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Background While Korea maintains a low prevalence of human immunodeficiency virus (HIV), the number of newly diagnosed cases has been steadily rising, reaching approximately 1,000 annually in recent years. The 2022 annual report from the Korea Disease Control and Prevention Agency revealed that women living with HIV (WLWH) constitute 6.4% of the total confirmed people living with the HIV population, totaling 1,219 individuals. Despite this, only a few studies have focused on WLWH in Korea. This study aims to analyze the epidemiological and clinical characteristics of WLWH in Korea. Materials and Methods We retrospectively collected data by reviewing the medical records of all WLWH who visited 10 urban referral hospitals across Korea between January 2005 and May 2023. Results A total of 443 WLWH were enrolled in this study. The predominant risk exposure was heterosexual contact, with 235 (53%) participants either married or cohabiting with a male partner at their initial clinic visit. Among the participants, 334 (77.7%) were Korean, 27 (6.1%) were Southeast Asian, and 19 (4.3%) were African. Antiretroviral therapy was initiated by 404 WLWH (91.2%). We observed 118 pregnancies in WLWH following their HIV diagnosis, resulting in 78 live births (66.1%), 18 induced abortions (15.2%), 10 pre-viable fetal losses (8.5%), and four stillbirths (3.4%). Over a cumulative follow-up duration of 3,202.1 years, the incidence rates of breast and cervical cancers were both 2.18 per 1,000 person-years. Additionally, the incidence rates of pelvic inflammatory disease, cervical intraepithelial neoplasm (above grade II), and osteoporosis were 4.67, 11.21, and 13.39 per 1,000 patient-years, respectively. Conclusion This is the first multicenter study to investigate the clinical and epidemiological characteristics of WLWH in Korea. The incidence and prevalence of diseases in women, including breast cancer, cervical cancer, and chronic comorbidities, are high in WLWH in Korea; therefore, further research and efforts are needed to manage these diseases. [ABSTRACT FROM AUTHOR]

With advancements in antiretroviral therapy (ART), the average lifespan of people with human immunodeficiency virus (HIV) is increasing, as is the number of older adults with HIV. Accordingly, the number of patients with HIV who undergo surgery or require critical care for various reasons is increasing. Since the prognosis of people with HIV depends on the continuous and effective maintenance of ART, there is a need to consider effectively maintaining ART in people with HIV in these conditions. This case involved a 55-year-old patient with well-controlled HIV who received ART and presented to the emergency room with acute abdominal pain. He was diagnosed with extensive bowel infarction and panperitonitis and received critical care in the intensive care unit, including mechanical ventilation and continuous renal replacement therapy. The patient was administered enteral nutrition via a nasogastric tube. The patient subsequently underwent extensive small bowel resection and developed short bowel syndrome. The patient maintained ART during that period. A literature review related to the use of ART under these conditions is included in this study. This case was discussed at the [Exploring Difficult Cases in HIV Clinics] of the Korean Society for AIDS Conference held in 2023. [ABSTRACT FROM AUTHOR]

Background: Even amid the coronavirus disease-19 (COVID-19) pandemic, the spread of multidrug-resistant bacteria and infection control are still important tasks. After recognizing the carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak that occurred in the isolation room for COVID-19, we would like to introduce what infection control measures were implemented to eradicate it. Materials and Methods: All COVID-19 patients with CRAB in any specimen admitted to the COVID-19 isolation ward of the tertiary hospital in Korea from October to November 2021 were analyzed. Results: During the outbreak, 23 patients with COVID-19 and CRAB infections were identified. The index case was an 85-year-old female referred from a long-term care facility. CRAB was identified in sputum culture in most patients (91.3%). The CRAB outbreak occurred mainly in the rooms around the index case. Environmental cultures on the floor, air inlet, air outlet, and window frame of the rooms were performed. The antimicrobial resistance patterns of CRAB from patients and the environment were identical; whole-genome sequencing analyses revealed isolated clonality. Infection control measures with enhanced environmental cleaning using 1,000 ppm sodium hypochlorite and phenolic compounds, enhanced hand hygiene, additional education, and mandatory additional gowning and gloving of COVID-19 personal protective equipment (PPE) were applied on 29 October. No CRAB infection cases occurred from 2 November for two weeks. Conclusion: In addition to applying PPE and COVID-19 precautions in COVID-19 isolation wards, adhering to strict contact precautions along with environmental control can help prevent the spread of multidrug-resistant bacteria. [ABSTRACT FROM AUTHOR]

