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Background Postexposure prophylaxis for occupational exposure to hepatitis B virus (HBV) plays an important role in the prevention of HBV infections in health care workers (HCWs). We examined data concerning the acceptable duration between occupational exposure and administration of a hepatitis B immunoglobulin (HBIG) injection in an occupational clinical setting. Methods A retrospective analysis was conducted with data from 143 cases of HCWs exposed to HBV in 15 secondary and tertiary teaching hospitals between January 2005 and June 2013. Data were taken from the infection control records of each hospital. Results Active vaccination after HBV exposure was started in 119 cases (83.2%) and postvaccination testing for hepatitis B antibody showed positive seroconversion in 93% of cases. In 98 cases (68.5%), HBIG was administered within 24 hours after HBV exposure; however, 45 HCWs (31.5%) received an HBIG injection more than 24 hours postexposure and 2 among the 45 received an injection after 7 days. Although 31.5% received an HBIG injection more than 24 hours postexposure, no cases of seroconversion to hepatitis b antibody positivity occurred. Conclusions For susceptible HCWs, HBIG administered between 24 hours and 7 days postexposure may be as effective as administration within 24 hours in preventing occupational HBV infection. [ABSTRACT FROM AUTHOR]

Objectives Purpose of this study was to compare clinical characteristics and treatment outcomes in diabetic and non-diabetic women with community-acquired APN (CA-APN). Methods We prospectively collected and analyzed clinical data of women with CA-APN who attended 11 hospitals in South Korea from March 2010 to February 2012. Results Of a total of 775 patients, 246 (31.7%) were diabetic and 529 (68.3%) non-diabetic. Fewer of the diabetic patients had flank pain (27.6% vs. 37.2% P = 0.009), symptoms of lower urinary tract infection (57.3% vs. 69.6% P = 0.001) and costovertebral angle tenderness (54.9% vs. 72.2% P < 0.001). However, more of them had C-reactive protein ≥20 mg/dL (40.7% vs. 27.4% P < 0.001), azotemia (29.3% vs. 13.4% P < 0.001) and bacteremia (53.7% vs. 38.2% P < 0.001). Final clinical failure rates and deaths did not differ between the two groups: 6.9% vs. 4.5%, P = 0.169; 2.0% vs. 1.7%, P = 0.747. However, hospitalization was longer in the diabetics than the non-diabetics (median 9.0 days vs. 7.0 days, P < 0.001). In logistic regression, diabetes was independently associated with longer hospitalization (OR 1.7, CI 1.1-2.7, P = 0.011), together with nausea/vomiting, history of admission within 1 year, bacteremia, azotemia, and dementia, as well as extended-spectrum β-lactamase (ESBL)-positivity and fluoroquinolone resistance of uropathogens. Conclusions CA-APN patients with diabetes have more severe disease manifestations and require longer hospitalization than non-diabetic patients although their clinical findings are less clear than those of non-diabetic patients. [ABSTRACT FROM AUTHOR]

Summary: Objective: The purpose of this study was to evaluate clinical features and outcomes of bacteremia in patients with liver cirrhosis (LC) and determine whether underlying LC is an independent risk factor for mortality in a population of patients with different underlying diseases. Methods: From the database of nationwide surveillance studies for bacteremia, data regarding bacteremia in patients with LC were analyzed and compared with those in patients with other diseases. Results: A total of 195 patients with LC were compared with 1659 patients with other underlying diseases. As for the site of infection, intraabdominal infection was more frequent in the LC group (P < 0.001), while pneumonia, urinary tract bacteremia, and primary bacteremia were more prevalent in the other diseases group (all P < 0.05). Patients with LC were more likely to have Klebsiella pneumoniae bacteremia (20.1% vs. 14.3%, P = 0.018), but less likely to have coagulase-negative staphylococcal bacteremia (5.1% vs. 10.4%, P = 0.028). The 30-day mortality rate was significantly higher in the LC group compared to the other disease group (27.2% [53/195] vs. 20.3% [336/1659], P = 0.025). Multivariate analysis revealed underlying LC as a significant predictor for mortality (OR, 2.11; 95% CI, 1.43–3.13; P < 0.001), along with old age, nosocomial acquisition, pneumonia, severe sepsis, and a higher Pitt bacteremia score. Conclusions: The mortality rate of patients with LC was significantly higher than that of patients with other diseases when they developed bacteremia. Underlying LC was found to be one of the independent risk factors for mortality in patients with bacteremia. [ABSTRACT FROM AUTHOR]

