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배경: There are limited data comparing the transmission rates and kinetics of viable virus shedding of the omicron variant to those of the delta variant. We compared these rates in hospitalized patients infected with delta and omicron variants. 방법: We prospectively enrolled adult patients with COVID-19 admitted to a tertiary care hospital in South Korea between September 2021 and May 2022. Secondary attack rates were calculated by epidemiologic investigation, and daily saliva samples were collected to evaluate viral shedding kinetics. Genomic and subgenomic SARS-CoV-2 RNA was measured by PCR, and virus culture was performed from daily saliva samples. 결과: A total of 88 patients with COVID-19 who agreed to daily sampling and were interviewed, were included. Of the 88 patients, 48 (59%) were infected with delta, and 34 (41%) with omicron ; a further five patients gave undetectable or inconclusive RNA PCR results and one was suspected of being co-infected with both variants. The baseline characteristics of the two groups were comparable except that fewer of the delta patients had been vaccinated, and the delta patients had more severe disease. The latter also had a higher secondary attack rate (31% [38/124]) vs. 7% [34/456], p<0.001 : Table 1). Multivariable analysis revealed that moderate-to-critical disease severity (HR 1.96), immunocompromised status (HR 2.17), fully- or 1st booster-vaccinated status (HR 0.49), and omicron infection (HR 0.44) were independently associated with prolonged viable virus shedding (Table 2). 결론: Patients with omicron infections had higher transmission rates but shorter periods of transmissible virus shedding than those with delta infections. [ABSTRACT FROM AUTHOR]

We investigated the proportion and characteristics of severe Corynebacterium striatum pneumonia in South Korea during 2014-2019. As part of an ongoing observational study of severe pneumonia among adult patients, we identified 27 severe C. striatum pneumonia cases. Most (70.4%) cases were hospital-acquired, and 51.9% of patients were immunocompromised. C. striatum cases among patients with severe hospital-acquired pneumonia (HAP) increased from 1.0% (2/200) during 2014-2015 to 5.4% (10/185) during 2018-2019, but methicillin-resistant Staphylococcus aureus (MRSA) infections among severe HAP cases decreased from 12.0% to 2.7% during the same timeframe. During 2018-2019, C. striatum was responsible for 13.3% of severe HAP cases from which bacterial pathogens were identified. The 90-day mortality rates were similarly high in the C. striatum and MRSA groups. C. striatum was a major cause of severe HAP and had high mortality rates. This pathogen is emerging as a possible cause for severe pneumonia, especially among immunocompromised patients. [ABSTRACT FROM AUTHOR]

Background This study aimed to evaluate whether fluvoxamine reduces clinical deterioration in adult patients with mild to moderate coronavirus disease 2019 (COVID-19), and to identify risk factors for clinical deterioration in patients admitted to a community treatment center (CTC). Materials and Methods A randomized, placebo-controlled trial was conducted in a CTC, in Seoul, Korea from January 15, 2021, to February 19, 2021. Symptomatic adult patients with positive results of severe acute respiratory syndrome coronavirus 2 real time-polymerase chain reaction within 3 days of randomization were assigned at random to receive 100 mg of fluvoxamine or placebo twice daily for 10 days. The primary outcome was clinical deterioration defined by any of the following criteria: oxygen requirement to keep oxygen saturation over 94.0%, aggravation of pneumonia with dyspnea, or World Health Organization clinical progression scale 4 or greater. Results Of 52 randomized participants [median (interquartile range) age, 53.5 (43.3 - 60.0) years; 31 (60.0%) men], 44 (85.0%) completed the trial. Clinical deterioration occurred in 2 of 26 patients in each group (P >0.99). There were no serious adverse events in either group. Clinical deterioration occurred in 15 (6.0%) of 271 patients admitted to the CTC, and all of them were transferred to a hospital. In multivariate analysis, age between 55 and 64, fever and pneumonia at admission were independent risk factors for clinical deterioration. Conclusion In this study of adult patients with symptomatic COVID-19 who were admitted to the CTC, there was no significant differences in clinical deterioration between patients treated with fluvoxamine and placebo. [ABSTRACT FROM AUTHOR]

