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Lactoferrin (LF) is known to possess anti-inflammatory activity, although its mechanisms of action are not well-understood. The present study asked whether LF affects the commitment of inducible regulatory T cells (Tregs). LF substantially promoted Foxp3 expression by mouse activated CD4+T cells, and this activity was further enhanced by TGF-β1. Interestingly, blocking TGF-β with anti–TGF-β Ab completely abolished LF-induced Foxp3 expression. However, no significant amount of soluble TGF-β was released by LF-stimulated T cells, suggesting that membrane TGF-β (mTGF-β) is associated. Subsequently, it was found that LF binds to TGF-β receptor III, which induces reactive oxygen species production and diminishes the expression of mTGF-β–bound latency-associated peptide, leading to the activation of mTGF-β. It was followed by phosphorylation of Smad3 and enhanced Foxp3 expression. These results suggest that LF induces Foxp3+ Tregs through TGF-β receptor III/reactive oxygen species–mediated mTGF-β activation, triggering canonical Smad3-dependent signaling. Finally, we found that the suppressive activity of LF-induced Tregs is facilitated mainly by CD39/CD73-induced adenosine generation and that this suppressor activity alleviates inflammatory bowel disease.

The smoking status of kidney transplant recipients and living donors has not been explored concurrently in a prospective study, and the synergistic adverse impact on outcomes remains uncertain. The self-reported smoking status and frequency were obtained from recipients and donors at the time of kidney transplantation in a prospective multicenter longitudinal cohort study (NCT02042963). Smoking status was categorized as "ever smoker" (current and former smokers collectively) or "never smoker." Among 858 eligible kidney transplant recipients and the 858 living donors, 389 (45.3%) and 241 (28.1%) recipients were considered ever smokers at the time of transplant. During the median follow-up period of 6 years, the rate of death-censored graft failure was significantly higher in ever-smoker recipients than in never-smoker recipients (adjusted HR, 2.82; 95% CI 1.01-7.87; P = 0.048). A smoking history of >20 pack-years was associated with a significantly higher rate of death-censored graft failure than a history of ≤20 pack-years (adjusted HR, 2.83; 95% CI 1.19-6.78; P = 0.019). No donor smoking effect was found in terms of graft survival. The smoking status of the recipients and donors or both did not affect the rate of biopsy-proven acute rejection, major adverse cardiac events, all-cause mortality, or post-transplant diabetes mellitus. Taken together, the recipient's smoking status before kidney transplantation is dose-dependently associated with impaired survival.

We evaluated the temporal trend of preemptive kidney transplantation (KT) and the effect of pretransplant dialysis duration on post-transplant outcomes. This was a nationwide cohort study of the first-time 3392 living donor KT (LDKT) recipients (2014-2019). The annual changes in proportion of preemptive KT, factors associated with preemptive KT, and post-transplant outcomes were analyzed. Preemptive KT was performed in 816 (24.1%) patients. Annual trend analysis revealed gradual decrease in preemptive KT over time (P = 0.042). Among the underlying causes of preemptive KT, the proportion of diabetes increased and that of glomerulonephritis decreased during the study period. Glomerulonephritis as the primary renal disease was a predictor of preemptive KT. Patients with pretransplant dialysis >6 months showed increased graft failure risk than preemptive KT in the subdistribution of hazard model for competing risk (adjusted hazard ratio [aHR], 2.53; 95% confidence interval [CI], 1.09-5.87; P = 0.031) and in propensity score-matched analysis (aHR, 2.45; 95% CI, 1.02-5.92; P = 0.034); however, pretransplant dialysis ≤6 months showed comparable graft survival with preemptive KT in both analyses. Preemptive KT declined over successive years, associated with an increase in diabetes and a decrease in glomerulonephritis as underlying causes of KT. Short period of dialysis less than 6 months does not affect graft survival compared with preemptive KT; however, longer dialysis decreases graft survival.