Summary: Background: The aim of this study was to identify risk factors for development of severe sepsis or septic shock and to evaluate the clinical impact of severe sepsis on outcome in patients with gram-negative bacteremia (GNB). Methods: From the database of a nationwide surveillance for bacteremia, patients with GNB were analyzed. Data of patients with severe sepsis or septic shock were compared with those of patient with sepsis. Results: Of 2286 patients with GNB, 506 (22.1%) fulfilled the criteria of severe sepsis or septic shock. Factors associated with severe sepsis or septic shock in the multivariate analysis included renal disease, indwelling urinary catheter, hematologic malignancy, and neutropenia. The 30-day mortality of patients with severe sepsis or septic shock was significantly higher than that of patients with sepsis (39.5% [172/435] vs. 7.4% [86/1170]; P < 0.001). Multivariable analysis revealed that solid tumor, liver disease, pulmonary disease, pneumonia, and pathogens other than Escherichia coli, which were risk factors of development of severe sepsis or septic shock, were also found to be strong predictors of mortality. Severe sepsis or septic shock was a significant factor associated with mortality (OR, 3.34; 95% CI, 2.35–4.74), after adjustment for other variables predicting poor prognosis. Conclusions: Severe sepsis or septic shock was a common finding in patients with GNB, predicting a higher mortality rate. Renal disease and indwelling urinary catheter were the most important risk factors significantly associated with severe sepsis or septic shock among patients with GNB. [ABSTRACT FROM AUTHOR]

This study aimed to construct a prediction algorithm, which is readily applicable in the clinical setting, to determine the mortality rate for patients with P. aeruginosa bacteremia. A multicenter observational cohort study was performed retrospectively in seven university-affiliated hospitals in Korea from March 2012 to February 2015. In total, 264 adult patients with monomicrobial P. aeruginosa bacteremia were included in the analyses. Among the predictors independently associated with 30-day mortality in the Cox regression model, Pitt bacteremia score >2 and high-risk source of bacteremia were identified as critical nodes in the tree-structured survival analysis. Particularly, the empirical combination therapy was not associated with any survival benefit in the Cox regression model compared to the empirical monotherapy. This study suggests that determining the infection source and evaluating the clinical severity are critical to predict the clinical outcome in patients with P. aeruginosa bacteremia. [ABSTRACT FROM AUTHOR]

Community-acquired acute pyelonephritis (CA-APN) is relatively rare in men. This study aimed to compare the clinical characteristics of CA-APN between male and female patients. We prospectively collected the clinical and microbiological data of hospitalized CA-APN patients aged ≥19 years in South Korea from March 2010 to February 2011 in 11 hospitals and from September 2017 to August 2018 in 8 hospitals. Only the first episodes of APN of each patient during the study period were included. From 2010 to 2011, 573 patients from 11 hospitals were recruited, and from 2017 to 2018, 340 patients were recruited from 8 hospitals. Among them, 5.9% (54/913) were male. Male patients were older (66.0 ± 15.2 vs. 55.3 ± 19.0 years, P < 0.001), had a higher Charlson comorbidity index (1.3 ± 1.5 vs. 0.7 ± 1.2, P = 0.027), and had a higher proportion of structural problems in the urinary tract (40.7% vs. 6.1%, P < 0.001) than female patients. Moreover, the total duration of antibiotic treatment was longer (21.8 ± 17.8 d vs. 17.3 ± 9.4 d, P = 0.001) and the proportion of carbapenem usage was higher (24.1% vs. 9.5%, P = 0.001) in men than in women. Male patients were hospitalized for longer durations than female patients (median, 10 d vs. 7 d, P < 0.001). Male CA-APN patients were older and had more comorbidities than female CA-APN patients. In addition, male patients received antibiotic treatment for a longer duration than female patients. [ABSTRACT FROM AUTHOR]

