581 results on '"Sang-Oh Lee"'
Search Results
152. Clinical significance of follow-up blood culture in patients with a single
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Taeeun, Kim, Seung Cheol, Lee, Min Jae, Kim, Jiwon, Jung, Heungsup, Sung, Mi-Na, Kim, Sung-Han, Kim, Sang-Oh, Lee, Sang-Ho, Choi, Jun Hee, Woo, Yang Soo, Kim, and Yong Pil, Chong
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Male ,Methicillin-Resistant Staphylococcus aureus ,Fever ,Bacteremia ,Middle Aged ,Staphylococcal Infections ,Anti-Bacterial Agents ,Survival Rate ,Blood Culture ,Recurrence ,Humans ,Female ,Prospective Studies ,Aged - Published
- 2019
153. Clinical Implications of the CMV-Specific T-Cell Response and Local or Systemic CMV Viral Replication in Patients With Moderate to Severe Ulcerative Colitis
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Jiwon Jung, Byong Duk Ye, Yang Soo Kim, Min Jae Kim, Se Jin Jang, Sung-Han Kim, Jun Hee Woo, Sang Hyoung Park, Sang-Ho Choi, Jene Choi, Kyung Hwa Jung, Suk-Kyun Yang, Jihun Kim, Dong-Hoon Yang, Sang-Oh Lee, Ho-Su Lee, and Yong Pil Chong
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0301 basic medicine ,medicine.medical_specialty ,H&E stain ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Internal medicine ,Major Article ,medicine ,cytomegalovirus ,ulcerative colitis ,business.industry ,Odds ratio ,medicine.disease ,Ulcerative colitis ,030104 developmental biology ,Infectious Diseases ,Real-time polymerase chain reaction ,Oncology ,Viral replication ,enzyme-linked immunospot ,T-cell response ,Immunohistochemistry ,030211 gastroenterology & hepatology ,business ,Viral load - Abstract
Background The precise role of cytomegalovirus (CMV) in ulcerative colitis (UC) remains disputed. We evaluated the association of CMV-specific host immune responses and systemic or local viral replication with responses to systemic steroids in patients with moderate to severe UC. Methods Patients who were hospitalized for moderate to severe UC between April 2015 and June 2016 were enrolled. At baseline, all enrolled patients underwent CMV-specific enzyme-linked immunospot assays, quantitative polymerase chain reaction (qPCR) analysis of blood and colonic tissue for CMV viral load, histopathological testing for CMV in colonic tissue by hematoxylin and eosin staining, and immunohistochemical (IHC) analysis. Clinical responses to steroid therapy based on the Oxford index were assessed on day 3. Results Of the 80 patients evaluated, 28 (35.0%) had poor responses to steroid therapy on day 3 of intensive treatment. The presence of inclusion bodies (32.1%) and high-grade (≥3) positivity on IHC (50.0%), as well as colonic (mean 1440.4 copies/mg) and blood (mean, 3692.6 copies/mL) CMV viral load, were higher in steroid-refractory UC patients than the control group (13.5%, 1.9%, mean 429.2 copies/mg, and mean 231.2 copies/mL, respectively; P = .046, .009, .017, and .002, respectively). However, CMV-specific T-cell responses were not associated with steroid-refractory UC. Multivariate analysis revealed that a higher Mayo score (odds ratio [OR], 2.00; P = .002) and higher blood CMV viral load via qPCR analysis (OR, 3.58; P = .044) were independent risk factors for steroid-refractory UC. Conclusions In patients with moderate to severe UC, higher Mayo score and blood CMV expression determined by qPCR are independently associated with steroid refractoriness. ClinicalTrials.gov registration number NCT 02439372.
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- 2019
154. Lung Transplantation as a Therapeutic Option in Acute Respiratory Distress Syndrome
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Sae Hoon Choi, Sang-Bum Hong, Tae Sun Shim, Hyung Ryul Kim, In-Cheol Choi, Seung-Il Park, Sang-Oh Lee, Kyung-Hyun Do, Dong Kwan Kim, Yong-Hee Kim, and Youjin Chang
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Adult ,Male ,medicine.medical_specialty ,ARDS ,Time Factors ,Waiting Lists ,Seoul ,Health Status ,medicine.medical_treatment ,Clinical Decision-Making ,030204 cardiovascular system & hematology ,Severity of Illness Index ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Risk Factors ,Interquartile range ,Internal medicine ,Severity of illness ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Lung transplantation ,Intensive care medicine ,Survival rate ,Aged ,Retrospective Studies ,Mechanical ventilation ,Respiratory Distress Syndrome ,Transplantation ,business.industry ,Patient Selection ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Treatment Outcome ,030228 respiratory system ,Female ,business ,Lung Transplantation - Abstract
Background Lung transplantation (LTPL) is considered as a salvage therapeutic option in patients with end-stage lung disease. However, there is a lack of sufficient data on the use of LTPL in patients with acute respiratory distress syndrome (ARDS). Although there are few case reports on lung transplant for ARDS, no case series exists up to date. The aim of this study was to evaluate the clinical outcomes of patients with ARDS in accordance with the LTPL status. Methods Patients who had severe ARDS (PaO2/FiO2 ratio ≤ 100 mm Hg with positive end-expiratory pressure ≥ 5 cm H2O) and were listed for LTPL with no underlying end-stage lung disease were included in this single-center retrospective study. Demographic and clinical data of the patients were collected and analyzed. Results Fourteen patients were listed for LTPL due to severe ARDS. All patients received mechanical ventilation, and 12 (86%) patients underwent extracorporeal membrane oxygenation. Of the 9 patients who underwent LTPL, 8 (89%) survived, whereas only 1 (20%) patient out of those who did not receive LTPL survived. The median survival time of the patients who underwent LTPL was 1996 days (interquartile range [IQR], 872-2239), compared with 49 days (IQR, 872-2239) in patients who did not undergo LTPL. The median survival time after LTPL was 64 months (IQR, 28-72). The 3-year survival rate of the recipients was 78%. Conclusions LTPL may be considered as a therapeutic option in a select group of patients with severe ARDS. However, the irreversibility of the patient's lung status should be considered.
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- 2018
155. Kinetics of viral load and cytokines in severe fever with thrombocytopenia syndrome
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Min Jae Kim, Yang Soo Kim, Yong Pil Chong, Min-Chul Kim, Byunghan Ryu, Sang-Oh Lee, Jeongmin Hong, Na-Young Jeon, Sung-Han Kim, Sang-Ho Choi, Ji Yeun Kim, Jun Hee Woo, and Ji-Soo Kwon
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Male ,Phlebovirus ,0301 basic medicine ,Fever ,medicine.medical_treatment ,Viremia ,Bunyaviridae Infections ,Article ,Severe fever with thrombocytopenia syndrome virus ,03 medical and health sciences ,Virology ,Republic of Korea ,medicine ,Humans ,Viral shedding ,Aged ,business.industry ,Middle Aged ,Viral Load ,medicine.disease ,Thrombocytopenia ,Kinetics ,Severe fever with thrombocytopenia syndrome ,030104 developmental biology ,Infectious Diseases ,Cytokine ,Immunology ,Interleukin 13 ,Cytokines ,RNA, Viral ,Female ,Chemokines ,Cytokine storm ,business ,Viral load - Abstract
Highlights • SFTS viremia persists until week 3 from the day of symptom onset. • The concentrations of inflammatory cytokines are elevated in SFTS patients. • IFN-α, IL-10, and IP-10 are associated with the initial cytokine storm., Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in China, Japan, and Korea, which is characterized by high fever, thrombocytopenia, and high mortality. It is hypothesized that a cytokine storm plays an important role in the pathophysiology of SFTS. However, limited data have been published on the detailed kinetics of the viral load and cytokine profiles throughout the course of this disease. Objectives We investigated the patterns of changes in cytokines and viral load in SFTS patients. Study design During the admission period of patients, RNA was extracted from plasma and quantified by reverse transcription polymerase chain reaction. In addition, cytokine bead arrays were performed for the 18 cytokines and chemokines selected for testing. Results The median time from admission to the negative conversion of SFTS viremia was 17.0 days. When censored patients were found to be negative for viral load at discharge, the median duration of viral shedding was 13.0 days (95% CI, 5.4–20.6). Interferon (IFN)-α, interleukin (IL)-10, and IFN-γ-induced protein (IP)-10 concentrations significantly increased in the early course of disease and then decreased during the hospital stay. However, the concentrations of tumor necrosis factor-α, IL-1β, IL-12p40, IL-13, IL-17A, Regulated on Activation and Normally T-cell Expressed and Secreted (RANTES), and vascular endothelial growth factor (VEGF) increased during the late course of disease. Initial IP-10 levels during hospital days 1–4 were the most significantly correlated with initial viral load (r = 0.88, P
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- 2018
156. Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities
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Jacob Lee, Young-Ki Lee, Kyung Don Yoo, Sang-Oh Lee, Hee Jung Jeon, Sang-Ho Lee, Yang Gyun Kim, Seung Jun Kim, Hayne Cho Park, and Ajin Cho
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Practice guideline ,lcsh:Internal medicine ,medicine.medical_specialty ,lcsh:Specialties of internal medicine ,Isolation (health care) ,medicine.medical_treatment ,030232 urology & nephrology ,Infection control ,Special Article ,03 medical and health sciences ,0302 clinical medicine ,lcsh:RC581-951 ,Medicine ,030212 general & internal medicine ,lcsh:RC31-1245 ,Intensive care medicine ,Dialysis ,business.industry ,Transmission (medicine) ,Hemodialysis units ,General Medicine ,Hospitals ,Clinical Practice ,Vaccination ,Standard precautions ,Hemodialysis ,business - Abstract
Patients receiving hemodialysis are vulnerable to infectious diseases due to their impaired immunity and high risk of exposure to pathogens. To protect patients, staff, and visitors from potential infections, each hemodialysis unit should establish and follow standard infection control and prevention measures. Therefore, clinical practice guidelines were developed by a working group of nephrologists and infection control specialists to provide evidence-based guidance for dialysis physicians and nurses, with the aim of preventing infection transmission and controlling infection sources in hemodialysis facilities. The areas of infection control covered by these guidelines include standard precautions, isolation strategies, vascular access, water treatment, cleaning/disinfecting/sterilizing, and vaccination. This special report summarizes the key recommendations from the Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities.