Background Korea has single health insurance system and insurance claim information on almost all medical practices in Korean hospitals is collected and processed by the Health Insurance Review and Assessment Service (HIRA). Since information about prescription of almost all hospitals is available in National Health Insurance (NHI) claim data, recently established the Korea National Antimicrobial Use Analysis System (KONAS) has been using NHI claim data as data source. The purpose of this study is to validate the accuracy of NHI claim data. Methods Data on all antimicrobial agents prescribed in four tertiary-care hospitals in Korea between January 2019 and December 2019 were obtained using NHI claim data extracted by HIRA and data extracted by common data model based on electronic health record (EHR) in each hospital. Antibiotics and antifungal agents according to the Anatomical Therapeutic Chemical class J01 and J02 were included while antiviral, antitubercular, antiparasitic, and topical antimicrobial agents were excluded. Antimicrobial consumption was measured as days of therapy (DOT) and standardized to per 1,000 patient-days. The ratio of monthly antimicrobial consumption calculated using the NHI claim data compared to that calculated using the common data model was demonstrated (HIRA/EHR ratio). Results The monthly HIRA/EHR ratio of broad-spectrum antibiotics predominantly used for hospital-onset infections was 1.08-1.12 and that of broad-spectrum antibiotics predominantly used for community-acquired infections was 1.11-1.21. The monthly HIRA/EHR ratio of other antimicrobial classes are as follows: antibacterial agents predominantly used for resistant gram-positive infections 1.15-1.31, narrow-spectrum beta-lactam agents 1.00-1.05, antifungal agents predominantly used for invasive candidiasis 1.00-1.27, and antibacterial agents predominantly used for extensive antibiotic-resistant gram-negative bacteria 0.70-1.09. Conclusion The monthly antimicrobial consumption calculated using NHI claim data differs from that calculated using EHR data by up to 30%. It would be desirable to establish a system that can analyze and monitor antimicrobial consumption using EHR data in each hospital in Korea in the future. Disclosures Hyunki Woo, BS, Evidnet Inc.: Employee changhui Kim, BS, Evidnet Inc.: Employee.

Background Antibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes. Antibiotic use for asymptomatic bacteriuria (ABU) has been defined as “antibiotics never events”, and urinary tract infection (UTI) is one of the most common infectious diseases for which antibiotics are prescribed in Korea. To establish an effective antimicrobial stewardship strategy, a qualitative assessment of antibiotic use in actual clinical syndrome is necessary. Methods Cases of positive urine cultures (≥105 CFU/ml), performed in inpatient, outpatient, and emergency departments in April 2021 were screened in 26 hospitals located throughout Korea. Cases were classified into ABU, lower UTI, and upper UTI. The appropriateness of antibiotic use was retrospectively evaluated by infectious disease specialists using quality indicators based on the domestic clinical guideline for ABU and UTI. Figure 1.Study flow diagram Results A total of 2697 cases of ABU or UTI were included. The appropriateness of antibiotic use was assessed in 1157 cases with asymptomatic bacteriuria, 677 and 863 cases with lower and upper UTI (Figure 1). Antibiotics were prescribed in 21.7% (251 of 1157) of ABU without appropriate indication. Of 66 ABU cases with appropriate indication in which prophylactic antibiotics were prescribed, the duration of antibiotics was adequate in only 34.8% (Table 1). For lower UTI, the appropriateness of empirical and definite antibiotics was 77.8% (527 of 677) and 68.0% (353 of 519). In terms of upper UTI, 86.3% (745 of 863) and 78.2% (583 of 746) was appropriate, respectively. The duration of antibiotics was adequate in 65.7% (421 of 641) of lower UTI and 77.9% (592 of 760) in upper UTI (Table 2, 3). Conclusion This nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that a significant proportion of antibiotics were prescribed inappropriately and, furthermore the duration of antibiotics was prolonged unnecessarily. Interventions for appropriate antibiotic use in ABU and UTI at the national level are required. Disclosures All Authors: No reported disclosures.