배경: COVID-19 increases the risk of invasive pulmonary aspergillosis. However, the risk factors for and the outcomes of COVID-19 associated pulmonary aspergillosis (CAPA) is reported differently from hospital to hospital and is not fully defined yet. We aim to identify the risk factors for and outcomes of CAPA in critically-ill COVID-19 patients. 방법: A single center retrospective cohort study was conducted in critically-ill COVID-19 patients with National Institute of Allergy and Infectious Disease Ordinal Scale of 6 or higher who admitted to a tertiary care hospital in South Korea from March 2020 to January 2022. CAPA was retrospectively defined using modified Aspergillosis in Intensive Care Unit (modified AspICU) criteria. 결과: A total of 269 critically-ill COVID-19 patients were hospitalized during the study period and 50 (18.6%) patients were diagnosed with CAPA (Table 1). The overall incidence of CAPA was 8.69 case per 1000 patient-day. (Figure 1) Median time from admission to CAPA diagnosis was 12 days. Multivariable analysis showed that receiving solid organ transplantation (odds ratio [OR] 4.716, 95% confidence intervals [CI] 1.137-19.556, p=0.033), mechanical ventilator use (OR 2.485, 95% CI 1.213-5.095, p=0.013), high dose steroid use (mean dose>1.5mg/kg/day) (OR 6.946, 95% CI 2.312-20.865, p=0.001), and having lymphopenia (OR 3.04, 95% CI 1.443-6.407, p=0.03) were independent risk factors for developing CAPA (Table 2,3). Patients with CAPA showed significantly higher 28-day mortality (46.0% vs. 15.5%, p<0.0001), in-hospital mortality (72.0% vs. 19.2%, p<0.0001) and longer hospital length of stay (31 vs. 16 days, p<0.001) compared to patients without CAPA. (Table 2) 결론: In this study, the severity of COVID-19, use of high dose steroid and immunocompromised conditions could be important risk factors for developing CAPA and CAPA diagnosis was associated with worse outcome. [ABSTRACT FROM AUTHOR]

배경: Computed tomography (CT) is a very useful tool for evaluating the etiology of patients with sepsis or septic shock. However, it is difficult to obtain contrast-enhanced CT images due to concerns about nephrotoxicity caused by contrast media, especially in patients with septic acute kidney injury (AKI). In this study, we aim to investigate the relationship between contrast media administration and long-term mortality and chronic kidney disease in patients with septic AKI. 방법: A total of 1,521 patients with septic shock admitted to a tertiary hospital in South Korea from July 2008 to November 2019 were retrospectively reviewed. A total of 609 adult septic shock patients with AKI who underwent contrast or non-contrast CT scans were enrolled. The primary outcome was 90-day mortality rate. The secondary outcomes were worsening AKI, 28-day mortality rate, chronic kidney disease, and maintain dialysis at 90 days between contrast CT group and non-contrast CT group. 결과: Of 609 septic AKI patients, 220 patients (36.1%) underwent contrast CT and 389 patients (63.9%) underwent non-contrast CT. The median age was 70.9 years, and 305 (50.1%) were male. There were no statistically significant differences in the outcomes between the contrast and non-contrast CT groups: 90-day mortality, 55.3% vs. 57.4%, p=0.682; worsening AKI, 1.8% vs. 2.1%, p=0.999; 28-day mortality, 41.4% vs. 42.3%, p=0.898; chronic kidney disease, 13.2% vs. 15.3%, p=0.73; and maintain dialysis at 90day, 0.0% vs. 0.8%, p=0.482. 결론: In conclusion, intravenous contrast media administration was not associated with long-term mortality, chronic renal impairment, and dialysis in patients with septic AKI. [ABSTRACT FROM AUTHOR]