배경: Despite the known clinical benefit of remdesivir in SARS-CoV-2 infection, its usage has been limited in patients with impaired renal function due to concern about the liver and renal toxicities by the accumulation of sulfobutylether-β-cyclodextrin. We compared adverse events between remdesivir-treated and non-remdesivir-treated groups in COVID-19 patients with renal impairment. 방법: Adult COVID-19 patients with a glomerular filtration rate of <30 ml/min/1.73 m2 at admission to a tertiary care hospital between November 2020 and March 2022 were retrospectively enrolled. Data on serum creatinine and liver chemistry tests at day 3 or 5, 10, 15, and 30 from admission or the start of remdesivir therapy were collected. 결과: A total of 101 patients with impaired renal function were enrolled including 34 patients receiving renal replacement therapy. Of 101 patients, 64 received remdesivir, while 37 did not. The median duration of remdesivir therapy was 4 (interquartile range, 3-5). Among patients who did not need dialysis initially, 18% (7/38) of remdesivir-treated patients developed acute kidney injury (AKI) at day 3-5, while 43% (16/29) of non-remdesivir-treated patients did. The proportion of patients with AKI decreased over time in remdesivir-treated patients (Figure 1). At day 3-5, 20% (13/64) of remdesivir-treated patients developed liver injury (mostly mild injury), while 30% (11/37) of non-remdesivir-treated patients did. There was no significant increase in alanine aminotransferase level over time in remdesivir-treated patients (Figure 1). No serious renal and hepatic adverse events related to remdesivir were observed. 결론: No significant increases in liver and kidney injury associated with remdesivir therapy were observed. These findings suggest that remdesivir therapy should not be easily withheld due to safety concerns of sulfobutylether-β-cyclodextrin in COVID-19 patients with renal impairment. [ABSTRACT FROM AUTHOR]

배경: Bacteremia caused by carbapenemase-producing Enterobacterales (CPE) is a growing concern due to its high mortality and limited treatment option. We evaluated the characteristics of subsequent CPE bacteremia in CPE stool carriers and analyzed risk factors for CPE bacteremia compared with non-CPE Enterobacter bacteremia. 방법: We retrospectively analyzed adult patients confirmed to have CPE colonization in stool surveillance culture in a tertiary hospital between January 2018 and February 2022. All episodes of Enterobacterales bacteremia within 6 months after CPE colonization were identified. 결과: During the study periods, a total of 1,174 patients were identified as CPE stool carriers. Of these patients, 58 (4.9%) experienced 70 episodes of subsequent CPE bacteremia after CPE colonization, whereas 102 (8.7%) had 123 episodes of subsequent non-CPE Enterobacterales bacteremia. Colonization with KPC producer, K. pneumoniae, and E. coli was significantly associated with CPE bacteremia (Table 1). Subsequent Enterobacterales bacteremia in CPE carriers was more frequently caused by non-CPE than by CPE (8.7% vs. 4.9%, p <0.001). When comparing the first episode of Enterobacterales bacteremia according to carbapenemase production, colonization with KPC producer and K. pneumoniae, multiple sites colonization, high Pitt’s score, ICU care, recent abdominal surgery, and prior carbapenem use were significantly associated with CPE bacteremia (Table 2). Multivariable analysis revealed that ICU care (adjusted odds ratio [aOR]: 4.09, 95% confidence interval 1.52 to 11.01, p <0.01), KPC colonizer (aOR: 4.22, p <0.01) and abdominal surgery within a week (aOR: 13.15, p =0.03) were independent risk factors for CPE bacteremia. 결론: In CPE carriers, non-CPE Enterobacterales were 1.8 times more likely to cause bacteremia than CPE. In a CPE carrier in ICU, colonized with KPC, and recent history of intraabdominal surgery, empirical therapy for CPE should be considered when sepsis is suspected. [ABSTRACT FROM AUTHOR]