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- 2018
157. Rapid Diagnosis of Tick-Borne Illnesses by Use of One-Step Isothermal Nucleic Acid Amplification and Bio-Optical Sensor Detection
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Ji Yeun Kim, Jun Hee Woo, Yong Pil Chong, Choong Eun Jin, Yang Soo Kim, Sung-Han Kim, Bonhan Koo, Yong Shin, Sang-Ho Choi, Min-Chul Kim, and Sang-Oh Lee
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0301 basic medicine ,Optics and Photonics ,medicine.medical_specialty ,Orientia tsutsugamushi ,030231 tropical medicine ,030106 microbiology ,Clinical Biochemistry ,Scrub typhus ,Real-Time Polymerase Chain Reaction ,Sensitivity and Specificity ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Tick borne ,Internal medicine ,Republic of Korea ,Epidemiology ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,biology ,business.industry ,Biochemistry (medical) ,SFTS virus ,Middle Aged ,medicine.disease ,biology.organism_classification ,Severe fever with thrombocytopenia syndrome ,Phlebotomus Fever ,Real-time polymerase chain reaction ,Scrub Typhus ,Tick-Borne Diseases ,Nucleic acid ,business ,Nucleic Acid Amplification Techniques - Abstract
BACKGROUND Scrub typhus and severe fever with thrombocytopenia syndrome (SFTS) are the most common tick-borne illnesses in South Korea. Early differentiation of SFTS from scrub typhus in emergency departments is essential but difficult because of their overlapping epidemiology, shared risk factors, and similar clinical manifestations. METHODS We compared the diagnostic performance of one-step isothermal nucleic acid amplification with bio-optical sensor detection (iNAD) under isothermal conditions, which is rapid (20–30 min), with that of real-time PCR, in patients with a confirmed tick-borne illness. Fifteen patients with confirmed SFTS who provided a total of 15 initial blood samples and 5 follow-up blood samples, and 21 patients with confirmed scrub typhus, were evaluated. RESULTS The clinical sensitivity of iNAD (100%; 95% CI, 83–100) for SFTS was significantly higher than that of real-time PCR (75%; 95% CI, 51–91; P = 0.047), while its clinical specificity (86%; 95% CI, 65–97) was similar to that of real-time PCR (95%; 95% CI, 77–99; P = 0.61). The clinical sensitivity of iNAD for scrub typhus (100%; 95% CI, 81–100) was significantly higher than that of real-time PCR for scrub typhus (67%; 95% CI, 43–85; P = 0.009), while its clinical specificity (90%; 95% CI, 67–98) was similar to that of real-time PCR (95%; 95% CI, 73–100; P > 0.99). CONCLUSIONS iNAD is a valuable, rapid method of detecting SFTS virus and Orientia tsutsugamushi with high clinical sensitivity and specificity.
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- 2018
158. The Results of In Situ Prosthetic Graft Replacement for Infected Aortic Disease
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Kyunghak Choi, Sang Jun Park, Gi-Young Ko, Youngjin Han, Yong-Pil Cho, Tae-Won Kwon, Sang-Oh Lee, and Min-Jae Jeong
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Male ,Reoperation ,medicine.medical_specialty ,Postoperative Hemorrhage ,030204 cardiovascular system & hematology ,030230 surgery ,Infections ,Single Center ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Recurrence ,Risk Factors ,medicine.artery ,medicine ,Humans ,Hospital Mortality ,Aged ,Retrospective Studies ,Aorta ,Sutures ,business.industry ,Length of Stay ,Middle Aged ,Vascular surgery ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Cardiac surgery ,Treatment Outcome ,Intestinal Perforation ,Cardiothoracic surgery ,cardiovascular system ,Female ,Stents ,business ,Liver Failure ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Abstract
Infected aortic disease is a serious clinical condition associated with significant morbidity and mortality. This study reviewed the outcomes of in situ aortic replacement with a prosthetic graft for infected aortic disease, including primary infected abdominal aortic aneurysms (PIAAA), infected aortic prosthetic grafts (IAPG), and infected aortic stent grafts (IASG). Twenty-eight consecutive patients who underwent in situ aortic replacement with a prosthetic graft for PIAAA, IAPG, and IASG at a single center from January 2001 to December 2015 were retrospectively analyzed. Demographics, clinical characteristics, medical management, surgical procedure, and clinical outcomes were included. Nineteen patients with a PIAAA, three with an IAPG following open repair of abdominal aortic aneurysm (AAA), and six with an IASG following endovascular aortic repair underwent in situ prosthetic graft replacement with infected tissue and graft removal. In-hospital mortality was 7.1% (2/28). One died of bleeding on postoperative day 12, and the other died of hepatic failure on postoperative day 32. Of six patients with an IASG, two had major complications that were related to barb injury at the proximal aorta. The reinfection rate was 14.3% (4 of 28) during a mean follow-up of 35.7 months (1–142 months). All new grafts of three patients with IAPG were reinfected. The other patient became reinfected after surgery for PIAAA with iatrogenic small bowel perforation that was not detected during surgery. In situ graft replacement of PIAAA and IASG is feasible with acceptable outcomes, but the outcome for IAPG is questionable.
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- 2018
159. Effect of cerebral embolus size on the timing of cardiac surgery for infective endocarditis in patients with neurological complications
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Ju Young Lee, Yong Pil Chong, Sung-Han Kim, Choong Gon Choi, Jiwon Jung, Sang-Ho Choi, Yong Kyun Kim, Yang Soo Kim, Jun Hee Woo, Shi Nae Yu, and Sang-Oh Lee
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Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,Cerebral embolus ,Time Factors ,Hemorrhage ,Neuroimaging ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Retrospective Studies ,business.industry ,Intracranial Embolism ,Retrospective cohort study ,Endocarditis, Bacterial ,General Medicine ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Cardiac surgery ,Infectious Diseases ,Infective endocarditis ,Female ,Nervous System Diseases ,business - Abstract
The optimal timing of cardiac surgery remains unclear for patients with neurological complications of infective endocarditis (IE). However, neuroimaging findings may allow more refined clinical decision-making. We analyzed clinical and advanced neuroimaging data for 135 patients with IE who had preoperatively diagnosed ischemic cerebral complications (86 patients) or hemorrhagic complications (49 patients), between January 1997 and May 2013. The effect of early surgery (within 3 and 7 days of ischemic and hemorrhagic complications respectively) on in-hospital mortality and 1-year adverse outcomes (mortality, relapse, or new embolic events) was estimated. Small cerebral emboli (≤2 cm) led to early surgery (cases with ischemic complications: 57% vs 26%, p = 0.04; cases with hemorrhagic complications: 56% vs 13%, p = 0.02). Early surgery was not significantly associated with increased rates of in-hospital mortality and 1-year adverse outcomes among patients with ischemic complications (14% vs 9%, odds ratio [OR] 1.67, 95% confidence interval [CI] 0.44-6.38, p = 0.52; 17% vs 14%, OR 1.27, 95% CI 0.39-4.14, p = 0.7 respectively). Only 1 patient (4%) with hemorrhagic complications experienced in-hospital mortality in the early surgery group, and early surgery was not significantly associated with 1-year adverse outcomes (21% vs 12%, OR 1.93, 95% CI 0.41-9.16, p = 0.46). The risks of in-hospital mortality and 1-year adverse outcome were not increased, even if cardiac surgery had been carried out earlier than previously described. Our findings suggest that early surgery, when indicated, may be performed for patients with IE and neurological complications, especially if the cerebral embolus has a diameter of ≤2 cm.
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- 2018
160. A Study on suggestion of the introduction of High Speed Express Train for Metro line 9
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Jung Soo Park and Sang oh Lee
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Computer science ,business.industry ,Electrical engineering ,Line (text file) ,business - Published
- 2017
161. A Regression Analysis Study on Customer Satisfaction considering the Mediation Effect of Safety of Operation - Focusing on Subway Line 9
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Sang-Oh Lee and Sung-Bong Jung
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Strategy and Management ,media_common.quotation_subject ,Geography, Planning and Development ,Applied psychology ,Energy Engineering and Power Technology ,Transportation ,Regression analysis ,Punctuality ,Subway line ,Automotive Engineering ,Mediation ,Headway ,Customer satisfaction ,Psychology ,Civil and Structural Engineering ,media_common - Published
- 2017
162. Ciprofloxacin treatment for cryptogenic Klebsiella pneumoniae liver abscesses
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Jun Hee Woo, Yang Soo Kim, Sang-Oh Lee, Heungsup Sung, Min-Chul Kim, Se Yoon Park, Mi-Na Kim, Sang-Ho Choi, Sung-Han Kim, Taeeun Kim, and Yong Pil Chong
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0301 basic medicine ,Microbiology (medical) ,biology ,Klebsiella pneumoniae ,business.industry ,Liver Abscess ,030106 microbiology ,Klebsiella infections ,medicine.disease ,biology.organism_classification ,Klebsiella Infections ,Microbiology ,Ciprofloxacin ,03 medical and health sciences ,Infectious Diseases ,medicine ,Humans ,business ,Liver abscess ,medicine.drug - Published
- 2017
163. Fluvoxamine Treatment of Patients with Symptomatic COVID-19 in a Community Treatment Center: A Preliminary Result of Randomized Controlled Trial.
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Hyeonji Seo, Haein Kim, Seongman Bae, Seonghee Park, Hyemin Chung, Heung-sup Sung, Jiwon Jung, Min Jae Kim, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Ki Young Son, and Yong Pil Chong
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SARS-CoV-2 ,COVID-19 ,HEALTH facilities ,COVID-19 treatment ,CORONAVIRUS diseases ,RANDOMIZED controlled trials - Abstract
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]
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- 2022
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164. 835. Comparison of the outcomes of patients with KPC and NDM-1-producing Enterobacteriaceae
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Hyeonji Seo, Jiwon Jung, Min Jae Kim, Yong Pil Chong, Yang Soo Kim, Sang-Oh Lee, Jun Hee Woo, Sang-Ho Choi, and Sung-Han Kim
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medicine.medical_specialty ,biology ,business.industry ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Enterobacteriaceae ,Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,Internal medicine ,Poster Abstracts ,medicine ,polycyclic compounds ,business - Abstract
Background Carbapenemase-producing Enterobacteriaceae infections are associated with high mortality. We aimed to compare the clinical outcomes of patients with Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae and those with New-Delhi-Metallo-beta-lactamase-1 (NDM-1)-producing Enterobacteriaceae. Methods We performed a retrospective cohort study of all adult patients (> 16 years old) with KPC or NDM-1-producing Enterobacteriaceae isolates in a 2,700-bed tertiary referral hospital in Seoul, South Korea between 2010 and 2019. Primary outcomes were infection within 30 days and 30-day mortality after the first isolation of KPC or NDM-1-producing Enterobacteriaceae. Results A total of 859 patients were identified during the study period. Of them, 475 (55%) were KPC group and 384 (45%) were NDM-1 group. KPC group tended to develop infection within 30 days after first isolation more frequently than NDM-1 group (31% vs. 26%; P = 0.07). Thirty-day mortality was significantly higher in KPC group compared to NDM-1 group (KPC, 17% (81/475) versus NDM-1, 9% (33/384), P < 0.001). Multivariate analysis revealed that APACHE II score (adjusted odds ratio [aOR], 1.12; P < 0.001), solid cancer (aOR, 2.56; P < 0.001), previous carbapenem therapy (aOR, 1.93; P = 0.004), development of infection of KPC or NDM-1-producing Enterobacteriaceae within 30 days (aOR, 2.63; P < 0.001), and KPC-producing Enterobacteriaceae (aOR, 1.62; P = 0.045) were independent risk factors for 30-day mortality. Table 1. Results of analyses of risk factors for 30-day mortality from initial positive culture date in patients with KPC or NDM-1- producing Enterobacteriaceae Figure 1. Kaplan–Meier survival estimates of patients with KPC or NDM-1-producing Enterobacteriaceae for 30-day mortality after first isolation: KPC (continuous line) versus NDM (dotted line). (log-rank test). Conclusion Our study suggests that KPC-producing Enterobacteriaceae is associated with poorer outcome compared to NDM-1-producing Enterobacteriaceae. Therefore, patients with KPC-producing Enterobacteriaceae colonization should be monitored carefully for development of infection, and appropriate antibiotics should be initiated as soon as possible. Disclosures All Authors: No reported disclosures
- Published
- 2020
165. Clinical safety of remdesivir therapy in COVID-19 patients with renal insufficiency.
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Somi Park, Lee Kyung Ah, Heungsup Sung, Mi-Na Kim, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, and Yong Pil Chong
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COVID-19 ,COVID-19 treatment ,KIDNEY failure ,REMDESIVIR ,ACUTE kidney failure - Abstract
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]
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- 2022
166. Clinical Characteristics of and Risk Factors for Subsequent Carbapenemase-producing Enterobacterales (CPE) Bacteremia in CPE Carriers.