배경: This study aimed to investigate the prognosis and prognostic factors for mortality in progressive multifocal leukoencephalopathy (PML) patients through a long observation period. 방법: This retrospective study was conducted in two tertiary hospitals in South Korea from 1999 to 2021. Patients diagnosed with PML were reviewed according to the American Academy of Neurology diagnostic criteria. The primary endpoint was long-term overall mortality. Each patient was followed up till death or the end of the study period. 결과: Total of 47 PML patients were included. Of 27 patients (57.4%) were diagnosed with HIV. Median last follow-up modified Rankin Scale (mRS) score was higher in the non-HIV PML group than that in the HIV group (5 vs. 4, p=0.020). Median survival duration was lower in the non-HIV group (184 vs. 1,564 days). The 1-year and overall mortality rates of PML patients were significantly higher in the non-HIV group than that in HIV group (60.0% vs. 25.9%, p=0.019; 80.0% vs. 40.7%, p=0.007). Initial mRS score (HR 1.685, p=0.038) and highly active antiretroviral therapy (HAART) in HIV patients (HR 0.374, p=0.013) had a significant effect on overall mortality. 결론: Survival duration of HIV-positive PML patients receiving HAART improved; however, the mortality rate is still high. Introduction of HAART in HIV patients and initial mRS score are significant prognostic factors for overall mortality in PML patients. [ABSTRACT FROM AUTHOR]

배경: Currently, therapeutic agents have focused on the hyperinflammatory response to severe COVID-19. If the similarities and differences between the immune responses of COVID-19 and bacterial sepsis could be identified in detail, it would provide an additional candidate for immunomodulators to treat severe COVID-19. We aimed to demonstrate the characteristics of the immunologic status of coronavirus disease 2019 (COVID-19) and sepsis patients through plasma cytokine/chemokine analysis. 방법: Patients diagnosed with severe COVID-19 or septic shock with lymphopenia, who were matched for age, sex, steroid administration, lymphocyte count, and severity, formed the study population. A total of 20 analytes were measured by Luminex assay. The study’s primary outcome was to compare the plasma cytokine/chemokines levels between the two study groups. 결과: A total of 36 patients were enrolled in this study. COVID-19 patients who were administered steroids showed significantly higher levels of plasma granulocyte macrophage colony-stimulating factor (GM-CSF) [16.3 pg/ml; interquartile range (IQR), 9.8-20.0 and 0.0 pg/ml; IQR, 0.0-3.9; P = 0.019]. Plasma interleukin-15 (IL-15) (0.0 pg/ml; IQR, 0.0-0.0 and 4.444 pg/ml; IQR, 0.0-5.120; P = 0.031), and IL-17A (0.0 pg/ml; IQR, 0.0-0.0 and 9.922 pg/ml; IQR, 0.0-12.937; P = 0.031) levels in COVID-19 group were lower than the sepsis group. The IL-10 (0.0 pg/ml; IQR, 0.0-2.4 and 29.1 pg/ml; IQR, 9.6-51.3; P = 0.017) and B-cell-activating factor of the TNF family (0.0 pg/ml; IQR, 0.0-0.0 and 1.8 pg/ml; IQR, 0.0-2.5; P = 0.032) levels were significantly lower in the non-steroid administered COVID-19 group. 결론: Differences in plasma cytokine/chemokines levels were observed between COVID-19 and sepsis patients with matching variables. GM-CSF showed higher concentration in COVID-19 group with steroid administration, implicating the efficacy of anti-GM-CSF antibodies as an adjunctive therapy to steroids in severe COVID-19 patients. [ABSTRACT FROM AUTHOR]

