Search

Background/Aims While most cancer patients with end-of-life (EOL) care receive antibiotic treatments, antibiotic use should be decided appropriately considering the benefits, side effects, resistance, and cost effects. Antimicrobial stewardship programs (ASP) are important for patients with EOL care, but there is limited study analyzing actual antibiotic use in EOL care and the perceptions of Korean medical staff. Methods Electronic medical records of 149 deceased cancer patients hospitalized in the medical hospitalist units at Asan Medical Center in Seoul from May 2019 to September 2021 were reviewed. Basic information, antibiotic use, duration, and changes were investigated. We surveyed medical staff’s perceptions of antibiotics in cancer patients with EOL. Results Of the 149 cancer patients with EOL care, 146 (98.0%) agreed with physician orders for life-sustaining treatment (POLST). In total, 143 (95.9%) received antibiotics, 110 (76.9%) received combination antibiotic treatment, and 116 (81.1%) were given antibiotics until the day of death. In a survey of 60 medical staff, 42 (70.0%) did not know about ASP, and 24 (40.0%) thought ASP was important in EOL care. Nineteen doctors (31.7%) discussed the use or discontinuation of antibiotics with patients or caregivers when writing POLST, but only 8 patients (5.6%) stopped antibiotics after POLST. Conclusions Most cancer patients with EOL care continue to receive antibiotics until just before their death. A careful approach is needed, considering the benefits and side effects of antibiotic use, and the patient’s right to self-decision. It is necessary to actively improve awareness of ASP and its importance for medical staff.

Abstract Background Primaquine is activated by CYP2D6 in the hepatocytes. In Korea, primaquine is the only hypnozoitocidal agent used for patients with vivax malaria. Thus, patients with poor CYP2D6 activity could have an increased risk of primaquine failure and subsequent relapse. The study sought to identify the association between CYP2D6 phenotype and recurrence of malaria in Korean patients. Methods A total of 102 patients with vivax malaria were prospectively enrolled from eight institutions in Korea. An additional 38 blood samples from patients with recurred vivax malaria were provided by the Korea Disease Control and Prevention Agency. Malaria recurrence was defined as more than one episode of vivax malaria in the same or consecutive years. CYP2D6 star alleles, phenotypes, and activity scores were examined. Results Genotyping for CYP2D6 was successful in 101 of the prospectively enrolled patients and 38 samples from the Korea Disease Control and Prevention Agency, of which 91 were included in the no-recurrence group and 48 were included in the recurrence group. Reduced CYP2D6 activity (intermediate metabolizer) phenotype was more common in the recurrence group than in the no-recurrence group (OR, 2.33 (95% CI, 1.14–4.77); p = 0.02). Patients with lower CYP2D6 activity had a higher probability of recurrence (p = 0.029). Conclusion This study suggests that CYP2D6 polymorphism may affect primaquine efficacy and thus Plasmodium vivax recurrence in Korea.

Fascioliasis, a food-borne helminthiasis, is primarily a disease of cattle and sheep that occasionally occurs in humans. The aquatic perennial herb water dropwort (Oenanthe javanica) has been identified as the primary source of human infections in Korea. Recently, a cluster of patients who had not ingested water dropwort, but had the use of a green vegetable delivery service in common was diagnosed with fascioliasis. Our study aimed to identify the association between the green vegetable juice delivery service and the occurrence of human fascioliasis.Patients with liver abscesses and eosinophilia were enrolled in this study. They were categorized into fascioliasis or non-fascioliasis groups according to serological test results, clinical manifestations, and computed tomography or magnetic resonance imaging findings. Patients were classified into the fascioliasis group when ova or the adult worms of the Fasciola species were detected or serological tests were positive, with compatible clinical and radiological findings.We included 30 patients in this study; 15 were assigned to the fascioliasis group and the remaining 15 to the non-fascioliasis group. The proportion of patients who utilized the juice delivery service was significantly higher in the fascioliasis group than in the non-fascioliasis group (53.3% vs. 0%, P

Background: Despite the high vaccination coverage rate, in-hospital transmission of measles continues to occur in South Korea. We present a measles outbreak in which two healthcare workers (HCWs) with presumptive evidence of measles immunity were infected by a patient with typical measles at a single hospital in South Korea. This facilitated the evaluation of measles seroprevalence in all HCWs. Methods: In 2018, suspected patients and contacts exposed during a measles outbreak were investigated based on their medical histories and vaccination status. Cases were confirmed by the detection of measles-specific immunoglobulin M or RNA. After the measles outbreak in 2018, measles IgG testing was conducted on a total of 972 HCWs for point-prevalence, including those exposed to the measles. In addition, we have routinely performed measles IgG tests on newly employed HCWs within one week of their hire date since 2019. The measles vaccine was administered to HCWs who tested negative or equivocally negative for IgG antibodies. Results: An index patient who returned from China with fever and rash was diagnosed with measles at a hospital in Korea. Two additional HCWs were revealed as measles cases: one was vaccinated with the two-dose measles–mumps–rubella (MMR) vaccine, and the other, who was born in 1967, was presumed to have immunity from natural infection in South Korea. All three patients harbored the same D8 genotype. No additional measles cases were identified among the 964 contacts of secondary patients. A total of 2310 HCWs, including those tested during the 2018 outbreak, underwent measles IgG tests. The average age at the time of the test was 32.6 years, and 74.3% were female. The overall seropositivity of measles was 88.9% (95% confidence interval, 87.5–90.1). Although the birth cohorts between 1985 and 1994 were presumed to have received the measles–rubella (MR) catch-up vaccination in 2001, 175 (89.3%) HCWs were born after 1985 among the 195 seronegative cases. Conclusion: Despite high population immunity, imported measles transmission occurred among HCWs with presumed immunity. This report underscores the importance of understanding the prevalence of measles susceptibility among newly employed HCWs. This is important for policymaking regarding hospital-wide vaccinations to prevent the spread of vaccine-preventable diseases.

배경: Despite high vaccination coverage rate, in-hospital transmission of measles continued to occur in South Korea. We thus evaluated the seroprevalence of measles in healthcare workers (HCWs) in a university-affiliated hospital in South Korea. 방법: In 2018, after an outbreak of measles occurred in our hospital, all HCWs underwent measles IgG tests for point-prevalence surveillance. In addition, we have routinely performed measles IgG test for new HCWs since 2019. The measles vaccine is administered to HCWs who tested negative or equivocal for IgG antibodies. 결과: A total of 2310 HCWs underwent measles IgG tests. The average age at the time of test was 32.6 years, and 74.3 % were female. The overall seropositivity of measles was 88.9 % (95% confidence interval, 87.5 - 90.1). Among the 195 seronegative cases, 175 (89.3%) HCWs were born after 1985, although the birth cohorts between 1985 and 1994 were presumed to have received the measles-rubella (MR) catch-up vaccination in 2001. 결론: Knowing the prevalence of susceptibility to measles of newly employed HCWs is important for policy-making on hospital-wide vaccinations to prevent vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]