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Sung-Woon Kang, Hyeonji Seo, Lee Kyung Ah, Heungsup Sung, Mi-Na Kim, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, and Yong Pil Chong
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KLEBSIELLA infections ,BACTEREMIA ,ESCHERICHIA coli ,COLONIZATION (Ecology) ,ABDOMINAL surgery ,ODDS ratio - Abstract
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]
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- 2022
167. Comparison of invasive fungal diseases between patients with acute myeloid leukemia receiving posaconazole prophylaxis and those not receiving prophylaxis
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Han-Seung Park, Eun Mi Yang, Je-Hwan Lee, Jung-Hee Lee, Sang-Ho Choi, Yang Soo Kim, Eun-Ji Choi, Sung-Han Kim, Sang-Oh Lee, and Kyoo-Hyung Lee
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medicine.medical_specialty ,Chemotherapy ,Posaconazole ,Exacerbation ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Case-control study ,Induction chemotherapy ,General Medicine ,Single Center ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,030212 general & internal medicine ,Adverse effect ,business ,medicine.drug - Abstract
Posaconazole prophylaxis is effective in decreasing the incidence of invasive fungal diseases (IFDs) in patients with acute myeloid leukemia (AML). However, the use of antifungal prophylaxis varies in real-life practice, and only a small number of studies have compared the incidence of IFDs between those receiving posaconazole prophylaxis and those without prophylaxis. We compared the clinical characteristics and outcomes of IFDs between patients with AML who received posaconazole prophylaxis and those without antifungal prophylaxis.We reviewed the medical records of adult AML patients who underwent induction chemotherapy between June 2016 and October 2019 at Asan Medical Center (Seoul, South Korea), where posaconazole prophylaxis is not administered in patients with gastrointestinal symptoms that may hinder sufficient absorption of oral prophylactic agents, and in patients with abnormal liver functions considering the possible exacerbation of adverse events. Patients who received posaconazole prophylaxis for ≥7 days were included in the prophylaxis group. Clinical characteristics and outcomes including the incidence of IFDs were compared between the 2 groups.Of the 247 patients with AML who underwent induction chemotherapy, 162 (66%) received posaconazole prophylaxis and 85 (34%) did not receive any prophylaxis. The incidence of proven/probable IFD was significantly higher in the no prophylaxis group than in the prophylaxis group (9.4% [8/85] vs 2.5% [4/162], P = .03). Of the 8 cases of IFDs in the no prophylaxis group, 7 were mold infections and 1 was invasive candidiasis. Of the 4 cases of IFDs in the prophylaxis group, 3 were mold infections and 1 was invasive candidiasis. Patients with posaconazole prophylaxis less frequently received therapeutic antifungal therapy (2.5% vs 9.4%, P = .03) and had a longer median, duration from chemotherapy to antifungal therapy compared with the no prophylaxis group (18 vs 11 days, P .99).Patients with AML who received posaconazole prophylaxis had a lower incidence of breakthrough IFDs compared with those who did not receive any prophylaxis. Invasive mold infection was the most common IFD regardless of antifungal prophylaxis.
- Published
- 2021
168. Clinical applications of interferon-γ releasing assays for cytomegalovirus to differentiate cytomegalovirus disease from bystander activation: a pilot proof-of-concept study
- Author
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Sang-Hyoung Park, Jun Hee Woo, Suk-Kyun Yang, Hyun Jung Lee, Sun-Mi Kim, Sung Shin, Sang-Ho Choi, Sung-Han Kim, Ho-Su Lee, Young Hoon Kim, Duck Jong Han, Kyung-Jo Kim, Sang-Oh Lee, Heungsup Sung, and Yang Soo Kim
- Subjects
Adult ,Male ,0301 basic medicine ,Enzyme-Linked Immunospot Assay ,Pneumonia, Viral ,030106 microbiology ,Cytomegalovirus ,Pilot Projects ,Pneumocystis carinii ,medicine.disease_cause ,Proof of Concept Study ,Immunocompromised Host ,Interferon-gamma ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Immunity ,medicine ,Humans ,Viral load ,Interferon gamma ,Prospective Studies ,Prospective cohort study ,Coinfection ,business.industry ,Pneumonia, Pneumocystis ,virus diseases ,Bystander Effect ,Middle Aged ,medicine.disease ,Pneumonia ,Infectious Diseases ,Viral replication ,Cytomegalovirus Infections ,Host-Pathogen Interactions ,Immunology ,Original Article ,Female ,Virus Activation ,030211 gastroenterology & hepatology ,business ,Biomarkers ,Interferon-gamma Release Tests ,medicine.drug - Abstract
Background/aims We evaluated the proposed clinical application of the combined interpretation of host factors and viral factors in two different cytomegalovirus (CMV) co-infection models. Methods We prospectively enrolled all human immunodeficiency virus non-infected patients with confirmed Pneumocystitis jirovecii pneumonia (PCP) and those with suspected gastrointestinal CMV disease in a tertiary hospital. All patients underwent CMV interferon-γ releasing assay (IGRA) for CMV (T-track CMV, Lophius Biosciences). We created the 2-axis model with the CMV IGRA results as the x-axis and the results for CMV virus replication as the y-axis, and hypothesized that cases falling in the left upper quadrant (high viral load and low CMV-specific immunity) of the model would be true CMV infections. The CMV IGRA results were concealed from the attending physicians. Results Of 39 patients with PCP, four (10%) were classified as combined CMV pneumonia, 13 (33%) as bystander activation, and the remaining 22 (56%) as no CMV infection. The data for all four patients with PCP and CMV pneumonia fell in the left upper quadrant of the 2-axis model. Of 24 patients with suspected gastrointestinal CMV disease, 12 (50%) were classified as gastrointestinal CMV disease and the remaining 12 (50%) as bystander activation with no gastrointestinal CMV disease. The data for 11 of the 12 patients (92%) with gastrointestinal CMV disease were located in the left upper quadrant of the 2-axis model. Conclusions Cases yielding low CMV IGRA results and high CMV viral replication appear to be true CMV infections. Further studies with large number of cases in different types of CMV disease should be proposed.
- Published
- 2017
169. Improvement of indirect enzyme-linked immunosorbent assay for detection of Japanese encephalitis virus antibodies in swine sera
- Author
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Sang-oh Lee, In-Soo Cho, Sung-Suk Choi, Seung Heon Lee, Dong-Kun Yang, Ha-Hyun Kim, Hyun-Ye Jo, and Sang-ho Jang
- Subjects
chemistry.chemical_classification ,Hemagglutination assay ,biology ,Zoonosis ,Japanese encephalitis ,medicine.disease ,Virology ,Virus ,Plaque reduction neutralization test ,Enzyme ,Antigen ,chemistry ,biology.protein ,medicine ,Antibody - Abstract
Japanese encephalitis (JE) is an important zoonosis caused by the mosquito-transmitted JE virus (JEV), which is a causative agent of reproductive failure in pregnant sows. Detection of JEV antibodies in swine is performed by hemagglutination inhibition (HI), virus neutralization (VN), and the plaque reduction neutralization test (PRNT). The most stringent PRNT is the 90% endpoint PRNT (PRNT90). These conventional assays are difficult to carry out in diagnostic laboratories with insufficient instruments or cell culture systems. An alternative assay that is easily conducted and time efficient is required. In this study, we improved the indirect enzyme-linked immunosorbent assay (I-ELISA) with clarified antigen for the detection of JEV antibodies. The I-ELISA results obtained from 175 swine serum samples were compared with HI, VN, and PRNT90 results. The sensitivity of I-ELISA was 91.8%, 95.0%, and 94.7% compared with HI, VN, and PRNT90 results, respectively. The specificity of I-ELISA was 92.2%, 94.7%, and 94.7% compared with HI, VN, and PRNT90 results, respectively. Moreover, the I-ELISA results were significantly correlated with the HI (r = 0.93), VN (r = 0.95), and PRNT90 (r = 0.92) results. These results suggest that the improved I-ELISA is useful for serosurveillance of JEV in swine.
- Published
- 2017
170. Impact of Revised Broad-Spectrum Cephalosporin Clinical and Laboratory Standards Institute Breakpoints on Susceptibility in Enterobacteriaceae Producing AmpC β-Lactamase
- Author
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Mi Na Kim, Yong Pil Chong, Ki-Ho Park, Mi Suk Lee, Yang Soo Kim, Sang-Oh Lee, Sang-Ho Choi, Sung-Han Kim, Heungsup Sung, and Jun Hee Woo
- Subjects
0301 basic medicine ,Cefotaxime ,medicine.drug_class ,Cefepime ,030106 microbiology ,Cephalosporin ,Antibiotics ,Ceftazidime ,Brief Communication ,Microbiology ,03 medical and health sciences ,Enterobacteriaceae ,medicine ,polycyclic compounds ,Pharmacology (medical) ,biology ,business.industry ,biochemical phenomena, metabolism, and nutrition ,biology.organism_classification ,bacterial infections and mycoses ,Citrobacter freundii ,Infectious Diseases ,Susceptibility ,Serratia marcescens ,Morganella morganii ,business ,medicine.drug - Abstract
We evaluated the impact of revised Clinical and Laboratory Standards Institute (CLSI) breakpoints for broad-spectrum cephalosporins (BSCs) on the susceptibilities of 1,742 isolates of Enterobacter species, Serratia marcescens, Citrobacter freundii, and Morganella morganii. The 2011 CLSI criteria for cefotaxime and ceftazidime reduced the rates of susceptibility by 2.9% and 5.9%, respectively. The 2014 CLSI criteria for cefepime reduced the rate of susceptibility by 13.9%, and categorized 11.8% isolates as susceptible-dose dependent (SDD) for cefepime. Among 183 isolates with extended-spectrum β-lactamase (ESBL) phenotype, implementation of the new criteria reduced the rates of susceptibility to cefotaxime, ceftazidime, and cefepime by 2.8%, 14.8%, and 53.6%, respectively. The proportion of ESBL phenotype among BSC-susceptible isolates was low (0.9% for cefotaxime, 3.0% for ceftazidime, and 3.3% for cefepime). In summary, implementation of new CLSI criteria led to little change in susceptibility to cefotaxime and ceftazidime but a substantial change in susceptibility to cefepime. The recognition of revised CLSI criteria for BSC and SDD will help clinicians to select the optimal antibiotic and dosing regimen.