To evaluate clinical features and prognostic factors of non- albicans candidemia, we conducted a retrospective multicenter cohort study at 7 university hospitals in Korea from January 2010 to February 2016. A total of 721 patients with non- albicans candidemia were included in the analysis. C. tropicalis was most commonly identified (36.5%), followed by C. glabrata (27.2%), C. parapsilosis (25.7%), and C. krusei (2.4%). Clinical presentation of C. tropicalis candidemia was most severe with highest median C-reactive protein level (10.1 mg/dL) and Acute Physiology and Chronic Health Evaluation II score (14, both P ≪ 0.05). C. tropicalis showed the highest 14- and 30-day mortality (28.9% and 44.1%). In multivariate analysis, C. tropicalis infection was significantly related with 14- (P = 0.005) and 30-day mortality (P = 0.033). In conclusion, C. tropicalis infection presented most severely and showed worst clinical outcome among non- albicans candidemia. • A multicenter cohort study was conducted for non- albicans candidemia. • Clinical presentation of C. tropicalis candidemia was most severe. • APACHE II score and C. tropicalis infection were associated with mortality. • Types of antifungal agents were not associated with outcome. [ABSTRACT FROM AUTHOR]

An epidemiologic surveillance of non- albicans candidemia for a 6-year period was conducted in Korea. Compared to the published epidemiologic data for the previous 6 years, an increase of C. glabrata (from 21.3% to 28.5%) and a decrease of C. parapsilosis (from 36.5% to 24.7%) were noticed. During the study period, C. tropicalis (36.4%) was most frequently isolated non- albicans Candida , followed by C. glabrata (28.5%), C. parapsilosis (24.7%), and C. krusei (2.6%). Replacement of primary amphotericin B treatment with echinocandins (P < 0.001) eliminated amphotericin B resistance (from 7.8% in 2011 to 0% in 2014). [ABSTRACT FROM AUTHOR]

Abstract To evaluate the impacts of fluconazole minimum inhibitory concentration (MIC) according to primary antifungal agents on Candida glabrata bloodstream infection (BSI), a multicenter retrospective cohort study was conducted in Korea, concerning the time period from January 2010 to February 2016. A total of 197 adult patients with C. glabrata BSI were included in the study, and neutropenia (P = 0.026), APACHE II score (P = 0.004), and fluconazole resistance (HR 3.960, 95% CI 1.395-11.246, P = 0.010) were associated with 30-day mortality in multivariate analysis. In subgroup analysis, fluconazole MIC = 32 μg/mL in the azole-treated group (HR 6.691, 95% CI 1.569-28.542, P = 0.010) and fluconazole MIC ≥ 64 μg/mL in the non-azole-treated group (HR 3.337, 95% CI 1.183-9.411, P = 0.023) showed the highest hazard ratio (HR) for 30-day mortality. Increased fluconazole MIC was associated with poor outcome both in azole- and non-azole-treated patients with C. glabrata BSI. Highlights • A multicenter cohort study was conducted for C. glabrata BSI. • Neutropenia, APACHE II, and fluconazole resistance were associated with mortality. • Fluconazole resistance was associated with mortality even in non-azole treated group. • Types of antifungal agents were not associated with outcome. [ABSTRACT FROM AUTHOR]