Background: Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales bacteremia is associated with significant mortality; however, no optimal antibiotic strategy is available. We aimed to evaluate the clinical outcomes according to the antibiotic regimens and identify risk factors for mortality in patients with KPC-producing K. pneumoniae and Escherichia coli bacteremia. Materials and Methods: This retrospective cohort study included all adult patients with monomicrobial bacteremia (KPC-producing K. pneumoniae or E. coli) between January 2011 and March 2021 at a 2,700-bed tertiary center. Results: Ninety-two patients were identified; 7 with E. coli bacteremia, and 85 with K. pneumoniae bacteremia. Thirty-day mortality was 38.0% (35/92). Non-survivors were more likely to have had nosocomial infection (88.6% vs. 63.2%, P = 0.01), high APACHE II scores (mean [interquartile range], 22.0 [14.0 - 28.0] vs. 14.0 [11.0 - 20.5], P <0.001), and septic shock (51.4% vs. 26.3%, P <0.001) and less likely to have been admitted to the surgical ward (5.7% vs. 22.8%, P = 0.04), undergone removal of eradicable foci (61.5% vs. 90.6%, P = 0.03), and received appropriate combination treatment (57.1% vs. 78.9%, P = 0.03) than survivors. No significant difference in mortality was observed according to combination regimens including colistin, aminoglycoside, and tigecycline. In multivariable analysis, high APACHE II scores (adjusted odds ratio [aOR], 1.14; 95% confidence interval [CI], 1.06 - 1.23, P <0.001), and appropriate definitive treatment (aOR, 0.25; CI, 0.08 - 0.74, P = 0.01) were independent risk factors for mortality. Conclusion: High APACHE II scores and not receiving appropriate definitive treatment were associated with 30-day mortality. Mortality did not significantly differ according to combination regimens with conventional drugs such as aminoglycoside and colistin. [ABSTRACT FROM AUTHOR]

Background: Bloodstream infection (BSI) is an important complication of extracorporeal membranous oxygenation (ECMO) and a major cause of mortality. This study evaluated the epidemiological and clinical characteristics of BSI that occur during ECMO application according to microbial etiology. Methods: Adult patients who underwent ECMO from January 2009 to December 2016 were retrospectively analyzed for BSI episodes at a 2,700-bed, tertiary center. Epidemiological and clinical characteristics and outcomes of BSI were evaluated and were compared for etiologic groups (gram-positive cocci, gram-negative rods, and fungi groups). Risk factors for 14-day mortality were analyzed. Results: A total of 1,100 patients underwent ECMO during the study period, and 65 BSI episodes occurred in 61 patients. The BSI incidence was 8.3 episodes/1,000 ECMO days, which significantly decreased over time (P = 0.03), primarily in gram-positive cocci BSI. Gram-positive cocci, gram-negative rods, and fungi accounted for 38%, 40%, and 22% of the 73 blood isolates, respectively. Baseline characteristics were comparable between groups. Catheter-related infection (CRI) and pneumonia were the most common sources of BSI; 52% of gram-positive cocci BSIs and 79% of fungi BSIs were caused by CRI, and 75% of gram-negative BSIs by pneumonia. Patients with gram-negative rods BSI died more frequently and earlier than those with other BSIs. Independent risk factors for 14-day mortality were older age and gramnegative rods BSI. Conclusions: The decreased BSI incidence during ECMO was mainly because of the decrease of gram-positive cocci BSI. The high early mortality of gram-negative rods BSI makes prevention and adequate treatment necessary. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) is the most common viral pathogen that negatively impacts on the outcome of liver transplantation. CMV cause febrile illness often accompanied by bone marrow suppression, and in some cases, invades tissues including the transplanted allograft. In addition, CMV has been significantly associated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall patient and allograft survival. To negate the adverse effects of CMV on outcome, its prevention, whether through antiviral prophylaxis or preemptive therapy, is regarded as an essential component to the medical management of liver transplant patients. Two recent guidelines have suggested that antiviral prophylaxis or preemptive therapy are similarly effective in preventing CMV disease in modest-risk CMV-seropositive liver transplant recipients, while antiviral prophylaxis is the preferred strategy over preemptive therapy for the prevention of CMV disease in high-risk recipients [CMV-seronegative recipients of liver allografts from CMV-seropositive donors (D+/R-)]. However, antiviral prophylaxis has only delayed the onset of CMV disease in many CMV D+/R- liver transplant recipients, and at least in one study, such occurrence of late-onset primary CMV disease was significantly associated with increased mortality after liver transplantation. Therefore, optimized strategies for prevention are needed, and aggressive treatment of CMV infection and disease should be pursued. The standard treatment of CMV disease consists of intravenous ganciclovir or oral valganciclovir, and if feasible, one should also reduce the degree of immunosuppression. In one recent controlled clinical trial, valganciclovir was found to be as effective and safe as intravenous ganciclovir for the treatment of mild to moderate CMV disease in solid organ (including liver) transplant recipients. In this article, the authors review the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.