- Published
- 2017
171. Diagnostic usefulness of dynamic changes of CMV-specific T-cell responses in predicting CMV infections in HCT recipients
- Author
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Heungsup Sung, Young-Shin Lee, Sang-Oh Lee, Yong Pil Chong, Young-Ah Kang, Kyoo-Hyung Lee, Jiwon Jung, Sun-Mi Kim, Sung-Han Kim, Sang-Ho Choi, Hyun Jung Lee, Yang Soo Kim, Je-Hwan Lee, Jung-Hee Lee, and Jun Hee Woo
- Subjects
Adult ,Male ,Enzyme-Linked Immunospot Assay ,T-Lymphocytes ,T cell ,medicine.medical_treatment ,Cmv infections ,Hematopoietic stem cell transplantation ,medicine.disease_cause ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,hemic and lymphatic diseases ,Virology ,Humans ,Medicine ,030212 general & internal medicine ,Immunity, Cellular ,business.industry ,ELISPOT ,Hematopoietic Stem Cell Transplantation ,virus diseases ,Cytomegalovirus ,Middle Aged ,Cell mediated immunity ,surgical procedures, operative ,Infectious Diseases ,medicine.anatomical_structure ,Cytomegalovirus Infections ,Immunology ,Female ,030211 gastroenterology & hepatology ,business - Abstract
CMV-specific cell mediated immune responses before and after hematopoietic stem cell transplantation (HCT) can categorize patients as at high or low risk of CMV development.We evaluated the usefulness of the CMV-specific T-cell ELISPOT assay for predicting the development of CMV infections after HCT in recipients with donor-positive and recipient-positive CMV serology (D+/R+ ).CMV pp65 and IE1-specific ELISPOT assays were performed before HCT (D0), and at 30 (D30) and 90 (D90) days after HCT.Of the 84 HCT recipients with D+/R+, 42 (50%) developed≥1 episode of CMV infection. Thirty-nine (64%) of 61 patients with Δ(D30-D0) pp6542 developed CMV infections compared with 3 (14%) of 21 patients with Δ(D30-D0) pp65≥42 (P0.001). Twenty-three (74%) of 31 patients with Δ(D30-D0) IE1-4 developed CMV infections compared with 19 (37%) of 51 patients with Δ(D30-D0) IE1≥-4 (P=0.001). pp65 Δ(D30-D0) ≥42 had 93% sensitivity for ruling out subsequent CMV infection, and pp65 Δ(D30-D0)42 followed by Δ(D30-D0) IE1-4 had 100% specificity for ruling in the subsequent CMV infection. In addition, 10 (53%) of 19 patients with Δ(D90-D30) pp6523 had relapsing CMV infections, compared with 3 (15%) of 20 patients with Δ(D90-D30) pp65≥23 (P=0.02). The sensitivity and specificity of Δ(D90-D30) pp65 were 77% (95% CI 50-92) and 65% (95% CI, 46-81).Dynamic change in the CMV-specific ELISPOT assay before versus after HCT appears to predict the subsequent development of CMV infection and relapsing CMV infection.
- Published
- 2017
172. Severe Fever with Thrombocytopenia Syndrome Presenting with Rhabdomyolysis
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Jiwon Jung, Yang Soo Kim, Sung-Han Kim, Sang-Ho Choi, Jun Hee Woo, Sang-Oh Lee, Sang-Bum Hong, and Min Gu Kim
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0301 basic medicine ,myalgia ,medicine.medical_specialty ,030106 microbiology ,Case Report ,urologic and male genital diseases ,Severe fever with thrombocytopenia syndrome ,Rhabdomyolysis ,03 medical and health sciences ,Acute renal failure ,0302 clinical medicine ,Internal medicine ,Medicine ,Pharmacology (medical) ,030212 general & internal medicine ,Leukopenia ,business.industry ,Myoglobinuria ,Febrile illness ,medicine.disease ,Infectious Diseases ,Elevated muscle enzyme ,Azotemia ,medicine.symptom ,business - Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging febrile illness. While many kinds of severe complications including acute renal failure have been reported, rhabdomyolysis is rarely reported in association with SFTS. A 54-year-old female farmer was admitted with fever and diffuse myalgia. Laboratory finding showed thrombocytopenia, leukopenia, azotemia, extremely elevated muscle enzyme levels and myoglobinuria. We describe a fatal case of rhabdomyolysis with acute renal failure complicated by SFTS.
- Published
- 2017
173. 1106. The incidence and risk factors associated with varicella zoster virus infection in kidney transplant recipients after 1-month acyclovir prophylaxis in a CMV preemptive therapy era
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Yang Soo Kim, Sang-Oh Lee, Jiwon Jung, Hyosang Kim, Duck Jong Han, Yong Pil Chong, Min Jae Kim, Su-Kil Park, Young Hoon Kim, S. Shin, Haein Kim, Sung-Han Kim, Jun Hee Woo, Sang-Ho Choi, and Joo hee jung
- Subjects
Ganciclovir ,Pediatrics ,medicine.medical_specialty ,business.industry ,viruses ,Incidence (epidemiology) ,Congenital cytomegalovirus infection ,virus diseases ,Varicella-zoster virus infection ,medicine.disease ,Kidney transplant ,Transplantation ,AcademicSubjects/MED00290 ,Infectious Diseases ,Oncology ,Post-herpetic neuralgia ,Poster Abstracts ,Epidemiology ,Medicine ,business ,medicine.drug - Abstract
Background Varicella zoster virus (VZV) infection is a well-known opportunistic infection in solid organ transplant recipients. Since the various strategies of the use of anti-herpetic drugs including ganciclovir or acyclovir have evolved, the epidemiology of VZV infection is changing. However, there are limited data on the recent incidence and risk factors of post-transplant VZV infection in popular preemptive ganciclovir era for CMV infection. We evaluated the incidence, risk factors and clinical characteristic of patients with development of post-transplant VZV infection in kidney transplant (KT) recipients after 1-month acyclovir prophylaxis in the hospital that adopted preemptive ganciclovir therapy for CMV infection. Methods All adult patients with seropositive CMV antibody admitted to a KT unit from January 2014 to December 2017 were retrospectively reviewed in a tertiary-care hospital in South Korea. Our hospital adopted preemptive ganciclovir therapy for CMV infection in all CMV seropositive KT recipients. We administered acyclovir prophylaxis for 1-month to CMV seropositive KT recipients. The primary endpoint was VZV infection development after KT. Results A total of 1295 KT recipients was followed up for 4295.8 person-years. The median follow-up period was 46.6 months (interquartile range (IQR) 34.3-59.5). Of the 1295 recipients, 100 (7.7%, 2.33 per 100 person-years, 95% confidence interval (CI) 1.89-2.83) patients developed VZV infection after KT. The median time for VZV infection development was 9.5 months (IQR 4.7-22.1). All patients had VZV-associated skin lesion, 9 postherpetic neuralgia, 2 visceral involvement and 3 disseminated infection. Of 100 patients, 16 patients need hospitalization due to VZV infection. In multivariate analysis, deceased donor KT (Hazard ratio (HR) 1.6; 95% CI 1.0-2.39, p = 0.05), mycophenolate maintenance immunosuppressive therapy (HR 0.3; 95% CI 0.14-0.75, p = 0.01) and rejection episode (HR 0.31; 95% CI 0.14-0.71, p = 0.01) were independently associated with VZV infection development after KT. Conclusion About one tenth of CMV seropositive KT recipients developed zoster after 1-month ACV prophylaxis during CMV preemptive strategy, especially in those who received deceased donor KT, mycophenolate therapy, and rejection episodes. Disclosures All Authors: No reported disclosures
- Published
- 2020
174. Antimicrobial Properties and Characteristic Changes of Nylon Treated with Glycidyltrimethylammonium chloride(GTAC) and Silver nanoparticles(AgNPs)
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Jaewoong Lee, Dakyung Kang, and Sang Oh Lee
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Materials science ,Glycidyltrimethylammonium chloride ,Organic chemistry ,Antimicrobial ,Silver nanoparticle ,Nuclear chemistry - Published
- 2016
175. Factors predicting life-threatening infections with respiratory syncytial virus in adult patients
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Sang-Ho Choi, Yong Pil Chong, Young Rock Jang, Taeeun Kim, Yang Soo Kim, Jun Hee Woo, Sang-Oh Lee, Se Yoon Park, Sung-Han Kim, and Min-Chul Kim
- Subjects
Adult ,Male ,0301 basic medicine ,Microbiology (medical) ,medicine.medical_specialty ,Critical Care ,030106 microbiology ,Respiratory Syncytial Virus Infections ,Logistic regression ,Virus ,Decision Support Techniques ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,law ,Lower respiratory tract infection ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Respiratory system ,Intensive care medicine ,Respiratory Tract Infections ,Aged ,Retrospective Studies ,Aged, 80 and over ,General Immunology and Microbiology ,business.industry ,Respiratory infection ,Retrospective cohort study ,General Medicine ,Emergency department ,Middle Aged ,Prognosis ,medicine.disease ,Respiration, Artificial ,Survival Analysis ,Intensive care unit ,Infectious Diseases ,Female ,business - Abstract
Respiratory syncytial virus (RSV) is a significant cause of acute respiratory illness with a clinical spectrum ranging from self-limiting upper respiratory infection to severe lower respiratory infection in elderly persons as well as young children. However, there are limited data on risk factors for life-threatening infections that could guide the appropriate use of antiviral agents in adult patients with RSV.We conducted a retrospective cohort study from October 2013 to September 2015. Adult patients with RSV who visited the emergency department were enrolled. Primary outcome was life-threatening infection (admission to intensive care unit, need for ventilator care or in-hospital death).A total of 227 patients were analysed. Thirty-four (15%) were classified as having life-threatening infections. By logistic regression, lower respiratory infection, chronic lung disease and bacterial co-infection were independent predictors of life-threatening infections. We developed a simple clinical scoring system using these variables (lower respiratory tract infection = score 4, chronic respiratory disease = score 3, bacterial co-infection = score 3 and fever ≥38 °C = score 2) to predict life-threatening infection. A score of5 differentiated life-threatening RSV from non-life-threatening RSV with 82% sensitivity (95% CI, 66-93) and 72% specificity (95% CI, 65-78).The use of a clinical scoring system based on lower respiratory infection, chronic respiratory disease, bacterial co-infection and fever appears to be useful for outcome prediction and risk stratification in order to select patients who may need early antiviral therapy.
- Published
- 2016
176. Diagnostic usefulness of bronchoalveolar lavage fluid xpert MTB/RIF in pauci-bacillary pulmonary tuberculosis
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Yong Pil Chong, Sung-Han Kim, Sang-Ho Choi, Tae Sun Shim, Yang Soo Kim, Kyung-Wook Jo, Jun Hee Woo, Min Jae Kim, Byunghan Ryu, Seung Hyun Lee, Jeongmin Hong, and Sang-Oh Lee
- Subjects
Microbiology (medical) ,Tuberculosis ,General Immunology and Microbiology ,medicine.diagnostic_test ,biology ,Cobas taqman ,business.industry ,General Medicine ,medicine.disease ,biology.organism_classification ,humanities ,03 medical and health sciences ,0302 clinical medicine ,Infectious Diseases ,Bronchoalveolar lavage ,030228 respiratory system ,Mycobacterium tuberculosis complex ,Pulmonary tuberculosis ,Immunology ,medicine ,030212 general & internal medicine ,Pulmonary pathology ,business - Abstract
Sir,In the present journal, an evaluation of Cobas TaqMan MTB test for the detection of Mycobacterium tuberculosis complex on various clinical specimens was presented [1]. Based on culture as refer...
- Published
- 2018
177. Impact of neutropenia on the clinical outcomes of Staphylococcus aureus bacteremia in patients with hematologic malignancies: a 10-year experience in a tertiary care hospital
- Author
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Yong Pil Chong, Heungsup Sung, Seung Cheol Lee, Mi-Na Kim, Byung-Han Ryu, Yewon Eom, Jiwon Jung, Sang-Oh Lee, Sang-Ho Choi, Min Jae Kim, Min Jeong Kim, Yang Soo Kim, Jun Hee Woo, and Sung-Han Kim
- Subjects
0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Staphylococcus aureus ,Neutropenia ,030106 microbiology ,Bacteremia ,Comorbidity ,medicine.disease_cause ,Tertiary Care Centers ,03 medical and health sciences ,0302 clinical medicine ,Medical microbiology ,Risk Factors ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,Incidence (epidemiology) ,Incidence ,Staphylococcus aureus bacteremia ,General Medicine ,Middle Aged ,Staphylococcal Infections ,medicine.disease ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Case-Control Studies ,Hematologic Neoplasms ,Female ,business - Abstract
Staphylococcus aureus bacteremia is one of the most serious bacterial infections and may lead to worse clinical outcomes in patients with prolonged severe neutropenia. However, clinical data on S. aureus bacteremia in neutropenic patients with hematologic malignancies are limited. We conducted two case-control studies using a 10-year prospective cohort of patients with S. aureus bacteremia. Neutropenic and non-neutropenic hematologic malignancy patients were compared on clinical characteristics and treatment outcomes. An additional matched case-control study using solid tumor patients was conducted. Risk factors for 12-week mortality were analyzed. Of 1643 patients with S. aureus bacteremia, 64 (3.9%) neutropenic and 108 (6.6%) non-neutropenic patients with hematologic malignancies were included in the study. There were no significant differences in the incidence of metastatic infection between the two groups (17.2% vs. 17.6%, p = 0.95), in contrast with a previous study that observed no metastatic infection in neutropenic patients. Twelve-week mortality in neutropenic patients with hematologic malignancies tended to be lower than in non-neutropenic patients with hematologic malignancies (15.6% vs. 26.9%, p = 0.09) and was significantly lower than in neutropenic patients with solid tumors (15.6% vs. 45.8%, p = 0.003). Independent risk factors for mortality in hematologic malignancy patients with S. aureus bacteremia were high Charlson comorbidity score, high APACHE II score, and skin and soft tissue infection. Neutropenia was not independently associated with mortality. Our findings suggest that neutropenia in hematologic malignancies may not affect the incidence of metastatic infection or 12-week mortality of S. aureus bacteremia.