배경: Dagnosis of invasive aspergillosis (IA) is often difficult due to need for invasive procedures. Next-generation sequencing of plasma microbial cell free DNA (cfDNA) can be a novel non-invasive diagnostic method. We evaluated the clinical accuracy and utility of microbial cfDNA whole genome sequencing (WGS) for diagnosis of IA in patients with hematologic malignancy (HM) or coronavirus disease (COVID-19). 방법: A single-center prospective cohort study was conducted in a tertiary hospital in Korea. We enrolled adult patients with HM or severe COVID-19, who suspected of IA and collected plasma samples. cfDNA was extracted from plasma and WGS was performed. IA diagnosis was retrospectively confirmed according to EORTC/MSG definitions in patients with HM, and modified AspICU criteria in patients with severe COVID-19. The final diagnosis of IA was compared to the results of microbial cfDNA WGS. 결과: Between Mar 2021 and Feb 2022, a total of 64 microbial cfDNA WGS was performed on the plasma samples from 37 participants (19 with HM and 19 with COVID-19) and 7 controls who didn’t have any evidence of fungal infection. In participants with HM, aspergillus cfDNA was detected in 100% (1/1) of proven and 84.6% (11/13) of probable IA cases. In participants with COVID-19, 46.7% (7/15) of probable IA showed positive aspergillus cfDNA. Positive agreement of detection of aspergillus cfDNA versus conventional diagnosis of proven/probable IA was significantly higher in participants with HM compared to COVID-19 (85.7% vs. 46.7%, p=0.011). Fifteen of 19 (78.9%) participants with positive aspergillus cfDNA had exposure to antifungal agents. In 7 participants, non-aspergillus pathogens detected by microbial cfDNA WGS were in accordance with those identified through conventional culture. 결론: Detection of aspergillus cfDNA showed high concordance with conventional diagnostic methods of proven/probable IA in patients with HM and could be a helpful non-invasive approach to IA diagnosis in those populations. [ABSTRACT FROM AUTHOR]

배경: Infective endocarditis (IE) remains a major medical problem with high morbidity and mortality. Appropriate antibiotic treatment lowers the risk of embolism, recurrence, and long-term mortality. However, there are concerns about adverse drug reactions and resistant strains due to long-term use of antibiotics. Therefore, we compared the difference in overall mortality according to the duration of postoperative antibiotics therapy in patients with IE. 방법: From 2005 to 2017, we retrospectively reviewed 416 patients with IE at a 2400-bed tertiary hospital in South Korea. A total of 234 IE patients who underwent valve surgery and appropriate duration of antibiotics were enrolled. They were divided into two groups based on the 2 weeks of postoperative antibiotic therapy. The primary outcome was long-term overall all-cause mortality. The secondary outcomes were reoperation rate, recurrence rate, and postoperative complications. 결과: The median follow-up duration was 71 (interquartile range [IQR], 46–109) months. The duration of postoperative antibiotic therapy was less than 2 weeks in 62 patients (26.5%) and more than 2 weeks in 172 patients (73.5%). The median age was 53 ([IQR], 39–63) years. The overall mortality was 12.8% (30/234). There were no statistical differences in overall mortality (12.9% vs. 12.8%, p=0.982), reoperation (6.5% vs. 4.1%, p=0.488), and recurrence (8.1% vs. 2.9%, p=0.135) between patients with postoperative antibiotic therapy less than 2 weeks and for ≥2 weeks, respectively. The duration of postoperative antibiotic therapy based on 2 weeks in the Kaplan-Meier curve was not associated with overall mortality (log-rank test, p=0.877). 결론: In conclusion, there was no statistically significant difference in the overall mortality, recurrence, and reoperation rate according to the duration of postoperative antibiotic therapy. If surgery and recommended total antibiotic duration are properly performed, a shorter duration of postoperative antibiotics might be considered. [ABSTRACT FROM AUTHOR]

배경: Coronavirus disease 2019 (COVID-19) in immunocompromised patients has become an important issue as severe acute respiratory syndrome coronavirus 2 has continuously spread. Sarcopenia is associated with a worse prognosis in COVID-19 and prevalent in lung transplant patients. This study aimed to investigate the difference in clinical outcomes according to sarcopenia in lung transplant patients with COVID-19. 방법: This study included patients who diagnosed as COVID-19 from December 2021 to May 2022 after lung transplantation in Severance Hospital. Thoracic muscle volume was measured using the cross-sectional area of the pectoralis, paraspinal, serratus, and latissimus muscles at the fourth vertebral region and the erector spinae muscle at the 12th vertebral region using the computed tomography (CT) scan after COVID-19. Multivariate logistic analysis was conducted to identify the associated factors with sarcopenia in lung transplant patients with COVID-19. 결과: Sixty-one patients with COVID-19 after lung transplantation were enrolled in this study and forty-two patients (68.9%) had sarcopenia. In the sarcopenic group, the length of stays was longer (12 days; inter-quartile range [IQR], 6-34 and 5.5 days; IQR, 5-12; P = 0.017), and there was no case of in-hospital death and invasive mechanical ventilator application in non-sarcopenic group. Multivariate logistic regression analysis showed that forced expiratory volume before COVID-19 and serum albumin were associated with sarcopenia. Thirteen of the patients in the sarcopenic group underwent subsequent CT scans after a median of 12 days, and the thoracic muscle index showed a further decreasing trend. 결론: In lung transplant patients with COVID-19, sarcopenia is frequently accompanied and might be associated with a worse prognosis. Assessment and interventions for sarcopenia is needed to improve the prognosis of lung transplant patients with COVID-19. [ABSTRACT FROM AUTHOR]