The C-reactive protein-to-albumin ratio (CAR) is a prognostic marker in various diseases that represents patients’ inflammation and nutritional status. We investigated the prognostic value of CAR in critically ill patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). We retrospectively collected data from eight hospitals in Korea. The patients were divided into quartiles according to CAR levels at the time of CRRT initiation. Cox regression analyses were performed to investigate the effect of CAR on in-hospital mortality. Among 3995 patients who underwent CRRT, the in-hospital mortality rate was 67.3% during the follow-up period. The 7-day, 30-day, and in-hospital mortality rates increased toward higher CAR quartiles. After adjusting for confounding variables, the higher quartile groups had an increased risk of in-hospital mortality (quartile 3: aHR, 1.15, 95% CI, 1.02–1.30, P=0.023; quartile 4: aHR, 1.33; 95% CI, 1.18–1.50, P

This study attempted to explore the barriers to physical activity of older patients with Hypertension. It aimed to provide robust evidence produced through their eyes. First, through the data analysis of the accelerometer and the decision of the research team, 10 out of the 30 applicants were invited to participate in a photovoice study. Photovoice is one example of participatory action research. Photovoice participants can communicate their unique experiences through photographs, providing a highly realistic and authentic perspective that is not possible to be understood with traditional qualitative research. This study inductively identified four main themes; health illiteracy, distortion of health information, fear of physical activity, and rejection of any life changes. Based on a specific understanding of the population’s perception of physical activity, this study attempted to provide evidence of why many elderly Korean patients with Hypertension stay inactive.

Coronavirus disease (COVID-19) has been spreading all over the world; however, its incidence and case-fatality ratio differ greatly between countries and between continents. We investigated factors associated with international variation in COVID-19 incidence and case-fatality ratio (CFR) across 107 northern hemisphere countries, using publicly available COVID-19 outcome data as of 14 September 2020. We included country-specific geographic, demographic, socio-economic features, global health security index (GHSI), healthcare capacity, and major health behavior indexes in multivariate models to explain this variation. Multiple linear regression highlighted that incidence was associated with ethnic region (p p $${R}^{2}$$ R 2 = 0.545) and CFR (partial $${R}^{2}$$ R 2 = 0.372), even after adjusting for various confounding factors.

We designed a highly sensitive reverse transcription nested polymerase chain reaction targeting the M-segment (NPCR-M) of severe fever with thrombocytopenia syndrome (SFTS) virus. NPCR-M was performed in parallel with three other referenced PCR assays QPCR-S, PCR-M, and NPCR-S to assess their clinical usefulness as routine diagnostic techniques for SFTS. In this multi-centered prospective study, 122 blood samples from 38 laboratory-confirmed SFTS patients and 85 control samples were used. The results demonstrated that QPCR-S and NPCR-S had better sensitivity rate up to 21 days after symptom onset however, the PCR-M showed poor sensitivity after 7 days of symptom onset. Our designed NPCR-M had a higher detection rate up to 40 days from symptom onset and revealed the persistence of SFTSV RNA in the early convalescent phase. No false-positive results were seen for the control samples. Additionally, NPCR-M showed positive results for a sample that initially showed negative results from other PCRs and for many other samples collected in the convalescent phase of SFTS. Our designed nested PCR is suitable for SFTSV detection in patients’ blood collected in the acute and early convalescent phase of SFTS, and shows better sensitivity and high specificity even up to 40 days after symptom onset.

Background Seasonal Influenza is still considered associated with seasonal morbidity and hospitalization in the elderly population. The World Health Organization (WHO) recommended seasonal quadrivalent influenza vaccine (QIV) to reduce burden of two currently circulating influenza B lineages. Until 2019 Korean National Immunization Program (NIP) recommended trivalent influenza vaccine (TIV) after ongoing debates on cost effectiveness of QIV for elderly population. Although influenza vaccine only showed modest effect on reducing influenza in elderly, this study aimed to evaluate the immunogenicity and safety of inactivated QIV in healthy participants ≥ 65 years of age. Methods A total of 274 healthy participants aged ≥ 65 years received a QIV. Seroconversion-based vaccine efficacy of 4 strains of seasonal influenza was assessed 21 days after vaccination and adverse events were monitored until 180 days after vaccination. Results The percentages of participants seroconverted after vaccination on HI antibody against each strain were 36.5% (99/271) to A/H1N1, 47.6% (129/271) to A/H3N2, 40.6% (110/271) to B Yamagata, and 49.1% (133/271) to B Victoria. The percentages of participants seroprotected after vaccination on HI antibody against each strain were 81.2% (220/271) to A/H1N1, 98.5% (267/271) to A/H3N2, 95.2% (258/271) to B Yamagata, and 93.7% (254/271) to B Victoria. There was no serious adverse event (SAE) related with the study vaccine. Conclusion The quadrivalent split influenza vaccine is expected to offer seroprotection against influenza A and both influenza B lineages even in the elderly population.