- Published
- 2019
178. Coinfection of Severe Fever with Thrombocytopenia Syndrome and Scrub Typhus in Patients with Tick-Borne Illness
- Author
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Hye Hee Cha, Min Jae Kim, Jun Hee Woo, Hyun Jung Lee, Sang-Ho Choi, Na Young Jeon, Sung-Han Kim, Yong Pil Chong, Ji Yeun Kim, Ji-Soo Kwon, Sang Hyun Ra, Yang Soo Kim, and Sang-Oh Lee
- Subjects
Male ,Phlebovirus ,medicine.medical_specialty ,030231 tropical medicine ,Scrub typhus ,Diagnostic evaluation ,Bunyaviridae Infections ,03 medical and health sciences ,0302 clinical medicine ,Viral genetics ,Tick borne ,Virology ,Internal medicine ,medicine ,Animals ,Humans ,In patient ,Aged ,Doxycycline ,Aged, 80 and over ,integumentary system ,business.industry ,Coinfection ,Articles ,Middle Aged ,medicine.disease ,bacterial infections and mycoses ,Orientia tsutsugamushi ,Severe fever with thrombocytopenia syndrome ,Infectious Diseases ,Scrub Typhus ,Tick-Borne Diseases ,RNA, Viral ,Parasitology ,Female ,business ,medicine.drug - Abstract
Severe fever with thrombocytopenia syndrome (SFTS) and scrub typhus are the most common tick-borne diseases in South Korea. However, few studies have systematically examined the simultaneous presence of the two diseases. We found that two (4.9%) of 41 patients with suspected and confirmed SFTS had evidence of coinfection with scrub typhus. In addition, two (3.6%) of 55 suspected and confirmed scrub typhus patients were identified to have coinfection with SFTS. Our data suggest that diagnostic evaluation for coinfection in patients with tick-borne illness and empirical doxycycline treatment in patients with SFTS may be warranted in areas endemic for both diseases until coinfection with scrub typhus is ruled out.
- Published
- 2019
179. Antagonistic Effect of Colistin on Vancomycin Activity against Methicillin-Resistant Staphylococcus aureus in
- Author
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Sungim, Choi, Song Mi, Moon, Su-Jin, Park, Seung Cheol, Lee, Kyung Hwa, Jung, Heung-Sup, Sung, Mi-Na, Kim, Jiwon, Jung, Min Jae, Kim, Sung-Han, Kim, Sang-Oh, Lee, Sang-Ho, Choi, Jin-Yong, Jeong, Jun Hee, Woo, Yang Soo, Kim, and Yong Pil, Chong
- Subjects
Methicillin-Resistant Staphylococcus aureus ,Mice, Inbred ICR ,Colistin ,Microbial Sensitivity Tests ,biochemical phenomena, metabolism, and nutrition ,Staphylococcal Infections ,bacterial infections and mycoses ,Anti-Bacterial Agents ,Mice ,Vancomycin ,Susceptibility ,Drug Resistance, Multiple, Bacterial ,Animals ,Humans ,Drug Therapy, Combination ,Female ,Drug Antagonism - Abstract
As concerns arise that the vancomycin MIC of methicillin-resistant Staphylococcus aureus (MRSA) could be increased by concurrent colistin administration, we evaluated the effect of colistin on vancomycin efficacy against MRSA via in vitro and in vivo studies. Among MRSA blood isolates collected in a tertiary-care hospital, we selected representative strains from community-associated MRSA strains (CA-MRSA; ST72-MRSA-SCCmec IV) and hospital-acquired MRSA strains (HA-MRSA; ST5-MRSA-SCCmec II). USA CA-MRSA (USA300), HA-MRSA (USA100), N315 (New York/Japan clone), and a MRSA standard strain (ATCC 43300) were used for comparison. We performed checkerboard assays to identify changes in the vancomycin MIC of MRSA following colistin exposure and evaluated the effect of a vancomycin-colistin combination using time-kill assays. We also assessed the in vivo antagonistic effect by administering vancomycin, colistin, and a combination of these two in a neutropenic murine thigh infection model. In the checkerboard assays, vancomycin MICs of all MRSA strains except N315 were increased by from 0.25 to 0.75 μg/ml following colistin exposure. However, the time-kill assays indicated antagonism only against ST5-MRSA and USA100, when the vancomycin concentration was twice the MIC. In the murine thigh infection model with ST5-MRSA and USA100, vancomycin monotherapy reduced the number of CFU/muscle >1 log(10) compared to a combination treatment after 24 h in ST5-MRSA, indicating an antagonistic effect of colistin on vancomycin treatment. This study suggests that exposure to colistin may reduce the susceptibility to vancomycin of certain MRSA strains. Combination therapy with vancomycin and colistin for multidrug-resistant pathogens might result in treatment failure for concurrent MRSA infection.
- Published
- 2019
180. Sternoclavicular septic arthritis caused by
- Author
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Young-Rock, Jang, Taeeun, Kim, Min-Chul, Kim, Heung, Sup Sung, Mi-Na, Kim, Min Jae, Kim, Sung Han, Kim, Sang-Oh, Lee, Sang-Ho, Choi, Jun Hee, Woo, Yang Soo, Kim, and Yong Pil, Chong
- Subjects
Adult ,Male ,Arthritis, Infectious ,Staphylococcus aureus ,Treatment Outcome ,Humans ,Female ,Osteomyelitis ,Middle Aged ,Staphylococcal Infections ,Sternoclavicular Joint ,Aged ,Anti-Bacterial Agents - Published
- 2019
181. Association between Tuberculosis, Statin Use, and Diabetes: A Propensity Score-Matched Analysis
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Yang Soo Kim, Sung-Cheol Yun, Jun Hee Woo, Sang-Oh Lee, Min-Chul Kim, Sung-Han Kim, and Sang-Ho Choi
- Subjects
Adult ,Male ,medicine.medical_specialty ,Statin ,Tuberculosis ,medicine.drug_class ,030231 tropical medicine ,Population ,Subgroup analysis ,Lower risk ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Virology ,Internal medicine ,Republic of Korea ,medicine ,Diabetes Mellitus ,Humans ,cardiovascular diseases ,education ,Propensity Score ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Hazard ratio ,nutritional and metabolic diseases ,Articles ,Middle Aged ,medicine.disease ,Infectious Diseases ,Propensity score matching ,Parasitology ,lipids (amino acids, peptides, and proteins) ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,business ,Risk assessment - Abstract
Statins have anti-inflammatory and immunomodulatory properties that may affect the development of tuberculosis (TB). We assessed the association between use of statins and the risk of active TB by propensity score matching. Furthermore, we analyzed the impact of statins on TB in patients according to the presence or absence of diabetes. The study was based on the National Health Insurance database and its subset database of the "medical checkup" population of South Korea. We identified 123,468 statin users and 439,546 non-statin users. After propensity score matching, 28,018 statin users and the same number of non-statin users were finally analyzed. The development of active TB was monitored in these matched pairs over 11 years. In the propensity score-matching analysis, the number of active TB cases was 30 in 30,303 person-years (0.99 per 1,000 person-years; 95% CI, 0.64-1.35) in the statin users and 235 in 167,857 person-years (1.40 per 1,000 person-years; 95% CI, 1.22-1.58) in the non-statin users. Statin users had a significantly lower risk of TB than non-statin users: hazard ratio (HR) 0.67 (95% CI, 0.46-0.98) (P = 0.04). A subgroup analysis showed that statin use reduced the risk of TB in subjects without diabetes, but not in patients with diabetes: HRs were, respectively, 0.28 (95% CI, 0.13-0.60) (P = 0.001) and 1.05 (95% CI, 0.66-1.67) (P = 0.84). There is epidemiologic evidence that statin decreases the risk of active TB. However, the protective effect of statins against TB is attenuated by diabetes.
- Published
- 2019
182. Can endoscopists differentiate cytomegalovirus esophagitis from herpes simplex virus esophagitis based on gross endoscopic findings?
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Do Hoon Kim, Kyung Hwa Jung, Sung-Han Kim, Ho June Song, Sang-Oh Lee, Jeong Hoon Lee, Eun Jeong Gong, Jun Hee Woo, Jonggi Choi, Yong Pil Chong, Hwoon-Yong Jung, Kee Don Choi, Gin Hyug Lee, Yang Soo Kim, and Sang-Ho Choi
- Subjects
Adult ,Male ,medicine.medical_specialty ,esophagitis ,Transplants ,Observational Study ,Comorbidity ,medicine.disease_cause ,Gastroenterology ,Antiviral Agents ,Sensitivity and Specificity ,Severity of Illness Index ,Diagnosis, Differential ,Tertiary Care Centers ,03 medical and health sciences ,Immunocompromised Host ,0302 clinical medicine ,Internal medicine ,Severity of illness ,medicine ,Humans ,030212 general & internal medicine ,endoscopy ,cytomegalovirus ,Cytomegalovirus esophagitis ,Aged ,Retrospective Studies ,Receiver operating characteristic ,business.industry ,Retrospective cohort study ,Cytomegalovirus ,Herpes Simplex ,General Medicine ,Middle Aged ,medicine.disease ,herpes simplex virus ,Transplantation ,030220 oncology & carcinogenesis ,Cytomegalovirus Infections ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Esophagoscopy ,Differential diagnosis ,business ,Esophagitis ,Research Article - Abstract
Supplemental Digital Content is available in the text, Differential diagnosis between herpes simplex virus (HSV) esophagitis and cytomegalovirus (CMV) esophagitis is challenging because there are many similarities and overlaps between their endoscopic features. The aims of this study were to investigate the implications of the endoscopic findings for the diagnosis of HSV and CMV esophagitis, and to develop a predictive model for differentiating CMV esophagitis from HSV esophagitis. Patients who underwent endoscopic examination and had pathologically-confirmed HSV or CMV esophagitis were eligible. Clinical characteristics and endoscopic features were retrospectively reviewed and categorized. A predictive model was developed based on parameters identified by logistic regression analysis. During the 8-year study period, HSV and CMV esophagitis were diagnosed in 85 and 63 patients, respectively. The endoscopic features of esophagitis were categorized and scored as follows: category 1 (−3 points): discrete ulcers or ulcers with vesicles, bullae, or pseudomembranes, category 2 (−2 points): coalescent or geographic ulcers, category 3 (1 points): ulcers with an uneven base, friability, or with a circumferential distribution, category 4 (2 points): punched-out, serpiginous, or healing ulcers with yellowish exudates. And previous history of transplantation (2 point) was included in the model as a discriminating clinical feature. The optimal cutoff point of the prediction model was 0 (area under receiver operating characteristic curve: 0.967), with positive scores favoring CMV esophagitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 96.8%, 89.4%, 92.6%, 87.3%, and 97.5%, respectively. The predictive model based on endoscopic and clinical findings appears to be accurate and useful in differentiating CMV esophagitis from HSV esophagitis.