배경: Interest in complications and sequelae following COVID-19 is increasing. Several articles have reported COVID-19-associated autoimmune diseases and the association of autoantibodies with the severity of COVID-19. Thromboembolic complications frequently occur in COVID-19 patients, and the anti-phospholipid antibody (aPL) is frequently detected. We conducted this study to investigate the prevalence, clinical significance, and persistence of anti-nuclear antibody (ANA) and aPL in COVID-19. 방법: This study enrolled the patients diagnosed with COVID-19 with oxygen demand, admitted to Severance Hospital, running a critical care unit for COVID-19 in South Korea from July 2020 to March 2022. ANA and aPLs were assessed using the immuno-assay kit. 결과: A total of 250 patients were enrolled during the study period. Among them, five patients showed ANA-positive, and 41 showed aPL-positive (IgM anti-Cardiolipin (aCL) antibody for seven patients, IgG aCL for seven patients, IgM anti-β2Glycoprotein1 antibody (aβ2-GPI) for 32 patients, and IgG aβ2-GPI for one patient). Two of the five ANA-positive patients, 13 of the 32 IgM aβ2-GPI-positive patients, 5 of the 7 IgM aCL-positive patients, and 2 of the 7 IgG aCL-positive patients were eligible for follow-up analysis, and 100%, 69.2%, 40%, and 50% of the patients remained autoantibody-positive, respectively. Except for the IgG aCL group, there were no differences in clinical outcomes, including thromboembolic complications, between the autoantibody-positive and negative groups. 결론: Our study demonstrated that a significant proportion of COVID-19 patients with oxygen demand showed autoantibody-positive and persisted several months after symptom onset. Whether these autoantibodies are related to long-term sequelae in COVID-19 patients requires further research. [ABSTRACT FROM AUTHOR]

배경: This study aimed to investigate the immunogenicity and reactogenicity of ChAdOx1 nCoV-19 vaccine according to pre-existing adenovirus(Ad) immunity. 방법: We prospectively enrolled individuals scheduled for COVID-19 vaccination in a tertiary hospital with 2,400 beds from March 2020. Pre-existing Ad immunity data was obtained by enzyme-linked immunosorbent assay at time point T0, before 1st ChAdOx1 nCov-19 vaccination. Immunogenicity data were obtained at 5 time points along the primary series of ChAdOx1 nCov-19 vaccination. Reactogenicity data were collected over 7 days after each vaccination. 결과: Total of 68 adult patients with two dose ChAdOx1 nCov-19 vaccination were finally enrolled. Pre-existing Ad immunity was positive in 49 patients (72.1%), and negative in 19 patients (27.9%). The geometric mean titer (GMT) of S-specific IgG antibodies were statistically higher in individuals without pre-existing Ad immunity at several time points: before 2nd ChAdOx1 nCov-19 vaccination (56.4 [36.6-125.0] vs. 51.0 [17.9-122.3], p=0.024); 2-3weeks after 2nd ChAdOx1 nCov-19 vaccination (629.5 [451.5-926.5] vs. 555.0 [287.3-926.0], p=0.049); 3 months after 2nd ChAdOx1 nCov-19 vaccination (274.5 [160.5-655.3] vs. 176.0 [94.3-255.3], p=0.033). The plaque reduction neutralization test (PRNT50) after 1st ChAdOx1 nCov-19 vaccination were statistically higher in individuals without pre-existing Ad immunity (245.2 [142.6-377.1] vs. 94.1 [44.4-157.5], p=0.021). In the absence of pre-existing Ad immunity, systemic events were observed with a higher frequency and chills were observed to be statistically significantly higher (73.7% vs. 31.9%, p=0.002). 결론: In individuals without pre-existing Ad immunity, the immune response to ChAdOx1 nCoV-19 vaccination was higher intensity and the reactogenicity to ChAdOx1 nCoV-19 vaccination was observed with a higher frequency. In order for Ad-derived vaccination to have sufficient immune response and longevity, it is necessary to evaluate pre-existing Ad immunity. [ABSTRACT FROM AUTHOR]