Across languages, a passive construction is known to manifest a misalignment between the typical order of event composition (agent-before-theme) and the actual order of arguments in the constructions (theme-before-agent), dubbed non-isomorphic mapping. This study investigates comprehension of a suffixal passive construction in Korean by Mandarin-speaking learners of Korean, focusing on isomorphism and language-specific devices in the passive. We measured learners’ judgment of the acceptability of canonical and scrambled suffixal passives as well as their reaction times (relative to a canonical active transitive). Our analysis generated three major findings. First, learners uniformly preferred the canonical passive to the scrambled passive. Second, as proficiency increased, the judgment gap between the canonical active transitive and the canonical suffixal passive narrowed, but the gap between the canonical active transitive and the scrambled suffixal passive did not. Third, learners (and even native speakers) spent more time in judging the acceptability of the canonical suffixal passive than they did in the other two construction types. Implications of these findings are discussed with respect to the mapping nature involving a passive voice, indicated by language-specific devices (i.e., case-marking and verbal morphology dedicated to Korean passives), in L2 acquisition.

Introduction: We hypothesize that remote patient monitoring (RPM) for automated peritoneal dialysis (APD) and feedback could enhance patient self-management and improve outcomes. The aim of this study was to evaluate the efficacy of RPM-APD compared to traditional APD (T-APD) without RPM. Methods: In this multicenter, randomized controlled trial, patients on APD were randomized to T-APD (n = 29) or RPM-APD (n = 28) at 12 weeks and followed until 25 weeks. Health-related quality of life (HRQOL), patient and medical staff satisfaction with RPM-APD, and dialysis-related outcomes were compared between the 2 groups. Results: We found no significant differences in HRQOL scores at the time of enrollment and randomization between RPM-APD and T-APD. At the end of the study, the RPM-APD group showed better HRQOL for the sleep domain (p = 0.049) than the T-APD group and the T-APD group showed better HRQOL for the sexual function domain (p = 0.030) than the RPM-APD group. However, we found no significant interactions between the time and groups in terms of HRQOL. Different HRQOL domains significantly improved over time in patients undergoing RPM-APD (effects of kidney disease, p = 0.025) and T-APD (burden of kidney disease, p = 0.029; physical component summary, p = 0.048). Though medical staff satisfaction with RPM-APD was neutral, most patients were quite satisfied with RPM-APD (median score 82; possible total score 105 on 21 5-item scales) and the rating scores were maintained during the study period. We found no significant differences in dialysis adherence, accuracy, adequacy, overhydration status, blood pressure, or the number of unplanned visits between the 2 groups. Discussion/Conclusion: Although HRQOL and dialysis-related outcomes were comparable between RPM-APD and T-APD, RPM-APD was positive in terms of patient satisfaction. Further long-term and large-scale studies will be required to determine the efficacy of RPM-APD. Trial Registration: CRIS identifier: KCT0003390, registered on December 14, 2018 – retrospectively registered, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=12348.

Although the physiological function of receptor-interacting protein kinase (RIPK) 3 has emerged as a critical mediator of programmed necrosis/necroptosis, the intracellular role it plays as an attenuator in human lungs and human bronchial epithelia remains unclear. Here, we show that the expression of RIPK3 dramatically decreased in the inflamed tissues of human lungs, and moved from the nucleus to the cytoplasm. The overexpression of RIPK3 dramatically increased F-actin formation and decreased the expression of genes for pro-inflammatory cytokines (IL-6 and IL-1β), but not siRNA-RIPK3. Interestingly, whereas RIPK3 was bound to histone 1b without LPS stimulation, the interaction between them was disrupted after 15 min of LPS treatment. Histone methylation could not maintain the binding of RIPK3 and activated movement towards the cytoplasm. In the cytoplasm, overexpressed RIPK3 continuously attenuated pro-inflammatory cytokine gene expression by inhibiting NF-κB activation, preventing the progression of inflammation during Pseudomonas aeruginosa infection. Our data indicated that RIPK3 is critical for the regulation of the LPS-induced inflammatory microenvironment. Therefore, we suggest that RIPK3 is a potential therapeutic candidate for bacterial infection-induced pulmonary inflammation.