- Published
- 2019
183. Diagnostic usefulness of molecular detection of Coxiella burnetii from blood of patients with suspected acute Q fever
- Author
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Joung Ha Park, Choong Eun Jin, Min Jae Kim, Yong Pil Chong, Sang-Ho Choi, Sang-Oh Lee, Sung-Han Kim, Yang Soo Kim, Jun Hee Woo, Moonsuk Bae, and Yong Shin
- Subjects
myalgia ,Adult ,DNA, Bacterial ,Male ,medicine.medical_specialty ,polymerase chain reaction ,Observational Study ,Q fever ,Gastroenterology ,Sensitivity and Specificity ,Serology ,03 medical and health sciences ,0302 clinical medicine ,Blood serum ,Predictive Value of Tests ,Internal medicine ,Republic of Korea ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Seroconversion ,Fluorescent Antibody Technique, Indirect ,biology ,business.industry ,Antibody titer ,General Medicine ,Middle Aged ,medicine.disease ,Coxiella burnetii ,biology.organism_classification ,Antibodies, Bacterial ,Immunoglobulin M ,030220 oncology & carcinogenesis ,Immunoglobulin G ,Acute Disease ,biology.protein ,Female ,medicine.symptom ,business ,Q Fever ,Research Article - Abstract
Diagnosis of Q fever is difficult due to the lack of distinct clinical features that distinguish it from other febrile diseases. Serologic testing is the gold standard method for diagnosing Q fever, but antibody formation may not be detectable for 2 to 3 weeks from symptom onset, limiting early diagnosis. We thus evaluated the diagnostic utility of polymerase chain reaction (PCR) to detect Coxellia burnetii DNA in serum from patients with suspected acute Q fever. All adult patients with suspected acute Q fever were prospectively enrolled at a tertiary-care hospital from January 2016 through July 2018. Acute Q fever was diagnosed using clinical and laboratory criteria: fever with at least one other symptoms (myalgia, headache, pneumonia, or hepatitis) and single phase II immunoglobulin G (IgG) antibody titers ≥1:200 or immunoglobulin M (IgM) antibody titer ≥1:50 (probable), or a fourfold increase or seroconversion in phase II IgG antibody titers as measured by indirect immunofluorescence assays between paired samples (confirmed). We performed PCR targeting the transposase gene insertion element IS1111a of C. burnetii. Of the 35 patients with suspected acute Q fever, 16 (46%) were diagnosed with acute Q fever including 8 probable and 8 confirmed cases; the remaining 19 (54%) were diagnosed with other febrile diseases. The proportion of males diagnosed with Q fever was higher than those diagnosed with other febrile diseases (88% vs 44%, P = .03), but there were no other significant differences in clinical characteristics between the 2 groups. The Q fever PCR sensitivity was 81% (95% confidence interval [CI], 54–96), specificity was 90% (95% CI, 67–99), positive predictive value was 87% (95% CI, 63–96), and negative predictive value was 85% (95% CI, 67–94). Q fever PCR testing using blood from patients with suspected acute Q fever seems to be a rapid and useful test for early diagnosis of Q fever.
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- 2019
184. Invasive Pulmonary Aspergillosis in Patients With Severe Fever With Thrombocytopenia Syndrome
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Jun Hee Woo, Seongman Bae, Yang Soo Kim, Sang-Oh Lee, Sang-Ho Choi, Sung-Han Kim, Min Jae Kim, Mi Young Kim, Yong Pil Chong, and Hye Jeon Hwang
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0301 basic medicine ,Microbiology (medical) ,Antifungal ,medicine.medical_specialty ,Aspergillosis invasive pulmonary ,Antifungal Agents ,Fever ,Severe Fever with Thrombocytopenia Syndrome ,medicine.drug_class ,030106 microbiology ,law.invention ,SFTS bunyavirus ,03 medical and health sciences ,law ,Internal medicine ,medicine ,Humans ,In patient ,skin and connective tissue diseases ,Retrospective Studies ,Invasive Pulmonary Aspergillosis ,business.industry ,Invasive pulmonary aspergillosis ,bacterial infections and mycoses ,medicine.disease ,Intensive care unit ,Thrombocytopenia ,respiratory tract diseases ,Severe fever with thrombocytopenia syndrome ,Intensive Care Units ,030104 developmental biology ,Infectious Diseases ,business ,Severe fever with thrombocytopenia syndrome virus - Abstract
Sixteen of 45 patients with severe fever with thrombocytopenia (36%) were admitted to an intensive care unit; 9 (56%) developed invasive pulmonary aspergillosis (IPA) within a median of 8 days (range, 2–11). Mortality was higher in the IPA vs non-IPA patients and in those without vs with antifungal therapy.
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- 2019
185. Correlation of fungal cultures from non-sterile sites and Galactomannan assay with the diagnosis of aspergillosis and mucormycosis based on sterile culture results and histopathologic findings
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Jiwon Jung, Sang-Oh Lee, Kyung Ja Cho, Heungsup Sung, Yang Soo Kim, Sung-Han Kim, Joon Seon Song, Taeeun Kim, Sang-Ho Choi, and Jun Hee Woo
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0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,Microbiological Techniques ,Pathology ,medicine.medical_specialty ,030106 microbiology ,Aspergillosis ,Mannans ,Tertiary Care Centers ,03 medical and health sciences ,Galactomannan ,chemistry.chemical_compound ,Young Adult ,0302 clinical medicine ,mental disorders ,Republic of Korea ,medicine ,Humans ,Mucormycosis ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,Paraffin Embedding ,General Immunology and Microbiology ,business.industry ,Sputum ,Galactose ,Sterilization ,General Medicine ,Middle Aged ,medicine.disease ,Immunohistochemistry ,Infectious Diseases ,Aspergillus ,chemistry ,Clinical value ,Mucorales ,Female ,business ,Bronchoalveolar Lavage Fluid ,psychological phenomena and processes - Abstract
Data on whether positive non-sterile fungal culture has the same clinical value as a positive galactomannan (GM) result are limited.Patients with biopsy-proven invasive aspergillosis or mucormycosis (over an 8-year period) in whom the results of GM and fungal culture of sputum and/or sinus aspirates were available were enrolled. Biopsy-proven cases were defined if fungal culture from a sterile biopsy specimen gave a positive result and/or hyphae were demonstrated by immunohistochemical staining for aspergillosis and mucormycosis.A total of 71 patients comprising 30 biopsy-proven cases of aspergillosis including 13 cases with positive sterile cultures and 41 biopsy-proven cases of mucormycosis including eight cases with positive sterile cultures were enrolled. Of 30 patients with aspergillosis, 15 (50%) revealed Aspergillus spp. growth from non-sterile site and none exhibited the agents of mucormycosis growth from non-sterile site. However, of 41 patients with mucormycosis, eight (20%) revealed the agents of mucormycosis growth from non-sterile site and three (7%) exhibited Aspergillus spp. growth from non-sterile site. In terms of GM assays, 23 (77%) of 30 patients with aspergillosis revealed positive GM results, and 17 (41%) of 41 patients with mucormycosis revealed positive GM assays. So, positive fungal culture from non-sterile site (88% [23/26]) were better correlated with the diagnosis than positive GM assay (57% [23/40]) (p value = .01).Positive fungal cultures from non-sterile sites better correlate with the diagnosis of aspergillosis and mucormycosis based on sterile culture results and histopathological findings than positive GM results.
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- 2019
186. Implementing Structured Clinical Templates at a Single Tertiary Hospital: Survey Study
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Byung Ook Seoung, Ji Eun Hwang, Sang-Oh Lee, and Soo-Yong Shin
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Focus (computing) ,Original Paper ,structured clinical template ,Information retrieval ,Computer science ,business.industry ,Vital signs ,Health Informatics ,Survey research ,Usability ,Focus group ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Template ,electronic health records ,Health Information Management ,Data extraction ,User experience design ,user experience ,030212 general & internal medicine ,business ,structured data entry ,data entry time - Abstract
Background Electronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry. Objective This study aims to verify the usability of structured templates by comparing data entry times. Methods A Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members. Results Based on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates. Conclusions The increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.
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- 2019
187. Implementing Structured Clinical Templates at a Single Tertiary Hospital: Survey Study (Preprint)
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Byung Ook Seoung, Soo-Yong Shin, Sang-Oh Lee, and Ji Eun Hwang
- Abstract
BACKGROUND Electronic health record (EHR) systems have been widely adopted in hospitals. However, since current EHRs mainly focus on lowering the number of paper documents used, they have suffered from poor search function and reusability capabilities. To overcome these drawbacks, structured clinical templates have been proposed; however, they are not widely used owing to the inconvenience of data entry. OBJECTIVE This study aims to verify the usability of structured templates by comparing data entry times. METHODS A Korean tertiary hospital has implemented structured clinical templates with the modeling of clinical contents for the last 6 years. As a result, 1238 clinical content models (ie, body measurements, vital signs, and allergies) have been developed and 492 models for 13 clinical templates, including pathology reports, were applied to EHRs for clinical practice. Then, to verify the usability of the structured templates, data entry times from free-texts and four structured pathology report templates were compared using 4391 entries from structured data entry (SDE) log data and 4265 entries from free-text log data. In addition, a paper-based survey and a focus group interview were conducted with 23 participants from three different groups, including EHR developers, pathology transcriptionists, and clinical data extraction team members. RESULTS Based on the analysis of time required for data entry, in most cases, beginner users of the structured clinical templates required at most 70.18% more time for data entry. However, as users became accustomed to the templates, they were able to enter data more quickly than via free-text entry: at least 1 minute and 23 seconds (16.8%) up to 5 minutes and 42 seconds (27.6%). Interestingly, well-designed thyroid cancer pathology reports required 14.54% less data entry time from the beginning of the SDE implementation. In the interviews and survey, we confirmed that most of the interviewees agreed on the need for structured templates. However, they were skeptical about structuring all the items included in the templates. CONCLUSIONS The increase in initial elapsed time led users to hold a negative opinion of SDE, despite its benefits. To overcome these obstacles, it is necessary to structure the clinical templates for optimum use. In addition, user experience in terms of ease of data entry must be considered as an essential aspect in the development of structured clinical templates.
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- 2019
188. Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea
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Seung-Il Park, Eun Jin Chae, Dae-Kee Choi, Kyung Hyun Do, Hyeong Ryul Kim, Tae Sun Shim, Sang-Bum Hong, In Ok Kim, Se Hoon Choi, In Cheol Choi, Kyung Wook Jo, Dong Kwan Kim, Geun Dong Lee, Sung Ho Jung, and Sang-Oh Lee
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Survival ,medicine.medical_treatment ,Single Center ,03 medical and health sciences ,Idiopathic pulmonary fibrosis ,0302 clinical medicine ,Internal medicine ,Chronic Kidney Disease ,medicine ,Lung transplantation ,030212 general & internal medicine ,Lung ,business.industry ,Medical record ,Chronic Lung Allograft Dysfunction ,medicine.disease ,Comorbidity ,Miscellaneous ,Transplantation ,Infectious Diseases ,medicine.anatomical_structure ,030228 respiratory system ,Original Article ,business ,Kidney disease ,Lung Transplantation - Abstract
Background Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. Methods Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. Results Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01-7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). Conclusion Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.