배경 The superinfection of multidrug-resistant bacteria is an important complication in critically ill COVID-19 patients. An outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) occurred in an isolation ward for COVID-19. We performed an outbreak investigation, and successfully controlled the outbreak with the enhanced environmental cleaning and additional gowning and gloving. 방법 This study analyzed all COVID-19 patients with CRAB in any specimen, who admitted to an isolation ward for COVID-19 of a tertiary hospital in South Korea from October to November 2021. 결과 During the outbreak period, a total of 23 patients with COVID-19 and CRAB were identified. Index case was 85-year old female patient who was referred from a long-term care facility. The mean age of cases was 72.9 and 14 (60.9%) patients were male. In most patients (91.3%), CRAB were identified in sputum culture, two were identified in blood culture at initial, and four patients were identified in sputum and blood culture at the same time. Most of the patients were applying high flow nasal cannula (26.1%) or mechanical ventilation (60.9%)(Table1). As shown in figure2, CRAB outbreak occurred mainly in the wards around the index case, and in particular, environmental culture was carried out in the area marked with a rectangle. CRAB was cultured on the floor, air inlet, air outlet, and window frame of the ward except for wards 3305 and 3319. Phenotypic antimicrobial resistance patterns of CRAB isolates from patients and environment were identical, and additional whole genome sequencing analyses are ongoing to find the clonality of isolates. We applied the infection control measures with the en- hanced environmental cleaning using sodium hypochlorite (NaClO) 1000ppm and phenolic compounds more than twice a day, enhanced hand hygiene, and additional gowning and gloving over personal protective equipment (PPE) mandatory for COVID-19 on 29th October. No additional CRAB cases occurred since 2nd November 2021 for two weeks. 결론 Even when PPEs and precautions for COVID-19 are applied to isolation wards for COVID-19, it is helpful for preventing transmission of multidrug-resistant bacteria to apply additional contact precautions and environmental cleaning [ABSTRACT FROM AUTHOR]

배경: Intestinal carriage with extended spectrum b-lactamase Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE) can persist for months, and it can increase the risk of transmission of multidrug-resistant strains. Several studies have shown that microbiota transplantation (FMT) can change gut microbiota in multiple diseases. We evaluated whether FMT can eradicate intestinal carriage with ESBL-E/CRE. 방법: The PubMed, Cochrane, and Embase databases were searched from their inception to October 2021 to identify the efficacy of FMT in ESBL-E/CRE by comparing 1-month and 3-month eradication rates between FMT group and non-FMT group. 결과: A total of five observational studies are included in this study, of which four are prospective studies and the other is retrospective study. All five studies included CRE colonization and only two studies included ESBL-E. Among the five studies including 160 patients, the 1-month eradication rate was significantly higher in the FMT group (38 of 75, 50.7%) compared to the non-FMT group (22 of 85, 25.9%) [RR=0.64; 95% CI (0.49-0.85); P=0.002]. Moreover, among the two studies including 53 patients, the 3-month eradication rate was also significantly higher in the FMT group (21 of 25, 84%) compared to the non-FMT group (10 of 28, 35.7%) [RR=0.55; 95% CI (0.42-0.72); P<0.001]. 결론: This study showed that FMT might be an effective way to decolonize multidrug-resistant Enterobacteriaceae. Therefore, a larger study about the use of FMT for multidrug-resistant Enterobacteriaceae might be needed. [ABSTRACT FROM AUTHOR]