Background The platelet-to-lymphocyte ratio (PLR) is a marker of inflammation and predictor of mortality in a variety of diseases. However, the effectiveness of PLR as a predictor of mortality in patients with severe acute kidney injury (AKI) is uncertain. We evaluated the association between PLR and mortality in critically ill patients with severe AKI who underwent continuous renal replacement therapy (CRRT). Methods This is a retrospective observational cohort study, and a total of 1044 patients with AKI who underwent CRRT in Kyungpook National University Hospital from 2017 to 2021 were analyzed. The study subjects were divided into quintiles according to the PLR at CRRT initiation. A Cox proportional hazards model was used to investigate the association between PLR and mortality. Results PLR was associated with in-hospital mortality in a non-linear manner, showing a higher mortality rate at both ends of the PLR. The Kaplan–Meier curve analysis revealed the highest mortality rates with the first and fifth quintiles, while the lowest mortality rate occurred with the third quintile. Compared with the third quintile (the lowest mortality rate group), the first (adjusted hazard ratio [aHR] 1.94, 95% confidence interval [CI] 1.44–2.62, P P = 0.002) quintiles of PLR had significantly higher in-hospital mortality. The first and fifth quintiles showed a consistently increased risk of 30-day and 90-day mortality compared with the third quintile. In the subgroup analysis, lower and higher PLRs were predictors of in-hospital mortality in patients with older age, female sex, hypertension, diabetes, and higher Sequential Organ Failure Assessment score. Conclusion Both the lower and higher PLRs were independent predictors of in-hospital mortality in critically ill patients with AKI who underwent CRRT. Thus, the PLR may be a useful and easily accessible prognostic indicator for patients with severe AKI.

The impact of pretransplant and posttransplant alcohol consumption on outcomes in kidney transplant recipients (KTRs) is uncertain. Self-reported alcohol consumption was obtained at the time of transplant and 2 years after transplant in a prospective cohort study. Among 907 KTRs, 368 (40.6%) were drinkers at the time of transplant. Compared to non-drinkers, alcohol consumption did not affect the risk of death-censored graft failure (DCGF), biopsy-proven acute rejection (BPAR), cardiovascular events, or all-cause mortality. Compared to persistent non-drinkers, the development of DCGF, BPAR, cardiovascular events, all-cause mortality, or posttransplant diabetes mellitus was not affected by the alcohol consumption pattern (persistent, de novo, or stopped drinking) over time. However, de novo drinkers had a significantly higher total cholesterol (p < 0.001) and low-density lipoprotein cholesterol levels (p = 0.005) compared to persistent non-drinkers 5 years after transplant, and had significantly higher total cholesterol levels (p = 0.002) compared to the stopped drinking group 7 years after transplant, even after adjusting for the use of lipid-lowering agents, age, sex, and body mass index. Although pretransplant and posttransplant alcohol consumption were not associated with major outcomes in KTRs during the median follow-up of 6.0 years, a new start of alcohol use after KT results in a relatively poor lipid profile.Clinical Trial Registration:clinicaltrials.gov, identifier NCT02042963.

Health-related quality of life (HRQoL) concerns satisfaction with life and happiness with regard to physical, mental, and social factors. RAND-36 is a publicly available, self-administered questionnaire that examines eight health dimensions. This study evaluated the HRQoL of the South Korean population using the RAND-36 questionnaire and compared HRQoL across sociodemographic characteristics. From May 2015 to May 2019, South Koreans who visited public places aged 19–80 years were recruited and the RAND-36 questionnaire was administered. Overall, 1002 participants were recruited (mean age 45.34 years, 52% men). Men scored better than women in both physical and mental health (p < 0.05). There were significant differences in bodily pain (p < 0.05), general health perception (p < 0.05), and energy/fatigue (p < 0.05) dimensions according to the participants’ health condition. The HRQoL of South Koreans was lower than average in most dimensions compared with other countries. As the first study to assess this, its data can be used in future studies that apply RAND-36 to evaluate the HRQoL of diseased individuals, as they can compare their findings with those of our study population.

