed that the proportion of Actinobacteria in the CD+ group was significantly lower than in the healthy control, but was unchanged compared to that in CDand VRE groups. At the genus level, compared to the healthy group, ±e CD+ group showed significantly lower proportions of Blautia, Bifidobacterium, Faecalibacterium et al. Compared to the VRE group, the CD+ group showed a significantly higher proportion of Anaerostipes. Conclusions: We could identify the intestinal microbiome characteristics ofKoreans with C. difficile colitis. It might help to develop microbiome based diagnostic and treatment modalities. [ABSTRACT FROM AUTHOR]

Background: The seropositivity rate of hepatitis B surface antigen (anti-HBs) antibodies is known to be ≥95% after hepatitis B virus vaccination during infancy. However, a low level or absence of anti-HBs in healthy children is discovered in many cases. Recent studies in adults reported that a reduced anti-HBs production rate is related to obesity. Purpose: To investigate whether body mass index (BMI) affects anti-HBs levels in healthy children following 3 serial dose vaccinations in infancy. Methods: We recruited 1,200 healthy volunteers aged 3, 5, 7, or 10 years from 4-day care centers and 4 elementary schools. All subjects completed a questionnaire including body weight, height, and vaccine type received. Levels of serum hepatitis B surface antigen (HBsAg) and anti-HBs in all subjects were analyzed using electrochemiluminescence immunoassay. The standardized scores (z score) for each sex and age were obtained using the lambda-mu-sigma method in the 2017 Korean National Growth Charts for children and adolescents. Results: Our subjects (n=1,200) comprised 750 males (62.5%) and 450 females (37.5%). The overall anti-HBs seropositivity rate was 57.9% (695 of 1,200). We identified significant differences in mean BMI values between seronegative and seropositive groups (17.45 vs. 16.62, respectively; P<0.001). The anti-HBs titer was significantly decreased as the BMI z score increased adjusting for age and sex (B=-15.725; standard error=5.494; P=0.004). The probability of anti-HBs seropositivity based on BMI z score was decreased to an OR of 0.820 after the control for confounding variables (95% confidence interval, 0.728–0.923; P=0.001). Conclusion: There was a significant association between anti-HBs titer and BMI z score after adjustment for age and sex. Our results indicate that BMI is a potential factor affecting anti-HBs titer in healthy children. [ABSTRACT FROM AUTHOR]

Fecal calprotectin (FC) is a marker of intraluminal intestinal inflammation. Intestinal inflammation may contribute to the pathophysiology of irritable bowel syndrome (IBS). This study evaluated FC levels in children with IBS and differences in FC levels in children stratified by IBS subtype and healthy controls (HCs). Methods: A total of 157 children with IBS and 56 HCs aged 4-16 years (119 boys, 94 girls, mean age of 9.48 years) were included in this prospective study. Children with IBS were diagnosed using the Rome III criteria and classified into 4 subtypes: IBS with constipation (IBS-C, n = 37), IBS with diarrhea (IBS-D, n = 54), IBS with alternating constipation and diarrhea (IBS-M, n = 49), and IBS unsubtyped (IBS-U, n = 17); postinfectious IBS (PI-IBS) was also considered. The FC concentration in stool samples was analyzed using an enzyme-linked immunosorbent assay. All participants answered a questionnaire regarding several demographic and clinical characteristics. Results: Children with IBS had significantly higher levels of FC than the HCs (88.71 µg/g vs. 17.77 µg/g). Among the 4 IBS subtypes, the FC concentration was highest in children with IBS-D, followed by those with IBS-M, IBS-C, and IBS-U (169.94 µg/g vs. 45.04, 31.22, and 33.52 µg/g, respectively), and these differences were statistically significant. For PI-IBS, 90% of cases were in the IBS-D group. Conclusions: The FC level was significantly higher in children with IBS than in HCs and differed depending on the IBS subtype, supporting the notion that IBS is a type of low-grade bowel inflammation. [ABSTRACT FROM AUTHOR]

Fecal calprotectin (FC) is a calcium- and zinc-binding protein of the S100 family, mainly expressed by neutrophils and released during inflammation. FC became an increasingly useful tool both for gastroenterologists and for general practitioners for distinguishing inflammatory bowel disease (IBD) from irritable bowel syndrome. Increasing evidences support the use of this biomarker for diagnosis, follow-up and evaluation of response to therapy of several pediatric gastrointestinal diseases, ranging from IBD to nonspecific colitis and necrotizing enterocolitis. This article summarizes the current literature on the use of FC in clinical practice [ABSTRACT FROM AUTHOR]