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- 2019
189. Selection of an appropriate empiric antibiotic regimen in hematogenous vertebral osteomyelitis
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Yong Pil Chong, Oh-Hyun Cho, Ki-Ho Park, Dong Youn Kim, In-Gyu Bae, Jun Hee Woo, Mi Suk Lee, Yang Soo Kim, Sung-Han Kim, Seong Yeon Park, Kyung-Chung Kang, Jung-Hee Lee, Chisook Moon, Byung-Han Ryu, Sang-Oh Lee, Sang-Ho Choi, and Yu-Mi Lee
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0301 basic medicine ,Bacterial Diseases ,Male ,Staphylococcus ,Antibiotics ,Ceftazidime ,Gene Expression ,Levofloxacin ,Empirical Research ,medicine.disease_cause ,0302 clinical medicine ,Ciprofloxacin ,Medicine and Health Sciences ,030212 general & internal medicine ,Connective Tissue Diseases ,Pathology and laboratory medicine ,Multidisciplinary ,Antimicrobials ,Clindamycin ,Drugs ,Osteomyelitis ,Pneumococcus ,Bacterial Infections ,Medical microbiology ,Middle Aged ,Anti-Bacterial Agents ,Infectious Diseases ,Vancomycin ,Medicine ,Drug Therapy, Combination ,Female ,Pathogens ,Rifampin ,medicine.drug ,Research Article ,Methicillin-Resistant Staphylococcus aureus ,medicine.medical_specialty ,Staphylococcus aureus ,medicine.drug_class ,Cefepime ,Science ,030106 microbiology ,Microbial Sensitivity Tests ,Amoxicillin-Potassium Clavulanate Combination ,Microbiology ,beta-Lactamases ,03 medical and health sciences ,Rheumatology ,Enterobacteriaceae ,Diagnostic Medicine ,Internal medicine ,Microbial Control ,medicine ,Humans ,Aged ,Retrospective Studies ,Pharmacology ,Bacteria ,business.industry ,Organisms ,Biology and Life Sciences ,Streptococcus ,Methicillin-resistant Staphylococcus aureus ,Spine ,Microbial pathogens ,Bacterial pathogens ,business - Abstract
Background Empiric antibiotic therapy for suspected hematogenous vertebral osteomyelitis (HVO) should be initiated immediately in seriously ill patients and may be required in those with negative microbiological results. The aim of this study was to inform the appropriate selection of empiric antibiotic regimens for the treatment of suspected HVO by analyzing antimicrobial susceptibility of isolated bacteria from microbiologically proven HVO. Method We conducted a retrospective chart review of adult patients with microbiologically proven HVO in five tertiary-care hospitals over a 7-year period. The appropriateness of empiric antibiotic regimens was assessed based on the antibiotic susceptibility profiles of isolated bacteria. Results In total, 358 cases of microbiologically proven HVO were identified. The main causative pathogens identified were methicillin-susceptible Staphylococcus aureus (33.5%), followed by methicillin-resistant S. aureus (MRSA) (24.9%), Enterobacteriaceae (19.3%), and Streptococcus species (11.7%). Extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and anaerobes accounted for only 1.7% and 1.4%, respectively, of the causative pathogens. Overall, 73.5% of isolated pathogens were susceptible to levofloxacin plus rifampicin, 71.2% to levofloxacin plus clindamycin, and 64.5% to amoxicillin-clavulanate plus ciprofloxacin. The susceptibility to these oral combinations was lower in cases of healthcare-associated HVO (52.6%, 49.6%, and 37.6%, respectively) than in cases of community-acquired HVO (85.8%, 84.0%, and 80.4%, respectively). Vancomycin combined with ciprofloxacin, ceftriaxone, ceftazidime, or cefepime was similarly appropriate (susceptibility rates of 93.0%, 94.1%, 95.8%, and 95.8%, respectively). Conclusions Based on our susceptibility data, vancomycin combined with a broad-spectrum cephalosporin or fluoroquinolone may be appropriate for empiric treatment of HVO. Fluoroquinolone-based oral combinations may be not appropriate due to frequent resistance to these agents, especially in cases of healthcare-associated HVO.
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- 2019
190. Clinical Characteristics and Radiologic Features of Immunocompromised Patients With Pauci-Bacillary Pulmonary Tuberculosis Receiving Delayed Diagnosis and Treatment
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Kyung Hwa Jung, Moonsuk Bae, Jun Hee Woo, Sungim Choi, Yong Pil Chong, Sung-Han Kim, Kyung-Wook Jo, Min Jae Kim, Yang Soo Kim, Sang-Oh Lee, Jooae Choe, Tae Sun Shim, Sang-Ho Choi, Joung Ha Park, and Mi Young Kim
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0301 basic medicine ,medicine.medical_specialty ,Tuberculosis ,030106 microbiology ,Lung metastasis ,Delayed diagnosis ,Malignancy ,03 medical and health sciences ,0302 clinical medicine ,Pulmonary tuberculosis ,Internal medicine ,pauci-bacillary ,Major Article ,Medicine ,030212 general & internal medicine ,business.industry ,Mycobacterial culture ,Odds ratio ,medicine.disease ,Pneumonia ,Editor's Choice ,immunocompromised ,Infectious Diseases ,Oncology ,tuberculosis ,business - Abstract
Background Pauci-bacillary pulmonary tuberculosis (TB) can be delayed to diagnose and start anti-TB therapy, especially in immunocompromised patients. We therefore evaluated the clinical and radiologic features of these delayed cases. Methods Immunocompromised adult patients with pauci-bacillary pulmonary TB were retrospectively enrolled in a tertiary hospital in an intermediate–TB burden country over a 5-year period. We defined “missed TB” or “not-missed TB” patients as those who started anti-TB therapy after or before positive mycobacterial culture results, respectively. Results Of 258 patients, 134 (52%) were classified in the missed TB group, and 124 (48%) in the not-missed TB group. Positive results of molecular tests including MTB polymerase chain reaction and/or Xpert TB/RIF were only obtained in the not-missed TB group (54/106, 54%). The median diagnostic delay in the missed TB group was longer than in the other group (30 vs 6 days; P < .001). In the missed TB group, the most common working diagnoses were pneumonia (46, 34%) and lung metastasis of malignancy (40, 30%). Typical radiologic findings for TB, such as upper lobe predominance and centrilobular nodules with tree-in-bud appearance, were less common in the missed TB group than in the other group. Old age (odds ratio [OR], 1.03), solid organ transplant (OR, 3.46), solid tumor (OR, 3.83), and hematologic malignancy (OR, 4.04) were independently associated with missed TB. Conclusions Care is needed to differentiate pauci-bacillary TB, especially in immunocompromised patients with the mentioned risk factors, even without the usual radiologic features of TB. Additional rapid diagnostic tests to rule out pauci-bacillary TB are urgently needed.
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- 2019
191. Risk factors and outcomes of patients with ocular involvement of candidemia
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Joo Yong Lee, Kyung Hwa Jung, Jun Hee Woo, Min Jae Kim, Jiwon Jung, Hyo-Ju Son, Sungim Choi, Sung-Han Kim, Sang-Ho Choi, Yong Pil Chong, Yang Soo Kim, Suhwan Lee, and Sang-Oh Lee
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Male ,0301 basic medicine ,Antifungal Agents ,Epidemiology ,Neutrophils ,Yeast and Fungal Models ,Pathology and Laboratory Medicine ,White Blood Cells ,0302 clinical medicine ,Risk Factors ,Animal Cells ,Medicine and Health Sciences ,Candida ,Fungal Pathogens ,Multidisciplinary ,Antimicrobials ,Eukaryota ,Drugs ,Middle Aged ,Prognosis ,Treatment Outcome ,Experimental Organism Systems ,Medical Microbiology ,Decreased Visual Acuity ,Medicine ,Female ,Pathogens ,Anatomy ,Cellular Types ,medicine.symptom ,Eye Infections, Fungal ,Research Article ,medicine.medical_specialty ,Neutropenia ,Fundus Oculi ,Immune Cells ,Science ,Immunology ,030106 microbiology ,Mycology ,Research and Analysis Methods ,Microbiology ,Asymptomatic ,03 medical and health sciences ,Signs and Symptoms ,Ocular System ,Diagnostic Medicine ,Microbial Control ,Internal medicine ,medicine ,Humans ,Candida Albicans ,Risk factor ,Microbial Pathogens ,Aged ,Retrospective Studies ,Pharmacology ,Antifungals ,Blood Cells ,business.industry ,Organisms ,Fungi ,Chorioretinitis ,Candidemia ,Biology and Life Sciences ,Retrospective cohort study ,Cell Biology ,Eye infection ,medicine.disease ,Yeast ,Confidence interval ,Ophthalmoscopy ,Ophthalmology ,Medical Risk Factors ,Animal Studies ,Lesions ,030221 ophthalmology & optometry ,Eyes ,business ,Head - Abstract
Background Ocular involvement of candidemia can result in serious complications, including vision loss. This study investigated the risk factors for ocular involvement in patients with candidemia and the outcomes of treatment. Methods Episodes of candidemia in hospitalized adults who underwent ophthalmic examinations within 2 weeks of candidemia onset between January 2014 and May 2017 were retrospectively reviewed. Their demographic characteristics, antifungal treatments, and visual outcomes were evaluated. Results During the study period, 438 adults were diagnosed with candidemia, with 275 (62.8%) undergoing ophthalmic examinations within 2 weeks. Of these 275 patients, 59 (21.5%) had fundoscopic abnormalities suggestive of ocular involvement, including 51 with chorioretinitis and eight with Candida endophthalmitis. Eleven patients were symptomatic. Persistent candidemia (adjusted odd ratio [aOR], 2.55; 95% confidence interval [CI], 1.29–5.08; P = 0.01), neutropenia during the preceding 2 weeks (aOR, 2.92; 95% CI, 1.14–7.53; P = 0.03), and C. albicans infection (aOR, 2.15; 95% CI, 1.09–4.24; P = 0.03) were independently associated with ocular involvement. Among the 24 patients with neutropenia, 41.7% had ocular involvements at the initial examination. Ophthalmologic examination even before the neutrophil recovery was positive in one-third of neutropenic patients. Out of the 37 patients in whom ocular outcomes after 6 weeks were available, 35 patients showed favorable or stable fundoscopic findings. Two patients had decreased visual acuity despite the stable fundoscopic finding. Conclusion Neutropenia within two weeks of candidemia was a risk factor for ocular involvement. More than 80 percent of patients with ocular involvements were asymptomatic, emphasizing the importance of routine ophthalmic examinations. The median 6 weeks of systemic antifungal treatment resulted in favorable outcomes in 89.2% of patients.
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- 2019
192. REDUCED USE OF THIRD-GENERATION CEPHALOSPORINS DECREASES THE ACQUISITION OF EXTENDED-SPECTRUM BETA-LACTAMASE–PRODUCING KLEBSIELLA PNEUMONIAE
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MD, Sang-Oh Lee, Lee, Eun Sun, Park, Shin Young, Kim, Sue-Yun, MD, Yiel-Hae Seo, and Cho, Yong Kyun
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- 2004
193. Epidemiology and Clinical Characteristics of Bloodstream Infection in Patients Under Extracorporeal Membranous Oxygenation.