We evaluated the clinical significance of the cefazolin inoculum effect (CIE) in methicillin-susceptible Staphylococcus aureus (MSSA) isolates. In total, 146 isolates were recovered from patients with MSSA bacteremia at 9 hospitals in Korea. The CIE was observed in 16 MSSA isolates, and while type A was the only detected β-lactamase in MSSA isolates exhibiting the CIE, no strains expressing type B, C, or D β-lactamases exhibited this effect. The CIE was only observed in agr group III and I isolates and was significantly more common in isolates with agr dysfunction than in those with functional agr ( P < 0.001). Even among isolates producing type A β-lactamase, the CIE was also prevalent in isolates with dysfunctional agr than in isolates with functional agr ( P = 0.025). This study demonstrates an association between the CIE of MSSA isolates and agr dysfunction, in addition to those between the CIE and type A β-lactamase. [ABSTRACT FROM AUTHOR]

Abstract: In vitro activities of ertapenem and 11 other comparator agents were tested against 1025 isolates of respiratory pathogens collected from 12 Asian countries. Resistance rate to ertapenem was 1.2% in 602 isolates of Streptococcus pneumoniae (MIC50, 0.06/MIC90, 1 μg/mL). Ertapenem was also very active against penicillin-, ciprofloxacin-, erythromycin-, and multidrug-resistant pneumococcal isolates (resistance rate: 3.5%, 2.7%, 1.9%, and 2.7%, respectively). Ertapenem-resistant pneumococcal isolates were found only in Vietnam and Korea. Ertapenem resistance was not found in methicillin-susceptible Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, and Klebsiella pneumoniae, including extended-spectrum β-lactamase producers. In vitro data suggest that ertapenem could be a useful treatment option for community-acquired pneumonia. [Copyright &y& Elsevier]

Abstract: A total of 59 vancomycin-resistant Enterococcus faecium (VREF) clinical isolates were collected from 8 Korean hospitals for 2 months in 2004. They were investigated by genotyping for glycopeptide resistance, multilocus sequence typing (MLST), esp repeat profiling, and structural analysis of Tn1546-like element. Nine of 59 VREF isolates (15.3%) from 5 hospitals in Korea showed VanB phenotype, but they contained vanA gene. MLST and esp repeat profiling indicated that E. faecium isolates with VanB phenotype and vanA genotype occurred from independent genetic background except 3 isolates from 1 hospital. Structural analysis of Tn1546 also showed that these isolates were not clonally related. Data showed a relatively high frequency of VREF isolates with incongruence between phenotype and genotype for glycopeptide resistance in Korean hospitals. [Copyright &y& Elsevier]

Abstract: In vitro activities of tigecycline were compared with 15 other comparator agents against recent clinical isolates of respiratory pathogens (623 Streptococcus pneumoniae, 105 Staphylococcus aureus, 92 Klebsiella pneumoniae, and 84 Haemophilus influenzae isolates) collected from 11 Asian countries. All isolates of S. pneumoniae from Asian countries were susceptible to tigecycline regardless of penicillin susceptibility with MIC90 of ≤0.06 mg/L. Both methicillin-resistant and methicillin-susceptible S. aureus isolates were susceptible to tigecycline with very low MIC90 values (0.25 and 0.12 mg/L, respectively). Tigecycline was also active against K. pneumoniae (98.9% susceptible; MIC50, 1 mg/L; MIC90, 2 mg/L) including 10 extended-spectrum β-lactamase–producing isolates and H. influenzae (100% susceptible; MIC50 and MIC90, 0.12 mg/L) from Korea. Data confirmed that tigecycline has an excellent in vitro activity against drug-resistant clinical isolates of respiratory pathogens from Asian countries. [Copyright &y& Elsevier]

Abstract: We report a case of infective endocarditis of the mitral valve, which was accompanied by pulmonary emboli traveling through an atrial septal defect. An 18-year-old male was admitted to our hospital due to a fever, polyarthritis and subcutaneous hemorrhage. Transthoracic echocardiography revealed a mobile mass and possible vegetation lodged in the mitral valve and a secundum-type atrial septal defect. Computed tomography revealed a hepatic, splenic and renal embolic infarction. During antibiotic therapy, he felt a sudden right flank pain. Follow-up computed tomography revealed a pulmonary embolic infarction that drifted through an atrial septal defect. This association is the first report, of pulmonary emboli which migrated through an atrial septal defect from the mitral valve. [Copyright &y& Elsevier]