Donor-recipient age difference (DRAD) is one of the reasons why patients on kidney waiting lists refuse to receive the offered organ. However, its impact on deceased donor kidney transplantation (DDKT) outcomes is still controversial.One hundred fifty-three kidney transplant recipients (KTRs) who received their first-time DDKT were enrolled. The KTRs were divided into groups by DRAD: group 1 (n = 74) (DRAD 0) and group 2 (n = 79) (DRAD ≥ 0). The KTRs in group 2 were divided into 3 subgroups: DRAD 0 to 10 (n = 35), 10 to 20 (n = 32), and ≥ 20 (n = 12). The outcome measures included estimated glomerular filtration rate (eGFR), delayed graft function (DGF), acute rejection (AR), and graft and patient survival.There were no significant differences in clinical outcomes between group 1 and 2 except eGFR until 5 years after DDKT. Among the subgroups of group 2, DGF, AR, patient survival, and eGFR until 5 years showed no significant differences. However, graft survival was significantly different (P = .015); in addition, in the DRAD ≥ 20 subgroup, graft survival decreased compared with that in the DRAD 10 to 20 subgroup and DRAD 0 to 10 subgroup (P = .020, P = .012, respectively). In a multivariate Cox proportional hazards analysis, the DRAD ≥ 20 subgroup showed a higher risk for graft failure than the DRAD 0 to 10 subgroup.Although donors were of the same age or older than recipients, DDKT showed acceptable graft outcomes. However, because donors over 20 years older than recipients showed a decreased graft survival, it might be important to consider this point in donor-recipient matching of DDKT.

본 연구에서는 취약계층 아동의 비만 형성에 대한 요인으로 식이 자기효능감, 신체적 자기효능감 및 아동이 지각하는 부모양육태도와의 관련성을 확인하므로 향후 취약계층 아동비만을 관리하는 간호중재 개발을 위한 기초자료를 제공하고자 시도되었다. 본 연구의 대상자는 K도 A시에 소재한 11개의 지역아동센터 방문하는 아동 중 취약계층 아동으로 본 연구에 참여하고자 부모와 아동이 함께 서면 동의한 대상자로 조사하였다. 수집된 자료는 SPSS Win(ver. 22.0)프로그램을 이용하여 백분율, 평균과 표준편차, t-test, ANOVA, pearson"s correlation, stepwise multiple regression을 통계 분석하였다. 연구 결과는 취약계층 아동의 비만요인으로는 식이자기효능감, 부모의 양육태도, 가족형태 · 편부모가정, 부모비만여부 · 한 부모비만이었고, 취약계측 아동의 이들 변수의 비만요인에 대한 설명력은 32%였다. 따라서 취약계층 아동의 비만형성을 예방하기 위해 아동의 식이자기효능감을 증진시킬 수 있는 프로그램을 개발할 필요성이 있겠다. 이러한 결과를 근거로 향후 취약계층 아동들이 가지는 환경적요인 즉 부모양육태도, 가족형태 등을 고려한 아동과 부모가 함께 참여할 수 있는 간호중재전략개발이 필요하다는 것을 제시한다.

Objectives To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old. Methods S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin. Results During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072). Conclusions Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.

Herein, we report a rare case of severe respiratory syncytial virus pneumonia after kidney transplant in a 46-year-old woman. The patient was diagnosed with end-stage renal disease and underwent living-donor kidney transplant. Direct flow cytometry crossmatch testing yielded positive results, and desensitization treatment with rituximab, plasmapheresis, and im-munoglobulin was performed before transplant. There were no complications. Five days after discharge, the patient was readmitted with a 2-day history of fever and diagnosed with bilateral pneumonia. The patient was placed on mechanical ventilation and given renal replacement therapy. Respiratory syncytial virus in the bronchial washings was detected via polymerase chain reaction. Broad-spectrum antibiotics, intravenous methylprednisolone, and immunoglobulin were admin-istered. Over-immunosuppression strategies, such as desensitization therapy, may result in severe respiratory syncytial virus pneumonia, even in kidney transplant recipients.