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Ji Hyun Yun, Sang-Bum Hong, Sung-Ho Jung, Pil Je Kang, Heungsup Sung, Mi-Na Kim, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Jun Hee Woo, Yang-Soo Kim, and Yong Pil Chong
- Subjects
BLOODBORNE infections ,EXTRACORPOREAL membrane oxygenation ,EPIDEMIOLOGY ,DISEASE incidence ,BACTEREMIA - Abstract
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]
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- 2021
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194. Risk Factors for Mortality in Patients with Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae and Escherichia coli bacteremia
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Sang-Ho Choi, Sang-Oh Lee, Seongman Bae, Yang Soo Kim, Min Jae Kim, Yong Pil Chong, Hyeonji Seo, Jiwon Jung, and Sung-Han Kim
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medicine.medical_specialty ,APACHE II ,biology ,Septic shock ,Klebsiella pneumoniae ,business.industry ,Tigecycline ,Odds ratio ,medicine.disease ,biology.organism_classification ,Infectious Diseases ,Interquartile range ,Internal medicine ,Bacteremia ,Colistin ,medicine ,Pharmacology (medical) ,business ,medicine.drug - Abstract
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
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- 2021
195. 1152. Characteristics of Patients with Invasive Infections Caused by Trichosporon asahii
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Jinyeong Kim, Jun Hee Woo, Yang Soo Kim, Sang-Oh Lee, Jiwon Jung, Yong Pil Chong, Sang-Ho Choi, Min Jae Kim, and Sung-Han Kim
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Infectious Diseases ,AcademicSubjects/MED00290 ,Oncology ,business.industry ,Poster Abstracts ,Medicine ,Trichosporon asahii ,business ,Microbiology - Abstract
Background Trichosporon asahii is main species for invasive infection by genus Trichosporon. There has been few data regarding the incidence, clinical characteristics, and treatment outcomes of T. asahii colonization and invasive infection. Methods We retrospectively reviewed the microbiological records of patients whose culture results were positive for T. asahii, from a tertiary hospital in South Korea between January 2009 and July 2018. Invasive disease was defined according to the consensus statement of the Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC-MSG). Results During the study period, a total of 259 clinical T. asahii isolates (137 urine, 55 respiratory specimen, 26 blood, 16 surgical site drainage, 9 tissue biopsy, 9 open discharge, 3 toe/nail, 2 pleural fluid and 2 stool) were collected from 102 patients. Of the 102 patients, 18 (18%) had invasive infection: fungemia (12 [67%]), complicated skin and soft tissue infection (3 [17%]), pneumonia with or without empyema (2 [11%]), and complicated intra-abdominal infection (1 [5%]). Invasive infection was associated with hematologic malignancy (33% vs. 7%, P=0.006), end stage renal disease requiring dialysis (28% vs. 7%, P=0.02), indwelling central venous catheter (94% vs. 54%, P =0.001), and prior antifungal agent use (50% vs. 18%, P=0.01). Invasive group had significantly higher in-hospital mortality than non-invasive group (61% vs. 27%, P = 0.006). Characteristics of 102 patients with invasive and non-invasive Trichosporon asahii disease Conclusion Invasive infection was associated with hematologic malignancy, end stage renal disease, indwelling of central venous catheter, and prior antifungal agent use, and high mortality up to 60%. Those with above risk factors should be monitored for development of invasive T. asahii infection. Disclosures All Authors: No reported disclosures
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- 2020
196. Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy
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Yu-Mi Lee, Duck Jong Han, Su-Kil Park, Young-Shin Lee, Tark Kim, Heungsup Sung, Yang Soo Kim, Jun Hee Woo, Sang-Ho Choi, Sung Shin, Sang-Oh Lee, Kyoo-Hyung Lee, Young Hoon Kim, Joo Hee Jung, Sung-Han Kim, Young-Ah Kang, Je-Hwan Lee, and Jung-Hee Lee
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0301 basic medicine ,Ganciclovir ,Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030106 microbiology ,Congenital cytomegalovirus infection ,Retinitis ,Cytomegalovirus ,Hematopoietic stem cell transplantation ,030230 surgery ,Gastroenterology ,Antiviral Agents ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Recurrence ,Risk Factors ,Internal medicine ,Republic of Korea ,medicine ,Secondary Prevention ,Humans ,Prospective Studies ,Prospective cohort study ,Kidney transplantation ,business.industry ,Prophylaxis ,Incidence (epidemiology) ,Incidence ,Hematopoietic Stem Cell Transplantation ,virus diseases ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Gastroenteritis ,surgical procedures, operative ,Infectious Diseases ,Cytomegalovirus Infections ,Cytomegalovirus Retinitis ,Original Article ,Female ,Cytomegalovirus retinitis ,business ,medicine.drug - Abstract
Background/Aims: Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy. Methods: We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period. Results: The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001). Conclusions: The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.
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- 2016
197. A novel diagnostic approach to detecting porcine epidemic diarrhea virus: The lateral immunochromatography assay
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Yong Kwan Kim, In-Soo Cho, Jung-Hwa Kim, Joon-Bae Kim, Dong-Soo Jeong, Dong-Jun An, Kwang-Myun Cheong, Seong-In Lim, Eun-Jeong Lee, Sang-oh Lee, and Byung-Hyun An
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Acute diarrhea ,Swine ,Real-Time Polymerase Chain Reaction ,Diagnostic tools ,Sensitivity and Specificity ,Article ,Chromatography, Affinity ,Microbiology ,Lateral flow test ,Sensitivity ,Antigen ,Virology ,Animals ,Antigens, Viral ,Swine Diseases ,biology ,Reverse Transcriptase Polymerase Chain Reaction ,Porcine epidemic diarrhea virus ,biology.organism_classification ,Reverse transcriptase ,Real-time polymerase chain reaction ,Specificity ,Immunochromatography ,Coronavirus Infections - Abstract
Highlights • A novel lateral immunochromatography (IC) assay was developed to detect PEDV antigen. • The IC assay has 96.0% sensitivity and 98.5% specificity compared with real-time reverse transcriptase PCR. • The detection limit for PEDV was 1 × 103 copies. • The IC assay could be stored at 4 °C or room temperature for 15 months without affecting its efficacy., Porcine epidemic diarrhea virus (PEDV) causes acute diarrhea and dehydration in sucking piglets and has a high mortality rate. An immunochromatography (IC) assay, known as a lateral flow test, is a simple device intended to detect the presence of target pathogens. Here, we developed an IC assay that detected PEDV antigens with 96.0% (218/227) sensitivity and 98.5% (262/266) specificity when compared with real-time reverse transcriptase (RT)-PCR using FAM-labeled probes based on sequences from nucleocapsid genes. The detection limits of the real-time RT-PCR and IC assays were 1 × 102 and 1 × 103 copies, respectively. The IC assay developed herein did not detect non-specific reactions with other viral or bacterial pathogens, and the assay could be stored at 4 °C or room temperature for 15 months without affecting its efficacy. Thus, the IC assay may result in improved PED detection and control on farms, and is a viable alternative to current diagnostic tools for PEDV.
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- 2015
198. Late paradoxical lymph node enlargement during and after anti-tuberculosis treatment in non-HIV-infected patients
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Shi Nae Yu, Oh-Hyun Cho, Jiwon Jung, Yong Kyun Kim, Jong-Young Lee, Sang-Ho Choi, Sung-Han Kim, Ki-Ho Park, Jun Hee Woo, Yang Soo Kim, Sang-Oh Lee, and Y. P. Chong
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Tuberculosis ,Antitubercular Agents ,Tuberculosis, Lymph Node ,Gastroenterology ,Tertiary Care Centers ,HIV Seronegativity ,Internal medicine ,Republic of Korea ,medicine ,Humans ,Prospective Studies ,Treatment Failure ,Prospective cohort study ,Lymph Node Tuberculosis ,Lymph node ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Medical record ,Paradoxical reaction ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,Infectious Diseases ,medicine.anatomical_structure ,Female ,Lymph Nodes ,business - Abstract
SETTINGS A tertiary referral centre in South Korea. OBJECTIVE To investigate the incidence, clinical characteristics and outcomes of late paradoxical response (>4 months after the initiation of anti-tuberculosis treatment) during and after anti-tuberculosis treatment in non-human immunodeficiency virus (HIV) infected patients with lymph node tuberculosis (TB). DESIGN We retrospectively reviewed the medical records of non-HIV-infected patients with lymph node TB between 1997 and 2007, and prospectively enrolled patients with newly diagnosed lymph node TB between 2008 and 2013. RESULTS Of 467 patients with confirmed and probable lymph node TB, 83 (18%) displayed a paradoxical response: 57 of these (69%) were classified as early and 26 (31%) as late paradoxical response. Patients with late paradoxical response (median 12 months) received more prolonged anti-tuberculosis treatment than those with early (median 9 months, P < 0.001) or no paradoxical response (median 9 months, P < 0.001). The frequency of post-treatment lymph node enlargement increased progressively from those without any paradoxical response (6%), through those with an early response (12%) to those with a late response (23%). CONCLUSIONS Paradoxical response presents late in about one third of non-HIV-infected patients with lymph node TB who experience a response. Although anti-tuberculosis treatment is commonly prolonged in patients with late paradoxical response, post-treatment lymph node enlargement is more frequent in these patients.
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- 2015
199. Infectious Causes of Eosinophilic Meningitis in Korean Patients: A Single-Institution Retrospective Chart Review from 2004 to 2018.
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Sunghee Park, Jiwon Jung, Yong Pil Chong, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, and Min Jae Kim
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KOREANS ,MENINGITIS ,BACTERIAL meningitis ,CEREBROSPINAL fluid examination ,CEREBROSPINAL fluid ,EOSINOPHILS ,NEUROCYSTICERCOSIS - Abstract
Eosinophilic meningitis is defined as the presence of more than 10 eosinophils per µl in the cerebrospinal fluid (CSF), or eosinophils accounting for more than 10% of CSF leukocytes in patients with acute meningitis. Parasites are the most common cause of eosinophilic meningitis worldwide, but there is limited research on patients in Korea. Patients diagnosed with eosinophilic meningitis between January 2004 and June 2018 at a tertiary hospital in Seoul, Korea were retrospectively reviewed. The etiology and clinical characteristics of each patient were identified. Of the 22 patients included in the study, 11 (50%) had parasitic causes, of whom 8 (36%) were diagnosed as neurocysticercosis and 3 (14%) as Toxocara meningitis. Four (18%) patients were diagnosed with fungal meningitis, and underlying immunodeficiency was found in 2 of these patients. The etiology of another 4 (18%) patients was suspected to be tuberculosis, which is endemic in Korea. Viral and bacterial meningitis were relatively rare causes of eosinophilic meningitis, accounting for 2 (9%) and 1 (5%) patients, respectively. One patient with neurocysticercosis and 1 patient with fungal meningitis died, and 5 (23%) had neurologic sequelae. Parasite infections, especially neurocysticercosis and toxocariasis, were the most common cause of eosinophilic meningitis in Korean patients. Fungal meningitis, while relatively rare, is often aggressive and must be considered when searching for the cause of eosinophilic meningitis. [ABSTRACT FROM AUTHOR]
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- 2021
- Full Text
- View/download PDF
200. Comparison of invasive fungal diseases between patients with acute myeloid leukemia receiving posaconazole prophylaxis and those not receiving prophylaxis: A single-center, observational, case-control study in South Korea.
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Eunmi Yang, Eun-Ji Choi, Han-Seung Park, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Jung-Hee Lee, Je-Hwan Lee, Kyoo-Hyung Lee, Sung-Han Kim, Yang, Eunmi, Choi, Eun-Ji, Park, Han-Seung, Lee, Sang-Oh, Choi, Sang-Ho, Kim, Yang Soo, Lee, Jung-Hee, Lee, Je-Hwan, Lee, Kyoo-Hyung, and Kim, Sung-Han
- Published
- 2021
- Full Text
- View/download PDF
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